Consciousness and Cognition 22 (2013) 1074–1081

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Consciousness and Cognition

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Turning back the hands of time: Autobiographical memoriesin dementia cued by a museum setting

1053-8100/$ - see front matter � 2013 Elsevier Inc. All rights reserved.http://dx.doi.org/10.1016/j.concog.2013.07.008

⇑ Corresponding author. Address: Department of Psychology and Behavioral Sciences, Center on Autobiographical Memory Research – CONAarhus University, Bartholins Alle 9, 8000 Aarhus C, Denmark.

E-mail address: amanda@psy.au.dk (A.N. Miles).

Amanda N. Miles ⇑, Lise Fischer-Mogensen, Nadia H. Nielsen, Stine Hermansen,Dorthe BerntsenDepartment of Psychology and Behavioral Sciences, Center on Autobiographical Memory Research, Aarhus University, Denmark

a r t i c l e i n f o a b s t r a c t

Article history:Received 23 January 2013Available online 15 August 2013

Keywords:Autobiographical memoryAgingDementia

The current study examined the effects of cuing autobiographical memory retrieval in 12older participants with dementia through immersion into a historically authentic environ-ment that recreated the material and cultural context of the participants’ youth. Partici-pants conversed in either an everyday setting (control condition) or a museum settingfurnished in early twentieth century style (experimental condition) while being presentedwith condition matched cues. Conversations were coded for memory content based on anadapted version of Levine, Svoboda, Hay, Winocur, and Moscovitch (2002) coding scheme.More autobiographical memories were recalled in the museum setting, and these memo-ries were more elaborated, more spontaneous and included especially more internal (epi-sodic) details compared to memories in the control condition. The findings have theoreticaland practical implications by showing that the memories retrieved in the museum settingwere both quantitatively and qualitatively different from memories retrieved during a con-trol condition.

� 2013 Elsevier Inc. All rights reserved.

1. Introduction

It is well established that as we age, we begin to show deficits in autobiographical memory. These deficits are even morepronounced in individuals with dementia. While there is an evident drop in the frequency of specific autobiographical mem-ories and a diminishing of episodic details in aging generally, this loss is considerably more pronounced in dementia (Seidl,Lueken, Thomann, Geider, & Schröder, 2011). At the same time several studies show that the distribution of memories acrossthe lifespan seems to remain relatively similar between older adults with dementia and older adults experiencing no signs ofdementia in that both show a dominance of memories from young adulthood, also known as the reminiscence bump (Addis& Tippett, 2004; Fromholt & Larsen, 1991; Fromholt et al., 2003; see Seidl et al., 2011, for review).

A potential consequence of the autobiographical memory deficits seen in dementia is a loss of identity. This is supportedby Addis and Tippett (2004) who found a relationship between some measures of autobiographical memory impairment indementia and changes in the quality and strength of identity. Complaints from both patients and caregivers also often de-scribe a loss of the person they once knew. A diminishing connection to the past could interrupt the sense of continuityestablished by the self or one’s identity across the lifespan, as well as diminishing the richness of a person’s past and currentquality of life (Conway & Pleydell-Pearce, 2000).

AMORE,

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As mentioned previously, event specificity is lacking in many of the memories retrieved by Alzheimer’s disease (AD) pa-tients. Semantic memory or semantic details seem to be left mostly intact until the later stages of the disease while access tothe richer episodic details associated with autobiographical memories deteriorates over the course of the disease (Seidl et al.,2011). Episodic details are details pertaining to a specific time and location. Such details are important for a sense of recol-lecting a specific past event (Levine et al., 2002).

Memory retrieval as most frequently studied to date has focused on voluntary (i.e. strategic and controlled) retrieval.However, as dementia progresses the loss of executive functioning makes this type of retrieval more difficult if not impos-sible. The difficulty in accessing the specific, episodic details of an event may be attributed to the loss of executive function-ing/control processes evident in general aging and dementia. Berntsen (2009) postulates that situational cues within thecurrent environment may have a high cue-item discriminability (Rubin, 1995) and therefore lead to involuntary (spontane-ous) retrieval of a specific memory, circumventing the strategic (voluntary) retrieval heavily reliant on executive functioning.This is consistent with findings from a diary study showing no age-related deficits in accessing specific episodic memoriesduring involuntary in contrast to voluntary recall (Schlagman et al., 2009). If this is indeed the case, dementia patients maybenefit from detailed cues from their past, enhancing the possibility for spontaneous retrieval of episodic details.

