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RESEARCH ARTICLE |
Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland.
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Abstract |
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FOR more than two decades, intensive gerontological research has focused on the efficacy of memory training for improving the memory abilities of older adults (Kliegl, Smith, & Baltes, 1989
; Lachman, Weaver, Bandura, Elliott, & Lewkowicz, 1992; Mohs et al., 1998; Rebok & Balcerak, 1989; Rebok, Rasmusson, & Brandt, 1996; Scogin, Storandt, & Lott, 1985; Troyer, 2001; Yesavage, 1985). Despite widespread variations in type of mnemonic technique (e.g., visual vs verbal mnemonics) and demographic background (e.g., young-old vs old-old), research has shown that healthy, nondemented older adults can improve their memory skills with instruction and practice (e.g., Best, Hamlett, & Davis, 1992; Caprio-Prevette & Fry, 1996; Rasmusson, Rebok, Bylsma, & Brandt, 1999; Woolverton, Scogin, Shackelford, Black, & Duke, 2001) and that booster training facilitates long-term remembering (Ball et al., 2002; Stigsdotter & Bäckman, 1989). Researchers have used these results as evidence of memory plasticity in later life, but many issues remain unresolved. The purpose of this article is to (a) review what researchers currently know about memory training methods and the potential mechanisms underlying their effects; (b) point out gaps in current understanding; and (c) discuss new directions for developing effective, accessible, affordable, and applicable memory improvement programs for healthy older adults. We consider both traditional approaches to memory training with older adults and more innovative, novel training methods.
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TRADITIONAL MEMORY TRAINING APPROACHES WITH OLDER ADULTS |
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). The first type of training usually involves brief instruction in a single, internal mnemonic technique specific to the recall task over the course of one or two group sessions (e.g., Rebok & Balcerak, 1989). The second type of traditional training involves several instructional sessions and/or multiple strategies with a full dose of the intervention ranging anywhere from 4 hours to 15 hours in a group interactive setting (e.g., Zarit, Cole, & Guider, 1981). Typically a trained instructor leads these programs and teaches a strategy, models the usage of that strategy for the class, and then provides opportunities for practice and corrective feedback.
Two mnemonic techniques or strategies that researchers have used most frequently with older adults are method of loci and the name–face mnemonic (Rebok & Balcerak, 1989; Verhaeghen & Marcoen, 1996; Yesavage & Rose, 1984). More recently, there has been increasing interest in the number mnemonic (Derwinger, Stigsdotter Neely, & Bäckman, 2005; Derwinger, Stigsdotter Neely, MacDonald, & Bäckman, 2005; Hill, Campbell, Foxley, & Lindsay, 1997), and several studies have used a variety of more basic memory encoding skills such as visual imagery and organization (Rankin, Karol, & Tuten, 1984; Rasmusson et al., 1999). Numerous studies have demonstrated the effects of such training on laboratory-based memory task performance; these effects are typically highly task specific. For example, in a study involving both young and old adults, training in the method of loci on a serial word recall task improved word recall for older adults, but the effects failed to transfer to a digit recall task (Rebok & Balcerak, 1989). A recent example of multiple strategy memory training can be seen in ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly; Ball et al., 2002; Jobe et al., 2001). In ACTIVE, researchers taught older adults numerous strategies for remembering word lists and sequences of items, text materials, and main ideas of stories during ten 1-hour group training sessions. The mnemonic techniques ranged from simple strategies involving categorization, association, and visualization to more complex strategies such as the method of loci. The training effects were immediate, task specific, and endured for up to 5 years, and there was some evidence of transfer to everyday functional outcomes (Willis et al., 2006). Both of these approaches are similar in that they involved didactic group sessions in which a trained instructor taught the trainees one or more mnemonic strategies, modeled the strategies, and then gave verbal feedback on the trainees' performance.
