Bridging the gap between clinical trials and community care: Translating a memory group for older people with mild cognitive impairment into a community-based organisation.

OBJECTIVES: Older people with mild cognitive impairment (MCI) are seeking interventions for maintaining independence. This study investigates the feasibility of translating a research-evaluated memory group (LaTCH) into a community-based organisation by evaluating the experiences of clients and trained staff. METHODS: Dementia Australia staff trained as facilitators of memory groups for 274 people with MCI and families. Clients and staff were interviewed regarding experiences from group participation. RESULTS: Clients and staff reported benefits of shared experience through group participation, leading to greater use of compensatory strategies. Staff observed client improvement in memory-related self-confidence, thereby reducing anxiety and increasing re-engagement in life activities. In their own professional roles, staff reported increased self-efficacy, leading to greater role satisfaction. Several challenges in running and sustaining the program were also identified. CONCLUSIONS: Memory group interventions can be feasibly delivered in a community setting and increase service access opportunities for older people with memory problems.

The Contribution of Prospective Memory Performance to the Neuropsychological Assessment of Mild Cognitive Impairment.

OBJECTIVE: Prospective memory difficulties are a feature of the amnestic form of mild cognitive impairment (aMCI). Although comprehensive test batteries of prospective memory are suitable for clinical practice, they are lengthy, which has detracted from their widespread clinical use. Our aim was to investigate the utility of a brief screening measure of prospective memory, which can be incorporated into a clinical neuropsychological assessment. METHODS: Seventy-seven healthy older adults (HOA) and 77 participants with aMCI were administered a neuropsychological test battery, including a prospective memory screening measure (Envelope Task), a retrospective memory measure (CVLT-II), and a multi-item subjective memory questionnaire (Prospective and Retrospective Memory Questionnaire; PRMQ) and a single-item subjective memory scale. RESULTS: Compared with HOA participants, participants with aMCI performed poorly on the Envelope Task (η(2) = .38), which provided good discrimination of the aMCI and HOA groups (AUC = .83). In the aMCI group, there was a small but significant relationship between the Envelope Task and the single-item subjective rating of memory, with the Envelope Task accounting for 5-6% of the variance in subjective memory after accounting for emotional status. This relationship of prospective memory and subjective memory was not significant for the multi-item questionnaire (PRMQ); and, retrospective memory was not a significant predictor of self-rated memory, single-item, or multi-item. CONCLUSION: A brief screening measure of prospective memory, the Envelope Task, provides useful support to traditional memory measures in detecting aMCI.

Strategies for improving memory: a randomized trial of memory groups for older people, including those with mild cognitive impairment.

BACKGROUND: Governments are promoting the importance of maintaining cognitive health into older age to minimize risk of cognitive decline and dementia. Older people with amnestic mild cognitive impairment (aMCI) are particularly vulnerable to memory challenges in daily activities and are seeking ways to maintain independent living. OBJECTIVE: To evaluate the effectiveness of memory groups for improving memory strategies and memory ability of older people, especially those with aMCI. METHODS: 113 healthy older adults (HOA) and 106 adults with aMCI were randomized to a six-week memory group or a waitlist control condition. Outcome was evaluated through knowledge and use of memory strategies, memory ability (self-report and neuropsychological tests), and wellbeing. Assessments included a six-month follow-up. RESULTS: Using intention to treat analyses, there were intervention effects for HOA and aMCI groups in strategy knowledge (HOA: η2= 0.20; aMCI: η2= 0.06), strategy use (HOA: η2= 0.18; aMCI: η2= 0.08), and wellbeing (HOA: η2= 0.11; aMCI: η2= 0.05). There were also intervention effects in the HOA group, but not the aMCI group, in self-reported memory ability (η2= 0.06) and prospective memory tests (η2= 0.02). By six-month follow-up, gains were found on most HOA outcomes. In the aMCI group gains were found in strategy use, and by this stage, gains in prospective memory were also found. CONCLUSION: Memory groups can engage older people in techniques for maintaining cognitive health and improve memory performance, but more modest benefits are seen for older adults with aMCI.

Uptake of a newly implemented advance care planning program in a dementia diagnostic service.

