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Age-Related Prospective Memory Decline: Contributions from Sleep and Opportunities for Intervention Lara Fine BA

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Age-Related Prospective Memory Decline: Contributions from Sleep and Opportunities for Intervention Lara Fine BA Age-related Prospective Memory Decline: Contributions from Sleep and Opportunities for Intervention Lara Fine B.A (Honours) This thesis is presented for the degree of Doctor of Philosophy, and in partial fulfilment of the requirements for the Master of Clinical Neuropsychology of The University of Western Australia School of Psychological Science 2019 Thesis Declaration I, Lara Fine, certify that: This thesis has been substantially accomplished during enrolment in this degree. This thesis does not contain material which has been submitted for the award of any other degree or diploma in my name, in any university or other tertiary institution. In the future, no part of this thesis will be used in a submission in my name, for any other degree or diploma in any university or other tertiary institution without the prior approval of The University of Western Australia and where applicable, any partner institution responsible for the joint-award of this degree. This thesis does not contain any material previously published or written by another person, except where due reference has been made in the text and, where relevant, in the Authorship Declaration that follows. This thesis does not violate or infringe any copyright, trademark, patent, or other rights whatsoever of any person. The research involving human data reported in this thesis was assessed and approved by The University of Western Australia Human Research Ethics Committee. Approval #s: 5361; 2086; 7799. Written patient consent has been received and archived for the research involving patient data reported in this thesis. This thesis contains published work and work prepared for publication, some of which has been co-authored. Signature: Date: 7th October 2019 i Abstract It is well established that older adults experience prospective memory deficits. However, research evaluating prospective memory interventions for older adults is limited. This thesis explores two novel avenues to improve older adults’ prospective memory. First, sleep is recognised as an important determinant of prospective memory performance in younger adults, and of older adults’ cognition generally. Thus, this thesis examines whether sleep disruption relates to poorer prospective memory in older adults; whether sleep disruption mediates age-related prospective memory decline; and whether improving older adults’ sleep can improve their prospective memory. Second, regarding potential cognitive interventions for prospective memory, age-related prospective memory decline is often conceptualised as decline in the executive aspects of prospective memory specifically. However, these aspects have, largely, been ignored in the intervention literature. Thus, this thesis evaluated a novel executive function intervention for prospective memory in older adults. To evaluate the relationship between sleep disruption and prospective memory and ageing (Chapter 2), older adults undertook assessment of sleep using actigraphy, and prospective memory using a laboratory task. Results indicated longer awakenings were associated with poorer prospective memory. Furthermore, the relationship between older age and poorer prospective memory appeared to operate via longer awakening length. Building on these results, Chapter 3 examined whether an intervention to improve older adults’ sleep could also improve their prospective memory. Older adults with poor sleep were allocated either to a cognitive behavioural therapy for insomnia (CBT-I) group, or waitlist control. Participants underwent assessment pre and post-intervention of prospective memory, and sleep with actigraphy and questionnaires. Contrary to ii prediction, despite subjective insomnia symptoms improving, CBT-I did not improve objective sleep, nor prospective memory. In a second intervention study, using a neuropsychological approach to treatment, (Chapter 4), older adults were allocated to receive (1) goal management training (an executive function intervention), (2) an established intervention for prospective memory’s retrospective components (implementation intentions), or (3) no intervention. Prospective memory was assessed pre and post-intervention. Results suggested some older adults had difficulty comprehending goal management training. Post-hoc analysis suggested that for those who did comprehend it, prospective memory improved relative to no intervention, but only for participants with poorer baseline prospective memory. Implementation intentions was similarly effective for participants with poorer baseline prospective memory. Direct comparison of the interventions did not suggest significant differences between them. Overall, the novel contributions made by this thesis are substantial. It includes studies that are among the first to examine (1) the relationship between prospective memory and sleep in older adults, (2) whether treating sleep problems can improve prospective memory, and (3) whether goal management training is effective at improving prospective memory in older adults. In summary, this thesis found there are possible opportunities to improve older adults’ prospective memory through sleep and executive function strategies. However, several cautionary points were raised. First, interventions appear likely to be specifically effective for older adults with poorer prospective memory, rather than all older adults. Second, whilst a relationship between sleep and prospective memory was demonstrated, suggesting improving sleep could improve prospective memory, older adults’ sleep disturbance may be more resistant to treatment with CBT-I. This finding needs further exploration, particularly as to whether potential treatment resistance relates to iii neurological changes underpinning poor sleep. Finally, when using executive interventions to improve prospective memory, researchers and clinicians will need to consider the complexity of the strategy and amount of training older adults will need. This is especially pertinent if intervention is targeted at older adults with poorer prospective memory, who may have potential underlying cognitive deficits affecting their comprehension of the intervention. iv Contents Thesis Declaration ......................................................................................... i Abstract ........................................................................................................ ii Contents........................................................................................................ v List of Tables............................................................................................... xi List of Figures ............................................................................................xiv Acknowledgements .................................................................................... xv Authorship Declaration: Co-authored Publications .................................. xvii CHAPTER 1................................................................................................. 1 General Introduction .................................................................................... 1 An overview of prospective memory .............................................................................. 2 The neurobiology of prospective memory ...................................................................... 5 Age-related decline in prospective memory.................................................................... 6 Cognitive ageing and sleep ........................................................................................... 11 Prospective memory intervention in older adults.......................................................... 12 External interventions ................................................................................. 13 Internal interventions................................................................................... 13 The current thesis .......................................................................................................... 23 References .................................................................................................. 25 Foreword to Chapter 2................................................................................ 35 CHAPTER 2............................................................................................... 36 Sleep Disruption Explains Age-Related Prospective Memory Deficits: Implications for Cognitive Ageing and Intervention ................................. 36 v Abstract ...................................................................................................... 37 Introduction ................................................................................................ 38 Sleep and cognition in older adults ............................................................................... 38 Sleep, depression and the cognitive processes underpinning prospective memory ......................................................................................................................... 39 Sleep and prospective memory: previous research ....................................................... 40 Aims and hypotheses .................................................................................................... 41 Method ....................................................................................................... 41 Participants.................................................................................................................... 41
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