With its ageing population, the prevalence of dementia in Hong Kong is expected to increase. Healthcare researchers from The Hong Kong Polytechnic University (PolyU) have developed an innovative mobile application-based cognitive remediation programme, Enhancing Memory in Daily Life (E-MinD Life), targeting those who experience memory complaints, mild cognitive impairment (MCI) and mild dementia. The programme, leveraging memory encoding strategies, provides early intervention to delay the functional deterioration associated with cognitive decline, supporting these individuals' independent living and enhancing their quality of life.
As individuals age, cognitive functions and memory gradually decline, affecting their ability to perform daily activities independently. Such memory decline is more pronounced in people with MCI. MCI is a significant area of interest in ageing and dementia research, and, more importantly, various studies suggest that it can indicate early dementia-related neuropathological changes years before a clinical diagnosis of dementia. Among the three stages of memory, namely encoding, storage and retrieval, the encoding stage is often the first to be affected in people with MCI, causing memory decline.
Developed by Prof. Karen LIU, Professor of the Department of Rehabilitation Sciences at PolyU, in collaboration with Dr Nikki TULLIANI, Associate Lecturer at Western Sydney University, the E-MinD Life programme is built on the principles of semantic and perceptual memory encoding, and innovatively integrates cognitive remediation into daily activities. As an early intervention, it aims to train older adults in the early stages of cognitive decline, while they still have the capacity to learn new skills and adopt memory strategies to better manage daily activities. The programme lasts for nine weeks, with three 60-minute sessions per week: one individualised therapist-led meeting followed by two self-administered sessions.
Humans can register new information to memory through semantic encoding and perceptual encoding of information. Prof. Karen Liu elaborated, "Semantic-based memory, also referred to as conceptual knowledge or declarative memory, encompasses our long-term understanding of objects, word meanings, facts, concepts, rules and people, acquired through our lifetime experiences. While these knowledges are organised into networks of connected ideas or concepts, semantic memory encoding enables us to associate new information with what we already know and remember it more efficiently. Perceptual-based memory encoding, on the other hand, involves capturing and storing visual information, such as images, in memory to help with recall."
As memory decline sets in, people with MCI often have difficulties with instrumental activities of daily living (IADLs), involving essential tasks such as household chores, shopping and managing finances, which are crucial for maintaining their independence in both home and community living. E-MinD Life incorporates semantic and perceptual encoding techniques into 12 common IADLs. These IADLs are categorised into three blocks: "meal preparation and clean-up activities", "laundry activities" and "communication and community activities," each comprising four tasks. By engaging participants in these structured tasks, the programme shows significant potential in fostering cognitive engagement and practical learning.
The encoding techniques enable participants to organise pertinent aspects like person, place, time and object, and establish connections between these concepts, enhancing learning and memory. The techniques include "visual imagery" and the "method of loci," which help participants connect visual information from memory; "chunking," which requires them to break down the IADL into different steps, give context to the chunks of information and then form a contextual story; and "self-generation," which asks them to use their own words to describe the IADL.
Based on a user-friendly mobile application, E-MinD Life utilises knowledge and methods derived from previous research, allows tailoring of the programme to meet participants' individual needs, and provides real-time feedback. In addition, by reaching out to larger populations, E-MinD Life is able to provide community-based interventions, extending the impact of cognitive remediation programmes beyond professional-led training.
Prof. Liu added, "Non-pharmacological treatments are essential for alleviating the decline in memory and cognitive abilities through effective preventive and early intervention measures. Enabling older adults and MCI individuals to easily use E-MinD Life at home, we aspire to create a cost-effective, self-administered and time-flexible means for personalised interventions. By teaching participants to apply semantic and perceptual encoding principles in everyday tasks, the programme supports individuals in overcoming challenges associated with memory decline. This initiative also marks a notable advancement in leveraging memory encoding to facilitate cognitive remediation."
To further refine the administration of E-MinD Life, focus groups and expert reviews were conducted to gain insights from healthcare professionals, as well as from older adult participants and their caregivers.
A pilot study on E-MinD Life was conducted in Australia to evaluate its usability. The qualitative analysis revealed that participants found the programme enjoyable and beneficial. Specifically, it increased memory awareness in daily life, stimulated the learning of new skills and technology, and provided an appropriate level of challenge. A Chinese version of E-MinD Life is currently being developed for trial use in Hong Kong.
Inspired by their prior endeavours in stroke rehabilitation, Prof. Liu and her team have explored memory encoding for older adults since 2006. After conducting a series of studies to understand the neuro-mechanisms associated with these memory encoding techniques, the findings were translated into clinical projects to assess their applicability within the clinical population. Subsequently, E-MinD Life has been developed with a commitment to promoting cognitive training for older adults in home settings.
