Endurance Exercise Training Attenuates the Waterpipe Smoke Inhaling-Induced Learning and Memory Impairment in Rats: Role of Neurotrophic Factors and Apoptotic System.

INTRODUCTION: The increasing prevalence of waterpipe tobacco smoking (WTS) and its detrimental effects on memory function have been reported. This study was conducted to investigate the effect of moderate-intensity endurance exercise on the detrimental effects of WTS on learning and spatial memory in rats. AIMS AND METHODS: Animals were divided into the Control group (CTL), the exercise group (Ex) which trained for 8 weeks, the WTS group (Wp) exposed to smoke inhalation (30 minutes per day, 5 days each week, and for 8 weeks), and the group that did exercise training and received waterpipe smoke together (Ex + Wp). Thereafter, learning and spatial memory were assessed by the Morris water maze test and hippocampal molecular measurements were done. RESULTS: Waterpipe smoke significantly impaired learning and spatial memory, decreased expression of neurotrophic factors IGF-1 and BDNF (p < .01 and p < .05 vs. CTL group, respectively), increased BAX to BCL-2 ratio (p < .001 vs. CTL group) in hippocampal tissue, and increased the percent of damaged neurons in the hippocampal CA1 area (p < .05 vs. CTL group). Combination of exercise training with WTS prevented learning and spatial memory disturbances and recovered expression of neurotrophic factors IGF-1 (p < .05 vs. Wp group), decreased BAX to BCL-2 ratio (p < .001 vs. Wp group), and reduced percentage of damaged neurons (p < .05 vs. Wp group). CONCLUSIONS: Findings suggest that moderate-intensity endurance exercise training can ameliorate learning and memory impairment caused by waterpipe smoke in rats. This effect partly results from increasing the expression of neurotrophic factors BDNF and IGF-1 and correcting pro/anti-apoptotic proteins balance in the hippocampal tissue. IMPLICATIONS: The popularity of WTS especially among youth is increasing. We assessed the effect of hookah smoke with/without exercise on learning and memory. Hookah smoke leads to CA1-neural injury and impairs learning and memory in rats. A combination of exercise training with hookah smoke attenuates these complications. This positive effect of exercise is partially mediated by the balancing of brain-derived neurotrophic factor (BDNF) and Insulin-like growth factor-1 (IGF-1) and also the BAX to BCL-2 ratio, a significant predictor of cell susceptibility to apoptosis. Extrapolation of these positive findings to humans needs complementary studies.

The preliminary effects of moderate aerobic training on cognitive function in people with TBI and significant memory impairment: a proof-of-concept randomized controlled trial.

This single-blinded RCT investigated cognitive effects of aerobic exercise in persons with TBI-related memory impairment. Five participants . were randomly assigned to 12-weeks of either supervised moderate intensity aerobic cycling or an active control. Outcome measures included neuropsychological assessments and structural neuroimaging (MRI,). The exercise group demonstrated greater improvements on auditory verbal learning (RAVLT; d=1.54) and processing speed (SDMT; d=1.58). The exercise group showed larger increases in volume of the left hippocampus (d=1.49) and right thalamus (d=1.44). These pilot data suggest that 12-weeks of moderate intensity aerobic cycling may improve memory and processing speed in those with TBI-related memory impairments.

Memory outcomes following hemispherectomy in children.