BACKGROUND: Advance care planning (ACP) provides a framework for discussion and documentation of future care preferences when a person loses cognitive capacity. It can assist people in the early stages of dementia to document their preferences for care at later stages of the illness. METHOD: A three-stage project introduced ACP to clients with mild cognitive impairment (MCI) or recently diagnosed dementia and their families through a specialist memory clinic. Over 8 months, all English-speaking clients (n = 97) and carers (n = 92) were mailed a survey assessing completed documentation for future care; understanding of the principles of ACP and willingness to get further information about ACP (Stage 1). Participants wanting more information were invited to a seminar introducing the ACP program and service (Stage 2). Participants wanting to complete ACP documentation could make an appointment with the ACP clinicians (Stage 3). RESULTS: Forty-eight (52.2%) carers and 34 clients (35.1%) responded to the survey. Most clients (62.1%) and carers (79.1%) expressed interest in ACP, and 78.6% of clients and 63.6% of carers believed that clients should be involved in their future medical decisions. Nine clients (26.5%; diagnoses: MCI = 5; AD = 3; mixed dementia = 1) and 9 carers (18.8%) attended the seminars, and 2/48 (4%) carers and 3/34 (8.8%) clients (diagnoses: MCI = 2; AD = 1) completed ACP. CONCLUSION: Despite initial interest, ACP completion was low. The reasons for this need to be determined. Approaches that may better meet the needs of people newly diagnosed with MCI and dementia are discussed.

Is the WMS-IV verbal paired associates as effective as other memory tasks in discriminating amnestic mild cognitive impairment from normal aging?

Paired associate learning tasks are reportedly particularly sensitive to preclinical Alzheimer's disease. We aimed to determine the effectiveness of the recently updated Wechsler Memory Scale verbal paired associates (VPA) in distinguishing the earliest stages of memory impairment (amnestic mild cognitive impairment, aMCI), and the clinical application at the case level, compared with other episodic memory tasks. Participants were 77 people with aMCI and 77 matched healthy older adults (HOA). VPA performance distinguished aMCI from HOA at the group level with large effect sizes, of similar size to the other tasks at immediate recall, but smaller than the CVLT-II list-learning task at delayed recall. Similarly, receiver operating characteristic (ROC) analysis demonstrated good discrimination, similar to other tasks, but again with CVLT-II more accurate at delayed recall. Although group differences remained for normative data, on a case basis using existing normative data the VPA failed to identify 70% of aMCI as impaired. The findings suggest further examination of the normative data is required before the VPA is useful in clinical practice, and highlight the importance of comprehensive neuropsychological assessment in detecting mild memory changes in older adults.

Relationship between control beliefs, strategy use, and memory performance in amnestic mild cognitive impairment and healthy aging.

OBJECTIVES: Little information is available regarding the extent of strategy use and factors that affect strategy use in amnestic mild cognitive impairment (aMCI). This study aimed to compare spontaneous strategy use and beliefs about the controllability of memory between aMCI and healthy older adult (HOA) samples and to explore the relationships between beliefs, strategy use, and memory performance for both groups. METHOD: The aMCI and HOA groups each composed of 60 individuals matched for age and education. The Memory Controllability Inventory was used to assess control beliefs, and the extent of semantic clustering on a list-learning task provided a measure of spontaneous strategy use. RESULTS: The aMCI group endorsed lower control beliefs and demonstrated poorer semantic clustering and memory performance compared with the HOA group. Although strategy use partially mediated the control beliefs-memory performance relationship for the HOA group, this was not replicated for the aMCI group. DISCUSSION: Despite the weak relationship between control beliefs and strategy use, and control beliefs and memory performance for the aMCI group, the strong relationship between strategy use and memory performance provides impetus for further research into factors that can be used as a means of enhancing strategy use in interventions for aMCI.

Semantic verbal fluency strategies in amnestic mild cognitive impairment.

OBJECTIVE: The primary aim of this study was to investigate the cognitive strategies used in semantic fluency (clustering, switching, and access to subcategories) in amnestic mild cognitive impairment (aMCI). In addition, we evaluated the impact of slowing in speed of information processing on semantic fluency performance. METHOD: Tests of semantic verbal fluency (animals, supermarket items) were administered to 33 participants with aMCI and 33 healthy older adults (HOA). A selected measure of speed of information processing was also administered. RESULTS: Analyses revealed significant impairment in word generation (animals, supermarket items) in the aMCI group relative to the HOA group (η² = .41). Furthermore, the aMCI group produced significantly smaller cluster sizes (η² = .12) and accessed fewer subcategories than the HOA group (η² = .11), whereas a difference in switching frequency between groups produced a small but nonsignificant effect. Although the aMCI group, as compared with the HOA group, demonstrated reductions in processing speed (η² = .17), covariance analyses adjusting for speed did not substantively alter the significant difference between groups in clustering and access to subcategories. CONCLUSIONS: When attempting semantic fluency, and as compared with healthy older adults, people with aMCI demonstrated difficulties in isolating semantic categories and loss of associative links within semantic categories. These findings are discussed in relation to an early degradation of semantic memory in aMCI.

