Shinshu Med J, 71⑴：63～71, 2023

Reminiscence Activates the Frontal Lobe andAmeliorates Negative Mood States in Cognitively Intact Older Adults
Chise Kobayashi, Motoki Ichikawa and Yuko Hirabayashi＊
Division of Nursing, School of Health Sciences, Shinshu University School of Medicine

Reminiscence is a non-pharmacological intervention that involves a narrative and reflective process of re­calling past thoughts, feelings, and experiences. The positive effects of reminiscence intervention for cognitively
intact older people have been reported ; however, the physiological mechanisms underlying the effect on thefrontal lobe during and after the reminiscence are not well understood. We have demonstrated increased oxy­
genated hemoglobin concentrations in the right frontal lobe and decreased deoxygenated hemoglobin concentra­
tions in both the frontal lobes during reminiscence in cognitively intact older participants using near-infrared
spectroscopy. Furthermore, the mood state of older participants was evaluated using Profile of Mood States andincreased subjective health perception scores and showed a significant improvement following reminiscencecompared with pre-reminiscence. Reminiscence-based intervention activated the frontal lobe and provoked pos­
itive emotion in the mood state and health perception in cognitively intact older participants. These findings
may improve treatment strategies of older adults for better quality of life. Shinshu Med J 71 : 63―71, 2023
(Received for publication May 16, 2022 ; accepted in revised form October 12, 2022)
Key words : frontal lobe, mood states, near-infrared spectroscopy, older adults, reminiscence

Ⅰ Introduction

studies reported that reminiscence therapy in older
adults improved their adaptation to old age and cog­

In 2020, the older population (aged 65 years andnitive status5）6）. However, the physiological mecha­over) was 36.19 million, constituting 28.8 ％ of thenisms underlying the effect on the frontal lobe of1）

total population in Japan . The normal aging processcognitively intact older adults during and after remi­in this population causes functional decline in physicalniscence are yet to be clarified.

and cognitive abilities, which can introduce issues re­

Near-infrared spectroscopy (NIRS) is a non-inva­

lated to adaptation to old age, and may influence thesive optical method for measuring concentration2）

independence of older people . Therefore, it is im­changes of oxygenated hemoglobin (oxy-Hb) and de­portant that the decline of cognitive functions is iden­

oxygenated hemoglobin (deoxy-Hb) in cerebral bloodtified and treated.

flow. Measuring the absorbance of the infrared light

Several approaches, including pharmacological andintensity at different wavelengths to calculate thenon-pharmacological strategies, can be used to treat

relative ratio of oxy-Hb to deoxy-Hb, using the mod­or to prevent the decline of cognitive functions in

ified Beer-Lambert law, is the principle of NIRS7）8）.

older individuals3）4）. Reminiscence therapy is usually

Neuronal activation causes an increase in oxy-Hb

used as a treatment for older patients because of its

and a decrease in deoxy-Hb in the activated cortical

non-pharmacological nature. In this context, several

area via neurovascular coupling9）10）. NIRS activation＊

Corresponding author : Yuko Hirabayashi
School of Health Sciences, University School of Medicine,
3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
E-mail : ykhiraba@shinshu-u.ac.jp

No. 1, 2023

studies usually include a combination of resting peri­
ods to assess baseline activities and brain activation
periods11）. To elucidate the physiological mechanisms
underlying the effect of reminiscence on cognition in
63

Kobayashi・Ichikawa・Hirabayashi

older adults, we assessed the frontal lobe activation

detection probes of NIRS were placed on the Fp1of cognitively intact older participants during remi­

and Fp2 positions in the 10/20 Electroencephalogra­

niscence using NIRS while simultaneously measuring

phy system, which covered the left and right frontal

their Profile of Mood States (POMS), heart rate varia­

lobe regions.

bility (HRV), and subjective health perception scores
before and after reminiscence.
Ⅱ
Ａ

Materials and Methods

Participants

Four different wavelength (775, 810, 850, 910 nm)
laser diodes were used as a light source. The distance
between the emitter and detector probes was 3.5 cm.
Oxy-Hb and deoxy-Hb concentrations measured
by NIRS are relative values. We treated the values

Twenty-one community-dwelling older adults with

before reminiscence as baseline values. The oxy-Hb

no diagnosis of dementia, psychiatric, or neurologicaland deoxy-Hb concentrations measured every 1 s indiseases participated in this study. Their age range

each participant were averaged for 10 s in each of

was 60-80 years (mean age ± standard deviation

the baseline, recalling, and story-telling periods.

