Archives of Gerontology and Geriatrics 47 (2008) 277–289

www.elsevier.com/locate/archger

Long-term effects of memory training

in the elderly: A longitudinal study
Sara Bottiroli, Elena Cavallini, Tomaso Vecchi *
Dipartimento di Psicologia, Università di Pavia, P.za Botta 6, 27100 Pavia, Italy
Received 21 October 2006; received in revised form 16 August 2007; accepted 23 August 2007
Available online 23 October 2007

Abstract

The effects of different types of memory training in young and older adults reported in a
previous study [Cavallini, E., Pagnin, A., Vecchi, T., 2003. Aging and everyday memory: the
beneficial effect of memory training. Arch. Gerontol. Geriatr. 37, 241–257] were again
investigated from a longitudinal perspective 2 years after the original memory training sessions.
The authors retested the original participants to measure the long-term effectiveness of two
mnemonic strategies: the loci technique and strategic training. Three groups of participants (13
adults, M = 24.1, 13 younger elderly, M = 64.2 and 13 older elderly, M = 74.4) were tested using
a battery of seven tasks and four questionnaires, to evaluate memory performance and meta-
memory variables. The three age groups and the two trainings showed similar results on memory
performance. Long-term effects were found only on two memory tasks, both were highly related
to everyday life showing that, without additional practice, memory performance tended to go
back to the original level. Moreover, the beneficial effects of the previous training sessions were
particularly evident for older adults in metamemory knowledge and for strategic training in
memory complaints. Results partially support the durability of memory training in improving
memory performance.
# 2007 Elsevier Ireland Ltd. All rights reserved.

Keywords: Memory training in elderly; Aging and metamemory; Longitudinal study

1. Introduction

The benefits of strategy training for improving older adults’ memory performance have
frequently been supported by experimental research (for a review, see Verhaeghen et al.,

* Corresponding author. Tel.: +39 03 8298 6456; fax: +39 03 8298 6272.
E-mail address: vecchi@unipv.it (T. Vecchi).

0167-4943/$ – see front matter # 2007 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.archger.2007.08.010
278 S. Bottiroli et al. / Archives of Gerontology and Geriatrics 47 (2008) 277–289

1992). However it is not clear yet whether the benefits of the training can be maintained
throughout the years.
Usually researches on memory training (e.g., Yesavage et al., 1983; Scogin et al., 1985)
are interested on short-term effects. On the contrary we know little about the long-term
effects, and the literature on this topic is not homogenous. Scogin and Bienas (1988)
evaluated long-term effects after 3 years from memory training sessions, both considering
memory performance and complaints. After the follow-up, older adults’ performance
returned to baseline levels and memory complaints did not change across this period of
time. However, other researchers (Kliegl et al., 1990; Neely and Bäckman, 1993a, 1993b)
reported long-term effects due to training even after some years. Oswald et al. (2002)
demonstrated long-term beneficial effects up to 5 years after baseline examination. A
similar trend was found by Ball et al. (2002) after a 2-year follow-up period.
These contradictory results on long-term effects may be explained on the basis of the
difficulty for participants to re-use learned strategies in everyday life (Herrmann and
Searleman, 1992). Elderly subjects often do not apply learned strategies after training
because their employment in daily life requires great practice and exercise (McEvoy and
Moon, 1988), or, alternatively, they tend to modify the learned strategies using them in a
personal fashion (Anschutz et al., 1985, 1987). As a consequence, only subjects who
incorporated trained skills into their repertoire of strategies and use them for the everyday
learning were likely to exhibit long-term training effects (Anschutz et al., 1985).
Nevertheless, a crucial aspect for analyzing long-term effects is related to spontaneous
practice after the follow-up period. Meyer et al. (1989) introduced older adults to the use of
an organizational strategy in order to learn a text. This strategy allows participants to read
the text whilst at the same time discovering the structure of each passage, which proved to
be useful in maintaining long-term gains. The beneficial effect of this type of training could
also be associated with the fact that it could be easily employed in everyday memory
practice such as reading a newspaper or a book (Dunlosky and Hertzog, 1998).
Regarding the effect of memory training on metamemory variables it seems that
memory beliefs are resistant to modification (Scogin et al., 1985; McDonald-Miszczak
et al., 1995; Pearman and Storandt, 2004) if training is focused on memory performance
only (Verhaeghen et al., 1992). Different considerations concern metamemory knowledge
since, compared to memory beliefs, the former can be gained through personal experience.
Troyer (2001) demonstrated that memory knowledge, metamemory and objective memory
performance can be effectively improved in old age through appropriate training.
In a previous study we investigated the effects of two different types of memory training
in improving memory functions in old age by taking into account ecological and laboratory
memory tasks and metamemory questionnaires (Cavallini et al., 2003). The data set of our
previous experiment confirmed the validity of both memory trainings in improving
memory performance and in reducing complaints about memory problems. Furthermore,
our study showed that participants were able to re-use learned strategies in transfer tasks,
thus improving their performance.
In the present paper, our aim is to evaluate the beneficial long-term effects of memory
training in young and old people. Subjects who participated in a previous training regime
(Cavallini et al., 2003) were re-tested 2 years after the training sessions. The study takes
into account different training effects in both experimental and everyday memory tasks
 S. Bottiroli et al. / Archives of Gerontology and Geriatrics 47 (2008) 277–289 279

