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Clinical Alzheimer’s disease (AD) trials currently face a critical shortfall of thousands of eligible participants, which inflates the duration and cost of the clinical study as well as threatens the scientific merit of promising clinical interventions. This recruitment crisis is further compounded by the fact that underrepresented and marginalized populations—particularly those identifying as a racial or ethnic minority, those with low socioeconomic status, or living in rural areas—have been historically underrepresented in ongoing AD clinical trials despite overwhelming evidence that such populations are at increased risk for developing dementia. As a result of various recruitment barriers, current AD clinical studies frequently reflect a decreasingly representative segment of the US population, which threatens the overall generalizability of these findings. The current narrative review provides an updated examination and critique of common recruitment barriers and potential solutions, as well as a discussion of theoretical approaches that may address barriers disproportionately experienced by underrepresented communities. AD clinical researchers are encouraged to take purposive action aimed at increasing diversity of enrolled AD clinical trial cohorts by actively identifying and quantifying barriers to research participation—especially recruitment barriers and health disparities that disproportionately prevent underrepresented and marginalized populations from participating in research. Furthermore, researchers are encouraged to closely track which individuals who express interest in AD research ultimately enroll in research studies to examine whether AD research participation is appropriately representative of the intended population for whom these new and novel AD interventions are being designed.

Objective:To measure caregivers’ and clinicians’ perception of false memories in the lives of patients with memory loss due to Alzheimer’s disease (AD) and mild cognitive impairment (MCI) using a novel false memories questionnaire. Our hypotheses were that false memories are occurring as often as forgetting according to clinicians and family members.Method:This prospective, questionnaire-based study consisting of 20 false memory questions paired with 20 forgetting questions had two forms: one for clinicians and the other for family members of older subjects. In total, 226 clinicians and 150 family members of 49 patients with AD, 44 patients with MCI, and 57 healthy older controls (OCs) completed the questionnaire.Results:False memories occurred nearly as often as forgetting according to clinicians and family members of patients with MCI and AD. Family members of OCs and patients with MCI reported fewer false memories compared to those of the AD group. As Mini-Mental State Examination scores decreased, the mean score increased for both forgetting and false memories. Among clinicians, correlations were observed between the dementia severity of patients seen with both forgetting and false memories questionnaire scores as well as with the impact of forgetting and false memories on daily life.Conclusion:Patients with AD experience false memories almost as frequently as they do forgetting. Given how common false memories are in AD patients, additional work is needed to understand the clinical implications of these false memories on patients’ daily lives. The novel false memories questionnaire developed may be a valuable tool.

Objectives:To examine factors that influence decision-making, preferences, and plans related to advance care planning (ACP) and end-of-life care among persons with dementia and their caregivers, and examine how these may differ by race.Design:Cross-sectional survey.Setting:13 geographically dispersed Alzheimer’s Disease Centers across the United States.Participants:431 racially diverse caregivers of persons with dementia.Measurements:Survey on “Care Planning for Individuals with Dementia.”Results:The respondents were knowledgeable about dementia and hospice care, indicated the person with dementia would want comfort care at the end stage of illness, and reported high levels of both legal ACP (e.g., living will; 87%) and informal ACP discussions (79%) for the person with dementia. However, notable racial differences were present. Relative to white persons with dementia, African American persons with dementia were reported to have a lower preference for comfort care (81% vs. 58%) and lower rates of completion of legal ACP (89% vs. 73%). Racial differences in ACP and care preferences were also reflected in geographic differences. Additionally, African American study partners had a lower level of knowledge about dementia and reported a greater influence of religious/spiritual beliefs on the desired types of medical treatments. Notably, all respondents indicated that more information about the stages of dementia and end-of-life health care options would be helpful.Conclusions:Educational programs may be useful in reducing racial differences in attitudes towards ACP. These programs could focus on the clinical course of dementia and issues related to end-of-life care, including the importance of ACP.

Objective: Telehealth offers the opportunity to address a growing need to improve access to specialty services, such as neuropsychology, particularly for older adults and those in rural areas. Init...

