SCIENTIFIC DEVELOPMENT AND PROMISE OF THE MEMORY WORKS®
FOR HELPING ANYONE IMPROVE MEMORY PERFORMANCE AND MEMORY FITNESS
By Douglass Herrmann, Ph.D.
EXECUTIVE SUMMARY
In the early 1990’s a plan was conceived by Practical Memory Institute to develop a new
means of self-memory training for older Americans. This plan ultimately evolved to a “multi-modal” system for memory improvement. The purpose of this Executive Summary is to describe the evolution of the current system and its potential benefits for providers and users. It has been our intent to create an interactive technology to provide dynamic self-training of memory skills of adults, especially older adults in a way never possible previously with books, classroom courses, audiotape, or videos. Our products offer three advantages: 1. Compelling graphics that engage, interest, and motivate users. 2. An iterative program allows user training as they progress through the program.
3. Acquisition of memory skills in a manner consistent with the latest principles of learning as uncovered by psychological research.
With the support of a series of grants from The National Institute on Aging of the National Institutes of Health, research supports the fact that interactive training is effective with healthy adults of all ages, with older adults with age-related memory impairment, and with victims of acquired brain injury. Furthermore, recent research, such as The ACTIVE ( for ‘Advanced Cognitive Training for Independent and Vital Elderly’) Study and a pilot study with MCI (or ‘mild cognitive impairment’) patients, indicates that memory training could be beneficial to persons with mild memory loss in ways both expected and unexpected. PMI’s current and future products offer great promise for application to persons at any age and stage as well as for thise with MCI, and mild to moderate brain injury.
SCIENTIFIC DEVELOPMENT OF INTERACTIVE MEMORY TRAINING PRODUCTS — Memory Training Prior to Interactive Multi-Media Technology
In the past four decades, numerous research articles have reported considerable success at training people to improve their memory skills (Herrmann, Weingartner, Searleman, & McEvoy, 1992). Once it was well established that healthy young adults could have their memory skills improved, many investigations attempted to determine what were the best training procedures for improving the memory of older adults (Ball, Berch, Helmers, Jobe, Leveck, Marsiske,, Morris, Rebok, Smith, Tennstedt, Unverzagt, & Willis, 2002; Hill, Shiekh, & Yesavage, 1988; Jobe, Smith, Ball, Tennstedt, Marsiske, Rebok, Morris, Willis, Helmers, & Leveck, 2000; McEvoy, & Moon, 1988 Mohs, Ashman, Jatzen, Albert, Brandt, Gordon, Rasmusson, Grossman, Jacobs & Stern, 1998; Poon, 1980; Poon, Rubin & Wilson, 1989; Rasmusson, Rebok, Bylsma, & Brandt, 1999; Rebok, & Balcerak, 1989; Rebok, Rasmusson & Brandt, 1997a; Saczynski & Rebok, 2004; Stigsdotter-Neely & Bachman,1993a, b; Verhaeghen, Marcoen & Goosens, 1992). Consideration was given as well to improving the memory of individuals with age-related memory impairment (Crook et al., 1985; Elias & Treland, 2000). Subsequently, a number of researchers developed training procedures to help improve the memory performance of individuals who had suffered from head injuries (Carney, Chesnut, Maynard, et al. ,1999; Parente & Anderson-Parente, 1996; Parente ; Sohlberg, & Mateer, 1987; Wilson, 1999). In addition, researchers also sought procedures that would help improve the memory of Alzheimer’s patients (Cahn-Weiner, Malloy, Rebok, & Ott, 2003; Camp, Foss, O’Hanlon et al., 1996; De Vreese, Neru, Fioravanti, Belloi, & Zanetti, 2001; Farina Fioravanti, Chiavari, 2002; Grandmaison & Simard, 2003; Hofmann, Hock, & Muller-Spahn, 1996; Karlsson, Backman, L., Herlitz, A. et al., 1989; Lowenstein, Acevedo, Czaja, & Duara, 2004).
