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Prospective memory impairment in neurological disorders: implications and management

Nature Reviews Neurology volume 17, pages 297–307 (2021)Cite this article

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Abstract

Prospective memory is a core neurocognitive ability that refers to memory for future intentions, such as remembering to take medications and to switch off appliances. Any breakdown in prospective memory, therefore, has serious implications for the ability to function independently in everyday life. In many neurological disorders, including Parkinson disease and dementia, prospective memory deficits are common even in the earliest stages and typically become more severe with disease progression. Consequently, clinical assessment of prospective memory is of critical importance. This article provides an overview of the various manifestations and neural bases of prospective memory deficits. To facilitate clinical decision-making, validated measures of this construct are identified and their suitability for clinical practice is discussed, focusing in particular on clinical sensitivity and psychometric properties. The article concludes by reviewing the approaches that can be used to rehabilitate different types of prospective memory impairment, and algorithms to guide the evaluation and treatment of these impairments are provided.

Key points

  • Prospective memory (PM) is a core neurocognitive ability that refers to the ability to execute delayed intentions and is an important predictor of the ability to function independently.

  • PM deficits are prominent in many neurological disorders, reflecting the demands that this complex multicomponent process places on a wide range of neural structures and networks and their connectivity.

  • Neurological disorders rarely present with a uniform profile of impairment, meaning that clinical assessments are crucial to the quantification of the nature, magnitude and specificity of any deficits.

  • Many validated PM assessments are now available that are appropriate for clinical use, and can be used to inform prognosis, rehabilitation and discharge planning.

  • A range of interventions are also available, the selection of which should be guided by the patient’s broader neurocognitive profile and the specific types of PM deficits that the patient exhibits.

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Fig. 1: The complex process of prospective remembering.
Fig. 2: The neural bases of PM.
Fig. 3: Performance patterns consistent with executive dysfunction.
Fig. 4: Performance patterns consistent with retrospective episodic memory dysfunction.
Fig. 5: Rehabilitation of PM impairments.

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Acknowledgements

J.D.H. was supported by an Australian Research Council Future Fellowship (FT170100096). The author thanks D. Lloyd and J.B. Mattingley for preparation of the original artwork for Fig. 2, and P.G. Rendell, S.J. Haines, G. Terrett and S.A. Raskin for advice on earlier drafts.

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    Julie D. Henry

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Glossary

Metacognition

Self-awareness and knowledge about one’s own cognitive abilities, such as being able to evaluate how well a task has been completed, monitor and detect performance errors, and reflect on the effectiveness of specific strategies.

Delayed intention

An objective or goal that needs to be completed at a later point in time.

Default mode network

The large-scale brain network that is active during periods of wakeful rest (such as when daydreaming), when there is no focus on the outside world.

Cognitive inhibition

The processes that allow the suppression of cognitive contents that are perceived as irrelevant or inappropriate, and the resistance to interference from unwanted but potentially attention-capturing stimuli.

Elaborative encoding

Memory aids that link to-be-remembered information to previously existing memories and knowledge, making it easier to recall the new information in the future.

Implementation intentions

An encoding strategy that involves generating and saying aloud a simple statement that has a precise format and structure.

Visualization

Formation of a mental visual image.

Spaced retrieval

An encoding strategy in which information is retrieved continuously across increasingly longer delay intervals.

Errorless learning

An encoding strategy that prevents patients from giving wrong answers.

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Henry, J.D. Prospective memory impairment in neurological disorders: implications and management. Nat Rev Neurol 17, 297–307 (2021). https://doi.org/10.1038/s41582-021-00472-1

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