Journal of Alzheimers Disease 49 (2016) 3143 31

DOI 10.3233/JAD-150378
IOS Press

Strategies for Improving Memory:

A Randomized Trial of Memory Groups
for Older People, Including those with Mild
Cognitive Impairment
Glynda J. Kinsellaa,b, , David Amesc,d , Elsdon Storeye , Ben Onga , Kerryn E. Pikea , Michael M.
Salingf , Linda Clareg , Elizabeth Mullalyh and Elizabeth Randh
a School of Psychology & Public Health, La Trobe University, Melbourne, Australia
b Department of Psychology, Cauleld Hospital, Cauleld, Australia
c National Ageing Research Institute, Parkville, Australia
d University of Melbourne Academic Unit for Psychiatry of Old Age, St Georges Hospital, Kew, Australia
e Department of Neuroscience (Medicine), Monash University, Alfred Hospital Campus, Melbourne, Australia
f University of Melbourne, Parkville, Australia
g Department of Psychology, University of Exeter, Exete, UK
h Cognitive, Dementia and Memory Service, Cauleld Hospital, Cauleld, Australia

Accepted 27 July 2015

Abstract.
Background: Governments are promoting the importance of maintaining cognitive health into older age to minimize risk of
cognitive decline and dementia. Older people with amnestic mild cognitive impairment (aMCI) are particularly vulnerable to
memory challenges in daily activities and are seeking ways to maintain independent living.
Objective: To evaluate the effectiveness of memory groups for improving memory strategies and memory ability of older people,
especially those with aMCI.
Methods: 113 healthy older adults (HOA) and 106 adults with aMCI were randomized to a six-week memory group or a waitlist
control condition. Outcome was evaluated through knowledge and use of memory strategies, memory ability (self-report and
neuropsychological tests), and wellbeing. Assessments included a six-month follow-up.
Results: Using intention to treat analyses, there were intervention effects for HOA and aMCI groups in strategy knowledge
(HOA: 2 = 0.20; aMCI: 2 = 0.06), strategy use (HOA: 2 = 0.18; aMCI: 2 = 0.08), and wellbeing (HOA: 2 = 0.11; aMCI:
2 = 0.05). There were also intervention effects in the HOA group, but not the aMCI group, in self-reported memory ability
(2 = 0.06) and prospective memory tests (2 = 0.02). By six-month follow-up, gains were found on most HOA outcomes. In the
aMCI group gains were found in strategy use, and by this stage, gains in prospective memory were also found.
Conclusion: Memory groups can engage older people in techniques for maintaining cognitive health and improve memory
performance, but more modest benefits are seen for older adults with aMCI.

Keywords: Aging, memory, memory training, mild cognitive impairment, prospective memory, randomized controlled trial

INTRODUCTION
Correspondence to: Professor Glynda Kinsella, School of Psy-

chology & Public Health, La Trobe University, Melbourne, Victoria,

In our aging societies, maintaining independent liv-
3086, Australia. Tel.: +61 03 9479 2409; Fax: +61 03 9479 1956; ing is important for sustaining physical and mental
E-mail: g.kinsella@latrobe.edu.au. health, thereby contributing to minimizing pressure on