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META-ANALYSES OF TRADITIONAL MEMORY TRAINING STUDIES WITH OLDER ADULTS |
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). Researchers also know that including other cognitive and noncognitive factors in the training can result in larger training gains and better training maintenance. For example, memory researchers are increasingly using multifactorial training approaches that focus on emotional states (depression, anxiety), belief structures (self-efficacy), and attentional skills (see Rebok, Rasmusson, & Brandt, 1997; Stigsdotter & Bäckman, 1989; West, Thorn, & Bagwell, 2003). As this evidence has continued to grow, there have been several reviews of the memory training literature (Kotler-Cope & Camp, 1990; McDougall, 1999; Storandt, 1991). There are also two meta-analytic reviews that support the efficacy of memory training across a broad array of memory tasks (Floyd & Scogin, 1997; Verhaeghen, Marcoen, & Goossens, 1992).
In a meta-analytic review of 31 memory training studies in the domain of episodic memory, Verhaeghen and colleagues (1992) examined pretest to posttest gains and variables that might influence performance gains in healthy participants aged 60 and older. Across studies, the pretest to posttest gains were significantly larger for mnemonic-training groups (SD = 0.73) than for both the placebo (SD = 0.37) and control groups (SD = 0.38). The researchers found that at least four variables influenced performance gains in the mnemonic-training groups. Treatment gains were largest when training was conducted in a group (vs individual) format, when pretraining and possibly additional memory-related interventions (such as using external memory aids or motivation enhancement) were provided, when sessions were relatively short (2 hr or less), and when the participants were younger. Interestingly, no differences in treatment gain resulted as a function of type of mnemonic taught or kind of pretraining used. The former result was consistent with more recent findings of Rasmusson and colleagues (1999), who compared three different types of memory training programs: a memory course, audiocassette training, and computerized training. All three intervention programs led to significant performance gains, leading the investigators to conclude that "mnemonically stimulating activity rather than any specific process is responsible for improvement" (p. 56). One must interpret with caution the finding that the effectiveness of memory training does not vary with type of pretraining, as relatively few studies have employed a pretraining component.
In a later meta-analysis of 27 studies, Floyd and Scogin (1997) examined the effectiveness of memory training on the subjective memory functioning and mental health of nondemented adults with a mean age of 60 and older. Some have argued that changing efficacy beliefs is as important or more important than changing actual memory performance, because it may motivate older adults to apply recently acquired memory strategies in new situations (West et al., 2003). Pretest and posttest effect sizes indicated that memory training led to improved subjective memory function (SD = 0.19), but the magnitude of the improvement was less than that obtained on objective memory measures (SD = 0.66) in the meta-analysis of Verhaeghen and colleagues (1992). Floyd and Scogin found no differences in effectiveness among mnemonic training, expectancy modification, or placebo procedures such as unstructured practice. Improvement of subjective memory functioning was enhanced by including pretraining in skills such as use of imagery and by including interventions to improve participants' attitudes toward the effects of aging on memory functioning. Again, the use of a pretraining component appears to be important whether the target is objective memory performance, memory beliefs, or both, although, as stated previously, one must exercise caution when interpreting the data because of the small number of comparative studies involving pretraining.
A more recent meta-analytic review of the memory training literature with older adults by Rebok and colleagues (2007, in preparation) examined the empirical basis for classifying memory training methods as evidence based. This review, conducted for Division 12, Section II, Clinical Geropsychology, of the American Psychological Association comprehensively reviewed the literature base on memory training with both normal elders and those with cognitive impairments. For a treatment to be considered as having shown beneficial treatment effects, more than 50% of the target problem treatment outcome measures must have shown both (a) statistically significant between-group treatment effects and (b) between-group effect sizes of at least 0.20. For within-subject designs, more 50% of the target problem posttreatment measures must have shown a minimum candidate treatment versus baseline comparison effect size of at least 0.20. To meet the evidence criteria, there must have been (a) at least two between-group design studies, with a minimum of 30 participants across studies representing the same age group and receiving the same treatment for the same target problem, and with prospective design and random assignment of participants to conditions; or (b) at least two within-subject or single-case studies, with a minimum of 30 participants across studies representing the same age group and receiving the same treatment for the same target problem, and with prospective design; or (c) a combination of one or more between-group and one or more within-subject or single-case studies, with a minimum of 30 participants across studies representing the same age group and receiving the same treatment for the same target problem; and (d) the majority of studies must have supported the treatment; and (e) the treatment procedures must have shown acceptable adherence to the treatment manual (Weisz & Hawley, 2001).