OBJECTIVE: A vast proportion of children with epilepsy exhibit memory impairments. Although numerous studies have examined memory performance following pediatric resective epilepsy surgery, little is known about the memory outcomes following hemispherectomy. The few studies that report on memory performance typically include restricted measures, consist of case reports, or do not report on preoperative performance. Given the current limitations, the aim of this study was to delineate pre- and postoperative memory functioning in youth who underwent a hemispherectomy. METHOD: Participants included patients who had undergone a hemispherectomy at the Hospital for Sick Children, between 1999 and 2016. Standardized neuropsychological assessments of verbal (digit span, word list recall, word pair recall, stories) and visual (faces, dot locations) memory abilities prior to and after surgery were reviewed. A Wilcoxon signed rank test and effect sizes was completed to compare patients' memory performance to population norms and to assess pre- to postoperative difference scores. RESULTS: Thirteen participants were included in the study: five patients completed preoperative assessments only and eight patients completed pre- and postoperative assessments. Preoperatively, patients performed substantially worse relative to population norms as indicated by large effect sizes (r: 0.5-0.9). Postoperatively, effect sizes were large for the majority of the memory tests, demonstrating considerable differences in patients' memory scores over time. When clinically meaningful changes were examined, stable performance was evident on 63% of the memory tasks. CONCLUSION: Overall, the results highlight that youth who are eligible for hemispherectomy demonstrate profound memory deficits prior to surgery. In addition, undergoing hemispherectomy was not necessarily associated with declined memory performance, with the majority of patients showing stable scores.

Chronic decompression illness cognitive dysfunction improved with hyperbaric oxygen: a case report.

Introduction: Altitude chamber exposures are used for training to allow aircrew to experience their hypoxia and pressure effect symptoms. Decompression illness (DCI) can occur subsequent to altitude chamber training or in operational aircraft when the cabin altitude is at least 18,000 feet. Definitive emergent treatment is hyperbaric oxygen (HBO2) to decrease bubble size, dissipate excess nitrogen, hyperoxygenate tissue and reduce inflammation. Case report: A 27-year-old female underwent altitude chamber training to 25,000 feet. She developed tingling in both legs and left arm, headache, dizziness, malaise, then difficulty talking. She underwent two HBO2 treatments. Over the next 12 months, she had paresthesia, decreased memory and cognitive function similar to symptoms seen following traumatic brain injury. She was referred 14 months after the event for evaluation. Using pre-deployment Automated Neuropsychological Assessment Metrics (ANAM) and serial tests over 58 HBO2 treatments, the patient demonstrated near-return to her pre-deployment test scores.. Discussion: The reason for HBO2 treatment was based on previous experience with chronic traumatic brain injury subjects where HBO2 improved outcome. The patient's chronic neurological symptoms mimicked chronic TBI. The patient was unique in that baseline cognitive tests existed that could be used to monitor her changes during the treatment series.

Multiple hippocampal transections: Post-operative Memory Outcomes and Seizure Control.

OBJECT: Temporal lobectomy with amygdalohippocampectomy is the standard surgical treatment for appropriate candidates with medically-intractable temporal lobe epilepsy. More recently, because of the risk of postoperative language/memory decline in a subset of patients with intact memory, a multiple hippocampal transection (MHT) approach has been proposed to preserve function. METHODS: Studies of MHT reporting both Engel and verbal memory outcome measures were included in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting of systematic reviews. Data were extracted on verbal memory function pre- and postoperatively, seizure outcome, and demographic factors. A random effects model was used to determine overall verbal memory function after MHT, and a meta-regression model was applied to identify factors associated with outcome. RESULTS: A total of 114 patients across five studies were included. Engel class I seizure outcome across all studies ranged from 64.7% to 94.7%, with 84 of the 114 patients achieving this outcome. Preoperative verbal memory score was most strongly associated with postoperative verbal memory preservation (p = 0.003). Of 59 patients with full verbal memory outcome scores, 86.8% (95% CI [confidence interval]: 77.6%-96%) had complete preservation of verbal memory relative to preoperative functional baseline. CONCLUSION: Multiple hippocampal transection is an evolving surgical technique. Although the present data are limited, the current systematic review suggests that this approach is effective at preserving verbal memory in patients with good baseline function. Although reasonable seizure outcomes have been reported with MHT, comparison to a well-established procedure such as temporal lobectomy and amydalohippocampectomy must be guided by further evidence.

Sleep quality and cognitive impairment in older Chinese: Guangzhou Biobank Cohort Study.

