A new frontier in spaced retrieval memory training for persons with Alzheimer's disease.

The objective of this pilot study was to investigate how a memory training technique called "Spaced Retrieval" (SR) might be effectively applied in helping persons with Alzheimer's disease improve their recall of recent events. Capitalising on the interdependence among spared and impaired memory systems, it was hypothesised that SR training with support at encoding and retrieval would facilitate the retention and recall of meaningful recent events. Eight participants with a diagnosis of Alzheimer's disease or related disorder were recruited for this study. The study employed a quasi-experimental multiple baseline treatment design across participants, items, and behaviours. SR training was provided in three domains: Semantic, Prospective, and Episodic recent memory. The results show important training gains made by all participants across conditions at post-training follow-up. In the Episodic condition, participants were able to recall specific details about recent events following training. This study provides preliminary evidence that individuals with mild to severe cognitive impairment can learn and recall new episodic information through Spaced Retrieval training. If replicated, these findings would support the use of Spaced Retrieval as an intervention tool to help individuals maintain their functioning in the area of episodic recent memory.

Spaced Retrieval and Episodic Memory Training in Alzheimer's Disease.

INTRODUCTION: This study replicated and extended the findings from the author's previous pilot study to further explore how a spaced retrieval (SR) memory training program might be effectively applied to help persons with Alzheimer's disease (AD)  improve both short- and long-term recall of recent episodic events. METHODS: A quasi-experimental within-subject group study was conducted with 15 participants with a diagnosis of AD. RESULTS: Compared to a control condition, all participants were able to spontaneously recall significantly more specific details about trained events, and their recall was significantly enhanced when they were provided with cues. Although the findings indicated that people with AD were able to encode information during training, recall gains diminished by the end of the maintenance period. DISCUSSION: This study provides evidence that individuals with mild to moderate AD can learn and recall new episodic information through SR training. These findings support the use of SR as an intervention tool to help individuals maintain their functioning in episodic recent memory. However, more research into maintaining the long-term recall of recent episodic events is warranted.

Episodic and semantic memory influences on picture naming in Alzheimer's disease.

This study investigated the relationship between semantic and episodic memory as they support lexical access by healthy younger and older adults and individuals with Alzheimer's disease (AD). In particular, we were interested in examining the pattern of semantic and episodic memory declines in AD (i.e., word-finding difficulty and impaired recent memory) vis-à-vis more preserved remote memories. We administered a picture naming task in which the episodic period of the pictures and whether the pictured items were unique to one period or commonly used across periods were varied. Groups of younger adults (N=40), healthy older adults (N=20) and older adults with AD (N=18) were asked to name drawings of objects in four conditions: dated unique, contemporary unique, dated common, and contemporary common. The results indicated that all participants named items that were common to both episodic periods more successfully than items unique to one period. An interaction was observed such that the healthy older and AD groups were more successful in retrieving names of objects presented in the dated compared to contemporary unique conditions, whereas the younger adults showed the reverse pattern. These results indicate that naming ability is affected both by the cumulative frequency of using an item over a lifetime and by when an item was first acquired. The findings support a theoretical stance which proposes an enduring reciprocal link between semantic and episodic memory. This theoretical relationship has practical implications for the development of intervention strategies when interacting with persons who have AD.

Sentence Context and Word-Picture Cued-Recall Paired-Associate Learning Procedure Boosts Recall in Normal and Mild Alzheimer's Disease Patients.

INTRODUCTION: The aim of this study was to employ the word-picture paradigm to examine the effectiveness of combined pictorial illustrations and sentences as strong contextual cues. The experiment details the performance of word recall in healthy older adults (HOA) and mild Alzheimer's disease (AD). The researchers enhanced the words' recall with word-picture condition and when the pair was associated with a sentence contextualizing the two items. METHOD: The sample was composed of 18 HOA and 18 people with mild AD. Participants memorized 15 pairs of words under word-word and word-picture conditions, with and without a sentence context. In the paired-associate test, the first item of the pair was read aloud by participants and used to elicit retrieval of the associated item. RESULTS: The findings suggest that both HOA and mild-AD pictures improved item recall compared to word condition such as sentences which further enabled item recall. Additionally, the HOA group performs better than the mild-AD group in all conditions. CONCLUSIONS: Word-picture and sentence context strengthen the encoding in the explicit memory task, both in HOA and mild AD. These results open a potential window to improve the memory for verbalized instructions and restore sequential abilities in everyday life, such as brushing one's teeth, fastening one's pants, or drying one's hands.