THE NEED FOR A BETTER METHOD FOR SELF – MEMORY TRAINING
Most practical work in the early days of memory training involved face-to-face or group training. Travel related issues as well as privacy concerns complicated the widespread adoption of this type of training since many people are sensitive about having memory problems and prefer not to participate in training that requires open admission of having these problems. Some research has focused on self-training with audiotapes and videos (West & Crook, 1992). Some people can improve themselves by reading memory improvement books; however, self-improvement is not easy. In the early 1990’s, Compact Disc Incorporated (CDI) developed a plan to use interactive computer based programs to provide self-memory training. Recognizing that the largest population of individuals who might benefit from self-memory training involved older Americans, CDI began working with the National Institute on Aging, which directed the company to respected memory researchers. CDI and the researchers then incorporated recent investigations into home-computer based programs and online interactive courses for older individuals (Furlong, 1989; Hoot,& Hayslip, 1983; McConatha, McConatha & Dermigny, 1994; Webster & Martocchio, 1993), into proposals to NIA. To focus the development of interactive self-memory training products, CDI and its research partners created the Practical Memory Institute (PMI) in 1995. The psychologists who made up the PMI team studied the memory improvement literature, conducted their own research, and formulated a plan for developing interactive self-memory training products. This research has been based on the latest procedures in computer graphics technology (Baldi, Plude, & Schwartz, 1996; Plude & Schwartz, 1996 a, b), the use of computers in memory training (Lynch, 2002; Rebok, Rasmusson, & Brandt, 1996), and on five important principles about how memory functions; principles that also indicate how memory skills might be improved: (1) memory training must capture the attention of the user (Plude, 1992) (2) procedures specific to different tasks must be incorporated (e.g., Baddeley, 1982) (3) psychological processing modes other than memory (such as a person’s physical and emotional state must be considered, (e.g., Herrmann, Plude, Yoder, & Mullin), 1999, (4) the subject’s knowledge about memory in general; knowledge that came to be called ‘metamemory’ (Lachman, Weaver, Bandura, Elliot, & Lewkowicz, 1992); Metacalf, 2002) must be considered (5) users should be taught to take account of their individual readiness to perform memory tasks (Plude, Benaderet, & Herrmann, 2001; Poon et al., 1986).
The way in which these principles were identified and applied to the design of interactive products (called “Memory Works”) is as follows. First, it has long been known that attention is crucial to memory. One virtue of multimedia presentations is that they enable the creation of graphics that are visually compelling. Consequently, extra effort has been devoted to the development of visuals in PMI multimedia that are instrumental to the training and which attract and sustain attention (Plude, 1992; Plude & Murphy, 1992; see also Sohlberg, & Mateer, 1987).
Second, numerous investigations in the 1970s and 1980s demonstrated that most memory processes are task specific (Baddeley, 1982; Tulving & Craik, 2002). Therefore, memory is improved by teaching skills that address specific memory tasks. Consequently, PMI products have been designed to impart skills for those tasks that are especially important to people. Validity research demonstrated that the PMI interactive software enables people to improve their skills at learning and remembering names and faces (Herrmann & Plude, 1998), facts, figures, and various intentions such as appointments, chores, and taking medicine (Herrmann, Plude, Yoder, Cook, Lopp, Gatling, Arkisha, Gaithright & Hartzler, 2002; Plude, Herrmann, & Schwartz, 2000); (The products that have been developed to address these memory tasks are called The Memory Works® for Names & Faces; The Memory Works® for Facts & Figures; and Best Intentions and The Nature of Memory®
Third, research in the 1980s and 1990s demonstrated that memory performance is affected by psychological modes other than memory and cognition (Goethals & Solomon, 1989; Herrmann & Searleman, 1990; Herrmann, Andrzejewski, & Rea, 1988; Herrmann, Plude, Yoder, & Mullin, 1999; McEvoy & Moon, 1988; Johnson, 1983; Memoryzine (The New Approach, 1996); Newell, 1990; Schacter, 1984; Searleman & Herrmann, 1994; Staats, 1981; Zacks & Hasher, 1992). These modes include a person’s physical and emotional state (Hertel, 1992; Mathews, 1996; Yoder & Elias, 1992) and the physical environment and social environment in which a memory task occurs. Therefore, memory can be improved by enhancing a person’s physical state through increased exercise (Rebok & Plude, 2001), and by improving emotional states through the arranging of the physical and social environment to facilitate learning so as to stimulate remembering. Consequently, PMI has developed interactive products that would enable a person to monitor the readiness of the different modes for memory performance (Mullin, Herrmann, & Searleman, 1993; Poon et al., 1986; Plude, Benaderet, & Hermann, 2001).
