Have you ever forgotten why you walked into a room? That was a failure in prospective memory. Prospective memory is remembering to do what you intended to do. Lapses in prospective memory can range from annoying (forgetting to water a plant) to life threatening (forgetting to take blood pressure medication). Read on to learn basic information about what prospective memory is and what speech-language pathologists (SLPs) might do in therapy to improve prospective memory.
Free DIRECT download: 13 prospective memory tasks (cheat sheet). (Email subscribers get free access to all the resources in the Free Subscription Library.)
Outline:
- What is prospective memory?
- 3 models for prospective memory.
- Which cognitive processes are involved?
- A 3-pronged approach to therapy.
- Try a research-based treatment plan.
- References.
- Related Eat, Speak, Think posts.
What is prospective memory?
Prospective memory is remembering to perform an intended task at some time in the future. Intact prospective memory is critical for living independently. Here’s a quick video explaining prospective memory.
Prospective memory is necessary for a multitude of tasks, such as remembering to:
- Turn off the stove.
- Take medication before going to bed.
- Pay bills on time.
- Report a new symptom.
Research suggests that older adults who have strong prospective memory skills are more likely to be living independently than older adults with weak prospective memory skills (Hering et al., 2018). Impaired prospective memory is common among adults and children with acquired brain injury (Mahan et al.,2017).
SLPs often work with people who have impaired prospective memory, trying to help them improve their safety and independence. But treating prospective memory can be challenging, and it’s a big topic that will require more than one post to write about. Read on to learn about prospective memory and how it’s treated in therapy.
3 models for prospective memory
Researchers don’t know exactly how prospective memory works, but there are three main models:
- Preparatory attentional and memory processes (PAM) theory.
- Multiprocess theory.
- Delay theory.
I’ll share briefly what these models are. Please note that I’m not an expert on prospective memory, so consider this an introduction to the concepts and read up on anything that interests you. (Strickland et al., 2017; Heathcote et al., 2015)
Much of the foundational research relies on research participants sitting in front of a computer and pushing a specific button when a target type of word appears on the screen. It could be a lexical decision (is this string of letters a word) or a semantic decision (is this word an animal).
During the experiments, the target doesn’t happen very often, and remembering to push the button is considered to be successful prospective memory.
PAM theory
The preparatory attentional and memory processes (PAM) theory proposes that in order for prospective memory to be successful, we have to actively think about our future intention while waiting for the right time to act.
PAM is a capacity-sharing process, meaning that keeping a future task in mind draws from our total cognitive functional capacity (ex. attention and processing capabilities). Actively monitoring for the right conditions to do the thing we’re waiting to do comes at a mental cost, slowing down our ability to engage in the task we’re currently performing.
Multiprocess theory
The multiprocess theory is similar to the PAM theory, but proposes we also have an automatic system that monitors for the right time to perform the task. The multiprocess theory suggests part of our functional capacity is unconsciously monitoring events until the right time to perform our intended action.
Have you ever been driving home, seen the grocery store, and suddenly remembered that you need to buy milk? That’s an example of a successful prospective memory retrieval that didn’t rely on you actively keeping the task in mind.
Delay theory
The delay theory is different from the PAM and multiprocess theories in that it isn’t a capacity-sharing model. The delay theory doesn’t propose that prospective memory lowers our functional capacity for the current task. Instead, the delay theory proposes that we make slower decisions while performing the current task due to increasing response thresholds.
Loft and Remington (2013) suggested that participants should respond faster to the stimuli in the lab if they’re given more processing time to allow the less frequent response to emerge. They found that asking participants to wait a mere 0.2 seconds after the presentation of a stimuli was enough to improve performance on prospective memory tasks in the lab.
The delay theory suggests that we may either deliberately or subconsciously slow our processing speed in order to allow us to respond to those infrequent prospective memory prompts that require us to change our behavior.
Which cognitive processes are involved?
The theoretical models are interesting, and I’m sure we’ll learn more as time goes along. Regardless of which model best fits the evidence, we can keep in mind the general processes involved. As Groot et al. (2002) point out, in order to successfully remember to perform intended tasks, we need to:
- Pay attention while forming the attention.
- Maintain the intention in working memory (consciously or subconsciously).
- Remember the intention at the appropriate time.
Read on to learn about an evidence-based approach to therapy to improve prospective memory.
A 3-pronged approach to therapy
Raskin et al. (2018) published a review of prospective memory interventions for people with acquired brain injury. I was able to access the preprint version, and these recommendations are pulled from this paper.