To date, Rebok and colleagues have obtained and reviewed almost 300 memory training studies for relevancy to these criteria. Of the studies considered (N = 218), 39 gave preliminary support for 16 treatments to be considered evidence based. These include studies involving instruction in multiple mnemonic techniques (e.g., Ball et al., 2002; Dunlosky, Kubat-Silman, & Hertzog, 2003; Hill, Storandt, & Simeone, 1990; Stigsdotter & Bäckman, 1989); and in specific strategies such as visual memory support (Sharps & Price-Sharps, 1996), story mnemonic (Hill, Allen, & McWhorter, 1991), method of loci (Hill et al., 1991), and cognitive restructuring (Caprio-Prevette & Fry, 1996). These initial findings suggest that there are potentially several evidence-based options for older adults who wish to improve their memory and reduce memory problems. However, to what extent evidence-based treatments work under real-world conditions where strict adherence to treatment protocols may be unrealistic is an open question. It is also important to note that the factors underlying the success of evidence-based treatments are not always known, and it is important to study the etiological mechanisms that may underlie the treatment effects.
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NOVEL MEMORY TRAINING PLATFORMS AND APPROACHES |
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; Strain, Blandford, Mitchell, & Hawranik, 2003), hospitalization (Chodosh et al., 2004), chronic health conditions (DiCarlo et al., 2000; Izquierdo-Porrera & Waldstein, 2002), and mortality (Schupf et al., 2005; Shipley, Der, Taylor, & Deary, 2006) have resulted in an increased need for population-level alternatives to formal group-based memory intervention. The increasing demand for such intervention alternatives necessitates the development of cost-effective, self-administered, and flexible training platforms that are easily distributable to the public.
Increasingly, researchers are exploring other training platforms and approaches to training memory abilities in older adults. These include collaborative training (Margrett & Willis, 2006; Saczynski, Margrett, & Willis, 2004), videotape and audiotape training (Rebok, Rasmusson, Bylsma, & Brandt, 1997; West & Crook, 1992), and online and CD-ROM-based training (Baldi, Plude, & Schwartz, 1996; Plude & Schwartz, 1996; Saczynski, Rebok, Whitfield, & Plude, 2004). These novel, trainerless training platforms are designed to overcome limitations of the more traditional training approaches involving accessibility and costs of training. Limiting training to small-group didactic sessions with a certified trainer may limit the number of older persons who are able to access the training. To what extent these novel approaches ultimately prove as effective as traditional approaches and lead to better maintenance and transfer of training is still an open question.
Collaborative Training
Researchers have suggested that the availability of collaborators can be an important component of successful cognitive performance in everyday life, particularly for older adults (Hulicka, 1982; Margrett & Willis, 2006; Saczynski, Margrett, & Willlis, 2004). Some cognitive intervention studies have incorporated this theoretical notion to address the question of how collaborative partners can enhance memory, thinking, problem solving, and other aspects of cognition among elders. For example, Saczynski, Margrett, and colleagues (2004) examined changes in strategic behavior in older married couples participating in a cognitive intervention study. Participants who had received training in inductive reasoning completed the training at home individually or as a couple. Overall, the collaborative and individual training groups showed a similar magnitude of strategy use at immediate and 3-month post test in terms of individual performance, but the collaborative group showed more maintenance of strategy use on a collaborative task. This type of trainerless training suggests that there may be cognitive benefits from collaborative activities, including memory activities, that involve individuals working on a common problem in an at-home setting. Hulicka (1982) provided a fascinating example of two older siblings collaborating together in a natural setting to remember information they had definitely known at one time about trips, friends, celebrations, and family problems.
