Gilles O. Einstein

Recruitment of Older Adults: Success May Be in the Details

PURPOSEnDescribe recruitment strategies used in a randomized clinical trial of a behavioral prospective memory intervention to improve medication adherence for older adults taking antihypertensive medication.nnnRESULTSnRecruitment strategies represent 4 themes: accessing an appropriate population, communication and trust-building, providing comfort and security, and expressing gratitude. Recruitment activities resulted in 276 participants with a mean age of 76.32 years, and study enrollment included 207 women, 69 men, and 54 persons representing ethnic minorities. Recruitment success was linked to cultivating relationships with community-based organizations, face-to-face contact with potential study participants, and providing service (e.g., blood pressure checks) as an access point to eligible participants. Seventy-two percent of potential participants who completed a follow-up call and met eligibility criteria were enrolled in the study. The attrition rate was 14.34%.nnnIMPLICATIONSnThe projected increase in the number of older adults intensifies the need to study interventions that improve health outcomes. The challenge is to recruit sufficient numbers of participants who are also representative of older adults to test these interventions. Failing to recruit a sufficient and representative sample can compromise statistical power and the generalizability of study findings.

Implementation intention encoding in a prospective memory task enhances spontaneous retrieval of intentions

Although forming implementation intentions (Gollwitzer, 1999) has been demonstrated to generally improve prospective memory, the underlying cognitive mechanisms are not completely understood. It has been proposed that implementation-intention encoding encourages spontaneous retrieval (McDaniel & Scullin, 2010). Alternatively one could assume the positive effect of implementation-intention encoding is caused by increased or more efficient monitoring for target cues. To test these alternative explanations and to further investigate the cognitive mechanisms underlying implementation-intention benefits, in two experiments participants formed the intention to respond to specific target cues in a lexical decision task with a special key, but then had to suspend this intention during an intervening word-categorisation task. Response times on trials directly following the occurrence of target cues in the intervening task were significantly slower with implementation-intention encoding than with standard encoding, indicating that spontaneous retrieval was increased (Experiment 1). However, when activation of the target cues was controlled for, similar slowing was found with both standard and implementation-intention encoding (Experiment 2). The results imply that implementation-intention encoding as well as increased target–cue activation foster spontaneous retrieval processes.

Prospective memory and aging: evidence for preserved spontaneous retrieval with exact but not related cues.

We examined whether normal aging spares or compromises cue-driven spontaneous retrieval processes that support prospective remembering. In Experiment 1, young and older adults performed prospective-memory tasks that required either strategic monitoring processes for retrieval (nonfocal) or for which participants relied on spontaneous retrieval processes (focal). We found age differences for nonfocal, but not focal, prospective-memory performance. Experiments 2 and 3 used an intention-interference paradigm in which participants were asked to perform a prospective-memory task (e.g., press Q when the word money appears) in the context of an image-rating task and were then told to suspend their prospective-memory intention until after completing an intervening lexical-decision task. During the lexical-decision task, we presented the exact prospective-memory cue (e.g., money; Experiments 2 and 3) or a semantically related lure (e.g., wallet; Experiment 3), and we inferred spontaneous retrieval from slowed lexical-decision responses to these items relative to matched control items. Young and older adults showed significant slowing when the exact prospective-memory cue was presented. Only young adults, however, showed significant slowing to the semantically related lure items. Collectively, these results partially support the multiprocess theory prediction that aging spares spontaneous retrieval processes. Spontaneous retrieval processes may become less sensitive with aging, such that older adults are less likely to respond to cues that do not exactly match their encoded targets.

Dual pathways to prospective remembering.

According to the multiprocess framework (McDaniel and Einstein, 2000), the cognitive system can support prospective memory (PM) retrieval through two general pathways. One pathway depends on top–down attentional control processes that maintain activation of the intention and/or monitor the environment for the triggering or target cues that indicate that the intention should be executed. A second pathway depends on (bottom–up) spontaneous retrieval processes, processes that are often triggered by a PM target cue; critically, spontaneous retrieval is assumed not to require monitoring or active maintenance of the intention. Given demand characteristics associated with experimental settings, however, participants are often inclined to monitor, thereby potentially masking discovery of bottom–up spontaneous retrieval processes. In this article, we discuss parameters of laboratory PM paradigms to discourage monitoring and review recent behavioral evidence from such paradigms that implicate spontaneous retrieval in PM. We then re-examine the neuro-imaging evidence from the lens of the multiprocess framework and suggest some critical modifications to existing neuro-cognitive interpretations of the neuro-imaging results. These modifications illuminate possible directions and refinements for further neuro-imaging investigations of PM.