(Verhaeghen et al., 1992), whilst at the same time assesses metamemory knowledge and
beliefs.

2. Method

We employed a battery of ecological and laboratory tasks together with four

questionnaires associated with memory beliefs, metacognitive knowledge and memory
complaints. Furthermore, the original study included two different types of memory
training (loci and strategic training) and this aspect was also evaluated.

2.1. Participants

Among the 60 subjects who took part in the previous study (Cavallini et al., 2003), 39
completed the 2-year follow-up. The final study sample was composed of three age groups:
13 adults (aged 20–35, mean = 24.1 years), 13 younger elderly (aged 60–70, mean = 64.2
years) and 13 older elderly (aged 70–80, mean = 74.4 years). Participants in the two elderly
groups were recruited from the local University of the Third Age. The loci and the strategic
training groups were composed of 20 and 19 subjects, respectively.

2.2. Testing materials

Five ecological and two laboratory tasks were used. Moreover, participants compiled
four questionnaires on metacognitive aspects. Extensive information about testing
materials is available in the previously published study (Cavallini et al., 2003).

2.2.1. Ecological tasks

Ecological tasks were developed in our laboratory (Cavallini et al., 2002, 2003). They
concerned aspects of everyday memory, such as story recall, shopping list recall, prospective
memory, memory for faces/names and places. We used ecological tasks to reproduce
situations and activities directly related to everyday life, since elderly people are reported as
being particularly sensitive to the setting and emotional conditions (Baltes and Baltes, 1990).

2.2.1.1. Story recall. A short written story – composed of 22 significant units – was given
to participants. All participants had 5 min to study the story and then carry out an
immediate written recall. Performance was evaluated on the basis of the number of
significant units correctly remembered.

2.2.1.2. Shopping list recall. A written shopping list was preliminary presented to
participants for 5 min. Then, subjects were asked an immediate written recall of the
shopping list. Performance was assessed on the basis of the number of items correctly
remembered.

2.2.1.3. Memory for activities planned for the week test (prospective memory). A list
composed of 18 appointments during a week was studied by participants for 5 min.
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Performance in an immediate written recall was evaluated on the basis of the number of
events correctly remembered.

2.2.1.4. Memory for faces/names. A list of 12 faces, each coupled with a name, was
presented to participants. Every photograph was presented for 30 s on a computer screen.
Then, the same faces, without the name, were shown on the computer screen, again 30 s for
each photograph, in a fixed randomized sequence. The subjects had to name each face
correctly. Performance was evaluated on the basis of the number of correct face/name
associations made.

2.2.1.5. Memory for places (ecological task but not associated training). A map of an
Italian city was presented to participants. The map was composed of the most important
streets along with the name and location of 10 target monuments. Participants had 5 min to
study the map and then write down the targets in their correct position on a blank map.
Performance was evaluated on the basis of the number of monuments correctly named and
located. This task was not included in the training sessions, thus it allowed us to evaluate
the ability to use learned strategies in different contexts.

