There is currently a need to identify feasible and effective interventions to help older individuals suffering from memory loss maintain functional independence and quality of life. To improve upon paper and pencil memory notebook interventions, the Digital Memory Notebook (DMN) application (app) was developed iteratively with persons with cognitive impairment. In this paper we detail a manual-based intervention for training use of the DMN app. A series of three case studies are described to illustrate the clinical process of the DMN intervention, the key components of the intervention and participants' perceptions of the intervention. The Reliable Change Index was applied to pre/post intervention scores that examined everyday memory lapses, daily functioning, coping self-efficacy, satisfaction with life, and quality of life with standardized measures. Following the intervention, two of three participants self-reported a clinically significant reduction in everyday memory lapses and improved everyday functioning. One participant reported clinically significant change in quality of life. All participants demonstrated clinically significant changes in their ability to cope with problems and build self-efficacy. Furthermore, all participants scored in the normative range post-intervention on the measure of satisfaction with life. Clinical observations and participant feedback were used for refinement of the DMN intervention (ClinicalTrials.gov NCT03453554).

Objective: Accurate insight into one's abilities facilitates engagement in rehabilitation and implementation of compensatory strategies. In this study, self-awareness, self-monitoring, and a new self-updating construct of insight were examined in amnestic mild cognitive impairment (aMCI).Method: Individuals with aMCI and healthy older adults (HOAs) completed a list-learning task in a laboratory setting, and a naturalistic task of everyday functioning in a campus apartment along with other standardized neuropsychological tests. Participants made predictions about performance on the memory and functional tasks prior to task experience (self-awareness), immediately after task experience (self-monitoring), and after a delay (self-updating).Results: Individuals with aMCI performed more poorly than HOAs on the memory task and other neuropsychological tests but not the functional task. For both the memory and functional task, performance predictions and prediction accuracy measures revealed that the aMCI group exhibited intact self-awareness, self-monitoring and self-updating. Prediction accuracy measures showed some association with an executive composite but not a memory composite.Discussion: Participants with aMCI demonstrated intact self-awareness, self-monitoring, and self-updating for a memory and functional task despite exhibiting poorer performance on neurocognitive tests compared to HOAs. These findings suggest that, even as memory in aMCI degrades, executive abilities may help sustain insight into difficulties, enabling adoption of cognitive strategies to support difficulties.

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