Researchers from Northern Michigan University’s Behavior Education Assessment and Research Center, or BEAR Center, have been working to find the answers.

For the past several months Ashley Shayter, a board-certified behavior analyst and instructor in NMU’s Department of Psychological Sciences, and assistant behavior analyst Jennifer Cammarata have been working with individuals who have dementia and aging-related mild cognitive impairment to see if a relatively simple behavioral intervention can help.

“The study that we’ve been conducting is looking at trying to improve memory and recall in individuals who are currently in the early stage of dementia,” Shayter said.

It’s critical to find a way to improve memory and recall in those with dementia due to the nation’s aging population, as one in 10 people age 65 and older has Alzheimer’s disease, which equates to roughly 5.5 million people in the U.S. This has an impact on society as a whole, as over 18 billion hours of care valued at $232 billion is provided by family and other unpaid caregivers, according to a 2018 report from the Alzheimer’s Association.

From left, Jennifer Cammarata, an assistant behavior analyst at Northern Michigan University is pictured with Ashley Shayter, a board certified behavior analyst and instructor in NMU’s Department of Psychological Sciences. (Photos courtesy of Northern Michigan University’s Behavior Education Assessment and Research Center)

“As behavior analysts we look at socially significant behaviors that not only affect the person, but the community and society at large,” Cammarata said. “And helping people to be autonomous for a longer period of time is really important to not only the individual, but to our community as well, to our population as a whole.”

Shayter and Cammarata have been using Acceptance and Commitment Training, or ACT — which focuses on language and how individuals interact with the world around them — to see if it can improve participants’ scores on assessments of memory and recall.

The researchers wanted to try ACT with this group, they said, as ACT has been recognized as an evidence-based treatment for a variety of other conditions, such as traumatic brain injuries, post-traumatic stress disorder, anxiety, depression, eating disorders, obsessive compulsive disorder and more. But its impacts on memory and recall in those with Alzheimer’s disease, dementia or memory loss had not been studied.

“We wanted to expand the current body of literature to see if it would be effective with this population,” Shayter said.

Another reason they wanted to try ACT with these participants is that “it’s cost effective and it’s accessible to anyone; anyone can be trained in the treatment if they have the correct supervision,” Cammarata said.

Jennifer Cammarata, an assistant behavior analyst at Northern Michigan University’s Behavior Education Assessment and Research, or BEAR, Center, presents an image to a participant in a study she is conducting. Study participants’ immediate and delayed recall of a number of images is assessed as a measure of memory in the study, which examines if Acceptance and Commitment Training can improve memory in dementia and mild cognitive impairment related to aging.

The training was done in one-hour sessions daily for eight days, with assessments before and after to measure progress. The assessments include the St. Louis University Mental Status Exam, the Iowa Trailmaking Test and an image recall test that assesses immediate and delayed recall of an image.

The group initially did a small pilot study at Mill Creek Assisted Living in Marquette with three participants to see if ACT had an impact — and it did. They found two out of three participants improved on the St. Louis University Mental Status Exam, while all participants improved on the trailmaking test and image recall tests.

“The results were pretty promising, so we wanted to continue the study to see if we’ll get the same results for additional participants,” Cammarata said.

Now, the researchers are working with a larger group of participants to see if the initial promising results will extend to a bigger sample size.

At the very beginning of the process, participants undergo the assessments. Then, the researchers wait eight days — the amount of time that the training would take — without giving the participant training, and administer the tests again.

Because the two testing sessions are done without any training or intervention between them, this serves as a control for the study, providing researchers with information on what a person scores without receiving any of the training.

This helps them rule out other explanations for improved scores after the intervention, as the control sessions aim to show it’s more than just the passage of time or taking the test twice that makes the difference.

“We can hone in a little bit on what’s going on (and know) that it wasn’t just time passing that improved scores,” Cammarata said.

Once the control period is done, participants then attend eight one-hour daily ACT sessions before undergoing a final round of the assessments.

The participants do the sessions one-on-one with a trained researcher and are encouraged to list what they can see, hear, smell, taste or touch, as well as how they interact with various thoughts they are having. Participants also learn more about goals, values and actions during the sessions and are provided with a “written plan of action” at the close of the last session, Shayter and Cammarata said.

“We also explore values as a part of the ACT component, and actions that will move us toward values,” Cammarata said. “And often times, when you’re in assisted living, values like keeping up with family and friends become difficult, although they’re still your value. Then, we discuss ways that you can have actions toward a value, like staying in touch with people when you’re no longer driving or not as mobile as you once were.”

They hope to publish their work so it can be shared with others in the scientific community and, hopefully, help others, noting that they look forward to continuing the research and already have a number of ideas for follow-up studies.

Cammarata and Shayter are grateful to Mill Creek and other assisted living facilities for allowing them to work with some of its residents for the study, they said.

Shayter emphasized that the research can be done just about anywhere and encourages interested assisted living facilities or caregivers to reach out if they have questions and/or are interested. Shayter can be reached at ashayter@nmu.edu.