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THESIS

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LIBRARY
Michigan State
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This is to certify that the
dissertation entitled
VERBAL MEDDRY PERFORMANCE IN ABLE OLDER ADULTS:

IMPACT OF MEMORY, ATTENTION, AND RELAXATION TRAINING

presented by

Michelle K. Daugherty

has been accepted towards fulfillment
of the requirements for

Ph. D. degree in 233“; ho] 081‘

mm M

Major professor

 

Date 10/ 15/ 99

MSU is an Affirmative Action/Equal Opportunity Institution 0- 12771

 

PLACE IN RErURN BOX to remove this checkout from your record.
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VERBAL MEMORY PERFORMANCE IN ABLE OLDER ADULTS:
IMPACT OF MEMORY, ATTENTION, AND RELAXATION TRAINING

By

Michelle K. Daugherty

A DISSERTATION
Submitted to ‘
Michigan State University
in partial fulfillment of the requirements
for the degree of
DOCTOR OF PHILOSOPHY
Department of Psychology

2000

ABSTRACT

VERBAL MEMORY PERFORMANCE IN ABLE OLDER ADULTS:
IMPACT OF MEMORY, ATTENTION, AND RELAXATION TRAINING

BY

Michelle K. Daugherty

This study examined the effects of combined memory and attention
training, combined memory and relaxation training, and no training on the verbal
memory abilities of able older adults. Participants (N = 84) for this study were
healthy, community-dwelling older adults who were offered two mood and
memory assessments and seven memory training workshops. Verbal memory
abilities were evaluated with the California Verbal Learning Test (CVLT) and the
Logical Memory stories from the Wechsler Memory Scale (WMS). In contrast to
findings from previous studies, most of which did not use control groups, all
predictions of greater verbal memory effects for memory/attention training vs.
memory/relaxation training and for both types of training vs. no training were not
supported. However, post-hoe analyses indicated that participants who received
memory and attention training performed better on a delayed recall task from the
CVLT than participants who received memory and relaxation training. Findings
also revealed that participants performed better on a task of recognition memory
than on a task of unstructured recall and that their verbal memory abilities
improved after being presented with cues. Implications of these findings are

discussed.

ACKNOWLEDGMENTS

I wish to sincerely thank Drs. Dozier Thornton, Ray Frankmann, and Joel
Nigg for their input and support as committee members. A special thanks is due
to Joel Nigg for sharing his knowledge of statistics and data analyses. I also
want to extend my deepest appreciation to Dr. Norman Abeles for his valuable
guidance and essential contributions throughout my work on this dissertation.
Furthermore, I am grateful for the numerous opportunities with which he has
provided me that have enabled me to greatly expand my clinical experience and
have helped shape my future career.

In addition, I want to thank my family for their unconditional love and
support. I especially want to thank my husband, Doug, and my daughter,
Madeline, for being the joy in my life. Watching Madeline grow over the past 16
months has provided me with a sense of amazement and clarity of purpose that

is unlike anything I previously had experienced.

iii

TABLE OF CONTENTS

LIST OF TABLES .................................................................................. vi
INTRODUCTION ................................................................................... 1
Attention in Older Adults ................................................................. 2
Definitions of Attention .......................................................... 2
Theories of the Aging of Attention ............................................ 6
Memory in Older Adults ................................................................ 14
Models of Memory .............................................................. 15
Encoding, Storage, and Retrieval .......................................... 18
Verbal Memory .................................................................. 21
The Relationship between Depression and Memory .................. 24
Improvement in Memory after Cognitive Retraining in Older Adults ........ 28
The Method of Loci ............................................................. 28
The Face-Name Mnemonic .................................................. 31
Attention/Concentration Training ........................................... 35
General Summary and Hypotheses ................................................ 39
Hypotheses ....................................................................... 40
METHOD ........................................................................................... 44
Participants ............................................................................... 44
Measures .................................................................................. 46
Beck Depression Inventory (BDI) ........................................... 46
Geriatric Depression Scale (GDS) .......................................... 46
Mini-Mental State Examination (MMSE) .................................. 47
California Verbal Learning Test (CVLT) ................................... 48
Wechsler Memory Scale (WMS) - Logical Memory ................... 49
Procedure ................................................................................. 50
RESULTS .......................................................................................... 54
Hypothesis 1 .............................................................................. 61
Hypothesis 2 .............................................................................. 62
Hypothesis 3 .............................................................................. 63
Hypothesis 4 .............................................................................. 64
Hypothesis 5 .............................................................................. 66
DISCUSSION ...................................................................................... 70
APPENDIX A
Beck Depression Inventory (Beck et al., 1961) .................................. 86
APPENDIX B
Geriatric Depression Scale (Yesavage et al., 1983) ............................ 88

iv

Table of Contents (Cont’d)

APPENDIX C

Mini-Mental State Examination (Folstein et al., 1975) .......................... 90
APPENDIX D

California Verbal Learning Test (Delis et al., 1987) ............................. 91
APPENDIX E

Wechsler Memory Scale — Logical Memory (Wechsler, 1955) ............... 98
REFERENCES .................................................................................. 101

Table 1:

Table 2:

Table 3:

Table 4:

Table 5:

LIST OF TABLES

Demographic Characteristics of Memory and Attention (M+A)
Training (Group A), Memory and Relaxation (M+R) Training

(Group B), and Control Groups ............................................. 56
Correlations among Pretest Dependent Variables ..................... 58

Correlations Among Dependent Measures and Pretest
Dependent Variables .......................................................... 59

Test-Retest Reliabilities of Dependent Variables (Pretest to
Posttest) ........................................................................... 6O

Univariate Analyses of Variance for Dependent Variables (with
BDI as a Covariate) ............................................................ 68

vi

INTRODUCTION

There are now more than 33 million Americans who are age 65 and over;
furthermore, the fastest growing group in the population consists of individuals
over the age of 85 (Doolittle & Wiggins, 1993). Currently, for persons who are 65
years of age, the mean life expectancy is approximately 19 years for females
and 15 years for males (LaRue, 1992). Thus, as the population of elderly adults
increases, more research examining the abilities of these individuals is needed.
Although many older adults are healthy, it is generally accepted that certain
cognitive functions decrease with increasing age. In particular, findings in the
literature provide support for a decrease in certain memory abilities of older
adults (Neely & Backman, 1995). Older adults frequently complain about verbal
memory difficulties, such as remembering names, lists, and conversations
(Yesavage, Rose, & Bower, 1983). It has also been suggested that limited or
deficient attentional abilities of elderly persons may contribute to the memory
deficits these individuals experience (Yesavage & Jacob, 1984). Research has
shown that healthy older adults can enhance their memory functioning by
Ieaming certain memory training techniques (Yesavage & Rose, 1984b),
although findings regarding the effects of combining memory training with an
attention training component are very limited. As it is important to continue to
develop and expand methods designed to improve memory functioning in old
age, this study investigated the effects of memory and attention training

techniques on the verbal memory abilities of healthy older adults.

Attention in Older Adults

Attention has been a major topic in research since the beginning of
experimental psychology in the late 18005 (McDowd & Birren, 1990). It is
defined as being "responsible for selectively preparing for, maintaining the
preparation for, and processing certain aspects of experience. Attention is also
responsible for the coordination of multiple simultaneous tasks" (Hartley, 1992,
p.5). However, attention in older adults did not become a focus of research
pursuit until more recently (McDowd & Birren, 1990). This lack of emphasis on
exploring the role of attention in cognitive functioning in the elderly is striking in
light of its essential role in one performing cognitive tasks to the best of one's
ability (LaRue, 1992; McDowd & Birren, 1990). Hence, if the ability to attend to
stimuli is impaired, many other cognitive abilities, such as memory, likewise may
be adversely affected. Learning and memory capacities have been shown to
exhibit deficits due to attentional dysfunction; thus, one factor that may contribute
to the reported age—decrements in memory in older adults is a decrease in
attentional abilities (Craik & Simon, 1980). However, studies assessing attention
in older adults often have yielded mixed results which has lead to some
confusion in the literature (LaRue, 1992).
Definitions of Attention

A review of the literature revealed various definitions of attention.
Attention as a general ability has been defined as a "global limited capacity to
support cognitive processing" (Plude & Hoyer, 1985, p.57). Attention is thought

"to be responsible for the transfer of information from the sensory memories to

short-term/working memory" and essential in any conscious or semi-conscious
cognitive processes (Ashcraft, 1989, p.64). According to a model of attention by
Pribram and McGuinness, attention consists of arousal ("a phasic short-lived and
reflex response to input"), activation ("a tonic long-lasting and involuntary
readiness to respond"), and effort (which coordinates arousal and activation and
leads to voluntary control) (McGuinness & Pribram, 1980, p.99). Most theories
of attention assume that the amount of information to which one can attend is
limited and that the maximum limit determines the number of effortful or
controlled processes that can occur concurrently (Ashcraft, 1989).

According to LaRue (1992), commonly examined categories of attention
include sustained attention/concentration, divided attention, selective attention,
and attentional shift/flexibility. McDowd and Birren (1990) defined sustained
attention/concentration as maintaining mental effort on a task over a period of
time; whereas, the authors stated that divided attention refers to the ability to
perform two different tasks simultaneously. At a more basic functional level,
selective attention is defined as the ability to filter out irrelevant stimuli in the
environment and to focus on goal-relevant information. Attentional shiftlflexibility
refers to the process by which an individual can shift his/her attention between
sets of stimuli, and alternately monitor both sources of information (LaRue, 1992;
McDowd & Birren, 1990).

Other investigators have described various factors of attention. In an
early study which attempted to identify processes involved in attention, Sack and

Rice (1974) found that attention consisted of the factors of selectivity, resistance

to distraction, and shifting. Results were based on the administration of specific
tests, which were designed to measure these three concepts, and on factor
analytic techniques. Stankov (1988), in part aiming to identify attentional factors
as separate from other cognitive abilities, found three attentional factors: search,
concentration, and attentional flexibility. Stankov also stated that support in the
literature for the existence of independent selective attention and divided
attention factors is lacking. Four factors of attention were posited by Mirsky
(1989). Using clinical measures, the factors identified were focus and execute,
vigilance, encode, and shift. Similar to Stankov (1988), Shum, McFarland, and
Bain (1990), also employing clinical measures of attention, found only three
factors of attention which they labeled visual-motor scanning, sustained selective
processing, and visual/auditory scanning. In a subsequent study, Shum,
McFarland, and Bain (1994) attempted to explore the relationship between the
clinical approach of using psychological tests to assess attention and the
information processing approach of assessing attention by using experimental
tasks based on theories of cognitive abilities. The authors found that the three
factors of attention that they had previously derived could be predicted by the
following six indices of information processing: mean reaction time, mean
movement time, feature extraction, identification, response selection, and motor
adjustment. Thus, the authors concluded that both the psychological testing and
the information processing approaches are measuring some of the same

attentional processes.

Although researchers often employ varying operational definitions of
attention, it has been theorized that these categories form a common system of
attention (Posner & Rafal, 1987). According to van Zomeren and Brouwer
(1994), it is unclear how many "distinct focused, divided, and sustained attention
abilities exis " (p.29). These authors describe a general, higher level of attention
that they refer to as Supervisory Attentional Control. Supervisory Attentional
Control in turn influences/controls the two dimensions of attention (selectivity and
intensity). The selectivity dimension includes focused attention and divided
attention; whereas, the intensity dimension consists of alertness and sustained
attention (van Zomeren & Brouwer, 1994). Schmidt, Trueblood, and Mewvin
(1994) performed a factor analysis on commonly used clinical tests of attention
and identified a clear one-factor solution. This factor may represent a global
dimension of attention which perhaps is similar to the Supervisory Attentional
Control described by van Zomeren and Brouwer (1994); however, Schmidt et al.
(1994) stated that there is little existing information to guide a conceptual
understanding of this one factor.

As can been seen from the above review of the literature, there are many
varying views of the operational definitions and components/factors of attention.
Thus, the reporting of mixed findings from studies of attention in older adults in
part may be due to employing different specific operational definitions of

attention (LaRue, 1992).

Theories (flie Wf Attention

Reduced Processingfiesources

In general, the reduced processing resources theory attributes age-related
decrements in cognitive functioning to a reduction in some vital processing
resource; however, the exact nature of this processing resource is not often
described. Salthouse (1988) concluded that most of the literature regarding
processing resources could be described using the metaphors of space, energy,
and time. His space metaphor refers to the notion that a finite working-memory
capacity exists which controls the amount of short-term storage that is possible
simultaneously. The energy metaphor refers to the literature that describes the
essential processing resources as attentional capacity. In this view, age-related
decrements in attentional abilities are due to a decrease in the energy that drives
cognitive processing (Hartley, 1992; Plude & Hoyer, 1985; Salthouse, 1988,
1991). The metaphor of time is based on the notion that the faster cognitive
processes can be performed, the more likely multiple operations will be
completed accurately (Salthouse, 1988).

According to a review of the literature by Salthouse (1988), between 24
and 30% of the age-associated decrements in cognitive functioning, including
memory, can be attributed to the mediation of a reduction in the amount of
processing resources. However, the specific role of reduced energy as
representing a decrease in attentional capacity in older adults is somewhat

unclear and is based more on speculation than empirical research (Salthouse,

1988). Currently, the reduced attentional energy hypothesis is not well defined
enough to make solid, testable predictions (Hartley, 1992).

fltomatic versus_Ejforfiufl Processing

Hasher and Zacks (1979) reported that cognitive processes differ in their
attentional requirements, which run along a continuum. The authors stated that
at either end of the 'attentional requirement' continuum are automatic and
effortful processes. Automatic processes "occur. . . without intention, . . .
without necessarily giving rise to awareness, and . . . without interfering with
other processing" (Hasher & Zacks, 1979, p. 362). These processes cannot be
consciously inhibited, and they require very little attentional energy. In contrast,
Hasher and Zacks described effortful processes, such as imagery, mnemonic
devices, clustering, and rehearsal, as voluntary, controlled processes that require
greater amounts of attention and effort. Thus, the number of effortful processes
in which an individual can engage simultaneously is limited. Hasher and Zacks
(1979) reported that decrements in attentional capacity in old age only affect the
efficiency and use of effortful processes. As the occurrence of automatic
processes requires only minimal attentional capacity, these processes should
remain relatively stable into old age.

In support of the idea that the ability to perform tasks requiring effortful
processes declines with old age, Craik and McDowd (1987), using cued recall
tasks (recall involving the presentation of cues) and recognition memory tasks
(involving the re-presentation of material) with young and elderly adults, found

that older individuals recalled words significantly more poorly than younger

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individuals. Furthermore, older adults performed less well on recall tasks than
on recognition tasks. The authors concluded that recall requires more effortful
processes than recognition, and thus older adults perform more poorly on tasks
requiring recall.

Light and Singh (1987) compared the performance of younger and older
adults on implicit and explicit memory tasks. Implicit memory involves processes
which are relatively automatic and require very little attention; in contrast, explicit
memory involved in recall and recognition requires conscious effort and
attention. Similar to Craik and McDowd's (1987) findings, results indicated that
both young and old adults performed similarly on implicit memory tests. The
authors found that older adults' ability to recall words was significantly worse
than that of younger adults; however, the study also revealed that older adults
performed more poorly on recognition tasks than younger adults, although the
authors did not compare recall and recognition abilities in older adults. Further
support for the stability of automatic processes in old age was provided by
Jennings and Jacoby (1993). Their findings indicated that automatic processes
associated with familiarity with names did not differ across young and old adults.
Titov and Knight (1997) also found that automatic processes did not differ
between younger, middle-aged, and older persons, but that effortful/controlled
processes for middle-aged and older adults differed from that of younger

participants.

