Memory andthe Machine

Advances in technology andresearch help individuals withmemory problems rediscovertheir independence andquality of life.

BY KRYSTYNA LAGOWSKI

Teaching someone to learnsomething new when theycan’t remember what they

had for lunch might seem like an ex-ercise in futility.

And if they’re already in the firststages of Alzheimer’s disease, youmay ask, what’s the point?

“That’s exactly the point,” says Bay-crest psychologist Dr. Eva Svoboda.“We’ve still got a window of time tointervene and keep their memoryfunctioning where it is.”

Dr. Svoboda is part of a ground-breaking pilot program at Baycrestfor individuals who have memory is-sues, or the early warning signs as-sociated with Alzheimer’s, alsoknown as Mild Cognitive Impair-ment (MCI).

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332008 Baycrest BREAKTHROUGHSTransforming The Way People Age

The program also includes Baycrestpsychologist Dr. Kelly Murphy, aswell as Baycrest psychologist Dr.Brian Richards, who created theMemory-Link program. Memory-Link is a Baycrest rehabilitation pro-gram that teaches individuals withamnesia to use a handheld electronicorganizer as a memory aid.

While a person with well-function-ing memory may occasionally forgetthe name of a recent acquaintance orthe contents of a short shopping list,a person with MCI will frequentlyhave trouble remembering thenames of people they have met re-cently, or will have an increased ten-dency to misplace things like housekeys.

“MCI is not subtle,” says Dr. GuyProulx, the director of psychology atBaycrest. “If it starts happening tosomeone you love and care for,you’ll know something is wrong.”

Thepilot program involved six clientswith MCI, who were given intensivetraining on handheld electronic or-ganizers, using key memory tech-niques and strategies similar to thoseused in the Memory-Link program.

“We can identify and help peoplefour or five years before they de-velop dementia, before they becometotally dependent,” says Dr. Proulx.

“Technology is working wonders asa tool to help people with MCI.

“From research, we know memoryis not one thing, it’s many things.When it deteriorates, there are stillsome beautifully preserved func-tions,” he says.

“The episodic memory system getsdamaged first,” says Dr. Svoboda.“That’s memory for everyday activ-ities, like what you had for lunch.”

“One of the systems that’s usuallypreserved is semantic memory. Thissystem stores general knowledgeabout you, theworld, andvocabulary– those types of things,” she says.

“Another is procedural memory,which is learning to ride a bike orplay the piano.”

Based on the format of the suc-cessful Memory-Link program,the first step was forming a partic-ipatory design group. “That in-cluded a few psychologists, acomputer science technician, andseveral clients with MCI,” says Dr.Svoboda. “We asked our clientswhat they wanted help with, andeverything they told us kept point-ing to an electronic organizer.They said they needed an everydaycalendar, somewhere to writedown phone numbers and keepnotes.

352008 Baycrest BREAKTHROUGHSTransforming The Way People Age

“We can identify and helppeople four or five years

before they develop dementia.”

Dr. Brian Richards introduces aclient to her electronic memoryaid.

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“But the average age of the groupwas mid-70s, and most of themwere retired. Some of them hadnever even used a computer,” shesays. “We realized the tool wewere developing for these clientshad to go beyond a little paperbooklet. But we didn’t know howthis older generation would taketo something technology-based,”she explains.

It turns out, the research team wasin for a surprise. “When ourclients came in for their first one-on-one training session, they did-n’t know anything aboutcomputers,” she says. “But by theend of the session, even those whowere most techno-phobic weresaying it was so easy, they couldn’tbelieve it.”

A number of different methodswere used to teach clients to tapinto their functioning memory sys-tems, while taking into accounttheir impaired memory.

“Initially, we were just showingour clients what to do, but thenwe started guiding them as theystarted using the electronic or-ganizer, so we were offering ‘en-vironmental support,’” shesays. “That tied into somethingwe call ‘vanishing cues,’ whereyou initially give a lot of sup-port, but then slowly take itaway.

“There’s a lot of repetition to en-sure what we call ‘errorless learn-ing,’” she says. “They’re notallowed to make mistakes becauseif their episodic memory isn’t

working, they can’t learn fromtheir mistakes. They can’t re-member the right way fromthe wrong way. In fact,making mistakes justmakes things worseand they can getvery confused. Ittakes a lot ofpatience onour part.”

D u r i n geach sessionwith Dr. Svo-boda, an activitysuch as entering anevent into a calendarfunction on the electronicorganizer was broken downinto 15 small steps. “We start outsimple, (how to enter things fortoday), then we build, (how to putthings into the future, how to at-tach notes), and thenwe get into the digitalcamera and voicerecorder.”

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This storyboard shows the breakdownof steps researchers used when teaching

clients to program their electronic organizers.

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Sessions during the pilot projectwere spaced out twice a week, amethod called “spaced repetition,”to keep the data fresh. There were10 one-hour sessions, each of whichfocussed on an event that the clientwould learn to load onto their elec-

tronic organizer.

Dr. Svoboda and herteam were impressedto find that their pro-tégés started usingthe electronic organ-izers in quite innova-tive ways. “One ofour clients became awhiz at the technol-ogy,” she says. “Hedownloaded GoogleMaps to his elec-tronic organizer, andshowed me how touse it. I’d never usedit before.

“Another client tooka picture of their dif-ferent coloured pillsto distinguish theirevening pills fromtheir morning pills.

“All we did was tutor them, andthey went way beyond what weshowed them,” she says.

The project is funded by Sportsfest,an annual event in which partici-pants engage in a variety of teamsports to raise funds for Alzheimer’sresearch and care at Baycrest. Or-ganizer and Baycrest board memberJordan Banks says, “This researchtakes technology to people whoneed it the most. It enables people toremain independent, and the longeryou can maintain that, the better.

“It also provides relief for the familyand caregiver, which is very impor-tant,” he says.

The next step is to develop softwarefor the electronic organizer gearedspecifically to the needs of peoplewith MCI. “We’re still in the forma-tive stages with our participatory de-sign team,” says Dr. Svoboda. “Ourclients are telling us what they needto remember, like names, currentevents and everything from garden-ing to music.”

The overall point of the program isto prolong the ability of someonewith MCI to function in everydaylife and stay engaged with their fam-ily and friends. “These people we’reworking with now are giving us a lotof good ideas,” she says. “We’re theones learning from them.”

392008 Baycrest BREAKTHROUGHSTransforming The Way People Age

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“It also provides relief for the

family and caregiver, which

is very important.”

Baycrest psychologist Dr. Eva Svoboda, (seated right) works with co-op studentAshwini Persaud, on the steps needed to store a date onto an electronic organizer.