To date, few studies have attempted to examine situation cued autobiographical memories in dementia patients. Re-cently, El Haj, Fasotti, and Allain (2012) found that autobiographical memories in dementia patients were retrieved fasterand were more specific when retrieved in a music condition than memories evoked in silence. The music played duringthe session was chosen by the participant (or his or her relatives), providing the participant with cues directly related to theirown pasts or goals. In doing so, the experimenters may have created an instance of high cue-item discriminability (e.g., highcorrespondence between the cue and an event in memory) and increased the retrieval support for the individuals in the mu-sic condition. Similarly, some assisted home for living facilities offer reminiscence therapy in which demented older areencouraged to retrieve autobiographical memories in response to items that they may associate with their past (e.g., pho-tographs, old objects). However, little is known as to the effects on autobiographical memory.

Here we try to provide a situation with extreme retrieval support by using a museum setting as our experimental con-dition. We compare frequency and quality of autobiographical memories retrieved in this condition to another (control) con-dition with similar, but less familiar cues. As such, we predict that the cues given to participants in the experimentalcondition will evoke more autobiographical memories than cues in the control condition. Moreover, the memories thatare retrieved in the experimental condition will be characterized by a greater level of episodic details, suggesting more rec-ollection of specific past events.

The experimental setting was a house in the open-air museum of urban history and culture, The Old Town, in Aarhus Den-mark. The house consisted of a kitchen, and two adjacent living rooms, all furnished and decorated in early 20th centurystyle. Thus, the Old Town allowed for total immersion into a holistic and historically authentic environment, which recon-structs the cultural and material context of our participants’ youth, allowing cuing of memories along a number of dimen-sions, including all modalities (i.e., odor, auditory, tactile, etc.) and the reenactment of activities (e.g., singing old songs,setting the coffee table with tablecloth and porcelain, holding and touching the old objects, eating cookies baked from anold recipe), in a style our participants would recognize from their childhood and youth, see Fig. 1. Since 2004, this housein The Old Town has been used for reminiscence therapy with elderly demented people. We therefore took advantage ofan already established space and group of reminiscence coordinators. The control condition was a meeting room in an agingactivity center with modern furniture and decorations.

Fig. 1. Participants in reminiscence therapy at The Old Town.

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2. Methods

2.1. Participants

Fourteen participants were recruited for the study. They were separated into five groups according to five different localcommunity centers of which they were members. Two participants were absent from the first session due to sickness andwere excluded from the rest of the study. Therefore, 12 participants were included in the study (M = 87.17 years, SD = 5.18;see Table 1). All participants were recruited via local elderly centers where the local dementia coordinator helped select eachparticipant. While there were no age or gender restrictions for inclusion within the study, there were coincidentally onlyfemale participants in the current study.

Each participant was diagnosed with dementia (Alzheimer’s disease, vascular, or a combination of both) or they exhibiteda reduction in cognitive ability by scoring 23 or less on the Mini Mental State Examination (MMSE; M = 20.58, Range: 14�25;see Table 1) (Folstein, Folstein, & McHugh, 1975). The formal diagnoses of the patients presenting with dementia were madeprior to the current study, and these were made via the Danish health care system involving an extensive series of examin-ations conducted by the patient’s general practitioner and specialists in the area of neurology and psychiatry. Otherwise, theMMSE was used to determine substantial cognitive impairment likely qualifying for a diagnosis of dementia in a comprehen-sive dementia evaluation. The cut-off used here (MMSE < 24) is conservative yielding less than 1% false positives. Indeed,individuals with higher scores often qualify for a dementia diagnosis (O’Bryant et al., 2008). The MMSE test was adminis-tered by a psychologist before either of the sessions took place. While each participant displayed a cognitive deficit, a sub-jective assessment was made by an assisted home for living staff member as to the participant’s eligibility to participate inthe study. Participants were judged to be healthy enough to complete the tests and interviews associated with the study.

None of the participants had experienced the loss of a relative within the two months prior to testing and all were phys-ically mobile in order to participate in the session at the Old Town. In order for participants to be included in the study, noother major psychiatric diagnoses were present.