Spatial Localization Hflothesis

Although the present study does not deal directly with visual search or
visual memory, older adults seem to experience some difficulties in these areas.
Thus, visual attention abilities of the elderly have been examined in order to
assess the impact on other cognitive functioning. Plude and Hoyer (1985)
reported that the age-deficits in the visual selective attentional abilities of older
adults are a result of a decrease in spatial localization capacities. Spatial
localization refers to the "ability to locate task-relevant information in the visual
field" (Plude & Hoyer, 1985, p.76). Rather than being viewed as a resource
which is reduced with advancing age, spatial localization is conceptualized as a
specific process involved in visual information processing (Hartley, 1992).
According to Plude and Hoyer (1985), as spatially locating relevant stimuli
becomes more difficult and requires more attentional energy as individuals age,
less attentional capacity is available for other cognitive processes, such as
memory.

Support for age-related decrements in spatial localization exists based on
studies of visual search (Hartley, 1992; Plude & Hoyer, 1985). Farkas and Hoyer
(1980) used a search task to examine the effects of differences between target
stimuli and irrelevant information on selective attention abilities. When elderly
participants were informed that target items would be in the same position for
each trial and contrasting irrelevant information was present, their localization
performance was similar to that of younger adults. Similarly, Madden (1983)

found that using spatial cueing to inform older adults about the location of a

THl

 

 

 

target helped to diminish the interference effects of nontarget distracter stimuli.
However, other evidence indicates that spatial cues benefit both older and
younger adults equally (Nissen & Corkin, 1985).

Some further support for the spatial localization hypothesis was provided
by Plude and Hoyer (1986). The authors used search (target location is varied)
and nonsearch (target location is fixed) tasks, and consistent with earlier
findings, reported that nontargets interfered with the detection of targets more
significantly for the older participants than younger participants, but only when
the task involved search. In addition, target acuity was equated across
conditions in order to account for an age-related decrement in parafoveal acuity
(Cerella, 1985). Plude and Hoyer (1986) concluded that their results may lend
support for the idea that spatial localization abilities decline with advancing age;
however, they also stated that an alternative explanation of their findings is the
existence of a general age-reduction in the capacity or speed of attentional
processes. In a similar vein, Madden and Allen (1991) concluded that a slowing
of central processing speed in the elderly could explain performance on a visual
search task. Debate still exists in the literature as to the implications of older
adults' performance on visual search tasks (McDowd & Birren, 1990);
nevertheless, decreased visual selective attentional performance of older adults,
which may indirectly affect memory, may be explained, at least in part, by the

spatial localization hypothesis.

10

Inhibition

The finding that elderly individuals can have difficulty in selectively
attending only to relevant stimuli and the results from the selective attention
studies discussed above (Farkas & Hoyer, 1980; Madden, 1983; McDowd &
Birren, 1990; Plude & Hoyer, 1986) have also been explained as being a result
of an age-related decrement in a central processing resource, inhibitory
functioning. Hasher and Zacks (1988) proposed that older adults have a
reduction in their inhibitory attentional mechanisms. This reduction, in turn,
permits irrelevant information to have access to activation and subsequently to
enter working memory. In support of this idea, Hasher and Zacks (1988)
reported that older adults have a greater number of intrusions of personal
memories when attempting to recall text than do younger adults. Older adults
seem to be deficient in their inhibition of irrelevant thoughts that may be
unintentionally activated by the experimental materials.

Results from a study by Kane, Hasher, Stoltzfus, Zacks, and Connelly
(1994) lend support for the notion of age-reduction in inhibitory processes. The
authors attempted to increase the ability of younger and older adults to suppress
attending to distracter stimuli. Findings revealed that although younger
participants were able to increase their ability to suppress irrelevant information,
older participants did not demonstrate a reliable suppression effect. Kane et al.
(1994) concluded that older adults exhibit age-related decrements in inhibitory
attentional processes related to identifying distracter items. Similarly, West and

Bell (1997) demonstrated that older adults have more difficulty than younger

11

adults do in inhibiting the interference from an incongruent word when attempting
to identify the color in which the word was printed.

In an effort to investigate age-related auditory selective attention deficits,
McDowd and Filion (1992) examined younger and older adults' allocation of
attention to relevant and irrelevant stimuli. Participants were instructed to either
attend to or ignore certain tones, and skin conductance orienting responses were
measured as an index of attentional allocation. Unlike the younger adults, older
individuals did not habituate to the 'ignored' stimuli; instead, older participants
continued to orient to both relevant and irrelevant stimuli. Similar to Hasher and
Zacks (1988) and Kane et al. (1994), McDowd and Filion concluded that older
adults have decrements in their ability to inhibit attention to irrelevant information.

As mentioned above, one implication of the age-deficit in inhibition is that
elderly individuals will experience more difficulty with correctly retrieving items
from memory. Gerard, Zacks, Hasher, and Radvansky (1991) found that older
adults were more susceptible to the interference effects of irrelevant data when
retrieving information from working memory. Gerard et al. (1991) concluded that
these results fit with Hasher and Zack's theory that age-decrements in the
inhibition of attention allow for more irrelevant information to enter working
memory. Thus, retrieval of relevant information from memory is more difficult as
it may become conceptually linked with irrelevant data.

In contrast, research conducted in the 19605 and 1970s generally did not
reveal deficits in inhibitory attentional abilities in older adults (Gerard et al.,

1991). No significant differences between younger and older adults in the

12

effects of interference on learning and memory were found. Gerard et al. (1991)
suggested that nonsignificant results during these decades might have been due
to the emphasis placed on recall measures rather than on the types of errors
made and response times. However, findings from a more recent study by Plude
and Doussard-Roosevelt (1989) did not support the age-decrement in inhibition
hypothesis. The performance of older adults did not differ from that of younger
adults, even when the number of distracter items was increased. Thus, although
support exists for an age decrease in attentional inhibition, it is not clear whether
this is a general problem involved in aging. The possible connection between
age-associated deficits in attentional processes and memory processes in older
age does merit further examination.

In general, a great deal of research indicates that there is an age-
associated decrement in attentional abilities which can reduce the efficiency of
cognitive processes, including memory; however, interpreting and generalizing
the specific nature of attentional deficits can be difficult as these studies
employed various operational definitions and tests of attention (Hartley, 1992;
Salthouse, 1988). Furthermore, many theoretical explanations of the aging of
attention exist and research results can lend support to one or more of these
theories; thus, the precise manner in which attentional abilities decrease with
age and the processes by which this affects the cognitive and memory abilities of

older individuals remains somewhat unclear.

13

Memory in Older Adults

It is widely accepted in the literature that aging has a negative impact on
memory performance. As memory deficits in healthy older adults are reported
frequently, the National Institute of Mental Health proposed the concept of and
developed the criteria for "Age-Associated Memory lmpainnent (AAMI)." In
addition, the Diagnostic and Statistical Manual of Mental Disorders - Fourth
Edition (DSM-IV; American Psychiatric Association, 1994) has established the
diagnostic category of "Age-Related Cognitive Decline." Individuals manifesting
AAMI or Age-Related Cognitive Decline are considered to be experiencing
normal age-related changes in memory functioning and can be distinguished
from persons suffering from memory impairments as a result of dementia or
other neurological conditions (Crook, Bartus, Ferris, Whitehouse, Cohen, &
Gershon, 1986; DSM-IV, 1994). Although the notion that healthy older adults
experience memory difficulties is widely accepted, disagreement exists as to the
exact nature of these memory deficits. In addition, it has been reported that
atrophy of the hippocampus is related to mild memory impairments in normal
older adults (Golomb, de Leon, Kluger, George, Tarshish, & Ferris, 1993).
However, clear explanations of why differences exist between younger and older
adults' memory abilities have not been provided (LaRue, 1992). It is important to
continue to clarify which aspects of memory are most affected by normal aging
and which processes are responsible for these changes in order to enhance

differential diagnosis of memory disorder, as well as to provide the most effective

14

cognitive retraining programs as possible for older adults (Mitrushina, Satz,
Chervinsky, & D'Elia, 1991).
Models of Memory

Memory §vstems

A memory systems account for age-related decrements and variability in
memory performance was provided by Tulving (1972, 1983, & 1985). In this
view, a distinction is made between the types of information to be remembered.
Tulving (1972) introduced the terms "episodic memory" and "semantic memory"
to distinguish between two categories of information in memory. He described
episodic memory as consisting of information for the events that happen in an
individual's life, including information presented in a laboratory/experimental
situation. Opposingly, semantic memory was proposed to consist of "the body of
organized, general, and highly overlearned information comprising an individual's
declarative knowledge system" (Salthouse, 1991, p.241). Later, Tulving (1985)
described "procedural memory" (memory from earlier experiences influencing
later performance) as a third system which he considered the most evolutionarily
and developmentally primitive system. He suggested that the memory systems
are organized in a monohierarchical fashion in which procedural memory
supports semantic memory that in turn supports episodic memory. Thus,
according to this view, episodic memory is the most vulnerable to the effects of

aging and trauma; whereas, procedural memory is the least vulnerable (Craik,

1994)

15

It is generally believed that episodic memory is affected by advancing age;
whereas, procedural and semantic memory remain stable or are affected only
minimally by the aging process (Craik, 1994; Craik & Jennings, 1992). However,
Salthouse (1991) disputed this notion somewhat with his conclusion that episodic
and semantic memory are not as easily distinguished by the effects of increasing
age as generally thought. According to this view, although age differences are
larger for tasks involving episodic memory than semantic memory, conclusions
regarding the effects of aging on these two types of memory should be tentative
at this time.

Information-Processing Models

Processing models of memory distinguish between types of memory. The
process of remembering begins with information being stored for a second or
less in sensory store/memory. Then information is transferred to primary/short-
tenn memory where it is held for approximately 30 seconds; this kind of memory
has also been referred to as immediate memory and is considered to be
capacity-limited in the amount of information that can be held at any one moment
(Kausler, 1994). After being rehearsed in primary memory, the information
subsequently is transferred to secondary/Iong-term memory, which involves the
preservation of information in memory from a few minutes to years and is
considered to be capacity-unlimited (Salthouse, 1991). The final stage of
memory involves the transferring of information to tertiary/remote memory, where

information is maintained for several years to decades.

16

The differential effects of aging on each stage of memory processing in
the information-processing model have been examined. In general, when speed
of processing is considered as an indicator of functioning, all of the stages of
processing appear affected by age (LaRue, 1992). However, when response
accuracy is employed as a measure of functioning, evidence for the effects of
age on sensory, primary, and tertiary memory is less confirming. Evidence
remains more convincing for the detrimental effects of aging on secondary
memory (LaRue, 1992; Salthouse, 1991).

D_egth-of-ProcessinLModel

According to Craik and Lockhart (1972), the dichotomy between short-
terrn memory stores and long-term memory stores is somewhat artificial. They
proposed that memory is based on levels of perceptual processing which run
along a continuum of analysis. Early stages of processing involve analysis of
sensory features; whereas, later stages are responsible for "pattern recognition
and the extraction of meaning" (Craik & Lockhart, 1972, p.675). Thus, the
greater the extent of cognitive analysis, the greater the depth of processing. As
a result of this perceptual processing, memory traces are formed. The authors
suggested that the durability/strength of the trace depends on the depth of
analysis (i.e., the deeper the level of processing, the stronger and more complex
the memory trace). A disadvantage of the depth-of-processing model is that it
tends to lead to general principles of operation rather than to specific °
mechanisms of memory which can be empirically tested (Craik & Jennings,

1992)

17

As discussed previously, Craik and McDowd (1987) found that older
adults performed more poorly on measures of recall than on those of recognition.
These results can be viewed in terms of Craik and Lockhart's (1972) depth-of-
processing theory. Older adults may be deficient in their ability to process
information at a deep level; thus, recall tasks (which involve retrieving information
from memory with few to no cues) are more difficult for them than recognition
tasks (which involve the re-presentation of information for recognition). Along
these lines, Craik and McDowd described their findings of older adult's memory
deficits (particularly on tasks of recall) in terms of these individuals being
adversely affected by a reduction in processing resources (Craik, 1994; Craik &
McDowd, 1987). This is similar to Hasher and Zacks' (1979) theory that older
adults experience deficits in effortful processing. Findings that older individuals
use clustering/chunking strategies less frequently than younger individuals when
presented with learning tasks support the view that the aging process decreases
effortful and deeper processing abilities (Eysenck, 1974; Mungas, Ehlers, &
Blunden, 1991).

W

Much research has been devoted to investigating specific cognitive
changes that are responsible for the age-related decrements in memory
performance. As memory is also commonly viewed as involving the processes
of encoding, storage, and retrieval,
efforts have been undertaken to discover whether deficits in these processes

affect secondary memory deficits in older adults. Alternate terminology for these

18

processes includes registration/acquisition, retention, and recall, respectively.
These processes do influence each other (e.g., if one fails to encode
information, then it likewise will not be stored nor can it be retrieved); however,
these processes are usually investigated separately. As researchers have had
difficulty defining storage in cognitive terms, studies have generally been more
focused on the effects of age on the processes of encoding and retrieval (Craik
& Jennings, 1992).

Research regarding age differences in encoding has yielded mixed
results. In several studies, encoding ability has been measured by assessing
older adults' performance on tasks of recognition of words. As recognition tasks
provide external cues, which significantly decrease processing demands, the
effects of storage and retrieval on performance are minimized (Mitrushina &
Satz, 1989). Mitrushina and Satz (1989) and Mitrushina et al. (1991) found that
four age groups of older adults did not differ in their performance on recognition
tasks of learned material. The authors concluded that older adults' ability to
encode information is unaffected by the aging process. However, this study did
not compare older participants to younger participants. Similarly, as discussed
previously, Craik and McDowd (1987) found that older adults' performance on a
task of recognition fell at a somewhat higher level than the performance of
younger adults. The mean age of the older participants was 72.8 years;
whereas, the mean age of the younger participants was 20.7 years. Thus, this
study also seems to indicate that the encoding abilities of older adults remain

intact. In contrast to these findings, Light and Singh (1987) found sizable age

19

differences between older and younger adults on a recognition task. However,
participants in this study were not initially instructed to remember target words.
Overall, the findings reported in the literature regarding age differences in
encoding are relatively discrepant, and the numerous methods employed by
these studies make interpretation of the discrepancies difficult. Various
individual factors may moderate memory performance and need further
consideration, as some research findings have indicated that education,
intellectual activity, and level of income can predict recall abilities in older adults
(Arbuckle, Gold, & Andres, 1986; Craik, Byrd, and Swanson, 1987).

Retrieval processes more generally have been found to be negatively
affected by increasing age (Craik & Jennings, 1992; Mitrushina & Satz, (1989);
Mitrushina et al. (1991), & Morris, Craik, & Gick, 1990). Retrieval abilities of
older adults have frequently been evaluated using measures of free recall (recall
unaided by cues or re-presentation of material) of words/word lists. As recall
tasks require more effort and must be "self-initiated" rather than guided by
external information, it follows that recall should be more adversely affected by
the aging process than recognition (Craik & Jennings, 1992, p.82). Craik and
McDowd (1987), as discussed previously, found that- older adults performed
more poorly on recall than recognition, thus suggesting that recall requires more
effortful retrieval processes than does recognition. However, Salthouse (1991)
suggested that findings of older adults having greater recognition versus recall

abilities may be a result of the great variation in the number or type of

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alternatives provided in recognition tasks in different studies. No standard test of
recognition exists.

In summary, findings regarding the effects of aging on memory abilities
indicate that episodic memory is more adversely affected by aging than semantic
and procedural memory. Likewise, secondary memory abilities have been more
conclusively found to decrease with increasing age than sensory, primary, or
tertiary memory abilities. Furthermore, older adults may have increasing
difficulty with effortful processing of information at an adequately deep level.
This may in turn contribute to the more general finding that older individuals
perform more poorly than younger individuals on tasks of retrieval involving free
recall. Findings regarding the effects of aging on encoding, as represented by
performance on tasks of recognition, have been more discrepant.