ISSN 1387-2877/16/$35.00 2016 IOS Press and the authors. All rights reserved
32 G.J. Kinsella et al. / MCI and Memory Training
limited social services, and governments worldwide
are promoting the importance of maintaining cogni-
tive health into older age [1]. In this respect, many
older people experience troublesome changes in mem-
ory performance [2, 3] and seek guidance regarding
how best to manage memory challenges in everyday
activities. This is especially the case for older peo-
ple who meet criteria for the amnestic form of mild
cognitive impairment (aMCI) in which, in addition to
subjective memory complaints, memory impairment
can be quantified through neuropsychological testing
[4]. The importance of aMCI is that it carries increased
risk of development of dementia due to Alzheimers
disease (AD), occurring at a rate of 515% per year
as distinct from 12% in healthy adults [5]; although
a proportion of this group never progress to develop
dementia [6, 7]. Nevertheless, it has been estimated
that up to 21% of older people (aged between 70 and
90 years) will display features of aMCI [7]. Therefore,
early cognitive interventions which moderate memory
difficulties and assist in maintaining functional inde-
pendence as long as possible would be useful to large
numbers of older people.
Studies of memory training for older people
through controlled practice on memory tasks (typically
computer-based) have provided compelling results,
forcing reconsideration of the potential for neu-
ronal plasticity in older brains [8, 9]. However, the
mental-exercise approach (or brain training) remains
contentious, with much of the criticism relating to lack
of generalization [10, 11], especially to everyday func-
tioning [12]. This is important for aMCI, as the memory
deficit is more problematic than for healthy older peo-
ple and a critical issue is to reduce memory disability
in daily activities rather than focusing exclusively on
performance in arcane memory tests.
Following from research demonstrating the efficacy
of cognitive strategies, or mnemonics, in experimen-
tal memory studies [1315], an alternative approach
is to train older adults in compensatory cognitive-
behavioral memory strategies to be used in real-world
situations. These approaches can be varied; for exam-
ple, using mnemonic techniques such as associative
strategies [16] to aid retrieval of a persons name;
or, using an external aid, such as a mobile phone
reminder, to remember to pick up the grandchildren
after supermarket shopping. Several meta-analyses
have identified pre to post gains on memory tests
in trained groups of healthy older adults [1720],
although all have cited caution in over-interpretation
of findings due to a highly variable and methodolog-
ically limited literature base [21]. Nevertheless, an
important study in memory strategy research is the
ACTIVE trial [22], involving over 2,800 healthy older
adults who were randomly allocated to one of three
training groups (memory, reasoning, or speed of pro-
cessing) or a no-contact control group. The memory
training module involved practicing various mnemonic
techniques, resulting in small gains on training-related
memory tests, up to a five-year follow-up (d = 0.23)
[23]. Although there was no effect on naturalistic cog-
nitive tests, there was some evidence of transfer at
10-year follow-up in self-ratings of instrumental activ-
ities of daily living [24]. Whether similar effects can
be obtained in aMCI is yet to reach a consensus, with
some research finding positive results [2528] but other
research reporting no, or only limited, effects [21,
2932].
Translating newly acquired knowledge about mem-
ory strategies to everyday situations requires behavior
change, and it is recognized from health promotion
studies that behavior change in older age is difficult to
achieve [33]. Readiness for using a memory strategy at
the appropriate time firstly requires a knowledge base
about strategies [34]. Hutchens et al. [35] demonstrated
that older people with aMCI have less capacity for
accessing strategy knowledge than healthy older peo-
ple, and that level of strategy knowledge was related to
actual memory performance. This indicates that mem-
ory interventions, especially for people with aMCI,
need to include components devoted to increasing
knowledge about memory strategies.
An additional issue, and consistent with theoret-
ical models of behavior change [36, 37], is that
personally-relevant skills training and promotion of
self-confidence in ability to apply these skills will be
more likely to encourage older people to use strategies
in daily activities [38, 39]. Group-based interventions,
or memory groups, provide opportunity for peer-
learning through sharing of experience in strategy-use
and have been identified as facilitating better out-
comes than individual-based training [18, 20]. Using
this information, we undertook a preliminary study of
a memory group for older adults with aMCI using a
multi-strategy approach and incorporating education
about health behaviors that facilitate effective mem-
ory performance [27]. We were able to demonstrate
gains in knowledge and use of strategies, and also a
small effect on everyday memory, demonstrable on
prospective memory tests. Many daily activities rely
on prospective memory, or remembering to perform
intended actions in the future (such as passing on a
message when you next meet a friend), and prospective
memory performance can provide a useful approach to
 G.J. Kinsella et al. / MCI and Memory Training
measurement of everyday memory competence [12].
However, the sample size was small (n = 20 per group)
and we did not include a comparison healthy older
adult group to evaluate the extent of gain from inter-
vention by the aMCI group. This indicates the need for
further study, especially as Reijnders et al. [29] con-
cluded from their systematic review of interventions
for older people that whether the effects of cognitive
interventions generalize to improvement in everyday
activities remains unresolved.
Therefore, our objective was to evaluate older peo-
ples responses to a cognitive-behavioral intervention,
i.e., memory group training, for improving everyday
memory performance. We focused on people with
aMCI as this group is particularly vulnerable to mem-
ory challenges in daily activities and are seeking
ways to maintain independent living. Our aim was
to improve memory ability through increased knowl-
edge of effective memory strategies, and by training
and modeling the use of several strategies that can be
applied in daily activities. We expected that following
intervention, and at six-month follow-up, older partic-
ipants, including those with aMCI, would demonstrate
greater knowledge and use of memory strategies,
and improved memory ability in daily life. By con-
trast, there was limited expectation that performance
would improve on standard neuropsychological tests
of memory as many strategies are difficult to use on
these researcher-controlled performance measures. We
did, however, expect that participants would report
improved wellbeing and self-confidence in everyday
memory performance.
MATERIALS AND METHODS
Participants
Participants were recruited to form two cohorts:
healthy older adults (HOA) and older adults diagnosed
with aMCI. Initial inclusion criteria for all participants
were: (a) age >60 years; (b) community-dwelling;
and (c) English language sufficient for neuropsycho-
logical assessment. Additional specific criteria were
used in the selection of participants for each cohort.
Participants with aMCI were diagnosed and referred
from memory clinics or experienced aged care special-
ists, following multidisciplinary diagnostic consensus
review (i.e., neurological, psychiatric, radiological,
neuropsychological, and functional assessment). Eli-
gible participants were further screened to satisfy
clinical criteria [4, 5]: (a) subjective memory complaint
(participant or informant had sought professional
33
investigation due to concern about memory perfor-
mance); (b) objective memory impairment 1.5 SD
or more below age norms for delayed recall on at least
one of four screening measures of episodic memory:
Hopkins Verbal Learning Test Revised (HVLT-R)
[40], Logical Memory subtest from the Wechsler Mem-
ory Scale Third Edition [41], Verbal Paired Associates
subtest from the Wechsler Memory Scale Fourth Edi-
tion [42], Complex Figure of Rey [43]; (c) absence of
significant impairment in basic activities of daily life
(Clinical Dementia Rating) [44] score <1, and indepen-
dent or only occasional assistance on the Alzheimers
Disease Functional Assessment and Change Scale-
personal sub-scale [45]; and (d) absence of dementia
using NINCDS-ADRDA criteria [46] and a Mini-
Mental Status Examination (MMSE) score of 24
[47]. HOA participants were volunteers who responded
to advertising in community centers and groups to find
out more about memory and memory strategies. In
addition to the initial inclusion criteria listed above,
HOA criteria were: (a) had not sought professional
assessment due to concern about memory; (b) perfor-
mance above - 1.5 SD of age norms on all of the four
screening measures of delayed memory; (c) absence
of impairment in activities of daily life (see above for
assessment).
Exclusion criteria for both groups were: (a) pres-
ence of significant co-morbidities liable to impact on
cognition; and (b) presence of significant visual and/or
auditory impairment uncorrected by aids. All potential
participants were reviewed by a case selection panel
including a neurologist (ES), a psychiatrist (DA), a
neuropsychologist (GJK), and the research coordinator
(KEP), who formed a consensus decision on eligibility.
Study design and expectations
The study was a randomized controlled cross-over
trial of a memory group intervention (see Fig. 1
which illustrates the study design). The trial was
approved by ethics committees at La Trobe University
and participating health services, and registered with
the Australian and New Zealand Clinical Trials Reg-
istry, N012605000711617. At recruitment, participants
(HOA and aMCI) were offered a training program in
strategies for everyday memory challenges. If willing
to participate, informed consent procedures, a neu-
ropsychological assessment, and screening assessment
for eligibility were undertaken (see Table 1 for per-
formances on selected neuropsychological tests for
screening). This was followed by baseline pre-test
assessment on the outcome measures (listed below),
34 G.J. Kinsella et al. / MCI and Memory Training

Assessed for eligibility

n = 378

Excluded n = 159
Did not meet study criteria n = 138
Declined/unavailable n = 21

Pre-test
113 HOA 106 aMCI

Early Intervention Late Intervention

Randomizaon

Allocated Early Intervenon 59 HOA 51 aMCI Allocated Late Intervenon 54 HOA 55 aMCI

Early Intervenon

Early Post-test

Completed Post-test Early 56 HOA 43 aMCI Completed Post-test Early 53 HOA 48 aMCI
Did not complete Post-test Early n = 11 Did not complete Post-test Early n=8
Withdrew 2 HOA 6 aMCI Withdrew 1 HOA 1 aMCI
Illness/Unavailable 1 HOA 2 aMCI Illness/Unavailable 6 aMCI

Late Intervenon
Late Post-test

Completed Post-test Late 55 HOA 39 aMCI Completed Post-test Late 51 HOA 43 aMCI
Did not complete Post-test Late n=5 Did not complete Post-test Late n=7
Withdrew 1 HOA Withdrew 4 aMCI
Illness/Unavailable 4 aMCI Illness/Unavailable 2 HOA 1 aMCI

Six-month Follow-up

Completed 6-mo Follow-up 53 HOA 37 aMCI Completed 6-mo Follow-up 48 HOA 36 aMCI
Did not complete 6-mo Follow-up n=4 Did not complete 6-mo Follow-up n = 10
Withdrew 1 HOA Withdrew 1 HOA 5 aMCI
Illness/Unavailable 2 aMCI Illness/Unavailable 1 aMCI
Protocol violaon 1 HOA Protocol violaon 2 HOA 1 aMCI

Fig. 1. Diagram to show flow of participants through the study design.

and subsequent block randomization by diagnostic
group to early- or late-intervention by a member of the
research team (BO) who had no contact with partici-
pants, using a computer algorithm. Participants in the
early-intervention condition were invited to the next
memory group scheduled to start within two weeks and
participants in the late-intervention (a wait-list control
group at this stage) were informed that there was a delay
until they could join the next memory group. Follow-
ing the six-week memory group intervention there was a
two-week delay interval before both groups underwent
post-assessment (early post-test). This was followed
by a cross-over phase in procedure such that the par-
ticipants in the late-intervention groups were provided
with the intervention while the participants in the early-
intervention groups crossed to a maintenance phase. On
completion of the cross-over phase and a further two-
week delay interval, both groups underwent a further
 G.J. Kinsella et al. / MCI and Memory Training 35