2.2. Design

A within subjects design was adopted, in which participants took part in two different sessions. The sessions also tookplace in two different locations: the Old Town (the experimental condition) and an aging activity center (a control conditionin terms of an everyday setting). The order in which the two sessions took place was counterbalanced across groups.

2.3. Materials

The cues to be used in the Old Town session were chosen to represent both objects from everyday life and objects forspecial occasions (e.g., Christmas and confirmation). The objects were very common, and it was therefore assumed thatthe participants would have encountered the objects previously. Once nine cues for the Old Town were selected, counter-parts from modern time were found. These cues represented the same everyday life and special occasion objects but froma more modern period. See Table 2 for the full list of the cues presented in each condition.

2.4. Verbal fluency task

Other than the MMSE, participants were also given a category fluency task (Lezak, Howieson, Bigler, & Tranel, 2012; Kor-oza & Cullum, 1995). Three categories were chosen: animals, things that make people happy and things that make people

Table 1Participant demographics, MMSE and Verbal Fluency scores.

Age MMSE VF-animal VF-happy VF-sad

P1 86 23 11 9 8P2 88 20 8 7 6P3 86 22 9 4 5P4 88 14 4 3 2P5 76 22 5 4 1P6 87 21 11 6 4P7* 87 19 8 9 4P8* 82 25 5 4 2P9* 85 23 17 8 3P10* 93 16 3 5 3P11 96 20 8 5 0P12 92 22 9 8 4

M SD M SD M SD M SD M SD87.17 5.18 20.58 3.09 8.17 3.81 6.00 2.13 3.50 2.20

Note: The participants which were formally diagnosed with dementia prior to the study have been indicated with an asterisk (*).

Table 2Cues presented in both the Old town and Activity center conditions.

The Old Town Activity center

Direct cues

Rick’s coffee substitution Organic coffeeOld-fashioned phone (one knob to the central) Modern phone (cell phone)Christmas decoration (Christmas heart in paper) Modern Christmas decoration (Santa elf)Scrap books (including scraps) Collectible cardsMarbles French fries game in plasticSmall slate and chalk (for school) CalculatorHand-held whisk Electric handmixerOld-fashioned confirmation card Modern confirmation cardWhite knitted hand towel for the kitchen Black plain terry cloth hand towel for the kitchenTwo famous old-fashioned songs: ‘‘Jens Vejmand’’ (1905) and ‘‘Jeg ved

en lærkerede’’ (1924)Two famous modern songs: ‘‘Kald det kærlighed’’ (1993) and ’’Smuk som etstjerneskud’’ (2000)

Indirect cues

Old-fashioned china coffee pot (with coffee made in an old-fashionedway) and cream

Modern thermos for coffee (with coffee made on a coffee-machine) andlow fat milk

Old-fashioned vanilla-flavored cookies baked in the Old Town’s bakery Cookies with M&M’s from the supermarketThe reminiscence employee with old-fashioned clothes from 1910 The reminiscence employee with normal modern clothes

Note: There were a few irregularities in the cues between Group 1 and the rest of the groups. A minor change was that the participants were presented witha Christmas heart in crochet instead of paper. A meat mincer and a hand blender were also presented instead of the hand-held whisk and the electrichandmixer the other groups were presented. This particular change was made due to the unwieldiness of the meat mincer. Another minor change involvedthe snacks the first group received. Instead of old-fashioned vanilla-flavored cookies, they enjoyed crepes. Unfortunately, the crepes were too messy and theswitch was made to cookies. All of these changes were made after the first group in order to improve the cues for the study.

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sad. While the animal category was chosen as a more traditional semantic fluency task, the other two were chosen as theyhave previously been shown to identify people with severe depression (Fuld, 1980), see Table 1.

2.5. Procedure

Each of the 5 groups completed a session in the Old Town and a session in the activity center (as well as four interviews,which will not be presented here) which were separated by approximately one week. The order of the two sessions wascounterbalanced across groups with half the groups participating in the Old Town session first, followed by the activity cen-ter, while the other half of the groups participated in the activity center session first, and followed by the Old Town. Therewere no order effects observed (ps > .18). One group showed an advantage for recognition, but this advantage was seen to thesame extent in both conditions and thus not reflecting an effect of order. Present at every session were the 2–3 participants,the interviewer, the contact person or dementia coordinator from the local assisted homes for living, and two research assis-tants. Only the participants and the interviewer took active part in the session while the others observed.