2.2.2. Laboratory tasks

These tasks were used to evaluate the participants’ working memory ability in
laboratory tasks.

2.2.2.1. Memory for lists of figures. Twenty figures of common objects, were presented to
participants on a computer screen, each figure lasting 3 s. The participants’ task was to
orally recall the names of the figures. Performance was evaluated on the basis of the
number of figures correctly recalled, regardless of the order of presentation.

2.2.2.2. Memory for word-lists. Twenty words of common objects were presented to
participants on a computer screen, each word lasting 3 s. The participants’ task was to
orally recall the words. Performance was evaluated on the basis of the number of words
correctly recalled, regardless of the order of presentation.

2.2.3. Questionnaires
Questionnaires were used to evaluate participants’ metamemory abilities.

2.2.3.1. Metamemory questionnaire (Cornoldi and De Beni, 1989). A questionnaire

composed of 12 questions about the knowledge of memory functions.

2.2.3.2. Everyday memory questionnaire (Sunderland et al., 1983). A questionnaire

composed of 35 questions concerning the self-evaluation of everyday forgetfulness.
Answers were given on a five-point scale, ranging from ‘‘Never’’ to ‘‘Many times a day’’.

2.2.3.3. Self-efficacy questionnaire (Cavallini et al., 2002). Questionnaire composed of

25 items about the self-evaluation of memory performance in different everyday
situations. Questions were about short-term memory for numbers and words, memory for
 S. Bottiroli et al. / Archives of Gerontology and Geriatrics 47 (2008) 277–289 281

faces/names, for places, prospective memory, etc. Answers were given on a five-point
scale ranging from ‘‘Not at all’’ to ‘‘Entirely’’.

2.2.3.4. Confidence questionnaire (De Beni et al., 1996). Questionnaire composed of ten
questions about the self-evaluation of memory performance in different everyday
situations. Questions were about short-term memory for numbers and words, memory for
faces/names, places, prospective memory, etc. Answers were ‘‘YES’’, if subjects thought
they were able to remember, ‘‘MAYBE’’ if unsure and ‘‘NO’’ if they thought they were
unable to remember. Subjects answered by judging their abilities in five different
situations: (a) their actual memory ability, (b) their past memory ability, (c) their future
memory ability, (d) memory ability of a group of peers, and (e) younger peoples’ memory
ability.

2.3. Memory training

2.3.1. Loci training

Participants were instructed in the method of loci. This mnemonic technique
involves the use of a very well-known place, such as a familiar route or a particular
room, as a structure for encoding and retrieving new information (Bower, 1970). Items
that have to be remembered are successively associated with locations from the mental
map. At recall, one mentally revisits the ordered locations and retrieves the imagined
items. Loci training is based upon the fact that it is possible to acquire a general
strategic attitude.

2.3.2. Strategic training

Different strategies were shown, according to task typology, such as association,
categorization, mental images of items, etc. Participants may choose the best strategy
according to the characteristics of the material. This training is based upon the rationale
that different materials need different strategies.

2.4. Procedure

This longitudinal study took place over 2 years. Testing phases and memory training
comprised a total of 11 sessions lasting approximately 90 min each. In the first two
sessions (test), baseline data were collected, including seven memory tasks and four
questionnaires. The next five sessions (Sessions 3–7) comprised memory training.
Subjects practiced all laboratory and ecological tasks, except the memory for places
test. Participants were randomly assigned to loci or to strategic training. In Sessions 8
and 9 (retest-1) and Session 10 and 11 (retest-2), participants performed the memory
tasks and the questionnaires again. An interval of 2 years past between the two retesting
phases. The tasks’ order of presentation was counterbalanced during each phase. The
first set of analysis regarding the test and retest-1 phases was previously published by
Cavallini et al. (2003). Memory tasks and questionnaires were administered in
individual sessions, while memory training was explained and practiced in group
sessions.
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3. Results

Data were analyzed in a 3 ! 3 ! 2 repeated measures analysis of variance (ANOVA),

with age (three groups: adult, younger elderly and older elderly) and training (two levels:
loci and strategic) as between-subjects factors, and phase (three levels: test, retest-1 and
retest-2) as within-subject factor. The comparisons of the factor main values were
performed by means of a post hoc procedure. In particular, Tukey’s test with 0.05
significance level was applied according to Keppel (1991).
Because the aim of the study was to examine maintenance of acquired memory skills,
analyses concerning the main effect of age were excluded in the results.