Videotape and Audiotape Training
The widespread availability of videotape and audiotape technology has led to research exploring their effectiveness for training memory abilities in older adults. These technologies offer a cost-effective, practical alternative to the traditional instructor-led memory class, making training available to many older adults in their homes. West and Crook (1992) tested the effectiveness of videotape memory training in two groups of middle-aged and older adults using (a) a videotaped presentation of interactive imagery for object location recall and linking items on a list, and (b) the image–name match method for name recall. They found that both groups performed significantly better at posttest after the training than did a wait-listed group, and there was evidence for short-term maintenance of performance and generalization to other memory tasks (such as face recognition; see West et al., 2000, for a full discussion of the advantages of videotape memory training). Rebok, Rasmusson, Bylsma, and colleagues (1997) examined the effectiveness of two commercially available audiocassette memory improvement programs in a sample of community-living elderly adults. Participants reported finding the tape programs acceptable and potentially useful for improving memory. They also thought they were less likely to develop Alzheimer's disease after having completed the training. However, there were no greater gains in actual memory test performance in the treatment condition than in the no-treatment control condition. Despite the promises of rapid memory improvement with such programs, the effectiveness of commercial audiocassette training programs for older adults remains to be demonstrated.
Online and Computerized Training
Computerized memory intervention is an alternative to traditional training and has proved effective in specific study populations. One common criticism of computerized memory intervention with older adults is that the training platform is unfamiliar to them and thus may render the intervention weak or ineffective. Most notably, fewer than one third of computer users older than age 65 have ever used the Internet, and those who have tend to be in higher income categories and have more education than nonusers (Kaiser Family Foundation, 2005). Although this will become less of an issue as the baby boom cohort ages, it is difficult to generalize from the present studies given the elite nature of the participant samples. According to the U.S. Census Bureau (2003), the corresponding figure of Internet users among persons aged 55 to 64 years is 56.6%. It is therefore reasonable to expect that by 2010 more than 50% of Americans older than age 65 will be online. Limited work within the training platform has demonstrated that computerized memory training is effective for normally aging adults (Finkle & Yesavage, 1990; Herrmann & Plude, 1998; Larrabee & Crook, 1989; Plude & Schwartz, 1996; Rebok et al., 1996). Additionally, computerized versions of memory training may be effective with older adults in light of studies examining older adults and computer usage. Previous research has suggested that simple instructions are effective for teaching older adults how to use computers and web technology (Morrell, Park, Mayhorn, & Kelley, 2000), and one of older adults' main reasons for wanting to use computers is to obtain access to health information (Morrell, 2005). These findings indicate that older adults can, and want to, learn to use computers, particularly to seek health information, such as skills involved in the maintenance of cognitive performance.
Because of the increasing number of older adults buying computers and using the Internet, there are now efforts to utilize computer technology to train memory. For example, Rager and colleagues (2006) are currently working on a Phase II Small Business Innovation Research project funded by the National Institute on Aging to develop an Internet-based Memory University® for elders. The Memory University® will provide mnemonic training, information, and memory assessment specifically targeted toward independently living, community-residing older adults. The curriculum will focus on areas of memory that elders had identified in Phase I as being most problematic, including names and faces, facts and numbers, and future actions (such as remembering appointments). Internet technology offers many advantages over conventional, in vivo classroom training activities. For example, the accessibility of programming via the Internet provides an excellent means by which to provide both periodic booster sessions and repeated practice opportunities. It also may offer an opportunity to study the effects of temporal spacing on memory enhancement. In a study currently underway using the web, more than 2,000 participants are being trained at interstudy intervals ranging from minutes to 1 year to determine what effect spacing has on long-term retention (Pashler, Rohrer, & Cepeda, 2006). Researchers are also studying the effectiveness of CD-ROM-based memory training with elderly adults and the role of computer experience in moderating training effectiveness (Baldi et al., 1996; Saczynski, Rebok, Whitfield, & Plude, 2004; in press). These studies have shown that older adults can benefit from interactive multimedia training and that the training benefits are similar to those found in more traditional approaches. As researchers develop newer memory training technologies, it will become increasingly important to look at individual difference factors related to computer knowledge that may limit training effectiveness. It will also be important to determine whether training done individually via computer can be made more effective by adding a group interactive component (e.g., chat room features, bulletin board, online coach).