The sessions in the activity center took place in a neutral, modern conference room with a table in the middle and chairsaround. All items which were not from the current time period (e.g., old paintings) were removed from the room. The sessionin the Old Town took place in the living room, which had a table in the middle and a sofa and some chairs around it. Therewas a burning stove and no electrical light in the room. All furniture and decorations belonged to the museum and wereoriginal pieces deriving from the beginning of the 20th century (see Fig. 1). The entire setting was an authentic reproductionof an early 20th century home, including the house itself. The participants entered the house through the cobble stone back-yard and were guided through the low-ceilinged house to the living room, where the session took place.

The sessions in the Old Town and the control condition all had the same course. As the participants arrived and wereseated, coffee and cookies were offered. After some introductory small talk the cues were passed around to each participant.The interviewer used open and investigative questions to each cue. For instance: ‘‘Do you know this one?’’ and made sure toask all participants about the cue if they did not say anything themselves. The interviewer would also encourage the partic-ipants to tell more, for instance by saying: ‘‘I am not familiar with that. Could you please tell me some more?’’. The inter-viewer used the same procedure in both conditions and spoke the same in each condition. After the nine cues had beenpassed around, the people present (including the observers) sang two songs, after which the session ended. This order ofthe events mimicked the order of events that has generally been used during reminiscence therapy in the Old Town. Wechose to follow this well-established procedure, which had shown to generally work well with demented individuals in thisparticular context – that is, made them feel at ease and at home in the situation.

2.6. Coding

The transcripts of the sessions were coded with a coding scheme adapted from Levine et al. (2002). Each line was given aline number in the transcription. A line could consist of several sentences, as only a change in the person speaking produceda new line. Each line was coded separately. Each variable was coded as dichotomous unless otherwise specified.

Table 3Means and standard deviations of the dependent variables, t-tests and p-values for two-tailed binomial tests.

Old Town Control t Binomial p-value

M SD M SD

Memory 120.83 56.87 102.67 65.47 1.92� =.039Recall 91.92 55.02 73.58 59.24 2.46* =.039Recognition 23.08 9.03 22.58 10.02 .16 =.774Autobiographical 99.58 48.38 80.58 56.42 2.16� =.039Internal 12.08 7.29 6.83 6.73 3.42** =.003External 88.58 45.41 76.67 54.81 1.38 =.003Spontaneity 66.00 41.38 53.42 48.96 2.00� =.003Time (implicit) 6.67 4.08 5.92 6.71 .61 =.146Time (explicit) 6.33 4.62 4.92 6.30 .98 =.146Place 14.92 11.49 13.42 13.74 .85 =.388Elaborated Details 15.93 14.45 13.83 13.37 2.12� =.146

* p < .05.** p < .01.� p < .09.

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Every line was first coded for the presence of a memory. There were three different coding possibilities: 0 if there was nomemory content, 1 if the line included recognition, and 2 if the line included recall. If the line was coded as presenting amemory, the line was then coded for the presence or absence of autobiographical memory. Only if the line included auto-biographical memory material were the rest of the variables coded.

The next four codings further distinguished the type of memory present in each line. Internal events were indicated if amemory included a description of an event that lasted less than a day. An internal detail would be indicated by one of thefollowing characteristics consistent with Levine et al. (2002) previous operationalization: a specific event, an individual orindividuals present besides the narrator, weather conditions, physical action/reaction, and emotional action/reaction. Exter-nal semantic information was indicated if a memory included a description of general autobiographical knowledge, a re-peated or general event or a prolonged condition (Levine et al., 2002)1.

The next part of the coding concerned the time frame of the memory/memories in each line. A distinction was made be-tween an explicit and implicit description of time. If a memory in the line mentioned a certain year or the age of the partic-ipant at the time of the memory (including datable life periods, e.g. confirmation, or historical periods, e.g. the day of theliberation of Denmark after World War II) then the time description was coded as explicit. A coding of an implicit timedescription would include non-datable but inferred or general timeframe, for instance season or time of year (including for-mal feasts like Christmas), month, weekday, and time of day. Age at the time of the event was coded if the exact age of theparticipant during the event was explicit in the line. Period of event was coded if the period of time for an event appeared inthe line (i.e., before school age (0–5 years); school age (6�15 years); early adulthood (16�30 years); mid-adulthood(31�50 years); late adulthood (86�95 years); and recent period (86�95 years).

