DEVELOPMENTAL AND KEY QUESTION: DEMENTIA

TOPIC 2: COGNITIVE PSYCHOLOGY

2.1.6 DEVELOPMENTAL PSYCHOLOGY IN MEMORY

Including at least one of these:

• Sebastián and Hernández-Gil (2012) discuss developmental issues in memory span development, which is low at 5 years old and develops as memory capacity increases up to 17 years old.

• Dyslexia affects children's memory span and working memory, impacting their learning.

• The impact of Alzheimer’s disease on older adults and its effects on memory.

2.4 KEY QUESTIONS

2.4.1 ONE KEY QUESTION RELEVANT TO TODAY’S SOCIETY

This is to be discussed as a contemporary rather than an academic argument.

2.4.2 CONCEPTS, THEORIES, AND/OR RESEARCH

Drawn from cognitive psychology as covered in this specification.

Suitable Examples

• How can psychologists’ understanding of memory help patients with dementia?

• How can knowledge of working memory be used to treat dyslexia?

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WHAT IS ALZHEIMER’S DISEASE AND ITS CAUSES?

Alzheimer’s disease is the most common form of dementia, affecting memory, cognition, and daily functioning. It is characterised by progressive brain damage caused by the build-up of amyloid plaques and neurofibrillary tangles. These protein abnormalities disrupt communication between brain cells and eventually lead to their death, causing brain atrophy. The hippocampus and prefrontal cortex—crucial for memory and decision-making—are among the first areas affected. As the disease progresses, other brain regions are impacted, leading to widespread cognitive and physical decline.

CAUSES OF ALZHEIMER’S DISEASE

The precise causes of Alzheimer’s disease are still under investigation, but research has identified several contributing factors:

• Amyloid Plaques and Neurofibrillary Tangles: Amyloid-beta proteins form plaques that disrupt cell-to-cell communication, while tau proteins tangle, destabilising neurons. Though these features are hallmark indicators, emerging research questions whether they are primary causes or consequences of other processes.

• Genetics: Certain genetic mutations, such as the presence of the APOE-e4 gene, significantly increase the risk of developing Alzheimer’s. However, not everyone with these genes will develop the disease, highlighting the interplay between genetics and other factors.

• Ageing: Age is the most significant risk factor. Natural processes like oxidative stress and the accumulation of cellular damage increase vulnerability as people age.

• Vascular Health: Conditions such as high blood pressure, diabetes, and high cholesterol impair blood flow to the brain, exacerbating neuronal damage.

• Chronic Inflammation: Long-term inflammation in the brain, possibly triggered by infections or immune system dysfunction, has been linked to Alzheimer’s.

• Lifestyle Factors: Environmental and behavioural factors, such as poor diet, lack of physical activity, and low cognitive engagement, also play a role. These modifiable risks underscore the importance of a healthy lifestyle in potentially reducing the likelihood of developing Alzheimer’s

DIAGNOSING DEMENTIA

Dementia often progresses unnoticed in its early stages because many people attribute memory problems to normal ageing. As a result, symptoms may not be recognised until the disease is significantly advanced.

Professor Bruno at Liverpool Hope University has developed a test to diagnose dementia before noticeable symptoms appear. His test involves a word recall exercise, where patients are asked to remember words from a list of 15.

In healthy individuals, the primacy effect means that words from the start of the list are well-recalled because they are rehearsed into long-term memory (LTM). However, some patients recalled words from the middle of the list instead, which indicates pathological memory loss rather than the typical effects of ageing.

Professor Bruno distinguishes between “healthy” memory loss, which comes naturally with age, and “pathological” memory loss, which is more likely to signal dementia. His test aims to detect warning signs of dementia early, allowing interventions before sufferers notice memory problems themselves.

The cognitive psychology behind this test includes the Multi-Store Model and concepts such as displacement theory, which explains why middle-list words are usually forgotten due to the limited capacity of short-term memory (STM). Failure to recall primacy words suggests an inability to transfer information to LTM, a hallmark of pathological memory loss.

ALZHEIMER’S DISEASE: STAGES AND IMPACT ON MEMORY, COGNITION, AND PHYSICAL FUNCTION

EARLY STAGE (MILD)

In the early stage, the symptoms are subtle but noticeable to close family and friends. The primary changes include memory difficulties, but other cognitive and behavioural shifts may also emerge.

MEMORY IMPAIRMENTS

• Short-term memory is most affected, with individuals frequently forgetting recent conversations, events, or appointments.

