Ina J. Berg

Long-term effects of memory rehabilitation: A controlled study

Abstract Severely closed-head-injured patients (n = 39) received either memory strategy training or drill and repetitive practice on memory tasks; a control group received no treatment. The treatment procedures were evaluated by subjective ratings, by memory tasks on which an effect of the use of strategies was expected and by reaction time tasks to control for spontaneous recovery or motivational factors. Tests were administered before and after two 3-week periods of training and at follow-up 4 months after the end of therapy. Neither treatment procedure showed significant effects on reaction time measures. Both groups of trainees subjectively rated the effects of therapy on their everyday memory functioning as highly positive, although significant effects on objective memory performance scores could only be demonstrated in the strategy training group. These results appeared most clearly at the 4-month follow-up.

Speed of information processing after unilateral stroke

Speed of information processing in the subacute stage after stroke was studied in 88 first ever, unilateral, ischemic stroke patients. The patient group included 42 right and 46 left hemisphere patients. Seventy-one control subjects were also examined. Four reaction time tasks with different levels of complexity were used: two visuomotor, and two semantic categorisation tasks. The results showed that stroke causes a decrease in decision making speed, but that the effect is different for right and left hemisphere patients. The right hemisphere group were slower than the control group on all reaction time tasks, and slower than the left hemisphere patients on the visuomotor tasks. The left hemisphere patients were slower than the healthy controls, only on the most complex tasks, the categorisation tasks.

Relations between subjective evaluations of memory and objective memory performance.

Several explanations for the weak relations between subjective memory judgments and objective memory performance were investigated in two groups of normal older adults. Group 1 sampled a general population (mean age 61.6 yr., range 46–89), while Group 2 sampled subjects who were on a waiting list for memory training (mean age 63.0 yr., range 45–85 years). In both groups, subjective memory judgments were assessed with global ratings of memory capacity and with ratings of frequency of forgetting in specific memory situations. Memory performance was assessed with several well-known tests and with recently developed tests for domain-specific aspects of memory. Most tests concerned episodic memory. Study 1 also included measures of semantic, incidental, and working memory. Study 2 further examined the influence of the domain-specificity of objective and subjective measures for remembering names, intentions, and texts. Relations between memory self-reports and performance were weak in both groups and for all kinds of tests. Against expectations, the low correlations could not be explained by differences between ecological and laboratory tests or incidentally and intentionally remembered information, or by differences between specific failures compared to global, stereotyped judgments. Surprisingly, correlations did not increase when subjective and objective measures assessed the same ability, like remembering names. Also noncognitive variables (mood and lifestyle) did not influence the relations. The (weak) relations between subjective and objective memory measures were comparable for subjects over and under 65 years of age. Furthermore, relations were comparable for the general population sample and the memory compliant group.

Subjective changes in emotion, cognition and behaviour after stroke: Factors affecting the perception of patients and partners

The presence and severity of changes in emotion and cognition experienced by left- and right-sided stroke patients and observed by their partners were compared at 3 months poststroke. The results showed that, regardless of the side of stroke, several changes were reported by half of the stroke patients and their partners. It appeared that while left hemisphere stroke patients agreed with their partners on the number and severity of most changes, partners of right hemisphere patients reported more frequent and more severe changes than the patients themselves. The level of observability of the altered behaviour, distress of the partner, distress of left-sided stroke patients and hemispatial neglect of right-sided stroke patients emerged as factors related to disagreement between stroke patient and partner.

Rehabilitation of memory for people's names

In a training study, memory-impaired patients were taught strategies to improve the learning of new names and the retrieval of familiar peoples names. To improve new name learning, the patients were encouraged to give more meaning to a persons name, without requiring an explicit association between the face and the name. Strategies to improve retrieval of familiar names mainly concerned ways to resolve tip-of-the-tongue states. Learning names to faces improved following training on one of the two target tests and this improvement was maintained six months following training. Retrieval of familiar peoples names also improved immediately following the training, although the improvement disappeared at the six-month follow-up. Two control memory tests and a group of normal subjects, who received no training, were used to discriminate an effect of training from the effects of repeated testing and the extensive attention received by the trained group.

