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Memory Training Program for Older Adults

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Title: Memory Training Program for Older Adults
Language: English
Authors: Lee, Pai-Lin, Chang, Hui-Hsiang, Huang, Chih Kun, Cheng, Wen-Chen, Lee, Pi-Yu, Chao, Hui-Chen
Source: Educational Gerontology. 2018 44(10):614-626.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 13
Publication Date: 2018
Document Type: Journal Articles
Reports - Research
Education Level: Adult Education
Descriptors: Memory, Training, Older Adults, Educational Gerontology, Experimental Groups, Control Groups, Outcomes of Treatment, Intervention, Exercise, Educational Games, Daily Living Skills, Associative Learning, Cognitive Tests, Foreign Countries
Geographic Terms: Taiwan
DOI: 10.1080/03601277.2018.1511099
ISSN: 0360-1277
Abstract: Objective: Memory loss affects a large proportion of older adults. Research indicates a positive association between memory training and better memory performance as people age. However, studies on specific memory training using an experimental design are limited. This study explored whether memory training has improved memory performance in a group of older adults.Method: A convenience sample of 48 participants was recruited from two communities. Disregarding dropouts, this left 23 experimental (mean age = 65.4 ± 6.0, range = 56-80) and 19 control participants (mean age = 64.5 ± 4.9, range: 57-72). The intervention consisted of 60-min classes held on a weekly basis continuing for 8 weeks. The class session was held after a 1-h exercise class and before a 1-h session of cognitive games. The pre-post objective memory performances, including associative, list, text, place, grocery learning, and transfer-effect of daily event memory (ecology validity), were examined to determine whether the intervention was effective.Results: Intragroup: With Wilcoxon test, the findings showed that the intervention of both the list and place learning had significant differences for the experimental group, but not for the control group. Intergroup: The main effects were found for the associative and text learning. The mixed design ANOVA indicated that there is an interaction (time x group) on the dependent variable of the place learning test. Daily events memory: We found within group that the pre-post differences were significant for the experimental group but not for the control group.Conclusion: The study showed that memory training can help older adults to ameliorate memory loss problems and these findings deserve more attention.
Abstractor: As Provided
Number of References: 56
Entry Date: 2019
Accession Number: EJ1203916
Database: ERIC
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  Value: <anid>AN0134309827;egr01oct.18;2019Jan29.10:17;v2.2.500</anid> <title id="AN0134309827-1">Memory training program for older adults </title> <p>Objective: Memory loss affects a large proportion of older adults. Research indicates a positive association between memory training and better memory performance as people age. However, studies on specific memory training using an experimental design are limited. This study explored whether memory training has improved memory performance in a group of older adults. Method: A convenience sample of 48 participants was recruited from two communities. Disregarding dropouts, this left 23 experimental (mean age = 65.4 ± 6.0, range = 56-80) and 19 control participants (mean age = 64.5 ± 4.9, range: 57-72). The intervention consisted of 60-min classes held on a weekly basis continuing for 8 weeks. The class session was held after a 1-h exercise class and before a 1-h session of cognitive games. The pre-post objective memory performances, including associative, list, text, place, grocery learning, and transfer-effect of daily event memory (ecology validity), were examined to determine whether the intervention was effective. Results: Intragroup: With Wilcoxon test, the findings showed that the intervention of both the list and place learning had significant differences for the experimental group, but not for the control group. Intergroup: The main effects were found for the associative and text learning. The mixed design ANOVA indicated that there is an interaction (time x group) on the dependent variable of the place learning test. Daily events memory: We found within group that the pre-post differences were significant for the experimental group but not for the control group. Conclusion: The study showed that memory training can help older adults to ameliorate memory loss problems and these findings deserve more attention.</p> <p>Keywords: Memory training; memory loss; cognitive performance; older adults</p> <p>Cognitive decline is prevalent in older adults (Rebok et al., 2014). There are different types of nonpharmacological cognitive interventions for cognition improvement. Cognitive training generally engages the guided practice of standard tasks to increase or maintain particular cognitive functions (Alves et al., 2013; Buschert, Bokde, & Hampel, 2010; Clare & Woods, 2004), while cognitive stimulation involves activities that aim to enhance a more global/general cognitive functioning (Clare & Woods, 2004). Cognitive stimulation and training often involve similar activities, and it is difficult to concretely distinguish between stimulation and training programs (Tardif & Simard, 2011), thus, both terms were used interchangeably in the present study.</p> <p>Cognitive reserve is an essential concept to the understanding of cognitive health. The term "cognitive reserve" is originated from Katzman et al.'s study in 1988. Researchers found that cognitive reserve is like resilience to protect the brain (Horstman, 2012). Studies have found that education, occupation, socio-economic status, and lifestyle might contribute to cognitive reserve (Bennett, Arnold, Valenzuela, Brayne, & Schneider, 2014; Raz & Lindenberger, 2010; Richards & Sacker, 2003; Scarmeas et al., 2003; Tucker-Drob, Johnson, & Jones, 2009). Cognitive reserve helps the brain to have the abilities to find alternative ways to deal with the failures or declines.