This chapter discusses what memory is and how information is collected to form memories for later recall. Six neurological landmarks are shown, with basic information on the location of those landmarks within the brain and how they contribute to memory function. A basic knowledge of these brain regions and how they contribute to memory is needed to understand how the memory process breaks down when a patient has dementia, which may impact the creation of a person-centered plan of care.

This chapter discusses the differences between working memory (sometimes called sensory memory) and short-term memory based on the work of Alan Baddeley, a psychologist and researcher known for his work on memory. Both types of memory are outlined as related to normal memory function, which should be understood as these memory functions are impaired early for people with dementia.

This chapter describes long-term memory and its mechanisms. Declarative (explicit) and nondeclarative (implicit) memory are discussed, with relevant examples provided. Deficits for all components are also provided to help the learner gain a deeper appreciation for the deficits seen in the people we serve.

Memory impairments can stem from damage to many different structures of the brain, which is why there are different diagnoses under the dementia umbrella. This chapter discusses some simple pathophysiology as it relates to Alzheimer's dementia specifically, with rules, guidelines, and strategies for the provision of memory treatment. Understanding these ideas is particularly important for sound memory treatment.

This chapter will help the clinician understand the theoretical underpinnings of spaced retrieval. Discussion of how these theoretical underpinnings combat memory challenges posed by dementia or how they take advantage of preserved function allow for a deeper appreciation of why the intervention works for people with dementia.

This chapter will help the clinician recognize how to identify the needs or desires of people with dementia. Discussion of consideration for support, patient behaviors, and gaining care partner insight will help the clinician determine what to address with spaced retrieval. Identification of needs and desires is paramount to development of a person-centered plan of care. This chapter includes memory goal examples addressing safety, ADLs, orientation and wayfinding, details, and information.

In this chapter, clinicians will learn to conduct the spaced retrieval screening and reading screenings, which are useful in helping to identify appropriate candidates for the intervention and identify reading and comprehension ability for the use of visual aids. Demonstration examples and forms for clinical use are provided.

This chapter helps the clinician understand how to develop a lead question and response based on the identified need or desire to use during the therapy session. Setting these up correctly is one of the more important parts of finding success with spaced retrieval. Relevant examples are provided for use in your own clinical practice.

This chapter describes how to create a continuous visual cue for use within the practice sessions to enhance patient learning outcomes. Use of a continuous visual cue was not included in early spaced retrieval research, but more recent studies show use of one will help increase the rate of learning and retention. Picture examples of continuous visual cues used in therapy sessions are shown.

This chapter teaches the spaced retrieval protocol in four easy steps for the first practice sessions and all subsequent therapy sessions. Adhering to this protocol helps the clinician to utilize the theoretical underpinnings in part 1 of this series without having to think about it. Later, modifications can be made if they are warranted, but starting with this protocol is the first step. Demonstrations are provided to assist with learning and implementation.

"I tried spaced retrieval and it just doesn't work" is a sentiment Dr. Benigas has heard on more than one occasion. Luckily, if the recommended protocol has been followed and the patient still isn't meeting the goal, spaced retrieval is flexible and allows for modifications that can systematically be tested with the patient to see if improvements can be made. It is important to try some of these changes before discounting the modality's effectiveness.

Documenting progress during therapy is important for reimbursement and measurement of outcomes. Changes during spaced retrieval are sometimes easy to miss because the sessions are redundant and can all seem the same to a clinician with intact memory function. Being able to track small incremental changes over time is helpful when advocating for additional treatment and knowing when to modify the modality or discontinue use of spaced retrieval. This chapter will also help the clinician to recognize when to stop spaced retrieval for patients experiencing failure and success and learn how to support outcomes.

Acquiring skills on how to include the care team for support outside of therapy sessions and to help with maintenance is important for outcomes. This chapter teaches how to include care teams and families, offers ideas to increase success, and gives suggestions for cotreatment with examples.

Memory aids can be thought of as a prosthetic device, like glasses for seeing better, hearing aids for hearing better, or dentures for eating better. When memory function is lost, a person’s dependence on others increases. A memory aid can help to decrease dependence and improve quality of life. This chapter will help the clinician screen for the appropriateness of a memory aid to enhance conversation, learn how to design a memory aid according to the research, and identify how to enhance conversation using memory aids, with a demonstration to support learning and implementation.