PROSPECTIVE MEMORY TRAINING IN OLDER ADULTS

This study evaluates the results of a training program for prospective remembering. The goal of the training was to improve prospective memory by associating cues from the retrieval situation with the to be remembered information. The training group consisted of 20 participants, aged between 45 and 81 years. The effects of strategy training were compared with those of an educational training group (N = 23 , age range 45-84) directed at reducing worries about forgetfulness, and a retest control group (N = 22 , age range 46-74). The educational training and retest control groups did not differ in demographic characteristics and test performance and were combined into one control group. Subjective evaluations revealed that subjects were very satisfied with the effects of training. This also was true for subjects in the educational training condition. The objective effects of training were evaluated with a telephone task which had to be performed in the daily life situation, and a prospective categorization task performed in the laboratory. Despite the low reliabilities of the prospective tasks, a significant but small effect of training compared to the combined control group was found on the sum score of prospective tests. The training effect was not related to age or pretraining performance level. At the three months follow-up, however, performance of the control group had increased to the level of the trained group. As expected, training effects did not generalize to other memory measures (assessed with tests for remembering names) or control measures (assessed with visuo-motor reaction time tests).This study evaluates the results of a training program for prospective remembering. The goal of the training was to improve prospective memory by associating cues from the retrieval situation with the to be remembered information. The training group consisted of 20 participants, aged between 45 and 81 years. The effects of strategy training were compared with those of an educational training group (N = 23 , age range 45-84) directed at reducing worries about forgetfulness, and a retest control group (N = 22 , age range 46-74). The educational training and retest control groups did not differ in demographic characteristics and test performance and were combined into one control group. Subjective evaluations revealed that subjects were very satisfied with the effects of training. This also was true for subjects in the educational training condition. The objective effects of training were evaluated with a telephone task which had to be performed in the daily life situation, and a prospective categorization t...

Four-year follow-up of a controlled memory training study in closed head injured patients.

Abstract In a controlled group study Berg, Koning-Haanstra, and Deelman (1991) compared the effects of memory strategy training with the effects of drill and practice training and no treatment in severely head injured patients. Four months after training the group in the strategy condition performed significantly better on three memory tests than the patient groups in the other two conditions. Four years following this last evaluation, 31 of the 38 patients from the original training study were retested on the same memory tests. Thirteen normal subjects, who had already served as normal controls in the training study, were also retested. In contrast to the results four years earlier, memory performance was the same for all three patient groups. The level of performance of the patients was still well below the level of the normal controls. One reason for the disappearance of the advantage of the strategy group over the other two patient groups, was the drop-out of patients with relatively poor memory score...

SPARED RECOGNITION CAPACITY IN ELDERLY AND CLOSED-HEAD-INJURY SUBJECTS WITH CLINICAL MEMORY DEFICITS

This study describes the performance of three groups of subjects on a pictorial forced-recognition task, the Hundred Pictures Test. The aim was to determine whether subjects with memory deficits (elderly and closed-head-injured subjects) would perform as well as healthy young subjects, both on immediate and very long-term recognition. The results indicate that memory for complex meaningful pictures is spared in subjects with an otherwise impaired memory, and that despite increasing forgetting rates with increasing retention intervals (up to 27 weeks), still no differences are found between performance of these subjects and healthy young controls. It will be discussed how this result might be interpreted.

Evaluation of an intervention directed at the modification of memory beliefs in older adults

In clinical practice, memory interventions often aim to improve negative beliefs and expectations about memory in the elderly. The (implicit or explicit) assumption is often that changing beliefs and expectations about memory does not only improve subjective memory judgments, but leads to improved memory performance as well. Surprisingly few studies, however, have evaluated these objectives effects. The present study describes an intervention directed at reducing negative stereotypes and worries about memory. Both subjective and objective effects were assessed in an intervention group (N = 22, mean age 63 years) and compared to a no - treatment control group (N = 23, mean age 61 years). Subjects were very satisfied with the effect of the intervention . The intervention had a positive effect on subjective reports on knowledge and worries about forgetfulness. The positive subjective effects, however, were not accompanied by an improved performance on memory tests. Age and initial memory performance were not...

Psychosocial and cognitive rehabilitation of patients with solvent-induced chronic toxic encephalopathy: A randomised controlled study

Background: There is little experience with the (neuro) psychological treatment of patients with solvent-induced chronic toxic encephalopathy (CSE). In this randomised controlled trial (RCT), a treatment programme was evaluated based on previous outcome studies of patients with chronic fatigue, whiplash and traumatic brain damage. Methods: The treatment consisted of 8 group sessions based on cognitive behavioural principles focusing on inadequate illness behaviours, and 8 sessions of cognitive strategy training to compensate memory problems. The research design was an RCT with follow-up, comparing the cumulative effect of the 2 interventions allocated in random order with a waiting-list control group. Outcome measures were treatment satisfaction, self-ratings of psychosocial and cognitive changes, psychosocial and memory questionnaires and neuropsychological tests. Multiple linear regression analyses were performed with baseline scores, treatment versus control condition, effort status, and litigation or financial compensation status as predictors. Results: Ninety-five patients started treatment, 84 patients had complete data. Treatment satisfaction was high. After the treatment, only the treatment group had improved on objective memory tests and on complaints related to CSE, but not on other questionnaires. Treatment effects diminished at follow-up. Insufficient effort and litigation were negatively associated with treatment outcome. Conclusions: The positive treatment effects on the cognitive tests were only temporary. It might be important to study the effect of booster sessions to update practiced cognitive strategies. Effort was an important predictor of success, more important than involvement in a litigation procedure. This finding should have implications for the selection of patients.