Explicit and implicit memory for music in healthy older adults and patients with mild Alzheimer's disease.

Introduction: Previous studies have found that music paired with lyrics at encoding may improve the memory performance of patients with mild Alzheimer's disease (AD). To further explore memory for different types of musical stimuli, the current study examined both implicit and explicit memory for music with and without lyrics compared to spoken lyrics. Method: In this mixed design, patients with probable mild AD (n = 15) and healthy older adults (n = 13) listened to auditory clips (song, instrumental, or spoken lyrics varied across three sessions) and then had their memory tested. Implicit memory was measured by the mere exposure effect. Explicit recognition memory was measured using a confidence-judgment receiver operating characteristic (ROC) paradigm, which allowed examination of the separate contributions made by familiarity and recollection. Results: A significant implicit memory mere exposure effect was found for both groups in the instrumental and song but not the spoken condition. Both groups had the best explicit memory performance in the spoken condition, followed by song, and then instrumental conditions. Healthy older adults demonstrated more recollection than patients with AD in the song and spoken conditions, but both groups performed similarly in the instrumental condition. Patients with AD demonstrated more familiarity in the instrumental and song conditions than in the spoken condition. Conclusions: The results have implications for memory interventions for patients with mild AD. The implicit memory findings suggest that patients with AD may still show a preference for information familiar to them. The explicit memory results support prior findings that patients with AD rely heavily on familiarity, but also suggest that there may be limitations on the benefits that music can provide to recognition memory performance.

Response bias and response monitoring: Evidence from healthy older adults and patients with mild Alzheimer's disease.

Patients with Alzheimer's disease (AD) often exhibit an abnormally liberal response bias in recognition memory tests, responding "old" more frequently than "new." Investigations have shown patients can to shift to a more conservative response bias when given instructions. We examined if patients with mild AD could alter their response patterns when the ratio of old items is manipulated without explicit instruction. Healthy older adults and AD patients studied lists of words and then were tested in three old/new ratio conditions (30%, 50%, or 70% old items). A subset of participants provided estimates of how many old and new items they saw in the memory test. We demonstrated that both groups were able to change their response patterns without the aid of explicit instructions. Importantly, AD patients were more likely to estimate seeing greater numbers of old than new items, whereas the reverse was observed for older adults. Elevated estimates of old items in AD patients suggest their liberal response bias may be attributed to their reliance on familiarity. We conclude that the liberal response bias observed in AD patients is attributable to their believing that more of the test items are old and not due to impaired meta-memorial monitoring abilities.

The use of metacognitive strategies to decrease false memories in source monitoring in patients with mild cognitive impairment.

Patients with amnestic mild cognitive impairment (MCI) and Alzheimer's disease (AD) often demonstrate high rates of false memories, leading to stressful and frustrating situations for both patients and caregivers in everyday life. Sometimes these false memories are due to failures in monitoring the source of the information. In the current study, we examined interventions aimed to enhance the use of the metacognitive "recall-to-reject" memory strategy. Such interventions could improve source memory and decrease false memory in patients with MCI. Because the picture superiority effect (better memory for pictures compared to words) has been shown to be present in both patients with MCI and healthy older controls, we investigated whether pictures could help patients with MCI use a recall-to-reject strategy in a simulation of real-world source memory task. In this experiment, patients with MCI and healthy older adults were asked to simulate preparing for and then taking a trip to the market. Subjects first studied 30 pictures of items in their "cupboard," followed by a list of 30 words of items on their "shopping list." At test, participants saw 90 pictures (30 cupboard, 30 list, 30 new) organized as they would be if walking down the market aisles, and are provided with either standard or metacognitive instructions. With standard instructions, they were asked if they needed to buy the item. With the metacognitive instructions, they were asked a series of questions to help guide them through a recall-to-reject strategy to highlight the different sources of memories. Results showed that the metacognitive instructions did significantly reduce the false memory rates for patients with MCI. Further studies need to investigate how to best implement these practical strategies into the everyday lives of patients.

The influence of strategic encoding on false memory in patients with mild cognitive impairment and Alzheimer's disease dementia.

Patients with Alzheimer's disease (AD) dementia exhibit high rates of memory distortions in addition to their impairments in episodic memory. Several investigations have demonstrated that when healthy individuals (young and old) engaged in an encoding strategy that emphasized the uniqueness of study items (an item-specific encoding strategy), they were able to improve their discrimination between old items and unstudied critical lure items in a false memory task. In the present study we examined if patients with AD could also improve their memory discrimination when engaging in an item-specific encoding strategy. Healthy older adult controls, patients with mild cognitive impairment (MCI) due to AD, and patients with mild AD dementia were asked to study lists of categorized words. In the Item-Specific condition, participants were asked to provide a unique detail or personal experience with each study item. In the Relational condition, they were asked to determine how each item in the list was related to the others. To assess the influence of both strategies, recall and recognition memory tests were administered. Overall, both patient groups exhibited poorer memory in both recall and recognition tests compared to controls. In terms of recognition, healthy older controls and patients with MCI due to AD exhibited improved memory discrimination in the Item-Specific condition compared to the Relational condition, whereas patients with AD dementia did not. We speculate that patients with MCI due to AD use intact frontal networks to effectively engage in this strategy.