The notion that memory can be improved through acquiring skills and practicing them is very old,
dating back to prehistory (Yates, 1966). For exam­ple, the story in The Iliad was told for generations through the use of mnemonic strategies before it was finally written down. Books that teach read­ers how to improve their own memory have also been around for a very long time (Grey, 1756). Interestingly, the old how-to books taught tech­niques that are virtually identical with those advo­cated in more contemporary books such as those generated by Jerry Lucas (Green, 1999; Lorayne & Lucas, 1996).

Training people how to remember information more effectively can be aimed not only at people with identifiable disorders, but also at people whose memory performance has declined as a result of nor­mal, age-related changes (Camp, 1998; West, 1995). As you may have realized in our earlier discussion about memory strategies, most of them share sev­eral things in common. First, they require paying attention to the incoming information. Second, they rely on already stored information to facilitate mak­ing new connections with the new material. Finally, the best strategies are those that, in the process of encoding, provide the basis for future retrieval cues. In short, the very best memory strategies are the ones that practically guarantee that the appropriate cue will be available to access the stored informa­tion when it must be retrieved (West, 1995).

Memory aids or strategies can be organized into meaningful groups. Among the most useful of these classifications is Camp and colleagues’ (1993) E-I – E-I-O framework. The E-I-E-I-O framework com­bines two types of memory, explicit memory and implicit memory, with two types of memory aids, external aids and internal aids. Explicit memory involves the conscious and intentional recollection of information; remembering this definition on an exam is one example. Implicit memory involves effortless and unconscious recollection of informa­tion; knowing that stop signs are red octagons is usually not something that people need to exert effort to remember when they see one on the road. External aids are memory aids that rely on envi­ronmental resources, such as notebooks or calen­dars. Internal aids are memory aids that rely on mental processes, such as imagery. The Aha! or O!

Table 6.1

The E-I-E-I-O Framework

External

Appointment book Grocery list

Color-coded maps Sandpaper letters experience in the framework is the one that comes with suddenly remembering something. As you can see in Table 6.1, the E-I-E-I-O framework helps organize how different types of memory can be combined with different types of memory aids to provide a broad range of intervention options to help people remember.

We can use Camp and colleagues’ approach to examine research on external and internal memory aids. In addition, we will briefly review two alterna­tives, memory exercises and medications.

External Memory Aids. External memory aids are objects such as diaries, address books, calendars, notepads, microcomputers, and other devices commonly used to support memory in everyday situations such as taking notes during a visit to the physician (McGuire & Codding, 1998). Some external aids involve actually using some external device to store information (e. g., computers and date books), whereas others involve the use of exter­nal aids to cue action (e. g., setting a book out so you won’t forget it).

In general, explicit-external interventions are the most frequently used, probably because they are easy to use and widely available (Cavanaugh, Grady, & Perlmutter, 1983). For example, virtu­ally everyone owns an address book, and small notepads are sold in hundreds of stores. These explicit-external interventions have potential value for improving older adults’ cognitive performance in real-world settings. In a simulation of juror behavior, older adults who took notes when viewing a complex trial provided more detailed and cohesive accounts of the crime (Fitzgerald, 2000). The prob­lem of remembering one’s medication schedule is
best solved with an explicit-external intervention: a pillbox that is divided into compartments cor­responding to days of the week and different times of the day. Research shows that this type of pillbox is the easiest to load and results in the fewest errors (Park, Morrell, Frieske, Blackburn, & Birchmore, 1991; Park, Morrell, & Shifrin, 1999). Along these same lines, Morrow, Hier, Menard, and Leirer (1998) trained older adults with external aids such as icons representing time of day and the number of pills to take. This also helps older adults remember their medication. Memory interventions like this can help older adults maintain their independence. Nursing homes also use explicit-external interven­tions, such as bulletin boards with the date and weather conditions, to help residents keep in touch with current events.

Advocating the use of external aids in memory rehabilitation is becoming increasingly popular. Camp (1998) recommends external aids in working with Alzheimer’s patients. For example, caregivers may label their kitchen cabinets to make it easier for the person with Alzheimer’s disease to remember what is in them. Harris (1984a) suggests that for external cues to be most effective, they should (1) be given close to the time that action is required, (2) be active rather than passive, (3) be specific to the par­ticular action, (4) be portable, (5) fit a wide range of situations, (6) store many cues for long periods, (7) be easy to use, and (8) not require a pen or pencil.

Countering this trend toward greater use of external strategies, West (1995) cautions that over­reliance on external aids can be a problem. She argues that memory is much like a muscle, which needs to be exercised in order to stay in shape, an approach we will consider a bit later.