The role of conflict resolution styles on nursing staff morale, burnout, and job satisfaction in long-term care.

This study focuses on the ability of nursing staff to interact with residents in a way that affects positively on the nurses' well-being and occupational satisfaction. It investigates the role of coping skills related to staff-resident interactions, in particular, the use of conflict resolution styles and their influence on the level of morale, burnout and job satisfaction of nursing professionals. A self-administered questionnaire was used to collect information from 161 direct care nursing staff. The authors used a multiple regression procedure to examine the influence of predictors on nursing staff outcomes. Multivariate analyses indicated that nurses' psychological morale, occupational stress, and job satisfaction are influenced by conflict resolution styles, after controlling by individual characteristics, work demands, and work resources factors. The findings highlight the importance of considering personal coping abilities to foster positive staff-resident interactions and to increase nurses' morale and job satisfaction.

Conflict resolution styles: a comparison of assisted living and nursing home facilities.

In this exploratory study, the authors investigated how interpersonal conflict is resolved in assisted living and nursing home facilities. In particular, the authors examined whether conflict resolution styles differed between type of facility and between residents and staff in each type of facility. Four focus groups were conducted--two with residents and two with staff from each type of facility. The focus groups centered on discussing the occurrence of conflict and how each participant handled it. Discourse analysis was employed to identify participants' use of three styles of conflict resolution: controlling, solution-oriented, and non-confrontational. The results indicate that staff in each care context showed a preference for the solution-oriented approach. Residents in each setting reported equal use of the non-confrontational and solution-oriented styles. The findings suggest that preferred conflict resolution styles may vary more as a function of the role of each communicator than the context of the care setting.

Perceptions of family caregivers' psychosocial behavior when communicating with spouses who have Alzheimer's disease.

The literature for caregivers of persons with Alzheimer's disease (AD) notes the importance of attending to the linguistic and psychosocial dimensions of communication. The objective of this study was to investigate the relationship between psychosocial aspects of caregivers' behavior and communication outcomes for persons with AD and their spousal caregivers. In the first part of the study, we selected 40 segments of audio-recorded conversations between persons with AD and their spouses. We then asked 20 healthy seniors who were not caregivers to listen to and read the conversation segments and evaluate each segment along four psychosocial dimensions. They were also asked to independently rate how smooth the communication was in each segment. We hypothesized that when caregivers' speech is perceived to be respectful, caring, not controlling, and/or it ascribes competence to their spouses, it would be associated with more effective communication. Our results supported these hypotheses in that communication was more likely to be rated higher in smoothness when the content and manner of caregivers' speech were perceived to have positive psychosocial qualities. The findings have implications for training caregivers on effective psychosocial behavior when interacting with persons who have AD.

Do you remember? How caregivers question their spouses who have Alzheimer's disease and the impact on communication.

This study examined the types of questions caregivers use and their outcomes when conversing with their spouse with Alzheimer's disease (AD). Of particular interest was caregivers' use of yes-no and open-ended questions and the demands they make on the memory of the person with AD. It was hypothesized that communication between caregivers and their spouses would be more successful when caregivers used yes-no rather than open-ended questions; however, it was also predicted that a more positive communication outcome would occur when caregivers used open-ended questions that requested information from semantic rather than episodic memory. Eighteen caregivers and their spouses diagnosed with AD were audiotaped while they conversed for approximately 10 min on a topic of their choosing. The conversations were transcribed and coded according to the occurrence of questions, the type of question (yes-no, choice, or open-ended), the type of memory required to respond to a question (semantic or episodic), and the outcome of a response to a question (communication breakdown). The results indicated that caregivers used yes-no and open-ended questions to a similar extent, whereas episodic questions were used almost twice as frequently as semantic questions. Communication was more successful when caregivers used yes-no compared with open-ended questions and when questions placed demands on semantic rather than episodic memory. The findings from this study suggest that caregivers can reduce communication problems by avoiding the use of questions that depend on episodic memory. In addition, while yes-no questions were associated with more favorable outcomes than open-ended questions, the latter do not need to be avoided if they refer to information that draws only on semantic memory.

Effectiveness of communication strategies used by caregivers of persons with Alzheimer's disease during activities of daily living.

