Memory retrieval using paper vs. technology

Apr 7 7:00am | Dr. Dona Locke, HABIT AZ Director | @DrDonaLocke | Comments (15)

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In the HABIT program, one of our core components is encouraging our patients with memory loss due to Mild Cognitive Impairment (MCI) to use a memory support system. We specifically recommend that system be a pencil and paper day planner rather than using technology-based organizational tools. There are a number of reasons for this recommendation, but one of those is research suggesting that initial encoding of information (getting information to stick the first place) and retrieval of that information (remembering information later) is stronger when using a paper-based system as compared to using technology. In that context, I want to share a new study that further supports this finding

Researchers at the University of Tokyo published their study in in the March 19, 2021 issue of Frontiers in Behavioral Neuroscience. If you'd like to read their paper, you can find it here. In addition, here is a news release further summarizing their research and findings.

The study

Briefly, the researchers assigned study participants keep track of scheduled appointments and related information using one of three methods: a paper calendar, a smartphone, or using an electronic stylus on a Tablet. They evaluated memory for those details one hour after a distraction task.  They also evaluated how active certain areas of the brain were during a memory retrieval task using functional magnetic resonance imaging (fMRI).

Their findings

The researchers found a number of interesting findings in support of using a paper note taking system:

  1. Those in the paper group took a significantly SHORTER time to record/write information than the tablet or smartphone groups.
  2. With simpler information, the paper group was more accurate in recalling the information they recorded. When the information became more complex, the groups performed similarly.
  3. All three groups activated memory retrieval structures but the paper group brain activation was significantly higher than the tablet or smartphone groups.

Their conclusions

On page 8 of their paper the authors state, "These results indicate that the cognitive processes for the Note [paper] group were actually deeper and more solid." In the new article about their work, Professor Kuniyoshi L. Sakai, stated "Paper is more advanced and useful compared to electronic documents because paper contains more one-of-a-kind information for stronger memory recall."

Our conclusions

In addition to the other reasons we recommend paper (1-technology is always changing, which is not helpful for our patients living with Mild Cognitive Impairment and 2-writing is a more familiar and ingrained skill learned in childhood for most older adults. Technology is a much more recent skill development and we see that older skills are typically more resilient in patients with MCI), this study provides additional support for deeper processing of information in the first place when writing things on paper rather than using technology. One limitation is that this particular study was completed in younger adults without any memory problems. Thus, it may not generalize the same way to older adults with Mild Cognitive Impairment. In HABIT, we see our paper and pencil memory support system as an ongoing tool so that our patients don't have to worry about remembering all their important information with only their brain's memory systems. Nevertheless, increased memory system activation and increased likelihood that one will remember the information certainly doesn't hurt! It is also interesting that this study was conducted with younger adults who will have more concurrent skill building with pencil and paper and technology than our older adults. So, if anything, we might expect the difference between modalities to be even greater in older adults whose brains have even LESS experience with technology and MORE experience with paper.

Our bottom line

Our HABIT team will continue to recommend paper and pencil day planner type tools over using technology with our patients. Indeed--all our HABIT staff members use pencil and paper planners for their own needs as well!

I'd be interested in your experiences with technology vs. paper--what you like and don't like and if there is a format you like best!  I personally like the system we developed which shows me just one day at a time and has sections for appointments, a to do list, and notes all in one page. I love it and I take it everywhere! How about you?

My favorite part of the paper planner is by far the to-do list. Having my to-do for just today in front of me, rather than the classic, exhaustive to-do list of everything sitting on my desk, has been a game changer for how productive I am and how well I pace myself getting through my to-dos!

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@drmelaniechandler

My favorite part of the paper planner is by far the to-do list. Having my to-do for just today in front of me, rather than the classic, exhaustive to-do list of everything sitting on my desk, has been a game changer for how productive I am and how well I pace myself getting through my to-dos!

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I agree! I feel so much less pressure with this to do list system!

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I have been going to Speech Therapy for a few months now, and have been encouraged to use the tools that I will use, for me that is a smart watch for the time, month, day…and my cell phone for calendar appointments.

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My wife and I (patient) have used the Mayo planner since late January. We are committed to use it and eliminate the electronic calendar. We both prefer written.

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I have always found, whether in coursework or daily living, that writing down things, taking notes, etc rather than typing them onto a screen, cements the knowledge in my brain. These days, dates, etc are also backed up by technology in addition to sticky notes!

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I am 91 years old and without my smart watch and phone my to do list would not exist. I can’t read my writing to begin with but it takes me a minute to write a couple of words after a ten minute search for my Calendar. My watch is always on my wrist yes even at night when I remember many things to do. It takes me 20 seconds to say to my watch “reminder 9 am call the Doctor. At 9 am it buzzes me and shows the note. I can then tell it to call the Doctor and it does. There is no limit to the items you can add and included or how distant you want to date items. And unlike me it has perfect memory? I am already somewhat handicapped without my smart watch and phone I would need a full time physical assistant. Incidentally, I dictated this message into my iPad and electronically copied it into your space. We seniors need all the electronic help we can get. Do you know if I fall and become unconscious my watch will dial 911 and tell them where I am? It will also tell me my heart rate, blood oxygen level and take and take a ECG. OH, yes it keeps perfect time. Many many useful things.

