How do we compensate for memory loss?

Remembering to perform a future action is a critical part of daily life. 

Psychologists refer to this as our “prospective memory,” and some examples include remembering to pay bills on time, returning library books when they’re due, or getting to doctor’s appointments.

Brooke Beech is a Washington State University doctoral student specializing in clinical neuropsychology. She works with older adults to examine how aging affects thinking and everyday behavior. 

“I have a particular interest in factors that relate to everyday memory,” Beech says.

During normal aging, most people will experience a mild, gradual decline in their prospective memory. But there are tools available to help compensate for memory loss. They can be as simple as leaving a pill box on the counter as a memory aide for taking medication or setting a phone alarm as a reminder to complete a task, Beech says.

Her recent research compared the effectiveness of paper memory aides—such as written notes on a calendar—versus technology-driven memory aides. In healthy older adults, both methods yielded similar results.

“At the end of the day, having memory strategies that you like, are comfortable with, and that you’ll use consistently is really what matters,” Beech says.

Learn more

WSU Neuropsychology and Aging Lab

WSU Department of Psychology

“Healthy lifestyles protect brains...and lower dementia risk” (Fall 2024 Washington State Magazine)

CogSMART

TrialMatch (Alzheimer’s Association)

Transcript

Viewscapes, the podcast of Washington State Magazine

Episode 30: How do we compensate for memory loss?

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Larry Clark: We all must remember to pay bills on time, return library books when they’re due, or get to doctor’s appointments. But as people get older, there’s a good chance that they will need strategies to help with the normal, gradual decline in memory. Fortunately, there are tools available to help compensate for memory loss.

Welcome to the Washington State Magazine podcast. I’m Larry Clark, editor of the magazine. We connect you to Washington State University research, campus life, and fascinating alumni. 

In this episode, magazine science writer Becky Kramer talks to Brooke Beech, a WSU doctoral student specializing in clinical neuropsychology. Brooke works with older adults to examine how aging affects thinking and everyday behavior. She gives us some insight into memory loss, tools to help compensate, and her research on memory aides.

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Becky Kramer: So Brooke, welcome to the Washington State Magazine podcast.

Brooke Beech: Thanks so much. It's great to be here.

BK: So you're earning a doctorate in psychology at WSU. And what is your area of specialty?

BB: I specialize in clinical neuropsychology, which is a subfield that is focused on understanding relationships between the human brain and behavior. We draw conclusions about brain behavior relationships by having individuals complete standardized tasks that give us a really targeted sample of behavior or a cognitive skill. So, for example, I might ask you to learn a list of words and then remember it over time to assess memory. Or I might ask you to solve a series of simple puzzles to allow me to capture processing speed. So within clinical neuropsychology, there are many populations that you can specialize in working with, for example, epilepsy, multiple sclerosis, brain injury, oncology patients. But in particular, I specialize in working with older adults to examine what thinking and everyday behavior looks like as we age. 

BK: So how did you get interested in this area of older adults and memory?

BB: Yeah, so I think that many of us in psychology and health care and related fields have some powerful experiences that shape our interests. I have a really long-standing history of interest in brain behavior relationships, dating all the way back to when I was in high school, and I pretty quickly declared a neuroscience and psychology double major when I entered college. And around this time, I was actually engaged in animal research, and I thought I would pursue a PhD in behavioral neuroscience. However, there were a series of diagnoses in some loved ones that really rapidly sparked this desire for a more human touch in my work. So over the span of a couple years, my great-grandmother was diagnosed with vascular dementia, my great aunt was diagnosed with frontotemporal dementia, and my grandmother had a head injury that resulted in some pretty significant cognitive impairment. I had a first-hand encounter in witnessing the role that neuropsychology can play in helping a team of providers really converge on a diagnosis and develop a targeted treatment plan. I knew that this was a career path that I would find not only incredibly interesting, but very fulfilling. 

BK: That's interesting. My mom had vascular dementia and I had no idea that high blood pressure causes dementia. 

BB: So many risk factors there.

BB: I was going to just talk a bit about some early experiences I got with older adults before I went on to grad school. I had the opportunity to work at the University of Kentucky Sanders Brown Center on Aging. So, for a number of years, I ran clinical trials, which I just absolutely loved.

And for me, the most interesting trials were the ones that revolved around non-pharmacological interventions to support memory and thinking. So things like diet, exercise, cognitively stimulating activities, memory aids, streamlining medication regimens. That really shaped what I was looking for when I was doing my grad school search and is ultimately how I ended up in the Neuropsychology and Aging lab at WSU.

BK: How does our memory change as we age?

BB: Yeah, so as we age, there are some normative changes that can occur. The frontal lobes of our brain play a pretty important role in a lot of functions that are closely related to memory. So paying attention to incoming information, suppressing distractors, making sure that all that good information really gets into our brain and gets encoded. And unfortunately this part of our brain is just a little bit more sensitive to the aging process than other parts of our brain that are maybe a little deeper in there, a bit more protected. So we can see some gradual, mild declines in things like everyday memory as we age. So I just want to reassure listeners that there is, you know, a degree of change that you might be noticing in yourself that is completely normative, in comparing across decades, for example.