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COMBINED MEMORY INTERVENTION APPROACHES |
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; Podewils et al., 2005; Yaffe, Barnes, Nevitt, Lui, & Covinsky, 2001). Although the effects of physical exercise on cognition have been mixed, there is growing evidence that selected aspects of cognition are responsive to increases in physical exercise (Abbott, White, Ross, Masaki, Curb, & Petrovich, 2004; Weuve, Kang, Manson, Breteler, Ware, & Grodstein, 2004). Researchers have noted the cognitive benefits of exercise for both aerobic and anaerobic activity (Colcombe & Kramer, 2003). Fabre, Chamari, Mucci, Masse-Biron, and Prefaut (2002) combined cognitive and physical training using a full factorial design. They reported that combined aerobic training and cognitive training led to greater effects on memory performance than did either aerobic training or cognitive training alone. However, their study was limited to a small convenience sample (N = 32) of unimpaired older adults aged 60 to 76. Recently, Small and colleagues (2006) studied the effects of a short-term healthy lifestyle program combining mental and physical exercise, stress reduction, and healthy diet on cognition and brain metabolism in 17 nondemented middle-aged and older adults with mild age-related memory complaints. They reported improved measures of verbal fluency and reduced dorsolateral prefrontal cortical metabolism, suggesting that such a program may result in greater cognitive efficiency of a brain region involved in working memory functions. There were no significant changes in subjective memory measures in the intervention group, perhaps due to the small sample size. No studies have examined the combined effects of physical training and structured memory training on memory function in a large, representative sample of community-dwelling elders. There have also been few combined intervention studies that have systematically examined the different types of training using multiple comparison groups. We are currently conducting a pilot study funded by the Erickson Foundation of a mind–body training program with senior adults living in a continuing care retirement community. The overall goal of this study is to develop a combined intervention program that will improve memory, increase physical activity, and promote everyday functional performance and independence in healthy older adults. The goal will be achieved through the integration of a lifestyle physical activity program (walking) and an in-class computerized memory training program, with the aim of determining whether combining the two programs yields interactive or synergistic effects compared with memory training alone. Currently, we are conducting the mind–body program with groups of low-active and high-active seniors to determine if the effects are greater among those who are more sedentary.
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MEMORY ENHANCEMENT THROUGH COGNITIVE STIMULATION |
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; Scarmeas, Levy, Tang, Manly, & Stern, 2001; Wilson et al., 1999, 2002a, 2002b, 2003, 2005). Intervention programs that embed memory enhancement opportunities within the context of natural everyday activity potentially have much to offer (Studenski et al., 2006). Fried, Rebok, Carlson, and colleagues (see Fried, Carlson, Friedman, Frick, Glass, Hill et al., 2004; Glass, Friedman, Carlson, Hill, Frick, Ialongo et al., 2004) explored the effects of participation in an intensive senior service program called Experience Corps® on the cognitive and functional status of older adult volunteers. The Experience Corps® program was designed to bolster memory, and executive functioning in particular, by enabling older adults to (a) exercise mental flexibility across roles, (b) develop working memory skills via literacy exercises with children, (c) engage in cooperative problem solving, and (d) participate in program activities that exercise multiple dimensions of cognitive ability. The volunteers worked for at least 15 hours per week across the course of an entire school year with children in Grades K–3 on meaningful activities involving literacy tutoring, library use, and behavioral management. It was the intention that these roles meet unmet school needs and simultaneously increase the volunteers' cognitive, physical, and social activity.