Table 1
Sample characteristics of HOA and aMCI groups
HOA (n = 113) aMCI (n = 106) 2
M (SD) M (SD)
Demographic variables
Age: years 72.27 (6.95) 76.08 (7.10) 0.07
Gender: female n (%) 82 (74%) 61 (58%) 0.02
Education: more than 12 y n (%) 73 (65%) 55 (52%) 0.01
WTAR: predicted IQ 109.56 (7.84) 108.83 (7.37) <0.01
MMSE 28.93 (1.01) 26.95 (1.87) 0.31
Screening memory measures
HVLT-R delayed recall 9.09 (2.12) 0.94 (1.63) 0.82
Logical Memory delayed recall 23.27 (7.56) 7.67 (6.73) 0.55
Verbal Paired Assoc delayed recall 7.50 (1.88) 3.85 (2.27) 0.44
Rey Figure delayed recall 16.37 (5.68) 7.58 (5.18) 0.40
Outcome measures (baseline pre-test)
Strategy Repertoire 20.42 (8.21) 16.13 (6.90) 0.08
MMQ Strategy internal 12.72 (5.79) 10.87 (5.76) 0.03
MMQ Strategy external 21.36 (5.93) 21.80 (5.56) <0.01
MMQ Ability 49.26 (9.03) 43.73 (11.79) 0.07
CAMPROMPT total 23.16 (6.59) 13.16 (8.06) 0.32
CVLT II delayed recall 11.57 (2.95) 3.17 (3.26) 0.65
MMQ Contentment 45.59 (11.72) 32.54 (11.01) 0.25
WTAR, Wechsler Test of Adult Reading; Wechsler, 2001. p < 0.05, p < 0.001.

post-assessment (late post-test), followed at six months
after training completion with a final assessment (six-
month follow-up).
By comparing the randomized intervention groups at
early post-test (for both HOA and aMCI participants),
the effect of intervention on the outcome measures
was evaluated, with the expectation that the early-
intervention groups would perform better than the
late-intervention groups (waitlist controls). At late post-
test, when all participants had received intervention,
we expected that all participants would have improved
as compared to pre-test performances. By six-month
follow-up, we anticipated some decline in perfor-
mance, but expected that all participants would have
made gains in outcome performances as compared to
pre-test.
Intervention
The La Trobe and Caulfield Hospital (LaTCH) Mem-
ory Group program consisted of six 2-hour weekly
sessions conducted by neuropsychologists or an experi-
enced occupational therapist assisted by co-facilitators,
and held in health service facilities throughout Mel-
bourne and regional Victoria, Australia. Group size
ranged from six to twelve, and consisted of a mix of
HOA and aMCI participants who could bring a family
member or friend if they wished. The LaTCH pro-
gram was developed from our earlier experience of
memory groups [27] and built upon an evidence-based
literature relating to memory, aging, and memory strate-
gies that can be implemented by persons with aMCI
as well as older adults [25, 27, 31, 48]. The LaTCH
program was manualized, facilitators were trained in
the program, and there were regular training meetings
throughout the study to ensure protocol adherence. The
interactive sessions provided information about mem-
ory and changes in memory as a result of health and
lifestyle issues, aging, or neurological disorder. We
used a problem-solving approach to illustrate com-
mon everyday memory problems, and provided practice
in cognitive strategies (e.g., task organization, seman-
tic association, visual imagery, retrieval practice, goal
planning). As a frequently used approach to compen-
sation of memory impairment is the use of external
aids [49], the sessions explored a variety of aids (e.g.,
diaries/smartphones/manual timers) for various tasks
and situations. We also addressed coping strategies to
develop self-efficacy and emotional balance in respond-
ing to everyday memory challenges [39]. At the end of
each session, participants received handouts covering
the session material, and an assignment to facili-
tate application and practice of the skills in everyday
activities.
Participants assigned to the late-intervention groups
(the waitlist controls) did not receive experimental
intervention until the cross-over stage; but the aMCI
participants did receive usual care from their referring
36 G.J. Kinsella et al. / MCI and Memory Training
clinicians in the memory clinics and all the participants
could access community-based support services.
Outcome assessments
Assessors, who were graduate psychologists, were
masked to the randomized condition and also to the
diagnostic group of the participant (HOA, aMCI).
Reflecting the multidimensional structure of the
intervention, the primary outcomes covered several
domains of interest:
Strategy knowledge: The Strategy Repertoire Test
[31] measured the number and quality of memory
strategies that were familiar to the participant by pro-
viding eight hypothetical everyday memory scenarios
(e.g., remembering to pass on a message), and required
participants to list as many strategies as possible that
would be useful for each situation (internal consistency
Cronbachs alpha 0.78 [35]). Responses were scored
by effectiveness and specificity: 2 points for each spe-
cific strategy; 1 point for a non-specific strategy; and,
0 points for an ineffective or non-strategy (inter-rater
reliability r = 0.94 [35]).
Strategy use: The Multifactorial Memory Question-
naire, the 19-item Strategy subscale (MMQ-Strategy)
[50] was used to assess self-reported frequency of strat-
egy use in everyday memory tasks (Cronbachs alpha
0.83; test-retest r = 0.88). Internal strategies are reliant
on cognitive manipulation to improve memory (e.g.,
forming a semantic association of a name with a face),
whereas external strategies recruit external aids or envi-
ronmental cues (e.g., smartphone reminders). To reflect
this distinction, we used factor scores for internal and
external strategies [51].
Memory ability: The Multifactorial Memory
QuestionnaireAbility subscale (MMQ-Ability) [50]
provided a 20-item self-rating of memory ability
in everyday life (Cronbachs alpha 0.93; test-retest
r = 0.86). In addition, observed memory performance
was assessed through two standard neuropsycholog-
ical tests: the Cambridge Assessment of Prospective
Memory (CAMPROMPT) [52] total score assessed
prospective memory or remembering to perform
intended activities; and the California Verbal Learning
TestSecond Edition (CVLT-II) [53] long delay recall
score assessed episodic memory and new learning. For
both of these measures, alternate forms were used and
counterbalanced across the assessment phases.
Wellbeing: The Multifactorial Memory
QuestionnaireContentment subscale (MMQ-
Contentment) [50] was used to assess wellbeing.
Eighteen items described emotions and perceptions
linked to memory performance and self-belief in the
controllability of memory (Cronbachs alpha 0.95;
test-retest r = 0.93).
Statistical method and sample size estimate
All statistical analyses were undertaken with IBM
SPSS v. 21. Socio-demographic and clinical charac-
teristics between diagnostic groups (HOA, aMCI) at
baseline were compared by ANOVAs for interval-
scaled variables, with eta-squared (2) given as the
effect size, and chi-square (2) analyses were used for
categorical variables, with phi-squared (2) given as the
effect size.
Missing data analysis with SPSS (EM technique)
suggested that data could be assumed to be missing at
random, Little MCAR test, 2 (1830, n = 219) = 1923,
p = 0.06. Therefore, adopting an intention-to-treat
approach, missing data was imputed with SPSS in
which demographic and screening data was used to
predict missing pre-test scores and then, together, to
predict missing scores at early post-test, late post-test,
and follow-up. Statistical results arising from ANOVAs
and ANCOVAs were pooled from the 20 imputed
datasets; namely, means were pooled by averaging, F
and 2 by median, SD by formula (see [54]), and p by
re-calculation from F and df.
As significant differences were expected between
diagnostic groups at pre-test on the outcome mea-
sures from four domains (strategy knowledge, strategy
use, memory ability, and wellbeing), the effect of
randomized memory intervention (early versus late)
was analyzed separately for each diagnostic group
(HOA, aMCI), and assessed by comparing randomized
subgroups(early-versuslate-intervention)atearlypost-
test,usingANCOVAs,withpre-testscoresascovariates.
Gains from any intervention effects on outcomes mea-
sures in HOA and aMCI groups were assessed by
ANOVAs at late post-test and at six-month follow-up,
using gain (difference) scores from pre-test.
The differential impact of memory intervention on
diagnostic groups was compared at late post-test using
ANOVAongainscores(frompre-test),andatsix-month
follow-up using ANOVA on gain scores (from pre-test).
The sample size required to detect a medium effect
of intervention between randomized groups (early-
versus late-intervention) was estimated to be 45 per
randomized group for a power of 0.80 at = 0.05 [55].
Assuming a 15% drop-out rate, we planned for a min-
imum of 104 HOA and 104 aMCI participants (52 per
randomized group).
 G.J. Kinsella et al. / MCI and Memory Training 37