Background and objectives: To understand the perceptions, knowledge, and understanding of memory, cognition, and aging among older veterans. Research design and methods: Twelve male, Caucasian, community-dwelling veterans from a suburban New England demographic area, aged 62 to 83 years, participated in qualitative interviews. The interviews were audio recorded, transcribed verbatim, and subsequently coded by three independent reviewers. The responses were calculated and analyzed for major themes. Results: Veterans equated healthy aging to be both of a physical and cognitive nature, although a significant subset viewed especially intact cognitive faculties to be a sign of successful aging despite physical limitations. Two of the most widely cited concerns about aging were loss of functional independence and the progression of cognitive decline into dementia, although most of the participants were unable to accurately describe dementia or Alzheimer’s disease. Military service was associated with both positive (e.g., social support) and negative (e.g., trauma) associations with aging. Most of the participants noted the importance of a healthy diet and exercise in aging but were unable to accurately describe a healthy diet or exercise regimen or the effect of these activities on the brain. Discussion and implications: Aging veterans represent a unique population among older adults, and more information is required to understand their specific needs. Older male veterans are less likely to engage in healthcare; for some, education alone may be enough to improve engagement, whereas for others an estimate of current cognitive function would provide the extra motivation required.

Supporting returning veterans' job-seeking, hiring, and retention issues has become an essential goal for effective community reintegration. Given both the particular strengths and challenges associated with veterans transitioning from military to civilian life, multiple models for supported employment have become integrated into Veterans Affairs health care facilities across the nation. In this article, we review the state of vocational rehabilitation for veterans, with a particular focus on individual placement and support-supported employment (IPS-SE), the current vocational services model that is considered the gold standard of vocational rehabilitation. Various modifications to the IPS-SE model are presented, including additions such as cognitive rehabilitation, contingency management, motivational interviewing, supported self-employment, and transitional work. Finally, recommendations are made about future directions and strategies to expand access to IPS-SE-based programs and to effectively meet the needs of returning veterans for employment in jobs of their choice. (PsycINFO Database Record

Work plays a significant role in how people identify themselves, and successful return to work is associated with significant psychological and rehabilitative benefits. Unfortunately, despite the many benefits of employment, Veterans who experience mild traumatic brain injury and have mental health issues often have significant difficulty getting their vocational needs met. Considering that a consistent relationship between cognitive dysfunction and difficulties with employability has been firmly established, cognitive rehabilitation may enhance engagement in vocational rehabilitation and return to work outcomes. In this pilot study, we evaluated a 12 wk cognitive rehabilitation intervention embedded within vocational rehabilitation services. Eighteen Veterans were randomly assigned to receive either the embedded cognitive rehabilitation intervention (n = 10) or a control condition offering supportive client-centered therapy that did not focus on employment or cognitive rehabilitation (n = 8); all Veterans (intervention and control groups) received vocational rehabilitation services. This pilot feasibility study demonstrated efficient implementation of an embedded cognitive rehabilitation intervention within vocational rehabilitation. The current pilot data revealed small to moderate effect sizes on employment outcomes. Given these preliminary findings, a larger outcome study is warranted.

We conducted a randomized controlled trial of the Aging Well through Interaction and Scientific Education (AgeWISE) program, a 12-week manualized cognitive rehabilitation program designed to provide psychoeducation to older adults about the aging brain, lifestyle factors associated with successful brain aging, and strategies to compensate for age related cognitive decline.Forty-nine cognitively intact participants ≥ 60 years old were randomly assigned to the AgeWISE program (n = 25) or a no-treatment control group (n = 24). Questionnaire data were collected prior to group assignment and post intervention. Two-factor repeated-measures analyses of covariance (ANCOVAs) were used to compare group outcomes.Upon completion, participants in the AgeWISE program reported increases in memory contentment and their sense of control in improving memory; no significant changes were observed in the control group. Surprisingly, participation in the group was not associated with significant changes in knowledge of memory aging, perception of memory ability, or greater use of strategies.The AgeWISE program was successfully implemented and increased participants' memory contentment and their sense of control in improving memory in advancing age.This study supports the use of AgeWISE to improve perspectives on healthy cognitive aging.

