Memory In Older Adults Research Articles

Influence of social activities on delayed memory in older adults: A cross-cultural study

This study investigated the impact of social activities on delayed memory among older adults, framed within Social Support Theory and Social Gerontology. By comparing Chinese and American populations, we aim to fill a gap in the cross-cultural research on this topic. Using data from the China Health and Retirement Longitudinal Study and the U.S. Health and Retirement Study, we employed quantitative analysis with Stata 18.0. We discovered that social activities like internet use, card games, and volunteer work significantly enhance delayed memory across both cultures. However, cultural differences influence the types of social activities that are more prevalent in each context and affect the degree of their impact on cognitive health. In China, card games had a stronger effect on delayed memory, while in the United States, volunteer work and internet use exerted a more pronounced impact. These findings highlight the importance of culturally tailored interventions and the combined role of family and community support systems in promoting cognitive health among older adults.

Behavioral and electrophysiological evidence for preserved specific associative episodic memory in older adults

Aging is often linked to a decline in associative memory. Prior research has shown that older adults have difficulty retrieving specific associative memory but can retrieve gist associative memory when deliberately differentiating test pairs with different levels of specificity during associative recognition. In this study, we utilized the context reinstatement paradigm to examine whether older adults could retrieve specific memory in situations where associations do not necessarily need to be voluntarily retrieved. Thirty-five older adults were directed to intentionally link objects with unique background scenes during encoding. Subsequently, test objects were presented against either the reinstated or similar background scenes during a recognition memory task, where participants were required to identify whether the objects were old or new regardless of their background contexts. Event-related potentials (ERP) were recorded to uncover the electrophysiological correlates of specific associative episodic memory. Behavioral results revealed higher memory sensitivity for object recognition when the background scenes were reinstated than when those were similar in older adults. ERP results indicated that older adults exhibited a more prominent fronto-centrally distributed positivity during object recognition in the reinstated than in similar contexts. Our results suggest that older adults may preserve their ability to retrieve specific memory for associations through an involuntary, spontaneous recollection process, which holds important theoretical implications for age-related associative memory deficits.

Effects of sleep on the glymphatic functioning and multimodal human brain network affecting memory in older adults.

Understanding how sleep affects the glymphatic system and human brain networks is crucial for elucidating the neurophysiological mechanism underpinning aging-related memory declines. We analyzed a multimodal dataset collected through magnetic resonance imaging (MRI) and polysomnographic recording from 72 older adults. A proxy of the glymphatic functioning was obtained from the Diffusion Tensor Image Analysis along the Perivascular Space (DTI-ALPS) index. Structural and functional brain networks were constructed based on MRI data, and coupling between the two networks (SC-FC coupling) was also calculated. Correlation analyses revealed that DTI-ALPS was negatively correlated with sleep quality measures [e.g., Pittsburgh Sleep Quality Index (PSQI) and apnea-hypopnea index]. Regarding human brain networks, DTI-ALPS was associated with the strength of both functional connectivity (FC) and structural connectivity (SC) involving regions such asthe middle temporal gyrus and parahippocampal gyrus, as well as with the SC-FC coupling ofrich-club connections. Furthermore, we found that DTI-ALPS positively mediated the association between sleep quality and rich-club SC-FC coupling. The rich-club SC-FC coupling further mediated the association between DTI-ALPS and memory function in good sleepers but not in poor sleepers. The results suggest a disrupted glymphatic-brain relationship in poor sleepers, which underlies memory decline. Our findings add important evidence that sleep quality affects cognitive health through the underlying neural relationships and the interplay between the glymphatic system and multimodal brain networks.

Cortico-hippocampal interactions underlie schema-supported memory encoding in older adults.

Although episodic memory is typically impaired in older adults (OAs) compared to young adults (YAs), this deficit is attenuated when OAs can leverage their rich semantic knowledge, such as their knowledge of schemas. Memory is better for items consistent with pre-existing schemas and this effect is larger in OAs. Neuroimaging studies have associated schema use with the ventromedial prefrontal cortex (vmPFC) and hippocampus (HPC), but most of this research has been limited to YAs. This fMRI study investigated the neural mechanisms underlying how schemas boost episodic memory in OAs. Participants encoded scene-object pairs with varying congruency, and memory for the objects was tested the following day. Congruency with schemas enhanced object memory for YAs and, more substantially, for OAs. FMRI analyses examined how cortical modulation of HPC predicted subsequent memory. Congruency-related vmPFC modulation of left HPC enhanced subsequent memory in both age groups, while congruency-related modulation from angular gyrus (AG) boosted subsequent memory only in OAs. Individual differences in cortico-hippocampal modulations indicated that OAs preferentially used their semantic knowledge to facilitate encoding via an AG-HPC interaction, suggesting a compensatory mechanism. Collectively, our findings illustrate age-related differences in how schemas influence episodic memory encoding via distinct routes of cortico-hippocampal interactions.

