The use of metacognitive strategies to decrease false memories in source monitoring in patients with mild cognitive impairment

Abstract

Patients with amnestic mild cognitive impairment (MCI) and Alzheimer's disease (AD) often demonstrate high rates of false memories, leading to stressful and frustrating situations for both patients and caregivers in everyday life. Sometimes these false memories are due to failures in monitoring the source of the information. In the current study, we examined interventions aimed to enhance the use of the metacognitive "recall-to-reject" memory strategy. Such interventions could improve source memory and decrease false memory in patients with MCI. Because the picture superiority effect (better memory for pictures compared to words) has been shown to be present in both patients with MCI and healthy older controls, we investigated whether pictures could help patients with MCI use a recall-to-reject strategy in a simulation of real-world source memory task. In this experiment, patients with MCI and healthy older adults were asked to simulate preparing for and then taking a trip to the market. Subjects first studied 30 pictures of items in their "cupboard," followed by a list of 30 words of items on their "shopping list." At test, participants saw 90 pictures (30 cupboard, 30 list, 30 new) organized as they would be if walking down the market aisles, and are provided with either standard or metacognitive instructions. With standard instructions, they were asked if they needed to buy the item. With the metacognitive instructions, they were asked a series of questions to help guide them through a recall-to-reject strategy to highlight the different sources of memories. Results showed that the metacognitive instructions did significantly reduce the false memory rates for patients with MCI. Further studies need to investigate how to best implement these practical strategies into the everyday lives of patients.

False memories in patients with mild cognitive impairment and mild Alzheimer’s disease dementia: Can cognitive strategies help?

“…Patients with MCI-AD tended to perform in the intermediate range, in terms of both true and false memory, between patients with AD and healthy older controls across studies. Notably, patients with MCI-AD could generally apply cognitive strategies in order to improve their memory discrimination across studies, suggesting that while their hippocampal memory abilities may be impacted by AD, they still retained other cognitive abilities (e.g., executive functions), allowing them to successfully use cognitive strategies to improve their performance on memory tests, occasionally to a level similar to that of healthy controls (Brueckner & Moritz, 2009; Deason et al, 2017).…”

“…However, in a recent study, Deason, Nadkarni, and colleagues (2017) found that using a metacognitive strategy that enhanced recall-to-reject monitoring reduced false memories in patients with mild cognitive impairment. In their study, patients with MCI-AD and healthy older adults were presented with a simulated trip to the grocery store where they first studied items in the cupboard (viewed as pictures), then they studied items on their shopping list (viewed as words), and subsequently were tested on a mixture of old (both items from their cupboard and shopping list) and new pictures.…”

“…Though signal detection theory establishes that response criterion and discrimination are orthogonal in recognition memory decisions (Kantner, Vettel, & Miller, 2015; Macmillan & Creelman, 2004), it would have been desirable to see improved discrimination as well as a shift in response bias. Recently, Deason et al (2017) further examined whether AD patients could shift their responses patterns appropriately when instead of an explicit instruction as in the Waring et al (2008) study, they had only the underlying ratio of old/new items to influence their behavior. Participants were not provided with any instructions, but the ratio of old/new items varied between study/test sessions.…”

“…This pattern of performance occurs because the pictures that were presented along with the words conferred an added dimension to the studied material that tends to improve the accuracy of memory judgments. With the distinctiveness heuristic, an individual might say to herself, “the word on the test is spider and it must be a new word, because if I saw a picture of a spider I’m quite sure I would have remembered it!” Although the distinctiveness heuristic and other monitoring strategies have been found to be highly effective strategies among young and old healthy participants (Dodson & Schacter, 2002), the evidence of effectiveness in patients with AD is far more variable (Abe et al, 2011; Budson, Dodson, Daffner, & Schacter, 2005; Budson, Sitarski, et al, 2002; Deason et al, 2017; Pierce et al, 2008).…”

False Memories: The Other Side of Forgetting

“…This work established that many AD patients' false memories were related to the fact that they could remember the general idea, meaning, or gist of an event, but not the specific details (Budson, Daffner, Desikan, & Schacter, 2000). Part of their difficulty with false memories was related to the fact that patients have an abnormal sense of familiarity for things that were actually new (Deason et al, 2017).…”