Once a person could assess his or her readiness, it was possible to prepare for memory tasks and enhance memory performance to a greater degree than if the person proceeded without any knowledge of one’s readiness. Accordingly, two of the task-specific programs were equipped with simplified monitors (The Nature of Memory®; Best Intentions®) and an online Monitor devoted to an extensive monitoring of Memory Readiness™. Fourth, research in the 1980s and 1990s found that meta-memory knowledge affects memory performance (Metcalfe, 2002). Accordingly, all of our programs work to explain to users of our products how the training worked. In addition, one program was created to summarize the history of different approaches to memory improvement (Herrmann & Chaffin, 1988; Herrmann & Searleman, 1992), to briefly review both the process of monitoring for memory readiness and illustrations of devices that externally aid and remind a person’s memory (Yoder & Herrmann, 2002). Fifth, research into the improvement of memory skills and the rehabilitation of memory impairment recognized that training must be tailored to the memory capabilities and medical backgrounds of individuals seeking a positive change in memory performance (Poon et al., 1986; Parente & Herrmann, 2003). This multimodal approach assumed that training has to be adjusted to the memory competence a person brings to training, the unique ways of this person’s approach to memory tasks, and the degree of confidence this person has in his or her memory at the beginning of training. Moreover, training must take account of a person’s specific memory skills and the nature of their neurological impairments (Mayes, 1988).
Finally, the effectiveness of our interactive training programs lies in all of these factors working together in a person’s use of a particular program. Step by step, users build their skills across a session within a program (Saczynski, Rebok, Whitfield, & Plude, 2004) and, of course, across sessions. Interactive training allows a user to monitor his or her progress and thereby know what to work on next (Dunlosky, Kubat-Silman, & Hertzog, 2003). Thus was born the Mult-Modal Model® of memory.
ALTERNATIVE COMPUTER PRODUCTS FOR MEMORY SELF-TRAINING
After the development of the CD-ROM memory training, PMI developed other forms of training in order to reach individuals not accustomed to training with computers (McConatha, McConatha, & Dermigny, 1994; Morrell, Kelley, Park, & Mayhorn, 1997; Morrell, Mayhron, & Bennett, 2000; Morrell, Mayhorn, & Bennett, 2001). PMI has created pamphlets that summarize the content of each of the CD-ROM courses. In addition, PMI has created Memory University® on the Web for adults who prefer receiving knowledge by reading instead of viewing computer graphics. These courses present linear formatted memory training for the same content covered on the random access CD-ROMs: names, faces, facts, figures, intentions, and knowledge verbally. Today, downloadable versions of The Memory Works are available at the TheMemoryWorks.com.
Memory University courses can be taken on the Web or can be downloaded and read at one’s own pace. For individuals seeking to improve memory and for caregivers seeking a deeper understanding of the origins of memory-improvement techniques (Herrmann & Chaffin, 1988; Herrmann & Searleman, 1992), PMI created a program that reviews some of the history of memory improvement, i.e., the Nature of Memory®.
THE BROADER EFFECTIVENESS OF PMI PRODUCTS
The effectiveness of PMI’s products was made possible by grants awarded by the National Institute on Aging and by the team of many PMI scientists who worked to create these products. A wide range of adults, including older adults with age-related memory impairments understand them easily. From the beginning, it was the hope of the scientists on the PMI team that their products in some form would eventually be used to help people with all manner of memory problems. Service providers will make the ultimate decisions as to how PMI products may be used and/or revised to be used more effectively with people with certain medical histories depending upon the nature and extent of neurological impairment (Herrmann, Schooler, Caplan, Lipman, Grafman, Schoenbach, Schwab, & Johnson, 2001). To date, these products have been useful to adults regardless of age, to older adults with concerns about memory, to older adults with age-related memory impairment (Rybash, 1999), and to adults who have suffered head injury (Herrmann & Parente, 1994; Parente & Herrmann, 2003).
In addition to developing products to help people who desired to improve their memory performance, the PMI team has also developed courses for caregivers of individuals with serious memory impairments. These courses are designed to conform to the principles and findings of effective caregiver treatment developed by Milttleman (2002, 2003). One form of caregiver training currently exists in the form of a Web course (Herrmann, 2002). In addition, PMI will soon publish a small and very readable book that advises caregivers how to help individuals with serious memory impairments (Herrmann, Parente, & Rebok, in preparation).
MCI Pilot Study
A recent pilot study, characterized as ‘promising’ by Mary Mittelman, Dr.P.H. at NYU School Medicine in personal communication with Robert Rager, is an example of the growing body of scientific thought that cognitive intervention, applied properly, can provide benefits for a very broad range of memory impairment conditions including dementias. An abstract of “A Pilot Study of Psychosocial Interventions for Individuals with MCI” (Marini & Mittelman, submitted for review) is presented with permission.