BACKGROUND: evidence concerning the relationship between sleep quality and cognitive impairment is limited and inconsistent. OBJECTIVE: to examine the association of sleep quality with memory impairment and poor cognitive function in a large sample of older Chinese. METHODS: 15,246 participants aged 50+ years of the Guangzhou Biobank Cohort Study who attended the second physical examination from 2008 to 2012 were included. Sleep quality was assessed using Pittsburgh Sleep Quality Index (PSQI), and cognitive performance was assessed using both Delayed Word Recall Test (DWRT) and Mini-Mental State Examination (MMSE). Memory impairment was defined by DWRT score < 4 and poor cognitive function by MMSE score < 25. RESULTS: after adjusting for potential confounders, lower habitual sleep efficiency was associated with a higher risk of memory impairment and poor cognitive function with a dose-response pattern (both P for trend <0.001). The adjusted odds ratio (OR, 95% confidence interval (CI)) for poor cognitive function in those with the sleep efficiency of 75-85%, 65-75% and <65%, versus ≥85%, was 1.31 (1.12-1.53), 1.41 (1.16-1.73) and 1.33 (1.09-1.63), respectively. No association of the global PSQI score with memory impairment or poor cognitive function was found. CONCLUSIONS: in older Chinese people, lower habitual sleep efficiency was associated with a higher risk of memory impairment and poorer cognitive function.

Clinical and cost effectiveness of memory rehabilitation following traumatic brain injury: a pragmatic cluster randomized controlled trial.

OBJECTIVE: To evaluate the clinical and cost effectiveness of a group-based memory rehabilitation programme for people with traumatic brain injury. DESIGN: Multicentre, pragmatic, observer-blinded, randomized controlled trial in England. SETTING: Community. PARTICIPANTS: People with memory problems following traumatic brain injury, aged 18-69 years, able to travel to group sessions, communicate in English, and give consent. INTERVENTIONS: A total of 10 weekly group sessions of manualized memory rehabilitation plus usual care (intervention) vs. usual care alone (control). MAIN MEASURES: The primary outcome was the patient-reported Everyday Memory Questionnaire (EMQ-p) at six months post randomization. Secondary outcomes were assessed at 6 and 12 months post randomization. RESULTS: We randomized 328 participants. There were no clinically important differences in the primary outcome between arms at six-month follow-up (mean EMQ-p score: 38.8 (SD 26.1) in intervention and 44.1 (SD 24.6) in control arms, adjusted difference in means: -2.1, 95% confidence interval (CI): -6.7 to 2.5, p = 0.37) or 12-month follow-up. Objectively assessed memory ability favoured the memory rehabilitation arm at the 6-month, but not at the 12-month outcome. There were no between-arm differences in mood, experience of brain injury, or relative/friend assessment of patient's everyday memory outcomes, but goal attainment scores favoured the memory rehabilitation arm at both outcome time points. Health economic analyses suggested that the intervention was unlikely to be cost effective. No safety concerns were raised. CONCLUSION: This memory rehabilitation programme did not lead to reduced forgetting in daily life for a heterogeneous sample of people with traumatic brain injury. Further research will need to examine who benefits most from such interventions.

RECOVERY OF MEMORY AFTER CEREBRAL ARTERY ANEURYSM SURGERY.

The principal study objective was to define whether memory deficits (numerical, working, verbal-mechanical, verbal-logical and visual memory) occurred in patients submitted to surgery for brain artery aneurysm and whether significant recovery of memory took place with time. The study sample included 92 patients, i.e. 35 (38%) male and 57 (62%) female patients aged 27 to 76 years. Neuropsychological testing was conducted at Zagreb University Hospital Centre, Department of Neurosurgery, from 1998 to 2012, in two time intervals: first within 11 months following surgery, and then 12 to 48 months after surgery. The obtained results showed that verbal-mechanical, verbal-logical, and visual memory deficits were present in the first testing interval. In the second testing, the verbal-logical and visual memory deficits were still present, while the tests of verbal-mechanical memory showed deficits in capacity and learning curve, but the results for short- and long-term memory were within the normal ranges. Neither the first nor the second testing showed deficits of numerical and working memory. Based on our results, we can conclude that long-term verbal-mechanical and visual short- and long-term memory had recovered to a statistically significant level, whereas other types of memory showed no significant recovery.