Verbal Memom

As is apparent from the above discussion, age-related deficits in memory
tend to vary according to the aspects of memory being assessed and
methodology being employed. The studies described in the preceding
paragraphs measured verbal memory as represented by memory for words/word
lists, as is commonly found in the literature on memory and aging. This is likely a
result, at least in part, of elderly adults fre’quently complaining of verbal memory
difficulties, such as not remembering an individual's name after an introduction or
not remembering what they or others have just said (Kausler, 1985). In addition,
a recent study found that verbal memory processes activate additional brain

regions than those usually associated with memory (medic-temporal and

21

diencephalic structures). Findings implicated the left prefrontal cortex and
retrosplenial area in the encoding of verbal material and the right prefrontal
cortex and the precuneus in the retrieval of this material (Shallice, Fletcher, Frith,
Grasby, Frackowlak, & Dolan, 1994), although support for these findings is
limited and conclusions are speculative.

Schaie and Willis (1993) collected cross-sectional data for the 5th wave of
the Seattle Longitudinal Study in an attempt to discover patterns of age
differences across different ability domains, including verbal memory. In this
study, verbal memory was defined as "the ability to encode, store, and recall
meaningful language units," and was represented by measures of immediate
recall, delayed recall, and word fluency. The authors found that older adults
performed more poorly on word and list learning than younger adults, but that
younger adults had more difficulty on the word fluency task than older adults.
The authors stated that this may be a result of list Ieaming involving episodic
memory and verbal fluency involving semantic memory. Schaie and Willis also
found that women performed significantly better than men on all of the verbal
memory measures; verbal IQ was not controlled, although no differences in
gender were found on a measure of verbal ability. This perhaps indicates that
women, during their lifetime, develop better verbal skills than men which thus
may result in greater verbal memory abilities in old age. Using derived ability
factor scores, findings also indicated that younger adults have greater verbal

memory ability than older adults.

22

A study by Hultsch, Hertzog, and Dixon (1990) investigated the ability
correlates of verbal memory as related to adulthood and aging. The sample
consisted of 584 males and females in three age groups (19-36, 55-69, and 70-
86 years). Verbal memory was measured by recall of words and of text. Similar
to Schaie and Willis' study (1993), results indicated that younger adults
outperformed older adults and men performed more poorly than women on
verbal memory tasks. Additional results indicated that the variance associated
with age was greatly reduced when differences in individual cognitive processing
variables were taken into account. These individual differences in ability, which
included semantic speed, comprehension speed, working memory, verbal
fluency, clustering, and reading comprehension, were found to account for
approximately half of the variance in text and word recall. A related study by
Hultsch, Hertzog, Small, McDonald-Miszczak, and Dixon (1992) examined
whether evidence existed for longitudinal change over the course of three years
in cognitive abilities, including verbal working memory, text recall, and word
recall. Findings indicated that earlier-born individuals had a larger decrement in
verbal working memory performance than the later-bom individuals. The authors
did not find a decline in performance on the text and word recall measures;
however, they suggested that a longer time interval may be required to observe
these predicted decrements.

As mentioned above, clustering or semantic organization (grouping
related information into categories) of verbal material may enhance verbal

memory abilities (Burke & Light, 1981; Hultsch et al., 1990; Kausler, 1994).

23

 

 

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Frequently, studies investigating the categorical organizational abilities of older
adults compare memory performance on free-recall trials to that on cued-recall
trials. According to Burke and Light (1981), semantic organization abilities in
older adults are not as stable as had been previously thought; however,
conflicting findings exist in the literature as a result of the varying paradigms
used. It has been suggested that more passive forms of semantic processing
are unaffected by the aging process; whereas, more active forms of categorical
clustering (independently discovering semantic relationships) are subject to age-
related decrements (Dobbs, Aubrey, & Rule, 1989). This may be a result of
older adults experiencing a decrease in their effortful processing abilities. Along
these lines, elderly individuals' verbal memory abilities may be enhanced when
logical contextual connections are provided, such as with a short story (Meyer &
Rice, cited in Albert, 1984).

In general, results of studies examining the verbal memory abilities of
older adults indicate that these individuals tend to perform worse than younger
individuals on verbal learning and memory tasks. The effects of gender may
also need to be considered. Furthermore, older adults tend to have deficits in
active semantic organization abilities which may be a result of decreased effortful
processing abilities.

The Relationship between Dew

As evidence from the above discussion indicated, memory abilities of

older adults may be enhanced through various semantic techniques; however,

the memory functioning of older adults may also be hindered by depression.

24

Among older adults, depression is the second most common mental disorder;
only dementia occurs more frequently (LaRue, 1992). Depression has been
found to occur for the first time in 10-20% of adults 60 years of age and older
(Ruegg, Zisook, & Swerdlow, 1988). Depression has been investigated as both
a clinical syndrome, in which symptoms must meet various criteria in order to
receive a diagnosis, and as a range of symptoms which vary in severity and are
assessed by using self-report scales (Karel, 1997). Although older adults have
been found to have the lowest rates of the clinical syndrome, major depression,
adults aged approximately 70 years and older tend to report the greatest
number of depressive symptoms when compared to adults in their late 305 to
late 603, although further and more general conclusions cannot be drawn as a
result of the diverse measurements used in this type of research (Karel, 1987;
Kessler, Foster, Webster, & House, 1992; Newmann, 1989). As depression is
considered to be multidetermined, Karel (1997) investigated the factors that may
influence the development of depression in older adults. The author found that
as an individual ages, helshe experiences an increase in biological vulnerability
to depression as a result of an increase in the "prevalence of multiple medical
and neurological disorders," as well as a result of possible side effects from
medication (Karel, 1997, p.858). Furthermore, a gradual increase was found in
the number of stressful life events reported by older adults beginning in their late
50s and included chronic illness, disability, and deaths of spouses, family

members, and friends; this continual increase in stressful life events may

25

account, at least in part, for the increased reporting of depressive symptoms by
very old adults.

According to the results of a meta-analytic study, depression and memory
are significantly related to one another (Burt, Zembar, & Niederehe, 1995).
Depressed persons have been shown to have difficulty using semantic encoding
strategies to organize to-be-remembered information (Weingartner, Cohen,
Murphy, Martello, & Gerdt, 1981). Furthermore, depressed older adults may
exhibit greater levels of cognitive impairment as compared to depressed younger
adults. In mild to moderate depression, cognitive deficits experienced by older
individuals are usually mild in nature. In contrast, one in five older individuals
suffering from more severe depression experience serious cognitive impairments
(LaRue, 1992). The most noticeable difference in neuropsychological test
performance between severely depressed and nondepressed older adults are on
tests of Ieaming and recall and visuospatial processing.

There are two views regarding the origins of cognitive deficits which result
from depression (Jorm, 1986). The first states that depressed people
experience secondary effects of depression. They have the ability to perform
well on cognitive tasks, but are unable to do so as a result of reduced motivation,
having depressive thoughts and worries, and/or suffering from feelings of learned
helplessness. The second theory proposes that the cognitive deficits are
intrinsic to and directly caused by the depression itself and not just a secondary
cause of depression. Although there is some evidence to support both of these

views, little research has been conducted to test each view directly (Jorm, 1986).

26

 

 

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In any case, evidence does suggest that depressed individuals have difficulty
with tasks which require effortful processing, such as tasks of secondary memory
and elaborate encoding abilities (Roy-Byme, Weingartner, Bierer, Thompson, &
Post, 1986; Weingartner et al., 1981 ).

Studies assessing immediate recall of paragraph length stories revealed
that depressed older adults performed at a lower level than expected for their
age (LaRue, 1992). Their performance was similar to the performance of
individuals with mild Alzheimer's disease. In contrast, studies involving list-
learning have yielded somewhat more confusing results. LaRue (1992)
concluded that depressed patients, as generally diagnosed using DSM-lll-R
criteria, have normal learning curves on list-learning tasks; although, results of a
study by Sweeney, Wetzler, Stokes, and Kocsis (1989) indicated that severity of
depression, as classified by Research Diagnostic Criteria (RDC), is negatively
related to performance on initial trials of verbal list-Ieaming tasks. These authors
did not find that depression is related to performance on subsequent trials.
However, Deptula, Singh, and Pomara (1993), using self-report rating scales to
assess levels of depression, found a significant negative relationship between
elderly adults' memory performance on a verbal list-Ieaming task and
depression. Comparing the findings of these studies is difficult though, as
d'rfferent methods were used to assess depression. Although some findings are
discrepant, it can be concluded that depression, either as a clinical syndrome or
as based on self-report, can cause cognitive and memory deficits, and thus its

effects on performance must be controlled in experimental studies.

27

Improvement in Memory after Cognitive Retraining in Older Adults

Because older adults experience deficits in memory abilities and
frequently complain about these perceived difficulties, efforts have been made to
discover effective training programs to improve the verbal memory skills of these
individuals. A significant focus in the literature has been on improving elderly
persons' recall of word lists and names. The two techniques most commonly
used in this endeavor are the method of loci (used for remembering word lists)
and the face-name mnemonic (used for remembering names). In addition, some
attempts have been made to use attention/concentration training techniques to
enhance the memory abilities of older individuals.
ILLe—Mgthodf of Loci

Improving the abilities of elderly adults to remember lists of words might
only seem relevant to laboratory settings; however, there are comparable tasks
in daily living which involve this skill (Yesavage & Rose, 1983). For example,
remembering needed grocery items, appointments, and/or activities or errands
which need to be done all involve list-learning. The method of loci has frequently
been used with all age groups in an effort to improve this skill. The method of
loci is a visual imagery technique which involves an individual generating and
Ieaming in order a list of locations from a familiar surrounding. Then helshe
creates a visual image which involves the first list item to-be- remembered and
the first location from his/her loci list. For example, if the first item is a loaf of
bread and needs to be remembered with the location of a circle drive, the subject

would picture a large puffy circular loaf of bread floating around the circular drive.

28

Each subsequent item on the to-be-remembered list is then matched with each
subsequent location. In order to recall the list of words, the individual must take
a mental walk through the pathway of their loci and remember the visual image
and item associated with each location (Yesavage & Rose, 1984).

Anschutz, Camp, Markley, and Kramer (1985) trained 10 older adults to
use the method of loci in order to remember a list of nouns and a list of grocery
items. Training sessions consisted of two 60 minute sessions. Participants were
tested on their recall of nouns prior to and eight weeks after training. Results
indicated that recall significantly improved. For the grocery list, each subject
generated a list of 30 words, 12 of which were chosen for recall. Participants
were taken grocery shopping and required to shop for the 12 items. Four weeks
later, this task was repeated with different grocery items. Near perfect
performance was found for both grocery trials. Results also revealed that
participants who continued to use the method of loci technique during the
second grocery trial performed better during the final free recall task than those
who modified their strategies. However, caution needs to be taken when
interpreting these results, as only 10 participants were used and no control group
existed.

A study by Kliegl, Smith, and Baltes (1989) used the method of loci
technique to examine the cognitive plasticity of the abilities of elderly adults. The
serial recall of words was tested for a group of 20 older adults (mean age = 71.7
years) and compared to that of a group of 4 younger adults (mean age = 22.8

years). Pretesting was conducted prior to the administration of 26 training

29

sessions to both groups; posttesting was then completed. Results indicated that
both the older and younger groups improved significantly in their serial recall.
However, younger adults' performance improved to a greater extent than the
performance of older adults. The authors concluded that younger adults have
greater cognitive plasticity than older adults, but that older adults do have an
adequate level of plasticity in order to benefit from method of loci training. It is
important to note however that the number of training sessions each subject
received depended upon their performance; thus, participants did not receive
uniform training. In addition, once again, the generalizability of these results may
be questioned in that the younger subject group only consisted of four individuals
and results were not compared to a control group.

Kliegl et al. (1989) were able to replicate the above results using groups of
18 young adults and 19 older adults, thus increasing the ability to generalize their
findings. Baltes and Kliegl (1992) extended Kliegl et al.'s (1989) work by
increasing the number of training sessions to a standard of 38. As with the Kliegl
et al. (1989) study, these authors found that both older and younger adults' recall
performance improved after method of loci training, but that younger adults'
performance improved significantly more than older adults'. Thus, these results
strengthen Kliegl et al.'s (1989) conclusion that although older adults have an
adequate level of cognitive plasticity for retraining, younger adults‘ have a
significantly greater amount of cognitive plasticity, though again no control group

was used.

30

Yesavage & Rose (1984b) investigated the effectiveness of two variations
of the method of loci technique. They trained one group of older adults to
perform the standard method of loci technique and another group of older adults
to perform the method of loci technique and to make judgments of the
pleasantness of each visual image association. In contrast to the previously
discussed results, findings indicated that the number of items recalled improved
only for the older adults in the Loci + Judgment group. Yesavage and Rose
(1984b) did find that both groups in their study improved in the number of items
that were recalled in the correct order. The authors concluded that these results
may be due to differences in methodology between studies. This study trained
participants during three sessions; whereas, the Kliegl et al. (1989) and Baltes
and Kliegl (1992) studies used approximately 26 and 38 sessions, respectively.
Once again, however, no control group was used. Thus, differences in
methodologies and the failure to include control groups may hinder the
generalizability of results; although, in general, studies examining the
effectiveness of the method of loci technique provide evidence that this type of
training may improve the recall memory abilities of older adults.

The Fag-flame Mnemonic

Due to the difficulty older adults experience in recalling names, imagery
techniques, such as the face-name mnemonic, have been developed in an effort
to improve this type of recall (Yesavage, Rose, & Bower, 1983). The face-name
mnemonic technique developed by McCarty (1980) involves a) identifying a

prominent feature of the face; b) modifying the person's name into a high-

31

imagery object ; and c) associating the facial feature with the high-imagery
object through the use of visual imagery. In order to recall a person's name, one
must recall the prominent feature of the face, which should subsequently aid in
the recall of the image association. The transformed name must then be
recalled and decoded into the original name (Yesavage et al. 1983). For
example, in order to remember that a woman's name is Pearl, one could identify
that she has a prominent smile, then could visualize her mouth opening wide to
reveal pearls dancing around inside. When seeing her later, one would think of
her mouth, the pearls dancing around inside of it, and her name, "Pearl."

Yesavage and Rose (1984a) trained 67 participants, divided into young,
middle-aged, and older adult groups, with the face-name mnemonic technique.
Training sessions were provided on two consecutive days. Recall of names was
assessed prior to and after training. Results indicated that all three groups
significantly improved in their recall of names and that level of improvement was
equivalent for the groups. Although a control group was not included, the
authors stated that these findings suggest that the face-name mnemonic
technique is equally effective in improving the memory abilities of young, middle-
aged, and older adults.

Similar to the previously described Yesavage and Rose (1984b)
investigation of the combination of imagery and affective judgment, Yesavage et
al. (1983) examined the effects of training elderly adults to use the face-name
mnemonic combined with making judgments about the pleasantness of their

visual image association. The recall performance of this groups was compared

32

to the performance of a group trained only in the face-name mnemonic
technique and to a control group which was not taught an imagery technique.
Training consisted of one session per day for five consecutive days. Unlike the
Yesavage and Rose (1984b) findings, the Yesavage et al. (1983) results
indicated that although the face-name mnemonic and judgment group performed
better than the face-name mnemonic only group, the recall of both of these
groups improved significantly after training when compared to the control group.
As previously mentioned, Yesavage and Rose (1984b) study had only three
training sessions; whereas, the Yesavage et al. (1983) study had five sessions.
The increase in the number of training sessions may have contributed to these
more positive findings; however, the results of the two studies are somewhat
difficult to compare as each used a different imagery technique. In general,
Yesavage et al. (1983) stated that their findings increase confidence in the use
of face-name mnemonics as a memory training technique. Further support for
the effectiveness of the face-name mnemonic technique was found by
Gratzinger, Sheikh, Friedman, and Yesavage (1990). These authors examined
the name recall differences between groups of older adults who received farm-
name mnemonic training combined with either additional imagery training,
relaxation training, or both additional imagery and affective judgment training.
No differences in recall were found between groups; however, the participants'
recall performance in all three groups significantly improved after training.
Yesavage (1984) investigated relaxation training on the effectiveness of

the face-name mnemonic training on recall performance. Thirty-nine elderly

33

participants were divided into two groups and received six training sessions. The
first group received relaxation training followed by face-name mnemonic training,
and the second group received nonspecific techniques on improving one's
attitude followed by face-name mnemonic training. Findings indicated that
participants in both groups improved in their recall ability after training, but that
the individuals in the combination mnemonic and relaxation training group
improved to a greater extent than those in the mnemonic and nonspecific
technique training group. Yesavage (1984) concluded that relaxation may help
to reduce anxiety levels in order to be able to more effectively use mnemonic
strategies. These results also provide further support for the effectiveness of the
face-name mnemonic training; although, again a control group receiving no
training was not used.