A multifaceted prospective memory intervention to improve medication adherence: Design of a randomized control trial

Adherence to prescribed antihypertensive agents is critical because control of elevated blood pressure is the single most important way to prevent stroke and other end organ damage. Unfortunately, nonadherence remains a significant problem. Previous interventions designed to improve adherence have demonstrated only small benefits of strategies that target single facets such as understanding medication directions. The intervention described here is informed by prospective memory theory and performance of older adults in laboratory-based paradigms and uses a comprehensive, multifaceted approach to improve adherence. It incorporates multiple strategies designed to support key components of prospective remembering involved in taking medication. The intervention is delivered by nurses in the home with an education control group for comparison. Differences between groups in overall adherence following the intervention and 6 months later will be tested. Systolic and diastolic blood pressure levels also will be examined between groups and as they relate to adherence. Intra-individual regression is planned to examine change in adherence over time and its predictors. Finally, we will examine the association between executive function/working memory and adherence, predicting that adherence will be related to executive/working memory in the control group but not in the intervention group.

The Testing Effect: Illustrating a Fundamental Concept and Changing Study Strategies

An important recent finding is that testing improves learning and memory. In this article, the authors describe a demonstration that illustrates this principle and helps students incorporate more testing into their learning. The authors asked students to read one text using a Study–Study strategy and one text using a Study–Test strategy. One week later, the authors tested students’ memory for both texts with short-answer quizzes. The results revealed the standard testing effect and served as the basis for a laboratory report that required students to analyze and interpret the results and to answer questions about the testing effect and the experimental design. At the end of the term, students indicated that they were engaging in more testing during their studying.

Prospective memory: Effects of divided attention on spontaneous retrieval

We examined the effects of divided attention on the spontaneous retrieval of a prospective memory intention. Participants performed an ongoing lexical decision task with an embedded prospective memory demand, and also performed a divided-attention task during some segments of lexical decision trials. In all experiments, monitoring was highly discouraged, and we observed no evidence that participants engaged monitoring processes. In Experiment 1, performing a moderately demanding divided-attention task (a digit detection task) did not affect prospective memory performance. In Experiment 2, performing a more challenging divided-attention task (random number generation) impaired prospective memory. Experiment 3 showed that this impairment was eliminated when the prospective memory cue was perceptually salient. Taken together, the results indicate that spontaneous retrieval is not automatic and that challenging divided-attention tasks interfere with spontaneous retrieval and not with the execution of a retrieved intention.

Rhesus Monkeys (Macaca mulatta) and Capuchin Monkeys (Cebus apella) Remember Future Responses in a Computerized Task

Planning is an important aspect of many daily activities for humans. Planning involves forming a strategy in anticipation of a future need. However, evidence that nonhuman animals can plan for future situations is limited, particularly in relation to the many other kinds of cognitive capacities that they appear to share with humans. One critical aspect of planning is the ability to remember future responses, or what is called prospective coding. Two monkey species (Macaca mulatta and Cebus apella) performed a series of computerized tasks that required encoding a future response at the outset of each trial. Monkeys of both species showed competence in all tests that were given, providing evidence that they anticipated future responses and that they appropriately engaged in those responses when the time was right for such responses. In addition, some tests demonstrated that monkeys even remembered future responses that were not as presently motivating as were other aspects of the task environment. These results indicated that monkeys could anticipate future responses and retain and implement those responses when appropriate.

The best of both worlds: emotional cues improve prospective memory execution and reduce repetition errors

Prospective memory (PM) errors are commonly investigated as failures to execute an intended task (e.g., taking medication), and some studies suggest that emotional PM cues significantly reduce such failures. In Experiment 1, we extended these findings and additionally explored whether improved PM performance with emotional cues comes at the expense of performance on the ongoing task. Our results indicated that both younger and older adults are more likely to respond to emotional than to neutral PM cues, but the emotional cues did not differentially disrupt the performance on the ongoing task for either age group. Because older adults are also prone to mistakenly repeating a completed PM task, in Experiment 2 we further examined whether emotional PM cues increased repetition errors for older adults. Despite equivalent opportunity for repetition errors across cue type, older adults committed significantly fewer repetition errors with emotional than with neutral cues. Thus, these experiments demonstrated that older adults can effectively use emotional cues to help them initiate actions and to minimize repetition errors.

The impact of emotion on prospective memory and monitoring: No pain, big gain

The emotionally enhanced memory effect is robust across studies of retrospective memory, with heightened recall for items with emotional content (e.g., words like “murder”) relative to neutral items (e.g., words like “envelope”). Only a handful of studies have examined the influence of emotion on prospective memory (PM), with mixed results. In some cases emotion enhances PM, and in others it impairs PM. Interpretation of these findings is clouded by methodological differences across studies and by the fact that, to date, no study has examined the impact of emotion on PM monitoring. In our study, we assessed PM performance when PM targets were neutral, negative, and positive, and also investigated monitoring across these different PM target types. Participants showed heightened PM performance for positive and negative relative to neutral targets, yet there was no evidence of additional monitoring for emotional targets. In fact, measures of monitoring were significantly reduced when the PM targets were emotional rather than neutral. Our findings suggest that it is possible to boost PM performance in a focal task using emotional cues, and that the use of emotional cues reduces the need for monitoring.