Verbal learning and memory outcome in selective amygdalohippocampectomy versus temporal lobe resection in patients with hippocampal sclerosis.

PURPOSE: With the advent of new very selective techniques like thermal laser ablation to treat drug-resistant focal epilepsy, the controversy of resection size in relation to seizure outcome versus cognitive deficits has gained new relevance. The purpose of this study was to test the influence of the selective amygdalohippocampectomy (SAH) versus nonselective temporal lobe resection (TLR) on seizure outcome and cognition in patients with mesial temporal lobe epilepsy (MTLE) and histopathological verified hippocampal sclerosis (HS). METHODS: We identified 108 adults (>16years) with HS, operated between 1995 and 2009 in Denmark. Exclusion criteria are the following: Intelligence below normal range, right hemisphere dominance, other native languages than Danish, dual pathology, and missing follow-up data. Thus, 56 patients were analyzed. The patients were allocated to SAH (n=22) or TLR (n=34) based on intraoperative electrocorticography. Verbal learning and verbal memory were tested pre- and postsurgery. RESULTS: Seizure outcome did not differ between patients operated using the SAH versus the TLR at 1year (p=0.951) nor at 7years (p=0.177). Verbal learning was more affected in patients resected in the left hemisphere than in the right (p=0.002). In patients with left-sided TLR, a worsening in verbal memory performance was found (p=0.011). Altogether, 73% were seizure-free for 1year and 64% for 7years after surgery. CONCLUSION: In patients with drug-resistant focal MTLE, HS and no magnetic resonance imaging (MRI) signs of dual pathology, selective amygdalohippocampectomy results in sustained seizure freedom and better memory function compared with patients operated with nonselective temporal lobe resection.

Health care provider experiences in primary care memory clinics: a phenomenological study.

BACKGROUND: There is a growing need for community-based services for persons with Alzheimer's disease and related dementias (ADRD). Memory clinic (MC) teams in primary care settings have been established to provide care to people with ADRD. To consider wider adoption of these MC teams, insight is needed into the experiences of practitioners working in these models. The purpose of the current study is to explore the experiences of health care providers (HCPs) who work in primary care Memory Clinic (MC) teams to provide care to persons with Alzheimer's disease and related dementias (ADRD). METHODS: This study utilized a phenomenological methodology to explore experiences of 12 HCPs in two primary care MCs. Semi-structured interviews were completed with each HCP. Interviews were recorded and transcribed verbatim. Colaizzi's steps for analyzing phenomenological data was utilized by the authors. RESULTS: Three themes emerged from the analysis to describe HCP experiences: supporting patients and family members during ADRD diagnosis and treatment, working in a team setting, and personal and professional rewards of caring for people with ADRD and their family members. CONCLUSIONS: Findings provide insight into current practices in primary care MCs and on the motivation of HCPs working with persons with ADRD.

A summary on the effectiveness of the Amsterdam memory and attention training for children (Amat-c) in children with brain injury.

OBJECTIVE: To summarise the current research on the effectiveness of the Amsterdam Memory and Attention Training for Children (Amat-c). METHODS: A literature search was conducted to find articles published about the Amat-c, using PubMed, psychINFO, and PsychBITE databases. Relevant search terms included Amat-c, attention and memory, and childhood ABI. RESULTS: Our literature search identified 7 articles that described 5 separate studies including 61 children in total (mostly TBI). Only one study had a control group. All results indicated positive effects on memory and attention, although in three of the studies, these results were not statistically tested. Positive results were generally maintained six months follow up. CONCLUSIONS: This review showed that the Amat-c is effective for treating attention and memory disturbances in children with ABI. However, evidence is limited and training material is outdated. We suggest that the Amat-c should be digitised and implemented in a school setting and further evaluated.