Similar to Yesavage (1984), Yesavage and Jacob (1984) combined
relaxation and the face-name mnemonic training in an effort to improve name
recall for elderly adults. However, only one group of participants was used in this
study, and two training sessions were conducted. Participants' recall was tested
three times: prior to relaxation training, after relaxation training, and after the
face-name mnemonic training. Results indicated that recall improved after both
the relaxation and mnemonic training had been given, but not after the relaxation
training alone. Yesavage and Jacob (1984) also examined the effects of this
combined training on the relationship between name-face recall and the
attentional abilities of these participants. Using a computerized divided attention

task to evaluate attentional abilities, the authors found that relaxation training

34

improved the participants' attention, and that better attention performance
significantly correlated with improvements in name-face recall. However, the
task used to evaluate attention in this study is specific to one component of
attention. In addition, the attention/name-face recall correlation does not imply
causation and is difficult to interpret. Generally though, it does seem that the
name-face mnemonic training technique is effective in improving name-face
recall abilities of older adults, and that additional training in relaxation and in
making affective judgments may enhance these effects.
Atte_ntionlConcengation Training

Studies examining the effects of attention/concentration training on the
cognitive abilities of older adults are sparse. Furthermore, most of the existing
studies have examined the training effects on elderly adults' attentional abilities,
rather than their memory functioning.

Willis, Cornelius, Blow, and Baltes (1983) did examine the impact of
attention training on older adults' memory span abilities, although the major
focus of their study was aimed at improving the attentional abilities of these
participants. Seventy-three elderly adults received five attention training
sessions which were intended to enhance four dimensions of attention:
discrimination, selective attention, attention switching, and concentration-
vigilance. Results indicated that attention training did improve older adults'
attentional abilities; however, this training did not have an effect on memory span

abilities. It should be noted that Willis et al. (1983) only used attention training

35

sessions in this study and did not incorporate any type of memory training into
their protocol. Additionally, no control group was used.

Yesavage and Rose (1983) investigated the effectiveness of the
combination of concentration and memory training on older adults' memory
abilities. Two groups were used for this study. One group received
concentration training (which included relaxation training) followed by the method
of loci training, and the other group received the two types of training in the
reverse order. Concentration training involved techniques to enhance selective
and sustained attention, such as noting and recalling details from pictures and
performing list-learning tasks with background verbal interference. Findings
indicated that although both groups' ability for immediate and delayed recall pairs
of words and text improved after training, the group receiving concentration
training prior to the method of loci training performed significantly better than the
group that received training in the reverse order. The authors concluded that
elderly persons who receive concentration training before memory training may
derive greater benefits from this latter type of training. It is important to note,
however, that relaxation training was included as a component of concentration
training in this study, and thus it is difficult to disentangle which training factors
may have influenced results. Furthermore, no control group was included in this
study.

Rockstroh, Dietrich, and Pokorny (1995) used a somewhat different
method of attention and memory training in an attempt to improve attention and

memory abilities. Twenty-four elderly and 23 younger participants took part in

36

two training periods, each of which consisted of four sessions, which involved
practice training using parallel test versions to baseline and outcome measures.
The tests used measured orientation, focused attention, verbal memory, and
nonverbal memory. The authors found that the performance of both elderly and
young participants improved on all measures after practice training. Rockstroh
et al. (1995) concluded that older adults' cognitive test performance can be
improved by training. However, it is questionable whether the improvements
found by having elderly adults practice skills by taking parallel test versions of
post-tests can be generalized to other tests and real-world tasks which involve
attention and memory abilities.

Similar to Yesavage and Rose (1983), Neely and Backman (1995) also
examined the effects of attention training combined with the method of loci and
relaxation training. Training was administered in the same order to a group of 23
older adults. An additional 23 older adults did not receive any training and thus
served as a control group. Attention training involved focused and divided
attention tasks, as well as working-memory tasks. Results revealed that the
elderly adults who received the combined training immediately improved in their
recall of concrete words and were able to maintain this improvement after six
months. In contrast, control participants' recall did not improve. Additionally,
neither age, years of education, nor Mini-Mental State Examination scores were
predictors of performance gains. The authors suggested that this may be due to
the small range of variation in these variables for these participants. Overall,

Neely and Backman (1995) concluded that multifactorial training improves older

37

adults' recall; however, as the experimental group received attention, method of
loci, and relaxation training, the authors noted that it is unclear which of these
training components contributed to their findings.

In summary, imagery training techniques involving the method of loci and
the face-name mnemonic appear to benefit the memory abilities of older adults.
Research also indicates that additional techniques, such as affective judgment
training, relaxation training, and attention/concentration training may enhance the
benefits of the more traditional mnemonic training. It seems likely that
techniques specifically designed to enhance cognitive abilities, such as attention
training, may provide more direct benefits to individuals experiencing memory
problems than techniques, such as relaxation, which are more broad in focus.
However, as discussed above, drawing more specific conclusions regarding the
enhancement of memory using attention training techniques is difficult as a result
of the combination of attention and relaxation training in these studies. Also,
generalizing results to all elderly adults may be questioned as most of these
studies did not include groups of untrained participants to serve as controls. It is
important to use control groups in these types of treatment studies in order to
investigate whether participants can be affected by nonspecific factors. Simply
having been included in an experimental group may affect participants' post-
treatment performance; this needs to be examined before more definitive
conclusions can be drawn regarding the effects of memory, attention, and

relaxation training.

38

General Summary and Hypotheses

Overall, it can be concluded that attentional abilities decline with
increasing age. Resolving conflicting findings is difficult as many studies
operationalize attention in a variety of ways. Several theories exist to explain the
processes involved in and causes for age-related decrements in attention;
however, results in the literature can often be attributed to more than one theory.
Elderly individuals also have been found to experience decreases in memory
functioning with advancing age. In particular, secondary memory abilities appear
most affected by the aging process. Older adults tend to have greater difficulty
with tasks of free recall than younger adults. This suggests problems with
encoding and/or retrieval; however, studies examining encoding abilities have
revealed conflicting findings. In addition, research has shown that active
semantic organization abilities of older adults may be deficient. These findings
from studies of memory seem compatible with attentional theories involving age-
related decreases in effortful processing (Hasher & Zacks, 1979), as well as with
memory theories suggesting that depth of processing abilities decrease with
increasing age (Craik & Lockhart, 1972). Attentional deficits in elderly adults
may contribute to the decreases found in memory functioning. Furthermore, the
effects of depression need to be controlled statistically as more severe levels of
depression can hinder performance on measures of memory.

As attention and memory abilities tend to decline in normal aging, it is
important to develop ways in which older adults can improve their memory

functioning. Research has shown that memory training techniques involving

39

imagery (the method of loci and the face-name mnemonic) can enhance elderly
adults' performance on memory measures. However, the effects of adding
additional components, such as attention training, to memory training on older
adults' memory abilities are somewhat unclear. It seems plausible though that
adding a specific and targeted cognitive training component, such as attention
training, to memory training will improve memory functioning more than by
adding a more general component, such as relaxation, to memory training;
although this needs investigation. In addition, generalizing findings from studies
involving memory training is somewhat difficult as control groups frequently have
not been used. As research has indicated that older adults experience
decreases in their verbal memory abilities and these individuals frequently
complain about these difficulties, the present study examined the effects of
combining memory and attention training on the verbal memory abilities of
healthy older adults. The performance of this group was compared to the
performances of a group receiving memory and relaxation training and a control
group not receiving any training. Thus, this study expanded and improved upon
the methods used in previous studies.
Hypotheses

These hypotheses are formulated in terms of nine components of the
California Verbal Learning Test (CVLT) and the Logical Memory from the
Wechsler Memory Scale. Detailed information about these dependent variables
is given below under "Measures." Based on the above review of the literature,

the following hypotheses were tested:

40

1. Participants who receive combined memory and attention training will perform
better on overall verbal memory measures than participants who receive
combined memory and relaxation training. Both groups of participants who
receive training will perform better on overall verbal memory measures after
training than participants in a control group who do not receive training.

Specifically, the group that receives memory and attention training will
have greater total recall scores on the CVLT and greater total recall scores on
LM than the group that receive memory and relaxation training. Both groups will
have greater total recall scores on the CVLT and greater total recall scores on
LM after training than a control group.

2. Participants who receive combined memory and attention training will
demonstrate more active and organized recall strategies than those who receive
combined memory and relaxation training. Participants in both groups will
demonstrate more active and organized recall strategies after training than those
in a control group who do not receive training.

Specifically, participants who receive memory and attention training will
use semantic clustering strategies more frequently on the CVLT than participants
who receive memory and relaxation training. Participants in both training groups
will use semantic clustering strategies more frequently on the CVLT after training
than participants in a control group.

3. Participants in all groups will perform better on a task of recognition memory
than on a task of free recall. However, the performance of those who receive

combined memory and attention training on recognition and recall tasks will be

41

better than the performance of those who receive combined memory and
relaxation training. The performances of participants in both training groups on
recognition and recall tasks will be better after training than the performance of
those in a control group.

Specifically, participants in all groups will have higher pretraining
recognition scores than long-delay free recall scores on the CVLT. Those who
receive memory and attention training will have higher recognition and long-delay
free recall scores than those who receive memory and relaxation training.
Participants in both training groups will have higher recognition and long-delay
free recall scores on the CVLT after training than participants in a control group.
4. As older adults tend to benefit from information being presented with cues, all
groups of participants will perform better on pretraining cued recall than on
unstructured word recall. However, participants in the memory and attention
group will improve more than the participants in the memory and relaxation
group in their unstructured word recall. Both groups will have higher
unstructured word recall scores after training than a control group

Specifically, all groups of participants will have higher pretraining short-delay
cued recall scores than short-delay free recall scores on the CVLT and higher
pretraining long—delay cued recall scores than long-delay free recall scores on
the CVLT. However, after training, participants in the memory and attention
group will have higher short-delay free recall scores and long-delay free recall
scores on the CVLT than those in the memory and relaxation group. Both

groups will have higher free recall scores after training than the control group.

42

5. Participants who receive combined memory and attention training will perform
better on an unstructured immediate word recall measure than participants who
receive combined memory and relaxation training. Both groups of participants
who receive training will perform better on unstructured immediate word recall
after training than participants in a control group who do not receive training.
Specifically, participants who received memory and attention training will
have higher CVLT Trial 1 immediate free recall scores than participants who
received memory and relaxation training. Both groups will perform better after

training than the control group.

43

METHOD

Participants

The participants for the current study consisted of 84 individuals from an
ongoing Michigan State University (MSU) Psychological Clinic research project
on aging. The participants were community-dwelling older adult volunteers over
the age of 60 who were recruited from senior citizen groups, faculty and staff
retiree groups from MSU, and other Mid-Michigan area locations.
Advertisements and flyers were used to recruit these individuals. Older adults
who earned a score of 24 or greater on the Mini Mental State Examination and
did not report any significant history of severe neurological or medical problems
(e.g., stroke, significant traumatic brain injury) were included in analyses. In
addition, elderly individuals who were experiencing severe levels of depressive
symptomatology were not included in the larger study; instead, they were
referred for treatment.

For the larger study, participants who met the selection criteria (see
above) were randomly assigned to three treatment conditions: memory and
attention training, memory and relaxation training, and a control condition in
which no training was provided. For each of these three groups, the treatment
conditions were imposed between a pre-treatment (Time 1) and a post-treatment
(Time 2) set of measurements on nine dependent variables. These dependent
variables were the eight subscales of the CVLT and LM of the Wechsler

Memory Scale. These scales are described below.

44

As part of the larger study, participants were offered two mood and
memory assessments and seven memory training sessions. As studies in the
literature using between two and eight sessions have revealed similar significant
results to studies employing 26-38 sessions, seven sessions for the current
study was selected as useful and practical. As described above, individuals
were randomly assigned to one of three groups receiving either
memory/attention training, memory/relaxation training, or no training. Those not
receiving training (control group) were offered to participate in memory training
sessions after they had completed their second assessment. The combined
memory and attention training group consisted of 40 older adults, the combined
memory and relaxation group consisted of 32 older adults, and the control group
consisted of 12 older adults. The smaller control group likely is a result of
individuals (who were being recruited as control participants) not wanting to
participate in the current study when it entailed their completing two full
assessments prior to gaining admission to the memory training workshops.

According to Cohen (1992), in order to detect an effect size (1) of .40
(corresponding to power = .80) for main effects for between-groups when using
ANOVAs for statistical analysis, a sample size of 63 participants (21 participants
for each of three groups) is required. As the current study included 84
participants (32 and 40 participants for the memory/attention training and
memory/relaxation training groups, respectively, and 12 participants for the
control group), this should have been adequate for power to approximate the .80

level.

45

Measures

Beck Depression Inventory (BDI)

The BDI (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961; see Appendix
A) is a self-report instrument which assesses the intensity of depressive
symptoms on a 4-point rating scale. Beck (1987) recommended ranges of
scores to indicate three levels of depressive symptomatology. According to
Beck, scores ranging from 0 - 9 reflect normal functioning, scores ranging from
10 - 19 reflect minimal to mild levels of depressive symptomatology, and scores
equal to or greater than 20 reflect moderate to severe levels of depressive
symptomatology.

Meta-analytic investigation of the BDI revealed that its internal consistency
ranged from .73 to .92 (mean = .86) and its concurrent validity as represented
by correlation with clinical ratings of psychiatric patients ranged from .55 to .96
(mean =.72; Beck, Steer, & Garbin, 1988). Research also has shown that the
BDI has good internal consistency and stability in testing older adults (Beck,
Steer, & Garbin, 1988). Using customary cutoff scores, the BDI was able to
accurately detect major and minor depressive disorders in elderly, with a
misclassification rate of only 16-17% (Gallagher, Nies, 8 Thompson, 1983).
Therefore, the BDI can effectively be used to screen for depression in older
adufls.

Geriatric Depression Scatle (GDS)

The GDS (Yesavage, Brink, Rose, Lum, Huang, Adey, & Leirer, 1983; see

Appendix B) is a self-report rating scale which was specifically designed to

46

evaluate levels of depressive symptomatology in the elderly. This measure
focuses on mood aspects of depression, and minimizes the number of questions
regarding somatic symptoms. It consists of 30 yes/no questions which pertain to
the feelings of the subject during the past week including the day of testing. The
recommended ranges to be used to assess levels of depression are 0 - 9
(normal), 10 - 19 (mild depression), and 20 and above (severe depression).

Results of research indicated that the concurrent validity of the GDS,
when correlated with the BDI, was .73 (Beck, 1978). Factor analysis of the GDS
revealed a major factor, labeled dysphoria, and two minor factors, referred to as
worry/obsessive thought and apathy/withdrawal (Pannalee, Katz, & Lawton,
1989). In addition, as measured against the Research Diagnostic Criteria,
criterion validity was found to be .82 (Yesavage et al., 1983).

Mini-Mental State ExaanaQn (MMSE)

The MMSE (Folstein, Folstein, & McHugh, 1975; see Appendix C) was
designed to briefly assess cognitive functioning. This instrument assesses the
following functions: orientation, immediate recall, attention and calculation,
intermediate recall, and language. The maximum obtainable score is 30 points;
a score below 24 suggests impairment in cognitive functioning.