Place of the event was coded as present if a memory in the line included an explicit description of one of the following: acity, street, building, room, part of a room, or place related to the residence of others or the participant. In addition, we codedfor more elaborated details. These elaborated details were coded as present if a memory in the line included an elaboratedcharacteristic of a person, event, game etc., which was not necessary for understanding the essential part of the memory.

Finally, the events were coded for spontaneity. We defined spontaneity as a memory in the line which was producedspontaneously by the participant and not as a response to a direct or indirect question from someone. If an autobiographicalmemory that was previously described spontaneously was repeated later in the interview but contributed nothing new, thenthe event was coded as a repeated autobiographical memory.

One group (approximately 20% of the participants and groups) was used for developing the current coding manual. Thetranscriptions of the sessions involving this group were coded by two independent raters. Transcriptions from yet anothergroup were used to establish the interrater reliability between the two coders. The agreement between the raters was 87–99% across the different variables. Since the raters established such a high level of agreement, they were allowed to code theremaining data independently.

3. Results

Because of large variability across the twelve participants, we present the results in terms of two-sided binomial tests, seeTable 3. In order to provide more information, the means, standard deviations, and t-tests for the dependent variables arealso included in Table 3. The participants had more memories in The Old Town then in the control condition. We found that10 of the 12 participants had more statements coded as dealing with memories in the Old Town condition than in the controlcondition, p = .039. A similar effect was found for statements indicating actual recall of remembered material in contrast to

1 If there was a line which included multiple internal or external details, we also coded these in addition to whether or not an internal or external detail werepresent. However, these occurrences were few and of little theoretical importance. We have therefore decided not to present or discuss them further.

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statements involving simple recognition, for which there were no differences between the Old Town and the control condi-tion (Table 3). Importantly, more memories with autobiographical contents were produced during the sessions in the OldTown than in the control condition, in that, 10 of the 12 participants described more autobiographical memories in theOld Town than in the control condition, p = .039.

The qualities and level of details of the memories also differed between the two conditions. As expected, the large major-ity (11 of 12) participants had more internal (i.e., episodic) details in the Old Town than in the control session, p = .003. Asimilar effect was found for the number of external details. Furthermore, participants seemed to spontaneously (with noprobes) recall more memories in the Old Town session than in the control session. Of the 12 participants, 11 spontaneouslyretrieved more memories in the Old Town condition than in the control condition, p = .003. It should be mentioned that theparticipants did not say more in the Old Town session and that the interviewer also did not speak more in the Old Town thanin the control session (ps > .10). Therefore, the differences seen between the two conditions were not due to more probing orsupport from the interviewer, or simply the participants speaking more in one condition than the other. It short, it appearedthat the museum setting activated more memories that were autobiographical, contained event specific details and wereremembered spontaneously. For examples of autobiographical memories occurring during the session in The Old Town,see Appendix A. The rest of the conversations that were not scored for memory content were comprised of informal chitchator everyday conversation about the weather or their current lives and future plans.

Additionally, though there were few dated events, we examined the temporal distribution of the events that were date-able. The pattern of results was similar between the two conditions with the majority of events occurring during childhoodand early adulthood. A total of 92 (Old Town = 47, Control = 45) dateable events from the period 6�15 years of age and an-other 19 (Old Town = 12, Control = 7) from the period 16�30 years of age were mentioned by the participants. This is in com-parison to the periods covering the age 31�95 where only four events in total were mentioned across conditions andparticipants v2(1) = 99.55, p < .0001.

Due to the small sample size, we were unable to statistically examine differences between those with a formal diagnosisof dementia and those without. However, an inspection of the MMSE scores in Table 1 shows that these two groups appearedvery similar on this test both concerning mean score and range of the MMSE (Mdiagnosed = 20.75, range 16�25; Mnon-diag-

nosed = 20.50, range 14�23). Rank order correlation with the MMSE scores and the memory variables in Table 2 showed highcorrelation coefficients, generally ranging .50–.70 across the variables for both the Old Town and the control conditions.Thus, the MMSE scores clearly appeared to be valid measures of degree of cognitive impairment in the present study.