RESULTS icantly different in general cognition (MMSE) and the

Characteristics of the groups (HOA and aMCI)
From a referral pool of 378 potential participants,
138 did not meet study criteria but only 21 potential
participants declined or were unavailable during the
study phase. Therefore, we recruited 219 (113 HOA,
106 aMCI). A flow diagram of the progress of the sam-
ple through the phases of the study and reasons for
exclusions is provided in Fig. 1. By the final six-month
follow-up, there were 174 participants (i.e., 80%)
remaining from the initial sample. It should be noted
that attrition by six-month follow-up (which included
non-adherence to the intervention, i.e., attending <4
out of the 6 sessions) was considerably lower from the
HOA group than from the aMCI group (11% versus
31%); however, within each diagnostic group, there
was no differential attrition between the randomized
intervention groups (HOA: 10% early versus 11% late;
aMCI: 28% early versus 34% late). There was no
significant difference in age (HOA p = 0.116; aMCI
p = 0.225), gender (HOA p = 0.506; aMCI p = 0.289),
education (HOA p = 0.079; aMCI p = 0.463), or screen-
ing memory performance (HVLT R delayed recall,
HOA p = 0.137; aMCI p = 0.814) between the ini-
tial sample and the participants retained at six-month
follow-up, in either diagnostic group.
Table 1 shows that the randomized HOA and aMCI
groups were similar in distribution of years of educa-
tion and predicted IQ. However, the mean age of the
aMCI group (76.08 y) was several years older than the
HOA group (72.27 y) and the percentage of females
was slightly lower in the aMCI group than the HOA
group. As expected, the diagnostic groups were signif-
screening measures of memory. At baseline (pre-test)
the aMCI group provided significantly lower scores
than the HOA group on all of the outcome measures
apart from reporting equivalent use of external strate-
gies (MMQ Strategy - external).
Effect of randomized intervention
The effect of randomized memory intervention
(early versus late) was assessed separately for HOA
and aMCI groups by ANCOVAs at early post-test,
using the pre-test scores of the outcome measures as
covariates (see Table 2).
Significant improvements in strategy knowledge
(Strategy Repertoire) were demonstrated with a large
intervention effect for the HOA group (2 = 0.20) and a
moderate effect for the aMCI group (2 = 0.06). Signif-
icant improvements in self-reported strategy use were
foundthroughlargeeffectsintheHOAgroupforinternal
strategies (2 = 0.18) and a moderate effect for exter-
nal strategies (2 = 0.07). There was also a moderate
effect reported by the aMCI group for internal strate-
gies (2 = 0.08); however, not for external strategies
(2 = <0.01).
With respect to self-rated memory ability in every-
day tasks (MMQ ability), improvement in response
to intervention was reported in the HOA group with
a moderate effect (2 = 0.06), but not in the aMCI
group (2 < 0.01). Correspondingly, observed mem-
ory performance on the neuropsychological measure
of everyday prospective memory (CAMPROMPT total
score) showed a small but non-significant effect in the
HOA group (2 = 0.02), but not in the aMCI group
(2 < 0.01). On the neuropsychological measure of

Table 2
Comparing randomized (early versus late) intervention subgroups, separately for HOA and aMCI, at early post-test using ANCOVA with pre-test
as covariate
HOA intervention subgroups aMCI intervention subgroups
Early (n = 59) Late (n = 54) 2 Early (n = 51) Late (n = 55) 2
Outcome measure M (SD) M (SD) M (SD) M (SD)
Strategy Knowledge
Strategy Repertoire 28.52 (9.93) 20.42 (8.41) 0.20 19.47 (8.14) 16.19 (6.88) 0.06
Strategy Use
MMQ Strategy- Internal 17.85 (5.99) 13.47 (5.53) 0.18 14.24 (6.84) 9.90 (6.47) 0.08
MMQ Strategy- External 23.99 (5.73) 21.68 (4.69) 0.07 21.73 (7.08) 22.11 (6.92) <0.01
Memory Ability
MMQ Ability 51.50 (9.17) 47.87 (8.69) 0.06 46.90 (12.15) 44.75 (9.39) <0.01
CAMPROMPT total 27.35 (6.77) 24.88 (6.94) 0.02 15.79 (9.25) 15.75 (8.94) <0.01
CVLT II long delay 11.64 (3.35) 12.14 (2.93) <0.01 3.88 (3.83) 2.93 (3.57) <0.01
Wellbeing
MMQ Contentment 50.14 (10.83) 44.06 (12.22) 0.11 34.74 (11.50) 32.04 (12.81) 0.05
p < 0.05, p < 0.01, p < 0.001.
38 G.J. Kinsella et al. / MCI and Memory Training

Table 3
Long-term gains (from pre-test) within diagnostic group (HOA, aMCI) at late post-test and six-month follow-up,
as well as a comparison of these gains between diagnostic groups
Assessment Stage Combined HOA Combined aMCI HOA versus aMCI
group (n = 113) group (n = 106) Differential gain
Gain (from Pre-test) Gain (from Pre-test)
M 95% CI M 95% CI 2
Strategy Repertoire
Late Post-test 6.73 [5.02, 8.44] 1.93 [0.46, 3.39] 0.07
six-month follow-up 7.35 [5.67, 9.04] 1.58 [0.28, 3.45] 0.09
Strategy Use Internal
Late Post-test 4.92 [3.92, 5.92] 3.19 [2.00, 4.38] 0.02
six-month follow-up 3.86 [2.91, 4.81] 2.29 [1.32, 3.26] 0.03
Strategy Use - External
Late Post-test 3.02 [2.18, 3.86] 1.38 [0.38, 2.38] 0.03
six-month follow-up 2.27 [1.34, 3.20] 0.95 [0.01, 1.88] 0.02
Memory Ability
Late Post-test 2.14 [0.71, 3.57] 1.66 [0.08, 3.39] <0.01
six-month follow-up 1.05 [0.37, 2.47] 0.79 [0.94, 2.53] <0.01
CAMPROMPT total
Late Post-test 5.38 [4.14, 6.61] 4.77 [3.35, 6.19] <0.01
six-month follow-up 5.05 [3.78, 6.31] 4.09 [2.56, 5.62] <0.01
CVLT II long delay
Late Post-test 0.76 [0.22, 1.28] 0.64 [0.05, 1.22] <0.01
six-month follow-up 0.59 [0.14, 1.04] 0.02 [0.53, 0.57] 0.01
MMQ Contentment
Late Post-test 4.24 [2.67, 0.81] 3.33 [1.46, 5.20] <0.01
six-month follow-up 2.43 [0.66, 4.19] 1.55 [0.27, 3.37] <0.01
p < 0.05, p < 0.001.