The current study examined the effect of diagnosis threat on self-efficacy and neuropsychological performance in mild traumatic brain injury (TBI). Forty-nine participants with a history of mild TBI were randomized to a diagnosis threat or control group. The diagnosis threat group were told they were selected based on their history of TBI, while control group participants were told to perform their best. Individuals in the diagnosis threat group reported significantly lower academic self-efficacy than control participants. The groups performed differently on only one neuropsychological measure. These results suggest that diagnosis threat may have a greater impact on psychological factors than on cognitive performance.

BACKGROUND/STUDY CONTEXT: Although the Clock Drawing Test (CDT) is a popular tool used to assess cognitive function, limited normative data on CDT performance exist. The objective of the current study was to provide normative data on an expanded version of previous CDT scoring protocols from a large community-based sample of middle to older adults (aged 43 to 91) from the Framingham Heart Study.The CDT was administered to 1476 Framingham Heart Study Offspring Cohort participants using a scoring protocol that assigned error scores to drawn features. Total error scores were computed, as well as for subscales pertaining to outline, numeral placement, time-setting, center, and "other."Higher levels of education were significantly associated with fewer errors for time-setting (Command: p.001; Copy: p = .003), numerals (Command: p.001), and "other" (Command: p.001) subscales. Older age was significantly associated with more errors for time-setting (Command: p.001; Copy: p = .003), numerals (Command: p.001), and "other" (Command: p.001) subscales. Significant differences were also found between education groups on the Command condition for all but the oldest age group (75+).Results provide normative data on CDT performance within a community-based cohort. Errors appear to be more prevalent in older compared with younger individuals, and may be less prevalent in individuals who completed at least some college compared with those who did not. Future studies are needed to determine whether this expanded scoring system allows detection of preclinical symptoms of future risk for dementia.

Spouses provide the majority of care for individuals with Alzheimer's disease (AD). The qualitative literature suggests that couples adopt one of two perspectives in their accounts of AD: a We/Us approach where couples describe experiences as a composite whole or an I/Me approach where couples describe themselves as experiencing the impact of AD separately. Little is known about how these perspectives relate to the individual characteristics of either affected party. This study investigated the experiences of dyads taking both approaches. Eleven spousal dyads were divided into I/Me (n=5) and We/Us (n=6) groupings based on qualitative analyses completed as part of a larger project. Diagnosed individuals were given measures of cognitive and functional ability and caregivers completed anxiety, depression, burden, relationship satisfaction, and positive aspects of caregiving measures. We found no significant differences between groups on patient cognitive or functional ability, or caregiver anxiety, depression, burden, or relationship satisfaction. However, We/Us caregivers expressed more positive aspects of caregiving than I/Me caregivers. These findings suggest the I/Me approach is not associated with differences in variables of patient cognitive status or functional ability or caregiver emotional health, perceived burden, or relationship satisfaction. Caregivers taking a We/Us approach, however, were able to identify more positive aspects of caregiving. This may be related to mutual compassion, a characteristic of the We/Us approach, which may be protective.

Patients with Alzheimer's disease (AD) dementia exhibit high rates of memory distortions in addition to their impairments in episodic memory. Several investigations have demonstrated that when healthy individuals (young and old) engaged in an encoding strategy that emphasized the uniqueness of study items (an item-specific encoding strategy), they were able to improve their discrimination between old items and unstudied critical lure items in a false memory task. In the present study we examined if patients with AD could also improve their memory discrimination when engaging in an item-specific encoding strategy. Healthy older adult controls, patients with mild cognitive impairment (MCI) due to AD, and patients with mild AD dementia were asked to study lists of categorized words. In the Item-Specific condition, participants were asked to provide a unique detail or personal experience with each study item. In the Relational condition, they were asked to determine how each item in the list was related to the others. To assess the influence of both strategies, recall and recognition memory tests were administered. Overall, both patient groups exhibited poorer memory in both recall and recognition tests compared to controls. In terms of recognition, healthy older controls and patients with MCI due to AD exhibited improved memory discrimination in the Item-Specific condition compared to the Relational condition, whereas patients with AD dementia did not. We speculate that patients with MCI due to AD use intact frontal networks to effectively engage in this strategy.

