Elaborated spaced-retrieval and prospective memory in mild Alzheimer's disease

Prospective memory, or the timely remembering of a planned action, is conceptualised as a cognitive process demanding episodic memory and executive attention. Impairments in these skills are characteristic of the cognitive decline in early Alzheimer's disease, providing an expectation of prominent prospective memory difficulties in this population, and yet surprisingly, memory performance in early Alzheimer's disease has rarely been evaluated within a prospective memory framework. In a preliminary study we demonstrated that older adults with early Alzheimer's disease (n = 14), as compared to healthy older adults (n = 14), were significantly impaired in a simple experimental paradigm of prospective remembering (a text-reading task). In a subsequent intervention study, we investigated the efficacy of spaced-retrieval for improving the prospective remembering performance of older adults with early Alzheimer's disease (n = 16) compared to healthy older adults (n = 16) under two learning conditions: a spaced-retrieval technique alone or spaced-retrieval combined with elaborated encoding of task. The majority of the Alzheimer's disease group (63%) demonstrated benefit in prospective remembering in the combined condition as compared to spaced-retrieval alone. Participants with Alzheimer's disease who demonstrated better executive attention (Trail Making – set-shifting) and/or better retrospective memory (Hopkins Verbal Learning Test–Revised – recognition) were more successful in the combined learning condition.     

The episodic buffer and learning in early Alzheimer's disease

The role of working memory, specifically the episodic buffer, in the learning performance of patients with very mild (n = 18) and mild (n = 12) Alzheimer's disease as compared with healthy older adults (n = 29) was investigated using a series of word-lists that were manipulated (clustered, unclustered) to explore the impact of strategic organizational skills under varying attention conditions (full, divided). Results indicated that the learning performance for all three groups under full attention was better than that under divided attention, but only for the clustered word-lists. Moreover, in contrast to the mild Alzheimer's disease group, both the healthy older controls and the very mild Alzheimer's disease group demonstrated better performance on clustered word-lists than on unclustered lists, suggesting active strategic organizational skills, even at delayed free recall. The overall pattern of results indicates a staging of working-memory impairment in early Alzheimer's disease.     

Specific measures of executive function predict cognitive decline in older adults

Decline in executive function has been noted in the prodromal stage of Alzheimer's disease (AD) and may presage more global cognitive declines. In this prospective longitudinal study, five measures of executive function were used to predict subsequent global cognitive decline in initially nondemented older adults. Of 71 participants, 15 demonstrated significant decline over a 1-year period on the Dementia Rating Scale (Mattis, 1988) and the remaining participants remained stable. In the year before decline, the decline group performed significantly worse than the no-decline group on two measures of executive function: the Color-Word Interference Test (CWIT; inhibition/switching condition) and Verbal Fluency (VF; switching condition). In contrast, decliners and non-decliners performed similarly on measures of spatial fluency (Design Fluency switching condition), spatial planning (Tower Test), and number-letter switching (Trail Making Test switching condition). Furthermore, the CWIT inhibition-switching measure significantly improved the prediction of decline and no-decline group classification beyond that of learning and memory measures. These findings suggest that some executive function measures requiring inhibition and switching provide predictive utility of subsequent global cognitive decline independent of episodic memory and may further facilitate early detection of dementia.     

Cognitive functioning over 3 years in community dwelling older adults with chronic partial epilepsy

Little is known about cognitive functioning of older adults with chronic partial epilepsy. We examined cognitive performance of this epilepsy patient group over 2-3 years. Seventeen older adults with epilepsy and 17 healthy older adults were administered measures of overall cognition and verbal memory at baseline and 2-3 years later. At baseline, older adults with epilepsy performed below controls on overall cognition and verbal memory (p's<0.001). These deficits generally remained stable at follow-up, although executive control appeared to decline (p<0.05). Older adults with epilepsy showed a failure to benefit from practice on a verbal memory measure (p=0.017). Older adults with epilepsy demonstrated cognitive deficits that generally are not progressive. A failure to benefit from repeat exposure to a Delayed Recall task could indicate learning deficits. These patients may also progressively lose executive control, possibly as a result of accelerated aging.     