Cognitive rehabilitation for prospective memory can include:
- Compensatory strategies.
- External memory aids.
- Internal memory techniques.
- Restorative exercise.
- Metacognitive instruction.
We should consider including an external memory aid (calendar, planner, reminders) with any treatment plan.
We could also consider training external implicit strategies such as helping our patients form a habit of performing the task or pairing the tasks with an existing habit.
If we wanted to include an internal memory technique, visual imagery and rote rehearsal are more likely to be effective than other internal memory strategies, but internal memory strategies require a longer treatment time.
Raskin et al. (2018) share that there is limited research examining the question of whether restorative exercise is beneficial for people with acquired brain injury.
Metacognitive awareness strategies can improve prospective memory. In one study, researchers randomly texted the word “stop” to participants. This intervention served to prompt participants to self-monitor their activities and intended goals. Context-free cueing such as this can be faded over time.
Trying to maintain the intention to perform a task was not effective in people with acquired brain injury, perhaps because it requires intact self-monitoring skills. For example, in the past, we might have asked patients to make a plan and repeat aloud 3 times, “When I do ___, I will do ___.” Research suggests that this intervention isn’t likely to be successful with people with acquired brain injury.
Try a research-based treatment plan
Raskin et al. (2018) suggest we might structure our treatment plan in this way:
- Several sessions to identify and train an appropriate external compensatory tool.
- A few sessions to train visual imagery and rote repetition to improve performance.
- The final sessions may focus on having the patient keep a diary of successes and failures to promote generalization and metacognitive awareness.
In summary, intact prospective memory is critical for living safely and independently. Prospective memory is often affected by brain injury, but this doesn’t necessarily mean a permanent loss of independence. People with acquired brain injury may be able to compensate for impaired prospective memory.
The information in this post is intended to give you an overview on the topic. Please check out the references or related posts below for more information.
References
- Groot, Y. C., Wilson, B. A., Evans, J., & Watson, P. (2002). Prospective memory functioning in people with and without brain injury. Journal of the International Neuropsychological Society : JINS, 8(5), 645–654. https://doi.org/10.1017/s1355617702801321
- Heathcote, A., Loft, S., & Remington, R. W. (2015). Slow down and remember to remember! A delay theory of prospective memory costs. Psychological review, 122(2), 376–410. https://doi.org/10.1037/a0038952
- Hering, A., Kliegel, M., Rendell, P., Craik, F., & Rose, N. (2018). Prospective Memory Is a Key Predictor of Functional Independence in Older Adults. Journal of the International Neuropsychological Society,24(6), 640-645. doi:10.1017/S1355617718000152
- Mahan, S., Rous, R., & Adlam, A. (2017). Systematic Review of Neuropsychological Rehabilitation for Prospective Memory Deficits as a Consequence of Acquired Brain Injury. Journal of the International Neuropsychological Society,23(3), 254-265. doi:10.1017/S1355617716001065
- Raskin, S., Williams, J., & Aiken, E. (2018)A review of prospective memory in individuals with acquired brain injury. The Clinical Neuropsychologist,32(5), 891-921. DOI: 10.1080/13854046.2018.1455898
- Strickland, L., Heathcote, A., Remington, R. W., & Loft, S. (2017). Accumulating evidence about what prospective memory costs actually reveal. Journal of experimental psychology. Learning, memory, and cognition, 43(10), 1616–1629. https://doi.org/10.1037/xlm0000400
Related Eat, Speak, & Think posts
- How to use spaced retrieval with errorless learning to improve memory.
- How to plan cognitive therapy with 6 questions. (Learn about Systematic Instruction)
- How to treat post-COVID cognitive dysfunction.
Free DIRECT download: 13 prospective memory tasks (cheat sheet). (Email subscribers get free access to all the resources in the Free Subscription Library.)
Featured image by Mart Production by Pexels.
Lisa earned her M.A. in Speech-Language Pathology from the University of Maryland, College Park and her M.A. in Linguistics from the University of California, San Diego.
She participated in research studies with the National Institute on Deafness and other Communication Disorders (NIDCD) and the University of Maryland in the areas of aphasia, Parkinson’s Disease, epilepsy, and fluency disorders.
Lisa has been working as a medical speech-language pathologist since 2008. She has a strong passion for evidence-based assessment and therapy, having earned five ASHA Awards for Professional Participation in Continuing Education.
She launched EatSpeakThink.com in June 2018 to help other clinicians be more successful working in home health, as well as to provide strategies and resources to people living with problems eating, speaking, or thinking.
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