ABSTRACT
Objective: Individuals who suffer from Mild Cognitive Impairment (MCI) exhibit normal functioning in daily activities and general cognitive ability, but their memory is abnormally poor for their age and education. A number of research studies have shown beneficial effects of memory training interventions in normal elderly, but very few have been conducted among people with MCI. This research attempts to test the efficacy of a psychosocial intervention for individuals with MCI.
Method: A pilot study of an intervention composed of memory training classes and exercises, utilizing a wait-list control design with an MCI population was conducted. Results: The immediate intervention group showed a significant increase in ability to recognize faces, compared to a the wait-list control group, as evidenced by improved performance on the Face Recognition subtest of the WMS-III. Subjects in the wait-list control group also significantly improved in their recall of items in the Free and Cued Selective Reminding Test, after they received memory training. Conclusion: These results suggest that further studies utilizing similar interventions are warranted, as they may lead to better memory functioning in tasks of every-day-life in individuals suffering from MCI.
In conclusion, memory intervention using modern science-based methods is being broadly applied in mainstream clinical cognitive rehabilitation. Further, based on acceptance by the general public and among leading clinicians and researchers in the field of cognitive rehabilitation, the staff at PMI believe that their products are the most effective science-based tools available for training and retraining memory skills and should be considered for use with persons with mild to moderate dementia, including MCI.
SUMMARY
The PMI team has carefully considered how its products might be used effectively with victims of Alzheimer’s disease. Because PMI products have proved useful with individuals with age-related memory impairment and with some neurological impairment, these products will be useful to some individuals in the early stage of Alzheimer’s disease, especially those with MCI. Growing evidence in support of the usefulness of computerized training for individuals with age-related memory deficits (Gunther, Schafer, Holzner, & Kemmler, 2003) and Alzheimer’s disease (Hofmann, Hock, & Muller-Spahn, 1996; Hofmann, Rosler, Schwarz, Muller-Spahn, Krauchi, Hock, & Seifritz, 2003) has recently been reported. There also have been recent reviews (see De Vreese, Nri, Fioravanti, Belloi, & Zanetti, 2001; Grandmaison & Simard, 2003) supporting the effectiveness of various memory treatment approaches that are similar to the ones incorporated within the PMI memory training products. These reviews include procedures for minimizing the occurrence of errors or mistakes during the learning phase (the so-called errorless learning technique) and for testing for the repeated recall of newly learned information at increasingly longer retention intervals or with an increasing number of intervening items (the so called space retrieval technique). These techniques, when used in combination with the other training methods featured in PMI products, such as the Memory Monitor® module, or more linear memory training available on line via Memory University®, offer a set of powerful tools for improving memory.
The PMI team is ready to modify its products, and online programs, in ways recommended by cognitive rehabilitation specialists so that revised forms of our products may be maximally effective in treating the memory problems of victims of mild dementia (Cahn-Weiner, Malloy, Rebok, & Ott, 2003; Grandmaison & Simard, 2003; Hawley, & Cherry, 2004; Rebok, Holtzman, Koh, Miles, & Saczynski, 2004) and where appropriate, revised to be especially useful to caregivers of MCI patients (Mittelman, 2002, 2003). We look forward to working with cognitive rehabilitation specialists in ways to advise us on how to utilize our products so that they may be more useful to victims of brain injury especially in developing programs in attention and memory for persons with post-traumatic brain injury through new SBIR grants from the National Institutes of Health or other grant making organizations and funding sources.
A complete list of references cited is available upon request. Send your request to Douglass Herrmann, Ph.D. at webmaster@memoryzine.com
Copyright© 1996-2011 Practical Memory Institute. All rights reserved. The Memory Works, MemoryZine, Best Intentions, Nature of Memory, Cognitive Technology, Memory Monitor, Multi Modal Model, Memory University, Memory Workout, Memory Assessor and PMI Practical Memory Institute are registered trademarks; and Memory Readiness, Ask Doctor Memory, Sharper Memory, ACTIVE Memory Works, Memory Health Notes, The New Approach to Memory Fitness, Improving Memory Skills For Today…And Memory Fitness For Life, and The Source For Retraining Cognition are trademarks of Compact Disc Incorporated under license to PMI.d.