A - 26 Self-Efficacy and Meta-Prospective Memory in Older Adults

Abstract Objective Bandura’s theory of self-efficacy (2012) highlights the role of self-appraisal in performance. Individuals with mild cognitive impairment (MCI) may inaccurately appraise their performance on memory-based tasks. The current study predicted that the MCI group would have lower self-efficacy predicting lower meta-prospective memory (meta-PM) accuracy compared to healthy controls. Researchers also predicted a negative relationship between self-efficacy and reported memory complaints regardless of group status. Method Participants were recruited through community flyers and a rural outpatient neuropsychology clinic. Participants (ages 60 to 90) were divided into MCI (n = 31) and healthy (n = 50) groups based on MMSE scores or prior neuropsychological diagnoses. Measures included generalized and task-specific appraisals of PM, objective PM performance, and a self-reported measure of generalized self-efficacy. Results MCI and healthy groups were equivalent in self-efficacy ratings t(79) = 1.43, p = 0.16, d = 0.33. There was no significant correlation between self-efficacy and meta-PM accuracy (r = −0.05, p = 0.64). The difference in correlations between self-efficacy and overall memory complaints between healthy and MCI groups was approaching significance (Fisher’s Z = -1.88, p = 0.06), mostly driven by the MCI group’s significant negative correlation (r = −0.50, p = 0.004*). There was also a significant difference between groups’ correlations in efficacy ratings and PM-only complaints (Fisher’s Z = -2.06, p = 0.04*), given the MCI group’s strong negative correlation (r = −0.57, p < 0.001**). Conclusions Self-efficacy was not significantly related to meta-PM accuracy; self-efficacy was significantly related to overall and prospective-only memory complaints, attributable to significant negative correlations within the MCI group. As such, the MCI group’s self-efficacy is significantly related to perceptions of PM functioning in their daily lives.

Noninvasive neurostimulation promotes working memory performance in older adults: a systematic review

Working memory is a core component of high-level cognitive functions. A key feature of cognitive decline in older adults is the impairment of working memory capacity, which is also observed in many clinical conditions. In recent years, noninvasive neurostimulation techniques have garnered extensive research attention for their potential to enhance human cognitive function, particularly in older adults. This review focuses on several advanced noninvasive neurostimulation techniques for working memory in older adults. A systematic search of the PubMed and Google Scholar literature databases was conducted, covering research papers published from 2013 to 2023. This review identified 19 articles on transcranial electrical stimulation, 6 on transcranial magnetic stimulation, and 2 on transcranial photobiomodulation techniques that met the inclusion criteria. These results suggest that transcranial electrical stimulation, especially transcranial alternating current stimulation and transcranial direct current stimulation, can improve working memory performance in healthy older adults. Transcranial direct current stimulation combined with cognitive training improves functional connectivity between relevant brain regions in addition to performance gains. Transcranial random noise stimulation, transcranial magnetic stimulation, and transcranial photobiomodulation also have the potential to improve working memory. Further research is needed to understand the neural mechanisms involved and optimize stimulation parameters. In addition, emerging techniques such as transcranial focused ultrasound may offer promising solutions for future studies on working memory enhancement in older adults.

Reducing age differences in the retrieval of verbatim and gist representations: Encoding manipulations.

Aging causes changes in episodic memory. While the ability to remember the general idea or gist of past episodes is relatively preserved from the effects of aging, the ability to remember the verbatim details of these episodes declines. The aim of the present study was to examine whether age-related differences in the quality of episodic representations could be reduced by manipulations of information encoding. Two experiments were conducted with younger adults (NExp.1 = 32, NExp.2 = 31, 18-27 years old) and older adults (NExp.1 = 31, NExp.2 = 30, 54-81 years old) in which either the retrieval of gist representations of studied items was facilitated by presenting items that could be grouped within the same category (Exp. 1) or the retrieval of verbatim details of studied items was facilitated by presenting the same items repeatedly (Exp. 2). Both manipulations proved effective in increasing retrieval of either gist or verbatim representations in a recognition task in younger and older adults. Increasing gist retrieval improved correct recognition performance for both younger and older adults but also led the latter to make more recognition errors. Increasing verbatim retrieval improved correct recognition performance for both younger and older adults, and the gain was greater for older adults. These findings support the notion that age-related changes in episodic memory can be explained by changes in the specificity of representations and suggest that simple encoding manipulations could improve episodic memory in older adults.