Researchers recently reported preliminary evidence of the effects of this program on the older volunteers, schools, and school children (see Fried et al., 2004; Glass et al., 2004; Rebok et al., 2004). During this pilot trial, 148 men and women aged 60 years and older were recruited and randomly assigned to serve in Experience Corps in Baltimore, Maryland. After randomization, 70 volunteers assigned to the program ultimately served in the schools. The volunteers were mostly African American women of low socioeconomic status (M age = 69, range 60–86). Activity data from this pilot randomized trial indicated that the Experience Corps program increased cognitive, physical, and social activity levels in participating seniors. As reported by Fried and colleagues (2004), elders in the Experience Corps program reported significant decreases in the number of hours they watched TV, whereas the controls increased this activity. They also reported being more physically active, and there were significant increases in kilocalories expended and in strength. Finally, the intervention group reported greater increases in the number of people they could turn to and the number who would check on them if sick, as well as a decrease in the feeling that they could have used more emotional support in the prior 6 months, compared to controls.
These pilot findings suggest that multimodal interventions may produce beneficial effects by simultaneously harnessing the effects of cognitive, physical, and social activity. We are currently exploring the extent to which these activities impact on memory and executive functions among adults at high risk sociodemographically for cognitive decline. In addition, Experience Corps extends the idea that a multimodal intervention may realize maximal success in a real-world setting in which components of the intervention are integrated into daily life, thus allowing for large daily doses. These doses were well tolerated and even excessive (in some cases, volunteers worked more than the minimum 15 hours per week) in a group at elevated risk for most major chronic diseases. Researchers have yet to examine durability of the intervention effects and evidence of transfer to everyday function. We discuss each of these important issues in the following section.
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DURABILITY OF TRAINING AND TRANSFER EFFECTS |
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; Sheikh, Hill, & Yesavage, 1986; Stigsdotter & Bäckman, 1989; Stigsdotter Neely & Bäckman, 1993a). However, there have been conflicting findings about the longer term (more than 1 year) effects of memory training. Sheikh and colleagues found that elders trained with a combination of relaxation and mnemonic techniques maintained their cognitive gains at 6 months. Anschutz, Camp, Markley, and Kramer (1987) reported that although 9 of 10 original participants used the method of loci for remembering a new word list, they did not use this mnemonic to enhance their recall in everyday situations. Scogin and Bienias (1988) followed 27 of 43 original participants in a self-taught memory training program. The memory training group had a significant decrease in memory performance and a substantial decrease in mnemonic usage over time, but they had no change in memory complaints.
A meta-analysis by Verhaeghen (2000) of longer-term follow-up studies showed that the net maintenance effect of training (i.e., pretest to follow-up effect size minus pretest to posttest effect size) was quite large. Over a 6-month interval, performance increased by 0.40 standard deviations as compared to a 0.28 standard deviation increase in retest groups. Over 3 years, performance declined slightly, by 0.11 standard deviations in the training groups compared with 0.06 standard deviations in the retest groups. Because the nature of the treatment effect here was the skill or strategy rather than the ability, Verhaeghen (2000) noted that even skill or strategy training can lead to durable effects.
Stigsdotter Neely and Bäckman (1993a, 1993b) reported promising findings on long-term maintenance in their multifactorial memory training program focusing on various cognitive (encoding and imagery) and noncognitive (relaxation techniques) factors that are critical to memory performance. Using samples from two previous studies that had shown maintenance of gains 6 months after training, Stigsdotter Neely and Bäckman (1993a) showed that all groups performed at the same level in the 3.5-year follow-up as in the 6-month follow-up. Ball and colleagues (2002) found that after 2 years, 711 older adults who had participated in the ACTIVE memory training program sustained their memory improvement, with similar maintenance effects in the other cognitive intervention conditions involving inductive reasoning and speed of information processing. More recently, Willis et al. (2006) reported positive effects of the ACTIVE cognitive training on memory, inductive reasoning, and speed of information processing at 5 years postintervention. The reasons for the discrepant findings on the long-term maintenance of memory training gains and the mechanisms underlying successful maintenance of mnemonic strategy usage are still unclear, but it is clear that opportunity for practice and periodic booster sessions are key ingredients of successful interventions. However, if trained participants return to nonstimulating environments and do not continue to practice the skills learned during training, one would expect the training gains to dissipate. One of the challenges for future research on maintenance is to explore everyday activities that would be effective in enhancing and maintaining memory function.
