Evaluation of a computer-assisted errorless learning-based memory training program for patients with early Alzheimer’s disease in Hong Kong: a pilot study

Figures & data

Figure 1 Examples of training scenarios. (A) Prospective memory and dual task training: prospective memory task, such as “switch off the stove after five minutes” while buying vegetables. (B) Face-name recognition training, combined with mnemonic memory strategies of association and spaced retrieval technique: selection photograph of same patient as shown before. (C) Memory training on community-living skills, ie, taking a bus at Mei Foo District. (D) Immediate positive reinforcement for right answer. (E) Memory training on attention and categorization of objects as being in the same group or not. (F) Memory training on working memory and counting number of Dim Sums.

Table 1 Outline of 12 sessions of individualized 30-minute errorless learning memory training

Session	Training theme and content
1	Sensory memory: attention and working memory training I (counting of fruit), dual task (counting of fruit and hearing the sound of a cat), delayed recall of daily objects
2	Sensory memory: attention and working memory training I (counting of fruit), dual task (counting of fruit and hearing the sound of a cat), delayed recall of daily objects
3	Working memory: attention and working memory training I (counting of fruit), dual task (counting of fruit and hearing the sound of a cat), delayed recall of sentences (basic), calculation task
4	Prospective memory: attention and working memory training I (counting of fruit), prospective memory and simultaneous task, delayed recall of sentences (advanced), calculation task
5	Prospective memory: attention and working memory training II (counting of persons and Dim Sums), prospective memory and simultaneous task, delayed recall of sentences (advanced)
6	Memory strategy (face-name): attention and working memory training II (counting of persons and Dim Sums), mnemonics and strategies on face-name recognition/association and recall and organization
7	Memory strategy (face-name): attention and working memory training II (counting of persons and Dim Sums), mnemonics and strategies on face-name recognition/association and recall and organization
8	Memory strategy (home-making and habit training): attention and working memory training II (counting of persons and Dim Sums), mnemonics and strategies on organization/suitable placing of objects at home
9	Memory strategy (home-making and habit training): attention training, categorization, and working memory III (money recognition and counting), mnemonics and strategies on organization/suitable placing of objects at home
10	Memory strategy (shopping and money management): attention training, categorization, and working memory III (money recognition and counting) and shopping strategies (delayed recall and money exchange)
11	Memory strategy (shopping and money management): attention training, categorization, and working memory III (money recognition and counting) and shopping strategies (delayed recall and money exchange)
12	Memory strategy (community-living skills): attention training, categorization, and working memory III (money recognition and counting) and application of community-living skills in use of transport and money exchange

Table 2 Demographic data for subjects and baseline comparisons between the three treatment groups

	Group (n = 19)
	Computer-assisted EL memory training group (n = 7)		Therapist-led EL memory training group (n = 6)		Waiting-listing control group (n = 6)		P value#
	Count	%	Count	%	Count	%
Gender
Male	1	14.3	3	50.0	2	33.3
Female	6	85.7	3	50.0	4	66.7	0.40
Education
nil	3	42.8	1	16.7	2	33.3
<2 years	1	14.3	1	16.7	1	16.7
3–6 years	2	28.6	2	33.2	1	16.7
Secondary	1	14.3	1	16.7	2	33.3
University	0	0.00	1	16.7	0	0.00	0.97
Marital status
Divorced	1	14.3	0	0.0	0	0.0
Married	2	28.6	3	50.0	3	50.0
Single	1	14.3	0	0.0	1	16.7
Widowed	3	42.8	3	50.0	2	33.3	0.999
	Mean	(SD)	Mean	(SD)	Mean	(SD)	P value##
MMSE	15.3	(2.7)	17.0	(3.5)	17.6	(4.7)	0.56
GDS	2.5	(2.30)	2.1	(1.1)	1.6	(2.7)	0.48
DRS	100.5	(11.3)	101.5	(15.1)	89.5	(11.8)	0.14
HKLLT	8.1	(1.9)	6.5	(2.1)	9.3	(3.8)	0.17
BAPM	1.2	(0.3)	1.3	(0.4)	1.3	(0.4)	0.88
MBI	97.5	(2.5)	96.0	(3.7)	96.0	(4.7)	0.80
HKLIADL	18.5	(6.1)	15.6	(5.0)	11.6	(5.5)	0.15

Notes:

# P value by Fisher Exact test;

## P value by Kruskal-Wallis test.

Abbreviations: EL, errorless learning; SD, standard deviation; MMSE, Mini-Mental State Examination; GDS, Geriatric Depression Scale-Short Form; DRS, Dementia Rating Scale; HKLLT, Hong Kong List Learning Test; BAPM, Brief Assessment of Prospective Memory-Short Form; MBI, Modified Barthel Index; HKLIADL, Hong Kong Lawton Instrumental Activities of Daily Living Scale.

