The goal of our study was to examine the possible effects of a strategies-based training intervention on objective memory performance and subjective memory in healthy older adults. While slight declines in memory naturally occur in the aging process, these changes may impact the quality of life for older adults.

Patients (n = 11, aged 50-80, mean age = 70.73, SD = 4.41) with subjective memory complaints were recruited from memory clinics within an academic medical center. All participants engaged in one-on-one, three one-hour memory training sessions over the course of several weeks to undergo strategies-based training intervention (e.g., mnemonics). All participants completed neuropsychological battery of tests at baseline and at post-intervention (about 8-10 weeks after baseline). Tests included the Montreal Cognitive Assessment (MoCA), the Hopkins Verbal List Test (HVLT-R), the Visual Reproduction subtest of the Weschler Memory Scale (WMS-IV), and the Multiphasic Memory Questionnaire.

Data were analyzed using a mixed between-within subjects ANOVA and t-tests. Groups were created based on the participant’s MoCA score. While a total of 11 participants completed baseline testing and the memory training sessions, two did not return for post-intervention testing; as such their data were excluded from analyses. Older adults with a MoCA score of 26-30 (n = 6), but not older adults with a MoCA score 25 and below (n = 3), had a significant improvement in visual learning and encoding, F (1, 7) = 10.028, r = .50, p < .05. The high MoCA performers demonstrated an improved performance in their immediate visual memory from baseline (M = 10, SD = 3.53) to post-intervention (M = 12, SD = 3.35), t(9) = .895, p = .001 (two-tailed). Ratings of memory satisfaction among high MoCA performers also increased from baseline (M = 48, SD = 11.47) to post-intervention (M = 51, SD = 5.43), t(9) = .707, p < .05 (two-tailed). Among both groups, a significant increase in perceived memory ability was demonstrated from baseline (M = 50, SD =10.1) to post-intervention (M = 54, SD = 12.35), t(8) = .807, p < .05 (two-tailed).

These findings indicate that a brief memory training program may improve visual encoding and subjective memory in healthy older adults with memory concerns. Individuals with subjective memory concerns who undergo a cognitive training program seem to demonstrate improved encoding of nonverbal material. These participants also reported a greater memory satisfaction and improved perceived memory ability after completion of a memory training program. Interestingly, these findings were only seen in adults whose MoCA performance was within normal limits. Although a systematic review suggests the improvement of memory performances on cognitively impaired participants (Simon, Yokomizo, & Bottino, 2012), this may not have been demonstrated in the current study due to a low sample size and/or to the brief duration of the cognitive training. Future directions include increasing sample size and offering booster sessions to explore whether cognitively impaired adults may benefit from repetition.

Many individuals who experienced a mild traumatic brain injury (mTBI) have persistent cognitive complaints. Traditional cognitive rehabilitation (TCR) interventions were primarily developed for severe neurological injury which has limited effectiveness in rehabilitation of active duty military personnel who have the goal of returning to full military operational status. To remain on active duty, warfighters must have sufficient mental competency to safely and effectively function in complex environments such as combat. There is need for a cognitive rehabilitation approach that addresses demands of military personnel to expedite return to duty. The Strategic Memory Advanced Reasoning Training (SMART) program is novel alternative to TCR. SMART is an evidence-based advanced reasoning protocol that enhances cognitive domains essential to military readiness (e.g., mental agility, strategic learning, problem solving, and focus) and requires less than half of the treatment time. The objective of this study was to assess the efficacy of SMART compared to TCR in terms of overall recovery as well as change in specific cognitive domains.

Participants were recruited from a military treatment facility. All patients had at least one diagnosed mTBI as well as persistent cognitive complaints. Participants completed the Rey-15 to ensure performance validity. Final sample was SMART n = 28 and SCORE n = 19. Primary dependent measure was the Global Deficit Scale (GDS). GDS was calculated from: Hopkins Verbal Learning Test-Revised (HVLT-R); Delis Kaplan Executive Functioning System Color Word (CW) and Trail Making (TM), Paced Auditory Serial Addition Test (PASAT), and the Symbol Digit Modality Test (SDMT). Demographically corrected t-scores were converted to deficit scores as follows: >40 = 0, 35-39 = 1, 30-34 = 2, 25-29 = 3, 20-24 = 4, <20 = 5. Deficit scores were averaged to calculate GDS. For each measure, Hohen’s g was analyzed for effect size comparisons pre-post treatment.

Average number of treatment hours was significantly lower in the SMART condition (SMART: M = 18.47 hours, SD = 2.17; TCR: M = 42.42 hours, SD = 3.79, p <.001). A repeated measures ANOVA showed a significant change on GDS post-treatment (F = 30.25, p < .001) with a large effect size (n2 = .402); however, the interventions did not differ on GDS change. Impact on cognitive domains was relatively equivalent for processing speed (SMART h = 0.67 vs TCR h = -.54) and executive function (SMART h = -0.92 vs TCR h = -.85); however, SMART had a larger impact on memory (SMART h = -0.81 vs TCR h = -.39). SMART resulted in large improvements in retention and recognition memory which were minimally impacted by TCR.

Both TCR and SMART had comparable effectiveness in improving cognitive impairment, though SMART was completed in less than half of the treatment time. Both interventions had large effect sizes on processing speed and executive functioning; however, SMART was more effective in improving long-term memory. Memory is an integral part of military readiness. Further investigation is required to determine the relative effectiveness of these two approaches to improving cognitive readiness of the warfighter.

Several studies have shown an increase in memory performance after teaching mnemonic techniques to older participants. However, transfer effects to non-trained tasks are generally either very small, or not found.

The present study investigates the efficacy of a multifactorial memory training program for older adults living in a residential care center. The program combines teaching of memory strategies with activities based on metacognitive (metamemory) and motivational aspects. Specific training-related gains in the Immediate list recall task (criterion task), as well as transfer effects on measures of short-term memory, long-term memory, working memory, motivational (need for cognition), and metacognitive aspects (subjective measure of one's memory) were examined. Maintenance of training benefits was assessed after seven months.

Fifty-one older adults living in a residential care center, with no cognitive impairments, participated in the study. Participants were randomly assigned to two programs: the experimental group attended the training program, while the active control group was involved in a program in which different psychological issues were discussed.

A benefit in the criterion task and substantial general transfer effects were found for the trained group, but not for the active control, and they were maintained at the seven months follow-up.

Our results suggest that training procedures, which combine teaching of strategies with metacognitive–motivational aspects, can improve cognitive functioning and attitude toward cognitive activities in older adults.