BK: So you talk about prospective memory in your research, and what is prospective memory and what happens to it as we age?

BB: So long-term everyday memory can really be broken down into two categories. So we have retrospective memory, prospective memory, and I'll talk a little about each of those. Retrospective memory is generally, I think, what comes to mind when we're thinking about memory. So that involves our ability to recall experiences and information that was encountered in the past. For example, I'm in a book club so I need to remember the title of our chosen novel, as well as the date and time of our scheduled meeting. Then prospective memory, on the other hand, has to do with remembering to act on that information and actually go do something in the future. There are a number of cues for knowing to act.

BB: They can be event-based or they can be time-based. So event-based cues, something happens in the environment and that kind of triggers our memory, tells us it's time to act. Time-based, I think, is a little bit more intuitive, something happening on a particular day or, you know, like at 6 p.m., for example. So, like I was speaking about in the previous question, we do see some normative age related changes in memory and prospective memory is actually a little bit more vulnerable. As we age, then retrospective memory is just kind of based on the different brain structures that are involved there. The frontal lobes, again, are a little bit more sensitive to that aging process and we can see some modest declines that again are often not cause for concern and there are a number of skills we can use to keep us sharp and functioning at our best.

BK: So why is prospective memory so important for independent living? 

BB: Absolutely, that is such an important question. It's one that a lot of my research really hinges on. Accurate prospective memory is just an absolutely foundational component for completing instrumental activities of daily living. So these are tasks that have to do with things like running a home and being able to live on your own. So when we're conceptualizing independent living, there are a number of areas that we examine. Managing finances, shopping and errands, cooking, completing our chores and general home maintenance, transportation, keeping appointments, and managing medications. So as you can see, through all those different activities of daily living, you can see how remembering to do something in the future is incredibly important.

BB: So, for example, remembering to remit that bill payment prior to the due date, remembering to go by the grocery store when you're noticing, “Oh, I'm running low on milk and eggs. I should do that next time I'm out and in the neighborhood.” Perhaps keeping that doctor's appointment that you have about a month for now, or remembering to take medications according to their prescribed schedule.

BK: What are some strategies people can use to compensate for memory loss?

BB: So within the field of neuropsychology, as well as some related health care disciplines, we can teach people how to effectively use what we call compensatory strategies. So, really broadly, this is any kind of tool or behavior that helps you work around a perceived challenge, such as memory loss, and then perform that activity more accurately. So for memory loss specifically, we would be really focusing on strategies that deepen your learning of information, that serve as good external repositories for information, and that provide clear reminders. So to deepen learning, there are a number of internal strategies that you could use or strategies that you kind of house within your own mind. So things like reducing distractions so you can really focus on incoming information, as well as to make sure that information gets encoded, maybe engaging in repetition, like rereading information or taking a moment to say the information that you just read out loud. Even better than just repeating is what we call elaboration or kind of going beyond that and really making connections or kind of putting your own spin on information. That might look like teaching information you just learned to somebody else in your own words or developing a memory technique like an acronym or a rhyme or some kind of way to visualize that information. 

BB: And while these internal strategies are really important, it's a little risky to rely on just our brains for remembering, especially if you're concerned at all for memory loss. So this is where those external strategies can really come in. And those are just what they sound like. The information or the memory queue is residing outside of the individual, often in a tangible format. So this would include things like writing information on your calendar or a to do list that you display in a central location of the home, maybe setting a medication visibly out on your kitchen table so you remember to take it with meals or putting reminder alerts on your computers and cell phones. So because those external strategies are outside of the person's mind, they're often preferred by older adults or other individuals who have memory concerns, because it kind of reduces that pressure to remember independently. And often just seeing that strategy out in the open, maybe a note placed in a certain location can really jog your memory and you're good from there.

BK: So one of the things I had read about is if you're in a large parking lot, taking a picture to help you locate your car later. And that would be an example of one of those external strategies.

BB: That's a perfect example.

BK: One of your recent research papers looks at digital strategies versus paper strategies. And did you find any differences in their effectiveness?

BB: Oh, I love this question because the answer to it ended up surprising me. So in some of my previous work, I developed coding systems that rate the quality of people's strategies used for some everyday tasks that require prospective memory. And this strategy quality rating essentially captures how thorough, how salient, and how factually correct your strategies are. And the tasks that we had people complete reflected communication, keeping appointments, health management, financial management. And this initial work showed that in this sample of older adult participants, people who used higher quality sets of strategies performed better on these everyday prospective memory tasks. And I doubt this is surprising to anyone, but it served as some initial validation of those rating systems. 

BB: So fast forward a couple months after this initial study, and one of my undergraduate research assistants brings a really excellent question to me. She asks, “Would this relationship look different in digital strategies as compared to paper strategies like you were asking about?” So we discussed this further and decided that we were really interested in exploring one, if digital strategies earned a higher quality score than those paper strategies, and two, if the digital strategies would then support more accurate completion of those prospective memory tasks. These questions felt really important to us just due to the proliferation of technology across all aspects of everyday life over the past 15, 20 years or so, as well as increasing rates of personal technology use by older adults. And what we ultimately found in our sample is that the strategies that participants used, that were digital, were, in fact, of higher quality.

