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
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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)



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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)
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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)

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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).
◦
◦
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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

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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
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(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
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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)
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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)
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Computer-assisted cognitive assessment
電腦輔助認知評估
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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)
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Comparisons between the computer-assisted
test and the Paper-and-pencil Tests
Paper-and-pencil Tests
Questionnaires
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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
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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)
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Functional Assessment:
Occupational Performance
Grocery Shopping
Memory
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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
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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
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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
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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)
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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)
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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
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Training
Home Scenario
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b. Use of a model
shop scenario
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Practice
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Shopping Scenario
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Orientation/ Identification
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Thank You!
David Man
[email protected]
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