EXPRESS: The Impact of Subtle Contextual Information on Remembering to Complete Academic Goals.

Remembering to complete goals-termed prospective memory (PM)-is critical for success in everyday life, yet minimal empirical work has been dedicated to examining prospective memory within an educational setting. The main goal of this study was to investigate students' ability to complete numerous future-oriented academic intentions (PM tasks) while simultaneously paying attention to a lecture and to see if working memory capacity (WM) and adding subtle contextual information would support the students' likelihood of completing their PM tasks. Participants took part in a 2-hour session of college course-like activities. Throughout the session, there was occasionally the opportunity to complete one of several naturalistic PM tasks. The following findings are based on the results of our Bayesian models. Providing subtle contextual clues about when PM tasks could be completed was found to likely increase performance. The number of PM intentions to be remembered (i.e., load) produced no discernable effect on ongoing task performance or PM performance. Furthermore, individual differences in WM capacity were likely to be predictive of a near-zero change in PM performance. The current findings hold meaningful implications for educators, wherein providing context, even at a subtle level, can enhance students' ability to remember to complete tasks, without altering their ability to focus on the tasks at hand. Moreover, it appears that asking students to remember to complete multiple, prospective in-class tasks is not likely to hinder task completion or their ability to focus on other ongoing tasks.

Randomized Controlled Comparative Effectiveness Trial of Risk Model-Guided Clinical Decision Support for Suicide Screening.

Suicide prevention requires risk identification, appropriate intervention, and follow-up. Traditional risk identification relies on patient self-reporting, support network reporting, or face-to-face screening with validated instruments or history and physical exam. In the last decade, statistical risk models have been studied and more recently deployed to augment clinical judgment. Models have generally been found to be low precision or problematic at scale due to low incidence. Few have been tested in clinical practice, and none have been tested in clinical trials to our knowledge. Methods: We report the results of a pragmatic randomized controlled trial (RCT) in three outpatient adult Neurology clinic settings. This two-arm trial compared the effectiveness of Interruptive and Non-Interruptive Clinical Decision Support (CDS) to prompt further screening of suicidal ideation for those predicted to be high risk using a real-time, validated statistical risk model of suicide attempt risk, with the decision to screen as the primary end point. Secondary outcomes included rates of suicidal ideation and attempts in both arms. Manual chart review of every trial encounter was used to determine if suicide risk assessment was subsequently documented. Results: From August 16, 2022, through February 16, 2023, our study randomized 596 patient encounters across 561 patients for providers to receive either Interruptive or Non-Interruptive CDS in a 1:1 ratio. Adjusting for provider cluster effects, Interruptive CDS led to significantly higher numbers of decisions to screen (42%=121/289 encounters) compared to Non-Interruptive CDS (4%=12/307) (odds ratio=17.7, p-value <0.001). Secondarily, no documented episodes of suicidal ideation or attempts occurred in either arm. While the proportion of documented assessments among those noting the decision to screen was higher for providers in the Non-Interruptive arm (92%=11/12) than in the Interruptive arm (52%=63/121), the interruptive CDS was associated with more frequent documentation of suicide risk assessment (63/289 encounters compared to 11/307, p-value<0.001). Conclusions: In this pragmatic RCT of real-time predictive CDS to guide suicide risk assessment, Interruptive CDS led to higher numbers of decisions to screen and documented suicide risk assessments. Well-powered large-scale trials randomizing this type of CDS compared to standard of care are indicated to measure effectiveness in reducing suicidal self-harm. ClinicalTrials.gov Identifier: NCT05312437.

Ebola salience, death-thought accessibility, and worldview defense: A terror management theory perspective.

According to terror management theory, individuals defend their cultural beliefs following mortality salience. The current research examined whether naturally occurring instances of death (i.e., Ebola) correspond to results found in laboratory studies. The results of two experiments demonstrated that participants experienced a greater accessibility of death-related thoughts in response to an Ebola prime during a regional outbreak. Study 2 also showed that increased mortality awareness following an Ebola manipulation was associated with greater worldview defense (i.e., religious fundamentalism). Together, these results suggest that reminders of death in the form of a disease threat operate similarly to a mortality salience manipulation.

Improving Prospective Memory in Healthy Older Adults and Individuals with Very Mild Alzheimer's Disease.

