Memory-strategy training in Older People with Subjective Memory Complaints: an explorative study

With the aging population, more and more people present to the memory clinic
with subjective memory complaints (SMC). Whereas in some instances these SMC
are due to an underlying age-relate disease (e.g. dementia), sometime no
obvious reason for these SMC is found. Nonetheless, these patients often
present with mild memory deficits and have an increased risk for future severe
cognitive decline. Because of this increased risk, it is extremely important to
explore potential interventions that reduce this risk of future deterioration.
For this, we will focus on memory-strategy training, using a training protocol
that has previously been validated in patients suffering from mild traumatic
brain injury. In short, this intervention aims at improving memory in daily
life situations by offering different types of strategies, namely internal ones
(e.g. organizing information to improve remembering) and external ones (e.g.
using a diary). Hence, this is a compensatory strategy, in which strategies are
used to compensate for the deficits in memory functioning. This training will
be compared to a training in which the memory functions itself are practiced (a
restorative strategy, e.g. practicing remembering the locations of objects).
Our hypothesis is that, compared to the restorative training, the
memory-strategy training will have a larger positive effect on memory
functioning. For this, we will focus on memory tests that mimic daily life

The primary objective is to examine the efficacy of the memory-strategy
training for treatment of mild memory impairments in patients with SMC,
focusing on memory functions crucial for daily life functioning.
Secondary objectives are the subjective experience of participating patients in
the improvement in memory functioning (Goal Attainment Scaling), memory
complaints measured with the MAC-Q, cognitive complaints measured with the CFQ,
Instrumental Activities of Daily Living (IADL), and health-related quality of
life as measured by the SF-36.

The study will be a double-blind randomized controlled trial in which the
efficacy of the memory-strategy training will be compared with the restorative
training.

The investigational treatment is based on the standardized Memory Strategy
protocol (see
http://www.neuropsychologischebehandeling.nl/protocollen/protocol/117341/geheuge
n). The investigational treatment focuses on different strategies that can be
employed in order to compensate for the lower memory performance. Together with
a therapist, participants practice different strategies; subsequent practice
items will be handed out so the participant can continue practicing the
strategy at home. The restorative training consists of practicing memory tests
on a computer. For this, the program Cogpack will be employed. This program
consists of memory tasks such as remembering the locations at which different
objects are presented.
Both the memory strategy and the restorative training will consist of 7 weekly
sessions (each session will take approximately 90 minutes).

Nature and extent of the burden and risks associated with participation,
benefit and group relatedness: All tests and methods that are used are
non-invasive and not stressful for the patient. All tests and tasks are
widely-used validated and reliable paper-pencil or computerized tasks. The
participant can work in his/her work pace, and if desired additional breaks
will be taken. Treatment is also non-invasive and scarcely stressful: a
therapist will always be present and assess the patient*s burden and eventually
take appropriate measures such as inserting a resting break.