Suitability of memory aids and strategies for people with posterior cortical atrophy: protocol for a scoping review.

BACKGROUND: Posterior cortical atrophy (PCA) is a neurodegenerative syndrome characterised by progressive visuospatial and visuoperceptual impairment. Recent research shows that memory impairment can also occur as an early symptom of the condition and that the impairment can be ameliorated by providing support in the memory recall phase, for example, by presenting a related cue. In Alzheimer's disease (AD), which is defined by an amnestic syndrome, memory aids and strategies have been used to help support everyday memory, which in turn can have a positive impact on patient and carer outcomes. Similar support for PCA could be achieved by using memory aids and strategies which help to encode and/or retrieve information, yet there are currently no guidelines for memory strategies that may be suitable in PCA. Due to the central visual disorder that defines PCA, careful consideration is needed when making recommendations. METHODS: A scoping review will be conducted of published studies that have assessed memory aids and strategies in people with AD and related dementias where memory is considered a core or supplementary feature, with the aim of distinguishing those that may be suitable or adaptable for PCA. The systematic search will include the electronic databases MEDLINE, PsycINFO and CINAHL, using search terms for dementia and memory aids and strategies identified in pilot searches. Findings will be mapped and described based on methods used, population, clinical data and memory aids and strategies identified. DISCUSSION: The scoping review will give an overview of the memory aids and strategies used in people with AD and related dementias and identify characteristics, modality and pragmatics to evaluate their suitability and adaptability for a PCA population. Tailored memory support strategies for people living with PCA could improve memory performance, with knock-on positive effects on patient and carer outcomes.

Utility of a novel tablet computer software for memory impairment in participants with brain injuries: A randomized control trial.

This study examined the effectiveness of a novel information and communication technology (ICT) tool developed for external memory compensation to improve memory function in participants with brain injuries. In this 3-month randomized control study, participants with memory impairment secondary to brain injury were randomly assigned on a 1:1 basis to either intervention (the ICT tool [ARATA]) or 3-month waitlist control groups. This study's primary outcome measure was memory-related difficulties in everyday life, assessed using the Everyday Memory Checklist (EMC). Secondary outcomes included tests for memory function and psychosocial status, all of which were administered by blinded assessors. Seventy-eight participants (53 males, 25 females; mean age, 43.5 ± 12.7 [SD] years) were enrolled and 39 participants were allocated to each group (intervention and control). There was no significant difference in EMC scores between the two groups throughout the study (mean 0.26; 95% CI: -2.55-3.07; p=0.853); however, the intervention group scored significantly higher on the Rivermead Behavioural Memory and General Self-Efficacy tests compared to the control group. While the ICT tool did not improve the primary study outcome, evidence suggests that the ICT tool can improve memory functions related to activities of daily living.

Practitioners' knowledge, acceptability and use of external memory aids with individuals with cognitive deficits: An exploratory study.

External memory aids (EMA) are within the most effective cognitive rehabilitation techniques, having demonstrated a positive impact in terms of memory functioning in individuals with multiple cognitive deficits. Despite its proven efficacy, there is yet poor dissemination of these techniques in clinical settings. The current study aims to evaluate the level of knowledge, degree of use, and usage expectations of EMAs by health practitioners, responsible to implement these techniques. A quantitative, descriptive, and cross-sectional study was developed, and 120 practitioners working with cognitively impaired patients participated in the study. One questionnaire was developed to assess participants' knowledge and use of EMAs. Results indicate that the level of global knowledge regarding EMAs is poor, despite superior to its actual use. The degree of perceived acceptance of these prosthetics by their users is positive and stronger than the likelihood of practitioners to use these tools with their patients. This study suggests that the actual implementation of EMAs as rehabilitation tools is still poor, despite the growing evidence-based research highlighting its effectiveness to compensate for cognitive deficits. Future studies should target the current factors that are influencing the underutilization of EMAs, to improve and optimize its dissemination and to benefit cognitively impaired patients.

