Clinical Support Data

Pathways to Memory™ is a customized cognitive intervention program for individuals with memory impairing illnesses or conditions. This seven-component program is designed to improve the cognitive ability, memory, quality of life, and quality of relationships for clients and their families.

The Pathways to Memory™ program can prevent or postpone a move to a residential care facility due to loss of skills, cognitive or behavioral issues.

The Pathways to Memory™ program began its formation in 2004. Professional Memory Care Specialist, Ann M. Doetterl, began researching clinical studies conducted at Washington University in St. Louis as well as follow up studies conducted at the University of Miami. These studies found that implicit memory remains intact for individuals in early and middle stage Alzheimer’s Disease and that a regular cognitive stimulation regime and program can preserve implicit memory. Individuals can regain and maintain levels of functional independence and have an improved quality of life.

• Dr. Randy L. Buckner, Department of Psychology, Department of Radiology, Department of Anatomy and Neurobiology, and the Howard Hughes Medical Institute of Washington University School of Medicine, St. Louis, MO 63130 USA
• Dr. Cindy Lustig, Duke University, Department of Psychology, University of Michigan, Department of Psychology of Washington University School of Medicine, St. Louis, MO 63130 USA
• Dr. David A. Loewenstein, Dr. Sara J. Czaja, Dr. Amarilis Acevedo and Dr. Ranjan Duara, Wien Center for Alzheimer’s Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL and the Department of Psychiatry and Behavioral Sciences and the Center on Aging, University of Miami School of Medicine, Miami, FL 33140 USA

Primary Research and Completed Studies

“Preserved Neural Correlates of Priming in Old Age and Dementia”

Neuron, Volume 42, Issue 5, 10 June 2004, Pages 865-875 Copyright© Cell Press Dr. Randy Buckner, PhD., and Dr. Cindy Lustig Department of Psychology, Department of Radiology, Department of Anatomy and Neurobiology, and the Howard Hughes Medical Institute of Washington University School of Medicine, St. Louis, MO 63130 USA

Volunteers were divided into three groups: young adults, older adults without dementia, and older adults with dementia of the Alzheimer’s type (DAT). Drs. Buckner and Lustig used functional magnetic resonance imaging (fMRI) (1.5T Siemens Vision scanner) to look at how and where their brains were working as they were put through series of memory recall exercises.

Through the collection and study of the fMRI scans of each group, they found the brains of the Alzheimer’s adults worked harder at word-recall tasks than the brains of the young adults and the older adults without dementia. They also concluded that although the disease was present, the brains of the Alzheimer’s patients are more intact than had been thought and that they retain what is known as implicit or unconscious memory.

Conclusion: As they practiced the word recall exercises, the fMRI scans indicated the tasks became easier and response times were reduced. The study showed the Alzheimer’s group benefited from priming or repetition-based cognitive stimulation with changes in brain activation in the frontal lobe along the inferior frontal gyrus similar to those shown by the young adults.

Taken together, the findings implicated the benefits of an appropriately designed cognitive regime and rehabilitation program to preserve implicit memory. Furthermore, individuals with dementia of the Alzheimer’s type (DAT) can improve their memory performance with priming activities.

In addition to the National Institute of Health and the National Institute on Aging, Drs. Lustig and Buckner’s study was supported by the Alzheimer’s Association, the Howard Hughes Medical Institute, the James S. McDonnell Foundation, and the Richard and Mildred Poletsky Education Award.

Primary Research and Completed Studies

“Cognitive Rehabilitation of Alzheimer’s Disease Patients”

American Journal of Geriatric Psychiatry, Issue 12, pages 395-402, August, 2004 American Association for Geriatric Psychiatry Dr. David A. Loewenstein and Dr. Ranjan Duara, M.D. Wien Center for Alzheimer’s Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL and the Department of Psychiatry and Behavioral Sciences and the Center on Aging, University of Miami School of Medicine, Miami, FL 33140 USA

The efficacy of a new Cognitive Rehabilitation (CR) program on memory and functional performance of impaired Alzheimer’s Disease patients was evaluated. Participants in the Cognitive Rehabilitation (CR) condition participated in two 45-minute sessions twice per week for 24 total sessions. CR training included face-name associations tasks, object recall training, functional tasks (e.g. making change, paying bills), orientation to time and place, visuo-motor speed of processing, and the use of a memory notebook.

Three techniques, known as spaced retrieval, dual cognitive support, and procedural memory training demonstrated promise in their ability to enhance learning in AD patients. Learning trials were separated by progressively longer time intervals filled with conversation or mental tracking tasks to prevent rehearsal of the to-be-remembered information. It has been postulated that Spaced-retrieval technique works by engaging implicit memory processes, by tapping procedural systems and by decreasing reliance on semantic or declarative mechanisms.

Participants in Cognitive Rehabilitation demonstrated improved performance on tasks; gains in recall of face–name associations, orientation, cognitive processing speed, and specific functional tasks were present post-intervention and at a 3-month follow-up.

Conclusion: A systematic program of cognitive rehabilitation can result in maintained improvement in performance on specific cognitive and functional tasks in impaired Alzheimer’s disease patients.