• Repetition of questions or misplacing items is common.

COGNITIVE DECLINE

• Difficulty planning, organising, and solving problems, such as managing finances or following recipes.

• Decreased ability to concentrate or find the right words during conversations (mild language difficulties).

PHYSICAL AND BEHAVIOURAL CHANGES

• Individuals typically remain physically functional but may show mild apathy or withdrawal from activities.

• Subtle changes in mood, such as increased irritability or anxiety, may occur.

MIDDLE STAGE (MODERATE)

During this stage, memory loss and cognitive decline become more pronounced, and the disease begins to interfere with daily life significantly. Behavioural and emotional symptoms often emerge, and physical function may begin to deteriorate.

MEMORY IMPAIRMENTS

• Episodic memory declines, making recalling significant life events, such as weddings or holidays challenging.

• Semantic memory is affected, with individuals forgetting the names of familiar people or objects.

• Working memory struggles lead to losing track of tasks or conversations.

COGNITIVE DECLINE

• Disorientation and confusion become more frequent, including difficulty recognising locations or navigating familiar places.

• Language impairments worsen, with difficulty finding words, forming coherent sentences, or understanding instructions.

• Poor judgment and increased impulsivity may lead to unsafe behaviours.

PHYSICAL AND BEHAVIOURAL CHANGES

• Behavioural symptoms, such as agitation, wandering, or compulsive behaviours, become more apparent.

• Sleep disturbances are common.

• Some individuals begin to experience motor difficulties, such as problems with coordination or balance.

LATE STAGE (SEVERE)

In the final stage of Alzheimer’s disease, cognitive and physical decline are profound. Individuals become entirely dependent on caregivers for all aspects of daily life.

MEMORY IMPAIRMENTS

• Global memory failure occurs, with individuals losing recognition of close family members and their sense of identity.

• Even procedural memory, such as walking or eating, is severely affected.

COGNITIVE DECLINE

• Communication abilities are nearly non-existent, with only a few words or phrases retained.

• Awareness of surroundings is minimal.

PHYSICAL DETERIORATION

• Severe motor difficulties develop, including an inability to walk, sit, or control movements.

• Loss of bladder and bowel control is standard.

• Swallowing difficulties increases the risk of choking or aspiration pneumonia.

• Weight loss and frailty often accompany physical decline.

THE PROGRESSIVE NATURE OF ALZHEIMER'S

Alzheimer’s disease is not limited to memory loss; it involves a broader spectrum of cognitive and physical challenges. The progression through these stages highlights the increasing care needs and the emotional and practical burdens on patients and caregivers.

HOW ALZHEIMER’S AFFECTS DIFFERENT TYPES OF MEMORY

SHORT-TERM MEMORY

Short-term memory is among the first areas affected by Alzheimer’s. Patients struggle to retain recent information, leading to frequent repetition or confusion.

• Patients often forget conversations, events, or appointments within minutes.

• Asking the same question repeatedly or forgetting where an object was just placed.

EPISODIC MEMORY

Episodic memory, which stores personal experiences tied to specific times and places, gradually deteriorates as the disease progresses.

• Loss of the ability to recall autobiographical events and their contextual details.

• Forgetting the details of a family holiday or the events of a birthday party.

SEMANTIC MEMORY

Semantic memory, which involves general knowledge and facts, becomes increasingly impaired, especially in the middle stages of Alzheimer’s.

• Difficulty recalling factual information or recognising familiar concepts.

• Struggling to name everyday objects, such as calling a "pen" a "stick" or forgetting the name of a country’s capital.

PROCEDURAL MEMORY

Procedural memory, which stores motor skills and learned routines, remains intact longer but eventually declines in the later stages.

• Skills that were once automatic become difficult or impossible to perform.

• Forgetting how to use a fork, tie a shoelace, or ride a bike as the disease progresses.

WORKING MEMORY

Working memory, which holds and manipulates information for brief periods, is affected early in Alzheimer’s.

• Patients struggle to maintain focus and complete tasks requiring short-term mental effort.

• Forgetting what they were doing mid-task, such as losing track of the steps while cooking or reading.

THE COMPREHENSIVE IMPACT OF ALZHEIMER'S ON MEMORY

Alzheimer’s progressively disrupts all forms of memory, starting with short-term recall and episodic experiences, eventually affecting semantic, procedural, and working memory. This widespread memory deterioration underscores the disease's complexity and highlights the need for tailored interventions to support cognitive and functional abilities.