Enhancing Documentation Precision in Ophthalmic Surgery: A Quality Improvement Project.

Background Effective clinical documentation, particularly operative notes, is essential for maintaining healthcare standards and fostering interdisciplinary communication. This study focuses on improving the quality of ophthalmic operative notes by adopting the Royal College of Surgeons (RCS) guidelines for good surgical practice. Methodology A retrospective cross-sectional audit at Khyber Teaching Hospital, Pakistan, assessed 138 operative notes against the RCS criteria. After an educational session and the placement of memory aids in operation theaters, a re-audit of 125 notes was conducted. Parameters were selectively applied based on relevance to specific cases, and omissions were discussed with the local ethical committee. Results The initial audit revealed deficiencies in 10 critical areas, with only three parameters exceeding 85% accuracy. The re-audit showed significant improvement across these parameters, achieving documentation of 85.3% of all criteria. Paired t-test results indicated a substantial difference in documentation quality before and after interventions. Conclusions A combined strategy involving surgeon education, memory aids, and adherence to established standards significantly enhances operative note quality. The study underscores the importance of sustained reinforcement mechanisms for continuous improvements in documentation practices.

Memory rehabilitation: restorative, specific knowledge acquisition, compensatory, and holistic approaches.

Memory impairment following an acquired brain injury can negatively impact daily living and quality of life-but can be reduced by memory rehabilitation. Here, we review the literature on four approaches for memory rehabilitation and their associated strategies: (1) the restorative approach, aimed at a return to pre-morbid functioning, (2) the knowledge acquisition approach, involving training on specific information relevant to daily life, (3) the compensatory approach, targeted at improving daily functioning, and (4) the holistic approach, in which social, emotional, and behavioral deficits are addressed alongside cognitive consequences of acquired brain injury. Each memory rehabilitation approach includes specific strategies such as drill and practice (restorative), spaced retrieval (knowledge acquisition), memory aids (compensatory), or a combination of psychotherapy and cognitive strategies (holistic). Past research has demonstrated mixed support for the use of restorative strategies to improve memory function, whereas knowledge acquisition strategies show promising results on trained tasks but little generalization to untrained tasks and activities of daily living. Compensatory strategies remain widely used but require intensive training to be effectively employed. Finally, the holistic approach is becoming more widespread due to improvements in psychosocial wellbeing, yet there are considerable resource and cost requirements. Several factors can influence rehabilitation outcomes including metacognition and emotional disturbances. Considerations for future research to improve the applicability of strategies for memory rehabilitation include assessing memory impairment severity, examining memory needs in daily life, and exploring the long-term effects of memory rehabilitation.

Aiding Adherence to Glaucoma Medications: A Systematic Review.

PURPOSE: To provide a comprehensive assessment of the strategies studied to date that focus on improving glaucoma medication adherence. METHODS: A systematic review of the literature was conducted in MEDLINE (PubMed), Embase (Elsevier), and Scopus (Elsevier) from inception to March 1, 2021, of publications describing a device or strategy used to improve glaucoma medication adherence. RESULTS: 42 studies described by 50 papers were included. Five categories were identified: reminder systems, medication simplifications, behavioral change programs, education, and alternative engagement strategies. CONCLUSION: Most studies (40 of the 42) addressed the question of improved adherence directly, with 26 finding improved adherence. Notably, 14 examined the clinical effects of the intervention, either in terms of intraocular pressure (IOP) or visual fields. Only three found an improvement in IOP. None demonstrated a between group difference in visual field progression.

A Novel IoT Based Positioning and Shadowing System for Dementia Training.