Personal computer-based cognitive training in Parkinson's disease: a case study.

Parkinson's disease (PD) is a neurodegenerative disorder that is best managed by a combination of medication and regular physiotherapy. PD's main symptoms involve the motor system, but cognitive disorders can be very severe as well. The aim of this study was to evaluate the effects of the computerized rehabilitative tool Esercizi di Riabilitazione Cognitiva (ERICA) in the cognitive recovery of a patient with PD. The patient was a 65-year-old man affected by PD with motor complications and severe cognitive and behavioural alterations. He underwent two different types of intensive rehabilitation training: standard cognitive rehabilitation alone and in combination with specific personal computer (PC)-based cognitive training. We evaluated his neuropsychological profile before and after the two types of training by using a specific psychometric battery. Only at the end of the PC training did we observe improvement in cognitive function as well as mood stabilization. When used in addition to standard cognitive rehabilitation, PC-based cognitive training may be a valuable tool in improving cognitive skills, with regard to attention, memory process, and executive functions. PC-based cognitive training may be able to help optimize managing the symptoms of PD.

Relationship between self-reported and objectively measured physical activity and subjective memory impairment in breast cancer survivors: role of self-efficacy, fatigue and distress.

PURPOSE: Many breast cancer survivors report cancer and cancer treatment-associated cognitive change. However, very little is known about the relationship between physical activity and subjective memory impairment (SMI) in this population. The purpose of this study is to examine the relationship between physical activity and SMI and longitudinally test a model examining the role of self-efficacy, fatigue and distress as potential mediators. METHODS: Post-treatment breast cancer survivors (N = 1477) completed measures of physical activity, self-efficacy, distress (depression, concerns about recurrence, perceived stress, anxiety), fatigue and SMI at baseline and 6-month follow-up. A subsample (n = 362) was randomly selected to wear an accelerometer. It was hypothesized that physical activity indirectly influences SMI via exercise self-efficacy, distress and fatigue. Relationships were examined using panel analysis within a covariance modeling framework. RESULTS: The hypothesized model provided a good fit in the full sample (χ2 = 1462.5, df = 469, p = <0.001; CFI = 0.96; SRMR = 0.04) and the accelerometer subsample (χ2 = 961.8, df = 535, p = <0.001, CFI = 0.94, SRMR = 0.05) indicating increased physical activity is indirectly associated with reduction in SMI across time, via increased exercise self-efficacy and reduced distress and fatigue. CONCLUSIONS: Higher levels of physical activity, lower levels of fatigue and distress and higher exercise self-efficacy may play an important role in understanding SMI in breast cancer survivors across time. Future research is warranted to replicate and explore these relationships further. Copyright © 2016 John Wiley & Sons, Ltd.

Repetition-lag memory training is feasible in patients with chronic stroke, including those with memory problems.

PRIMARY OBJECTIVE: Repetition-lag memory training was developed to increase individuals' use of recollection as opposed to familiarity in recognition memory. The goals of this study were to examine the feasibility of repetition-lag training in patients with chronic stroke and to explore whether the training might show suggestions of transfer to non-trained tasks. RESEARCH DESIGN: Quasi-experimental. METHODS AND PROCEDURES: Patients (n = 17) took part in six repetition-lag training sessions and their gains on the training and non-trained tasks were compared to those of age-matched healthy controls (n = 30). MAIN OUTCOMES AND RESULTS: All but two patients completed the training, indicating that the method is feasible with a wide range of patients with stroke. The amount patients gained on the training task was similar to that of healthy controls (that is, the Group × Time interactions were by-and-large not significant), suggesting that patients with stroke might benefit to the same degree as healthy adults from this training. Both groups showed some indication of transfer to the non-trained backward digit span task and visuospatial memory. CONCLUSIONS: These findings show that repetition-lag memory training is a possible approach with patients with stroke to enhance recollection. Further research on the method's efficacy and effectiveness is warranted.

Short-term neurocognitive outcomes following anterior temporal lobectomy.