TREATING DEMENTIA

COGNITIVE STIMULATION

Cognitive stimulation therapy focuses on keeping the mind active through structured activities often involving memories. Patients participate in group discussions, games, and puzzles, which can be tailored to their interests or past experiences. For example, sessions might include:

• Looking at old photographs or memorabilia

• Listening to familiar songs from their youth

• Participating in activities that use familiar skills, such as knitting or bowling

This therapy is most effective in the mild to moderate stages of dementia. Research indicates that it can:

• Slow disease progression, particularly memory decline

• Reduce stress and loneliness, providing patients with a sense of community and purpose

VARIATIONS IN COGNITIVE STIMULATION

Other forms of cognitive stimulation include music therapy or interaction with animals. A notable example comes from Providence Mount St Vincent Residential Home ("The Mount") in Seattle. This care home brings together its 400 residents with 150 kindergarten children five days a week. The children and residents play games, tell stories, and interact socially.

Staff report that these activities often lead to “moments of grace,” where residents temporarily regain lucidity and engage meaningfully. Such activities stimulate episodic and semantic memory and improve emotional well-being.

THE DEMENTIA VILLAGE

Hogewey, a care home in the Netherlands, provides an innovative environment for dementia patients. Unlike traditional care homes, Hogewey is designed as a self-contained village where residents can live normally.

Features of Hogewey include:

• Freedom to move: No locked doors, allowing residents to wander safely.

• Themed environments: Different parts of the village resemble various lifestyles, such as upper-class homes with lace and chandeliers or urban areas with cafes and pop music.

• Integrated care: Staff, including nurses and caregivers, act as shopkeepers, waiters, or community organisers to create a naturalistic setting.

Hogewey employs Validation Therapy, which involves affirming residents' perceptions rather than challenging their delusions. For example, staff “go along with” patients’ beliefs about living in the past rather than contradicting them.

Benefits of this approach include:

• Reduced stress: Patients are less agitated because they are not continually told they are wrong.

• Improved fitness: Residents stay active and require less medication than dementia patients in traditional care homes.

While innovative, this method has sparked ethical debates about deception in dementia care. Proponents argue that the improved quality of life outweighs the moral concerns, as residents are happier and healthier.

OTHER TREATMENTS AND STRATEGIES

In addition to cognitive therapies and environments like Hogewey, several other treatments and lifestyle interventions can support dementia patients:

PHARMACOLOGICAL TREATMENTS

• MEMANTINE
  A medication that regulates glutamate levels in the brain to slow cognitive decline in moderate to severe dementia.

• CHOLINESTERASE INHIBITORS
  Drugs like donepezil enhance communication between brain cells by preventing the breakdown of acetylcholine, a neurotransmitter involved in memory and learning.

DIET AND EXERCISE

• NUTRITIONAL INTERVENTIONS
  Diets rich in antioxidants, omega-3 fatty acids, and vitamins (e.g., the Mediterranean diet) may protect brain health.

• PHYSICAL ACTIVITY
  Regular exercise improves blood flow to the brain, supports cardiovascular health, and can delay cognitive decline.

ENVIRONMENTAL ADJUSTMENTS

• MEMORY AIDS
  Labelled objects, calendars, and digital reminders help patients navigate their environment.

• CONSISTENT ROUTINES
  Familiar schedules and surroundings reduce confusion and promote stability.

CONCLUSION

While there is no cure for dementia, a combination of early diagnosis, cognitive therapies, innovative care environments, and lifestyle interventions can significantly improve the quality of life for sufferers. Psychological theories, such as memory models and reconstructive memory, provide valuable insights into these treatments, bridging research and practical care. By tailoring interventions to individual needs, psychology continues to offer hope and dignity to those living with dementia.

APPLYING PSYCHOLOGY TO THE KEY QUESTION

AO2 REQUIREMENTS

Questions about your Key Question will test AO2 (Application of Concepts and Ideas). This means that alongside describing dementia and possible interventions, you must link your answers to psychological theories and studies.

Questions might follow one of two formats:

1. A two-part question, with one part asking for a summary of your Key Question and another part requiring the application of psychology.

2. A single question that combines explanation and application. In this case, it’s helpful to structure your answer in two sections: explain the key concepts and then apply them.

FEATURES OF DEMENTIA AND ALZHEIMER’S

Dementia involves cognitive decline, but sufferers don’t lose all memories equally. Different types of memory are affected at different stages, explained through psychological theories:

• Episodic Memory: Tulving’s model shows that episodic memory, which stores personal events, is typically the first to decline. Recent episodic memories are lost first, while older ones are retained longer.