A rapid increase in the number of patients with dementia, particularly memory decline or impairment, has led to the loss of self-care ability in more individuals and increases in medical and social costs. Numerous studies, and clinical service experience, have revealed that the intervention of nonpharmacological management for people with dementia is effective in delaying the degeneration caused by dementia. Due to recent rapid developments in information and communications technology, many innovative research and development and cross-domain applications have been effectively used in the dementia care environment. This study proposed a new short-term memory support and cognitive training application technology, a "positioning and shadowing system," to delay short-term memory degeneration in dementia. Training courses that integrate physical and digital technologies for the indoor location of patients with dementia were constructed using technologies such as Bluetooth Low Energy, fingerprint location algorithm, and short-range wireless communication. The Internet of Things was effectively applied to a clinical training environment for short-term memory. A pilot test verified that the results demonstrated learning effects in cognitive training and that the system can assist medical personnel in training and nursing work. Participants responded with favorable feedback regarding course satisfaction and system usability. This study can be used as a reference for future digital smart cognitive training that allows observation of the performance of patients with dementia in activities of daily living.

The Dementia Early Stage Cognitive Aids New Trial (DESCANT) intervention: A goal attainment scaling approach to promote self-management.

OBJECTIVES: This study investigated goals identified by people with dementia and their carers to promote the self-management of symptoms and abilities; measured achievement using goal attainment scaling (GAS); and explored the reflections of Dementia Support Practitioners (DSPs) facilitating it. METHODS AND DESIGN: Within this pragmatic randomised trial, DSPs gave memory aids, training and support to people with mild to moderate dementia and their carers at home. Data were collected across seven NHS Trusts in England and Wales (2016-2018) and abstracted from intervention records and semi-structured interviews with DSPs delivering the intervention, supplemented by a subset of the trial dataset. Measures were created to permit quantification and descriptive analysis and interview data thematically analysed. A GAS measure for this intervention in this client group was derived. RESULTS: Engagement was high across the 117 participants and 293 goals were identified. These reflected individual circumstances and needs and enabled classification and assessment of their attainment. Seventeen goal types were identified across six domains: self-care, household tasks, daily occupation, orientation, communication, and well-being and safety. On average participants achieved nominally significant improvement regarding the specified goals of 1.4 with standard deviation of 0.6. Five interviews suggested that DSPs' experiences of goal setting were also positive. CONCLUSIONS: GAS is useful for assessing psychosocial interventions for people with early-stage dementia. It has a utility in identifying goals, promoting self-management and providing a personalised outcome measure. There is a strong case for exploring whether these clear benefits translate to other interventions in other populations in other places.

Cuing Prospective Memory With Smartphone-Based Calendars in Alzheimer's Disease.

OBJECTIVES: We investigated the effect of using smartphone-based calendars (Google and Outlook Calendar) on prospective memory in Alzheimer's disease (AD). METHODS: we recruited two groups of participants with mild AD. In one group, prospective memory was cued by a paper-and-pencil calendar, whereas in the second group prospective memory was cued by a smartphone calendar application. After 2 weeks of training to familiarize the participants with calendar use, we invited participants to perform three prospective events per week (e.g., remembering to go to the grocery store) during a 3-week period. Events were cued either by the paper- or smartphone-based calendar. RESULTS: we observed fewer omissions of prospective events in the smartphone-based calendar group than in the paper-based calendar group. CONCLUSIONS: our study suggests positive effects of smartphone calendar applications on prospective memory in AD.

A comparison of different types of prospective memory reminders in schizophrenia.

People with schizophrenia often experience difficulties with prospective memory (PM), but few empirical studies have directly compared the effectiveness of different types of reminders in remediating these difficulties. In the present study, two distinct types of reminders were compared to a standard (no reminder) condition in outpatients with schizophrenia (n = 30) and controls (n = 30). Using an adapted version of the well-validated laboratory PM measure, Virtual Week, participants were asked to complete three different conditions (counterbalanced), in which they were (i) provided with access to self-initiated reminders, (ii) provided with experimenter-initiated reminders, and (iii) completed a standard (no-reminder) condition. Both groups benefited from the provision of reminders, but self-initiated reminders were the most beneficial, particularly for time-based tasks. These data align with a broader literature that shows PM can be enhanced by the use of reminders. However, it extends this literature in an important way by showing that these benefits are equivalent for people with schizophrenia, and may be greatest where access to reminders is self-initiated. The implications of these data for the development of rehabilitative interventions are discussed.