[SD] : 70.1±4.7 years, 6＝male, 15＝female). All par­Values measured during baseline, recalling, and sto­

ticipants were healthy and right-handed.

rytelling were the average oxy-Hb and deoxy-Hb

Ｂ

concentrations during 0-10 s before the start of re­

MMSE
The Mini-Mental State Examination (MMSE) was

calling, 100-110 s after the start of recalling, and 70-

used to screen for cognitive impairment in partici­

80 s after the start of storytelling, respectively. The

pants. It assessed mental function in a number ofoxy- and deoxy-Hb values from recalling and story­

areas, including orientation in time and place, alert­

telling were compared to those measured during

ness, attention, calculation, and memory. This test

baseline. Since the NIRS data had a large individual

has minimum and maximum scores of 0 and 30, re­variability, we compared the averages of the 10 s

spectively.

when the NIRS data were most stable. These 10 sＣwere 0-10 s before the start of recalling, 100-110 s

Reminiscence
We used a simple reminiscence as described byafter the start of recalling, and 70-80 s after the start

Webster et al. in 2010. The interviews with partici­

of storytelling.

pants were unstructured, using open prompts such

Ｅ

POMS

as “Please tell me about your good memories in

The Profile of Mood States (POMS) was used tochildhood”. Preliminary experiments were conduct­gauge the participants psychological responses. The

ed to determine the optimal NIRS measurement

POMS comprises 35 adjectives rated on a 0 (not attimes for baseline, recalling, and storytelling, whichall) to 4 (extremely) scale that can be consolidated

were 2 min each, taking into account the participants’

into the following seven effective dimensions : A-Hages and other factors. Therefore, reminiscence was(anger and hostility), C-B (confusion and bewilder­conducted with a 2-min introduction (baseline period),ment), D-D (depression and dejection), F-I (fatigue

a 2-min recalling period, and a 2-min verbal story­

and inertia), T-A (tension and anxiety), V-A (vigor

telling (storytelling period). The prompt for memory

and activity), F (friendliness) and TMD (total moodrecalling was given just after the baseline period.

disturbance). For the Japanese subjects, the Japa­

The interviews were conducted by a trained nurse

nese edition of the POMS second edition (POMS 2)

who had attended a workshop on reminiscence andwas used. In this study TMD was calculated by sub­was familiar with its implementation.

tracting V-A from the sum of the scores for A-H,

Ｄ

C-B, D-D, F-I, and T-A.

NIRS measurements
Concentration changes of oxy-Hb and deoxy-Hb

Ｆ

Subjective health perception

were measured using NIRO-300 (Hamamatsu Pho­

Subjective health perception was measured bytonics KK, Hamamatsu, Japan). The emission andasking the participants the question “How do you

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Shinshu Med J

ol. 71Effect of reminiscence on frontal lobe activation

rate your health at the present time? ” This question

error.

was answered using a 4-point Likert scale with theＪfollowing options : 1＝very bad, 2＝bad, 3＝good, 4＝

Ethical considerations

This study was approved by the institutional ethics

very good.

committee of Shinshu University before the study

Ｇ(approval number 3762). All participants were well

HRV analysis
HRV is an indicator of autonomic nerve activity,

informed about the purpose and methods of the study,measuring variations in the R-R interval per beat.

and written informed consent was obtained fromAn activator AC-301A (GMS, Japan) was used foreach participant.

continuous recording the R-R interval. Time series

Ⅲdata were obtained for 1 min for power spectral

Results

analysis using Memcalc/Tarawa (GMS, Japan). The

The participants’ MMSE scores were between 27

analysis was performed with a low frequency (LF)

and 30 (One with 27, five with 28, four with 29, andcomponent of 0.04 ～ 0.15 Hz and a high frequency

11 with 30). Most participants had no cognitive im­(HF) component of 0.15～0.40 Hz.

pairments.

Ｈ

Study proceduresFig. 1A shows the grand average oxy-Hb concen­

Changes in the oxy-Hb and deoxy-Hb concentra­

tration in the left and right frontal lobes of all partic­

tions on NIRS and HRV were monitored in a quiet

ipants during the period from probe attachment toroom. Participants sat on a chair, and the probes werecompletion of reminiscence (recalling and storytell­

attached. They were instructed to minimize head anding). In this study, reminiscence was composed of the

body movements as much as possible during the mea­

recalling and storytelling periods. This figure indi­

surements. The POMS and Likert scale of subjective

cates that oxy-Hb increased during the period of

health perception were completed before and afterrecalling and storytelling in both frontal lobes.

the reminiscence. The interval times between theFig. 1B shows the grand average deoxy-Hb con­evaluation of POMS, Likert scale of subjective healthcentration in the left and right frontal lobes of allperception and reminiscence were 20 min each. Mea­

participants during the period from probe attach­surements of NIRS and HRV were started 2 min

ment to completion of reminiscence. The deoxy-Hb

before reminiscence and ended 4 min after reminis­

concentration decreased during the period of recalling

cence. All procedures were performed by a trained

and storytelling in both frontal lobes.

nurse.
Ｉ

Statistical analyses

The oxy-Hb concentrations in the right frontal
lobe during recalling (0.69±0.39 μmol/L) and story­