Multisensory training based on an APP for enhanced verbal working memory in older adults

With the increasing aging population, contemporary society faces the imperative to develop approaches that efficiently delay the age-related decline in working memory capacity, which is a critical area within cognitive aging research. Nevertheless, there is insufficient evidence to support the efficacy of verbal working memory training across various sensory modalities (visual, auditory, and audiovisual) in enhancing the verbal working memory capacity of older adults. In this study, 60 healthy older adults (mean age = 67.07 ± 3.79 years, comprising 34 women and 26 men, mean education = 15.55 ± 2.53 years) were randomly assigned to one of four groups: visual verbal working memory (V-VWM) group, auditory verbal working memory (A-VWM) group, visual-auditory verbal working memory (VA-VWM) group, and a control group. The training duration spanned 12 days. We also investigated whether baseline level and education predicted the outcomes. Findings indicated that V-VWM training had a large effect on improving V-VWM task performance (Cohen's d = 1.765), A-VWM training showed a substantial effect on A-VWM task performance (Cohen's d = 1.904), and VA-VWM training demonstrated a significant effect on VA-VWM task performance (Cohen's d = 2.319) over pretest scores in older adults. Enhancements achieved through V-VWM training exhibited near transfer effects, improving performance in both A-VWM and VA-VWM tasks. In contrast, gains from A-VWM training were selectively transferred to the VA-VWM task. Furthermore, VA-VWM training led to improvements not only in V-VWM and A-VWM tasks but also extended to verbal operation span task with a significant 29.7 % increase. However, no significant transfer effects were observed for the DSF and DSB tasks across the three training groups. The maintenance effect of VA-VWM training persisted for two weeks across tasks involving VA-VWM, V-VWM, and A-VWM. The baseline of VWM span score influence the effect of V-VWM training and transfer effect of VA-VWM training. Education level did not predict the training effects of V-VWM, A-VWM, and VA-VWM. These findings highlight the nuanced effects of sensory-specific verbal working memory training in older adults, emphasizing the potential of tailored interventions to enhance specific aspects of cognitive function, while also highlighting the promising applications of mobile device training in enhancing cognitive skills among the elderly.

Dendritic spine head diameter predicts episodic memory performance in older adults.

Episodic memory in older adults is varied and perceived to rely on numbers of synapses or dendritic spines. We analyzed 2157 neurons among 128 older individuals from the Religious Orders Study and Rush Memory and Aging Project. Analysis of 55,521 individual dendritic spines by least absolute shrinkage and selection operator regression and nested model cross-validation revealed that the dendritic spine head diameter in the temporal cortex, but not the premotor cortex, improved the prediction of episodic memory performance in models containing β amyloid plaque scores, neurofibrillary tangle pathology, and sex. These findings support the emerging hypothesis that, in the temporal cortex, synapse strength is more critical than quantity for memory in old age.

Exercise effects on brain health and learning from minutes to months: The brain EXTEND trial

Despite evidence that aerobic exercise benefits the aging brain, in particular the hippocampus and memory, controlled clinical trials have not comprehensively evaluated effects of aerobic exercise training on human memory in older adults. The central goal of this study was to determine chronic effects of moderate-to-vigorous intensity aerobic exercise on the hippocampus and memory in non-demented, inactive adults ages 55–80 years. We determine effects of aerobic exercise training with a 6-month randomized controlled trial (RCT) comparing 150 min/week of home-based, light intensity exercise with progressive moderate-to-vigorous intensity aerobic exercise. For the first time in a large trial, we examined temporal mechanisms by determining if individual differences in the rapid, immediate effects of moderate intensity exercise on hippocampal-cortical connectivity predict chronic training-related changes over months in connectivity and memory. We examined physiological mechanisms by testing the extent to which chronic training-related changes in cardiorespiratory fitness are a critical factor to memory benefits. The Exercise Effects on Brain Connectivity and Learning from Minutes to Months (Brain-EXTEND) trial is conceptually innovative with advanced measures of hippocampal-dependent learning and memory processes combined with novel capture of the physiological changes, genetic components, and molecular changes induced by aerobic exercise that change hippocampal-cortical connectivity. Given that hippocampal connectivity deteriorates with Alzheimer's and aerobic exercise may contribute to reduced risk of Alzheimer's, our results could lead to an understanding of the physiological mechanisms and moderators by which aerobic exercise reduces risk of this devastating and costly disease.