OBJECTIVES: To test the utility of a memory-encoding strategy for improving prospective memory (PM), the ability to remember to execute future goals (e.g., remembering to take medications), which plays an important role in independent living in healthy older adults and those with very mild Alzheimer's disease (AD). DESIGN: Participants were randomly assigned to an encoding strategy condition or a standard encoding condition. SETTING: A longitudinal study conducted at an Alzheimer's disease research center. Testing took place at the center and in a university testing room. PARTICIPANTS: Healthy older adults (Clinical Dementia Rating (CDR) = 0.0, n = 38) and those classified as being in the very mild stage of AD (CDR = 0.5, n = 34). INTERVENTION: A simple strategy ("If I see Cue X, then I will perform Intention Y") was used to strengthen PM encoding and reduce the probability of forgetting to execute one's future plans. MEASUREMENTS: PM was assessed using Virtual Week, a laboratory task that requires the simulation of common PM tasks (the types of tasks performed in everyday life), such as taking one's medication at breakfast. RESULTS: The encoding strategy significantly reduced PM failures in healthy older adults and those with very mild AD and was effective regardless of the individual's episodic memory ability. CONCLUSION: This encoding strategy was successful in reducing PM errors in healthy older adults and those with mild AD with a range of memory abilities.

A fresh pair of eyes on prospective memory monitoring.

Remembering to complete one's future intentions is termed prospective memory. We employed a new eyetracking paradigm to concretely observe the impact of environmental cues on strategic monitoring within a visual prospective memory task. Participants worked on a continuous living-count task comprising images, while simultaneously being asked to respond to a prospective memory target when it appeared. Importantly, the prospective memory target appeared in a different area of the participant's visual field than did the continuous task, which is consistent with prospective memory in many real-world situations, and further allows for a clear index of strategic monitoring processes. Subtle cues in the form of semantically related images were embedded in the continuous task to prompt monitoring for the prospective memory target. Overt strategic monitoring was operationalized as the number of times participants fixated on the designated target area, and cue-driven monitoring was defined by the number of fixations on the prospective memory target region directly after fixating on a related cue. Overt strategic monitoring for the prospective memory target was directly observed for participants in the prospective memory condition, and cue-driven monitoring was also observed in these participants, since they were more likely to initiate monitoring immediately after fixating on a semantically related cue, relative to an unrelated cue. This psychophysiological approach afforded precise measurement of the strategic monitoring process and revealed how contextual cues in the environment interact with the cognitive mechanisms supporting prospective memory.

An implementation intention strategy can improve prospective memory in older adults with very mild Alzheimer's disease.

OBJECTIVES: This study tested whether (1) very mild Alzheimer's disease (AD) is associated with impaired prospective memory (PM) for tasks that are supported by either spontaneous retrieval (focal PM) or strategic monitoring (non-focal PM) and (2) implementation intention (II) encoding could improve PM performance in very mild AD. DESIGN: Thirty-eight healthy older adults and 34 with very mild AD were randomly assigned to perform two PM tasks in either the standard or the II encoding condition. METHOD: All participants performed blocks of category decision in which they were asked to respond to a focal PM target (e.g., the word 'orange') and a non-focal PM target (e.g., words that begin with the letter 'o'). Half of the participants encoded PM instructions in the standard manner, while the other half had a stronger encoding by forming IIs. PM accuracy and category decision accuracy and reaction times were measured. RESULTS: Participants with very mild AD showed deficits in both focal and non-focal PM performance compared to the healthy controls, reflecting deficits in both spontaneous retrieval and strategic monitoring. Participants with very mild AD in the II encoding condition showed better focal PM performance relative to those in the standard encoding condition. CONCLUSIONS: Deficits in both focal and non-focal PM are associated with very mild AD and IIs may be a helpful behavioural intervention for the focal PM deficits. PRACTITIONER POINTS: Multiple deficits in PM are observable in very mild AD. Implementation intentions may enhance focal PM in very mild AD. Future research using larger samples is needed to better understand the effect of II on non-focal PM tasks in healthy older adults and those with very mild AD. The use of simple laboratory PM tasks may limit the generality of our findings. Future research is needed to investigate whether IIs improve PM over a range of more realistic tasks.

Resource depletion does not influence prospective memory in college students.

This paper reports an experiment designed to investigate the potential influence of prior acts of self-control on subsequent prospective memory performance. College undergraduates (n=146) performed either a cognitively depleting initial task (e.g., mostly incongruent Stroop task) or a less resource-consuming version of that task (e.g., all congruent Stroop task). Subsequently, participants completed a prospective memory task that required attentionally demanding monitoring processes. The results demonstrated that prior acts of self-control do not impair the ability to execute a future intention in college-aged adults. We conceptually replicated these results in three additional depletion and prospective memory experiments. This research extends a growing number of studies demonstrating the boundary conditions of the resource depletion effect in cognitive tasks.

The Dynamic Multiprocess Framework: evidence from prospective memory with contextual variability.