After outlining major trends in the literature base, highlighting the shortcomings, and suggesting future areas of study, this chapter calls for including more sociological analysis, namely attention to social location, in research on the individual's changing perspectives in Alzheimer's Disease (AD), or AD narratives. Rather than assuming that illness experiences can be universalized, variables such as race/ethnicity, marital status, class, gender, religiosity, and age as well as the roles of mass media and medicine, matter deeply in how AD is interpreted and experienced. This chapter proposes that psychosocial studies of the topic need to systematically explore at least five areas: 1) comprehensive illness narratives, including the potential positive aspects, 2) the role of sociodemographic variables, 3) the narrative transformations throughout the illness trajectory, 4) the bioethical implications of diagnosing individuals increasingly earlier, and 5) the impact of institutional forces like mass media and modern medicine on illness narratives.

OBJECTIVE The imagination inflation effect is a type of memory distortion defined as an increased tendency to falsely remember that an item has been seen, or an action has been performed, when it has only been imagined. For patients with very mild Alzheimer's disease (AD), susceptibility to the imagination inflation effect could have significant functional consequences in daily life. METHOD We assessed whether patients with very mild AD were more or less susceptible to the imagination inflation effect when compared with healthy older adults. In the first session, participants were read an action statement such as "fill the pillbox" and engaged in 1 of 3 activities: listened to the statement being read, performed the action, or imagined performing the action. During the second session, participants imagined action statements from the first session, as well as new action statements. During the recognition test, participants were asked to determine whether action statements were or were not performed during the first session. RESULTS We found that imagining performing actions increased the tendency of patients with very mild AD to falsely recall the action as having been performed to an extent similar to that of healthy older adults. CONCLUSION We concluded that, similar to healthy older adults, patients with very mild AD were susceptible to the imagination inflation effect, which we attributed to difficulties with source monitoring and reliance on familiarity.

Most studies investigating correlates of Alzheimer's disease (AD) caregiver burden have focused on the role of objective factors as opposed to subjective factors. Although objective variables (e.g., caregiver age, patient dementia severity, functional status) have been shown to be significantly associated with burden, the correlations generally are modest and explain relatively little of the variability in caregiver outcomes. Moreover, many of these objective variables are not modifiable and are of limited use in the development of caregiver interventions. Thus, there continues to be a need to identify powerful and modifiable determinants of caregiver burden. This study examined the role of two subjective factors—self-efficacy and depressive symptoms—as predictors of AD caregiver burden. Based on a sample of 80 AD caregivers, hierarchical regression analyses revealed that self-efficacy and depressive symptoms each had a significant independent effect on the experience of burden even after accounting for objective factors. These findings suggest that caregiver interventions aimed to reduce burden may benefit from the incorporation of specific strategies to increase self-efficacy and decrease depressive symptoms.

Social and behavioral research on Alzheimer’s disease (AD) has largely neglected the potential positive appraisals of AD experiences relative to the so-called stress and burden assumed to accompany the condition. The very word caregiving implies a unidirectional and exclusively negative experience for everyone involved. Spouses provide the majority of care for individuals with AD yet few prior studies have examined the association between positive caregiving appraisals and quality of marital relationship. The qualitative literature suggests that these couples adopt either a We/Us approach where they describe experiences as a composite whole or an I/Me approach where they describe themselves as experiencing the impact of AD separately. Little is known about how these perspectives relate to the individual characteristics of either party. Eleven spousal dyads were divided into I/Me (n = 5) and We/Us (n = 6) groupings based on qualitative analyses. Diagnosed individuals were given measures of cognitive and functional ability and caregivers completed anxiety, depression, burden, relationship satisfaction, and positive aspects of caregiving measures. We found no significant differences between groups on patient cognitive or functional ability, or caregiver anxiety, depression, burden, or relationship satisfaction. However, We/Us caregivers expressed more positive aspects of caring than I/Me couples. These findings suggest the I/Me approach is not associated with differences in cognitive status or functional ability or carer emotional health, perceived burden, or relationship satisfaction. Those taking a We/Us approach, however, were able to identify more positive aspects of caring. This may be related to mutual compassion and could be protective.