Scores obtained by the standardization sample for the MMSE, which
consisted of 63 healthy older adults, and by younger psychiatric patients ranged
from 24.6 to 27.6. The scores for demented individuals ranged from 9.6 to 12.2.
In addition, test-retest reliabilities, during a 24-hour period, were reported to be

.85 to .99 (Mitrushina & Satz, 1991).

47

Qalifomia Verfl Leami‘npg Test (CVLT)

The CVLT (Delis, Kramer, Kaplan, & Ober,1987; see Appendix D) is a
measure of verbal Ieaming and memory. The test involves five presentations
(trials 1-5) of a shopping list consisting of 16 items from four different categories
(tools, spices/herbs, clothing, and fruits), as well as one presentation of a list of
distracter items. Most of the subscales within the CVLT consist of a total of 16
possible shopping items, and thus, performances across subscales are easily
compared.

The CVLT was designed to "quantify and provide normative data on how
a Ieaming task is solved, that is, the different strategies, processes, and errors
an examinee may display" (Delis, Kramer, Freedland, & Kaplan, 1988, pp.123-
124). The test evaluates concepts researched in cognitive psychology which
have been found to distinguish different neurological populations. The CVLT
assesses such variables as total recall, cued recall, semantic and serial learning
strategies, serial position effects, Ieaming rates, consistency of item recall,
proactive and retroactive interference, retention during short and long delays,
perseverations and intrusions, and recognition. For the purposes of this study,
the variables from the CVLT that were examined are total recall, recall after trial
1, recall after a short delay, recall after a long delay, cued recall after a short
delay, cued recall after a long delay, semantic clustering, and recognition.

A factor analysis of the CVLT was conducted by Delis, Kramer,
Freedland, & Kaplan (1988) using the scores of 286 normal participants. This

analysis revealed six factors which the authors termed general verbal Ieaming,

48

response discrimination, learning strategy, proactive effect, serial position effect,
and acquisition rate. Relevant to the current study, the first factor includes the
variables total recall, short-delay free recall, short-delay cued recall, long-delay
free recall, long-delay cued recall, semantic clustering, and recognition. The
third factor, Ieaming strategy, also includes the semantic clustering variable. The
authors concluded that these results indicate that memory performance on the
CVLT is represented by several theoretically meaningful factors. The numerous
concepts and memory strategies represented by the CVLT variables make this
instrument much more valuable than most memory tests which rely only on
global recall scores. In addition, Delis, Kramer, Kaplan, and Ober (1987)
reported that the CVLT total immediate recall across five trials had a correlation
of .66 with the Wechsler Memory Scale (WMS) - Memory Quotient and
correlations in the .60 range with many other WMS variables.

Wechsler Memorv Scfiale (WMS; - Logical Memom

Stories A and B of Logical Memory (LM) from the WMS (Wechsler, 1955;
see Appendix E) served as a measure of text recall. For this study, only
immediate recall of the stories was assessed, as LM was administered as part of
the Senile Dementia Alzheimer's Type (SDAT) Battery which does not include
the assessment of delayed recall (Storandt, Botwinick, Danziger, Berg, and
Hughes, 1984). After being read each LM story, participants were required to
immediately recall verbatim as much information as possible. The maximum

score for each story, based on the total number of information units possible, is

49

22. A total score was then obtained based on performance on both of the LM
stories.

In several factor analytic studies, LM has consistently been found to load
on the memory factor (Prigatano, 1978). The LM stories also have been found
to have a significant negative relationship (I = -.38) with the Halstead-Reitan
Average Impairment Scale among participants with brain damage (Russell,
1975). Results from clinical research indicate that LM is sensitive to memory
deficits and characterizes memory disorders in various patient groups, such as
those with dementia, multiple sclerosis, and depression (Spreen & Strauss,
1991).

Procedure

All participants in the experimental groups were assessed on the mental
status measure, depression measures, and memory measures prior to (pretest)
and after (posttest) receiving training sessions. Participants in the control group
were tested approximately five weeks apart prior to receiving any training.
Assignment to experimental and control groups was randomized. Pretest and
posttest assessments were conducted at approximately a five week interval.
Assessment sessions took approximately two hours. All tests used in the larger
study were administered according to their standardized procedures. As stated
earlier, the tests relevant to this study were administered as part of a more
comprehensive cognitive assessment battery for a larger MSU Psychological
Clinic aging project. Testing for the larger study was conducted by MSU clinical

psychology doctoral students who have experience in the assessment of older

50

adults; these graduate students were blind to group assignment at pretest and
posttest assessments. The tests were scored by each examiner, and then re—
scored by a student responsible for data entry.

The participants were not given monetary compensation for their
involvement in this study; instead, they took part in workshops consisting of one
of two types of memory training sessions. These individuals were also informed
that they would be given feedback regarding their cognitive performance on the
assessment measures. Testing was conducted individually with each
participant, and testing sessions usually took place on the MSU campus in a
comfortable, quiet location or at participants' homes. All training workshops were
conducted on the MSU campus and took place twice per week for seven
sessions.

Training sessions, provided as part of the larger study, again were
conducted by MSU clinical psychology doctoral students who had experience
working with older adults. Workshops usually consisted of 5 - 10 group
members and were led by the same clinician for seven sessions. Each session
lasted for approximately 90 minutes. Instructors followed a training manual in
order to conduct the seven session workshops (see below). Data from
participants who attended less than five of the seven workshops were excluded
from analyses.

The experimental groups received memory training with either an
additional attention training component or relaxation training component.

Attention training techniques were similar to those described by van Zomeren

51

and Brouwer (1994); relaxation training was modeled after procedures
developed by Benson, Beary, and Carol (1974). Memory training component
that both experimental groups received began with educational instruction and
discussion of age-related memory loss. The memory training consisted of
teaching the method of loci technique and the face-name mnemonic technique,
as well as discussing topics such as memory awareness and self-evaluation,
memory and self-concept, self-change skills, pleasant activities and depression,
positive thinking, and assertiveness. Educational handouts on all of these topics
were provided. Reinforcement of the memory techniques included repetition of
the practice tasks, positive feedback, and homework assignments.

In addition to receiving the memory training described above, one
experimental group received attention training as an additional training
component which involved strategy and stimulation training. For the strategy
attention training, guidelines were provided and discussed regarding preventing
interruptions, avoiding time pressures, creating structure, and analyzing
priorities. The stimulation attention training aspect involved practicing attention
tasks, such as word searches, picking out missing details from pictures, and
finding target letters/words among distracter items. The other experimental
group received relaxation training as an additional component to the memory
training. This additional training did not include any attention training exercises.
Instead, these sessions included discussing the benefits of relaxation and

practicing relaxation exercises.

52

As stated above, individuals in the control group did not receive any
training until they had been administered a pretest and posttest at an interval of
approximately five weeks. At that point, they were entitled to participate in the
training workshops. The inclusion of their data in the current study did not

depend on their workshop attendance.

53

RESULTS

The groups for the present study consisted of participants who received
[a] memory and attention training (p=40), [b] memory and relaxation training
(p=32), and [c] no training (controls) (p=12). Demographic data for the groups
are presented in Table 1. The three groups differed in their initial level of
depression (E(2,81)=3.09, p=.05). Thus, initial level of depression was covaried
in analyzing data. In addition, females performed significantly better than males
on the majority of the verbal memory measures, consistent with findings in the
literature (Hultsch, Hertzog, & Dixon, 1990; Schaie & Willis, 1993). Results were
checked separately for males and females; however, no significant interactions
were found between gender and group except for the CVLT first trial. Therefore,
results are reported with men and women combined and the one relevant
interaction is discussed below (Hypothesis 5). Any differences between the
results from the combined group and the male and female groups is noted
below. As the percentages of male and female participants differed between
groups (see Table 1), analyses were conducted again with gender as a
covariate; however, these results did not differ in significance from the prior
results. No significant differences were found for the remaining demographic
variables.

The basic design for the present study is a three—group comparison of the
pretest and posttest dependent variables. Thus, the multivariate analysis of

variance (MANOVA) routine of SPSS (Version 8.0, 1997) was used as a

54

convenient way to conduct univariate analysis of variance (ANOVA) for the
dependent variables. However, parts of certain hypotheses involved comparing
test performance across all groups; therefore, paired-samples t-tests were used
in these cases.

Correlations among the dependent variables in the pretest data for the
present study are presented in Table 2. Correlations among depression
measures used and the pretest dependent variables are shown in Table 3. In
addition, test-retest reliabilities of the dependent variables are presented in Table
4. The means and standard deviations of the dependent variables that were

used in ANOVAs for all hypotheses are shown in Table 5.

55

Table 1

Demographic Characteristics of Memory and Attention (M+A)Training (Group A), Memory and
Relaxation (M+R) Training (Group B), and Control Groups

 

 

M+A Group M+R Group Controls E d_f p
(E40) (0:32) (n=12)
(Group A) (Group B)
Gender (Frequencies)
Males 15 16 5
Females 25 16 7
Age
Mean 70.82 72.84 69.17 1.52 (2,81) .23
(SD) (6.92) (5.76) (8.67)
Education
Mean 16.35 16.50 16.75 .09 (2,81) .91
(SD) (2.75) (2.96) 3.25
Estimated Verbal IQ
Mean 119.62 120.66 120.12 .17 (2,81) .85
(SD) (8.10) (7.00) (7.34)
MMSE
Mean 28.63 28.28 29.00 1.12 (2,81) .34
(SD) (1.39) (1.71) (1.21)
Pretest BDI
Mean 8.25 7.47 3.50 3.09 (2,81) .05
(SD) (7.38) (4.24) (2.58)
Posttest BDI
Mean 8.05 7.19 3.92 3.09 (2,80) .14
(SD) (7.65) (5.07) (2.54)

(Table 1 continued)

 

Note. MMSE = Mini-Mental State Examination; BDI = Beck Depression Inventory; GDS =

Geriatric Depression Scale

56

Table 1 (continued)

Demographic Characteristics of Memory and Attention (M+A)Training (Group A), Memory and
Relaxation (M+R) Training (Group B), and Control Groups

 

 

M+A Group M+R Group Controls E gt p
(2:40) (fl=32) (0:12)
(Group A) (Group B)
Pretest GDS
Mean 6.98 7.06 3.25 1.47 (2,80) .24
(SD) (6.71) (5.90) (3.11)
Posttest GDS
Mean 6.08 6.44 3.00 2.01 (2,81) .14
(SD) (6.79) (6.16) (2.30)

 

Note. MMSE = Mini-Mental State Examination; BDI = Beck Depression Inventory; GDS =
Geriatric Depression Scale

57

Table 2

Correlations among Pretest Dependent Variables

 

 

1.LM Total -

2.CVLT TR .54“ -

3.Trial 1 .38“ .66“ -

4.Short Free .33“ .76“ .44“ -

5.Short Cue .32" .77“ .38“ .87M -

6.Long Free .36“ .81“ .48“ .85“ .87“ -

7.Long Cue .35” .76“ .39" .85“ .88“ .89"

8.Seman CL .37“r .58" .45“ .54” .50“ .49" .47“ -

9.Recognitn .44" .37" .18 .44" .44“ .41" .53“ .34" -

 

Note. All dependent variable p’s = 82 - 84;

LM Total = Logical Memory Total Score; CVLT TR = CVLT Total Recall; Trial 1 = CVLT
Trial 1; Short Free = CVLT Short-Delay Free Recall; Short Cue = CVLT Short-Delay Cued
Recall; Long Free = CVLT Long-Delay Free Recall; Long Cue = CVLT Long-Delay Cued
Recall; Seman CL = CVLT Semantic Cluster Ratio; Recognitn = CVLT Recognition Hits;
“p<.001

58

Table 3

Correlations among Depression Measures and Pretest Dependent Variables

 

 

BDI GDS

BDI -

GDS .86“ -
LM Total -.07 -.09
CVLT TR .01 .00
Trial 1 -.14 -,14
Short Free -.05 -.05
Short Cue -.09 -.10
Long Free —.10 -.06
Long Cue -.01 .01
Seman CL -.04 -.03
Recognition .06 .06

 

Note. All dependent variable p’s = 82 - 84;

BDI = Beck Depression Inventory; GDS = Geriatric Depression Scale; LM Total = Logical
Memory Total Score; CVLT TR = CVLT Total Recall; Trial 1 = CVLT Trial 1; Short Free =
CVLT Short-Delay Free Recall; Short Cue = CVLT Short-Delay Cued Recall; Long Free =
CVLT Long-Delay Free Recall; Long Cue = CVLT Long-Delay Cued Recall; Seman CL =
CVLT Semantic Cluster Ratio; Recognition = CVLT Recognition Hits;

“p<.001

59

Table 4

Test-Retest Reliabilities of Dependent Variables (Pretest to Posttest)

 

 

LMTotal .68“

CVLT TR .71 **

Trial 1 ,44"

Short Free .63"

Short Cue .69“

Long Free .68“

Long Cue .73”

Seman CL .56“
Recognitn .31“

 

Note. All dependent variable p’s = 82 - 84;

Row Headings = Pretest Dependent Variables; Column Headings = Posttest Dependent
Variables;

Pretest Dependent Variables: LM Total = Logical Memory Total Score; CVLT TR = CVLT Total
Recall; Trial 1 = CVLT Trial 1; Short Free = CVLT Short-Delay Free Recall; Short Cue = CVLT
Short-Delay Cued Recall; Long Free = CVLT Long-Delay Free Recall; Long Cue = CVLT Long-
Delay Cued Recall; Seman CL = CVLT Semantic Cluster Ratio; Recognitn = CVLT Recognition
Hits;

Posttest Dependent Variables: 1.: Logical Memory Total Score; 2.= CVLT Total Recall; 3.=
CVLT Trial 1; 4.= CVLT Short-Delay Free Recall; 5.= CVLT Short-Delay Cued Recall; 6.= CVLT
Long-Delay Free Recall; 7.= CVLT Long-Delay Cued Recall; 8.= CVLT Semantic Cluster Ratio;
9.= CVLT Recognition Hits;

“p<.001

6O

The reliabilities shown in Table 4 are based on a test-retest period of
approximately five weeks. The following are test-retest reliabilities that were
available in the CVLT manual of CVLT scores after a one-year interval: Total
Recall: r = .59”; Short-Delay Free Recall: r = .39; Short-Delay Cued Recall: r =
.66°; Long-Delay Free Recall: r = .64°; Long-Delay Cued Recall: r = .79°;
Semantic Cluster Ratio: r = .493; and Recognition Hits: r = .473 (ap<.05; bp<.01;
°p<.001).