4. Discussion

The Old Town condition showed more memories recalled, more autobiographical memories, more internal (episodic) andexternal details. There were also more spontaneously recalled memories within the Old Town condition. Thus, overall, therewas an improvement in the quality of the memories with the help of the cues provided in the Old Town condition. Thesefindings agree with our hypotheses concerning cue-item discriminability and the spontaneity of the recall. Dementia pa-tients experiencing a decline in executive function would have more difficulty in reaching specific episodic details. Withadditional retrieval support in the form of specific, multi-sensory, environmental cues with a relevance to their past, partic-ipants may circumvent a voluntary or generative mode of retrieval and spontaneously retrieve specific details.

These findings agree with previous research showing an improvement in recall in both healthy younger and older adultswith additional retrieval support in terms of verbal prompts (e.g., Levine et al., 2002) and in older people with dementiausing music cues (El Haj et al., 2012). The present study goes beyond this previous work by providing a total immersion intoa holistic and historically authentic environment which reconstructed the environmental context of the participants’ youthand facilitated cuing of memories along a number of dimensions, including all sensory modalities and the reenactment ofspecific activities. In contrast to previous work, our study also measured memory along a number of different dimensions.

Our results show an increase in both the frequency and quality of the memories recalled during the Old Town session incomparison to the session in the control condition. This difference was not simply due to the participants speaking more inthe Old Town session or to the interviewer saying more in the Old Town, because no differences were found with regard tonumber of utterances and words spoken in the two settings.

Further, while there were not so many dateable events within the conversations in the present study, we examined thefrequency of recorded events across the lifespan. The pattern of results provides further evidence of a temporal gradient inepisodic or incident memory in dementia in terms of a marked dominance of memories from childhood and early adult-hood in both the Old Town and the control condition (Greene, Hodges, & Baddeley, 1995; Moscovitch et al., 2005; Seidlet al., 2011). These data are consistent with current consolidation theories, such as the multiple trace theory, according towhich there are more traces to these older memories as they are more rehearsed (Moscovitch et al., 2005, but see alsoSquire & Alvarez, 1995 for an alternative explanation). Consistent with previous work, we found an increase in the fre-quency of events in childhood and young adulthood. This was present in both the Old Town and the control condition.When various sampling methods are employed, autobiographical memories across the lifespan repeatedly have showna similar temporal pattern, including in depressed and dementia patients (Fromholt et al., 2003). Typically, there is an in-crease in the number of reported events in young adulthood, during the years of identity formation, which researchershave named the reminiscence bump (Rubin, Wetzler, & Nebes, 1986). There are a few theoretical accounts for the

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existence and robustness of the bump in young adulthood across varying cuing techniques and participant populations.One such account emphasizes the increased frequency of important transitional events. It is during late adolescenceand early adulthood that many individuals experience leaving school, beginning a career, getting married, and having chil-dren; all of which may contribute to a person’s identity or centrality to a person’s lifestory further increasing the fre-quency of rehearsal and likelihood of later recall. The subsequent years to the bump period are characterized by theirrelative stability, and as such, there is a drop in the number of reported events. Therefore, the lack of differences betweenthe two conditions is unsurprising.

The findings from the present study should be evaluated with a number of limitations in mind. First, we had a very smallsample size with a relatively wide range in the level of cognitive impairment as evaluated by the MMSE. The latter yielded agreat individual variation in memory performance. A larger sample with a smaller range in cognitive impairment might haveallowed us to detect even more differences between the two conditions. However, given that the MMSE scores correlatedwith our memory measures, we also feel that this variability has allowed us a potential insight into the immersions effec-tiveness on dementia patients; with patients with less cognitive impairment potentially benefiting the most. Second, onlyfour of our participants had a clinical diagnosis of dementia, while the remaining participants were included in the studyon the basis of their score on the MMSE. Although we used a conservative cut-off and although our non-diagnosed partic-ipants were clearly comparable to the ones with a formal diagnosis both with regard to the mean and the range on theMMSE, further research should aim at replicating and extending the present findings, using a diagnosed group only. Third,there is a general interest for researchers and clinicians about methods capable of dissociating between mild cognitiveimpairment (MCI) and dementia or predicting dementia from patients currently diagnosed with MCI. The focus of the cur-rent study did not touch on this area of interest, but future research utilizing the current paradigm could include a groupwith MCI as a comparison for the dementia patients we interviewed; potentially leading to a better understanding of thedistinctions between MCI and dementia and the progression of the disease.

