Implicit processes enhance cognitive abilities in mild cognitive impairment.

Previous work has shown that older adults with typical age-related memory changes (i.e., without cognitive impairment) pick up irrelevant information implicitly, and unknowingly use that information when it becomes relevant to a later task. Here, we address the possibility that implicit processes play a similarly beneficial role in the cognitive abilities of individuals with amnestic mild cognitive impairment (aMCI). Twenty-two individuals with aMCI and 22 matched controls participated in a picture judgment task while instructed to ignore distractions in the form of word/non-word letter strings. Memory for the distracting words was later tested with a word-fragment completion task. Both groups showed a priming effect, that is, they were significantly more likely to solve fragments of previously presented than non-presented words. However, the aMCI group had significantly higher scores than the older adults without cognitive impairment, t(42) = 2.16, p < .05, Cohen's d = 0.67. Our findings suggest that individuals with aMCI can enhance their performance on an explicit cognitive task, in this case, word-fragment completion, if previously exposed to the relevant information implicitly, opening up possible interventions aimed at this population.

Usability and Accessibility of the ArtontheBrain™ Virtual Recreation Activity for Older Adults With Low Vision Due to Age-Related Macular Degeneration.

Experiencing visual art can inspire, be an overall positive leisure activity, and has been linked to improved cognition, especially in older adults. Access to artwork in a museum environment can comprise a variety of barriers, including difficulties linked to its visual experience for persons that are visually impaired. The present study explored the barriers and facilitators experienced by 15 older adults (age 65 to 93) living with age-related macular degeneration when using an iPad to access ArtontheBrain™, a virtual art museum recreation experience created by members of this team. Using the Concurrent Think Aloud method, participants were asked to continuously comment on their experiences with the application while being audio/video recorded. Indeed, codes were determined by identifying frequently stated and emphasized ideas or behaviors of participants using the ArtontheBrain™ application. Transcripts underwent thematic analysis and indicated that the main access barriers were linked to control of the contrast, magnification, and the tactile interface on the tablet device. The learn and play activities as well as the text-to-speech feature were identified as facilitators for ArtontheBrain™ engagement. The present findings should also be considered in the larger context of application development, as this study provides insight pertaining to the needs of low vision individuals regarding usability and accessibility.

Neurocognitive Outcome Following Recovery from Severe Acute Respiratory Syndrome - Coronavirus-1 (SARS-CoV-1).

OBJECTIVE: Severe acute respiratory syndrome (SARS) is a highly contagious viral respiratory illness associated with hypoxia and dyspnea. Many of those who contracted and recovered from SARS during the 2002-2003 outbreak reported persistent physical, psychological, and cognitive difficulties. Here, we investigated the residual influences of SARS on cognition for a subset of healthcare professionals who recovered and were referred for neuropsychological evaluation through their workplace insurance. METHOD: Twenty-eight healthcare professionals were evaluated on neuropsychological and mood functioning approximately 1.5 years post-recovery from a severe respiratory illness. Test scores were compared with age-matched normative data, and correlations were examined between mood, self-report memory scales, subjective complaints (e.g., poor concentration, pain, fatigue), illness severity (i.e., length of hospitalization, oxygen use during hospital stay), and cognitive performance. RESULTS: Participants performed within age expectations on the majority of cognitive measures including overall memory ability. Although processing speed was generally within normal limits, 43% showed significant speed-accuracy trade-offs favoring accuracy over maintaining speed. Deficits were observed on measures of complex attention, such as working memory and the ability to sustain attention under conditions of distraction. Participants endorsed poorer memory ability than same-age peers on a meta-memory measure and mild to moderate depression and anxiety symptoms. Objective test performance was largely uncorrelated with self-reports, mood, or illness severity, except for moderate correlations between complex attention and participants' subjective ratings of Everyday Task-Oriented Memory. CONCLUSIONS: These findings demonstrate specific long-term cognitive deficits associated with SARS and provide further evidence of the cognitive effects of hypoxic illnesses.

Accessible Virtual Arts Recreation for Wellbeing Promotion in Long-Term Care Residents.

The efficacy of a technology-driven visual arts recreation activity, delivered virtually, was evaluated for its potential to achieve positive impacts, similar to traditional arts-interventions, on wellbeing in long-term care residents. Thirty-one residents (average age 86.8 years; SD = 9.4) engaged with the arts-intervention for 30-minutes, twice weekly, for 6 weeks with either a partner or as part of a group. Wellbeing indicators included self-reported psychological and health-related wellness, and attention capacity. Binomial tests of postintervention change revealed a significant above-chance probability of improvement in one or more wellbeing indicators (p < .05). Postparticipation feedback survey scores were positive (p < .05). Cognitive status did not influence outcome; however, other participant characteristics such as younger age, higher openness-to-experience (personality trait), and lower baseline mood were significantly associated with positive response to the intervention (p < .05). Findings demonstrate technology may be an effective platform for promoting accessibility to beneficial arts-interventions for older adults.