Hypothesis 1

This hypothesis stated that participants in Group A (combined memory and
attention training) would perform better on overall verbal memory measures
(CVLT Total Recall and Logical Memory Total Score) than participants in Group
B (combined memory and relaxation training). In addition, this hypothesis stated
that both groups would perform better after training than participants in a control
group that did not receive training. The hypothesis was tested by conducting two
repeated measures ANOVA, each of which had one within-subjects factor with
two levels (CVLT Total Recall'[pretest and posttest] and Logical Memory Total
Score [pretest and posttest], respectively) crossed with one between-subjects
factor (group). Prior to conducting the ANOVAs, CVLT Total Recall (pretest and
posttest) and Logical Memory Total Score (pretest and posttest) were converted
to z-scores. The time by group interactions for the dependent variables were
nonsignificant (CVLT Total Recall, E(2,78) = .49, p=.62; Logical Memory Total
Score, E(2,78) = .34, p=.72) (See Table 5); thus, Hypothesis 1 was not

supported. Post-hoc repeated measures ANOVAs comparing the two

61

experimental groups without the smaller control group also revealed
nonsignificant time by group interactions (CVLT Total Recall, E (1 ,67) = .00,
p=.97; Logical Memory Total Score, E(1,67) = .61, p=.44). Conducting separate
repeated measures ANOVAs for CVLT Total Recall and for Logical Memory
Total Score did reveal a main effect for time for CVLT Total Recall (E(1,79) =
30.108, p<.001). Inspection of the means for all groups on CVLT Total Recall
indicated that all groups improved from pretest to posttest (See Table 5) ;
however, no significant time by group interaction was found.
Hypothesis 2

This hypothesis stated that participants in Group A (combined memory and
attention training) would demonstrate more active and organized recall strategies
than participants in Group B (combined memory and relaxation training).
Additionally, both groups would demonstrate more active and organized recall
strategies than a control group. Hypothesis 2 was tested by conducting a
repeated measures ANOVA with one 2 level within-subjects factor (pretest and
posttest CVLT Semantic Clustering Ratio) crossed with one between-subjects
factor (group). As shown in Table 5, a time by group interaction for the
dependent variable was not significant (Semantic Clustering, E(2,79) = .31,
p=.74), thus not providing support for this hypothesis. Results did reveal a main
effect for time for semantic clustering (E(1,79) = 5.01, p<.05). Inspection of the
means indicated that all groups improved from pretest to posttest. However, the
relative contributions of males and females to this score differed. A repeated

measures ANOVA for female participants revealed a main effect for Semantic

62

Clustering (_E(1,44) = 8.51, p<.05) indicating that the women’s performance
across all groups improved over time; however, a repeated measures ANOVA
for male participants did not reveal a main effect for this variable, E(1,31) = .27,
p=.61. In addition, a post-hoc repeated measures ANOVA comparing the two
experimental groups also revealed a nonsignificant time by group interaction,
E(1,68) = .53, p=.47.

Hypothesis 3

The first part of this hypothesis stated that all participants would perform
better at pretest on a task of recognition memory (CVLT Recognition Hits) than
on a task of free recall (CVLT Long-Delay Free Recall). Because these two
variables are on the same scale (raw score out of 16 possible words), this part of
the hypothesis was tested using a paired-samples t-test to compare all
participants pretest performance on Recognition Hits to that on Long-Delay Free
Recall. Results of the paired-samples t-test supported this portion of Hypothesis
3; scores were higher across all groups for recognition than free recall, 1(82) =
16.99, p<.001.

The second part of this hypothesis stated that participants in Group A
(combined memory and attention training) would perform better on free recall
and recognition tasks (CVLT Long-Delay Free Recall and CVLT Recognition
Hits) than participants in Group B (combined memory and relaxation training).
Both groups were hypothesized to perform better on these measures than a
control group. This portion of Hypothesis 3 was tested by conducting two

repeated measures ANOVAs, each of which had one within-subjects factor with

63

two levels (CVLT Long-Delay Free Recall [pretest and posttest] and CVLT
Recognition Hits [pretest and posttest], respectively) crossed with one between-
subjects factor (group). Time by group interactions for the dependent variables
were nonsignificant (CVLT Long-Delay Free Recall, _E(2,78) = 2.24, p=.11; CVLT
Recognition Hits, E(2,78) = .08, p=.93) (See Table 5). Main effects were found
for time for both dependent variables (CVLT Long-Delay Free Recall, E_(1,78) =
9.27, p<.05; CVLT Recognition Hits, _E(1,78) = 109.48, p<.001) indicating that all
groups improved over time on both variables. A post-hoc repeated measures
ANOVA comparing the two experimental groups without the smaller control
group did reveal a significant time by group interaction for CVLT Long-Delay
Free Recall, fi(1,67) = 4.55, p<.05; inspection of the means indicates that
although both groups improved, as predicted Group A (combined memory and
attention training) improved more than Group B (combined memory and
relaxation training). Paired-samples t-tests revealed that Group A significantly
improved from pretest to posttest on Long-Delay Free Recall, t(39) = 4.66,
p<.001; whereas, Group B’s improvement was not statistically significant, 1(30) =
1.94, p=.06.
Hypothesis 4

The first part of this hypothesis stated that all participants would benefit
from information being presented with cues and would perform better on pretest
cued recall than on unstructured word recall (CVLT Short-Delay Cued Recall vs.
CVLT Short-Delay Free Recall; CVLT Long-Delay Cued Recall vs. CVLT Long-

Delay Free Recall). Once again, because all of these variables are on the same

64

scale (raw score out of 16 possible words), this part of the hypothesis was tested
using paired-samples t-tests. Comparisons were made between all participants
pretest performance on [a] CVLT Short-Delay Cued Recall to that on CVLT
Short-Delay Free Recall and on [b] CVLT Long-Delay Cued Recall to that on
CVLT Long-Delay Free Recall. Results of the two paired-samples t-tests
supported this portion of Hypothesis 4 (Short-Delay Cued Recall was better than
Short-Delay Free Recall, t(82) = 7.89, p<.001; Long-Delay Cued Recall was
better than Long-Delay Free Recall, 1(82) = 6.51, p<.001).

The second part of Hypothesis 4 stated that participants who received
combined memory and attention training (Group A) would perform better on free
recall measures (CVLT Short-Delay Free Recall; CVLT Long-Delay Free Recall)
than participants who received combined memory and relaxation training (Group
B). In addition, this part of the hypothesis stated that both groups would perform
better on these measures than a control group. Two repeated measures
ANOVAs were conducted, each of which had one 2-level within-subjects factor
(CVLT Short-Delay Free Recall [pretest and posttest] and CVLT Long-Delay
Free Recall [pretest and posttest], respectively) crossed with one between-
subjects factor (group). The time by group interactions for the dependent
variables were nonsignificant (CVLT Short-Delay Free Recall, E(2,79) = .33,
p=.72; CVLT Long-Delay Free Recall, E(2,79) = .20, p=.82) (See Table 5).
Results did reveal main effects for time for both dependent variables (CVLT
Short-Delay Free Recall, E(1,79) = 7.69, p<.01; CVLT Long-Delay Free Recall,

_E(1,79) = 4.44, p<.05); inspection of the means indicated that all groups

65

 

improved from pretest to posttest on both variables. A post-hoc repeated
measures ANOVA comparing the two experimental groups revealed
nonsignificant time by group interactions for both CVLT Short-Delay (_E(1,68) =
.77, p=.38) and Long-Delay (E(1,68) = .01, p=.91). Thus, the second part of
Hypothesis 4 was not supported.
Hypothesis 5

This hypothesis stated that participants in Group A (combined memory and
attention training) would perform better on unstructured immediate word recall
(CVLT Trial 1) than participants in Group B (combined memory and relaxation
training). Again, both groups were hypothesized to perform better on
unstructured immediate word recall after training than a control group.
Hypothesis 5 was tested by conducting a repeated measures ANOVA with one 2
level within-subjects factor (pretest and posttest CVLT Trial 1) crossed with one
between-subjects factor (group). The time by group interaction for Trial 1 was
nonsign'rficant, E(2,78) = 1.08, p=.34. However, there was a main effect for time
for Trial 1 (_E(1,78) = 18.39, p<.001) because all groups improved from pretest to
posttest. Results from conducting a post-hoc ANOVA comparing the two
experimental groups also revealed a nonsignificant time by group interaction for
Trial 1, E(1,68) = 1.56, p=.22. A repeated measures ANOVA for male
participants did reveal a marginally significant time by group interaction for Trial
1, _F_(2,31) = 3.3, p=.05; however, results of paired-samples t-tests revealed that
the only significant pretest to posttest improvement in Trial 1 recall occurred for

male control participants, 1(4) = 5.10, p<.01. It is noteworthy that the sample

66

consisted of only five male control participants. No significant difference in Trial
1 recall existed between the male groups at pretest (E(2,31) = 2.31, p=.12) or at
posttest, _F_(2,31) = .12, p=.89. Thus, based on all of these results, this

hypothesis was not supported.

67

Table 5

Univariate Analyses of Variance for Dependent Variables (with BDI as a Covariate)

 

 

M+A Group M+R Group Controls _E Q; p
(Group A) (Group 8)
LM Total (Hyp. 1)
Pretest: Mean 19.97 17.13 17.50
(SD) (5.71) (5.80) (5.73)
Posttest: Mean 20.58 18.63 18.75
(SD) (6.44) (6.29) (5.97)
Time Main Effect .77 (1,78) .38
Group Main Effect 2.37 (2,78) .10
Time x Group .34 (2,78) .72
CVLT TR (Hyp. 1)
Pretest; Mean 44.48 42.87 41.25
(SD) (9.26) (8.46) (10.91)
Posttest: Mean 50.88 47.94 50.75
(SD) (12.04) (9.89) (11.99)
Time Main Effect 30.11 (1,79) .00
Group Main Effect .71 (2,79) .50
Time x Group 1.36 (2,79) .26
Seman CL (Hyp. 2)
Pretest; Mean 1.71 1.70 1.75
(SD) (0.71) (0.84) (0.92)
Posttest; Mean 2.03 2.20 2.14
(SD) (1.07) (0.93) (1.05)
Time Main Effect 5.01 (1,79) .03
Group Main Effect .09 (2,79) .92
Time x Group .31 (2,79) .74
Long Free (Hyp. 3)
Pretest: Mean 8.20 8.71 8.17
(SD) (3.01) (2.87) (2.82)
Posttest: Mean 10.13 9.63 10.08
(SD) (3.42) (3.56) (3.58)
Time Main Effect 9.27 (1,78) .00
Group Main Effect .01 (2,78) .99
Time x Group 2.24 (2,78) .11
Recognitn (Hyp. 3)
Pretest Mean 13.55 13.97 13.50
(SD) (2.23) (1.89) (3.03)
Posttest; Mean 14.63 14.32 13.83
(SD) (1.72) (1.59) (2.55)
Time Main Effect 109.4 (1.78) -00
Group Main Effect -33 (2.78) 72
Time x Group .08 (2,78) .93
(Table 5 continued)

 

68

Table 5 (continued)

Univariate Analyses of Variance for Dependent Variables

 

 

 

M+A Group M+R Group Controls E _d_f p
(Group A) (Group B)
Short Free (Hyp. 4)
Pretest Mean 8.05 7.94 8.08
(SD) (3.62) (2.95) (2.87)
Posttest: Mean 9.60 9.56 8.92
(SD) (3.31) (3.63) (3.63)
Time Main Effect 7.69 (1 ,79) .01
Group Main Effect .08 (2,79) .93
Time x Group .33 (2,79) .72
Short Cue (Hyp. 4)
(paired-samples t-test)
Pretest: Mean 9.35 9.45 9.42
(SD) (3.13) (2.35) (3.29)
Posttest: Mean 10.85 10.78 1 1.50
(SD) (2.82) (3.09) (2.68)
Long Free (Hyp. 4)
Pretest: Mean 8.20 8.71 8.17
(SD) (3.01) (2.87) (2.82)
Posttest: Mean 10.13 9.63 10.08
(SD) (3.42) (3.56) (3.58)
Time Main Effect 4.44 (1 ,79) .04
Group Main Effect .01 (2,79) .99
Time x Group .20 (2,79) .82
Long Cue (Hyp. 4)
(paired-samples t-test)
Pretest: Mean 9.30 9.55 9.17
(SD) (3.07) (3.00) (2.69)
Posttest: Mean 10.83 10.63 11.42
(SD) (2.96) (3.10) (2.88)
Trial 1 (Hyp. 5)
Pretest: Mean 6.05 5.65 5.67
(SD) (1.43) (1.56) (2.31)
Posttest: Mean 7.58 6.69 7.45
(SD) (2.66) (1.67) (2.25)
Time Main Effect 18.39 (1,78) .00
Group Main Effect 2.05 (2,78) .14
Time x Group 1-03 (2.78) -34

 

Note. LM Total = Logical Memory Total Score; CVLT TR = CVLT Total Recall; Seman CL =

CVLT Semantic Cluster Ratio; Long Free = CVLT Long-Delay Free Recall; Recognitn = CVLT
Recognition Hits; Short Free = CVLT Short-Delay Free Recall; Short Cue = CVLT Short-Delay
Cued Recall; Long Cue = CVLT Long-Delay Cued Recall; Trial 1 = CVLT Trial 1

69

DISCUSSION

The overall objectives of the present study were to examine the effects of
memory/attention training and memory/relaxation training on the verbal memory
abilities of healthy older adults. In general, it was predicted that participants who
received combined memory and attention training would perform better on verbal
memory measures than those who received combined memory and relaxation
training. Furthermore, it was predicted that participants in both experimental
groups would perform better than participants in a control group.

The results of the present study provide some support for the prediction that
memory and attention training would have more beneficial effects than memory
and relaxation training on the verbal memory abilities of healthy older adults.
Specifically, this prediction was supported by way of participants in Group A
(combined memory and attention training) performing better after training on
Long-Delay Free Recall than participants in Group B (combined memory and
relaxation training). However, given the post-hoc nature of this finding, it needs
to be regarded with some tentativeness at best. All other predictions regarding
the differential effects of combined memory and attention training, combined
memory and relaxation training, and no training were not supported. Specifically,
interactions between time and group for the dependent variables (Logical
Memory Total Score, CVLT Total Recall, Semantic Clustering Ratio, Recognition
Hits, Short-Delay Free Recall, Long-Delay Free Recall, and CVLT Trial 1) were

not significant. Thus, the overall evidence from the present study for the

70

effectiveness of combined memory and attention training and combined memory
and relaxation training is weak.

In the realm of the overall verbal memory abilities of healthy older adults,
the prediction that healthy older adults would perform better on a task involving
recognition memory than on a task involving unstructured free recall was
supported. This was represented by all participants performing better at pretest
on CVLT Recognition Hits than on CVLT Long-Delay Free Recall. Along these
lines, the prediction that healthy older adults’ verbal memory abilities would
improve after being presented with cues was also supported. Specifically,
participants in all groups performed better on CVLT Short-Delay Cued Recall
than on CVLT Short-Delay Free Recall and performed better on CVLT Long-
Delay Cued Recall than on CVLT Long-Delay Free Recall. These results are
discussed in turn below for each hypothesis.

The first prediction was that participants who received combined memory
and attention training would perform better than participants who received
combined memory and relaxation training on overall verbal memory measures,
as represented by scores on Logical Memory and CVLT Total Recall, and that
both groups would perform better than a control group. This was not supported.
No significant interaction was found between time and group for Logical Memory
or CVLT Total Recall. Based on findings in the literature that elderly individuals
can experience difficulties in effortful processes requiring higher levels of
attention (Hasher & Zacks, 1979; Jennings & Jacoby, 1993; Light & Singh,

1987), in selective attention abilities (Farkas & Hoyer, 1980; Madden, 1983;

71

McDowd & Birren, 1990; Plude & Hoyer, 1986), and in inhibitory attentional
processes (Hasher & Zacks, 1988; Kane et al., 1994; West & Bell, 1997), it was
proposed that adding an attention-training component to memory training would
more greatly enhance older adults’ memory abilities than would combining
relaxation and memory training. However, results indicated that all participants,
regardless of group assignment, significantly improved from pretest to posttest in
their CVLT Total Recall performance, but did not significantly improve in their
Logical Memory performance.

The improvement of all participants, including the individuals in the control
group, in CVLT Total Recall may be the result of a nonspecific effect of simply
being included in a study designed to improve memory. This may be similar to
the medical placebo effect which can aid in or cause recovery from illness and
disease. Recently, placebo effects have not only been to shown to be caused by
pharrnacologically inactive agents but also by elements of the patient-physician
encounter, such as being told when recovery from an illness will occur, being
given expectations regarding the powerful effects of medicines, and receiving
diagnostic tests (Brown, 1998; Sox, Margulies, & Sox, 1981; Thomas, 1987).
Thus, perhaps being contacted by experimenters involved with a study designed
to improve memory and receiving a battery of tests designed to assess memory
abilities can improve memory functioning.