new learning (CVLT II delayed recall), neither the
HOA group nor the aMCI group showed a significant
improvement following intervention.
As can be seen in Table 2, estimate of wellbeing
and self-efficacy as measured through the MMQ-
Contentment scale, showed improvement following
intervention for both HOA and aMCI groups with a
moderate effect for the HOA group (2 = 0.11), and a
small effect for the aMCI group (2 = 0.05).
Gains in outcome measures at late post-late
and six-month follow-up
By late post-test (see Table 3) when all partici-
pants had received intervention, both diagnostic groups
(HOA, aMCI) showed significant gains in strategy
knowledge; but only the HOA group maintained an
effect at six-month follow-up (M = 7.35, 95%CI [5.67,
9.04]). Both diagnostic groups achieved significant
gains in internal strategies through memory interven-
tion at post-late (HOA M = 4.92, 95% CI [3.92, 5.92];
aMCI M = 3.19, 95% CI [2.00, 4.38]) and also at six-
month follow-up (HOA M = 3.86, 95% CI [2.91, 4.81];
aMCI M = 2.29, 95% CI [1.32, 3.26]). Similarly, there
were significant gains for both diagnostic groups in
external strategies at post-late (HOA M = 3.02, 95% CI
[2.18, 3.86]; aMCI M = 1.38, 95% CI [0.38, 2.38]) and
maintained at six-month follow-up (HOA M = 2.27,
95% CI [1.34, 3.20]; aMCI M = 0.95, 95% CI [0.01,
1.88]).
There were gains in self-reported memory perfor-
mance (Memory Ability) for the HOA group at late
post-test (HOA M = 2.14, 95% CI [0.71, 3.57]) but not
for the aMCI group (M = 1.66, 95% CI [0.81, 3.39]).
However, neither group maintained gains by six-month
follow-up (HOA M = 1.05, 95% CI [0.37, 2.47];
aMCI M = 0.79, 95% CI [0.94, 2.53]). In relation to
neuropsychological test performances, both diagnostic
groups showed significant gains on the CAMPROMPT
at late post-test (HOA M = 5.38, 95% CI [4.14, 6.61];
aMCI M = 4.77, 95% CI [3.35, 6.19]) and maintained
at six-month follow-up (HOA M = 5.05, 95% CI [3.78,
6.31]; aMCI M = 4.09, 95% CI [2.56, 5.62]). On the
CVLT long delay, the HOA group showed signifi-
cant gains at late post-test and at six-month follow-up
(late post-test - HOA M = 0.76, 95% CI [0.22, 1.28]
and follow-up HOA M = 0.59, 95% CI [0.14, 1.04]);
whereas aMCI only showed significant gain at late
post-test (M = 0.64, 95% CI [0.05, 1.22]) but not at
six-month follow-up (M = 0.02, 95% CI [0.53, 0.57]).
Finally, in relation to wellbeing and self-efficacy,
both diagnostic groups (HOA, aMCI) showed signifi-
cant gains at late post-test on the MMQ-Contentment
scale(HOA M = 4.24, 95% CI [2.67, 5.81]; aMCI
 G.J. Kinsella et al. / MCI and Memory Training
M = 3.33, 95% CI [1.46, 5.20]), but only the HOA
group maintained an effect at six-month follow-up
(M = 2.43, 95% CI [0.66, 4.19]).
Differences in extent of gains on outcome
measures between diagnostic groups
Pre-test differences between diagnostic groups
(HOA, aMCI) were found, as expected, on most out-
come measures, using ANCOVAs at pre-test with
age as the covariate (see Table 1). Of greater inter-
est was whether age-adjusted gains were different
between diagnostic groups at late post-test and six-
month follow-up (see HOA versus aMCI column,
Table 3).
A differential gain between HOA and aMCI groups
in Strategy Repertoire was significant at late post-
test (2 = 0.07) and at six-month follow-up (2 = 0.09),
favoring the HOA group. For internal strategies,
gains were significantly different between HOA and
aMCI groups at late post-test (2 = 0.02) and six-
month follow-up (2 = 0.03), favoring the HOA group.
In addition, the HOA group gained more in exter-
nal strategies use at post-test than the aMCI group
(2 = 0.03), and at six-month follow-up (2 = 0.02).
There were no significant differences in gains in self-
reported Memory Ability between diagnostic groups at
post-test and follow-up. There were also no diagnostic
group differences in gains at post-test and follow-up
in relation to neuropsychological test performances
(CAMPROMPT and CVLT-II).
Finally, in relation to wellbeing estimates, there were
no diagnostic group differences in gains at post-test and
follow-up on the MMQ-Contentment.
DISCUSSION
We explored two main questions: (i) does a six-week
memory group improve knowledge and use of strate-
gies in older people, especially in those with aMCI?
and (ii) do memory ability and wellbeing improve
following a memory group? We used a cognitive-
behavioral intervention (the LaTCH Memory Group
program), which allowed the training and modeling of
compensatory strategies that can be readily applied in
daily activities. We found that in older age participants,
including those with aMCI, knowledge about mem-
ory strategies improved following intervention, and
that there was a behavioral change with greater use of
strategies in daily activities, while wellbeing and self-
confidence in memory also improved. These effects
were translated into improved memory ability (in daily
39
activities and prospective memory test performance) in
the HOA group, but not for the aMCI group. By six-
month follow-up, gains persisted on most outcomes
for the HOA group; however, for the aMCI group gains
were only maintained in strategy use in daily activities,
although it was also noted that by this stage there were
gains in prospective memory test performance. The
trial findings are encouraging as they indicate benefits
from memory groups for older age participants, albeit
with generally larger and more varied effects for the
HOA group than the aMCI group.
In relation to the first question, strategy knowledge
is a necessary prelude to using an appropriate strategy
in real life activities [35]; by increasing an understand-
ing of the range of strategies that can be considered for
specific tasks, an older person will be more prepared
for unexpected situations when a go to strategy fails
[17]. For example, following training one of the par-
ticipants reported being able to successfully use goal
planning (implementation intention) [56] to remem-
ber an appointment later in the day after he mislaid
his mobile phone (and reminder function). Neverthe-
less, despite immediate gains following intervention,
and in contrast to the HOA group, the aMCI group
was unable to demonstrate long-term gains in strat-
egy knowledge. In earlier small sample studies with
aMCI participants [27, 31], it was reported that strat-
egy knowledge gains could be maintained up to three
or four months post-training, but there was no fur-
ther follow-up assessment. In contrast, our six-month
follow-up provides a more challenging test of sustain-
able change. It was also apparent that even before the
intervention our aMCI group was less able than the
HOA group in identifying appropriate strategies for
everyday memory scenarios, suggesting deterioration
in pre-existing semantic knowledge [57]. The loss of
semantic memory in aMCI adds a further constraint in
learning and maintaining new skills, and highlights the
potential benefit of extending the number of sessions in
the primary memory group or adding booster sessions
for consolidating newly acquired information in peo-
ple confronted by significant memory difficulties [58].
However, our decision to constrain the number of ini-
tial sessions in the memory group was determined by
feedback about the feasibility of group length from par-
ticipants in our earlier pilot study [27]. Furthermore,
in their systematic review of intervention studies, Rei-