Clinical measures of prospective memory in amnestic mild cognitive impairment.

Recent research has established that individuals with amnestic mild cognitive impairment (aMCI) have impaired prospective memory (PM); however, findings regarding differential deficits on time-based versus event-based PM have been less clear. Furthermore, the diagnostic utility of PM measures has received scant attention. Healthy older adults (n = 84) and individuals with aMCI (n = 84) were compared on the Cambridge Prospective Memory Test (CAMPROMPT) and two single-trial event-based PM tasks. The aMCI participants showed global impairment on all PM measures. Measures of retrospective memory and complex attention predicted both time and event PM performance for the aMCI group. Each of the PM measures was useful for discriminating aMCI from healthy older adults and the time- and event-based scales of the CAMPROMPT were equivalent in their discriminative ability. Surprisingly, the brief PM tasks were as good as more comprehensive measures of PM (CAMPROMPT) at predicting aMCI. Results indicate that single-trial PM measures, easily integrated into clinical practice, may be useful screening tools for identifying aMCI. As PM requires retrospective memory skills along with complex attention and executive skills, the interaction between these skills may explain the global PM deficits in aMCI and the good discriminative ability of PM for diagnosing aMCI.

Names and numberplates: quasi-everyday associative memory tasks for distinguishing amnestic mild cognitive impairment from healthy aging.

Amnestic mild cognitive impairment (aMCI) delineates a population at high risk for subsequently developing Alzheimer's disease (AD)--that is, people with preclinical AD. Associative episodic memory tasks are particularly sensitive to preclinical AD; however, they often lack ecological validity, which is important when evaluating performance in daily activities. We describe the development of two quasi-everyday associative memory tasks--the La Trobe Face-Name test and the La Trobe Numberplate task--and their utility in profiling and separating 70 aMCI participants from 101 healthy older adults (HOA) compared with standard episodic memory tasks. aMCI participants performed significantly worse overall and demonstrated a greater forgetting rate than HOA on both tasks. The everyday tasks separated aMCI from HOA participants as effectively as standard episodic memory tasks and were well tolerated. These tasks provide a valuable addition to neuropsychologists' toolkits with enhanced ecological (verisimilitude) and face validity for assisting in counseling clients, measuring the effect of interventions, and profiling everyday memory performance in HOA and aMCI.

Knowledge and use of memory strategies in amnestic mild cognitive impairment.

Despite the inclusion of memory strategy training in many interventions for amnestic mild cognitive impairment (aMCI), little research has directly examined knowledge and use of memory strategies in aMCI and their relationship to memory performance in order to guide the development of targeted interventions. The present study aimed to compare strategy knowledge and use between an aMCI and a healthy older adult (HOA) sample, and to determine the contribution of strategy knowledge and use to memory performance in each of these groups. The sample comprised 37 aMCI and 52 HOA participants aged over 60 years. All participants completed questionnaires to assess strategy knowledge and self-reported use of internal and external strategies in everyday life. In addition, strategy use was observed on the measures of retrospective and prospective memory performance (the CVLT-II and the CAMPROMPT). The aMCI group demonstrated decreased strategy knowledge and observed use of internal strategies, although equivalent observed use of external strategies compared with the HOA group. Furthermore, they reported equivalent use of both internal and external strategies. Observed use of strategies was significantly associated with retrospective memory performance for both groups and prospective memory performance for the aMCI group, supporting the inclusion of strategy training in interventions.

Learning and memory in amnestic mild cognitive impairment: contribution of working memory.

In addition to deficits in delayed recall, recent research suggests that participants with amnestic mild cognitive impairment (aMCI) demonstrate diminished use of strategic encoding strategies during learning. Few studies have explored the cognitive mechanisms underlying this deficit. The aim of this study was to investigate in aMCI whether components of working memory (executive attention--attention set-shifting, dividing and focusing attention; and episodic buffer functions--strategic retrieval and manipulation of information) predict strategic encoding strategies during learning (semantic clustering). Thirty-three participants with aMCI and 33 healthy older adults (HOA) were administered neuropsychological tests assessing word-list learning and working memory. The aMCI group demonstrated significant impairment in acquisition, retrieval of information, and decreased use of semantic clustering strategies. Use of semantic clustering in the aMCI group was not predicted by measures of executive attention or phonemic verbal fluency, but was predicted by semantic verbal fluency performance. In the HOA group, semantic clustering was strongly related to semantic verbal fluency. These findings suggest that in aMCI, diminished strategic encoding strategies during learning (semantic clustering) is selectively related to the strategic function of the episodic buffer, but only when in interaction with the manipulation and retrieval of semantic associations.