Age-related differences in metacognitive reactivity in younger and older adults

When we monitor our learning, often measured via judgments of learning (JOLs), this metacognitive process can change what is remembered. For example, prior work has demonstrated that making JOLs enhances memory for related, but not unrelated, word pairs in younger adults. In the current study, we examined potential age-related differences in metacognitive reactivity. Younger and older adults studied lists of related and unrelated word pairs to remember for a later cued recall test where they would be presented with one of the words from the pair and be asked to recall its associate. Additionally, participants either made a JOL for each pair or had an inter-stimulus interval of equal duration as the JOL period. Results revealed that while making metacognitive judgments did not significantly affect memory in younger adults (i.e., no reactivity), this procedure impaired memory in older adults (i.e., negative reactivity), particularly for unrelated word pairs. Specifically, older adults demonstrated better cued recall when each word was followed by an inter-stimulus interval than when asked to predict the likelihood of remembering each word during the study phase. This may be a consequence of JOLs increasing task demands/cognitive load, which could reduce the elaborative encoding of associations between word pairs in older adults, but older adults’ preserved or even enhanced semantic memory may mask negative reactivity for related word pairs. Future work is needed to better understand the mechanisms contributing to the reactivity effects in younger and older adults for different types of to-be-remembered information.

The Impact of Kundalini Yoga on Cognitive Function and Memory: A Systematic Review of Randomized Controlled Trials.

Cognitive decline and dementia are significant public health challenges influenced by various modifiable and non-modifiable risk factors. Kundalini yoga (KY) has emerged as a promising non-pharmacological intervention to enhance cognitive function and memory in older adults at risk of cognitive decline. This systematic review aims to evaluate the effects of KY on cognitive function, memory impairment, and related neurobiological and psychological outcomes in older adults. A comprehensive literature search was conducted across PubMed, MEDLINE, Scopus, Web of Science, and the Cochrane Library, covering studies published from January 2000 to December 2023. Randomised controlled trials (RCTs) were included to compare KY with other cognitive enhancement strategies, such as memory enhancement training (MET) and psychoeducation. Five RCTs with 215 participants met the inclusion criteria. The studies varied in sample size (11 to 81 participants) and duration (12 to 24 weeks). The participants were older adults (≥55 years) with mild cognitive impairment (MCI) or subjective cognitive decline (SCD). The interventions compared KY with MET or psychoeducation. KY consistently improved memory performance and executive function. Significant mood enhancements, increased hippocampal volume, and better neural connectivity were observed. KY also reduced pro-inflammatory cytokines and altered ageing-related gene expression, demonstrating both cognitive and neurobiological benefits. KY appears to be a promising intervention for enhancing cognitive function, mood, and neurobiological health in older adults at risk of cognitive decline and dementia. While further research with more extensive, well-designed RCTs is needed to confirm these findings and optimise intervention strategies, the existing evidence supports the integration of KY into cognitive health programmes. Practitioners should ensure proper training and gradual progression to maximise benefits and minimise risks.

Age differentially impacts adaptive immune responses induced by adenoviral versus mRNA vaccines against COVID-19.

Adenoviral and mRNA vaccines encoding the viral spike (S) protein have been deployed globally to contain severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Older individuals are particularly vulnerable to severe infection, probably reflecting age-related changes in the immune system, which can also compromise vaccine efficacy. It is nonetheless unclear to what extent different vaccine platforms are impacted by immunosenescence. Here, we evaluated S protein-specific immune responses elicited by vaccination with two doses of BNT162b2 or ChAdOx1-S and subsequently boosted with a single dose of BNT162b2 or mRNA-1273, comparing age-stratified participants with no evidence of previous infection with SARS-CoV-2. We found that aging profoundly compromised S protein-specific IgG titers and further limited S protein-specific CD4+ and CD8+ T cell immunity as a probable function of progressive erosion of the naive lymphocyte pool in individuals vaccinated initially with BNT162b2. Our results demonstrate that primary vaccination with ChAdOx1-S and subsequent boosting with BNT162b2 or mRNA-1273 promotes sustained immunological memory in older adults and potentially confers optimal protection against coronavirus disease 2019.