</p> <p>The activity engagement hypothesis posits that the involvement of physical, social, and intellectual activities in older adulthood prevents the decline of the cognitive abilities, indicating that engaging in activities affects later cognitive performance (Fratiglioni, Paillard-Borg, & Winblad, 2004; Salthouse, 2006; Vaughan et al., 2014). Scarmeas et al. (2003) revealed that higher level of various activities (physical, intellectual, and social activities, such as rides, travel, reading books, playing cards, visiting friends, participating in religious activities, etc.) may affect cognitive reserve by partially mediating the relationship between brain damage and the clinical manifestation of Alzheimer's disease (AD). Along the same lines, the theory of cognitive reserve posits that those engaged in a high level of environment factors (e.g. lifestyle activities, higher educational or occupational attainment) can tolerate more age-related brain changes or AD-related pathology, thus, leading to the more efficient neurological processes, which maximizes cognitive performance (Bennett et al., 2014; Hultsch, Hertzog, Small, & Dixon, 1999; Stern, 2002, 2012).</p> <p>One study revealed that community-dwelling older adults (<emph>N</emph> = 2,305) who engaged in a higher frequency of leisure-time physical and cognitive activities showed better episodic memory and executive functions (Lee, 2014). Numerous studies have argued that episodic memory and executive functions are significantly related to dementia (Inoue et al., 2012; Schroeter et al., 2012; Vogel, Mortensen, Gade, & Waldema, 2007). One possible mechanism for the link between cognitive stimulation and cognitive function might be due to cognitive stimulation promotes neural plasticity and reduces AD incidences in the healthy elderly (Pieramico, Esposito, Cesinaro, Frazzini, & Sensi, 2014). A Cochrane's review on cognitive stimulation combined the data from nine randomized controlled trials (RCTs) and concluded that the effect of cognitive stimulation on the cognitive function is well-documented, over and above any medication effects (Woods, Aguirre, Spector, & Orrell, 2005). Some studies suggested that the benefits may well be maintained for over a year (Spector, Orrell, & Woods, 2010), or even 10 years (Rebok et al., 2014). Neuroimaging data also support the notion that memory-targeted training provokes a positive alteration in the cortical thickness of the hippocampal subfields (Engvig et al., 2012).</p> <p>The training session and period vary from study to study. For example, one day or less (Landau, Schumacher, Garavan, Druzgal, & D'Esposito, 2004), five sessions in 2 weeks (Carretti, Borella, & De Beni, 2007), five sessions in 5 weeks and more (Penner et al., 2012; Westerberg & Klingberg, 2007), 10 sessions over 5-6 weeks (Rebok et al., 2014), 16 sessions over 8 weeks (Penner et al., 2012), and up to 10 sessions over 10 weeks (Lee et al., 2017) or even longer programs. Penner et al. (2012) crafted a computerized working memory training tool, BrainStim, which compared high-intensity training (16 sessions, four times per week for 4 weeks) against distributed training (16 sessions, two times per week for 8 weeks) in healthy adults. The results indicate that distributed training led to increased performance in all the cognitive domains when compared to high-intensity training and also the control group without training. It has been suggested that intense training causes stress, leads to increased exhaustion, and reduces motivation. In contrast, distributed learning allows the CNS time to consolidate and reconstruct the learned information (Terry, 2003). One meta-analysis study quantitatively assessed whether computerized cognitive training (CCT) programs can enhance cognition in healthy older adults. The findings revealed that more than three training sessions per week were ineffective, and only weak evidence for sessions less than 30 min, or receiving training at home (Lampit, Hallock, & Valenzuela, 2014).</p> <p>Cognitive training has demonstrated efficacy for reducing cognitive decline in normal aging (Hertzog, Kramer, Wilson, & Lindenberger, 2008; Rebok, 2008). It has been suggested that combined cognitive exercise and memory strategy training may be optimal for compensating memory losses (Gates, Sachdev, Singh, & Valenzuela, 2011). However, evidence of its effectiveness in enhancing cognitive performances by utilizing cross-cultural (Taiwan) cognitive stimulating materials (e.g. memorization of a virtual Chinese location city map) is rare. Further, few studies have investigated how intervention programs affect real-life events (ecological validity). Ecological validity is the degree to which the experimental measures are representative of real-life events, that is, the study findings were obtained under conditions that are typical for what happens in real life (Brewer & Crano, 2000).</p> <p>Research indicates a positive association between memory training and better memory performance as people age. According to the theory of cognitive reserve, the function of the brain might be better or healthier if people use their brains more. Life-span developmental theory assumes that an individual's life has its own challenges and achievements in each important period of life (Baltes, Lindenberger, & Staudinger, 1998). This theory focuses on individual development, and the development of each period of life is modifiable or plastic (Willis & Schaie, 2009). To some extend, both theories advocate that parts of brain health are under one's own control, as long as one keep on training (or exercising) his/her brain regularly.