Cognitive aids for people with early stage dementia versus treatment as usual (Dementia Early Stage Cognitive Aids New Trial (DESCANT)): study protocol for a randomised controlled trial.

BACKGROUND: There is a growing need for an evidence-based approach to home support for people with dementia and their carers following diagnosis but research on the effectiveness and cost-effectiveness of different approaches is sparse. The Dementia Early Stage Cognitive Aids New Trial (DESCANT) will evaluate the clinical and cost-effectiveness of a range of memory aids, training and support to people with mild to moderate dementia and their carers at home and compares that intervention with treatment as usual. METHODS/DESIGN: This is a multi-site, pragmatic randomised trial preceded by a feasibility study and internal pilot. We aim to allocate at random 360 pairs comprising a person with mild to moderate dementia and an identified carer between the DESCANT intervention and treatment as usual. We assess participants at baseline, 13 and 26 weeks. The primary outcome measure is the Bristol Activities of Daily Living Scale; other participant outcomes include cognition, quality of life, activities of daily living and social networking; carer outcomes include quality of life, sense of competence and mental health. To enhance this quantitative evaluation we are conducting a qualitative component and a process evaluation to assess the implementation process and identify contextual factors associated with variation. DISCUSSION: The DESCANT intervention reflects current policy to enhance the capabilities of people with dementia after diagnosis and their carers. If it is clinically and cost-effective, its modest nature and cost will enhance the likelihood of it being incorporated into mainstream practice. TRIAL REGISTRATION: Current Controlled Trials, ISRCTN12591717 . Registered on 29 July 2016. Protocol number: 31288: North West - Haydock Research Ethics Committee, 20/06/2016, ref.: 16/NW/0389.

External memory aids for memory problems in people with multiple sclerosis: A systematic review.

Approximately 40-60% of people with multiple sclerosis (MS) have memory problems, which adversely impact on their everyday functioning. Evidence supports the use of external memory aids in people with stroke and brain injury, and suggests they may reduce everyday memory problems in people with MS. Previous reviews of people with MS have only evaluated randomised trials; therefore this review included other methodologies. The aim was to assess the efficacy of external memory aids for people with MS for improving memory functioning, mood, quality of life, and coping strategies. Seven databases were systematically searched. Intervention studies that involved training in the use of external memory aids, e.g., personal digital assistants, with at least 75% of people with MS, were included. Based on study design, quality was rated with the SCED or PEDro scale. Nine studies involving 540 participants were included. One single case experimental design (mean of 8 on SCED scale) and eight group studies (mean of 5 on PEDro scale) were included. One study reported a significant treatment effect on subjective memory functioning, two on mood, and two on coping strategies. There is insufficient evidence to support or refute the effectiveness of external memory aids for improving memory function in people with MS.

Technological memory aid use by people with acquired brain injury.

Evans, Wilson, Needham, and Brentnall ( 2003 ) investigated memory aid use by people with acquired brain injury (ABI) and found little use of technological memory aids. The present study aims to investigate use of technological and other memory aids and strategies 10 years on, and investigate what predicts use. People with ABI and self-reported memory impairments (n = 81) completed a survey containing a memory aid checklist, demographic questions and memory questionnaires. Chi-square analysis showed that 10 of 18 memory aids and strategies were used by significantly more people in the current sample than in Evans et al. ( 2003 ). The most commonly used strategies were leaving things in noticeable places (86%) and mental retracing of steps (77%). The most commonly used memory aids were asking someone to remind you (78%), diaries (77%), lists (78%), and calendars (79%) and the most common technologies used were mobile phone reminders (38%) and alarms/timers (38%). Younger people who used more technology prior to their injury and who use more non-technological memory aids currently were more likely to use technology. Younger people who used more memory aids and strategies prior to their injury and who rated their memory as poorer were more likely to use all types of memory aids and strategies.