Table 3 Friedman’s test of repeated measures in each group

Outcomes	Computer-assisted EL memory training group	Therapist-led EL memory training group	Waiting-list control group
	Mean (SD)	Mean (SD)	Mean (SD)
MMSE pretest	17.00 (3.58)	17.67 (4.76)	15.29 (2.75)
MMSE post-test	19.67 (5.20)	19.00 (4.73)	17.29 (3.15)
MMSE follow-up test	18.00 (4.29)	17.67 (5.54)	17.00 (3.37)
P value	0.09	0.46	0.26
GDS pretest	2.17 (1.17)	1.67 (2.73)	2.57 (2.30)
GDS post-test	0.67 (0.52)	3.67 (4.59)	4.43 (4.24)
GDS follow-up test	1.17 (1.60)	4.00 (4.65)	4.43 (4.58)
P value	0.5	0.06	0.4
DRS pretest	101.50 (15.12)	89.50 (11.88)	100.57 (11.36)
DRS post-test	106.17 (15.38)	100.00 (14.64)	101.43 (12.95)
DRS follow-up test	99.17 (19.04)	98.17 (11.62)	100.57 (11.56)
P value	0.04	0.03	0.63
HKLLT pretest	6.50 (2.07)	9.33 (3.88)	8.14 (1.95)
HKLLT post-test	10.67 (4.97)	13.83 (5.42)	9.43 (2.94)
HKLLT follow-up test	9.00 (3.46)	13.33 (4.46)	11.71 (5.88)
P value	0.12	0.11	0.08
BAPM pretest	1.33 (0.48)	1.39 (0.43)	1.26 (0.37)
BAPM post-test	1.07 (0.13)	1.10 (0.29)	1.18 (0.16)
BAPM follow-up test	1.07 (0.23)	1.31 (0.64)	1.38 (0.43)
P value	0.15	0.1	0.62
MBI pretest	96.00 (3.74)	96.00 (4.73)	97.57 (2.51)
MBI post-test	98.83 (2.04)	98.50 (1.97)	98.29 (2.63)
MBI follow-up test	99.17 (2.04)	98.50 (2.35)	99.57 (1.13)
P value	0.02	0.46	0.29
HKLIADL pretest	15.67 (5.01)	11.67 (5.54)	18.57 (6.13)
HKLIADL post-test	17.83 (5.49)	14.17 (4.12)	16.43 (7.57)
HKLIADL follow-up test	14.67 (4.76)	14.83 (6.01)	16.86 (5.93)
P value	0.4	0.42	0.54

Note: P value by Friedman’s test.

Abbreviations: EL, errorless learning; SD, standard deviation; MMSE, Mini-Mental State Examination; GDS, Geriatric Depression Scale-Short Form; DRS, Dementia Rating Scale; HKLLT, Hong Kong List Learning Test; BAPM, Brief Assessment of Prospective Memory-Short Form; MBI, Modified Barthel Index; HKLIADL, Hong Kong Lawton Instrumental Activities of Daily Living Scale.

Table 4 Effect of treatment effect on outcome variables between and within the three treatment groups

Outcomes	Computer-assisted EL memory training group	Therapist-led EL memory training group	Waiting-list control group	P value##
	Mean (SD)	Mean (SD)	Mean (SD)
MMSE	2.67 (3.39)	1.33 (2.42)	2 (0.82)	0.7
P value#	0.04	0.09	0.16
GDS	1.86 (3.24)	−1.5 (1.05)	2 (2.53)	0.009**
P value#	0.06	0.11	0.03
DRS	4.67 (2.88)	10.5 (9.71)	0.86 (7.73)	0.16
P value#	0.03	0.27	0.55
HKLLT	4.17 (5.04)	4.5 (3.56)	1.29 (1.60)	0.16
P value#	0.06	0.22	0.07
MBI	2.83 (2.32)	2.5 (3.33)	0.71 (1.60)	0.2
P value#	0.125	0.04	0.28
HKLIADL	2.17 (5.85)	2.5 (3.27)	−2.14 (4.30)	0.14
P value#	0.42	0.11	0.24
BAPM	−0.26 (0.51)	−0.29 (0.27)	−0.07 (0.30)	0.38
P value#	0.25	0.063	0.69

Notes:

# P value by Wilcoxon signed rank test for within-group treatment effect;

## P value by Kruskal-Wallis test for between-group treatment effect. negative scores on GDS and BAPM indicate improvement.

** P value <0.01.

Abbreviations: EL, errorless learning; SD, standard deviation; MMSE, Mini-Mental State Examination; GDS, Geriatric Depression Scale-Short Form; DRS, Dementia Rating Scale; HKLLT, Hong Kong List Learning Test; BAPM, Brief Assessment of Prospective Memory-Short Form; MBI, Modified Barthel Index; HKLIADL, Hong Kong Lawton Instrumental Activities of Daily Living Scale.

Table 5 Carryover effect of outcome variables between and within the three treatment groups

	Computer-assisted EL memory training group	Therapist-led EL memory training group	Waiting-list control group	P value##
	Mean (SD)	Mean (SD)	Mean (SD)
MMSE	−1.67 (3.39)	−1.33 (3.14)	−0.29 (2.21)	0.57
P value#	0.21	0.28	0.75
GDS	0.50 (1.38)	0.33 (0.82)	0.00 (1.53)	0.58
P value#	0.41	0.32	0.99
DRS	−7.00 (5.48)	−1.83 (7.99)	−0.86 (5.08)	0.42
P value#	0.22	0.28	0.59
HKLLT	−1.67 (2.94)	−0.50 (4.85)	2.29 (4.50)	0.23
P value#	0.21	0.79	0.17
MBI	0.33 (0.82)	0.00 (3.63)	1.29 (3.15)	0.73
P value#	0.32	0.99	0.36
HKLIADL	−3.17 (3.76)	0.67 (4.13)	0.43 (2.23)	0.15
P value#	0.09	0.68	0.59
BAPM	0.00 (0.23)	0.20 (0.50)	0.20 (0.35)	0.67
P value#	0.99	0.47	0.23

Notes:

# P value by Wilcoxon signed rank test for within-group carryover effect;

## P value by Kruskal-Wallis test for between-group carryover effect. negative scores on GDS and BAPM indicate improvement.

Abbreviations: EL, errorless learning; SD, standard deviation; MMSE, Mini-Mental State Examination; GDS, Geriatric Depression Scale-Short Form; DRS, Dementia Rating Scale; HKLLT, Hong Kong List Learning Test; BAPM, Brief Assessment of Prospective Memory-Short Form; MBI, Modified Barthel Index; HKLIADL, Hong Kong Lawton Instrumental Activities of Daily Living Scale.