Prospective memory in older adults with cognitive decline – what and how to manage? Prof David Man, PhD Pre-conference workshop I (WS1-2): 11 Dec 2013 1 Definitions of Prospective Memory Prospective memory (PM) refers to remembering to do things in future time points or respond when occurrence of a particular event (Radford, Lah, Say, & Miller, 2011) The cognitive ability of remembering to carry out planned intentions or actions at future points in time (McDaniel & Einstein, 2007) A process of: formation, retention, delayed initiation and execution intentions (Kliegel, Mackinlay, & Jäger, 2008) A key component in multitasking situation Core in daily living (ADL, IADL) 2 PM impacts in daily living • Prospective memory has a major impact on individuals’ ADL as well as quality of life. • It leads to difficulty in making plan and performing the future task in everyday life such as remembering to meet the teacher at 2 p.m., remembering to buy grocery items in shop. • More negative effects in social life, vocational activities and instrumental activities of daily living (Fleming et al,2008) 3 Prospective memory problems in dementia Prospective memory as an early indicator of dementia (Huppert & Baardsall, 1993) High prevalence of PM impairment in elderly and earlystage dementia (Huppert, Johnson & Nickson, 2001) Reduced PM function in age-related decline, MCI and dementia (Farina,Young, Tabet & Rusted, 2013; Thompson, Henry, Rendell, Withall & Broadaty, 2010; 2011) Affecting prospective memory and retrospective memory in MCI (Costa, Caltagirone, Carlesimo, 2011) AD and vascular dementia [and similar pattern of functional impairment ](Livner, Laukka, Karisson, Bäckman, 2009) 4 Characteristics Intentions that cannot be immediately performed have to be maintained until appropriate opportunity occurs This process of forming a delayed intention (Ellis and Kvavilashvili, 2000; McDaniel and Einstein, 2000). ◦ ◦ 5 Everyday examples of prospective memory tasks ◦ remembering to take medication on time, ◦ to check the oven to see if a cake is cooked ◦ to keep a hospital appointment… Components of PM I. Prospective Component Remembering at an appropriate moment that one must do something (Kvavilashvili & Ellis, 1996) II. Retrospective Component 6 Recalling what is to be done (Kvavilashvili & Ellis, 1996) Key sub-types of PM I. Event-based PM a bookshop) (e.g. buying a book when seeing Event-based tasks are those that must be carried out in association with a particular event (for example passing on a message when you see a particular colleague)(Einstein and McDaniel, 1990) Involves an environmental cue to initiate an action (Guynn, Einstein, & Breneiser, 2004) II. Time-based PM (e.g. attend an appointment at 11am) Time-based tasks are those that must be carried out at a particular time or after a certain amount of time (Einstein and McDaniel, 1990) Requires a self-initiated strategy to monitor the environment to recognize the time to react (Einstein & McDaniel, 2005) III. Activity-based 7 (e.g. take medication after meals) Day-to-day problems in older adults Event-based Time-based Example 1 Example 2 1. 2. 3. 4.8 Turning off stove when water is fully boiled Going to yum cha at 6am tomorrow Going to a medical appointment in 6 weeks’ time Getting money from bank when there is only 100 dollars cash at hand Available PM Tests PM tasks - standardized tests PM tests Paper-andpencil tests Laboratory tests 9 Self- rated Questionnaires Technological assessments Computerbased tests Flash-based programs; Virtual reality; Prospective remembering video procedures (PRVP) Paper-and-pencil Tests 3 common PM assessment -Laboratory Tests (Shum, Fleming, & Neulinger, 2000) The Rivermead Behavioral Memory Test (RBMT; Wilson, Cockburn, & Baddeley, 1985; Wilson, Cockburn, & Baddeley, 2003) The Cambridge Behavioural Prospective Memory Test (Groot et al., 2002) with its revised version, the CAMPROMPT (Wilson et al., 2005), The Cambridge Prospective Memory Test (CAMPROMT; Wilson et al., 2005) The Memory for Intentions Screening test (MIST; Raskin, 2009) 10 Paper-and-pencil Tests Self-rated/self-report type of questionnaires The Prospective Memory Questionnaire (PMQ; Hannon, Adams, Harrington, Fries-Dias, & Gibson, 1995) The Prospective and Retrospective Memory Questionnaire (PRMQ; Smith, Della