External-implicit combinations, more widely used with children, nevertheless have applicability with older adults in some situations. For example, many nursing homes use different color schemes to designate different wings or sections of the build­ing. Because people process the color-coded aspects of the building automatically, the implicit nature of this external cue makes it ideal for people who may otherwise have difficulty learning and remembering new information.

Attention and Memory 219

Internal Memory Aids. Looking at Camp and col­leagues’ examples of internal memory aids may trigger some personal experiences. For example, most people use rote rehearsal in preparing for an examination (repeating Camp—E-I-E-I-O over and over), or use mental imagery in remembering the location of their car in a parking lot (we’re parked near the giraffe on the light post). Most research on memory training concerns improving people’s use of these and other internal strategies that supply meaning and help organize incoming information (Backman & Larson, 1992; Willis, 1996). Classic examples of formal internal strategies include the method of loci (remembering items by mentally placing them in locations in a familiar environ­ment), mental retracing (thinking about all the places you may have left your keys), turning letters into numbers, and forming acronyms out of initial letters (such as NASA from National Aeronautic and Space Administration).

Most memory improvement courses train people to become proficient at using one of these internal strategies. For example, Yesavage (1983) trained older adults to use images to help themselves remember people’s names. As shown in Figure 6.4, this training was effective. Interestingly, certain per­sonality traits may be associated with who benefits most from training. Gratzinger, Sheikh, Friedman, and Yesavage (1990) found that people who scored high on openness to experience (a dimension of personality) performed better with imagery than other people. In particular, the fantasy subfactor of the openness dimension (i. e., the tendency to engage in internal fantasizing) was related to greater improvement as a result of imagery training. It may be that people who find it easy to fantasize may be better at coming up with the imagery that help them remember people’s names.

More recent research has also shown that train­ing on internal strategies improves memory signifi­cantly. For example Dunlosky and colleagues (2003) trained older adults either to use standard strate­gies such as imagery or to use imagery strategies along with skills to accurately monitor and control their learning. Both groups outperformed a control group that received no training. Most important,

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older adults who were also trained to rely on moni­toring their learning performed substantially better than those adults who were just trained on standard imagery strategies. Clearly, more research needs to be conducted to understand why adults stop using internal memory strategies that are effective in improving recall and how long they maintain the effects of training after the sessions are over.

The internal strategies we have examined so far fall into the explicit-internal category in Camp and colleagues’ system. However, as noted earlier, explicit strategies require effortful processing and are more taxing on the elderly. Thus, explicit mem­ory intervention would most likely boost memory performance for those elderly who are least likely to suffer failures or for young adults (Rybash, 1996). In fact, healthy older adults are less willing to use effortful internal strategies. In addition, older adults with dementia are unlikely to benefit from these types of strategies (Camp, 1998). Thus, Camp

argues that older adults would benefit more from preserved implicit memory abilities.

One implicit-internal memory aid that has proven quite powerful is based on a technique called spaced retrieval. Camp and colleagues (Camp, 1998; Bourgeois et al., 2003) relate that even people with Alzheimer’s disease can learn new things with this technique. The researchers were able to teach people with Alzheimer’s disease the names of the staff who worked with them even though they had no idea of when or where they acquired this information.

Memory Drugs. Although considerable research has focused on the underlying neurological mecha­nisms in memory, little definitive information is available that can be easily translated into treat­ment approaches, though this is not for lack of trying. For example, we still are not sure which neu­rotransmitters are primarily involved with memory. Many attempts at enhancing memory through the use of drugs that affect neurotransmitters (e. g., acetylcholine) have been made, but so far have produced only modest, short-term improvements
with no long-term changes. Much of the work aimed at improving specific types of memory also has been disappointing (Lombardi & Weingartner,

1995) . This kind of research is especially important for people with Alzheimer’s disease and related disorders.

Combining Strategies. Which memory strategy is best clearly depends on the situation. For example, remembering names probably demands an internal strategy, whereas remembering appointments can most easily be helped by external strategies. For optimal improvement, the best approach is to tailor specific strategies to specific situations.

This is exactly what McEvoy and Moon (1988) did. They designed a comprehensive multiple – strategy training program for improving older adults’ memory in everyday situations. To remem­ber names, older adults were taught an internal strategy emphasizing the need to associate new names with already known information. In con­trast, use of external aids with information on how to review them was used for remembering

appointments such as occasional physician visits. McEvoy and Moon found that after training, par­ticipants had fewer complaints about their memory for names and faces, appointments, routine tasks, and spatial orientation.

McEvoy and Moon’s study points out the impor­tance of tailoring an intervention to fit the problem. What works best for one kind of information may not help us remember another. Moreover, their work also emphasizes the need for broad-based comprehensive intervention programs. Training people to remember only one kind of information is not helpful when their daily lives are filled with far more complicated demands.