• Semantic Memory: Semantic memory, which holds general knowledge, deteriorates separately. For example, sufferers may recognise a face but forget the name. This aligns with Schmolck et al.’s findings that semantic and episodic memories rely on different brain areas.

• Procedural Memory: Procedural memories, such as the ability to read or use a phone, are initially preserved but deteriorate later. The loss of these abilities contributes to confusion and dependency.

Schemas, a key concept from Reconstructive Memory, explain why familiar stimuli—like old songs or familiar surroundings—can temporarily restore memories, as they activate related schemas in long-term memory.

DIAGNOSING DEMENTIA

Early diagnosis is crucial for managing dementia. Professor Bruno’s word recall test highlights how cognitive psychology supports diagnostic tools:

• Primacy Effect: According to the Multi-Store Model, early items in a list are rehearsed into long-term memory (LTM) and recalled more easily.

• Displacement Theory: Middle items are displaced in short-term memory (STM) due to its limited capacity.

If a patient struggles to recall primacy items, it suggests a problem with LTM, which Bruno terms “pathological.” This allows clinicians to identify early signs of dementia before more severe symptoms develop.

COGNITIVE STIMULATION

Cognitive stimulation therapies aim to engage multiple types of memory, slowing cognitive decline:

• Episodic Memory: These therapies often focus on recalling childhood and early adult memories, which are retained the longest.

• Semantic Memory: Using general knowledge to connect and retrieve episodic memories can aid recall.

• Procedural Memory: Activities such as singing or games reinforce procedural memories, delaying their decline.

Reconstructive Memory supports this approach, showing that schemas help reconstruct memories. By immersing patients in familiar settings or activities, cognitive stimulation reactivates schemas, aiding memory recall and improving quality of life.

DEMENTIA VILLAGES

Dementia villages, such as Hogewey in the Netherlands, are designed based on psychological principles:

• Schema Activation: Different areas of the village are tailored to specific schemas, such as rural or urban settings. These familiar environments allow residents to function more independently and with less distress.

• Validation Therapy: Staff at Hogewey adopt a validation approach, where they avoid challenging the residents' beliefs and behaviours. This reduces confusion and anxiety by allowing residents to “live in the past.”

While practical, such approaches raise ethical questions. Critics argue that creating artificial environments deceives patients, conflicting with ethical standards in healthcare. However, evidence suggests these interventions improve physical health, cognitive engagement, and overall well-being.

EXEMPLAR ANSWER

Key Question: How can cognitive psychology help people suffering from dementia?

Dementia, affecting 850,000 people in the UK, leads to memory loss, confusion, and cognitive decline, with Alzheimer’s being the most common type. While there is no cure, early diagnosis and targeted interventions can slow its progression.

Summary: Professor Bruno’s word recall test uses displacement theory and the primacy effect to identify early symptoms. Cognitive stimulation therapies reconnect patients with their past using episodic and semantic memory. Dementia villages like Hogewey create familiar environments tailored to residents’ schemas, reducing confusion and improving quality of life.

Application: Tulving’s model of long-term memory explains the loss of episodic and semantic memories in dementia. Reconstructive memory highlights the role of schemas in therapy, showing how familiar stimuli can aid recall. Displacement theory underpins diagnostic tests, identifying dysfunction in long-term memory storage.

Conclusion: Cognitive psychology provides valuable tools to diagnose and manage dementia, improving patients’ and caregivers’ lives. Ethical concerns, such as deception in dementia villages, must be weighed against these interventions' clear benefits.

This detailed response balances theory and application, covering the core aspects of memory affected by dementia and the interventions that psychology offers.

TYPICAL EXAM QUESTIONS ON DEVELOPMENTAL PSYCHOLOGY IN MEMORY

The following questions align with the Edexcel specification for developmental psychology topics, focusing on Alzheimer’s disease and its impact on memory. These are structured to reflect past paper formats and the specification content.

1. DEFINE ALZHEIMER’S DISEASE AND EXPLAIN HOW IT AFFECTS MEMORY (4 MARKS)
   Students should provide a concise definition of Alzheimer’s disease as a progressive neurodegenerative condition. Answers should outline its impact on memory, such as short-term memory loss in the early stages and global memory decline in the advanced stages.

