The benefits of errorless learning for people with amnestic mild cognitive impairment.

The aim of this study was to explore whether errorless learning leads to better outcomes than errorful learning in people with amnestic mild cognitive impairment (MCI), and to examine whether accuracy in error recognition relates to any observed benefit of errorless over errorful learning. Nineteen participants with a clinical diagnosis of amnestic MCI were recruited. A word-list learning task was used and learning was assessed by free recall, cued recall and recognition tasks. Errorless learning was significantly superior to errorful learning for both free recall and cued recall. The benefits of errorless learning were less marked in participants with better error recognition ability. Errorless learning methods are likely to prove more effective than errorful methods for those people with MCI whose ability to monitor and detect their own errors is impaired.

Phenomena of awareness in dementia: heterogeneity and its implications.

Despite much research on the relationship between awareness and dementia little can be concluded concerning their relationship and the role of other factors. It is likely that studies capture different phenomena of awareness. This study aimed at identifying and delineating such variation by analysing data from three questionnaires obtained during the longitudinal study of awareness in 101 people with early-stage dementia. The data concerned awareness in relation to memory, activities of daily living and socio-emotional function. Significant differences in patterns of discrepancies were obtained. This suggests that the awareness phenomena involved were structurally different; and that, in turn, this may reflect variation in the intrinsic linking between awareness and its 'object' (different 'objects' determining different kinds of judgements). The identification of such differences is necessary so that appropriate methodologies can be applied to the study of awareness in different contexts.

Memory awareness profiles differentiate mild cognitive impairment from early-stage dementia: evidence from assessments of performance monitoring and evaluative judgement.

BACKGROUND: Measures of memory awareness based on evaluative judgement and performance monitoring are often regarded as equivalent, but the Levels of Awareness Framework suggests they reflect different awareness phenomena. Examination of memory awareness among groups with differing degrees of impairment provides a test of this proposition. METHOD: Ninety-nine people with dementia (PwD), 30 people with mild cognitive impairment (PwMCI), and their relatives completed isomorphic performance monitoring and evaluative judgement measures of memory awareness and were followed up at 12 and (PwD only) 20 months. In addition to the resulting awareness indices, comparative accuracy scores were calculated using the relatives' data to establish whether any inaccuracy was specific to self-ratings. RESULTS: When making evaluative judgements about their memory in general, both PwD and PwMCI tended to overestimate their own functioning relative to informant ratings made by relatives. When monitoring performance on memory tests, PwD again overestimated performance relative to test scores, but PwMCI were much more accurate. Comparative accuracy scores indicated that, unlike PwD, PwMCI do not show a specific inaccuracy in self-related appraisals. CONCLUSIONS: The results support the proposition that awareness indices at the levels of evaluative judgement and performance monitoring should be regarded as reflecting distinct awareness phenomena.

Meta-representational awareness in mild cognitive impairment: an interpretative phenomenological analysis.

Awareness in mild cognitive impairment (MCI) has been studied primarily from a quantitative perspective, which has yielded inconclusive results. A qualitative approach may provide a more in-depth profile of awareness of symptoms and changes among people living with MCI. Few qualitative studies have considered awareness in MCI; therefore, the focus here will be on the experience of living with MCI, and particularly on the psychological impact of living with memory difficulties and how these impact on daily life. Twenty five participants with a clinical diagnosis of MCI who had been informed of their diagnosis were interviewed. Interpretative phenomenological analysis was used to analyse interview transcripts. Four higher order themes were identified. An exploratory model is proposed with a dominant theme of 'Fear and uncertainty'; this underpins 'Interdependence', 'Life goes on as normal' and 'Disavowal of difficulty' which are representative of coping responses resulting from appraisal of memory and cognitive difficulties. Participants did not use the term 'MCI', suggesting that this term had little meaning for them; nevertheless, there was a wish for a definitive explanation of the difficulties. The themes elicited from participant accounts indicate that the symptoms of MCI are perceived as a threat to psychological well-being which results in context-specific appraisal of the symptoms of MCI.

Dissociation between implicit and explicit manifestations of awareness in early stage dementia: evidence from the emotional Stroop effect for dementia-related words.

OBJECTIVE: To determine whether people with dementia (PwD), and carers of PwD, show a processing bias to dementia-related words in an emotional Stroop task, and if so, whether the presence of such a bias is related to level of explicit awareness of the condition. METHOD: Seventy-nine people with early stage Alzheimer's disease (AD), vascular or mixed dementia, and their carers, completed an emotional Stroop task. Time taken to colour-name dementia-related and neutral words was compared within and between groups. Additionally, as a comparison, ratings of the awareness of the condition shown by PwD were made on the basis of a detailed interview with each PwD and his/her carer. RESULTS: PwD and carers showed the same level of increase in response times to salient compared to neutral words. In the PwD this effect was unrelated to the degree of awareness that they demonstrated regarding the condition. CONCLUSIONS: The emotional Stroop effect in response to dementia-related words in PwD indicates that preserved implicit awareness of the condition can be elicited even where there is reduced explicit awareness.