Communication difficulties between individuals with Alzheimer's disease (AD) and their caregivers are commonly reported. Caregivers carry the burden of managing breakdowns in communication because people with AD are often unable to modify their communicative behavior. To assist caregivers in this endeavor, clinicians and caregiving professionals have offered a variety of strategies aimed at accommodating the individual's declining abilities. Many of these strategies are intuitively appealing, but they lack empirical support. This study investigated the effectiveness of 10 frequently recommended communication strategies when employed by family caregivers of persons with AD. In particular, we assessed (a) which strategies family caregivers report using and with what degree of success, (b) which of these strategies are used by caregivers in actual interactions with their spouses, and (c) which strategies contribute to improved communication. The study included a self-report questionnaire and wireless audio-recorded interactions between 18 persons with AD and their spousal caregivers during activities of daily living. The findings validate the effectiveness of certain communication strategies (e.g., simple sentences) but not others (e.g., slow speech). The results should be of interest to both family members and professionals who want to enhance communication and the quality of their interactions with persons with Alzheimer's disease.

The Effect of a Community-Engaged Arts Program on Older Adults' Well-being.

This mixed-methods study evaluated the effect of a community-engaged arts program on the physical, emotional, and social well-being of seniors. Weekly workshops were offered over a three-year period at community centers where artists worked with four groups of seniors to produce a collective art piece or performance for public presentation. Participants completed pre- and post- questionnaires, and group interviews were conducted at the program's end. Paired t-test analyses indicated that seniors experienced improvement in perceived overall health, experience of pain, and sense of community. Interpretive descriptive analysis of the group interviews revealed six themes that informed understanding : (1) providing structure and discipline; (2) facilitating coping; (3) requiring hard work and effort; (4) bringing out one's artistic side; (5) promoting social involvement; and (6) making a contribution. These results are consistent with previous research and contribute to further understanding of how community-engaged arts can benefit the well-being of older people.

The role of caregiver prosody in conversations with persons who have Alzheimer's disease.

This research was supported in part by funding from the British Columbia Medical Services Foundation (BCM02-0115). The funding source had no role in the design, methods, participant recruitment, data collection, interpretation of the study, or in the preparation of the manuscript for publication. Approval for the study was granted by the University of British Columbia Behavioural Ethics Review Board, and participants provided informed consent. This study investigated whether aspects of family caregivers' prosody (pitch and loudness) would be associated with successful or unsuccessful conversations with spouses who have Alzheimer's disease (AD). Secondary analysis was conducted of 12 caregivers' speech when interacting with spouses who have AD. Acoustic analyses were conducted to calculate the fundamental frequency (pitch) and intensity (loudness) of caregivers' speech. The results showed no significant overall differences between the caregivers' pitch or loudness in either successful or unsuccessful conversations. However, for 1 subgroup of caregivers, an increase in pitch variation and loudness was associated with unsuccessful communication, whereas for another subgroup the opposite pattern was observed-reduced pitch variation and loudness with unsuccessful communication. The results provide preliminary directions for helping family caregivers become aware of how characteristics of their speech prosody may relate to the quality of communication when interacting with persons who have AD.

Recommended and reported use of communication strategies in Alzheimer caregiving.

Individuals with Alzheimer disease experience cognitive and behavioral impairments that affect their ability to communicate. In an effort to compensate for these declines, a number of communication strategies have been recommended in the literature for Alzheimer disease caregivers. These include recommendations for caregivers to modify their language behavior and/or the context of communication. The purpose of this study was to (1) review the Alzheimer disease caregiving literature and identify communication strategies commonly recommended for family caregivers and (2) determine how often caregivers report using these strategies and how effective they feel each is in facilitating communication. A review of the literature identified 10 recurring communication strategies. A questionnaire was constructed that asked caregivers to report on the use and efficacy of these 10 strategies. Twenty family (spouse) caregivers of persons diagnosed with Alzheimer disease completed the questionnaire. The results show that caregivers perceived using the 10 strategies, although the strategies appearing most frequently in the literature were not necessarily the ones used most often by caregivers. A positive correlation was observed between caregivers' perceived use of strategies and their effectiveness. Use and efficacy of a strategy did not significantly vary as a function of dementia severity or the gender of the caregiver. The findings provide evidence that caregivers are aware of their communication behavior and modify it in ways that they think improve communication with their spouse.