Finally, another potential concern, which is a general drawback to the field of autobiographical memory, is that we haveno indication as to the accuracy or frequency of rehearsal for the memories relayed by our participants. Future studies mightaddress the veracity of the participants’ memories based on family accounts. We, however, have no reason to doubt the par-ticipants. On the contrary, it is quite likely that some of the memories discussed during the sessions in the current study arehighly rehearsed events from each individual’s past.

The current study employed a novel paradigm and setting to facilitate the retrieval of autobiographical memories. Wereplicate previous findings on episodic memory and normal aging and extend this research to dementia and to a more nat-ural environmental setting and cuing paradigm. In spite of the small sample size, the results of the study are promising, byshowing a consistent pattern of results along a number of different memory variables. In addition to demented individuals,we believe that the benefits garnered from additional retrieval support in authentic historical environments would also en-hance retrieval for other groups having difficulty attaining specificity, including healthy older adults and potentially de-pressed patients as well.

More broadly, the current study has implications for current practice. The techniques and reminiscence setting used inthe current study may be applied to dementia patients and assisted home for living facilities. We find that providing retrievalsupport, in terms of naturalistic historical cues, allows participants to retrieve more specific and detailed memories fromtheir past. In the later years of life, when reminiscence may play a larger role, an increase in quality of life through such rem-iniscence activities is generally expected, but the effects on autobiographical memory have not been documented before.Further, the present findings may also hold implications more specifically for reminiscence therapy. While memory booksand other memory aids have been used in reminiscence work, findings from the present study suggest that immersion intoa more holistic and historically authentic environmental cuing may be especially beneficial.

Acknowledgments

The authors would like to thank the Danish National Research Foundation (DNRF93) and the Danish Council for Inde-pendent Research: Humanities for funding. We would also like to thank Tina Jeppesen for her valuable contributions to sev-eral phases of the project and the coordinators at each of the local activity centers: Mie Jensen, Susanne Bennekou, CharlotteSørensen, Helle Caspersen, Hanne Sørensen, and Mette Harby. Finally, we would like to thank Den Gamle By (The OldTown), Lotte Kofoed, Henning Lindberg, Tove Engelhardt Mathiassen and Birgitte Kryger for their continued support andadvice.

Appendix A. Examples of spontaneously reported memories in the Old Town (translated by the authors, names arefictitious)

2.1. Example 1

In the control condition, Bertha only responds occasionally when there is a conversation about toys. In the Old Town, ascrapbook is circulated around to the participants and a conversation about toys is followed by a memory filled with episodicdetail.

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Bertha said:

I had a doll that was so .. so big (she holds her hand around 80 cm above the floor to show how big the doll was). And uh.And so it had a porcelain head, and I was so pleased with it, but/then it was broken, and so uh .. Dad uh .. bought a newone, I got it for my birthday. I was so glad it that I danced around with it, and then I fell of course, and then it went topieces. And then I got a rap on the buttocks. We had a small walking stick one my brothers had received as a birthdaygift. And so he bought it, and if we were not completely obedient we got a few raps with it.

2.2. Example 2

In the control condition, another woman (Astrid) tells about not having a phone at home, and that it was possible to bor-row a phone at the phone exchange, when she is shown a modern cell phone. The Old Town has an old phone displayed.Astrid tells again about not having a phone at home, but she also adds that she was a maid and functioned as an operatorat a telephone exchange. And a memory of a very specific and dramatic day is described.

Astrid said:

... As a young girl I worked at a telephone exchange .. and took .. took care of the phone and plugged in all those whowanted to be connected with .. with so and so. ... And then they would ask for such and such numbers, and so I had somesuch plugs connected to wires, and then the number, which the person asked for, was plugged in and then you said‘‘Please’’ ..Interviewer: Could you listen?Astrid: (laughs) Yes, one might. ... Well, I must be honest .... There was .. uhh abad fire. And it was .. it was my in-law’s house. ... And then of course there was a call for the fire-brigade .. and .. and fireengines and .. and the call went through where .. where I sat. But I did not know .. that it was exactly that house that wasburning .... So I forwarded the call .. and so .. that way so .. later I got to know that it was my in-law’s house that wasburning.

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