Checking the lists: A systematic review of electronic checklist use in health care.

OBJECTIVE: We conducted a literature search to examine the effects and experiences surrounding the transition from paper to electronic checklists in healthcare settings. We explore the types of electronic checklists being used in health care, how and where they were evaluated and seek to identify the successes and failures of using electronic checklists in healthcare, including use of checklists to ensure completeness of documentation in the electronic medical record. BACKGROUND: Formalized checklist use as a memory and decision aid in aviation has resulted in significant increases in safety in that domain. Checklists have also been successfully introduced to reduce errors in some areas of healthcare; however, in some contexts checklists failed to provide some of the expected benefits. Adapting and integrating checklists electronically into the healthcare workflow provides opportunities and challenges that need to be better understood to make checklist adoption a success in health care. METHOD: We conducted a literature search of the English language literature in MEDLINE using PubMed for peer-reviewed literature of implementation and use of electronic or computerized checklists related to clinical or healthcare use. We reviewed the studies and included in this review those papers that discussed in depth the development process and that conducted controlled studies to assess the effectiveness of checklists and the evaluation of their acceptance in the clinical context. RESULTS: The literature search using the keywords electronic checklist OR computerized checklist returned a total of 23 peer-reviewed papers. Out of these 15 were included in the review, with 8 excluded because they did not evaluate checklist use for patient care. APPLICATION: More rigorous application of known principles and methods from Human Computer Interaction research and the behavioral sciences can provide a clearer, more comprehensive understanding of the conditions that affect the development and use of checklists.

Smartphones as assistive technology following traumatic brain injury: a preliminary study of what helps and what hinders.

PURPOSE: Smartphones have great potential as a convenient, multifunction tool to support cognition and independence following traumatic brain injury (TBI). However, there has been limited investigation of their helpful and less helpful aspects for people with TBI. We aimed to investigate patterns of smartphone use amongst individuals with TBI, identify potential barriers to use, and examine the relationships between smartphone use and daily functioning. METHOD: Twenty-nine participants with TBI and 33 non-injured participants completed the Smartphone Survey, and measures of subjective and objective cognitive functioning, mood, and community integration. RESULTS: Smartphone use was equally common in both groups, and patterns of app use were similar. More participants with TBI than the comparison group listed using their smartphone as a memory aid as its main benefit. Difficulty in learning how to use the smartphone was identified by participants with TBI, however only 10% had been shown how to use it by a clinician. Those with poorer subjective cognitive function used memory/organisational apps more frequently; and higher communication app use with better social integration, in participants with TBI. CONCLUSIONS: These findings suggest that smartphones have potential in improving independence following TBI, but receiving support in using them is vital. Implications for Rehabilitation Smartphones are accessible, acceptable, convenient devices for most individuals with traumatic brain injury (TBI), and are perceived as a useful memory and organizational aid as well as having multiple other helpful functions. Use of communication apps such as text messages and social media is associated with better social and community integration in people with TBI. Direct instruction on how to use smartphone apps is more important for people with TBI than for non-injured individuals. Developers of apps designed for this population should prioritize ease of app use, large displays, and availability of technical support, while maintaining an engaging design and interface.

Creating external reminders for delayed intentions: dissociable influence on "task-positive" and "task-negative" brain networks.