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@heh48cah

I am 91 years old and without my smart watch and phone my to do list would not exist. I can’t read my writing to begin with but it takes me a minute to write a couple of words after a ten minute search for my Calendar. My watch is always on my wrist yes even at night when I remember many things to do. It takes me 20 seconds to say to my watch “reminder 9 am call the Doctor. At 9 am it buzzes me and shows the note. I can then tell it to call the Doctor and it does. There is no limit to the items you can add and included or how distant you want to date items. And unlike me it has perfect memory? I am already somewhat handicapped without my smart watch and phone I would need a full time physical assistant. Incidentally, I dictated this message into my iPad and electronically copied it into your space. We seniors need all the electronic help we can get. Do you know if I fall and become unconscious my watch will dial 911 and tell them where I am? It will also tell me my heart rate, blood oxygen level and take and take a ECG. OH, yes it keeps perfect time. Many many useful things.

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Wow! Impressive!

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I have kept a daily written planner for years and still do at the ripe old age of 58! And I still LOVE using an old fashioned planner that I write in every day to help me keep track of all I need to do throughout the year. I also put some notes in my cell phone when I'm on the run BUT I always write the notes in my planner once I get home.

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I've used an 'old-fashioned' Daytimer for so many years, this design since the '90's. I like the simplicity, ease of entry since I have painful, swollen, frozen hands/fingers/wrists so don't write easily, but my entries are short and sweet. I only choose to see only one day at a time, as otherwise it gets too full and bothersome. It's more concise. And, it's not always with me, as Ive trained myself to keep it bedside at night, and chairside if working on laptop or at desk. This works. I take it in a carry bag with my other 'stuff' like protein snacks or water or diet coke bottles, other papers re Mayo schedule and other information I may need. That way, it's basically always nearby.

I love idea of cell calendar, but it's difficult to enter unless I use voice entry, which will work. But, mostly, I haven't learned how to do the calendar easily and it took me hours to set up the new phone!

It sounds like Mayo or Habit has a day planner you designed or use. Yes? If so, is it available to others, patients? I'd like to know about it…
Blessings to you all and for your program. elizabeth

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I can't argue with test results, but I cover too much ground to keep my to-do list on anything but my phone. As a TBI case I have memory issues, but I need something to alert me when I have an appointment. My Occupational Therapist encouraged me to use the to-do list on my phone. It's working for me. I do take my wife's written grocery list but then I have to decipher what she wrote.
For me, digital is more practical.

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@heh48cah

I am 91 years old and without my smart watch and phone my to do list would not exist. I can’t read my writing to begin with but it takes me a minute to write a couple of words after a ten minute search for my Calendar. My watch is always on my wrist yes even at night when I remember many things to do. It takes me 20 seconds to say to my watch “reminder 9 am call the Doctor. At 9 am it buzzes me and shows the note. I can then tell it to call the Doctor and it does. There is no limit to the items you can add and included or how distant you want to date items. And unlike me it has perfect memory? I am already somewhat handicapped without my smart watch and phone I would need a full time physical assistant. Incidentally, I dictated this message into my iPad and electronically copied it into your space. We seniors need all the electronic help we can get. Do you know if I fall and become unconscious my watch will dial 911 and tell them where I am? It will also tell me my heart rate, blood oxygen level and take and take a ECG. OH, yes it keeps perfect time. Many many useful things.

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I am impressed! Where do you learn to use all that technology? Thanks, Sandy

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@ess77

I've used an 'old-fashioned' Daytimer for so many years, this design since the '90's. I like the simplicity, ease of entry since I have painful, swollen, frozen hands/fingers/wrists so don't write easily, but my entries are short and sweet. I only choose to see only one day at a time, as otherwise it gets too full and bothersome. It's more concise. And, it's not always with me, as Ive trained myself to keep it bedside at night, and chairside if working on laptop or at desk. This works. I take it in a carry bag with my other 'stuff' like protein snacks or water or diet coke bottles, other papers re Mayo schedule and other information I may need. That way, it's basically always nearby.

I love idea of cell calendar, but it's difficult to enter unless I use voice entry, which will work. But, mostly, I haven't learned how to do the calendar easily and it took me hours to set up the new phone!

It sounds like Mayo or Habit has a day planner you designed or use. Yes? If so, is it available to others, patients? I'd like to know about it…
Blessings to you all and for your program. elizabeth

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Hi @ess77! Yes, we at HABIT have designed a day planner for our patients with memory impairment. It is a checkbook size book that includes the current month with a two pages per day format combined with an additional book that shows the entire year for future planning. The month at a time book has sections each day for appointments, to dos, and notes. It is similar to other commercial systems in many ways, but a bit smaller and also a bit more simplified in many cases. We do not sell them to the public as yet, but we get this question a lot so we've been discussing how we might do so.

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