Technology Use among Family Caregivers of People with Dementia.

This study explored family caregivers' use of technology to care for people with dementia living at home. Three questions were pursued: (1) what are the important, unmet needs of family caregivers, (2) how do they use technologies to assist in care tasks, and (3) what do health care providers know about caregivers' needs and technology use? Two comprehensive surveys were developed to answer these questions: one for family caregivers (n = 33), and one for health care providers (n = 60). Descriptive and quantitative analyses showed that caregivers' important, unmet needs were in the domains of information, formal services, and emotional support. Caregivers make limited use of technology but believe in its potential usefulness. Health care providers agree that technology is useful in dementia care; however, they underestimate caregivers' willingness to adopt technologies to communicate with providers. Findings prove caregiver willingness to use technology to support their care role and provide guidance regarding the caregiver needs that these technologies should address.

Sex differences in cortisol and memory following acute social stress in amnestic mild cognitive impairment.

OBJECTIVE: Older adults with amnestic mild cognitive impairment (aMCI) develop Alzheimer's type dementia approximately 10 times faster annually than the normal population. Adrenal hormones are associated with aging and cognition. We investigated the relationship between acute stress, cortisol, and memory function in aMCI with an exploratory analysis of sex. METHOD: Salivary cortisol was sampled diurnally and during two test sessions, one session with the Trier Social Stress Test (TSST), to explore differences in the relationship between cortisol and memory function in age-normal cognition (NA) and aMCI. Participants with aMCI (n = 6 women, 9 men; mean age = 75) or similarly aged NA (n = 9 women, 7 men, mean age = 75) were given tests of episodic, associative, and spatial working memory with a psychosocial stressor (TSST) in the second session. RESULTS: The aMCI group performed worse on the memory tests than NA as expected, and males with aMCI had elevated cortisol levels on test days. Immediate episodic memory was enhanced by social stress in NA but not in the aMCI group, indicating that stress-induced alterations in memory are different in individuals with aMCI. High cortisol was associated with impaired performance on episodic memory in aMCI males only. Cortisol in Session 1 moderated the relationship with spatial working memory, whereby higher cortisol was associated with worse performance in NA, but better spatial working memory in aMCI. In addition, effects of aMCI on perceived anxiety in response to stress exposure were moderated by stress-induced cortisol in a sex-specific manner. CONCLUSIONS: We show effects of aMCI on Test Session cortisol levels and effects on perceived anxiety, and stress-induced impairments in memory in males with aMCI in our exploratory sample. Future studies should explore sex as a biological variable as our findings suggest that effects at the confluence of aMCI and stress can be obfuscated without sex as a consideration.

An Incidental Learning Method to Improve Face-Name Memory in Older Adults With Amnestic Mild Cognitive Impairment.

OBJECTIVE: Forgetting names is a common memory concern for people with amnestic mild cognitive impairment (aMCI) and is related to explicit memory deficits and pathological changes in the medial temporal lobes at the early stages of Alzheimer's disease (AD). In the current experiment, we tested a unique method to improve memory for face-name associations in people with aMCI involving incidental rehearsal of face-name pairs. METHOD: Older adults with aMCI and age- and education-matched controls learned 24 face-name pairs and were tested via immediate cued recall with faces as cues for associated names. During a 25- to 30-min retention interval, 10 of the face-name pairs reappeared as a quarter of the items on a seemingly unrelated 1-back task on faces, with the superimposed names irrelevant to the task. After the delay, surprise delayed cued recall and forced-choice associative recognition tests were administered for the face-name pairs. RESULTS: Both groups showed reduced forgetting of the names that repeated as distraction and enhanced recollection of these pairs. CONCLUSIONS: The results demonstrate that passive methods to prompt automatic retrieval of associations may hold promise as interventions for people with early signs of AD.

Self-referential processing improves memory for narrative information in healthy aging and amnestic Mild Cognitive Impairment.