On the other hand, the improvement of all participants in CVLT Total Recall
may reflect practice effects, as the interval of time between the administration of

the pretest and posttest was only approximately four to six weeks. Performance

72

 

on the CVLT may be more susceptible to practice effects than Logical Memory
as the CVLT involves the immediate recall of a list of words for each of five trials,
recall of these words after both a short and long delay, and recognition of these
words in a final trial; whereas, Logical Memory for this protocol entails only the
immediate recall of a short paragraph that is presented once. The magnitude of
practice effects associated with the CVLT and with Logical Memory are not
directly compared in the literature, although recent findings do indicate that
significant practice effects occur for both of these tests (Rapport, Axelrod,
Theisen, Brines, Kalechstein, & Ricker, 1997). The results regarding Logical
Memory may differ between the present study and the Rapport et al. (1997)
study due to the latter study’s use of a newer version of Logical Memory stories
from the WMS-R and to the inclusion of delayed recall for Logical Memory.
Requiring participants to recall the Logical Memory stories after a 30-minute
delay, in addition to requiring immediate recall of the stories, may have
enhanced practice effects in the Rapport et al. (1997) study. Findings from
another recent study also revealed a moderate practice effect on Logical
Memory from the WMS-R for college students (Dikmen, Heaton, Grant, and
Temkin; 1999). Furthermore, Dikmen et al. reported that practice effects tend to
be greater for individuals who are younger and have higher levels of education.
Thus, perhaps the older age of the participants in the present study limited the
effects of practice for Logical Memory, but their high level of education

contributed to possible practice effects for the CVLT.

73

The second hypothesis, that participants in Group A (combined memory
and attention training) would demonstrate more active, organized recall
strategies, as represented by the CVLT Semantic Clustering Ratio, than
participants in Group B (combined memory and relaxation training) and that both
groups would demonstrate more active, organized recall strategies than those in
a control group was not supported. Instead, initial results indicated that all
participants improved from pretest to posttest in their ability to use active,
organized recall strategies. Examination of the relative contributions of males
and females to this score revealed that females across all groups improved in
their semantic clustering abilities over time; whereas, the males did not improve.
The finding that women were able to improve their semantic clustering strategies
supports the reports in the literature that females tend to have more intact verbal
memory abilities as they age as compared to males (Hultsch et al., 1990; Schaie
& Willis, 1993) and corresponds to the finding in the present study that females
performed better than males across all verbal memory measures. However,
memory training did not have any greater effect on using active recall strategies
than simply being included in a control group that received no training. Once
again, improvement in semantic clustering ability over time may be a result of
nonspecific effects of being included in a study of memory abilities and/or
practice effects of the CVLT.

The first prediction for Hypothesis 3 that all participants would perform
better at pretest on a task of recognition memory, as represented by CVLT

Recognition Hits, than on a task of free recall, as represented by CVLT Long-

74

Delay Free Recall, was confirmed by the data. All participants scored higher on
recognition than on free recall. These results support the findings in the
literature that older adults tend to perform more poorly on measures of recall
than on those of recognition and that deficits in the ability to process information
at a deep level may contribute to free recall difficulties (Craik & Lockhart, 1972;
Craik & McDowd, 1987; Craik, 1994). Deficits in older adults’ deeper processing
abilities may cause retrieving words from memory with no cues to become more
difficult than simply recognizing the words. Again this is similar to Hasher and
Zacks’ (1979) theory that older adults have deficits in effortful processing
abilities.

The second prediction for Hypothesis 3 was that participants who received
combined memory and attention training would perform better on free recall and
recognition tasks (CVLT Long-Delay Free Recall and Recognition Hits,
respectively) than participants who received combined memory and relaxation
training, and that both groups would perform better on these measures than a
control group. Initial findings revealed that participants in all groups improved
over time on both free recall and recognition. However, a post-hoc comparison
of the two experimental groups without the smaller control group revealed that
although both groups improved in their free recall (Long-Delay), participants who
received combined memory and attention training did improve more than those
who received memory and relaxation training.

The above finding indicates, specifically, that the long-delay recall abilities

of healthy older adults are enhanced by practicing attention-related tasks when

75

Ieaming memory improvement techniques; although, due to the post-hoc nature
of this finding, it needs to be interpreted very tentatively. At the same time, this
result is consistent with the theory that decreases in attentional capacity as
adults age affects the efficiency and use of effortful processes, thus contributing
to memory deficits (Craik & McDowd, 1987; Hasher & Zacks, 1979; Light &
Singh, 1987; Titov & Knight, 1997). Furthermore, the current finding is
somewhat similar to Neely and Backman’s (1995) results that attention training
combined with the method of loci training improved older adults’ recall ability;
however, these authors included a relaxation-training component in their
attention/method of loci training. Thus, it is difficult to distinguish between the
effects of attention training and relaxation training in the Neely and Backman
study; whereas, the present finding does tentatively reveal one differential effect
of attention and relaxation training. Although a post-hoc distinction was made
between the two experimental groups, it should be noted that significant
differences between the performance of the experimental and control groups
were not found.

The first prediction for Hypothesis 4 that all participants would benefit from
information being presented with cues was supported. Participants across all
groups performed better at pretest on cued recall tasks (CVLT Short-Delay Cued
Recall and Long-Delay Cued Recall) than on free recall tasks (CVLT Short-Delay
Free Recall and Long-Delay Free Recall). These cued recall tasks involved the
presentation of cues for semantic categories. As older adults have been

reported to have deficits in their ability to actively categorize words (Burke &

76

 

Light, 1981; Dobbs et al., 1989), the present finding indicates that providing cues
to aid in semantic categorization enhances the memory abilities of older adults.

The second prediction for Hypothesis 4 stated that participants in Group A
(combined memory and attention training) would perform better on free recall
measures (CVLT Short-Delay Free Recall and Long-Delay Free Recall) than
participants in Group B (combined memory and relaxation training), and that both
groups would perform better on these measures than participants in a control
group. This prediction was not confirmed by the data. Results indicated that
participants across all groups improved over time on both free recall measures.
Neither the combined memory and attention training nor the combined memory
and relaxation training seemed to have any greater effect on older adults’ verbal
memory abilities than simply being included in this study in a control group.

The final prediction that participants who received combined memory and
attention training would perform better on unstructured immediate word recall
(CVLT Trial 1) than participants who received combined memory and relaxation
training was not supported In addition, the expectation that both groups would
perform better on this measure than participants in a control group was not
confirmed. All participants, regardless of group, improved over time in their
unstructured immediate word recall. Once again, the nonspecific effects of being
included in this study and/or the practice effects associated with the CVLT may
have contributed to the improvement across groups. Upon examination of the
relative contributions of males versus females to the Trial 1 scores, an

unexpected marginally significant interaction between time and group on Trial 1

77

for males was found. Male participants in the control group exhibited greater
improvement in their unstructured immediate word recall than either male
participants in Group A (combined memory and attention training) or male
participants in Group B (combined memory and relaxation training). However,
this likely is a result of small sample size; the male control group consisted of
only five participants.

It is noteworthy that the control group in the present study consisted of only

 

12 participants. The small size of this group (relative to the 40 and 32
participants in the memory/attention training and memory/relaxation training
groups, respectively) may have contributed to the lack of distinction between the
experimental and control conditions. Furthermore, it was more difficult to recruit
participants for the control group than for the experimental groups as the control
participants were not allowed to take part in the memory training groups until
they had completed both the pretest and posttest. Some individuals refused to
take part in this study as a result of having to wait to participate in the training
groups until they had completed two testing sessions. Therefore, the individuals
that did agree to participate in the control group may have been highly self-
selected in their level of motivation. This may have positively affected their test
performance in that these participants may have been more motivated to
perform their best during memory testing. In addition, the control participants
reported experiencing fewer depressive symptoms than participants in the

experimental groups (see Table 1). Thus, individuals in the control group may

78

have been more able to perform to the best of their ability as a result of
experiencing better moods and/or fewer somatic difficulties.

Overall, these results tentatively indicate that combined memory and
attention training more effectively enhances the specific ability of healthy older
adults to recall words after a long delay than combined memory and relaxation
training. However, the experimental groups did not recall words better after a
long delay than the control group. Additionally, combined memory and attention
training does not seem to have a greater effect on overall verbal memory,
semantic clustering, immediate recall, short-delay recall, cued recall, or
recognition abilities of older adults than does combined memory and relaxation
training nor than does inclusion in a control group. In general, these results
seem to indicate that memory/attention training and memory/relaxation training
techniques were relatively ineffective. It should be noted, however, that the
effects of memory/attention and memory/relaxation training may have been
difficult to detect due to the small size of the control group.

Regarding overall verbal memory abilities, as predicted able elderly perform
better on tasks involving the recognition of verbal information as opposed to the
free recall of this information. Furthermore, older adults’ verbal memory abilities
are enhanced by the presentation of cues that aid in the categorical organization
of verbal material.

These results highlight the importance of including control groups in
treatment outcome studies; without the inclusion of a control group in the present

study, it would appear that both types of memory training improved the verbal

79

memory abilities of healthy older adults. Specifically, the improvement that
occurred over time across all groups in overall verbal memory (CVLT Total
Recall), immediate recall (CVLT Trial 1), semantic clustering for women, delayed
free recall (CVLT Short-Delay Free Recall; CVLT Long-Delay Free Recall), and
recognition would appear to have been the result of the cognitive retraining
techniques when in fact, the improvement may have been caused by CVLT
practice effects and/or the nonspecific effects of being included in this study. It is
interesting to note that most of the cognitive retraining studies in the literature
have not employed control groups (Anschutz et al., 1985; Baltes & Kliegl, 1992;
Gratzinger et al., 1990; Kliegl et al., 1989; Rockstroh et al., 1995; Willis et al.,
1983; Yesavage, 1984; Yesavage & Jacob, 1984; Yesavage & Rose, 1983;
Yesavage & Rose, 1984a; Yesavage & Rose, 1984b) and thus, findings from
these studies that memory and/or attention training improves cognitive abilities
may be in question.

Two studies in the literature which did employ control groups have
similarities and differences to the current study (Yesavage et al., 1983; Neely &
Backman, 1995). As discussed previously, Yesavage et al. (1983) compared the
recall abilities of elderly adults who were trained to use the face-name mnemonic
technique combined with making affective judgments of their visual image
association, those who were trained only in the face-name mnemonic technique,
and elderly adults who did not receive training. Both of the experimental groups
performed better than the control group; however, the interaction was not

significant. The present study did employ the face-name mnemonic technique;

80

however, training also included the method of loci imagery technique in addition
to either attention or relaxation training. Thus, it is somewhat difficult to compare
the results of the two studies because different training techniques were used as
commonly occurs in the memory/attention training literature. Also, Yesavage et
al. (1983) used recall of names as the outcome measure in their study. As the
face-name mnemonic technique is intended to directly improve recall of names,
this likely contributed to Yesavage et al.’s findings.

Neely and Backman (1995) investigated the effects of attention, memory,
and relaxation training on older adults’ verbal memory. Similar to the present
study, attention training and the method of loci techniques were used in an effort
to improve recall of words; however, relaxation training was also included in the
one experimental group. Additionally, the face-name mnemonic technique was
not employed. Neely and Backman found that that participants who received the
combined training improved in their word recall; whereas, control participants did
not improve. The authors conceded that it is unclear which of the training
techniques contributed to their findings since all of the techniques were
combined for the experimental group. Once again, this makes it difficult to
compare the Neely and Backman results to the present findings, although
comparison of the pattern of effect sizes across groups from each of these
studies might shed light on the conflicting findings. If the patterns of data across
groups are similar, then greater support is provided for the notion that the small
size of the control group in the present study may have contributed to finding

several nonsignificant results.

81

The sample used for the present study was a relatively homogenous group
of individuals. Participants were Caucasian, middle class individuals from the
Mid-Michigan area. Furthermore, 93% of the participants spoke English as their
first language, and 85% of the participants had held professional or managerial
jobs. Also, the mean level of education and estimated verbal IQ for this sample
was well above average and the variance for each of these variables was low
(years education: mean = 16.46, standard deviation = 2.87; estimated verbal IQ:
mean = 120.09, standard deviation = 7.52 [See Table 1 for means and standard
deviations by group]). The inclusion of faculty retiree groups from MSU in this
sample likely contributed to the high mean level of education and estimated
verbal IQ. The lack of variability among participants may have contributed to the
limited findings in the present study. Thus, it should be noted that the present
findings may not generalize beyond highly educated, intelligent, Caucasian,
healthy older adults.

One limitation of the present study may be that the outcome measures
(CVLT and Logical Memory) used to evaluate memory improvement do not
adequately assess real-world positive changes that may have occurred as a
result of training. For instance, perhaps participants who received combined
memory and attention training improved more than participants who received
combined memory and relaxation training in their ability to remember where they
placed items in their homes and/or what their intended purpose was for entering
a particular room. Both groups may have improved more than the control group

in these areas. However, it is difficult to create objective measures of such

82

improvement. The present study focused on the verbal memory abilities of
elderly adults as these individuals frequently complain of verbal memory
difficulties, such as not remembering what others have just said (Kausler, 1985),
and as objective measures of these abilities exist.

An additional limitation of the current study may be that correlations among
certain CVLT dependent variables were high (See Table 2). Correlations
between Short-Delay Free Recall, Short-Delay Cued Recall, Long-Delay Free
Recall, and Long-Delay Cued Recall ranged between .85 and .89. This may
indicate that these dependent variables measure the same construct. Although
a significant interaction between time and group for Long-Delay Free Recall was
found for the memory/attention training and memory/relaxation training groups,
finding nonsignificant interactions between time and group for the remaining
highly correlated variables may be a result of repeatedly measuring the same
construct. Thus, finding several nonsignificant results in this study may not
represent as strong evidence against the notion that memory training can
enhance memory abilities as would obtaining numerous nonsignificant findings
for entirely different variables.

Future research in cognitive retraining of able older adults may benefit from
looking more closely at the effects of emotional factors, such as depression and
anxiety. As depression has been shown to negatively impact the memory
abilities of older adults (Burt et al., 1995; LaRue, 1992; Weingartner et al., 1981),
the present study did control for depression during data analysis; however, this

study did not measure nor control the particpants’ level of anxiety. Thus, future

83

studies may benefit from controlling for anxiety as an additional variable. Further
exploration of the relationship between these emotional factors and memory
training may help to clarify research findings.

Additionally, it is strongly recommended that future research examining
cognitive retraining of older adults include control groups to evaluate the
effectiveness of the different techniques used. It is also important to employ
control groups in an attempt to replicate the findings from previous memory and
attention training studies. Additionally, the use of larger sample sizes,
particularly regarding the control group in the present study, may be helpful in
obtaining more numerous significant findings. It may also be beneficial to use
verbal memory measures that have alternate forms so as to avoid the potential
practice effects of the CVLT. Moreover, future research should investigate the
effects of cognitive retraining techniques on memory using a more
heterogeneous sample so that future findings would more likely generalize to a

larger segment of healthy older adults in the general population.

84

APPENDICES

85

APPENDIX A

Beck Depression Inventory (Beck et al., 1961)

 

 

 

 

I Date:
Name: Marital Status: __ Age: Sex:
Occupation: Education:

 

 

This questionnaire consists of 21 groups of statements. After reading each group of statements carefully,
circle the number (0, 1. 2 or 3) next to the one statement in each group which best describes the way you
have been feeling the past week. including today. If several statements within a group seem to apply equally
well. circle each one. Be sure to read all the statements in each group before making your choi ice.

 

I do not feel sad. on 't ee am an worse than
I I I d r 1 I y
I feel sad. anyb°dy else
. . . I am critical of myself for my weaknesses
I am sad all the tune and I can t snap out of it. or mistakes

I am so sad or unhappy that I can t stand it. I blame myself all the'time for my mung

2 I am not particularly discouraged about the gaifigpgggu for everything bad
uture.
I feel discouraged about the future. 9 I don't have any thoughts of 1d . g myself.

I feel I have nothing to look forward to.