</p> <p>Research has shown the advantages of memory training, which facilitate healthy older adults improve their memory performance (Gross et al., 2012). Thus, cognitive training strategies were employed in the current research and six cognitive functions, like list learning, associative learning, text learning, place learning, grocery learning, and daily event learning, are used for the assessment. List learning and associative learning are frequently used by researchers (e.g. Baek, Kim, & Kim, 2012; Rabin et al., 2009; Rentz et al., 2010; Rizzuto & Kahana, 2001; Semkovska & McLoughlin, 2010) for measuring short-term memory. Both give measures of ability to recall words after repeated words presentation. Text learning measures of ability to recall major story ideas and ways that enable people to learn from texts have been discussed (Kintsch, 1994). Place learning and grocery learning were used for measuring short-term memory and spatial-memory by remembering place location in a virtual map and grocery items, respectively. Daily event learning happens in a real scenario, which the older adults need to observe and memorize the events happening around them. Compared with standard neuropsychological tests, the daily life event memory test was claimed as patient-friendly, less uncomfortable, and ecologically valid tests that can reflect cognitive function in daily life (Kim et al., 2018). The current intervention program was administered with a quasi-experimental RCT design, with structured sessions that targeted six specific cognitive functions: list learning, associative learning, text learning, place learning, grocery learning, and daily event learning. The goals of the present study are as follows: 1) to investigate whether the structured memory training promotes specific memory performance, among community dwelling elders in Taiwan and 2) to quantify the cognitive generalization of memory training to daily events (ecological validity).</p> <hd id="AN0134309827-2">Method</hd> <p></p> <hd id="AN0134309827-3">Participants</hd> <p>Totally, 42 healthy adults participated in the study with mean age of 65.4 ± 6.0 (range = 56-80) years for the experimental group and 64.5 ± 4.9 (range = 57-72) years for the control group. All of the participants were fully fluent in Mandarin Chinese. Study subjects with any neurological disease, such as dementia, were excluded from the study. Montreal Cognitive Assessment test scores (Nasreddine et al., 2005) for the experimental group were 27.0 ± 2.9 and for the control group were 26.4 ± 3.2. Subjects were recruited by posters and e-mail. All the participants gave their written informed consent to partake in the research, and the study was approved by the local ethics committee. Subjects were not paid for participation to ensure that motivation was not affected by monetary issues. The basic characteristics are as shown in Table 1.</p> <p>Baseline characteristics of the participants, and the pre-post information between groups in the study.</p> <p> <ephtml> <table border="1" cellpadding="3"><tbody><tr><td>Characteristics</td><td align="center">Cognitive training, <italic>n</italic> = 23</td><td align="center">Control, <italic>n</italic> = 19</td></tr></tbody><tbody><tr><td>Age</td><td>65.4 ± 6.0 (56-80)</td><td>64.5 ± 4.9 (57-72)</td></tr><tr><td>Female, n %</td><td align="center">16 (69.6)</td><td align="center">18 (94.7)</td></tr><tr><td>Education, mean ± SD (range)</td><td>13.7 ± 2.5 (8-17)</td><td>9.5 ± 2.6 (6-16)</td></tr><tr><td>MOCA</td><td>27.0 ± 2.9</td><td>26.4 ± 3.2</td></tr></tbody><tbody><tr><td /><td align="center" colspan="2">Cognitive training</td><td align="center" colspan="2">Control</td><td align="center" colspan="2">Between Group</td></tr></tbody><tbody><tr><td /><td align="center">Pre-training</td><td align="center">Post-training</td><td align="center">Pre-training</td><td align="center">Post-training</td><td align="center">Pre-</td><td align="center">Post</td></tr><tr><td /><td align="center">M (SD)</td><td align="center">M (SD)</td><td align="center">M (SD)</td><td align="center">M (SD)</td><td align="center" colspan="2">U (<italic>p value)</italic></td></tr><tr><td>Associative learning</td><td>18.348(8.337)</td><td>19.609(8.027)</td><td>9.684(6.111)</td><td>10.579(6.380)</td><td>90.500 (.001***)</td><td>84.500 (.001***)</td></tr><tr><td>List learning</td><td>12.087(7.428)</td><td>16.957(9.118)</td><td>12.789(5.711)</td><td>13.316(7.980)</td><td>196.000 (.569)</td><td>168.000 (.202)</td></tr><tr><td>Place learning</td><td>18.087(8.634)</td><td>23.435(8.857)</td><td>18.789(6.965)</td><td>18.895(7.505)</td><td>209.500 (.820)</td><td>144.000 (.059)</td></tr><tr><td>Text</td><td>9.609(0.783)</td><td>9.391(0.656)</td><td>9.158(1.608)</td><td>8.737(1.046)</td><td>174.500 (.189)</td><td>140.000 (.035*)</td></tr><tr><td>Grocery learning</td><td>22.783(6.082)</td><td>22.826(5.686)</td><td>21.500(5.458)</td><td>21.833(6.261)</td><td>165.000(.268)</td><td>188.500(.446)</td></tr><tr><td>Ecology</td><td>2.304 (1.105)</td><td>3.522 (1.377)</td><td>3.000(1.633)</td><td>3.632 (1.212)</td><td>151.500 (.083)</td><td>216.000 (.948)</td></tr></tbody></table> </ephtml> Note. M = mean; SD = standard deviation. Between group Mean differences were evaluated by Mann-Whitney method. *: <emph>p</emph> < .05; ***: <emph>p</emph> < .001</p> <hd id="AN0134309827-4">Measures</hd> <p>Most of the measures in the current study mimic Bottiroli, Cavallini, Dunlosky, Vecchi, and Hertzog (2013). In addition, the current study includes everyday event measure and omitted face-name measure (due to high difficult level to the participants). All cognitive tasks were administered during the pre- and post-training sessions, hence, two different versions (one for pre- and the other for post-training) of each task were provided. The time limit across the sessions differed to ensure the participants had enough time to complete their tasks. The fundamental features of each task are summarized below (please refer to Bottiroli et al., 2013 for details). Note the duration of the time and amount of task information for each task to be completed differ from their study, because our pilot study determined a modified version of the current study would cause much less stress for the participants.