Transfer
Prior memory intervention research has shown that training outcomes are highly specific to the mnemonic ability being trained (Kliegl et al., 1989; Mohs et al., 1998; Oswald, Ruppreccht, Gunzelmann, & Tritt, 1996; Rebok & Balcerak, 1989; Yesavage, 1985). That is, there is frequently little transfer to other laboratory memory tasks or to analogues of the training tasks encountered in everyday situations. Even though mnemonic training increases memory performance, elderly adults often encounter great difficulty transferring mnemonic usage into their daily lives (Brooks, Friedman, & Yesavage, 1993; Hill, Sheikh, & Yesavage, 1988; Kliegl, Smith, & Baltes, 1990). In their meta-analyses of memory training studies, Verhaeghen and colleagues (1992) and Floyd and Scogin (1997) concluded that interventions that emphasized teaching participants one or two mnemonic strategies were better than no intervention, but that future intervention studies must find ways to increase participants' awareness and knowledge (metamemory), decrease their negative beliefs (memory self-efficacy), and decrease their negative memory-related affect (anxiety). In addition, interventions that explicitly address everyday memory tasks are most likely to yield positive transfer to everyday life (Herrmann & Searleman, 1990). Several components of the ACTIVE memory skill training were designed to promote active transfer of the mnemonic training to everyday cognitive tasks (Ball et al., 2002; Jobe et al., 2001). These include the use of instructions and extensive practice in multiple mnemonic strategies, specifically strategies for organizing stimulus materials into meaningful categories (e.g., grocery shopping lists), organizing main ideas and details for remembering everyday text-based information (e.g., medication labels), and visualizing and associating items to be remembered (e.g., list of errands).
ACTIVE included booster training sessions at 11 and 35 months after training to help maintain training-related cognitive benefits over time and promote transfer of training to everyday behaviors (Willis et al., 2006). The effects of memory booster training on everyday activities are not known (McDougall, 1999). In ACTIVE (Willis et al., 2006), there was no significant effect of memory booster training 5 years after the initial training, but there was some limited evidence that cognitive training in nonboosted participants can reduce age-related decline in self-reported instrumental activities of daily living, although the effect only reached significance for the reasoning training group. Booster sessions may nevertheless be necessary to reinforce previously learned material and facilitate the transfer of training to the instrumental activities needed to maintain independent living. It also may be the case that training on memory alone is less effective than cross-training involving memory and other cognitive processes such as reasoning ability and speed of processing.
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WHAT RESEARCHERS NEED TO KNOW |
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). Recently, O'Hara and colleagues (2006) found that only 40% of participants who had been taught the method of loci and a face–name association technique reported that they had employed the techniques 5 years following the training, compared with 93% immediately following posttraining. People who self-reported using the techniques showed the highest performance overall both immediately posttraining and at follow-up.
In addition to exploring strategy usage, researchers should also measure pretraining to posttraining differences in factors such as anxiety, depression, confidence and motivation, mental speed, working memory, and practice effects, as investigators have linked these to memory performance and ability to benefit from training. For example, West and colleagues (2003) suggested that the key to the maintenance of memory training effects may lie in encouraging older adults to set personal goals, or to meet goals set by a trainer, in such a way as to increase their motivation to continue to use more challenging mnemonic techniques over extended periods of time. There is also a need to study the long-term changes in functional brain activity that occur as a result of memory training. Research by Nyberg and colleagues (2003) and others (Valenzuela et al., 2003) has shown that memory training is accompanied by immediate activity changes in the prefrontal and hippocampal areas and that these changes are related to changes in memory performance. However, to date, few if any studies have followed training participants to observe long-term neural changes.