jnders et al. [29] found no dose-relationship between
hours of intervention and effectiveness. Alternatively,
some test specific effects were found in the ACTIVE
study when booster training was provided [23] sug-
gesting that this approach may provide the greatest
40 G.J. Kinsella et al. / MCI and Memory Training
advantage for consolidating skill development in use
of strategies.
Of course, increasing knowledge alone will not guar-
antee changing behavior; therefore, providing skills
in the actual techniques and application of memory
strategies is necessary to persuade older adults that
they can manage their everyday memory more effec-
tively [39]. Furthermore, Dixon and de Frias [59]
reported that in a six-year observational study of older
adults, participants who were found to have a mild
memory deficit were increasingly less likely to use
memory strategies than older adults with normal mem-
ory function. In this context, it was notable that our
participants with aMCI, as well as the HOA group,
reported that their strategy use increased following
intervention, and long-term gains were found in both
internal and external strategies. The intervention, fol-
lowing the principles of promoting behavior change
[37], focused on modeling of strategies to real-world
scenarios and provided opportunity for mastery of skill
through practice and weekly assignments. Its multi-
strategy approach endorsed the position that different
people can use different strategies to assist perfor-
mance of everyday tasks [60]. Therefore, participants
were encouraged to develop skills in multiple strategies
rather than focus on one approach; thereby, providing
more secure scaffolding for real world demands [24].
Indeed, the positive shift in reported increased strat-
egy use was reflected in evidence of improvement in
objective memory performance. There were long-term
gains at six-month follow-up on prospective mem-
ory test performance for both groups, and the HOA
group showed a small effect in prospective mem-
ory immediately after intervention. The relevance of
prospective memory, or remembering to perform an
intended action at some point in the future, is that
memory complaints of older people are frequently
about prospective memory errors [12] and prospective
memory has been associated with capacity to main-
tain independent living [61]. The prospective memory
test used in the study (CAMPROMPT) allowed the
use of memory strategies to provide a more naturalis-
tic approach to memory testing, which may account for
why early intervention effects were noted on this test
but not on the word-list memory test (CVLT-II). Fur-
thermore, when questioned about how they approached
memory testing, many participants reported that they
would not use strategies on these tests as that would
be cheating. This illustrates the dilemma of a dis-
connection between performance in real life activities
and performance on clinical tests. The objective of
the memory group was to manage memory difficul-
ties in the real world rather than to effect a shift in
performance on traditional clinical tests where there is
often little opportunity to put into practice strategies
that are relevant for functional problems. A counter-
issue is that caution is also needed in interpreting the
apparent long-term gains on neuropsychological tests
as although alternate versions of tests were used and
counterbalanced across assessment phases, the contri-
bution of practice effects from familiarity with test
protocols must be considered. While neither group
reported improved memory ability in daily activities by
six-month follow-up, the HOA group did report benefit
immediately after intervention. Troyer et al. [31] pro-
posed a staged model of intervention effects, whereby
an increase in knowledge of what to do, is followed by
a behavioral change in increased use of strategies, and
finally by translation of behavioral change into task
performance change. In our study, there is support for
the translation of behavioral change (knowledge and
use of strategies) into task performance change for the
HOA group immediately following intervention and
qualified support for long-term task gains. However,
although some task gains were observed by six-month
follow-up, the aMCI group may need more extensive
intervention to be clipped onto a standard memory
group program to reinforce translation of strategy use
into functional behavior. This may take the form of
combining individualized goal-oriented sessions [62]
with the group sessions in order to reinforce the prac-
tical application of strategy use for personalized goal
attainment in everyday activities.
Finally, a component of the positive effect of the
memory groups is captured by the gains in wellbeing,
including increased self-efficacy or self-confidence in
managing memory performance (also see [39]) and
indexed through increased contentment with mem-
ory performance (MMQ Contentment). Although the
aMCI group could not maintain their early gains by
six-month follow-up, the HOA group was able to show
sustainable wellbeing effects from participation in the
memory group. Following intervention, most partici-
pants reported being reassured that they had been able
to meet with others who experienced similar memory
challenges in daily activities, and many participants
commented that as a result of attending the group, they
regained self-confidence and were able to re-engage
with former activities. For example, one participant
described returning to volunteer driving for meals on
wheels after he had mastered a technique for remem-
bering the routes to be taken for dropping off the meals.
It is the re-engagement with previous life activities as
much as engagement with new activities that represents
 G.J. Kinsella et al. / MCI and Memory Training
an important contribution in the pathway to better men-
tal health, as social re-engagement is potentially more
sustainable.
In relation to methodology, the major strengths of
our study are that the sample includes a large, well-
defined group of older people with aMCI, and that
the multi-component intervention was developed on
evidence-based techniques for improving memory per-
formance [17] and combined with current models of
effecting behavior change [37]. In addition, the study
methodology carefully adhered to CONSORT recom-
mendations and included a six-month follow-up to
evaluate gains in outcome measures after the interven-
tion had ceased. However, it should be noted that in
order to address our research questions, we elected to
use a randomized waitlist control group rather than
an active control. We used this approach as recruit-
ment of the aMCI group was through memory clinics,
where there was a reluctance to commit to an extended
delay (including the follow-up period) in offering the
memory groups for patients struggling with memory
difficulties. As a result the beneficial effects of the
intervention may have been moderated by the positive
expectances of the waitlist group, who were anticipat-
ing involvement in the memory group. Nevertheless,
we were still able to detect small to medium effects
following the randomized intervention in most of the
outcome measures. A further constraint of the wait-
list control group is that we are unable to specify
which component of the intervention was more potent
in effecting behavior change, including the impact
of therapeutic attention alone. However, by selecting