</p> <p>1. Associative learning</p> <p>Participants were presented with 30 paired associates, and the pairs included words selected from Paivio, Yuille, and Madigan (1968) concreteness and imagery norms. Each pair was printed on A4 paper and also projected onto a whiteboard. In both pre-post tests, the participants were instructed to study 30 word pairs for 10 min. Then, they were asked to write down the corresponding pairs within 10 min.</p> <p>2. List learning</p> <p>Participants were presented with 30 words, which included those selected from Paivio et al. (1968) concreteness and imagery norms. They were instructed to study the word list for 10 min and then to recall and write the list within 10 min.</p> <p>3. Place learning.</p> <p>Participants were presented with a virtual map of a city, which included the locations and names of 32 target places (e.g. train stations) and streets across the city. They were given a limit of 10 min to study the map and then an additional 10 min to fill in the locations and street names on a map with the information missing.</p> <p>4. Text learning</p> <p>Participants were presented with a short story that consisted of 163 Chinese words with 10 major ideas (e.g. It was a sunny Saturday on September 17. My parents, younger brother and me went shopping at the Dream Mall. We bought a pair of sports shoes, umbrella, and donuts.... It was a perfect and interesting day). Participants have 10 min to read the story and then to immediately answer 10 multiple choice questions.</p> <p> <bold>5</bold>. Grocery learning</p> <p>Participants were presented with a list of 30 grocery items (e.g. 1. battery, 2. milk, 3. toothbrush). Each item was written on one single A4 paper. They were asked to read and remember the words in the presented order within 10 min. Then, they were asked to write down as many grocery items in the presented order in 10 min.</p> <p>6. Daily events memory</p> <p>The study also tries to probe if the results can be generalized to circumstances beyond the research setting, also known as ecological validity (Brewer & Crano, 2000). We arranged one new research assistant who appeared in front of the participants right before the MOCA and was individually tested and interacted with the MOCA administrator. The participants were then asked five questions when the test ended. The daily events memory test process started with the assistant first who showed on her name card and said that she found an envelope but do not know who to turn to. The envelope was taken and put into the pocket of the test administrator. The five questions were: What is the name of the assistant? What was handed to the test administrator? Where did she put it? Did the assistant wear glasses? What color coat was she wearing?</p> <hd id="AN0134309827-5">Design and intervention</hd> <p>This study is of a multisite, quasi-experimental clinical trial design. Community residents were recruited as participants from October 2016 through January 2017, from metropolitan areas in southern Taiwan. The intervention focused on elderly memory strategy training because previous studies indicated that memory ability shows early age-related losses and is related to dementia (Rebok et al., 2014). Training was conducted during eight 3-h sessions over 8 weeks. Memory training focused on improving memory strategies on five memory tasks through instruction and practice in strategy usage. The schedule for the experimental and control groups is listed in Tables 2 and 3, respectively.</p> <p>The content and objective of the intervention schedule for the experimental group.</p> <p> <ephtml> <table border="1" cellpadding="3"><tbody><tr><td>Wk.</td><td align="center">Content</td><td align="center">Objective</td></tr></tbody><tbody><tr><td>1</td><td>Pretest</td><td>Baseline characteristics</td></tr><tr><td>2</td><td>Introduction, the importance of cognitive training memory techniques: visual image & sentence making</td><td>Encouraging participants' motivation Memory strategies practice (imaging and sentence making)</td></tr><tr><td>3</td><td>Associative learning memory techniques: visual image & sentence making</td><td>Memory strategies practice (imaging and sentence making)</td></tr><tr><td>4</td><td>List learning: visual image & sentence making</td><td>Memory strategies practice (imaging and sentence making), discussion</td></tr><tr><td>5</td><td>List learning: visual image & sentence making</td><td>Memory strategies practice (imaging and sentence making), discussion</td></tr><tr><td>6</td><td>Place memory: visual image & sentence making</td><td>Make the place meaningful for better memory</td></tr><tr><td>7</td><td>Tony Buzan SMASHIN' SCOPE Memory technique</td><td>Introducing Tony Buzan 12 memory techniques for strengthening memory</td></tr><tr><td>8</td><td>Method of Loci/Memory Palace</td><td>For remembering grocery</td></tr><tr><td>9</td><td>Review</td><td>Review the memory techniques taught in previous weeks</td></tr><tr><td>10</td><td>Post-test</td><td>Collect data for pre-post test comparisons and intervention effects determination</td></tr></tbody></table> </ephtml> </p> <p>The content and objective of lecture schedule for the control group.</p> <p> <ephtml> <table border="1" cellpadding="3"><tbody><tr><td>Wk.