2. DESCRIBE HOW ALZHEIMER’S DISEASE AFFECTS EPISODIC, SEMANTIC, AND PROCEDURAL MEMORY. USE EXAMPLES TO SUPPORT YOUR ANSWER (6 MARKS)
   Explain the specific effects on each memory type, using clear examples such as forgetting recent family events (episodic), difficulty recalling general knowledge (semantic), and the eventual loss of learned skills (procedural).

3. EXPLAIN THE RELATIONSHIP BETWEEN EPISODIC MEMORY DECLINE AND THE EARLY STAGES OF ALZHEIMER’S DISEASE (4 MARKS)
   Focus on how episodic memory loss, such as forgetting recent events or conversations, is one of the earliest symptoms families and caregivers notice.

4. DISCUSS HOW ALZHEIMER’S DISEASE ILLUSTRATES DEVELOPMENTAL CHANGES IN MEMORY DURING AGEING (8 MARKS)
   Discuss how Alzheimer’s reflects the natural decline of cognitive processes in older adults but with more pronounced and pathological changes compared to normal ageing.

5. EVALUATE THE PSYCHOLOGICAL AND SOCIAL IMPACTS OF ALZHEIMER’S DISEASE ON PATIENTS AND THEIR CAREGIVERS (8 MARKS)
   Explore the emotional distress and identity loss in patients and the emotional and practical strain on caregivers. Provide a balanced evaluation of these impacts, including any mitigating strategies.

6. EXPLAIN HOW ALZHEIMER’S DISEASE HIGHLIGHTS THE RECONSTRUCTIVE NATURE OF MEMORY (6 MARKS)
   Discuss how the disease disrupts the ability to reconstruct past events, blending fragmented memories with confusion, and relate this to reconstructive memory theory.

TASKS AND ACTIVITIES TO REINFORCE LEARNING

ODD ONE OUT (1 MARK EACH)

1. Which type of memory is least affected in the early stages of Alzheimer’s disease?
   A) Semantic memory
   B) Procedural memory
   C) Episodic memory

2. Which type of memory involves recalling personal life events?
   A) Semantic memory
   B) Procedural memory
   C) Episodic memory

3. Which type of memory allows a patient to describe the meaning of words?
   A) Episodic memory
   B) Procedural memory
   C) Semantic memory

4. Which type of memory would help a patient tie their shoelaces?
   A) Working memory
   B) Procedural memory
   C) Episodic memory

5. Which type of memory loss would cause a patient to repeatedly forget where they left their keys?
   A) Episodic memory
   B) Semantic memory
   C) Procedural memory

LOGICAL DEDUCTION QUESTIONS (2-4 MARKS EACH)

1. (2 MARKS) If a patient struggles to remember family holidays but can still describe the meaning of words, which type of memory is affected?

2. (2 MARKS) A patient confuses a “chair” with a “table.” What type of memory impairment does this indicate?

3. (3 MARKS) A caregiver observes that a patient has difficulty following multi-step instructions but still recognises familiar faces. Which memory system is likely impaired?

4. (4 MARKS) A patient can no longer recall their wedding day but still remembers how to play the piano. Which types of memory are affected and unaffected?

5. (3 MARKS) If a patient frequently forgets what they were doing mid-task, which type of memory is likely impaired?

DEVELOPMENTAL AND THEORETICAL QUESTIONS (4-6 MARKS EACH)

1. (6 MARKS) Discuss how the progression of Alzheimer’s disease highlights the reconstructive nature of memory.

2. (4 MARKS) Explain how the loss of episodic memory in the early stages of Alzheimer’s disease demonstrates the role of the hippocampus.

3. (6 MARKS) How might early interventions delay the progression of memory loss in Alzheimer’s disease?

4. (6 MARKS) Compare the impacts of Alzheimer’s disease on episodic and semantic memory, including examples of how these differences manifest.

APPLICATION TO REAL LIFE (4-6 MARKS EACH)

1. (6 MARKS) Write a short explanation of how understanding the impact of Alzheimer’s disease on memory could improve:

• Communication strategies for caregivers.

• Designing living environments for patients.

• Emotional support for families.

1. (6 MARKS) Propose three ways a care home could adapt its environment to better support residents with Alzheimer’s disease.

2. (4 MARKS) Explain why memory aids, such as calendars and photo albums, are particularly helpful for patients in the early stages of Alzheimer’s disease.

3. (6 MARKS) Discuss how a caregiver could use knowledge about procedural memory to support a patient in the middle stage of Alzheimer’s disease