3.1. Memory tasks

Mean values for performance and standard deviations for both ecological and laboratory
tasks are reported in Table 1.
Data from short story showed a significant main effect of phase F(2, 32) = 36.51,
p < 0.001. The main effect for training and the interactions were not reliable, F’s < 1.74.
Also for shopping list recall analyses revealed significant the main effect of phase F(2,
32) = 11.00, p < 0.001. The main effect for training and the interactions were not reliable,
F’s < 1.77. In both tasks the post hoc tests indicated that all participants initially benefited
from the training, while they returned to the initial level of performance after 2 years.
Regarding the memory for planned activities of a week, the ANOVA revealed a main
effect of phase F(2, 32) = 24.61, p < 0.001 and post hoc tests indicated that all participants
initially benefited from the training; interestingly, after 2 years, performance was lower
than before the beginning of the training. The main effect for training and the interactions
were not reliable, F’s < 1.84.
Data from face/name memory task showed a significant main effects of phase F(2,
32) = 14.55, p < 0.001. As evident from inspection of Fig. 1, post hoc tests showed a

Fig. 1. Mean percentage of performance in the memory for faces/names as a function of age and phase. Bars
represent the standard deviations.
 S. Bottiroli et al. / Archives of Gerontology and Geriatrics 47 (2008) 277–289
Table 1
Mean percentages of performance and standard deviations for ecological and laboratory tasks as a function of age and phase (Note: Scores in parentheses refer to Standard
Deviations)
Tasks Adult Younger elderly Older elderly
Test Retest-1 Retest-2 Test Retest-1 Retest-2 Test Retest-1 Retest-2
Ecological tasks
Story recall 0.60 0.81 0.58 0.41 0.60 0.52 0.41 0.56 0.41
(0.15) (0.13) (0.16) (0.12) (0.16) (0.12) (0.17) (0.11) (0.17)
Shopping list recall 0.72 0.85 0.70 0.51 0.65 0.51 0.41 0.60 0.53
(0.24) (0.16) (0.23) (0.21) (0.22) (0.14) (0.26) (0.26) (0.23)
Memory for planned 0.51 0.78 0.45 0.33 0.42 0.24 0.28 0.38 0.12
activities of a week (0.18) (0.20) (0.33) (0.22) (0.17) (0.14) (0.13) (0.17) (0.10)
Memory for places 0.79 0.93 0.83 0.61 0.76 0.66 0.48 0.71 0.58
(0.20) (0.14) (0.18) (0.27) (0.25) (0.24) (0.28) (0.24) (0.23)

Laboratory tasks
Memory for lists of figures 0.65 0.70 0.65 0.54 0.63 0.57 0.58 0.50 0.47
(0.09) (0.07) (0.13) (0.11) (0.14) (0.14) (0.16) (0.11) (0.14)
Memory for list of word 0.50 0.65 0.62 0.39 0.42 0.53 0.36 0.40 0.43
(0.10) (0.12) (0.12) (0.10) (0.16) (0.12) (0.11) (0.15) (0.11)