The ability to remember to execute delayed intentions is referred to as prospective memory. Previous theoretical and empirical work has focused on isolating whether a particular prospective memory task is supported either by effortful monitoring processes or by cue-driven spontaneous processes. In the present work, we advance the Dynamic Multiprocess Framework, which contends that both monitoring and spontaneous retrieval may be utilized dynamically to support prospective remembering. To capture the dynamic interplay between monitoring and spontaneous retrieval, we had participants perform many ongoing tasks and told them that their prospective memory cue may occur in any context. Following either a 20-min or a 12-h retention interval, the prospective memory cues were presented infrequently across three separate ongoing tasks. The monitoring patterns (measured as ongoing task cost relative to a between-subjects control condition) were consistent and robust across the three contexts. There was no evidence for monitoring prior to the initial prospective memory cue; however, individuals who successfully spontaneously retrieved the prospective memory intention, thereby realizing that prospective memory cues could be expected within that context, subsequently monitored. These data support the Dynamic Multiprocess Framework, which contends that individuals will engage monitoring when prospective memory cues are expected, disengage monitoring when cues are not expected, and that when monitoring is disengaged, a probabilistic spontaneous retrieval mechanism can support prospective remembering.

Evidence for a detrimental relationship between hypertension history, prospective memory, and prefrontal cortex white matter in cognitively normal older adults.

Hypertension affects many older adults and is associated with impaired neural and cognitive functioning. We investigated whether a history of hypertension was associated with impairments to prospective memory, which refers to the ability to remember to perform delayed intentions, such as remembering to take medication. Thirty-two cognitively normal older adult participants with or without a history of hypertension (self-reported) performed two laboratory prospective memory tasks, one that relied more strongly on executive control (nonfocal prospective memory) and one that relied more strongly on spontaneous memory retrieval processes (focal prospective memory). We observed hypertension-related impairments for nonfocal, but not focal, prospective memory. To complement our behavioral approach, we conducted a retrospective analysis of available structural magnetic resonance imaging data. Lower white matter volume estimates in the anterior prefrontal cortex were associated with lower nonfocal prospective memory and with a history of hypertension. A history of hypertension may be associated with worsened executive control and lower prefrontal white matter volume. The translational implication is that individuals who must remember to take antihypertensive medications and to monitor their blood pressure at home may be impaired in the executive control process that helps to support these prospective memory behaviors.

Dual n-back training increases the capacity of the focus of attention.

Working memory (WM) training has been reported to benefit abilities as diverse as fluid intelligence (Jaeggi et al., Proceedings of the National Academy of Sciences of the United States of America, 105:6829-6833, 2008) and reading comprehension (Chein & Morrison, Psychonomic Bulletin & Review, 17:193-199, 2010), but transfer is not always observed (for reviews, see Morrison & Chein, Psychonomics Bulletin & Review, 18:46-60, 2011; Shipstead et al., Psychological Bulletin, 138:628-654, 2012). In contrast, recent WM training studies have consistently reported improvement on the trained tasks. The basis for these training benefits has received little attention, however, and it is not known which WM components and/or processes are being improved. Therefore, the goal of the present study was to investigate five possible mechanisms underlying the effects of adaptive dual n-back training on working memory (i.e., improvements in executive attention, updating, and focus switching, as well as increases in the capacity of the focus of attention and short-term memory). In addition to a no-contact control group, the present study also included an active control group whose members received nonadaptive training on the same task. All three groups showed significant improvements on the n-back task from pretest to posttest, but adaptive training produced larger improvements than did nonadaptive training, which in turn produced larger improvements than simply retesting. Adaptive, but not nonadaptive, training also resulted in improvements on an untrained running span task that measured the capacity of the focus of attention. No other differential improvements were observed, suggesting that increases in the capacity of the focus of attention underlie the benefits of adaptive dual n-back training.

Using a modified lag task to measure adult age differences in working memory.

Four groups of adults, ages 40 to 70+ years, took the Modified Lag Task which requires that participants remember lists of words and subsequently recall the first, second, or third word from the end of the list. Previously, the task showed convergent validity with the operation span (a complex span measure) and a divergent validity with the digit span (a simple span measure). To establish predictive validity, the present study was designed to assess if this task could separate four age groups in working memory performance. The present study found support for the validity of the Modified Lag Task; however, additional research is warranted to further develop the construct validity of this task.

Goal-neglect links Stroop interference with working memory capacity.