Changes in cognitive function are a well established risk of anterior temporal lobectomy (ATL). Deficits in verbal memory are a common postoperative finding, though a small proportion of patients may improve. Postoperative evaluation typically occurs after six to 12months. Patients may benefit from earlier evaluation to identify potential needs; however, the results of a formal neuropsychological assessment at an early postoperative stage are not described in the literature. We compared pre- and postoperative cognitive function for 28 right ATL and 23 left ATL patients using repeated measures ANOVA. Changes in cognitive function were compared to ILAE seizure outcome. The mean time to postoperative neuropsychological testing was 11.1weeks (SD=6.7weeks). There was a side×surgery interaction for the verbal tasks: immediate memory recall (F(1,33)=20.68, p<0.001), short delay recall (F(1,29)=4.99, p=0.03), long delay recall (F(1,33)=10.36, p=0.003), recognition (F(1,33)=5.69, p=0.02), and naming (F(1,37)=15.86, p<0.001). This indicated that the left ATL group had a significant decrement in verbal memory following surgery, while the right ATL group experienced a small but significant improvement. For the right ATL group, there was a positive correlation between ILAE outcome and improvement in immediate recall (r=-0.62, p=0.02) and long delay recall (r=-0.57, p=0.03). There was no similar finding for the left ATL group. This study demonstrates that short-interval follow-up is effective in elucidating postoperative cognitive changes. Right ATL was associated with improvement in verbal memory, while left ATL resulted in a decrement in performance. Improvement in the right ATL group was related to improved seizure outcome. Short-interval follow-up may lend itself to the identification of patients who could benefit from early intervention.

Memory outcomes following cognitive interventions in children with neurological deficits: A review with a focus on under-studied populations.

Given the primary role of memory in children's learning and well-being, the aim of this review was to examine the outcomes of memory remediation interventions in children with neurological deficits as a function of the affected memory system and intervention method. Fifty-seven studies that evaluated the outcome of memory interventions in children were identified. Thirty-four studies met the inclusion criteria, and were included in a systematic review. Diverse rehabilitation methods for improving explicit and implicit memory in children were reviewed. The analysis indicates that teaching restoration strategies may improve, and result in the generalisation of, semantic memory and working memory performance in children older than 7 years with mild to moderate memory deficits. Factors such as longer protocols, emotional support, and personal feedback contribute to intervention efficacy. In addition, the use of compensation aids seems to be highly effective in prospective memory tasks. Finally, the review unveiled a lack of studies with young children and the absence of group interventions. These findings point to the importance of future evidence-based intervention protocols in these areas.

Can memory and executive functions in patients with obsessive-compulsive disorder predict outcome of cognitive behavioural therapy?

BACKGROUND: Most studies find that patients with obsessive-compulsive disorder (OCD) have impaired memory and executive functions. Cognitive behavioural therapy (CBT) is the recommended psychotherapeutic treatment of patients with OCD. We hypothesized that impairments in memory and executive functions would predict poor outcome of CBT. AIM: To investigate whether memory and executive functions in patients with OCD could predict outcome of CBT. METHODS: We assessed 39 patients with OCD before CBT with neuropsychological tests of memory and executive functions, the Hamilton Depression Rating Scale, and the Global Assessment of Functioning Scale. Furthermore, we assessed severity of OCD symptoms before and after CBT using the Yale-Brown Obsessive Compulsive Scale. RESULTS: There were no statistically significant differences between recovered (41%) and non-recovered patients (59%) on any neuropsychological test variables or on any baseline demographic variables. Furthermore, change in OCD symptoms was not predicted by neuropsychological test performances or baseline severity of OCD symptoms. The only statistically significant finding was that non-recovered patients had lower social functioning before CBT than recovered patients (p = 0.018, d = 0.797). CONCLUSIONS: Memory and executive functions in patients with OCD could not predict outcome of CBT, but level of social functioning may be a predictor of CBT outcome. Some of the main clinical implications are that we cannot use memory and executive functions, or baseline severity of OCD symptoms to determine which patients should be offered CBT.