While most if not all individuals seek to age successfully, factors that influence cognitive aging are just beginning to be understood. In years past, it was believed that genetic factors played a primary role in cognitive longevity, but it is now known that various lifestyle factors play an important role in successful cognitive and general aging. The present chapter aims to review lifestyle factors that contribute to cognitive health in older adults. In particular, we review research examining the role of exercise, sleep, diet and vascular health, and attitudes and stereotypes about aging on cognition in elders. We also discuss the impact of various cognitive, social, community-based, and multimodal- interventions on cognitive health. We conclude with recommended future research and intervention-oriented directions that may further our understanding and promotion of successful cognitive aging.

In a previous study (Simmons-Stern, Budson & Ally, 2010), we found that patients with Alzheimer's disease (AD) better recognized visually presented lyrics when the lyrics were also sung rather than spoken at encoding. The present study sought to further investigate the effects of music on memory in patients with AD by making the content of the song lyrics relevant for the daily life of an older adult and by examining how musical encoding alters several different aspects of episodic memory. Patients with AD and healthy older adults studied visually presented novel song lyrics related to instrumental activities of daily living (IADL) that were accompanied by either a sung or a spoken recording. Overall, participants performed better on a memory test of general lyric content for lyrics that were studied sung as compared to spoken. However, on a memory test of specific lyric content, participants performed equally well for sung and spoken lyrics. We interpret these results in terms of a dual-process model of recognition memory such that the general content questions represent a familiarity-based representation that is preferentially sensitive to enhancement via music, while the specific content questions represent a recollection-based representation unaided by musical encoding. Additionally, in a test of basic recognition memory for the audio stimuli, patients with AD demonstrated equal discrimination for sung and spoken stimuli. We propose that the perceptual distinctiveness of musical stimuli enhanced metamemorial awareness in AD patients via a non-selective distinctiveness heuristic, thereby reducing false recognition while at the same time reducing true recognition and eliminating the mnemonic benefit of music. These results are discussed in the context of potential music-based memory enhancement interventions for the care of patients with AD.

Positive aspects of the caregiving experience may buffer caregivers from the many negative psychological and physical consequences of caregiving. Understanding what factors relate to the recognition of positive aspects of caregiving is important for the enhancement of caregiver well-being. Self-efficacy is a potentially modifiable psychological construct that has been associated with positive thinking, improved control of negative affect, and enhanced motivation.This study examined the relationship between positive aspects of caregiving and self-efficacy among 57 family members caring for a loved one with Alzheimer's disease. Participant data was gathered through individual interviews conducted as a part of a larger randomized controlled trial of a caregiver intervention.We found that self-efficacy accounted for a significant percentage of the variance in positive aspects of caregiving after controlling for other factors commonly associated with positive aspects of caregiving including caregiver demographics, care recipient neuropsychiatric symptoms, and caregiver depression.Our results suggest that high self-efficacy relates to caregivers' perception of positive aspects of the caregiving experience.