Relationships between Stroop interference and working memory capacity may reflect individual differences in resolving conflict, susceptibility to goal neglect, or both of these factors. We compared relationships between working memory capacity and three Stroop tasks: a classic, printed color-word Stroop task, a cross-modal Stroop, and a new version of cross-modal Stroop with a concurrent auditory monitoring component. Each of these tasks showed evidence of interference between the semantic meaning of the color word and the to-be-named color, suggesting these tasks each require resolution of interference. However, only Stroop interference in the print-based task with high proportions of congruent trials correlated significantly with working memory capacity. This evidence suggests that the relationships observed between Stroop interference and working memory capacity are primarily driven by individual differences in the propensity to actively maintain a goal.

Evaluation of embedded malingering indices in a non-litigating clinical sample using control, clinical, and derived groups.

Although recent findings have indicated that a portion of college students presenting for psychoeducational evaluations fail validity measures, methods for determining the validity of cognitive test results in psychoeducational evaluations remain under-studied. In light of this, data are needed to evaluate utility of validity indices in this population and to provide base rates for students meeting research criteria for malingering and to report the relationship between testing performance and the level of external incentive. The authors utilized archival data from: (i) a university psychological clinic (n = 986) and (ii) a university control sample (n = 182). Empirically supported embedded validity indices were utilized to identify retrospectively suspected malingering patients. Group performance, according to invalidity and the level of incentive seeking, was evaluated through a series of multivariate mean comparisons. The current study supports classifying patients according to the level of incentive seeking when evaluating neurocognitive performance and feigned/exaggerated deficits.

A characterization of individual differences in prospective memory monitoring using the Complex Ongoing Serial Task.

Prospective memory--remembering to retrieve and execute future goals--is essential to daily life. Prospective remembering is often achieved through effortful monitoring; however, potential individual differences in monitoring patterns have not been characterized. We propose 3 candidate models to characterize the individual differences present in prospective memory monitoring: attentional focus, secondary memory retrieval, and information thresholding. Two experiments using a novel paradigm, the Complex Ongoing Serial Task (COST), investigated the resource allocation patterns underlying individual differences in monitoring. Individuals exhibited differential resource allocation patterns, and the differences remained relatively stable across experimental sessions. Resource allocation patterns associated with information thresholding (high prospective memory, preserved ongoing task performance) and attentional focus (high prospective memory, inefficient ongoing task performance) were superior to secondary memory retrieval (low prospective memory, very inefficient ongoing task performance). Importantly, personality (openness, prevention focus) and cognitive (primary, working, and secondary memory) individual differences influenced monitoring patterns. This research represents the first explicit attempt to elucidate individual differences in prospective memory monitoring patterns.

Structural correlates of prospective memory.

Prospective memory (PM) includes the encoding and maintenance of an intention, and the retrieval and execution of this intention at the proper moment in the future. The present study expands upon previous behavioral, electrophysiological, and functional work by examining the association between grey matter volume and PM. Estimates of grey matter volume in theoretically relevant regions of interest (prefrontal, parietal, and medial temporal) were obtained in conjunction with performance on two PM tasks in a sample of 39 cognitively normal and very mildly demented older adults. The first PM task, termed focal in the literature, is supported by spontaneous retrieval of the PM intention whereas the second, termed non-focal, relies on strategic monitoring processes for successful intention retrieval. A positive relationship was observed between medial temporal volume and accuracy on the focal PM task. An examination of medial temporal lobe subregions revealed that this relationship was strongest for the hippocampus, which is considered to support spontaneous memory retrieval. There were no significant structure-behavior associations for the non-focal PM task. These novel results confirm a relationship between behavior and underlying brain structure proposed by the multiprocess theory of PM, and extend findings on cognitive correlates of medial temporal lobe integrity.

Focal and nonfocal prospective memory performance in very mild dementia: a signature decline.

OBJECTIVE: In a recent study, performance on a certain kind of prospective memory task (PM), labeled focal PM, was sensitive to the very early stages of Alzheimer's disease (AD; Duchek, Balota, & Cortese, 2006). This study sought to replicate and extend these findings by investigating both focal and nonfocal PM, as well as possible influences of alleles of the apolipoprotein E (ApoE) gene. METHOD: Thirty-five healthy older adults and 33 adults in the very earliest stages of AD, as determined by the clinical dementia rating scale, completed both focal and nonfocal PM tasks. Performance on these tasks has been linked to qualitatively different cognitive processes (Scullin, McDaniel, Shelton, & Lee, 2010), thereby providing leverage to illuminate the specific processes that underlie PM failures in very early AD. Approximately half of the adults in each group were ApoE e4 carriers and half were noncarriers. We also obtained participants' scores on a battery of standard psychometric tests. RESULTS: There was a significant interaction between the type of PM task and dementia status, p < .05, ηp² = .12, demonstrating that the AD-related decline was more robust for focal than for nonfocal PM. Further, focal PM performance significantly discriminated between the very earliest stages of AD and normal aging, explaining variance unique to that explained by typical psychometric indices. ApoE status, however, was not associated with PM performance. CONCLUSION: The pronounced deficit observed in the focal PM task suggests that spontaneous retrieval processes may be compromised in very early AD.