</td><td align="center">Content</td><td align="center">Objective</td></tr></tbody><tbody><tr><td>1</td><td>Pre-test</td><td>Baseline characteristics</td></tr><tr><td>2</td><td>Aging and memory</td><td>Knowing normal aging and abnormal aging</td></tr><tr><td>3</td><td>Aging and memory</td><td>Knowing normal aging and abnormal aging</td></tr><tr><td>4</td><td>Dementia and protective factors</td><td>Knowing the symptoms of dementia and protecting factors</td></tr><tr><td>5</td><td>Dementia and protective factors</td><td>Knowing the symptoms of dementia and protecting factors</td></tr><tr><td>6</td><td>Learning resources for elders</td><td>Elders are able to find places for life-long learning</td></tr><tr><td>7</td><td>Learning resources for elders</td><td>Elders are able to find places for life-long learning</td></tr><tr><td>8</td><td>Nutrition and health</td><td>Balance nutrition was introduced and its relation with health</td></tr><tr><td>9</td><td>Nutrition and health</td><td>Balance nutrition was introduced and its relation with health</td></tr><tr><td>10</td><td>Post-test</td><td>Collect data for pre-post test comparisons and intervention effects determination</td></tr></tbody></table> </ephtml> Note. Physical exercise and board game activities were also included in the training program, in addition to cognitive training.</p> <p>The intervention program was designed based on the theoretical concepts of the metacognitive theory and the cognitive reserve. The metacognitive theory requires analyzing the characteristics of a task and adapting the strategies to fit the characteristics (e.g. Lemaire, 2010). The cognitive reserve theory suggested that life experiences may act to prevent or minimize brain pathology, through various brain stimulations such as education, occupational attainment, or through leisure activities (Stern, 2012). Regarding the intervention, the only difference between the experimental and control groups was the second part of the training program, with the features of the intervention as stated below.</p> <p>Features of the intervention included are as follows: (Refer to Table 2 for details):</p> <p>The control group received (Refer to Table 3 for details):</p> <p></p> <p></p> <ulist> <item> First part: 8-h exercising (stretching),</item> <p></p> <item> Second part: 8-h memorization strategies were taught, and</item> <p></p> <item> Third part: 8-h word games (crosswords, puzzles, travel-map, and scrabble).</item> <p></p> <item> First part: 8-h exercising (stretching),</item> <p></p> <item> Second part: 8-h health education lectures, and</item> <p></p> <item> Third part: 8-h word games (crosswords, puzzles, travel-map, and scrabble).</item> </ulist> <hd id="AN0134309827-6">Statistical analysis</hd> <p>The Wilcoxon test was used to determine whether the participants' median scores changed significantly within the groups (experimental and control) on the measures of associative learning, list learning, place learning, text learning, grocery learning, and daily event test. In addition, the effect size (Cohen <emph>d</emph>) on both groups was also calculated, to provide information about the magnitude of the intervention effects. The mixed design ANOVA was used to compare the mean differences between the experimental and control groups on performing tasks over the training period.</p> <hd id="AN0134309827-7">Results</hd> <p>The results from the Wilcoxon test explored intragroup differences; they suggested that both list learning and place learning had statistically significant differences in the pre-post tests for the experimental group, but not for the control group (Table 4). The effect size measure by Cohen's <emph>d</emph> also suggested that both list learning and place learning in the experimental group reached a moderate intervention effect (Cohen, 1988). Other tasks were not found with statistically significant differences.</p> <p>Pre-post test training gains (mean) within group comparisons.</p> <p> <ephtml> <table border="1" cellpadding="5"><tbody><tr><td /><td /><td /><td align="center" colspan="2">Intragroup differences p value <sup>c</sup></td></tr><tr><td /><td align="center">Cognitive training</td><td align="center">Control</td><td>Cognitive training</td><td>Control</td></tr></tbody><tbody><tr><td>Associative learning</td><td colspan="4" /></tr><tr><td> Mean gains (SD)</td><td>1.261 (-.310)</td><td>.895 (.269)</td><td>.294</td><td>.419</td></tr><tr><td> Effect size <italic>d</italic> <sup>a</sup></td><td>.154</td><td>.143</td><td colspan="2" /></tr><tr><td> At or above baseline level, %<sup>b</sup></td><td align="center">65</td><td align="center">47</td><td colspan="2" /></tr><tr><td>List learning</td><td colspan="4" /></tr><tr><td> Mean gains (SD)</td><td>4.870(1.690)</td><td>.526(2.268)</td><td>.014*</td><td>.541</td></tr><tr><td> Effect size <italic>d</italic> <sup>a</sup></td><td>.58</td><td>.074</td><td colspan="2" /></tr><tr><td> At or above baseline level, %<sup>b</sup></td><td align="center">57</td><td align="center">53</td><td colspan="2" /></tr><tr><td>Place learning</td><td colspan="4" /></tr><tr><td> Mean gains (SD)</td><td>5.348(.223)</td><td>.106(.540)</td><td>.000***.</td><td>.913</td></tr><tr><td> Effect size <italic>d</italic> <sup>a</sup></td><td>.61</td><td>.015</td><td colspan="2" /></tr><tr><td> At or above baseline level, %<sup>b</sup></td><td align="center">61</td><td align="center">53</td><td colspan="2">.</td></tr><tr><td>Text learning</td><td colspan="4" /></tr><tr><td> Mean gains (SD)</td><td>−.217(-.126)</td><td>−.421 (-.562)</td><td>.260</td><td>.121</td></tr><tr><td> Effect size <italic>d</italic> <sup>a</sup></td><td>−.3</td><td>−.315</td><td colspan="2" /></tr><tr><td> At or above baseline level, %<sup>b</sup></td><td align="center">48</td><td align="center">32</td><td colspan="2" /></tr><tr><td>Grocery learning</td><td colspan="4" /></tr><tr><td> Mean gains</td><td>.043 (-.396)</td><td>.333 (.803)</td><td>.775</td><td>.615</td></tr><tr><td> Effect size <italic>d</italic> <sup>a</sup></td><td>.007</td><td>.056</td><td colspan="2" /></tr><tr><td> At or above baseline level, %<sup>b</sup></td><td align="center">57</td><td align="center">63</td><td colspan="2" /></tr><tr><td>Ecology</td><td colspan="4" /></tr><tr><td> Mean gains (SD)</td><td>1.218(.272)</td><td>.632(-.421)</td><td>.002**</td><td>.228</td></tr><tr><td> Effect size <italic>d</italic> <sup>a</sup></td><td>1.062</td><td>−0.439</td><td