Neuromodulation therapies for geriatric depression.

Depression is frequent in old age and its prognosis is poorer than in younger populations. The use of pharmacological treatments in geriatric depression is limited by specific pharmacodynamic age-related factors that can diminish tolerability and increase the risk of drug interactions. The possibility of modulating cerebral activity using brain stimulation techniques could result in treating geriatric depression more effectively while reducing systemic side effects and medication interactions. This may subsequently improve treatment adherence and overall prognosis in the older patient. Among clinically available neuromodulatory techniques, electroconvulsive therapy (ECT) remains the gold standard for the treatment of severe depression in the elderly. Studies have proven that ECT is more effective and has a faster onset of action than antidepressants in the treatment of severe, unipolar, geriatric depression and that older age is a predictor of rapid ECT response and remission. The application of novel and more tolerable forms of ECT for geriatric depression is currently being examined. Preliminary results suggest that right unilateral ultrabrief ECT (RUL-UB ECT) is a promising intervention, with similar efficacy to brief-pulse ECT and fewer adverse cognitive effects. Overall findings in repetitive transcranial magnetic stimulation (rTMS) suggest that it is a safe intervention in geriatric depression. Higher rTMS stimulation intensity and more treatments may need to be given in the elderly to achieve optimal results. There is no specific data on vagus nerve stimulation in the elderly. Transcranial direct current stimulation, magnetic seizure therapy and deep brain stimulation are currently experimental, and more data from geriatric samples is needed.

A comparison of automatic and intentional instructions when using the method of vanishing cues in acquired brain injury.

Thirty-four participants with acquired brain injury learned word lists under two forms of vanishing cues - one in which the learning trial instructions encouraged intentional retrieval (i.e., explicit memory) and one in which they encouraged automatic retrieval (which encompasses implicit memory). The automatic instructions represented a novel approach in which the cooperation of participants was actively sought to avoid intentional retrieval. Intentional instructions resulted in fewer errors during the learning trials and better performance on immediate and delayed retrieval tests. The advantage of intentional over automatic instructions was generally less for those who had more severe memory and/or executive impairments. Most participants performed better under intentional instructions on both the immediate and the delayed tests. Although those who were more severely impaired in both memory and executive function also did better with intentional instructions on the immediate retrieval test, they were significantly more likely to show an advantage for automatic instructions on the delayed test. It is suggested that this pattern of results may reflect impairments in the consolidation of intentional memories in this group. When using vanishing cues, automatic instructions may be better for those with severe consolidation impairments, but otherwise intentional instructions may be better.

Memory difficulties are not always a sign of incipient dementia: a review of the possible causes of loss of memory efficiency.

INTRODUCTION OR BACKGROUND: Memory problems are a very common reason for presenting to primary care. There is a need for better treatments for dementia. Increased government and media interest may result in greater number seeking help for memory problems, which may not reduce the dementia gap but rather increase numbers seen who do not have dementia. This review highlights the issues around the diagnostic criteria and terminology used for people with memory complaints. SOURCES OF DATA: A comprehensive literature search using PubMed using keywords for articles on subjective memory decline (SMD)/impairment/complaints, subjective cognitive decline (SCD), mild cognitive impairment (MCI) and functional memory disorder (FMD). AREAS OF AGREEMENT: There is a need for early accurate detection of dementia syndromes so that trials of new treatments can begin earlier on the disease process. AREAS OF CONTROVERSY: Diagnostic criteria and terminology used for disorders of memory including SCD, MCI and FMD. GROWING POINTS: This article reviews SCD and whether this can be used to predict Alzheimer's disease. The review also discusses the terminology used for non-progressive memory problems and the long-term outcomes for this patient group. AREAS TIMELY FOR DEVELOPING RESEARCH: The accurate distinction of premorbid dementia syndromes from benign non-progressive memory problems. Studies of treatment options for people with benign non-progressive memory problems and longer-term follow-up to determine which patients develop chronic problems.