The Self-Reference Effect (SRE), enhanced memory for self-related information, has been established in healthy young and older adults but has had limited study in age-related memory disorders such as amnestic Mild Cognitive Impairment (aMCI). Additionally, the majority of SRE studies have been conducted using trait adjective paradigms, which lack ecological validity; memory for narrative information has real-world importance and has been shown to decline in healthy aging and, to a greater extent, in aMCI. The present study investigated whether self-referential processing promotes memory for narrative information in healthy aging and, for the first time, in aMCI. The promotion of recollection (vivid re-experiencing of an event) through self-referential processing, termed the Self-Reference Recollection Effect (SRRE; Conway and Dewhurst, 1995), was also examined, as was the potential impact of material valence on the SRE. Twenty individuals with aMCI and thirty healthy older controls encoded short narratives under self-reference, semantic, and structural conditions. Memory for narrative details was subsequently tested. Results indicated a SRE for narrative information in both aMCI and healthy control groups on a recognition memory test. The SRRE was found in healthy controls and individuals with aMCI. Material valence did not impact the SRE in either group. The SRE appears to be powerful enough to circumvent loss of hippocampal function in aMCI, possibly due to the multimodal nature of narrative information. Findings from this study highlight the potential of the SRE as an effective intervention tool for improving memory for narrative information in aMCI.

Self-Reference Effect and Self-Reference Recollection Effect for Trait Adjectives in Amnestic Mild Cognitive Impairment.

OBJECTIVES: The self-reference effect (SRE), enhanced memory for self-related information, has been studied in healthy young and older adults but has had little investigation in people with age-related memory disorders, such as amnestic mild cognitive impairment (aMCI). Self-referential encoding may help to improve episodic memory in aMCI. Additionally, self-referential processing has been shown to benefit recollection, the vivid re-experiencing of past events, a phenomenon that has been termed the self-reference recollection effect (SRRE; Conway & Dewhurst, 1995). Furthermore, it remains unclear whether the valence of stimuli influences the appearance of the SRE and SRRE. METHODS: The current study investigated the SRE and SRRE for trait adjective words in 20 individuals with aMCI and 30 healthy older adult controls. Ninety trait adjective words were allocated to self-reference, semantic, or structural encoding conditions; memory was later tested using a recognition test. RESULTS: While healthy older adults showed a SRE, individuals with aMCI did not benefit from self-referential encoding over and above that of semantic encoding (an effect of "deep encoding"). A similar pattern was apparent for the SRRE; healthy controls showed enhanced recollection for words encoded in the self-reference condition, while the aMCI group did not show specific benefit to recollection for self-referenced over semantically encoded items. No effects of valence were found. CONCLUSIONS: These results indicate that while memory for trait adjective words can be improved in aMCI with deep encoding strategies (whether self-reference or semantic), self-referencing does not provide an additional benefit. (JINS, 2018, 24, 821-832).

Leveraging older adults' susceptibility to distraction to improve memory for face-name associations.

Forgetting people's names is a common memory complaint among older adults and one that is consistent with experimental evidence of age-related decline in memory for face-name associations. Despite this difficulty intentionally forming face-name associations, a recent study demonstrated that older adults hyperbind distracting names and attended faces, which produces better learning of these face-name pairs when they reappear on a memory test (Weeks, Biss, Murphy, & Hasher, 2016). The current study explored whether this effect could be leveraged as an intervention to reduce older adults' forgetting of face-name associations, using a method previously shown to improve older adults' retention of a word list (Biss, Ngo, Hasher, Campbell, & Rowe, 2013). Twenty-five younger and 32 older adults studied 24 face-name pairs and were tested via immediate and delayed memory tests. During the 30-min retention interval, 10 of the face-name pairs reoccurred as distraction in an ostensibly unrelated face-judgment task, providing an opportunity to implicitly rehearse these pairs. Older adults showed reduced forgetting of repeated face-name pairs as well as improved recollection. Younger adults showed no reliable benefit. These findings indicate that useful distraction benefits older adults' memory for face-name associations, suggesting its potential utility as a memory intervention technique. (PsycINFO Database Record

A re-examination of Montreal Cognitive Assessment (MoCA) cutoff scores.

