What is the locus of the errorless-learning advantage?

In two experiments involving word-stem completion, an advantage was found for errorless over errorful-learning conditions, for both severely and moderately memory-impaired participants. This advantage did not depend on the implicit/explicit nature of the question asked. Additional tests showed that subsequent recognition of target items was good for both groups, but only in the absence of lures derived from participants' prior errors. Source-memory was shown to be virtually absent in the severely impaired group and only weakly present in the moderately impaired group. This combination of results suggests that preserved implicit memory, in the absence of explicit memory, is sufficient for an errorless-learning advantage to accrue.

Relearning face-name associations in early Alzheimer's disease.

Preliminary evidence for the effectiveness of cognitive rehabilitation interventions based on errorless learning principles in early-stage Alzheimer's disease (AD) was provided by Clare et al. (1999, 2000, 2001). The present study extends these findings in a controlled trial. Twelve participants meeting criteria for probable AD, with Mini-Mental State Examination scores of 18 or above, were trained in face-name associations using an errorless learning paradigm. Training produced a significant group improvement in recall of trained, but not control, items. Gains were largely maintained 6 months later, in the absence of practice. There were differences in individual response to intervention. Results did not differ according to medication status, and the intervention had no adverse effects on self-reported well-being, but participants who were more aware of their memory difficulties achieved better outcomes.

Awareness in early-stage Alzheimer's disease: relationship to outcome of cognitive rehabilitation.

Awareness of difficulties may have an important impact on functioning and response to intervention in early-stage Alzheimer's disease (AD). Clinical reports and retrospective studies suggest an association, but this has not previously been tested in a prospective study. Using a new measure of awareness, the Memory Awareness Rating Scale (MARS), which was designed to take account of methodological limitations identified in a review of previous studies, the present study explored the relationship between awareness of difficulties and outcome of a cognitive rehabilitation (CR) intervention in 12 participants with a diagnosis of early-stage Alzheimer's disease. The relationship between awareness and mood, behaviour and executive function was also assessed. The results provide the first demonstration in a prospective study that higher levels of awareness are related to better CR outcomes. Awareness was associated with depression and reported behaviour problems, but not with performance on tests of executive function. These results suggest that variations in level of awareness in early-stage AD are influenced by psychological factors, and that explanatory models need to take these factors into account. Awareness of difficulties may serve as a useful predictor of the likely effectiveness of CR, andthis may assist clinicians in selecting appropriate interventions for individuals with early-stage AD.

Depression and anxiety in memory clinic attenders and their carers: implications for evaluating the effectiveness of cognitive rehabilitation interventions.

BACKGROUND: The potential of cognitive rehabilitation (CR) for people who have a diagnosis of Alzheimer's disease (AD) is increasingly being recognised. It has been suggested, however, that interventions targeting memory functioning in AD have negative effects on the well-being of participants and carers in terms of mood and perceived strain. While some 'memory training' studies do report an increase in self-report scores on scales assessing these variables, it is not clear whether the changes are attributable to the intervention. There is some overlap between CR and 'memory training', but CR is a much more individualised approach, and therefore CR intervention studies often adopt within-subjects or single case experimental designs, for which relevant comparison data are required. METHOD: Participant and carer depression and anxiety, and carer strain, were assessed at initial attendance and again by postal survey 6 months later in a consecutive series of 94 Memory Clinic referrals who received standard treatment but no specialised CR interventions. RESULTS: At the group level, there were no statistically significant changes in scores at follow up, although the participants scoring above designated cut-points were not necessarily the same individuals at the two time points. CONCLUSIONS: The study provided useful comparison data for use in evaluating the effects of cognitive rehabilitation interventions on mood and carer strain, showing that in the absence of intervention scores remain generally stable over time. Significant changes observed in intervention studies should be viewed in this context.