A person’s subjective understanding of their memory functioning is called metamemory. Most individuals have some understanding of their memory strengths, which might guide subsequent behaviours¹¹. In non-depressed individuals, memory self-perceptions have been found to be accurate indicators of memory difficulties on objective tests¹², and may be indicators of underlying brain processes¹³.Sev-eral studies indicate that memory training interventions improve self-perceptions of memory ability and reduce memory complaints^14–16 . In healthy older adults, memory training may result in self-reported improvements in stability of memory functioning, and reduced anxiety and stress about memory functioning¹⁵. Effects of memory training on self-perceived memory are typically small, but neverthe-less significant^14,17. However, self-perceived memory ability is not always accurate. Persons with developing dementia may lose aware-ness of memory dysfunction as memory impairment advances^18,19.

There are three primary approaches to cognitive training intervention: cognitivestimulation,cognitiverehabilitationand cognitivetrain-ing²⁰. The choice of approach depends on the degree and nature of deficits.

Cognitive stimulation typically involves participation in group activ-ities and/or discussions aimed at general enhancement of cognitive and social functioning²¹. These types of interventions are non-specific to a cognitive domain, and include such activities as discussions of current events, supervised recreational activities, and group reminiscence therapies. Cognitive stimulation is typi-cally used for demented patients and often as a control condition in studies investigating the effects of cognitive training.

Cognitive rehabilitation is an individualized intervention designed for patients with a specific brain injury or neurological disor-der. Health-care providers work collaboratively with patients and their families or caregivers in order to identify personally rele-vant goals in day-to-day living and to develop strategies²⁰ that enhance functional tasks and activities of daily living, rather than increasing performance on a specific cognitive task²².

The focus of this chapter is cognitivetraining, which involves learning and practising strategies to improve specific cognitive functions, such as memory, attention, or problem-solving. Cognitive training is often administered to people with mild forms of diffi-culties associated with normal ageing, and to clinical populations, including persons with MCI, dementia or schizophrenia. The goals of cognitive training are to maintain or improve cognitive function, and to learn to compensate for deficits. Cognitive training is based on the assumption that, with intensive training, people will apply the strategies they learn to real-life situations beyond the training session. Cognitive training typically involves teaching skills and strategies in a standardized and structured fashion to individuals or to small groups¹². Strategies vary in difficulty level and can be traditional paper–pencil tasks, classroom instruction or computerized activities²⁰.

Many training techniques have been developed to specifically improve learning and recall. The techniques vary with respect to complexity, structure and application. One example is errorlesslearning, which is based on the premise that remembering new information will be more efficient if errors during learning are minimized and/or immediately corrected^23–25 . Spacedretrieval²⁶ which is also known as expanded rehearsal²⁷, is another common technique and involves learning and retaining new information by recalling the information over increasingly longer periods of time^28,29.

Mnemonic strategies have been one of the primary memory inter-ventions used within clinical settings. Generally, mnemonic strategies facilitate encoding and aid retrieval by enhancing the meaningfulness or personal relevance of information. Mnemonic strategies involve organizing information in meaningful ways, forming associations, or forming visual images. Examples include: (i) verbal organization (i.e. forming acronyms), (ii) semantic clustering and elaboration (i.e. categorizing lists of words into subgroups or clusters of items that share something in common; or creating a story linking all target words on a list), and (iii) visual imagery strategies (i.e. method of loci, face-name association, creating a mental picture of a target)¹¹.

One of the most popular and oldest mnemonic strategies is the methodoflocitechnique, which was used by ancient orators to remember long speeches. The method of loci involves imagining a familiar path and identifying unique landmarks along the path. Visual imagery is used to associate items on a list with each landmark along the imagined path. To remember the list, simply take a mental ‘walk’ along the path, recalling each image at each landmark.

Another popular mnemonic strategy is face-nameassociation³⁰ Individuals can use the face-name method for remembering someone they just met. The face-name strategy involves three steps: (i) looking at a person’s face and identifying a prominent facial feature, (ii) transforming the person’s name into something imaginative or that sounds concrete or meaningful, and (iii) developing a visual image integrating the prominent facial feature with the transformed name.

The efficacy of mnemonic or memory training strategies has been examined in a number of studies. Factors associated with memory improvement in one meta-analysis included younger age, higher cog-nitive functioning, group setting (versus individual training), shorter duration of sessions, education and ‘pretraining’¹⁷. Pretraining allows the participant to get comfortable with visualization and move beyond their comfort zone of thinking about ordinary or logical images. In addition, the number of sessions did not appear to limit the efficacy of memory training¹⁷. In fact, interventions as short as 4 weeks can be just as effective as programmes that are 8 weeks, or even 6–12 months long^31,32. Most research demonstrating effectiveness of mnemonic techniques has focused on healthy adults, both young and old, but persons over 75 years of age show less improvement³³. The few studies of efficacy in MCI populations have yielded mixed results^34,35. A subset of subjects from the ACTIVE study (Advanced Cognitive Training for Independent and Vital Elderly) who were identified as ‘memory impaired’(comparable to MCI) showed no sig-nificant benefit from memory training when compared to a no-contact control group, but had gains in speed of processing and inductive reasoning³⁶.

With the advancement of technology, researchers and clinicians are interested in computer-assisted training interventions for both healthy older adults and people with memory impairments. Initial studies have demonstrated that computer-based cognitive training has improved learning efficiency in healthy older adults³⁷,and supported cognitive and functional improvements in patients with AD³⁸. Computer-based software technology has also recently been , introduced in rehabilitative and training settings for patients with AD and MCI. Results seemed to suggest that the individualized rehabilitative intervention could have different effects according to a patient’s diagnosis³⁹. Cognitively intact older adults who received computer-based training demonstrated improvements in information processing, working memory and verbal learning/memory, and these gains were maintained over a five-month follow-up⁴⁰. In mildly demented patients, computer-based training improved immediate recall of visual information and delayed retention of topographical information³⁸. Combining a cognitive seminar and computer-assisted training in demented patients resulted in short-term improvement on measures of global cognitive functioning and short-term memory, as well as behavioural and social improvements⁴¹. Posit Science has developed a cognitive training program that contains increasingly difficult tasks of stimulus recognition, discrimination, sequencing and memory. Participants with mild cognitive changes associated with age demonstrated a significant increase on all computer tasks, with maintenance of improvements in attention over three months, when compared to active and no-contact controls⁴². In a subsequent larger trial, the Improvement in Memory with Plasticity-based Adaptive Cognitive Training (IMPACT) study⁴³, subjects demonstrated improvement in auditory memory and attention as compared to a general cognitive stimulation. program that functioned as the active control condition. Additionally, pilot studies have evaluated a computerized pro-gram, Brain Fitness by Dakim, which provides cognitive training and stimulation in language, visual processing, and memory domains. Results indicated improvement in memory functioning for those who could participate in the higher levels of the program, in addition to improved encoding and delayed recall for verbal pairs after just 10 sessions^44,45. Presently, a clinical trial is underway to investigate the short-and long-term impact of this computer program on memory functioning in a larger sample of older adults with mild memory complaints as compared to wait-list controls. As people become more technologically aware, computer pro-grams are likely to become an important conduit for simulating real-life environments and integrating goal-directed behaviours in order to increase ecological validity³⁸