Episodic memory and self-perceived memory in older adults during the pandemic

Episodic memory and self-perceived memory in older adults during the pandemic

Exercise-induced cortical disinhibition mediates the relationship between fitness and memory in older adults.

Regular exercise benefits learning and memory in older adults, but the neural mechanisms mediating these effects remain unclear. Evidence in young adults indicates that acute exercise creates a favourable environment for synaptic plasticity by enhancing cortical disinhibition. As such, we investigated whether plasticity-related disinhibition mediated the relationship between cardiorespiratory fitness and memory function in healthy older adults (n=16, mean age=66.06). Participants completed a graded maximal exercise test and assessments of visual and verbal memory, followed by two counterbalanced sessions involving 20min of either high-intensity interval training exercise or rest. Disinhibition was measured following intermittent theta burst stimulation via paired-pulse transcranial magnetic stimulation. In line with our hypotheses, we observed a positive correlation between cardiorespiratory fitness and verbal memory, which was mediated by plasticity-related cortical disinhibition. Our novel finding implicates cortical disinhibition as a mechanism through which the effects of acute bouts of exercise may translate to improved memory in older adults. This finding extends current understanding of the physiological mechanisms underlying the positive influence of cardiorespiratory fitness for memory function in older adults, and further highlights the importance of promoting exercise engagement to maintain cognitive health in later life. KEY POINTS: There are well established benefits of regular exercise for memory function in older adults, but the mechanisms are unclear. Cortical disinhibition is important for laying down new memories, and is enhanced following acute exercise in young adults, suggesting it is a potential mechanism underlying these benefits in ageing. Older adults completed a fitness test and assessments of memory, followed by two sessions involving either 20min of exercise or rest. Disinhibition was measured following intermittent theta burst stimulation via paired-pulse transcranial magnetic stimulation. Cardiorespiratory fitness was positively associated with memory performance. Higher fitness was associated with enhanced cortical disinhibition following acute exercise. Cortical disinhibition completely mediated the relationship between fitness and memory. This novel finding provides a mechanistic account for the positive influence of cardiorespiratory fitness on memory in later life, and emphasises the importance of regular exercise for cognitive health in older populations.

Multi-night acoustic stimulation is associated with better sleep, amyloid dynamics, and memory in older adults with cognitive impairment.

Sleep is a potential early, modifiable risk factor for cognitive decline and dementia. Impaired slow wave sleep (SWS) is pronounced in individuals with cognitive impairment (CI). Cognitive decline and impairments of SWS are bi-directionally linked in a vicious cycle. SWS can be enhanced non-invasively using phase-locked acoustic stimulation (PLAS), potentially breaking this vicious cycle. Eighteen healthy older adults (HC, agemean±sd, 68.3 ± 5.1) and 16 older adults (agemean±sd, 71.9 ± 3.9) with CI (Montreal Cognitive Assessment ≤ 25) underwent one baseline (sham-PLAS) night and three consecutive stimulation nights (real-PLAS). EEG responses and blood-plasma amyloid beta Aβ42/Aβ40 ratio were measured pre- and post-intervention, as was episodic memory. The latter was again evaluated 1week and 3months after the intervention. In both groups, PLAS induced a significant electrophysiological response in both voltage- and time-frequency analyses, and memory performance improved in association with the magnitude of this response. In the CI group, both electrophysiological and associated memory effects were delayed compared to the healthy group. After 3 intervention nights, electrophysiological response to PLAS was no longer different between CI and HC groups. Only in the CI sample, stronger electrophysiological responses were significantly associated with improving post-intervention Aβ42/Aβ40 ratios. PLAS seems to improve SWS electrophysiology, memory, and amyloid dynamics in older adults with CI. However, effects on memory require more time to unfold compared to healthy older adults. This indicates that PLAS may become a potential tool to ameliorate cognitive decline, but longer interventions are necessary to compensate for declining brain integrity. This study was pre-registered (clinicaltrials.gov: NCT04277104).