Orientation to person, place, and time is often impaired because of memory loss. External memory aids are an effective way to address these needs within a care community or at home. This chapter will help the clinician identify how to use memory aids to enhance orientation and wayfinding for people with memory loss. Sample goals, a demonstration, and more than a dozen examples are shown for implementation.

Person-centered care continues to be the focus of all healthcare environments. One avenue a clinician can take to meet this demand is supporting a patent’s wants and needs while supporting or improving safety. This chapter will show clinicians how to use memory aids to improve communication of wants, needs, and safety for people with memory loss. Relevant examples are shown and sample goals provided.

Many individuals with memory impairment seem to lose interest in their familiar hobbies or activities and seem apathetic or depressed about life. They may not remember the activities they would enjoy, remember the words to describe what they would like to do, or recognize or understand the words used to invite them to participate. As in other chapters, memory supports can help to increase interest and engagement. This chapter will discuss these supports, with the provision of examples, challenges, and solutions and a demonstration to support learning and implementation.

People experiencing memory impairment commonly repeat questions and engage in other challenging behaviors as impairment progresses. This chapter explores strategies for determining the resident's underlying need, and ideas for redirecting residents toward meaningful activities. The chapter provides examples of using memory books, cue cards, and other tools to remediate challenging behaviors.

In many care communities, clinicians are asked to complete person-centered dementia care programs to improve communication or reduce behaviors. It may be expected that the therapist make recommendations or develop person-centered activities or programs geared toward each resident's identified need. This chapter will give a plethora of examples of how to successfully execute these programs and work with care teams to support your efforts.

In order to maintain personhood, individuals living with dementia need a reason to get out of bed each day. The Montessori philosophy focuses on identifying roles and routines that enable individuals to contribute to the community in a meaningful way.

The Montessori philosophy creates a caring community that is aligned with the individual’s needs, interests, abilities, skills, and strengths. Specially designed materials increase engagement and the environment is carefully prepared to meet and nurture the needs of each person. Staff know when to observe and step back, allowing the person with dementia to experience the moment.

The Montessori environment in long-term care is carefully prepared to compensate for declarative memory impairment and support independence. Cues such as low height shelves filled with accessible materials, signage, lighting, contrast, and templates are used to support independence.

In this chapter, you will meet June. June was a new admission to a skilled nursing facility in the early days of the COVID-19 pandemic. She demonstrated perceived negative behaviors such as calling 911 and standing at the door waiting for her son to pick her up. This chapter shows you what needs and desires Dr. Benigas was able to identify and how she addressed these concerns in therapy. Portions of the case are demonstrated.

In this chapter, you will meet Abram. Abram was living at home with declining memory. His son wanted to improve Abram's self-care routine, with the goal of delaying placement in a care community. This chapter shows how Dr. Benigas worked with the son to create a memory support for Abram and how she improved Abram's self-care routine with spaced retrieval and external memory aids. Portions of the case are demonstrated.

Since 2009, Dr. Benigas has been mentored by Michelle Bourgeois, PhD, who dedicated her entire career to improving communication and quality of life for people with dementia. This chapter concludes with an interview with Dr. Bourgeois.

In this chapter, you will meet clinician Elizabeth and skilled nursing resident Lynn. This case example was written based on the frequent requests Dr. Benigas has received to use person-centered dementia care programs by the companies she has worked for. The challenges of implementing these programs are real, especially with little to no budget. Dr. Benigas has utilized the general principles of the Montessori philosophy when responding to such requests to make meaningful change instead of simply checking a box for an employer.

Dr. Benigas was taught the Montessori philosophy by Jennifer Brush, MA, CCC-SLP. Jennifer is an inaugural member of the Association Montessori Internationale (AMI) Advisory Board for Montessori for Dementia and Aging and is the only AMI-certified trainer for Montessori for dementia and aging in the US, and one of two trainers of trainers in the world. This chapter concludes with an interview with Jennifer Brush.