Aging with elevated autistic traits: Cognitive functioning among older adults with the broad autism phenotype

BackgroundLittle is known about the impact of aging with autism spectrum disorder (ASD) on cognition. As a first step in addressing this gap in our knowledge, the current study examined cognitive functioning among older adults with elevated, but subclinical levels of autistic traits (i.e., the Broad Autism Phenotype; BAP) compared to older adults without the BAP.MethodForty older adults (aged 60–91, M = 73 years) were recruited and classified as meeting criteria for the BAP (n = 20) or not (control older adults, COA; n = 20). Different components of executive function as well as episodic memory were measured using standardized performance-based neuropsychological assessments in addition to a self-report questionnaire of executive function difficulties.ResultsDespite no differences in age, sex ratio, educational history or IQ, the BAP group demonstrated poorer performance on measures of executive function and episodic memory compared to the COA group. The BAP group also self-reported more executive function difficulties in everyday settings. Moreover, differences in working memory and attentional shifting were maintained after accounting for the influences of IQ and both depression and anxiety symptoms.ConclusionsThese findings suggest that aging with the BAP confers additional risk to cognitive function for older adults. As the BAP forms a bridge in the continuum from typical to atypical levels of autistic traits, these findings suggest that individuals with ASD might also incur cognitive costs as they age into older adulthood.     

Driver landmark and traffic sign identification in early Alzheimer's disease

OBJECTIVE: To assess visual search and recognition of roadside targets and safety errors during a landmark and traffic sign identification task in drivers with Alzheimer's disease. METHODS: 33 drivers with probable Alzheimer's disease of mild severity and 137 neurologically normal older adults underwent a battery of visual and cognitive tests and were asked to report detection of specific landmarks and traffic signs along a segment of an experimental drive. RESULTS: The drivers with mild Alzheimer's disease identified significantly fewer landmarks and traffic signs and made more at-fault safety errors during the task than control subjects. Roadside target identification performance and safety errors were predicted by scores on standardised tests of visual and cognitive function. CONCLUSIONS: Drivers with Alzheimer's disease are impaired in a task of visual search and recognition of roadside targets; the demands of these targets on visual perception, attention, executive functions, and memory probably increase the cognitive load, worsening driving safety.     

Prospective memory and subjective memory decline: A neuropsychological indicator of memory difficulties in community-dwelling older people

Introduction: Prospective memory difficulties are known to occur in Alzheimer’s disease, and may provide an early indicator of cognitive decline. Older people reporting high levels of subjective memory decline (SMD) but without evidence of cognitive decline on standard neuropsychological tests are increasingly considered at increased risk for Alzheimer’s disease. Therefore, the objective of this study was to investigate whether prospective memory performance is differentially impaired in older people reporting high levels of SMD as compared to a control group. Method: A total of 195 community-dwelling older adults (M_age = 73.48 years) were assessed for self-reported complaints of memory decline and allocated to either a group reporting high levels of SMD (SMD, n = 96) or a healthy control group (HC, n = 99). Groups were assessed on neuropsychological tests, an experimental prospective memory task (focal vs. nonfocal cue conditions), and a naturalistic prospective memory task. Results: The groups did not differ in performance on standard neuropsychological tests of working memory, executive attention, and episodic retrospective memory. Furthermore, on an experimental task of prospective memory (the Supermarket Shopping Trip task), although performance of both groups was better when cues for prospective memory were focal to the ongoing activity (η² = .35), the SMD group were not impaired relative to the control group. On a naturalistic prospective memory task, however, there was a small but significant effect, with the SMD group performing more poorly than the HC group (η² = .02). Conclusions: In older adults with high levels of SMD, naturalistic measures of prospective memory provide an approach to assessing memory performance that can offer a means of investigating the memory complaints of people with SMD. Identifying prospective memory difficulties in SMD also offers a focus for intervention.     

Continuous positive airway pressure treatment for sleep apnea in older adults

Daytime sleepiness and sleep disordered breathing are increased in older compared to middle-aged adults. The cognitive and cardiovascular sequelae associated with obstructive sleep apnea (OSA) have significant implications for the older adult who may already be suffering from chronic illness. Most of the evidence supporting the utilization of continuous positive airway pressure (CPAP) for the treatment of OSA has been generated from studies employing samples consisting predominately of middle-aged adults. To examine the efficacy of CPAP for the treatment of obstructive sleep apnea in older adults with an emphasis on adherence and related treatment outcomes, this paper reviews findings from clinical trials including older individuals as well as those specifically targeting this population. These studies have demonstrated that following CPAP therapy, older adults have increased alertness, improved neurobehavioral outcomes in cognitive processing, memory, and executive function, decreased sleep disruption from nocturia and a positive effect on factors affecting cardiac function, including vascular resistance, platelet coagulability and other aspects of cardiovascular health. Physiological differences in respiratory structure and function between younger and older adults of similar disease severity are believed to result in older individuals requiring titration at lower CPAP levels. Once initiated, CPAP treatment is tolerated by older adults, including those with Alzheimer's disease. Patterns of adherence in older individuals are consistent with that of middle-aged adults.     