Neural mechanisms of the relationship between aerobic fitness and working memory in older adults: An fNIRS study

Abstract A growing number of studies have revealed that higher aerobic fitness is associated with better working memory (WM) performance in older adults. However, the underlying functional neural mechanisms of this association remain under debate. It has been reported that aging increases recruitment of the prefrontal cortex (PFC) during cognitive tasks, and that this is associated with task performance in a compensatory manner. Therefore, this study aimed to clarify the prefrontal activation pattern that is associated with the relationship between aerobic fitness and WM performance in older adults, focusing on age-related extended prefrontal recruitment. Forty-seven older adults (65–74 years, 29 females) and 49 younger adults (18–24 years, 23 female) performed verbal and spatial n-back tasks, which included 0-, 1-, and 2-back conditions. Reaction time (RT) and accuracy (ACC) were assessed as indices of task performance. Prefrontal activation during the experimental tasks was monitored using functional near-infrared spectroscopy (fNIRS) and analyzed using an adaptive GLM method. We compared task performance and prefrontal activation between age groups to find age-related prefrontal activation patterns. Only older adults underwent a graded exercise test (GXT) to determine their ventilation thresholds (VT) as a measure of aerobic fitness, and, subsequently, the relationships among aerobic fitness, n-back task performance, and prefrontal activation in older adults were examined using correlation analysis and mediation analysis controlling for possible covariates. A comparison of task performance between groups revealed that older adults had slower RT and lower ACC than did younger adults, especially in the higher WM load 2-back condition. Group comparisons of prefrontal activation showed that older adults exhibited additional or greater activation than younger adults mainly in the ventrolateral PFC (VLPFC) and front polar area (FPA) in both the verbal and spatial 2-back conditions. Correlation analysis showed a relationship between higher VT, shorter RT for the verbal 2-back condition, and greater prefrontal activation of the bilateral FPA and right VLPFC during verbal 2-back conditions in older adults. In addition, mediation analyses indicated the possibility of a mediation effect of the prefrontal activation on the relationship between VT and RT for the verbal 2-back condition. These results suggest that older adults with higher aerobic fitness levels recruited more extended PFC regions, possibly for compensatory activation, to enhance their performance of the verbal n-back task. This study sheds light on the neural mechanisms underpinning the relationship between aerobic fitness and cognitive function in older adults.

Self-defining memories in older adults: Distribution across lifespan and characteristics of the reminiscence bump

Many studies have investigated the temporal distribution of autobiographical memories, but none has focused on Self-Defining Memories (SDMs), i.e. memories that are particularly important for personal identity, in a large non-clinical sample. No study has examined the temporal distribution of Self-Defining Memories (SDMs), i.e. memories that are particularly important for personal identity, in a large non-clinical sample of older adults. Moreover, we examined for the first time the characteristics of SDMs located in RB. Two hundred and eighty elderly adults aged from 65 to 90 years old reported three SDMs. Participants were non-institutionalized retirees screened for global cognitive function. Participants were asked to recall three SDMs. They also completed the Mini-Mental State Examination. The period from 0 to 9 years corresponds to a very limited recall of SDMs. A RB appears between for the 10–24 years period. Recalled memories are enhanced after the age of 50. The temporal distribution of recalled SDMs differed according to thematic content and emotion. The percentage of positive SDMs was the highest in RB compared with other life periods. Specificity, meaning-making, tension, redemption and contamination did not differ for bump SDMs versus non-bump SDMs. In addition, differences between men and women were observed. Our results confirm the existence of the classical temporal distribution of autobiographical memories for SDMs. Recalling positive bump SDMs might improve well-being in older adults.

Sleeping High and Getting Lost on the Spiky Road: What Affects Visual Memory in Older Adults With Epilepsy, and What Can We Do About It?

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Effects of extended practice and unitization on relational memory in older adults and neuropsychological lesion cases

ABSTRACT Unitization – the fusion of objects into a single unit through an action/consequence sequence – can mitigate relational memory impairments, but the circumstances under which unitization is effective are unclear. Using transverse patterning (TP), we compared unitization (and its component processes of fusion, motion, and action/consequence) with extended practice on relational learning and transfer in older adults and neuropsychological cases with lesions (to varying extents) in the medial prefrontal cortex (mPFC) or hippocampus/medial temporal lobe (HC/MTL). The latter included a person with bilateral HC lesions primarily within the dentate gyrus. For older adults, TP accuracy increased, and transfer benefits were observed, with extended practice and unitization. Broadly, the lesion cases did not benefit from either extended practice or unitization, suggesting the mPFC and dentate gyrus play important roles in relational memory and in unitization. The results suggest that personalized strategy interventions must align with the cognitive and neural profiles of the user.