Much research has documented the costs to memory from Alzheimer’s disease (AD). Individuals with AD are less likely than age- and education-matched controls to recognize or recall previously encountered events (Budson, Wolk, Chong, & Waring, 2006). AD patients also show difficulty remembering source information – specific information about the exact circumstances under which an event was encountered (e.g., Johnson, Hastroudi & Lindsay, 1993). They are less able than controls to remember: (a) whether an item was previously seen or imagined (e.g., Dalla Barba et al., 1999), (b) whether a sentence was completed by oneself or by another (e.g., Multhaup & Balota, 1997), (c) whether words had been previously presented in a red or green color (Tendolkar et al., 1999), (d) whether a fact was said by a man or a woman (Mitchell, Sullivan, Schacter, & Budson, 2006), (e) whether a word was presented during one task or another (Pierce, Sullivan, Schacter, & Budson, 2005; Pierce, Waring, Schacter, & Budson, 2008), (f) whether an item was presented during the study or test session (Budson, Dodson, Daffner, & Schacter, 2005), and (g) source information outside of the laboratory (Budson et al., 2004; Budson, Simons, Waring, Sullivan, Hussion, & Schacter, 2007; see Souchay & Moulin, 2009, for a review). Although the memory deficit from AD is increasingly clear, what is not clear is the extent to which AD patients are aware of this memory deficit. In other words, how well can AD patients monitor and judge the likely accuracy of memories? To foreshadow our results, this paper shows that AD patients are strikingly unaware of the accuracy of their memories. Even when their recognition performance is comparable to that of an older control group, AD patients are unable to distinguish between correct and incorrect recognition responses. Reliably monitoring one’s memory is critically important for knowing how much to trust a particular memory. One problem in particular that patients with AD experience is a high percentage of false memories, both in the laboratory (Budson, Daffner, Desikan, & Schacter, 2000) and in the real world (Budson et al., 2007). For instance, patients who falsely remember that they have already turned off the stove or have taken their medications when they have not will no longer be able to live independently. However, accurately monitoring memories is a potential mechanism for counteracting the influence of false memories when, for example, individuals are aware that a particular memory is likely to be false. Thus, understanding the extent to which patients with AD can monitor and judge the accuracy of their memories is an important clinical issue in addition to being of great theoretical interest. The small literature that has examined memory-monitoring on the part of Alzheimer’s patients has produced conflicting findings (see Pannu & Kaszniak, 2005, and Souchay, 2007 for reviews). On the one hand, patients with mild AD appear no different from healthy controls in using confidence ratings to judge the likely accuracy of answers to general knowledge questions (e.g., Who wrote Alice in Wonderland?) that assess well-learned or semantic information (Backman & Lipinska, 1993; Lipinska & Backman, 1996; see also Cosentino et al., 2007). Similarly, Moulin et al. (2003) observed no differences between AD participants and healthy older controls in monitoring the accuracy of recognition judgments. On the other hand, Souchay et al (2002) showed that AD patients were impaired in monitoring episodic memories. When completing a cued-recall test of recently-learned material, AD patients were much less accurate than older controls in providing feeling-of-knowing (FOK) judgments about the likelihood of recognizing an unrecallable item (Souchay et al., 2002). To our knowledge, no one has examined AD patients’ ability to monitor the likely accuracy of source judgments. In general, this pattern of AD patients – when compared to healthy older adults – showing a preserved ability to monitor the accuracy of semantic memories but an impaired ability to monitor the accuracy of episodic memories parallels a similar pattern that exists when healthy older adults are compared to younger adults. Older adults are either no different from or better than younger adults in monitoring the accuracy of responses to general knowledge questions – either with confidence ratings or by providing FOK judgments (e.g., Allen-Burge & Storandt, 2000; Butterfield, Nelson, & Peck, 1988; Dodson, Bawa, & Krueger, 2007; Perlmutter, 1978; Pliske & Mutter, 1996). However, older adults are much worse than younger adults in monitoring the accuracy of recently-learned (episodic) material: a) they provide less accurate FOK judgments on cued-recall tests (Souchay et al, 2000); and b) their confidence ratings are less well calibrated on both cued-recall tests and source memory tests because of the occurrence of high-confidence errors (Dodson et al., 2007a, 2007b; see also Dodson & Krueger, 2006). Dodson and colleagues proposed a misrecollection account to explain the pattern of older adults’ monitoring performance (Dodson et al., 2007a, 2007b). They suggested that advancing age is associated with an increased susceptibility of miscombining features of different events that in turn produce confidently-held misrecollections – memory problems that are likely caused by deterioration of the hippocampus and surrounding tissue (e.g., Shimamura & Wickens, 2009; Squire et al., 2004; and see Raz et al., 2005 for evidence of accelerated shrinkage of the hippocampus with healthy aging). This account predicts age-related differences in monitoring performance – because of the occurrence of high confidence errors – on all tests that require memory for specific details about recently-learned past events, such as source memory tests. The goals of the present study are twofold. First, given the similarity between older adults and AD patients in that both show relatively preserved monitoring of semantic memories and impaired monitoring of episodic memories (when compared to their respective control groups), we sought to test the misrecollection account as an explanation of the monitoring performance on the part of AD patients. Specifically, if AD patients show a more severe version of the same misrecollection impairment that is exhibited by older adults then we should observe that on a source memory test AD patients are more prone than older adults to make high confidence errors. The second goal is to examine whether the memory-monitoring deficit in AD patients is a byproduct of their overall weaker memory performance or whether this memory-monitoring deficit is a byproduct of a more specific, malfunctioning memory-monitoring mechanism. The answer to this question is unknown because in all extant studies AD patients show worse memory performance than their healthy older counterparts. Thus, worse memory-monitoring by AD patients may be a byproduct of their worse accuracy (see Hertzog et al., 2010 for a similar argument about differences in memory-monitoring between older and younger adults). No study has sought to compare the memory-monitoring abilities of AD patients and healthy older adults when both groups show comparable memory performance. To address these goals, we used a combination recognition and source identification paradigm that involves collecting confidence ratings for both memory judgments (e.g., Dodson, Bawa, & Krueger, 2007; Simons, Peers, Mazuz, Berryhill & Olson, 2010). At encoding, participants heard sentences that were presented by either a female or a male. At test, participants were presented with sentences and made an initial old-new recognition judgment (i.e., Did you encounter it before or is it new?) and for items receiving a judgment of old, participants made a source judgment about who presented the item earlier (i.e., male or female?). For both the recognition and the source judgments, participants rated the likely accuracy of their responses on a confidence scale from 50 (guessing) to 100 (certain). According to our misrecollection account, we should observe that AD patients make more high confidence errors than healthy older adults on the source judgment. Critically, if the monitoring impairment on the part of AD patients is not merely a byproduct of their worse accuracy then we should observe that even when AD patients and healthy older adults show comparable source identification accuracy, the AD patients still will exhibit a monitoring impairment. In other words, matching the AD patients and the older adults on source memory accuracy avoids a potential confound and so any observed differences in monitoring performance on this judgment cannot be attributed to differences in source accuracy.