BB: They were more thorough, more salient, more accurate compared to those paper-based strategies. And I think this makes a lot of sense in terms of ease of use. You can get down a large amount of information pretty rapidly when you're typing on a laptop or your cell phone as compared to when you're handwriting information when you might be prone to shorthand and then maybe later not remember what that means. Part two is where things got a little bit interesting when we were looking at task accuracy. We found that people who used only paper or other non-digital strategies actually carried out those prospective memory tasks just as accurately as the people who used digital strategies. this a few different ways. One factor to consider here is that the people who were in this study were all cognitively healthy. So there were no diagnoses of dementia or other conditions that have significant impacts on thinking. So perhaps this group who used only paper-based strategies didn't need really detailed reminders in order to do well in carrying out those tasks in the future. Or there may be other factors that influence how well people use strategies. Perhaps comfort or familiarity with the given strategy, or perhaps self-efficacy generally in terms of compensating, or the degree to which you believe you can do something well. I'm currently in the midst of examining some of those questions in my dissertation, so stay tuned for those results in the coming months. And I think the key takeaway message here for folks is to not feel pressure to adopt all of these new technologies to support your everyday memory if that's not something you're interested in. Instead, having strategy systems that you like, and that you know you're going to consistently use well and that you're comfortable with, is what really matters at the end of the day.

BK: That's good to know. So if someone is interested in checking out compensation strategies, either for themselves or others, where could they find more information?

BB: There is a plethora of information online in the form of brochures and different webpages that go into detail about these different types of strategies. And you can find this kind of information by using search terms like compensatory strategies, cognitive strategies, memory strategies, all to cast a wide net because us researchers are notorious for having multiple names for the same thing. And when people are looking, I would really encourage you to make sure that you're getting this information from a source that you trust, like a reputable medical center or a university. And if you'd like to go beyond just some casual reading and perhaps consider a structured program, I would really highly recommend CogSMART. It’s an excellent program that was developed by Dr. Beth Twamley at the University of California, San Diego, and it has just a really excellent research base behind it. It is a 12-module program that provides training and strategies to enhance prospective memory, retrospective memory, attention, cognitive flexibility, and problem solving. And I think the most exciting part is that within the past few years, Dr. Twamley and her team have adapted this and turned it into a web-based app that is freely available to the public. So you can take yourself through the modules that feel most personally relevant. There are ways to track progress towards your goals within the app and you can do it all at your own pace. Oh, sorry. Go ahead.

BK: Oh, I was just going to ask. So that is called CogSMART?

BB: CogSMART. Yes, exactly.

BK: Okay. And who again is the researcher?

BB: Beth Twamley.

BK: Okay. Thank you.

BB: Yeah, and in addition to CogSMART, sometimes people feel like they might benefit from working alongside a professional. Maybe, maybe you don't want to do this on your own. So for people who have ADHD, depression, or anxiety, or a brain injury, for example, the structure and the support that can come alongside with working with a provider can help people more readily and effectively implement those new skills into their everyday life. So there are psychologists as well as speech language pathologists and occupational therapists who specialize in providing these sorts of interventions if that's of interest to folks.

BK: Is there anything else you would like to mention about memory and compensation?

BB: I like to wrap up these conversations by talking about the importance of research. All the information that I've shared today came about because there were people who were willing to volunteer their time and help us advance knowledge, which is something that I'm just thrilled about. So grateful for. So I'd really love to encourage listeners to give some thought if taking part in research is something that's a good fit for them. It can feel a little bit intimidating to take that first step and get plugged in with research for the first time. Uncertainty can be uncomfortable and sometimes it's hard to know where to start. But there are a lot of ways that you can get involved with research that fit many levels of comfort, interest, as well as time availability. We have, you know, options ranging from survey research to one-time interviews, all the way to studies that might take place over the course of months or years for really ambitious people. 

BB: So again, we just encourage folks to see what's available at institutions near you. Universities and medical centers that have Alzheimer's disease research centers or aging centers are going to have the most in the way of research opportunities that are related to aging and related to topics that we've been discussing today. But any university with a psychology department will likely have some options, much like my own lab here at WSU. Additionally, TrialMatch is a service offered by the Alzheimer's Association, and that's a really great way to get connected with research that's a good fit for you. You just go onto their website and you fill out a simple profile of information, and then TrialMatch will generate a list of studies that fit your interests and that you might be eligible for.

BK: Thank you so much for joining me today.

BB: Absolutely. Thank you for having me. This is great.

Larry Clark: Thanks for listening.

To learn about participating in memory studies at Washington State University, visit the Department of Psychology’s website and search for the Neuropsychology and Aging Lab. The psychology department’s Facebook page occasionally advertises for study participants as well. You can find links in the show notes.

If you like the Washington State Magazine podcast, please like us on Apple Podcasts, Spotify, or wherever you listen. You can find more episodes and WSU stories at magazine.wsu.edu

Our podcast music is by WSU emeritus music professor and composer Greg Yasinitsky.

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