Striving for an ecologically valid assessment of prospective memory

Abstract

Background and aims: Deficits in prospective memory (PM) are common after brain injury and often have a detrimental impact on everyday functioning. Developing ecologically valid assessments of executive functioning has become an important focus of research, with the Dysexecutive Questionnaire (DEX) being frequently used clinically as a measure of real life executive dysfunction after brain injury. This study investigates the ecological validity of a range of tests, including computerised, virtual-reality and "lifelike" tasks, in assessing real-life difficulties in PM post-brain injury. Method: Thirty eight adults (mean age 47 years, SD 10.4) with acquired brain injury completed the following tests of PM: two simple computerised tests, the "JAAM" (office-based virtual-reality task), themodified Hotel Test (mHT) and the Cambridge Prospective Memory Test (CAMPROMPT). Informant rated DEX questionnaires were also completed. Results: Significant correlations were observed between DEX total scores and the following measures: JAAM PM score (rho=-.51), number of tasks attempted in the mHT (rho=-.45), with mHT total PM score showing a more modest correlation (rho=-.34), PM measure from the computerised tasks (rho=-.40) and CAMPROMPT total score (r=-.39). Conclusions: The majority of PM measures showed a significant association with everyday executive functioning with real-life difficulties being associated with poorer task performance. The complexity and high cognitive demands of the JAAM task may best replicate those encountered in real-life problem-solving settings. Nevertheless, the short duration and seemingly "real-life" quality of the multi-tasking environments of the mHT and CAMPROMPT make them clinically appealing.