Unlearning Ineffective Memory Strategies
In cognitive training research such as ACTIVE (Ball et al., 2002; Willis et al., 2006), the focus has typically been on training specific memory strategies, and less attention has been paid to the unlearning of inefficient (suboptimal) or ineffective mnemonic techniques. Participants often bring their own self-generated strategies to the training sessions, and, under some circumstances, these can be as effective as those taught by the trainer (Lachman et al., 1992). In other cases, these are less effective strategies on which participants perseverate despite their demonstrated lack of utility. A major challenge is to encourage older adults to use the techniques and skills on which they have been trained and to overcome perseverative tendencies that hinder the use of new strategies (Nyberg, 2005; Verhaeghen & Marcoen, 1996). Along these same lines, researchers need to know more about how older adults integrate their prior strategic knowledge with the knowledge gained during memory training. Investigators also need to focus more attention on the selection of strategies during training itself, because knowing when and how to use specific strategies in various memory situations may be a key to the successful transfer of training. For example, in learning a list of unrelated words, the method of loci technique may be a more productive strategy, whereas with a list of related words, the use of categorization may be more effective. Finally, researchers need to pay more attention to improving the use of external memory aids rather than focusing solely on internal mnemonics. In a survey study on the use of mnemonics by different groups, including academics and memory researchers, Park, Smith, and Cavanaugh (1990) reported that the most commonly used memory enhancement technique was writing things down, followed by using general internal mnemonic systems such as organization and rehearsal. Few people, regardless of which group they were in, reported using formal mnemonic systems such as the method of loci or the peg-word system. Improving external memory aids and teaching people about their effective utilization in everyday life might be a more cost effective way to improve memory than attempting to train individuals to use systems that require a great deal of cognitive effort and time to learn. The difficulties with getting people to accept and use these formal systems might help account for the problems in maintenance and transfer that investigators often find in memory training studies.
Understanding Who Benefits From Memory Training
More work also needs to be done on understanding who benefits from memory training. Cognitive training studies demonstrate that diverse socioeconomic, ability level, and ethnic populations benefit from traditional forms of memory training. Researchers have also demonstrated training effects for wide age ranges, including the oldest old (Singer, Lindenberger, & Baltes, 2003), normal elders (Ball et al., 2002), and individuals with cognitive impairment (see the recent meta-analysis by Sitzer, Twamley, & Jeste, 2006, on cognitive training effects in Alzheimer's disease). In particular, more attention needs to be paid to memory plasticity in adults older than age 80, as most of the training studies have involved younger old cohorts (Verhaeghen et al., 1992) and as the prevalence of cognitive impairments increases steeply with age. Although the evidence seems clear that plasticity of cognitive functions declines with advancing age (e.g., Singer et al., 2003; Verhaeghen & Marcoen, 1996), it is also clear that the aging brain does retain a considerable amount of reserve capacity (Reuter-Lorenz, 2002). Studies that use memory training techniques with older adults who are just beginning to experience preclinical cognitive decline but who do not yet have mild cognitive impairment or dementia will be an important facet of future memory training research. Such interventions may provide a window of opportunity in which to delay, and possibly reverse, the further progression of impairment.
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Acknowledgments |
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References |
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year followup studies. Journal of Gerontology: Psychological Sciences, 48,P233-P237.This article has been cited by other articles:
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  E. Dahlin, A. S. Neely, A. Larsson, L. Backman, and L. Nyberg Transfer of Learning After Updating Training Mediated by the Striatum Science, June 13, 2008; 320(5882): 1510 - 1512. [Abstract] [Full Text] [PDF]
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Abstract
Traditional Memory Training...