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similar higher performance in both retest-1 and retest-2 when compared to baseline in all
age groups. In this case, the beneficial effect of memory training was clearly visible after 2
years. The main effect for training and the interactions were not reliable, F’s < 1.55.
The memory for places test was an ecological task not specifically trained. Data
revealed a significant main effect of phase F(2, 32) = 8.39, p < 0.01. Post hoc tests
indicated a significant improvement between test and retest-1 phases for all participants;
however, performance decreased significantly between the two retesting phases, and no
significant difference between test and retest-2 was present. The main effect for training
and the interactions were not reliable, F’s < 1.59.
Data concerning the laboratory tasks were not as homogeneous as the ecological ones:
the phase effect was reliable in a laboratory task only, although no differences between the
two types of training were reported.
Regarding memory for a list of figures, analysis showed that there was neither a main
effect of phase nor training F’s < 2.85, although a complex pattern of two-way and three-
way interactions emerged. There was a significant interaction between phase and training,
F(2, 32) = 4.27, p < 0.05, between phase and age, F(4, 64) = 3.00, p < 0.05, and between
phase, training and age, F(4, 64) = 2.52, p < 0.05. Overall, these results indicate that the
younger elderly of the strategic training tended to have longer beneficial effects from the
training than the other groups.
Regarding memory for lists of words, the main effect of phase F(2, 32) = 15.97,
p < 0.01 was significant. Post hoc comparisons pointed out that performance improved as
an effect of training and these benefits were maintained across retest-1 and retest-2. An
interaction between phase and age was also found, F(4, 64) = 2.80, p < 0.05, indicating
that the two elderly groups did not improve their performance immediately after the
training but later, whereas younger adults showed an increase in performance shortly after
training and maintained it over 2 years. No other effects were significant F’s < 2.98.

3.2. Questionnaires

Mean values for performance and standard deviations in the four questionnaires are
reported in Table 2.
For the metamemory questionnaire, a main effect of phase F(2, 31) = 17.67, p < 0.001
was reported. Post hoc tests indicated that scores for all participants were higher in retest-2
than in test and retest-1, while no difference between test and retest-1 was found. All
participants, after 2 years, had an increased knowledge about how memory works. As
evident from inspection of Fig. 2, we found a reliable interaction between phase and age,
F(4, 62) = 2.78, p < 0.05, indicating that the increased values related to retest-2 were more
pronounced in the two elderly groups. No other effects were significant F’s < 1.60.
Regarding the everyday memory questionnaire, data highlighted a significant main
effect of phase F(2, 31) = 3.55, p < 0.05. Post hoc tests revealed that scores in retest-2
were enhanced in comparison to the test phase. No differences were found when retest-1
was compared with test and retest-2. Results suggest that there was a beneficial effect of
training, determining rather slow changes in the participants’ evaluation, thus becoming
evident only in the long run. The interaction between phase and training was also
significant, F(2, 31) = 3.34, p < 0.05, indicating that strategic training was more effective
 S. Bottiroli et al. / Archives of Gerontology and Geriatrics 47 (2008) 277–289
Table 2
Mean values (and standard deviations) in the questionnaires as a function of age and phase (Note: Scores in parentheses refer to Standard Deviations)
Questionnaires Adult Younger elderly Older elderly
Test Retest-1 Retest-2 Test Retest-1 Retest-2 Test Retest-1 Retest-2
Everyday memory 142.50 143.58 146.33 134.53 140.38 140.84 127.76 132.53 136.61
questionnaire (12.60) (12.89) (8.47) (23.83) (19.25) (20.05) (22.90) (21.45) (19.16)
Self-efficacy 93.00 99.58 96.16 89.69 96.00 91.76 81.50 81.33 81.91
questionnaire (17.43) (14.02) (14.70) (18.10) (9.79) (16.28) (7.91) (16.18) (13.81)
Confidence 104.41 106.33 104.08 92.33 97.75 93.50 88.91 87.58 87.66
questionnaire (9.38) (9.95) (8.98) (12.37) (13.42) (10.52) (7.99) (10.75) (9.39)

285
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Fig. 2. Mean values in the metamemory questionnaire as a function of age and phase. Bars represent the standard
deviations.

in modulating people’s evaluation through the years. No other effects were significant
F’s < 0.43.
The analysis concerning the confidence questionnaire showed no main effects or
interactions, F’s < 3.17, and a similar pattern was reported for the self-efficacy
questionnaire, F’s < 1.73.