OBJECTIVE: The Montreal Cognitive Assessment (MoCA; Nasreddine et al., 2005) is a cognitive screening tool that aims to differentiate healthy cognitive aging from Mild Cognitive Impairment (MCI). Several validation studies have been conducted on the MoCA, in a variety of clinical populations. Some studies have indicated that the originally suggested cutoff score of 26/30 leads to an inflated rate of false positives, particularly for those of older age and/or lower education. We conducted a systematic review and meta-analysis of the literature to determine the diagnostic accuracy of the MoCA for differentiating healthy cognitive aging from possible MCI. METHODS: Of the 304 studies identified, nine met inclusion criteria for the meta-analysis. These studies were assessed across a range of cutoff scores to determine the respective sensitivities, specificities, positive and negative predictive accuracies, likelihood ratios for positive and negative results, classification accuracies, and Youden indices. RESULTS: Meta-analysis revealed a cutoff score of 23/30 yielded the best diagnostic accuracy across a range of parameters. CONCLUSIONS: A MoCA cutoff score of 23, rather than the initially recommended score of 26, lowers the false positive rate and shows overall better diagnostic accuracy. We recommend the use of this cutoff score going forward. Copyright © 2017 John Wiley & Sons, Ltd.

Intraindividual variability in performance on associative memory tasks is elevated in amnestic mild cognitive impairment.

Elevations in intraindividual variability (IIV) are an indicator of neurocognitive compromise and are seen on reaction time tasks in individuals with mild cognitive impairment (MCI). We examined IIV on memory tasks known to be sensitive to early cognitive change in a group of 24 individuals with amnestic MCI and 21 matched controls. Traditional measures of accuracy and speed, as well as indices of IIV statistically purified for systematic between-group and trial effects, were derived from performance on two computer-based associative recognition tests of word-word and face-name pairs. Accuracy and speed were reduced and IIV was elevated in the MCI group compared to controls on both tasks. Logistic regression analyses demonstrated that IIV, but not speed, was a unique predictor of group membership, over and above performance accuracy. Observed elevations in IIV in MCI are congruent with the notion that IIV may reflect disturbance in distributed neural networks, including medial temporal regions, in addition to frontal systems dysfunction. Present findings have diagnostic implications for accurate identification of individuals with MCI and add to the growing literature on IIV as an early indicator of cognitive decline in older adults.

Face-name learning in older adults: a benefit of hyper-binding.

Difficulty remembering faces and corresponding names is a hallmark of cognitive aging, as is increased susceptibility to distraction. Given evidence that older adults spontaneously encode relationships between target pictures and simultaneously occurring distractors (a hyper-binding phenomenon), we asked whether memory for face-name pairs could be improved through prior exposure to faces presented with distractor names. In three experiments, young and older adults performed a selective attention task on faces while ignoring superimposed names. After a delay, they learned and were tested on face-name pairs that were either maintained or rearranged from the initial task but were not told of the connection between tasks. In each experiment, older but not younger participants showed better memory for maintained than for rearranged pairs, indicating that older adults' natural propensity to tacitly encode and bind relevant and irrelevant information can be employed to aid face-name memory performance.

Older adults show a self-reference effect for narrative information.

The self-reference effect (SRE), enhanced memory for information encoded through self-related processing, has been established in younger and older adults using single trait adjective words. We sought to examine the generality of this phenomenon by studying narrative information in these populations. Additionally, we investigated retrieval experience at recognition and whether valence of stimuli influences memory differently in young and older adults. Participants encoded trait adjectives and narratives in self-reference, semantic, or structural processing conditions, followed by tests of recall and recognition. Experiment 1 revealed an SRE for trait adjective recognition and narrative cued recall in both age groups, although the existence of an SRE for narrative recognition was unclear due to ceiling effects. Experiment 2 revealed an SRE on an adapted test of narrative recognition. Self-referential encoding was shown to enhance recollection for both trait adjectives and narrative material in Experiment 1, whereas similar estimates of recollection for self-reference and semantic conditions were found in Experiment 2. Valence effects were inconsistent but generally similar in young and older adults when they were found. Results demonstrate that the self-reference technique extends to narrative information in young and older adults and may provide a valuable intervention tool for those experiencing age-related memory decline.

Interacting effects of age and time of day on verbal fluency performance and intraindividual variability.

We explored the effects of age and time of day (TOD) on verbal fluency ability with respect to performance level and intraindividual variability (IIV). Verbal fluency, which involves complex cognitive operations, was examined in 20 older (mean age = 72.8 years) and 20 younger (mean age = 24.2 years) adults with test start time alternating between morning and evening across four days. Older adults generated more words in the morning and younger adults more in the evening, corresponding with self-report peak TOD. Age by TOD interactions were also observed across fluency tasks on the number of switches among subcategory exemplars during word generation and on the IIV observed in switching behavior. Older adults exhibited greater variability in switching in the evening than in the morning, whereas younger adults showed the opposite pattern. These findings demonstrate that processes involving energization (initiating and sustaining) and attentional control may be particularly sensitive to age differences in TOD influences on cognition.

The Impact of Memory Change on Daily Life in Normal Aging and Mild Cognitive Impairment.