discrete assessments of memory strategy knowledge,
strategy use, and memory ability as well as the more
general outcome measure of wellbeing, we minimized
the risk of over-interpreting the potential for simply
generalized effects from therapeutic attention.
In conclusion, our study findings provide support
for the effectiveness of memory groups as a feasible
intervention in an older age population to reduce and
limit cognitive difficulties in daily life. The value of
memory groups is that they provide a low cost method
for focusing on the engagement of older adults into
techniques for maintaining cognitive health. However,
our study findings suggest that a standard six-week
model of intervention needs adaptation to maximize
the benefits for people with aMCI. Although there was
no clear evidence of translation of intervention effects
into improved memory ability for the aMCI group,
there were intervention benefits (increased knowl-
edge and use of strategies, improved wellbeing and
self-confidence in memory) that provide important
41
contributions to maintaining independence and social
engagement in situations of memory difficulty. Future
research is needed to evaluate how these early train-
ing effects can be sustained over extended periods of
time by extending the sessions of the primary mem-
ory group; or, more specifically, to evaluate whether
the beneficial effects of the intervention for people
with aMCI can be enhanced by incorporating periodic
goal-oriented booster sessions to consolidate new skills
acquisition and also to improve self-confidence in
applying skills in daily activities. From a cost perspec-
tive, the memory group intervention has relatively low
resource requirements and can be readily incorporated
into existing health and community services. Such sus-
tainable practice is particularly important within the
context of meeting the concerns of our aging commu-
nities.
ACKNOWLEDGMENTS
The authors wish to acknowledge the study par-
ticipants who participated in the memory groups.
We also acknowledge the support of the Cognitive,
Dementia and Memory Services at Austin Health,
Barwon Health, Bendigo Health, Bundoora Extended
Care Centre, Caulfield Hospital, Melbourne Health,
St. Georges Hospital and Wantirna Hospital, as well
as Associate Professor Michael Woodward and Dr.
Alastair Mander for their referral of aMCI participants
to the study. We would also like to thank Dr. Sarah
Price, Dr. Nadia Petruccelli, Sam Parsons and Fenny
Muliadi for their contribution to the organization of
the study, and the research assistants who aided in data
collection. This work was supported by a NHMRC,
Australia grant (487318) to GJK, DA, ES, BO, MMS,
LC, EM, and ER. KEP is supported by a NHMRC
Clinical Research Training Fellowship (602543).
Authors disclosures available online (http://j-alz.
com/manuscript-disclosures/15-0378r1).
REFERENCES
[1] Editorial (2015) WHO takes up the baton for dementia. Lancet
Neurol 14, 455.
[2] Deary IJ, Corley J, Gow AJ, Harris SE, Houlihan LM, Marioni
RE, Penke L, Rafnsson SB, Starr JM (2009) Age-associated
cognitive decline. Br Med Bull 92, 135-152.
[3] Grady C (2012) The cognitive neuroscience of ageing. Nat
Rev Neurosci 13, 491-505.
[4] Albert MS, DeKosky ST, Dickson D, Dubois B, Feldman HH,
Fox NC, Gamst A, Holtzman DM, Jagust WJ, Petersen RC,
Snyder PJ, Carrillo MC, Their B, Phelps CH (2011) The diag-
nosis of mild cognitive impairment due to alzheimers disease:
Recommendations from the national institute on aging-
42 G.J. Kinsella et al. / MCI and Memory Training
alzheimers association workgroups on diagnostic guidelines
for alzheimers disease. Alzheimers Dement 7, 270-279.
[5] Petersen RC, Caracciolo B, Brayne C, Gauthier S, Jellic V,
Fratiglioni L (2014) Mild cognitive impairment: A concept in
evolution. J Intern Med 275, 214-227.
[6] Le Couteur DG, Doust J, Creasey H, Brayne C (2013) Politi-
cal drive to screen for pre-dementia: Not evidence based and
ignores the harms of diagnosis. BMJ 347, 1-6.
[7] Brodaty H, Heffernan M, Kochan NA, Draper B, Trollor JN,
Reppermund S, Slavin MJ, Sachdev PS (2013) Mild cognitive
impairment in a community sample: The Sydney memory and
ageing study. Alzheimers Dement 9, 310-317.
[8] Anguera JA, Boccanfuso J, Rintoul J, Al-Hashimi O, Faraji
F, Janowich J, Kong E, Larraburo Y, Rolle C, Johnston E,
Gazzaley A (2013) Video game training enhances cognitive
control in older adults. Nature 501, 97-101.
[9] Lampit A, Hallock H, Valenzuela M (2014) Computerized
cognitive training in cognitively healthy older adults: A sys-
tematic review and meta-analysis of effect modifiers. PloS
Med 11, 1-18.
[10] Owen AM, Hampshire A, Grahn JA, Stenton R, Dajani S,
Burns AS, Howard RJ, Ballard CG (2010) Putting brain train-
ing to the test. Nature 465, 775-778.
[11] Shipstead Z, Hicks KL, Engle RW (2012) Cogmed working
memory training: Does the evidence support the claims? J
Appl Res Mem Cogn 1, 185-193.
[12] McDaniel MA, Bugg JM (2012) Memory training interven-
tions: What has been forgotten? J Appl Res Mem Cogn 1,
45-50.
[13] Hampstead BM, Sathian K, Phillips PA, Amaraneni A,
Delaune WR, Stringer AY (2012) Mnemonic strategy train-
ing improved memory for object location associations in both
healthy elderly and patients with amnestic mild cognitive
impairment: A randomized, single-blind study. Neuropsy-
chology 26, 385-399.
[14] Kirchhoff BA, Anderson BA, Barch DM, Jacoby LL (2012)
Cognitive and neural effects of semantic encoding strategy
training in older adults. Cereb Cortex 22, 788-799.
[15] Roediger HL, Butler AC (2011) The critical role of retrieval
practice in long-term retention. Trends Cogn Sci 15, 20-27.
[16] Naveh-Benjamin M, Brav TK, Levy O (2007) The associative
memory deficit of older adults: The role of strategy utilization.
Psychol Aging 22, 202-208.
[17] Gross AL, Parisi JM, Spira AP, Kueider AM, Ko JY, Sacynski
JS, Samus QM, Rebok GW (2012) Memory training interven-
tions for older adults: A meta-analysis. Aging Ment Health 16,
722-734.
[18] Kelly ME, Loughrey D, Lawlor BA, Robertson IH, Walsh C,
Brennan S (2014) The impact of cognitive training and mental
stimulation on cognitive and everyday functioning of healthy
older adults: A systematic review and meta-analysis. Ageing
Res Rev 15, 28-43.
[19] Papp KV, Walsh SJ, Snyder PJ (2009) Immediate and delayed
effects of cognitive interventions in healthy elderly: A review
of current literature and future directions. Alzheimers Dement
5, 50-60.
[20] Verhaeghen P, Marceon A, Goossens L (1992) Improving
memory performance in the aged through mnemonic training:
A meta-analytic study. Psychol Aging 7, 242-251.
[21] Martin M, Clare L, Altgassen AM, Cameron MH, Zehn-
der F (2011) Cognition-based interventions for healthy older
adults and people with mild cognitive impairment. Cochrane
Database Syst Rev 1, 1-51.
[22] Ball K, Berch DB, Helmers KF, Jobe JB, Leveck MD, Mar-
siske M, Morris JN, Rebok GW, Smith DM, Tennstedt SL,
Unverzagt FQ, Willis SH (2002) Effects of cognitive training
interventions with older adult: A randomized control trial.
JAMA 288, 2271-2281.
[23] Willis SL, Tennstedt SL, Marsiske M, Ball K, Elias J, Koepke
KM, Morris JN, Rebok GW, Unverzagt FW, Stoddard AM,
Wright E (2006) Long-term effects of cognitive training on
everyday functional outcomes in older adults. JAMA 296,
2805-2814.
[24] Rebok GW, Ball K, Guey LT, Jones RN, Kim HY, King JW,
Marsiska M, Morris JN, Tennstedt SL, Unverzagt FW, Willis