Sala, Logie, & Maylor, 2000) The Comprehensive Assessment of Prospective Memory (CAPM; Waugh, 1999; CAPM-SF, Man et al, 2012; Cantonese Version – ongoing study) The Royal Prince Alfred Prospective Memory Test (Radford, Lah, Say & Miller, 2010) 11 Computer-assisted cognitive assessment 電腦輔助認知評估 12 Computer-based Tests 1. The Prospective Remembering Video Procedure (PRVP; Titov & Knight, 2001) 2. The Test e´cologique de me´moire prospective (TEMP; Ecological test of prospective memory; Potvin, Rouleau, Audy, Charbonneau, & Giguere, 2011) 3. The VR-based prospective memory test (Brooks, Rose, Potter, Jayawardena, & Morling, 2004) 13 Comparisons between the computer-assisted test and the Paper-and-pencil Tests Paper-and-pencil Tests Questionnaires 14 Computerassisted Laboratory tests Time for scoring needed More More Less Time to arrange Ax space and schedule Less More Less Effort from professionals More More Less Paper-and-pencil Tests Questionnaires Laboratory tests Computerassisted Inter rater difference N/A Higher Lower Simulated real-life situation No No Yes (better generalization to daily function, e.g. VR-based or computer-adaptive test) Meta-memory Affect Not affect Not affect Compensate disability No No Yes 15 Virtual reality based PM test (Hong Kong and Australian version) A 25- minutes VR based Prospective Memory test (VRPMT) With of PM time-based and event-based task for assessment Ongoing PM task in a shopping mall scenario (buying things or asking for information) use an errand list and a mobile phone (i.e. no need to use retrospective memory) (By David Man, PolyU, HK and David Shum, Griffith University, Australia) 16 Functional Assessment: Occupational Performance Grocery Shopping Memory 17 Functional assessment Short-term Immediate recall – spouse says “we’re out of milk” and you write it on list right away Long-term Delayed recall – know your preferred supermarket is Wellcome Prospective Cued recall – remember to get milk on the way home Semantic Immediate & delayed recall – knowing that you need to pay the milk etc at the counter by EPS Episodic Immediate & delayed recall – knowing where to pick up the required shopping items Occupational Performance Railway Ride Memory Functional assessment Short-term Immediate recall – ask direction of destination and go to proper platform for train to Tuen Mun Long-term Delayed recall – knowing the time taking for a single trip from Hung Hom to Tin Shui Wai Prospective Cued recall – remember to get a free newspaper before you enter the railway station Semantic Immediate & delayed recall – knowing that you have to pay by store valued card in order to get through the gate of entry Episodic Immediate & delayed recall – remember that you have to get off at Admiralty Station to go to Sheung Wan 18 Management of Prospective Memory Problems Requiring clients to remember appointment or things going to do afterwards Requiring clients to remember several things together at one time Allowing different degree of distraction Using role play, computer task, clerical work, telephone call as set tasks or distractors 19 Sample training sheet Date Duration (mins/ hour/days) Task to remember Distractors 1/10/2013 10 Send a verbal message to OT Sorting letters 11/11/2013 15 Changing task every 5 mins 10/12/2013 60 Changing task every 20 mins 20 Self initiation Correct task Comments (-) (-) Cannot recall tasks Clerical duty (+ ) (+) Satisfactory Clerical duties (+) (-) Miss something to do Hypothesis-based treatment methods a) b) c) d) e) f) g) h) i) 21 Attention training Working memory training Cue recognition Executive function Multi-tasking Time-based vs. event-based training Short-term and long-term PM training Behavioral training Compensatory/adaptive approach (e.g. google calendar, pop up manual/reminder) 22 Man, D.W.K., Chung, J.C.C., Lee, G.YY. (2011). Evaluation of a virtual reality-based memory training programme for Hong Kong Chinese older adults with questionable dementia: a pilot study. International Journal of Geriatric Psychiatry, 27(5), 513-520. a. Use of a model home 23 Training Home Scenario 24 b. Use of a model shop scenario 25 Practice 26 Shopping Scenario 27 28 29 Orientation/ Identification 30 31 Thank You! David Man [email protected] 32
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