Although it is generally accepted that patients with amnestic mild cognitive impairment (aMCI) and patients with Alzheimer's disease (AD) have significantly impaired recollection, recent evidence has been mixed as to whether these patients demonstrate impaired memorial familiarity. Recent work suggests that familiarity may remain intact for pictures, but not for words. Further, a recent event-related potential (ERP) study suggests that enhanced conceptual processing of pictures may underlie this intact familiarity. However, to date there has been no direct comparison of perceptual and conceptual-based familiarity for pictures and words in patients with aMCI and AD. To investigate this issue, patients with aMCI, patients with AD, and healthy older adults underwent four study-test conditions of word-word, picture-picture, word-picture, and picture-word. When stimuli undergo form change, it has been suggested that only conceptual processing can help support recognition in the absence of recollection. Our results showed that patients successfully relied on perceptual and conceptual-based familiarity to improve recognition for the within format conditions over the across format conditions. Further, results suggested that patients with aMCI and AD are able to use enhanced conceptual processing of pictures compared to words to allow them to overcome the deleterious effects of form change in a similar manner as controls. These results help us begin to understand which aspects of memory are impaired and which remain relatively intact in patients with aMCI and AD. This understanding can then in turn help us to assess, conceptualize, and build behavioral interventions to help treat these patients.

The objective of the present study was to provide normative data for Trail Making Test (TMT) time to completion and performance errors among cognitively normal older adults, and to examine TMT error rates in conjunction with time scores for pre-clinical and clinical Alzheimer's disease (AD) diagnostic decision-making. A sample of 526 individuals was classified into three diagnostic groups (normal controls, N=269; mild cognitive impairment, MCI, N=200; AD, N=57) by a multidisciplinary consensus conference. Results indicated that performance differed among the three groups for TMT A and B time scores as well as TMT B error rate. Diagnostic classification accuracy (i.e., sensitivity, specificity, and positive and negative predictive powers) is described for various combinations of the diagnostic groups. The findings show that TMT B time and errors are independently meaningful scores, and both therefore have clinical utility in assessing individuals referred for dementia evaluations.