Neural correlates of prospective memory across the lifespan

OVERVIEW: Behavioural data reveal an inverted U-shaped function in the efficiency of prospective memory from childhood to young adulthood to later adulthood. However, prior research has not directly compared processes contributing to age-related variation in prospective memory across the lifespan, hence it is unclear whether the same factors explain the 'rise and fall' of prospective remembering from childhood to later adulthood. The present study examined this question using a paradigm that allowed us to consider the behavioural and neural correlates of processes associated with the prospective and retrospective components of prospective memory. METHODS: We compared 14 adolescents, 14 young adults, and 14 old adults in a paradigm where the prospective memory task was embedded in a semantic categorization task. RESULTS: The behavioural data revealed an inverted U-shaped function with adolescents and old adults performing poorly relative to young adults. Analyses of the error data revealed that different processes may have contributed to failures of prospective memory in adolescents and older adults. This finding was supported by age differences in ERP-components for cue detection and post-retrieval processes. Additionally, source localization using LORETA revealed different patterns of neural recruitment for adolescents and older adults relative to younger adults. CONCLUSION: Our findings demonstrate that adolescents and older adults show different patterns of behavioural errors and neural recruitment for successful prospective remembering indicating that different processes may contribute to the 'rise and fall' of prospective memory across the lifespan.     

Spaced-retrieval effects on name-face recognition in older adults with probable Alzheimer's disease

Six older adults with probable Alzheimer's disease (AD) were trained to recall a name-face association using the spaced-retrieval method. We administered six training sessions over a 2-week period. On each trial, participants selected a target photograph and stated the target name, from eight other photographs, at increasingly longer retention intervals. Results yielded a positive effect of spaced-retrieval training for name-face recognition. All participants were able to select the target photograph and state the target's name for longer periods of time within and across training sessions. A live-person transfer task was administered to determine whether the name-face association, trained by spaced-retrieval, would transfer to a live person. Half of the participants were able to call the live person by the correct name. These data provide initial evidence that spaced-retrieval training can aid older adults with probable AD in recall of a name-face association and in transfer of that association to an actual person.     

Excitotoxic lesions of the rhinal cortex in the baboon differentially affect visual recognition memory, habit memory and spatial executive functions

To specify the functional role of the rhinal cortex, baboons with bilateral excitotoxic lesions of the rhinal cortex (RH group) were tested on a series of computerized memory and learning tasks. Preoperatively, they were trained to and then tested on a delayed nonmatching-to-sample (DNMS) task with trial-unique stimuli. Postoperatively, this visual recognition memory task was given twice. As compared to a sham-operated group, the RH group showed good retention of rule learning and were unimpaired on the Delay memory subtest. Performance on the List Length memory subtest was, however, severely impaired at both postoperative evaluations, with a significant negative correlation between cognitive performance and neuronal loss in rhinal areas. Visual habit memory and spatial working memory were assessed postoperatively only, using a concurrent discrimination learning task and both a delayed-response task (with a two- and four-location choice) and a delayed alternation task, respectively. The RH group was unimpaired on the first two tasks and was even faster than the controls in learning the delayed-response task with four locations. Finally, most RH baboons failed to learn the delayed alternation task within the limits of testing. These results indicate that neuronal loss in the rhinal cortex is sufficient to impair visual recognition memory, and extend the implication of this area to spatial executive functions. Furthermore, the observation of impaired recognition memory and executive processes with preserved procedural memory and retrograde memory suggests that damage to the rhinal cortex probably participates in the cognitive deficits typical of the early stages of Alzheimer's disease.     

Adaptive task prioritization in aging: selective resource allocation to postural control is preserved in Alzheimer disease.