“Alzheimer’s Patients May Retain ‘Implicit’ Memory” The Wall Street Journal – June 10, 2004 Reuters News Service

“Alzheimer’s patients may be capable of learning new ways to use their brains, scientists said, suggesting that it may be possible to help loved ones and caregivers better cope with the disease. The study convincingly shows that developing intervention programs may help elderly persons better deal with dementia related memory loss. Maintaining certain areas of memory through program interventions may help prolong a person’s functional independence.”

“Studies Suggest People with Alzheimer’s Disease Can Still Learn” NIH News – July 2, 2004 U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Aging

People who have Alzheimer's disease (AD) could be more capable of learning than previously thought, according to two new studies supported by the National Institute on Aging (NIA), a part of the National Institutes of Health. The promising studies suggest that some people with early cognitive impairment can still be taught to recall important information and to better perform daily tasks.

The findings of one study, by David A. Loewenstein, Ph.D., and colleagues at the University of Miami School of Medicine and Mount Sinai Medical Center, Miami Beach, are reported in the July-August 2004 issue of the American Journal of Geriatric Psychiatry.

At the end of the study, those in the rehabilitation group showed, on average, significantly improved ability to associate faces and names, had faster mental processing speeds, were better oriented to time and place, and were better able to make correct change for purchases than those in the control group.

"Our study shows that people with AD can learn. This learning can be greatly enhanced if you teach them certain techniques that target particular areas of the brain," Dr. Loewenstein says. "More importantly, by combining specific cognitive rehabilitation strategies, we can help people with AD remain engaged in daily activities and retain a connection to their family and friends and the world as a whole for a longer period of time."

In the June 2004 second study, by Dr. Cindy Lustig and Dr. Randy L. Buckner at Washington University School of Medicine in St. Louis, they examined a type of implicit memory that helps people act faster on items they have previously worked on than new items. In the study, participants were shown words and asked to judge if they represented something living, such as the word "DOG" or something nonliving, such as the word "DESK". Overall, young adults made faster judgments than their older peers and those who had AD. However, all three groups were faster when shown repeated words rather than new ones. This increase was about the same for all three groups, suggesting that this benefit of implicit memory remains in old age and even with Alzheimer's disease. The researchers also used functional magnetic resonance imaging (fMRI) to measure brain activity during the word judgments. They were especially interested in the left prefrontal cortex, a part of the brain involved in thinking about what words mean. They found that activity in this part of the brain was less for repeated words than for new ones. Along with the faster judgments, this reduction in brain activity suggests that seeing an item again had an important effect. Because the judgment for a word was made when the person saw it initially, the brain didn't have to work as hard at making a living/non-living judgment when the same word appeared again. In fact, even when people with AD couldn't remember which words they had seen, presenting the words again still helped them classify those words faster, and they also showed changes in brain activity like those of the young adults and their healthy older peers.

"One of the exciting findings from our study is the suggestion that the brain areas supporting high level, complex thinking still have some flexibility and these areas can change with some learning as we age and even in AD," Dr. Lustig says. "We're hoping our results will be useful in designing cognitive training and rehabilitation programs."

“Alzheimer’s May Leave Some Forms of Memory Intact”
Human Molecular Genetics.org - June 2, 2004
Howard Hughes Medical Institute
Dr. Randy Buckner, Washington University School of Medicine, St. Louis, MO.

Scientists’ discovery suggests that new strategies and rehabilitative programs may bolster and help retain cognitive function of those with Alzheimer’s disease as well as healthy older people. These findings of the studies suggest that if we can help people use their brain systems optimally by providing the right kinds of cues or task instructions, we may be able to help improve their overall function.

Dr. Randy Buckner states in this article, “Structured training programs might be the most effective approach. Our earlier work has shown that if you leave older adults to form their own approach to a task, that is the least helpful situation for them. Whereas, if you constrain the task and give very directed goals, the older adult can recruit those remaining neural areas. We’ve shown in this study that it is possible to tap into high-level cognitive areas to preserve memory function.”

Memory Fitness: A Guide for Successful Aging

Dr. Gilles O, Einstein, Chairman, Psychology Department, Furman University Dr. Mark A. McDaniel, Department of Psychology, Washington University Yale University Press, 7/15/2004, ISBN: 030010023X

Memory Fitness: A Guide for Successful Aging, relies on many rigorous academic studies but is written for the lay person. Dr. Einstein, says "It outlines some reasonable expectations about things people can do to perhaps increase their memory performances."

Neurons, the nerve cells that make up our brains, naturally lose some functionality throughout a lifetime. This is partially responsible for the "senior moments" and other lapses that people commonly encounter, which Dr. McDaniel stresses are normal — usually. Do anything that makes you struggle and problem-solve through significant cognitive effort," McDaniel suggests. "There are studies that show an association between challenging daily mental activity and memory maintenance as well as less dramatic loss of memory function."

“Rethinking Alzheimer’s”
Miller School of Medicine, University of Miami
Diane C. Lade, South Florida Sun-Sentinel, July 25, 2004

New research out of the University of Miami School of Medicine suggests exercises that train the brain could help those in the disease's early stages retain or, in some cases, regain their ability to do everyday tasks.

And those skills could allow them to lead normal lives longer and stay out of nursing homes -- results that study co-author Dr. David Loewenstein says signal promise for the future of what's called "cognitive retraining" or "cognitive rehabilitation."

“Rethinking Alzheimer’s”
Miller School of Medicine, University of Miami
Diane C. Lade, South Florida Sun-Sentinel, July 25, 2004