Brain-based versus external memory stores: influencing factors and underlying neural correlates

Technological advancements provide people with more opportunity to rely on external resources to support cognitive processes. These associated processes are defined as cognitive offloading (Risko & Gilbert, 2016). The current thesis aims to explore the psychological processes and neural mechanism of cognitive offloading. In Experiment 1, we developed an ‘optimal reminder’ task by calculating whether people were biased towards using reminders or their own memory, compared with an optimal strategy. If participants were biased, the second purpose of Experiment 1 was to assess whether such bias could be reduced through metacognitive advice. Results revealed people were biased towards setting reminders, and the bias was eliminated by metacognitive advice. Experiment 2 used the optimal reminder task to evaluate the effect of ageing on cognitive offloading. This showed that older people set more reminders than younger adults, but were less biased towards setting reminders when the impaired memory performance of older people was taken into account. Experiment 3 investigated the effects of three factors: delay length, metacognitive judgement, and clock revealability, on cognitive offloading in a time-based task (e.g. remembering to press a specific button after 10 seconds). We found participants’ use of reminders was based on both the characteristics of the task (i.e., delay and clock revealability) and metacognitive judgements. Experiment 4 used fMRI to evaluate whether an instruction to offload information to an external reminder triggered different brain activity to an instruction to forget or remember. Results showed that brain activity associated with an offload cue was similar, but not identical, to brain activity associated with a forget cue. We conclude by suggesting possible applications of the results to finding methods for improving intention offloading and avoiding memory failures

Optimal cognitive offloading: Increased reminder usage but reduced proreminder bias in older adults

Research into prospective memory suggests that older adults may face particular difficulties remembering delayed intentions. One way to mitigate these difficulties is by using external reminders but relatively little is known about age-related differences in such cognitive offloading strategies. We examined younger and older adults' (N = 88) performance on a memory task where they chose between remembering delayed intentions with internal memory (earning maximum reward per item) or external reminders (earning a reduced reward). This allowed us to distinguish (a) the absolute number of reminders used versus (b) the proreminder or antireminder bias, compared with each individual's optimal strategy. Older adults used more reminders overall, as might be expected, because they also had poorer memory performance. However, when compared against the optimal strategy weighing the costs versus benefits of reminders, it was only the younger adults who had a proreminder bias. Younger adults overestimated the benefit of reminders, whereas older adults underestimated it. Therefore, even when aging is associated with increased use of external memory aids overall, it can also be associated with reduced preference for external memory support, relative to the objective need for such support. This age-related difference may be driven at least in part by metacognitive processes, suggesting that metacognitive interventions could lead to improved use of cognitive tools. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Outsourcing Memory to External Tools: A Review of 'Intention Offloading'

How do we remember delayed intentions? Three decades of research into prospective memory have provided insight into the cognitive and neural mechanisms involved in this form of memory. However, we depend on more than just our brains to remember intentions. We also use external props and tools such as calendars and diaries, strategically placed objects, and technologies such as smartphone alerts. This is known as 'intention offloading'. Despite the progress in our understanding of brain-based prospective memory, we know much less about the role of intention offloading in individuals' ability to fulfil delayed intentions. Here, we review recent research into intention offloading, with a particular focus on how individuals decide between storing intentions in internal memory versus external reminders. We also review studies investigating how intention offloading changes across the lifespan and how it relates to underlying brain mechanisms. We conclude that intention offloading is highly effective, experimentally tractable, and guided by metacognitive processes. Individuals have systematic biases in their offloading strategies that are stable over time. Evidence also suggests that individual differences and developmental changes in offloading strategies are driven at least in part by metacognitive processes. Therefore, metacognitive interventions could play an important role in promoting individuals' adaptive use of cognitive tools

Characteristics, survival, and related factors of newly diagnosed colorectal cancer patients refusing cancer treatments under a universal health insurance program

BACKGROUND: Colorectal cancer is the third most commonly diagnosed cancer worldwide. Few studies have addressed the causes and risks of treatment refusal in a universal health insurance setting. METHODS: We examined the characteristics and survival associated with treatment refusal in patients with newly diagnosed colorectal cancer in Taiwan during 2004–2008. Treatment refusal was defined as not undergoing any cancer treatment within 4 months of confirmed cancer diagnosis. Patient data were extracted from four national databases. Factors associated with treatment refusal were identified through logistic regression using the generalized estimating equation method, and survival analysis was performed using the Cox proportional hazards model. RESULTS: Of the 41,340 new colorectal cancer cases diagnosed, 3,612 patients (8.74%) refused treatment. Treatment refusal rate was higher in patients with less urbanized areas of residence, lower incomes, preexisting catastrophic illnesses, cancer stages of 0 and IV, and diagnoses at regional and district hospitals. Logistic regression analysis revealed that patients aged >75 years were the most likely to refuse treatment (OR, 1.87); patients with catastrophic illnesses (OR, 1.66) and stage IV cancer (OR, 1.43) had significantly higher refusal rates. The treatment refusers had 2.66 times the risk of death of those who received treatment. Factors associated with an increased risk of death in refusers included age ≥75 years, insured monthly salary ≥22,801 NTD, low-income household or aboriginal status, and advanced cancer stage (especially stage IV; HR, 11.33). CONCLUSION: Our results show a lower 5-year survival for colorectal patients who refused treatment than for those who underwent treatment within 4 months. An age of 75 years or older, low-income household status, advanced stages of cancer, especially stage IV, were associated with higher risks of death for those who refused treatment