PURPOSE OF THE STUDY: Older adults with age-normal memory changes and those with amnestic mild cognitive impairment (aMCI) report mild memory difficulties with everyday problems such as learning new names or remembering past events. Although the type and extent of memory changes in these populations have been well documented, little is known about how memory changes impact their everyday lives. DESIGN AND METHODS: Using a qualitative research design, data were collected from three focus groups of older adults with normal memory changes (n = 23) and two focus groups of older adults with aMCI (n = 14). A thematic analysis using the constant comparative method was used to identify the impacts of memory change on key life domains. RESULTS: Four major themes emerged from the two groups, including changes in feelings and views of the self, changes in relationships and social interactions, changes in work and leisure activities, and deliberate increases in compensatory behaviors. Participants described both positive and negative consequences of memory change, and these were more substantial and generally more adverse for individuals with aMCI than for those with age-normal memory changes. IMPLICATIONS: There are similarities and important differences in the impact of mild memory change on the everyday lives of older adults with age-normal memory changes and those with aMCI. Findings underscore the need for clinical interventions that aim to minimize the emotional impact of memory changes and that increase leisure and social activity in individuals with aMCI.

Taoist Tai Chi® and Memory Intervention for Individuals with Mild Cognitive Impairment.

OBJECTIVE: It was hypothesized that a combined Taoist Tai Chi (TTC) and a memory intervention program (MIP) would be superior to a MIP alone in improving everyday memory behaviors in individuals with amnestic mild cognitive impairment (aMCI). A secondary hypothesis was that TTC would improve cognition, self-reported health status, gait, and balance. METHOD: A total of 48 individuals were randomly assigned to take part in MIP + TTC or MIP alone. The TTC intervention consisted of twenty 90 min sessions. Outcome measures were given at baseline, and after 10 and 22 weeks. RESULTS: Both groups significantly increased their memory strategy knowledge and use, ratings of physical health, processing speed, everyday memory, and visual attention. No preferential benefit was found for individuals in the MIP + TTC group on cognition, gait, or balance measures. CONCLUSIONS: Contrary to expectations, TTC exercise did not specifically improve cognition or physical mobility. Explanations for null findings are explored.

Naturalistic Action Performance Distinguishes Amnestic Mild Cognitive Impairment from Healthy Aging.

Individuals with amnestic mild cognitive impairment (aMCI) show minor decrements in their instrumental activities of daily living (IADL). Sensitive measures of IADL performance are needed to capture the mild difficulties observed in aMCI groups. Routine naturalistic actions (NAs) are familiar IADL-type activities that require individuals to enact everyday tasks such as preparing coffee. In the current study we examined the extent to which NAs could be used to help facilitate differential diagnosis of aMCI relative to composite measures of episodic memory, semantic knowledge, and executive function. Healthy older adults (n=24) and individuals with aMCI (n=24) enacted two highly familiar NAs and completed tests of episodic memory, semantic knowledge, and executive function. Binary logistic regression was used to predict group membership (aMCI vs. control participants). The regression analyses indicated that NA performance could reliably predict group membership, over and above measures of cognitive functioning. These findings indicated that NA performance can be used to help facilitate differential diagnosis of healthy aging and aMCI and used as an outcome measure in intervention studies.

Compromised naturalistic action performance in amnestic mild cognitive impairment.

OBJECTIVE: Routine naturalistic actions (NAs) are familiar activities that require the production of several actions in a particular order to achieve a specific goal, such as preparing a meal or paying bills. Given that amnestic mild cognitive impairment (aMCI) has been shown to be a risk factor for dementia, a better understanding of the cognitive processes that mediate NA performance is needed in order to facilitate efforts to promote functional autonomy in this population. METHOD: Performance of 2 highly familiar NAs, and their relationship to measures of episodic memory, semantic knowledge, and executive function was systematically investigated in a sample of healthy older adults (n = 24) and individuals with aMCI (n = 24). RESULTS: In general, measures of executive function were related to commission errors, while episodic memory was associated with the omission of supporting actions. However, both errors of omission and commission appeared to draw on a diverse array of cognitive processes. CONCLUSIONS: The findings provide preliminary evidence that the cognitive correlates of NA errors may not be as process pure as previously hypothesized in neuropsychological models. A more comprehensive understanding of the cognitive underpinnings of NAs in aMCI could lead to more effective intervention programs to promote functional autonomy and delay dementia onset. Furthermore, NAs may be administered in neurocognitive assessments to identify early changes in everyday functioning and facilitate differential diagnosis between healthy aging and aMCI.