Cognitive exertion and subsequent intention execution in older adults.

OBJECTIVES: Previous studies have demonstrated that increasing the demands of a prospective memory task is detrimental to older adults' performance; however, no studies have investigated how prior cognitive demands influence subsequent prospective memory. The present study sought to address this gap by using a resource depletion paradigm. METHODS: A sample of 107 older adults whose ages ranged from 60 to 85 years (M=71.91, SD=7.12) completed an initial task that was either cognitively taxing or relatively easy followed by either an attention-demanding prospective memory task or one that required minimal attentional resources. RESULTS: Initial cognitive exertion led to decrements in prospective memory performance in the attention-demanding situation, particularly for the old-old participants (age≥72); however, prior cognitive exertion did not influence subsequent prospective memory performance when the prospective memory task required minimal attentional resources. DISCUSSION: This study extends the negative effects of prior cognitive exertion to prospective memory in older adults. Also, dovetailing with past work, the depletion effects were limited to prospective memory tasks that are thought to require demanding attentional processes. The depletion effects were most pronounced for the old-old, suggesting that increased age may be associated with decline in attentional resources.

Focal/nonfocal cue effects in prospective memory: monitoring difficulty or different retrieval processes?

We investigated whether focal/nonfocal effects (e.g., Einstein et al., 2005) in prospective memory (PM) are explained by cue differences in monitoring difficulty. In Experiment 1, we show that syllable cues (used in Einstein et al., 2005) are more difficult to monitor for than are word cues; however, initial-letter cues (in words) are similar in monitoring difficulty to word cues (Experiments 2a and 2b). Accordingly, in Experiments 3 and 4, we designated either an initial letter or a particular word as a PM cue in the context of a lexical decision task, a task that presumably directs attention to focal processing of words but not initial letters. We found that the nonfocal condition was more likely than the focal condition to produce costs to the lexical decision task (task interference). Furthermore, when task interference was minimal or absent, focal PM performance remained relatively high, whereas nonfocal PM performance was near floor (Experiment 4). Collectively, these results suggest that qualitatively different retrieval processes can support prospective remembering for focal versus nonfocal cues.

The relationships of working memory, secondary memory, and general fluid intelligence: working memory is special.

Recent efforts have been made to elucidate the commonly observed link between working memory and reasoning ability. The results have been inconsistent, with some work suggesting that the emphasis placed on retrieval from secondary memory by working memory tests is the driving force behind this association (Mogle, Lovett, Stawski, & Sliwinski, 2008), whereas other research suggests retrieval from secondary memory is only partly responsible for the observed link between working memory and reasoning (Unsworth & Engle, 2006, 2007). In the present study, we investigated the relationship between processing speed, working memory, secondary memory, primary memory, and fluid intelligence. Although our findings show that all constructs are significantly correlated with fluid intelligence, working memory-but not secondary memory-accounts for significant unique variance in fluid intelligence. Our data support predictions made by Unsworth and Engle (2006, 2007) and suggest that the combined need for maintenance and retrieval processes present in working memory tests makes them special in their prediction of higher order cognition.

Can we improve the clinical assessment of working memory? An evaluation of the Wechsler Adult Intelligence Scale-Third Edition using a working memory criterion construct.

Working memory is the cognitive ability to hold a discrete amount of information in mind in an accessible state for utilization in mental tasks. This cognitive ability is impaired in many clinical populations typically assessed by clinical neuropsychologists. Recently, there have been a number of theoretical shifts in the way that working memory is conceptualized and assessed in the experimental literature. This study sought to determine to what extent the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) Working Memory Index (WMI) measures the construct studied in the cognitive working memory literature, whether an improved WMI could be derived from the subtests that comprise the WAIS-III, and what percentage of variance in individual WAIS-III subtests is explained by working memory. It was hypothesized that subtests beyond those currently used to form the WAIS-III WMI would be able to account for a greater percentage of variance in a working memory criterion construct than the current WMI. Multiple regression analyses (n = 180) revealed that the best predictor model of subtests for assessing working memory was composed of the Digit Span, Letter-Number Sequencing, Matrix Reasoning, and Vocabulary. The Arithmetic subtest was not a significant contributor to the model. These results are discussed in the context of how they relate to Unsworth and Engle's (2006, 2007) new conceptualization of working memory mechanisms.