OBJECTIVE: With age, the performance of multiple tasks decreases, a pattern exaggerated in Alzheimer disease (AD). At the same time, recent research, based on adaptive theories of healthy aging, indicates a preference of older adults to allocate resources toward tasks of higher immediate value (e.g., postural control). This study investigated whether such models also hold for pathologic cognitive aging. METHOD: Using a dual-task paradigm, the authors combined a working memory with a postural control task under easy and difficult conditions in patients with AD, older adults, older adults low on performance on a cognitive marker test, and young adults (N = 40). Participants repeatedly performed a cognitive and a postural control task both simultaneously and in isolation over the course of eight sessions. RESULTS: Consistent with earlier studies on divided attention in age and AD, the authors found large dual-task performance decrements with age and more so in AD. When not challenged, patients with AD showed large performance decrements under dual-task conditions in both postural control and working memory. With increasing difficulty in the postural control task, however, older adults, and more so patients with AD, maintained a high level of functioning in postural control, as compared with working memory. CONCLUSION: The findings indicate that the theory of selective optimization with compensation extends to pathologic aging and have broad implications for models of dual-task performance and executive control in aging and AD.     

Early detection and differential diagnosis of Alzheimer's disease and depression with neuropsychological tasks

The development of novel treatments for Alzheimer's disease (AD), aimed at ameliorating symptoms and modifying disease processes, increases the need for early diagnosis. Neuropsychological deficits such as poor episodic memory are a consistent feature of early-in-the-course AD, but they overlap with the cognitive impairments in other disorders such as depression, making differential diagnosis difficult. Computerised and traditional tests of memory, attention and executive function were given to four subject groups: mild AD (n = 26); questionable dementia (QD; n = 43); major depression (n = 37) and healthy controls (n = 39). A visuo-spatial associative learning test accurately distinguished AD from depressed/control subjects and revealed an apparent sub-group of QD patients who performed like AD patients. QD patients' performance correlated with the degree of subsequent global cognitive decline. Elements of contextual and cued recall may account for the task's sensitivity and specificity for AD.     

Automated Neuropsychological Test Battery (CANTAB) in mild cognitive impairment and in Alzheimer's disease

Neuropsychological deficits, such as poor episodic memory, are consistent features of mild cognitive impairment and also that of early stage of dementia. The aim of the present study was to detect cognitive dysfunction among patients with Alzheimer's disease or with mild cognitive impairment (MCI), which refers to a transitional state between the cognition of normal aeging and mild dementia regarded as a high-risk condition for the development of clinically probable Alzheimer's disease (AD). Computerized tests of memory, attention and executive functions were studied in groups of AD subjects (n=15) and MCI subjects (n=25). On all measures, the performance of the AD group was significantly weaker compared to healthy individuals or to the MCI group. The performance of both the AD and MCI patients in the Paired Associate Learning test was significantly impaired, which may suggest that MCI patients are already in the early stages of the disease.     

Does impaired executive functioning differentially impact verbal memory measures in older adults with suspected dementia?

The purpose of this study was to examine whether executive dysfunction differentially impacts list-learning and story recall tasks in a sample of older adults referred for suspected cognitive impairment. Older adults (N = 61) with mild cognitive impairment (MCI) or probable mild dementia, and those who did not meet criteria for diagnosis of dementia, were assessed using measures of executive function and verbal memory. Two groups were established based on performance on measures of executive function: (a) the No Executive Dysfunction group (NoED; n = 33) consisted of persons without impairment on any obtained measures of executive function; and (b) the Executive Dysfunction group (ED; n = 28) contained persons with impairment on at least one of the measures of executive function. The two groups were compared on performance on two measures of verbal memory, the California Verbal Learning Test-II (CVLT-II) and the Logical Memory (LM) subtest from the Wechsler Memory Scale-Revised (WMS-R). The NoED group performed significantly better than the ED group on the total learning and short delay free recall trials of the CVLT-II. However, there were no significant differences between the groups on the other indices of the CVLT-II (i.e., long delay free recall, recognition, recall repetitions, recall intrusions, or recognition false-positives) or on the immediate and delayed recall trials of the LM measure. These results support previous research demonstrating the impact of executive dysfunction on the acquisition of and short-delay retrieval of verbal information in older adults with suspected cognitive impairment.     

