How should we teach everyday skills in dementia? A controlled study comparing implicit and explicit training methods.

OBJECTIVE To compare the immediate and delayed effects of implicit and explicit training methods for everyday skills in patients with dementia. DESIGN Counterbalanced self-controlled cases series. SUBJECTS Convenience sample of 10 patients with dementia (Mini-Mental State Examination score between 15 and 26) and 16 age- and education-matched controls. INTERVENTION Two everyday tasks (using a microwave oven and a coffee machine) that were novel to all participants were trained in five 15-minute sessions. Each participant learned both tasks, one using an implicit learning method (modelling) and the other using an explicit learning method (providing verbal cues). Tasks and conditions were counterbalanced. MEASURES The participants' performance was videotaped to assess how well the tasks were performed before training, after each training session, and 7-10 days after the final training session. A rater, who was blind to the training method used, scored the number of correctly executed steps by viewing the videotapes. RESULTS The two training methods were effective in both the patient and healthy control groups, with there being a significant baseline-to-follow-up increase in the number of correctly completed steps (P < 0.001). There were no differences between the training methods (P = 0.16) and no significant interaction between training method and group (P = 0.31). CONCLUSIONS Older patients with mild dementia are able to acquire new skills that are relevant for daily life, showing a similar rate of learning regardless of whether implicit or explicit learning techniques are used.