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Article

Christopher Hertzog and Taylor Curley

Metamemory is defined as cognitions about memory and related processes. Related terms in the literature include metacognition, self-evaluation, memory self-efficacy, executive function, self-regulation, cognitive control, and strategic behavior. Metamemory is a multidimensional construct that includes knowledge about how memory works, beliefs about memory (including beliefs about one’s own memory such as memory self-efficacy), monitoring of memory and related processes and products, and metacognitive control, in which adaptive changes in processing approaches and strategies may be contemplated if monitoring of memory processes (encoding, retention, retrieval) indicates that alternative strategies may be required. Older adults generally believe that their memory has declined and that, on average, they have less control over memory and lower memory self-efficacy than young and middle-aged adults. Many but not all aspects of online memory monitoring are well preserved in old age, such as the ability to discriminate between information that has been learned versus not learned. A major exception concerns confidence judgments concerning whether recognition memory decisions are correct; older adults are more prone to high-confidence memory errors, believing they are recognizing something they have not encountered previously. The evidence regarding metacognitive control is more mixed, with some hints that older adults do not use monitoring to adjust control behaviors (e.g., devoting more time and effort to studying items they believe have not yet been well-learned). However, any age deficits in self-regulation based on memory monitoring or adaptive strategy use can probably be addressed through instructions, practice, or training. In general, older adults seem capable of exerting metacognitive control in memory studies, although they may not necessarily do so without explicit support or prompting.

Article

Aleksandra Kudlicka and Linda Clare

The number of people living with dementia is growing, and with limited pharmacological treatment options the importance of psychosocial interventions is increasingly recognized. Cognitive rehabilitation is particularly well placed to address the needs of people living with mild and moderate dementia and their family supporters, as it offers a range of tools to tackle the complexity of the condition. It utilizes powerful approaches of problem solving and goal setting combined with evidence-based rehabilitative techniques for managing cognitive impairments. It also incorporates strategies to address emotional and motivational aspects of dementia that may affect a person’s well-being. It is provided on an individual basis, usually in people’s homes, making it directly applicable to everyday life. It is also genuinely person-centered and flexible as the therapy goals are agreed in a collaborative process between the therapist, person with dementia, and family members. Cognitive rehabilitation does not claim to address underlying pathology, but instead focuses on a person’s functional ability and enjoyment of life. Evidence for effectiveness of cognitive rehabilitation in the context of mild and moderate dementia, mostly Alzheimer’s disease (AD), is gradually accumulating with a number of randomized control trials demonstrating that people with mild and moderate dementia can significantly improve their functioning in targeted areas. For example, the GREAT trial with 475 people with mild to moderate Alzheimer’s, vascular, and mixed dementia completed in 2017 in the United Kingdom demonstrated that cognitive rehabilitation improves everyday functioning in relation to individual therapy goals. There is a growing interest in cognitive rehabilitation and the focus shifts to extending evidence to less-common forms of dementia, particularly in people with non-amnestic presentation. Future efforts need to concentrate on promoting the approach and optimizing application in real-life settings with the aim of maximizing benefits for people living with dementia and their families.