colspan="2" /></tr><tr><td> At or above baseline level, %<sup>b</sup></td><td align="center">83</td><td align="center">47</td><td colspan="2" /></tr></tbody></table> </ephtml> Notes. Within group mean differences were evaluated by Wilcoxon test. *: <emph>p</emph> < .05; **: <emph>p</emph> < .01; ***: <emph>p</emph> < .001 a Effect size defined as training improvement from pre-test to post-test minus control improvement from pre-test to post-test divided by the intrasubject standard deviation (SD) of the composite score. Positive effect sizes indicate improvement. b Calculated as the percentage of participants in each group who were ≥ 0.66 standard errors of measurement above baseline. c Wilcoxon Signed-Rank Test was used to do nonparametric analysis of the intragroup differences</p> <p>Figure 1 shows the scores of all the tasks performed by the experimental and control groups from time 1 to time 2. A steeper slope indicates a larger improvement for the individual task. The list learning and place learning in the experimental group have a steeper slope when compared with the other tasks.</p> <p>PHOTO (COLOR): Figure 1. The scores of each task performed by the experimental and control groups from time 1 to time 2.</p> <p>Further, the mixed design ANOVA indicated that there are group of main effects on associative learning and text learning. This indicated that the intervention (experimental) group did have a better performance on these two learning tasks (Table 5). In addition, there was an interaction between the time factor (within subject) and the group factor (between subject) on the dependent variable of place learning test (Table 5). This indicated that the intervention group significantly improved their task performance on place learning from time 1 to time 2 when compared with the control group. The results also showed that post-learning had a significant improvement over pre-learning on list and place learning tasks for the combination of the two groups. However, these were not the focus of the study.</p> <p>Mixed design anova results for intergroup differences in each cognitive task.</p> <p> <ephtml> <table border="1" cellpadding="6"><tbody><tr><td>Source</td><td align="center">SS</td><td align="center">df</td><td align="center">MS</td><td align="center">F(<italic>p</italic>)</td><td align="center"><inline-graphic href="" /></td></tr></tbody><tbody><tr><td>pre_post_assocativelearning</td><td>24.174</td><td>1</td><td>24.174</td><td>1.547(.221)</td><td>.037</td></tr><tr><td>group</td><td>1628.632</td><td>1</td><td>1628.632</td><td>17.482(.000***)</td><td>.304</td></tr><tr><td>pre_post_assocativelearning*group</td><td>.697</td><td>1</td><td>.697</td><td>.045(.864)</td><td>.001</td></tr><tr><td>pre_post_listlearning</td><td>151.470</td><td>1</td><td>151.470</td><td>4.761(.035*)</td><td>.106</td></tr><tr><td>group</td><td>44.913</td><td>1</td><td>44.913</td><td>.513(.478)</td><td>.013</td></tr><tr><td>pre_post_listlearning*group</td><td>98.137</td><td>1</td><td>98.137</td><td>3.084(.087)</td><td>.072</td></tr><tr><td>pre_post_placelearning</td><td>154.699</td><td>1</td><td>154.699</td><td>12.878(.001**)</td><td>.244</td></tr><tr><td>group</td><td>76.614</td><td>1</td><td>76.614</td><td>.642(.428)</td><td>.016</td></tr><tr><td>pre_post_placelearning*group</td><td>142.985</td><td>1</td><td>142.985</td><td>11.903(.001**)</td><td>.229</td></tr><tr><td>pre_post_Text</td><td>2.121</td><td>1</td><td>2.121</td><td>1.507(.227)</td><td>.036</td></tr><tr><td>group</td><td>6.355</td><td>1</td><td>6.355</td><td>7.728(.008*)</td><td>.162</td></tr><tr><td>pre_post_Text*group</td><td>.216</td><td>1</td><td>.216</td><td>.153(.697)</td><td>.004</td></tr><tr><td>pre_post_Grocerylearning</td><td>.717</td><td>1</td><td>.717</td><td>.075(.785)</td><td>.002</td></tr><tr><td>group</td><td>26.139</td><td>1</td><td>26.139</td><td>.438(.512)</td><td>.011</td></tr><tr><td>pre_post_Grocerylearning*group</td><td>.424</td><td>1</td><td>.424</td><td>.045(.834)</td><td>.001</td></tr><tr><td>pre_post_ecology</td><td>17.785</td><td>1</td><td>17.785</td><td>11.444(.002*)</td><td>.222</td></tr><tr><td>group</td><td>3.375</td><td>1</td><td>3.375</td><td>1.670(.204)</td><td>.040</td></tr><tr><td>pre_post_ecology*group</td><td>1.785</td><td>1</td><td>1.785</td><td>1.149(.290)</td><td>.028</td></tr></tbody></table> </ephtml> Note. *: <emph>p</emph> < .05; **: <emph>p</emph> < .01; ***: <emph>p</emph> < .001</p> <p>Daily event test</p> <p>The study also tested if the cognitive intervention effect can be transferred to daily event memory for both the experimental and control groups. We found within group significance on the test for the experimental group but not for the control group (Table 5), indicating that the intervention seems helpful for the improvement of the daily event memory. However, there was no interaction effect found through the mixed design ANOVA between the time (time 1 to time 2) and the groups.</p> <hd id="AN0134309827-8">Discussion</hd> <p>The study investigated the cognitive intervention effects on the six tasks: associative learning, list learning, text learning, place learning, grocery learning, and the daily events. The study is unique for these reasons: (a) a quasi-experimental design for community elders through cognitive intervention is rare in Taiwan; (b) the study used various measures of cognitive tasks plus daily events (ecological validity). The ecological validity approach was used in the study in addition to the multiple task measures rarely found in previous studies and, thus, broadens the spectrum of the cognitive intervention program.