4. Discussion

The present study examined the long-term effects of memory training after a follow-up
period of 2 years. Our previous published study (Cavallini et al., 2003) showed an
immediate improvement due to memory training in ecological tasks, suggesting the
importance of teaching strategies or techniques. Unfortunately, this result was not found 2
years after training. In fact, the long-term effects observed during the follow-up period
were not homogeneous across tasks.
Only in the face/name memory test are the benefits maintained through the years. This
result may be attributed to the fact that this task is quite similar to daily life activities.
Everyday, we meet a number of people and have to remember their names and faces; thus
there are many occasions for practising the learned strategies and thereby show long-term
benefits. In contrast, it is less frequent to memorize a shopping list, due to the availability of
external support, or to recall a story, unless we are required to report it to someone. In the
memory for planned activities task, we even reported a level of performance that was lower
than the initial baseline. The memory for places test was employed in this study in order to
examine the ability to use the strategies on unknown material. We found a generalization
effect immediately after training for all participants, as described by Cavallini et al. (2003),
indicating that it is possible to use the strategies on new material. However, the higher level
of performance was not maintained over the following 2 years.
Previous training studies reported that the majority of people who participate in memory
training try to use the strategies in everyday life (Derwinger et al., 2005). Thus, it may be
that long-term effects of memory programs are related to how frequently people employ
 S. Bottiroli et al. / Archives of Gerontology and Geriatrics 47 (2008) 277–289 287

learned strategies in performing daily life activities, and to how much these activities are
similar to the tasks practiced in memory training.
Data from the laboratory tasks were consistent with the previous study (Cavallini et al.,
2003) with a rather non-homogeneous pattern of performance, in some cases indicating a
significant effect of training (i.e., in the list of words) but not in other cases (i.e., in the list
of figures). The difference between the two tasks could be due both to the features of the
material and to the amount of practice. Verbal abilities receive more practice since they are
involved in several kinds of tasks, such as shopping list recall, story recall, etc. On the
contrary, the lists of figures task is more related to visual abilities, which are less practiced
during memory training.
Metacognitive and emotional–motivational variables were also considered. We found
that metamemory knowledge improved while memory complaints decreased after 2 years,
indicating that subjects have a greater knowledge about memory operations after the
follow-up period. This effect was not present in our previous study (Cavallini et al., 2003),
but it is important to consider that memory knowledge during aging are simply less
accessible, rather than lacking (Hertzog and Hultsch, 2000). In fact, we reported that
variations in metamemory knowledge were stronger in the older groups suggesting that
training succeeded in making this knowledge more accessible. In addition, the everyday
memory questionnaire demonstrated that training determined significant long-term
beneficial effects, reducing everyday memory complaints. Moreover, strategic training
(i.e., a more complex but more flexible type of training) seems to produce greater
metacognitive benefits, probably because the knowledge of different strategies for different
situations allows the sensation of minor difficulties and forgetfulness in everyday life.
Training had no influence on memory beliefs, thus confirming our predictions about the
stability of metamemory beliefs, such as self-efficacy and confidence about memory
performance. Data are in agreement with the literature supporting the stability of
metamemory aspects (e.g., McDonald-Miszczak et al., 1995; Floyd and Scogin, 1997) as
well as with our previous study (Cavallini et al., 2003). In general, subjects after memory
training show an improvement only in memory performance, while their memory beliefs
remain unchanged (Scogin et al., 1985; Pearman and Storandt, 2004). Metamemory beliefs
seem to be a stable system requiring more time and intervention in order to undergo change
(Floyd and Scogin, 1997).
Another purpose of this study was to analyze long-term effects by comparing two
different memory interventions: loci versus strategic training. Overall, no major difference
was reported between the two types of training, both determined equal levels of
performance and similar long-term effects. This result was already evident in the first part
of this research (Cavallini et al., 2003) and can be explained considering that both types of
memory training were based on association strategies.
Moreover, no differences in long-term effects were found among the three age groups,
showing a similar pattern of training benefits in younger and older adults.
In conclusion, results show long-term effects in tasks that may be related to everyday
activities. The possibility of practising learned strategies in daily life seems to be the
crucial variable allowing participants to improve memory performance and maintain the
effects of training in the long term. People undergoing memory training often show greater
memory knowledge and fewer complaints, although this does not affect cognitive beliefs.
288 S. Bottiroli et al. / Archives of Gerontology and Geriatrics 47 (2008) 277–289

These are rather stable in old age and, overall, changes in metacognitive aspects do not
seem to directly affect performance.

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