I have thou hts of killin ,
I feel that the future 15 hopeless and that g g myself bin 1

would not carry them out.
things cannot improve I would like to kill myself.
3 Idonotfeellikeafailure. Iwouldkillmyselfiflhad the chance.
' I feel I have failed more than the
average person. III I don't cry any more than usual.
As I look back on my life. all I can see is I cry more now than I used to.
a lot of failures. I cry an the time now.

I 18911 8111 a complete failure as a Person- I used to be able to cry. but now I can 't cry

even though I want to.

4 I get as much satisfaction out of things as I
used ‘to. _ . 11 I am no more irritated now than I ever am.
I don t enjoy things the way I used to. I get annoyed or irritated more easily than
I don't get real satisfaction out of anything I used to.
anymore.

I feel irritated all the time now.

I don‘t get irritated at all by the things that
used to irritate me.

I am dissatisfied or bored with everything.

 

 

5 I don't feel particularly guilty.
I 1991 guilty a 800d 133-?t 0f the 1:1va 12 I have not lost interest in other people.
I feel quite guilty most of the time. I am less interested in other people than
I feel guilty all of the time. I used to be.
I have lost most of my interest in
3 I don‘t feel I am being punished. other people.
I feel I mav be punished. I have lost all of my interest in Other people.
I expect to be punished.
I feel I am being punished. 13 I make decisions about as well as
I ever could.
. . - - , I put off making decisions more than
7 I don tlfeel disappointed in my self. I used to
I am disappomted m myself. I have greater difficulty in making
I am disgusted With myself. decisions than before.
I hate myself. I can't make decisions at all anymore.

 

 

Subtotal Page 1 CONTINUED ON BACK

 

86

 

 

 

14

IS

17

13

I don't feel I look any worse than I used to.

I am worried that I am looking old or
unattraCtive.

I feel that there are permanent changes
in my appearance that make me look
unattractive.

I believe that I look ugly.

I can work about as well as before.

It takes an extra effort to get started at
doing something.

I have to push myself very hard to do
anvthing.

I can't do any work at all.

I can sleep as well as usual.
I don't sleep as well as I used to.

I wake up 1 -2 hours earlier than usual
and find it hard to get back to sleep.

. I wake up several hours earlier than I

used to and cannot get back to sleep.

I don't get more tired than usual.

I get tired more easily than I used to.

I get tired from doing almost anything.
I am too tired to do anything.

My appetite is no worse than usual.

My appetite is noc as good as it used to be.
My appetite is much worse now.

I have no appetite at all anymore.

 

15

21

I haven‘t lost much weight, if any, lately.
I have lost more than 5 pounds.

I have lost more than 10 pounds.

I have lost more than 1 5 pounds.

I am purposely trying to lose weight by
eating less. Yes No

 

 

I am no more worried about my health
than usual.

I am worried about physical problems
such as aches and pains: or upset
stomach; or constipation.

I am very worried about physical
problems and it's hard to think of
much else.

I am so worried about my physical
problems that I cannot think about
anything else.

I have not noticed any recent change
in my tnterest in sex.

I am less interested in sex than I used
to be.

I am much less interested in sex now.
I have lost interest in sex completely.

 

87

 

 

Subtotal Page 2

Subtotal Page 1

 

 

Total Score

 

APPENDIX B

Geriatric Depression Scale (Yesavage et al., 1983)

GDS

Name:

 

Date:

 

Total Score:

Clinician:

 

 

10.

11.

12.

l3.

14.

Choose the best answer for how you felt over the past week

Are you basically satisfied with your life? ..... Yes/No

Have you dropped many of your activities and interests? ..... Yes/No

Do you feel that your life is empty?....Yes/No

Do you often get bored? ..... Yes/No

Are you hopeful about the future? ..... Yes/No

Are you bothered by thoughts you can’t get out of your head? ..... Yes/No
Are you in good spirits most of the time? ..... Yes/No

Are you afraid that something bad is going to happen to you? ..... Yes/No
Do you feel happy most of the time? ..... Yes/No

Do you feel helpless? ..... Yes/No -

Do you often get restless and fidgety? ..... Yes/No

Do you prefer to stay at home, rather than going out and doing new
things? ..... Yes/No

Do you frequently worry about the future? ..... Yes/No

Do you feel you have more problems with memory than
most? ..... Yes/No

88

15.

16.

17.

18.

19.

27.

28.

29.

30.

Do you think it is wonderful to be alive now? ..... Yes/No

Do you often feel downhearted and blue? ..... Yes/No

Do you feel pretty worthless the way you are now? ..... Yes/No
Do you worry a lot about the past? ..... Yes/No

Do you find life very exciting? ..... Yes/No

Is it hard for you to get started on new projects? ..... Yes/No
Do you feel full of energy? ..... Yes/No

Do you feel that your situation is hopeless? ..... Yes/No

Do you think that most people are better off than you are? ..... Yes/No
Do you frequently get upset over little things? ..... Yes/No

Do you frequently feel like crying? ..... Yes/No

Do you have trouble concentrating? ..... Yes/No

Do you enjoy getting up in the morning? ..... Yes/No

Do you prefer to avoid social gatherings?.....Yes/No

Is it easy for you to make decisions? ..... Yes/No

Is your mind as clear as it used to be? ..... Yes/No

89

APPENDIX C

Mini-Mental State Examination (Folstein et al., 1975)

 

 

 

 

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w'demwdaudymbanomsecmdfamn Meryoulnvesaud 'fiag:
ammm/wwmmmmmdm “I'm
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mmw‘mmWM1mwmfiww . top
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deonectm

 

 

 

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wm/wwwmmwm flusccrosmnunber
dmhmcxada. Famdedmbadlwaa.

" NW
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camber.

Senna-3

 

V-JAW

 

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WsmNinwiwammwukM/wmkk Repeatiorpmd.
REPETmou

Askmastbieettonpm‘Nohandaorbtn' TalmWhn-igum
3-STAGE COMMAND . . . Fddsm ”a”
Gmmesubioctapioccdplanblankpaperarusyfirakounpapernyw Puts pa cancer
www.mnhwandpmtonmm: paper
READING .

F'M'Ctosoywrms'sheet. Askhim/hertomdtanddowhatltsays.
Scarceomctodyilho/smactuaflydosahis/hereyas. Oceans:
GMNufesubieaablaMpiccadpapet askfim/Mrmwriteam Itis
mum-41W. nmmmasubicctandamwbem

Camctgtamnarwpumdonmnotneccswy. Wm _—
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Ask 'cctto NW‘WM.AI10WMNW .
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« <31:
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_* - ‘3
Smmenumberofconectrepliestothetestituns. Itammspaledwwasgedmmww
correct letters given in propersequence (oneto five). Thermnmum scoresao form:

 

TOTAL SCORE:

 

90

APPENDIX D

California Verbal Learning Test (Delis et al., 1987)

LIST A: Immediate Free Recall, Trials 13
Instructions to Examinee:

Triall:

Let ‘s suppose you were going shopping on Monday. I 'm going to read a
list of items for you to buy. Listen carefully. and when I '12! through. I
wantyou to say back as many of the items asyou can. It doesn 't matter
what orderyou say them in —just tell me as manyasyou can. Are you
ready?
Trial 2:

I 'm going to repeat Monday‘s shopping list. Again. I want you to say
back as many items as you can. in any order. Be sure to also say the
items on the list thatyou told me the first time.

Trials 35:

I‘m going to repeat Monday's shopping list. Again. I want you to say
back as many items as you can. in any order: including items you may
have already told me.

 

KEY FOR CODING
RESPONSE TYPE

C a Correct

1? = Perseveration

I = Intrusion

 

 

 

 

chunllc Clultlr
Smnunlln Chill"

1 3
'5
3
o
3
5
E
U
I

 

91

LIST A: Immediate Free Recall.
Trials 4 8:. 5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

'2 .2 Table of i
5 5: Free-Recall , i
g 3 Word Order h E
: C E l ?
E 2 '6 a
E '6 a a
m a: LIST A E 2'
2 List 1 2 . 3 : 4 l 5
4
5
6
7
8
9
10
1 1
12
1 3
14
1 5
16
1 7
18
19 Serial cluster I i I '
score: 1 . |
Summary Table: LIST A (Monday List) Table of Serial Position Recall:
Immediate Free Recall LIST A Immediate Free Recall,
2 I Pvtuver- ! l Scmanuc m 1'5
TRIAL l Correct (C) I ationslP) l Intrusionul) ! Cluster ‘I Number 1 ‘
g I t I Remon I Comet ' of Total
x l 5 i l
3 ; E ’ Primacy '
n ' i l : ' i
‘ l ' t 1 l I
g ( 3 Middle ' l
3 r a a : l i
I 3 E '
l l l Recent)! l
4 ! i . ! m ! ' :oow.
. l ; l :
TOTAL 3 l ! 3
W

Record these totals in the
Summon-5~ ‘I‘able of Recall Errors (p 9)

92

LIST B
(Tuesday List)

Instructions: 'ow let's suppose that you
planned to go shopping again on Tuesday.

I 'm going to read a new list of items for you
to buy. When I‘m through. I want you to say
back as many asyou can. in any order:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LIST A:

Short-Delay Free Recall

Instructions: Now I 'd like you to tell me

all of the shoppingitems you can from the

Alonday list.

 

 

Perseverations (P):
Intrusions (I):
Semantic cluster score:

Serial cluster score:

 

 

Perseverations (P):

Intrusions (I):

Semantic cluster score:

l : 5 e
. c o .5
LIST B l 2 Responses g Responses 9:;
(Tuesday) ,3. E 3
List 3 3
.. ,' ~.".‘_. 51:71:;- 1’.’ .
toasterssz-sr. :é‘r. 1
.- -. 13mg ‘— .’~.A.—-..
cherries 233951' 2 2
'11" v; #.',‘2;;Jj..r::.r.:.5
halibut-'2- =~.3‘4§+.~h- 3
" v” T?- 2712;; c1129.»
m 3'5“: Me?" 4
‘ «re/m" .1; '1')...
pple , ...~..-.. 5
4‘: ‘ -- Jag/:5.-.
'r" \.v.- "If?“ ‘- v: .3;-
2‘28339 . 1' 7
m"“,‘n‘*dé§- -232; 8
7.52;; "“5: a; (_rfgo'
EB L £118 "'3‘. 9
I .. .mé‘ :‘fi'f‘.’ 10
n. r: . .;~.:-_;x 'u.."- ..
w i 9".) q f 1 1
skillet- "3 3. 12
’1'?! ~.'.—.-'r~ v ---
peaches , « - 13
salmon 7'" "‘ '— 14
m~n Emu) I, 351:": .3 .;:- -
' lo
bowl ‘ _. 16
17
18
19
20
Correct (C): Correct (C):

 

 

 

93

 

 

LIST A:
Short-Delay _Cued Recall

Instructions: Tell me all of the shopping
items from the Monday list that are:
(category)

Responses

Spices 8.: Herbs: Fruits:

 

Tools: Clothing:

 

 

Correct (C):
Perseverations (P):

Intrusions (I):

 

 

 

Time of day ShorbDelay
Cued Recall completed:

94

LIST A:
Long-Delay Free Recall

Time of day Long-Delay Free
Recall begun:

Time of day Short-Delay Cued
Recall completed:

Toral delay:

(Note: The total delay snould be about 20 minutes.)

Instructions: I read some shopping items

to you earlier: I'd likeyou to tell me all the
items you can from the Monday list—that was
the first list. the one that Iread to you five
times. Go ahead.

1
2
3
4
5
6
7
8
9

HHHI—IHHHHHH
(DmQCDUItbOONO-‘O

Sen-mule Cluster

 

 

 

Correct (C):
Perseverations (P):
Intrusions (I):

Semantic cluster score:

 

95

 

LIST A:
Long-Delay Cued Recall

Instructions: Ibll me all of the shopping
items from the Monday list that are:

 

 

 

 

 

 

 

 

 

 

 

(category)
Clothing: 'Ibols:
Fruits: Spices & Herbs:
Correct (C):
Perseverations (P):
Intrusions (1):
Summary Table of Recall Errors
List A. g L
f It: 1-5 ) Short-Delay Recall I Long-Delay Recall
Error Type I Total List B l Free : Cued 5 Free g Cued Total
‘ l 1 I
Perseverations l ' . 3 g
l
Intrusions: Free Recall : g

 

 

 

Cued Recall

 

 

 

 

96

 

LIST A:
Long-Delay Recognition

Instructions: I'm going to read a list of
shoppingitems. Afterl read each item. say
“les"if the item was from the Monday list.
and say “No" ifit was nor.

(Note: For each “Yes" response. place

a (w) in the one blank space to the right
of the word: for each "No" response. leave
the space blank.)

 

A - List A-Correctu-lits)
BS I 1.38: B-Shared
BX . List B-Xonshared
NP - NeztherList-Prot013pical
PS - Neither ListPhonemicallySimilar
L’N - Neither List-Unrelated

 

 

 

Discriminability:

0

False Positives Misses )

x 100

 

(1-

=(1-__)x100=

Response Bias:

 

False Post Live- Misses ..

 

______-___ TOTAL l I
Mel’s-ins“ Mime BOSSIBLE l16 4 l 4
l

[A BS

 

 

 

 

 

Note: If False Positives = O or
Misses = O. substitute a Total number of hits:
value of 1 when computing -
Response Bias.

 

 

'Ibtal number of false positives:
Ulises = 16 - Hits =

 

97

APPENDIX E

Wechsler Memory Scale — Logical Memory (Wechsler, 1955)

Stgrv A

I AM GOING TO READ TO YOU A LITTLE SELECTION OF ABOUT 4 OR 5 LINES. LISTEN
CAREFULLY BECAUSE HHEN I AM THROUGH I WANT YOU TO TELL ME EVERYTHING I READ TO
YOU. ARE YOU READY? (Do not re-read any portion of the story.)

ANNA THOMPSON / or SOUTH / BOSTON, / EMPLOYED / L 4
As A SCRUH ROMAN / IN AN OFFICE BUILDING, / REPORTED / L 3
AT THE CITY HALL / STATION / THAT SHE HAD RHHN HELD UP / z 3
ON STATE STREET / THE NIGHT BEFORE / AND ROBBED / L 3
OF 15 DOLLARS. / SHE HAD FOUR / LITTLE CHILDREN, / L a
Tag 3537 / HAS DUE, / AND THEY HAD NOT HATHN / z 3
FOR Two DAYS. / TH: ORRICHRS, / g 2
TOUCHHD BY THE RONAN'S STORY, / MADE up A PURSE / FOR HER. / l 3

TOTAL FOR STORY A (24

NOW HEAT DID I READ TO YOU? TELL ME EVERYTHING AND BEGIN AT THE BEGINNING.

Record verbatim:

98

§torv B

NOW I AM GOING TO READ YOU ANOTHER LITTLE SELECTION AND SEE HOW MUCH MORE YOU
CAN REMEMBER ON THIS. LISTEN CAREFULLY. (Do not re-read any portion of the

story.)

THE AMERICAN / LINER / NEH YORK / STRUCH A NINE / z 4
NEAR LIVERPOOL / MONDAY / EVENING. / IN SPITE OF A BLINDING / 5 4
SNOHSTORN / AND DARKNESS, / THE SIXTY / ' 1 3
PASSENGERS, INCLUDING 18 / WOMEN, / HERE ALL RESCUED, / 1 3
THOUGH THE BOATS / HERE TOSSED ABOUT / LIKE CORHS / z 3
IN THE HEAVY SEA. / THEY WERE BROUGHT INTO PORT / 1 2
THE NEXT DAY / BY A BRITISH / STRANER. / 1 3

TOTAL FOR STORY B /22

NOW WHAT DID I READ TO YOU? TELL ME EVERYTHING AND BEGIN AT THE BEGINNING.

Record RRERREIE=

Scoring
Story A: No. of Units Recalled =
Story 5: No. of Units Recalled =

Total No. of Units Recalled =

99

 

 

 

 

__

REFERENCES

100

 

I!

 

 

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