</p> <p>The key findings of the study and the results are:</p> <p>(<reflink idref="bib1" id="ref1">1</reflink>) Intragroup</p> <p>Cognitive intervention produced a statistically significant effect on the amelioration of cognitive task performance, such as list and place learning for the experimental group, but not for the control group. The reasons might be the information of similar (but not the same) list learning and place learning was provided and trained during the training periods, especially those encouraging the participants to produce the image of words and sentences made for the tasks. Accordingly, the participants learned and made use of these memory mnemonics to improve their performance on such tasks. The intragroup differences were not found significant on other tasks, such as associative learning, text learning, and grocery learning. For associative learning, the reasons might be that the task was not easy to produce images of the pairs. For text learning, the mean scores for both groups were high enough. Therefore, it is unlikely to make any improvement because it reached the ceiling effect for this task. Finally, for the grocery learning, we used the loci method as a memory mnemonic, but the method might not be that easy to use for the elderly.</p> <p>(<reflink idref="bib2" id="ref2">2</reflink>) Intergroup</p> <p>The main effects were found for the associative and text learning, but not for other tasks. This indicated that the participants who received the intervention performed better on the associative and text learning when compared with the control group. It seems reasonable that those participants who received practice during the training period did have training gains on these tasks, which are consistent with literature. (Bottiroli et al., 2013; Hertzog et al., 2008). Note the aforementioned associative learning, although difficult for the elderly, the experimental group was still possible to outperform the control group with training. However, no significant main effects were found for list learning, place learning, and grocery learning. We assumed that the training time was not long enough to make any improvement. It might be possible to achieve better performance if the training sessions were extended.</p> <p>(<reflink idref="bib3" id="ref3">3</reflink>) Interaction effect</p> <p>The study found significant interaction between the variable of time and group on place learning. Specifically, we found those who had received intervention performed much better on place learning than the control group from time 1 through time 2. This finding is promising since the memory problems in place learning can be reduced, using the training model in the study. Such an experimental design is rare, so the study served as a preliminary exploration for future studies. No other learning tasks of a significant interaction term was found in the study. We assumed that the reason might be due to this kind of cognitive training is not familiar (common) in the participants' daily lives and is not even easy to access in their culture too. Accordingly, these neophyte learners need more time to "digest," to understand and to get used to such tasks.</p> <p>(<reflink idref="bib4" id="ref4">4</reflink>) Daily event memory</p> <p>We designed a daily event activity that happened naturally in the experimental setting, to provide more into the ecological validity. The decline in most aspects of cognition is normal in later life. This study found benefits to cognitive training for promoting daily event memory in the experimental group. The results provide support for the role of the cognitive training that could possibly extend its (transfer) effects to the memory of daily life events, in addition to the original training target tasks. Memory losses or complaints have been shown as negatively correlated with the quality of life (Maki et al., 2014). Accordingly, the solution to minimize memory loss (and enhance cognitive health) is to develop strategies for becoming happier in later life (Lee, 2016) and increase cognitive and physical activity (Lee, 2014), among others. Given that the memory losses in everyday life can be reduced, the research design in the study seems to warrant further research.</p> <hd id="AN0134309827-9">Future study and limitations</hd> <p>One approach for future study might be collecting homogeneous participants (e.g. Lee et al., 2017), which can lead to a clearer interpretation of the results. Additionally, future study could include an older age group of those aged 85-94, for this is regarded as the fastest growing cluster going forward (Werner, 2011). The current study's intervention methods seem useful for supporting some of the memory tasks and daily events memory, but not all the tasks. How to design a more efficient and intensive scientific-based cognitive intervention to target specific cognitive task(s), or, to create a memory-training prescription (or exercise prescription) for memory improvement, will be one of the important directions for future study. One limitation of the study is that some of the experimental participants were from a self-directing learning club, and they might, therefore, have had a higher motivation for learning, which led to better performances in the study tasks. The study participants recruitment policy was based on a first-come first-serve, so this limitation is inherent. Also, it is not clear as to whether the observed effects are due, in part, to the social factors, and this also deserves a more focused research.</p> <hd id="AN0134309827-10">Conclusion</hd> <p>Memory intervention programs deserve more attention in the field of memory health. It has been well discussed that mental activity may reduce the risk of cognitive impairment and AD in elderly subjects (Andrade & Radhakrishnan, 2009). This study provided experimental evidence that supports cognitive intervention is useful with a key cognitive aging outcome of memory function. In general, the study outcome is promising and exciting, in that memory function can remain and even be improved through participating in a memory strategies group. How to develop these strategies for memory improvement, which is certainly related to a better quality in later life, may well be the focus and the responsibility of the researchers and policymakers in the field of gerontology.</p> <hd id="AN0134309827-11">Acknowledgments</hd> <p>This work was supported by grant MOST 105-2410-H-017-019-MY2, from Ministry of Science &Technology, Taiwan</p> <ref id="AN0134309827-12"> <title> References </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> Alves, J., Magalhães, R., Machado, Á., Gonçalves, Ó. F., Sampaio, A., & Petrosyan, A. ( 2013 ). Non-pharmacological cognitive intervention for aging and dementia: Current perspectives. <emph>World Journal of Clinical Cases</emph>, 1 ( 8 ), 233 - 241. doi: 10.12998/wjcc.v1.i8.233</bibtext> </blist> <blist> <bibl id="bib2" idref="ref2" type="bt">2</bibl> <bibtext> Andrade, C., & Radhakrishnan, R. ( 2009 ). 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  Label: Title