Studies of prospective memory and other paradigms requiring participants to remember delayed intentions typically reveal a distinction between lateral and medial rostral prefrontal cortex, whereby the experimental condition yields increased signal in the former region and decreased signal in the latter. These regions comprise nodes of larger "task-positive" and "task-negative" networks that often show opposite patterns of signal change in response to diverse cognitive demands. However, it is not clear to what extent activity in these networks is A) inverse but equivalent, or B) functionally dissociable. In order to address this question, participants performed an "intention-offloading" task while undergoing fMRI. On each trial they remembered a delayed intention, which they had the opportunity to fulfill after a brief filled delay. In one condition they were required to set an external reminder of this intention, while in the other they acted without any external memory aid. Results indicated a clear functional dissociation between the two networks. Compared with a control task with no delayed intention, there was a highly significant reduction in task-negative deactivation when participants used an external memory aid. However, there was no reduction in task-positive activation. These results are consistent with previous evidence that medial rostral prefrontal cortex plays a prominent role in representing the content of delayed intentions, accompanied by a reduction in BOLD signal and potentially increased theta-band oscillatory activity. This role is no longer required once an external reminder has been created. By contrast, lateral rostral prefrontal cortex may play a content-free role, unaffected by the offloading of content into the external environment.

mHealth and memory aids: levels of smartphone ownership in patients.

BACKGROUND: The use of mobile devices to deliver healthcare has not yet been exploited in neuropsychological rehabilitation. Smartphones have the potential to serve as multi-functional memory aids. AIMS: To investigate whether patients attending a clinic for mixed memory problems own smartphones, to determine whether this could be a widely applicable medium to use as a memory aids device. METHODS: A questionnaire on smartphone ownership was given to an opportunity sample of consecutive patients attending a neuropsychiatry and memory disorders outpatient clinic. Data were collected in 2012 and repeated 12 months later in 2013 to assess changes over time. RESULTS: Ownership of mobile phones was stable between 2012 (81%) and 2013 (85%), but ownership of smartphones showed a significant increase (from 26% to 40%). Age negatively predicted smartphone ownership. CONCLUSION: Despite cognitive or psychiatric problems, our patient group are as likely to own a mobile phone as a member of the general population. Ownership levels are at 40% and likely to increase in the future. Exploring how smartphones and their apps could function as memory aids is likely to be useful for a large enough number of patients to be clinically worthwhile.

An exploratory study of the effectiveness of memory AIDS for older people living in supported accommodation.

There is increasing evidence that electronic and other aids can support older people's memory. In an effectiveness study, we explored whether assistive technologies could benefit 200 potential beneficiaries in a naturalistic setting. We first interviewed 50 participants to assess needs and preferences for memory aids, then researched, developed and trialled specific aids, and finally administered a follow-up questionnaire assessing future use of aids. Matching aids to needs was not easy. Relatively few people were interested in trailing aids. Simpler aids were most successful. Participants were curious about electronic aids, but found them too complicated and not adapted enough to their needs. Assistance from other people was necessary to prompt use of all types of aids. Future effectiveness studies should focus on longer trials with greater training and support for participants, a wider range of technologies, and more promotion of possible benefits.

SenseCam reminiscence and action recall in memory-unimpaired people.

Case studies of memory-impaired individuals consistently show that reminiscing with SenseCam images enhances event recall. This exploratory study examined whether a similar benefit would occur for the consolidation of memories in memory-unimpaired people. We tested delayed recall for atypical actions observed on a lengthy walk. Participants used SenseCam, a diary, or no external memory aid while walking, followed by reminiscence with SenseCam images, diary entries, or no aid, either alone (self-reminiscence) or with the experimenter (social reminiscence). One week later, when tested without SenseCam images or diary entries, prior social reminiscence produced greater recall than self-reminiscence, but there were no differences between memory aid conditions for action free recall or action order recall. When methodological variables were controlled, there was no recall advantage for SenseCam reminiscence with memory-unimpaired participants. The case studies and present study differ in multiple ways, making direct comparisons problematic. SenseCam is a valuable aid to the memory impaired, but its mnemonic value for non-clinical populations remains to be determined.