Can we remember future actions yet forget the last two minutes? Study in transient global amnesia

Transient global amnesia (TGA) is a clinical syndrome characterized by the abrupt onset of a massive episodic memory deficit that spares other cognitive functions. If the anterograde dimension is known to be impaired in TGA, researchers have yet to investigate prospective memory (PM)--which involves remembering to perform an intended action at some point in the future--in this syndrome. Furthermore, as executive functions are thought to be spared in this syndrome, TGA provides an opportunity to examine the impact of a massive "pure" memory impairment on PM. We assessed 38 patients with a newly designed protocol that distinguished between the prospective (remembering to do something at the appropriate time) and retrospective (remembering what has to be done) components of PM. Moreover, we investigated episodic memory with an anterograde memory task and assessed executive functions, anxiety and mood, as well as their links with PM. We demonstrated that PM is impaired during TGA, with a greater deficit for the retrospective component than for the prospective component. Furthermore, we highlighted a strong link between these two components. Anterograde episodic memory impairments were correlated with retrospective component deficits in TGA patients, although we were able to confirm that executive functions are globally spared. We discuss this pattern of results within the theoretical framework of PM, putting forward new arguments in favor of the idea that PM deficits can occur mainly because of a massive anterograde memory deficit. The clinical consequences of PM impairment in TGA are examined.     

Interplay between memory and executive functions in normal and pathological aging

Healthy older adults and Alzheimer's disease (AD) patients are reported in the literature to be impaired in memory and executive functions. This research investigates the extent of these two abilities in determining pathological aging. Groups of young-old and old-old healthy people (Experiment 1) and individuals with amnestic mild cognitive impairment (a-MCI) and AD (Experiment 2) were administered verbal and visuo-spatial tests graded for memory and/or executive requirements. Results indicate a decline in visuo-spatial tasks requiring memory and executive functions in healthy aging. The a-MCI showed memory deficits similar to those shown by AD, but preserved executive functions. Executive function decline could be the critical feature of dementia.     

Age-related differences in the neural correlates of remembering time-based intentions

The present study used event-related potentials (ERPs) to explore the effect of age on the neural correlates of monitoring processes involved in time-based prospective memory. In both younger and older adults, the addition of a time-based prospective memory task to an ongoing task led to a sustained ERP activity broadly distributed over the scalp. Older adults, however, did not exhibit the slow wave activity observed in younger adults over prefrontal regions, which is considered to be associated with retrieval mode. This finding indicates that age-related decline in intention maintenance might be one source of the impaired prospective memory performance displayed by older adults. An 'anterior shift' in scalp distribution of the P3 was observed in older adults, and was related to lower levels of accuracy in prospective memory performance. This relationship suggests that possible factors responsible for age-related decline in prospective memory performance include the decreased efficiency of executive/frontal functions as well as the reduced amount of resources available for the prospective memory task.     

Understanding failure of visual paired associate learning in amnestic mild cognitive impairment

Impairment in visual paired associate learning occurs often in with amnestic mild cognitive impairment (aMCI), a condition considered to be an early stage of Alzheimer's disease (AD). To date, studies of aMCI have characterized impaired visual paired associate learning only in terms of summary scores such as total errors or total trials to criterion. The aim of this study was to determine the nature and magnitude of errors made on a continuous paired associate learning (CPAL) task designed to allow analysis of the component processes involved in paired associate learning. Twenty-one individuals with aMCI and 54 healthy age-matched older adults (HC) performed the CPAL task in which they had to learn six pattern-location pairings over six trials. Results suggested that aMCI patients performed significantly worse on the CPAL, both in learning rate and in error accumulation. Qualitative analyses of CPAL performance revealed that in aMCI there were significantly more errors on all indices except perseverative errors. When expressed as a percentage of total errors, abnormalities occurred only for within-search and exploratory errors. These findings suggest that poor performance on visual paired associate learning tasks in aMCI reflects impairments in both learning and executive function.     

Memory for intentions in amnestic mild cognitive impairment: time- and event-based prospective memory.

Amnestic mild cognitive impairment (aMCI) is associated with neuropathological changes in medial-temporal and frontal-system structures. By definition, retrospective memory is mildly impaired in aMCI. We examined whether prospective memory (PM) is also impaired, in particular time-based PM, which requires considerable self-initiation and inhibition. We administered time- and event-based PM tasks to 42 healthy older adults, 45 individuals with aMCI, and 24 individuals with Alzheimer's disease (AD). The healthy group performed better than the aMCI group, and the aMCI group performed better than the AD group on both PM tasks. Importantly, the aMCI group performed more poorly on the time- than event-based task, whereas the other groups performed comparably on both tasks. Findings suggest that PM, particularly time-based PM, is sensitive to the earliest cognitive changes associated with aMCI, possibly reflecting decreased self-initiation, attention switching, and/or inhibition on memory tasks because of early involvement of the frontal system.