  Group: Ti
  Data: Memory Training Program for Older Adults
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Lee%2C+Pai-Lin%22">Lee, Pai-Lin</searchLink><br /><searchLink fieldCode="AR" term="%22Chang%2C+Hui-Hsiang%22">Chang, Hui-Hsiang</searchLink><br /><searchLink fieldCode="AR" term="%22Huang%2C+Chih+Kun%22">Huang, Chih Kun</searchLink><br /><searchLink fieldCode="AR" term="%22Cheng%2C+Wen-Chen%22">Cheng, Wen-Chen</searchLink><br /><searchLink fieldCode="AR" term="%22Lee%2C+Pi-Yu%22">Lee, Pi-Yu</searchLink><br /><searchLink fieldCode="AR" term="%22Chao%2C+Hui-Chen%22">Chao, Hui-Chen</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Educational+Gerontology%22"><i>Educational Gerontology</i></searchLink>. 2018 44(10):614-626.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 13
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2018
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Adult+Education%22">Adult Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Memory%22">Memory</searchLink><br /><searchLink fieldCode="DE" term="%22Training%22">Training</searchLink><br /><searchLink fieldCode="DE" term="%22Older+Adults%22">Older Adults</searchLink><br /><searchLink fieldCode="DE" term="%22Educational+Gerontology%22">Educational Gerontology</searchLink><br /><searchLink fieldCode="DE" term="%22Experimental+Groups%22">Experimental Groups</searchLink><br /><searchLink fieldCode="DE" term="%22Control+Groups%22">Control Groups</searchLink><br /><searchLink fieldCode="DE" term="%22Outcomes+of+Treatment%22">Outcomes of Treatment</searchLink><br /><searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Exercise%22">Exercise</searchLink><br /><searchLink fieldCode="DE" term="%22Educational+Games%22">Educational Games</searchLink><br /><searchLink fieldCode="DE" term="%22Daily+Living+Skills%22">Daily Living Skills</searchLink><br /><searchLink fieldCode="DE" term="%22Associative+Learning%22">Associative Learning</searchLink><br /><searchLink fieldCode="DE" term="%22Cognitive+Tests%22">Cognitive Tests</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Taiwan%22">Taiwan</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/03601277.2018.1511099
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0360-1277
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objective: Memory loss affects a large proportion of older adults. Research indicates a positive association between memory training and better memory performance as people age. However, studies on specific memory training using an experimental design are limited. This study explored whether memory training has improved memory performance in a group of older adults.Method: A convenience sample of 48 participants was recruited from two communities. Disregarding dropouts, this left 23 experimental (mean age = 65.4 ± 6.0, range = 56-80) and 19 control participants (mean age = 64.5 ± 4.9, range: 57-72). The intervention consisted of 60-min classes held on a weekly basis continuing for 8 weeks. The class session was held after a 1-h exercise class and before a 1-h session of cognitive games. The pre-post objective memory performances, including associative, list, text, place, grocery learning, and transfer-effect of daily event memory (ecology validity), were examined to determine whether the intervention was effective.Results: Intragroup: With Wilcoxon test, the findings showed that the intervention of both the list and place learning had significant differences for the experimental group, but not for the control group. Intergroup: The main effects were found for the associative and text learning. The mixed design ANOVA indicated that there is an interaction (time x group) on the dependent variable of the place learning test. Daily events memory: We found within group that the pre-post differences were significant for the experimental group but not for the control group.Conclusion: The study showed that memory training can help older adults to ameliorate memory loss problems and these findings deserve more attention.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: Ref
  Label: Number of References
  Group: RefInfo
  Data: 56
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2019
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1203916
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1203916
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        Value: 10.1080/03601277.2018.1511099
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 13
        StartPage: 614
    Subjects:
      – SubjectFull: Memory
        Type: general
      – SubjectFull: Training
        Type: general
      – SubjectFull: Older Adults
        Type: general
      – SubjectFull: Educational Gerontology
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      – SubjectFull: Cognitive Tests
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      – SubjectFull: Foreign Countries
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      – SubjectFull: Taiwan
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      – TitleFull: Memory Training Program for Older Adults
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