SL (2014) Ten-year effects of the advanced cognitive train-
ing for independent and vital elderly cognitive training trial
on cognition and everyday functioning in older adults. J Am
Geriatr Soc 62, 16-24.
[25] Belleville S, Gilbert B, Fontaine F, Gagnon L, Menard E, Gau-
thier S (2006) Improvement of episodic memory in persons
with mild cognitive impairment and healthy older adults: Evi-
dence from a cognitive intervention program. Dement Geriatr
Cogn Disord 22, 486-499.
[26] Jean L, Bergeron ME, Thivierge S, Simard M (2010) Cog-
nitive intervention programs for individuals with might
cognitive impairment: Systematic review of the literature. Am
J Geriatr Psychiatry 18, 281-296.
[27] Kinsella GJ, Mullaly E, Rand E, Ong B, Burton C, Price S,
Phillips M, Storey E (2009) Early intervention for mild cog-
nitive impairment: A randomised controlled trial. J Neurol
Neurosurg Psychiatry 80, 730-736.
[28] Li H, Li J, Li N, Li B, Wang P, Zhou T (2011) Cognitive
intervention for persons with mild cognitive impairment: A
meta-analysis. Ageing Res Rev 10, 285-296.
[29] Rejinders J, Van Heugten C, Van Boxtel M (2013) Cognitive
interventions in healthy older adults and people with mild
cognitive impairment: A systematic review. Ageing Res Rev
12, 263-275.
[30] Stott J, Spector A (2011) A review of the effectiveness of
memory intervention in mild cognitive impairment (MCI).
Int Psychogeriatr 23, 526-538.
[31] Troyer AK, Murhpy KJ, Anderson ND, Moscovitch M, Craik
FIM (2008) Changing everyday memory behavior in amnes-
tic mild cognitive impairment: A randomised controlled trial.
Neuropsychol Rehabil 18, 65-88.
[32] Unvezagt FW, Kaston L, Johnson KE, Rebok GW, Mar-
siska M, Koepke KM, Elias JW, Morris JN, Willis SL, Ball
K, Rexroth DF, Smith DM, Wolinsky FD, Tennstedt SL
(2007) Effect of memory impairment on training outcomes
in ACTIVE. J Int Neuropsychol Soc 13, 953-960.
[33] Brawley LR, Rejeski WJ, King AC (2003) Promoting phys-
ical activity for older adults: The challenges for changing
behavior. Am J Prev Med 25, 172-183.
[34] Borkowski JG, Carr M, Pressley M (1987) Spontaneous
strategy use: Perspective from metacognitive theory. Intelli-
gence 11, 61-75.
[35] Hutchens RL, Kinsella GJ, Ong B, Pike KE, Parsons S, Storey
E, Ames D, Saling MM, Mullaly E, Rand E, Clare L (2012)
Knowledge and use of memory strategies in amnestic mild
cognitive impairment. Psychol Aging 27, 768-777.
[36] Bandura A (1997) Self-efcacy: The exercise of control, WH
Freeman, New York.
[37] Rothman AJ (2006) Initiative to Motivate Change: A review
of theory and practice and their implications for older adults.
In When Im 64, Carstensen LL, Hartel CR, eds. The National
Academic Press, Washington D.C., pp. 121-144.
[38] Stine-Morrow EAL, Basak C (2011) Cognitive interventions.
In Handbook of the psychology of aging, Schaie KW, Willis
SL, eds. Academic Press, San Diego, pp. 153-171.
 G.J. Kinsella et al. / MCI and Memory Training
[39] West RL, Bagwell DK, Dark-Freudeman A (2008) Self-
efficacy and memory aging: The impact of a memory
intervention based on self-efficacy. Neuropsychol Dev Cogn
B Aging Neuropsychol Cogn 15, 302-329.
[40] Brandt J, Benedict RH (2001) The Hopkins Verbal Learn-
ing Test Revised. Psychological Assessment Resources Inc.,
Lutz, Fl.
[41] Wechsler D (1997) Wechsler Memory Scale Third Edition
(WMS-III). The Psychological Corporation, San Antonio, TX.
[42] Wechsler D (2009) Wechsler Memory Scale Fourth Edition
(WMS-IV) Administrative and Scoring Manual. Pearson, San
Antonio, TX.
[43] Meyers JE, Meyers KR (1995) Rey complex figure test under
four different administration procedures. Clin Neuropsychol
9, 63-67.
[44] Morris JC (1993) The Clinical Dementia Rating (CDR): Cur-
rent version and scoring rules. Neurology 43, 2412-2414.
[45] Mohs RC, Doody Rs, Morris JC, Ieni JR, Rogers SL, Perdomo
CA, Pratt RD (2001) A 1-year, placebo-controlled preserva-
tion of function survival study of donepezil in AD patients.
Neurology 57, 481-488.
[46] McKhann GM, Knopman DS, Chertkow H, Hyman BT,
Jack CR Jr, Kawas CH, Klunk WE, Koroshetz WJ, Manly
JJ, Mayeux R, Mohs RC, Morris JC, Rossor MN, Schel-
tens P, Carrillo MC, Thies B, Weintraub S, Phelps CH
(2011) The diagnosis of dementia due to Alzheimers disease:
Recommendations from the national institute of aging-
alzheimers association workgroups on diagnostic guidelines
for alzheimers disease. Alzheimers Dement 7, 263-269.
[47] Anstey KJ, Burns RA, Birrell CL, Steel D, Kiely KM, Luszcz
MA (2010) Estimates of probable dementia prevalence from
population-based surveys compared with dementia preva-
lence estimates based on meta-analyses. BMC Neurol 10,
1-12.
[48] Craik FIM, Winocur G, Palmer H, Binns MA, Edwards M,
Bridges K, Glazer P, Chavannes R, Stuss DT (2007) Cog-
nitive rehabilitation in the elderly: Effects on memory. J Int
Neuropsychol Soc 13, 132-142.
[49] Evans JJ, Wilson BA, Needham P, Brentnall S (2003) Who
makes good use of memory aids? Results of a survey of people
with acquired brain injury. J Int Neuropsychol Soc 9, 925-935.
[50] Troyer AK, Rich JB (2002) Psychometric properties of a new
metamemory questionnaire for older adults. J Gerontol B
Psychol Sci Soc Sci 57, 19-27.
43
[51] Fort I, Adoul L, Holl D, Kaddour J, Gana K (2004) Psycho-
metric properties of the french version of the multifactorial
memory questionnaire for adults and the elderly. Can J Aging
23, 347-357.
[52] Wilson BA, Emslie H, Foley J, Shiel A, Watson P, Hawkins K,
Groot Y, Evans JJ (2005) The Cambridge Prospective Memory
Test, Harcourt Assessment, London.
[53] Delis DC, Kramer JH, Kaplan E, Ober BA (2000) CVLT-II:
California verbal learning test second edition adult version,
Psychological Corporation, San Antonio, TX.
[54] Baraldi AN, Enders CK (2010) An introduction to modern
missing data analyses. J Sch Psychol 48, 5-37.
[55] Faul F, Erdfelder E, Lang AG, Buchner A (2007) G*Power
3: A flexible statistical power analysis program for the social,
behavioural, and biomedical sciences. Behav Res Methods 39,
175-191.
[56] Gollwitzer PM (1999) Implementation intentions: Strong
effects of simple plans. Am Psychol 54, 493-503.
[57] Joubert S, Brambati SM, Ansado J, Barbeau EJ, Felician
O, Didic M, Lacombe J, Goldstein R, Chayer C, Kergoat
MJ (2010) The cognitive and neural expression of semantic
memory impairment in mild cognitive impairment and early
alzheimers disease. Neuropsychologia 48, 978-988.
[58] Fairchild JK, Friedman L, Rosen AC, Yesavage JA (2013)
Which older adults maintain benefit from cognitive train-
ing? Use of signal detection methods to identify long-term
treatment gains. Int Psychogeriatr 25, 607-616.
[59] Dixon RA, de Frias CM (2007) Mild memory deficits differ-
entially affect 6-year changes in compensatory strategy use.
Psychol Aging 22, 632-638.
[60] Hertzog C, Price J, Dunlosky J (2008) How is knowledge gen-
erated about memory encoding strategy effectiveness? Learn
Individ Diff 18, 430-445.
[61] Schmitter-Edgecombe M, Woo E, Greeley DR (2009) Char-
acterizing multiple memory deficits and their relation to
everyday functioning in individuals with mild cognitive
impairment. Neuropsychology 23, 168-177.
[62] Clare L, Bayer A, Burns A, Corbett A, Jones R, Knapp M,
Kopelman M, Kudlicka A, Leroi I, Oyebode J, Pool J, Woods
B, Whitaker R (2013) Goal-oriented cognitive rehabilitation
in early-stage dementia: Study protocol for a multi-centre
single-blind randomised controlled trial (GREAT). Trials 14,
1-15.