We conducted a paired t test to compare the POMS

telling (1.18±0.50 μmol/L) were significantly higherscores, subjective health perception scores, and HRVthan those measured at baseline (-0.31±0.22 μmol/L)data before and after the reminiscence. The average(p＜0.01 and p＜0.01, respectively) (Fig. 2).

oxy-Hb and deoxy-Hb concentrations obtained fromThe deoxy-Hb concentrations in the right frontal

the NIRS data during the recalling and storytellinglobe during recalling (-0.61±0.16 μmol/L) were notperiods were compared with the concentrations

significantly different from those measured at baseline

during the baseline period using the paired Student’s(-0.41±0.13 μmol/L) (p＝0.07) ; however, those during

t test. The correlation analysis between the differ­

the storytelling period (-0.89±0.18 μmol/L) were sig­

ences in POMS TMD scores and NIRS results before

nificantly lower than those at baseline (p＜0.01) (Fig. 3).

and after the reminiscence was evaluated using

The oxy-Hb concentrations in the left frontal lobe

Pearson’s correlation coefficient. P-values of ＜ 0.05

during recalling (0.17±0.34 μmol/L) and storytellingwere considered to indicate statistical significance.

(0.72±0.52 μmol/L) were not significantly different

We used IBM SPSS26 software for statistical analy­

from those at baseline (-0.34±0.38 μmol/L) (p＝0.09

sis. Data are presented as the mean ± 1 standard

and p＝0.13, respectively) (Fig. 2).

No. 1, 2023

65

Kobayashi・Ichikawa・Hirabayashi

Fig. 1 Grand average concentrations of oxygenated hemoglobin (A) and deoxygenated hemoglobin (B) duringbaseline (0-120 s) and reminiscence (120-360 s) measured using near-infrared spectroscopy for allparticipants. Reminiscence comprises recalling periods (120-240 s) and storytelling periods (240-360 s). The
data show the relative concentrations (μmol/L) every 10 s. The solid circle shows the concentrations of theright frontal lobe, and the open circle shows the concentrations of the left frontal lobe.

Fig. 2 Mean relative values of oxygenated hemoglobin (oxy-Hb) for the right frontal lobe (black bar) and left
frontal lobe (shaded bar) before reminiscence (baseline) and during reminiscence (recalling andstorytelling) in all participants. Oxy-Hb values of the right frontal lobe during recalling and storytellingwere significantly higher than those at baseline (＊＊p＜0.01). The vertical bars are standard errors.

The deoxy-Hb concentrations in the left frontal

than those at baseline (-0.41±0.19 μmol/L) (p＜0.001

lobes during recalling (-0.84±0.18 μmol/L) and story­

and p＜0.001, respectively) (Fig. 3). We found no

telling (-1.23±0.21 μmol/L) were significantly lower

difference in the results of NIRS data between male66

Shinshu Med J

ol. 71Effect of reminiscence on frontal lobe activation

Fig. 3 Mean relative values of deoxygenated hemoglobin (deoxy-Hb) for the right frontal lobe (black bar) and left
frontal lobe (shaded bar) before reminiscence (baseline) and during reminiscence (recalling and storytelling)in all participants. Deoxy-Hb values of the right frontal lobe during storytelling were significantly lower
than those at baseline (＊＊p＜0.01). Deoxy-Hb values of the left frontal lobe during recalling and storytellingwere significantly lower than those at baseline (＊＊＊p＜0.001). The vertical bars are standard errors.
Table 1 Comparison of the Profile of Mood States second edition scores for before and afterreminiscence (n＝21)
7 Factors & Total Mood Disturbance

BeforeAfterp-value

Anger - Hostility

1.7

±

0.4

0.3 ±

0.1

＊＊＊

Confusion - Bewilderment

2.4

±

0.6

1.1

±

0.4

＊

Depression - Dejection
Fatigue - Inertia
Tension - Anxiety

2.4
1.2
4.0

±
±
±

0.6
0.3
0.7

0.9
0.6
1.6

±
±
±

0.3
0.3
0.3

＊＊＊

Vigor - Activity
Friendliness

13.3
14.1

±
±

0.8
0.7

14.3
15.6

±
±

0.9
0.7

n.s.

Total Mood Disturbance

-1.6

±

2.2

-9.9

±

1.4

＊＊＊

n.s.
＊＊＊

＊

The data are presented as means±standard errors of the 7-factor scores and TMD score
measured by the POMS 2. P values were calculated using a paired t test.
＊＊＊: p＜0.001, ＊ : p＜0.05, n.s. : not significant.

and female participants (data not shown).

higher after reminiscence than before reminiscence

The average POMS 2 scores for the participants(F : p＜0.05). We found no correlation between the

before and after the reminiscence are summarized indifferences in POMS TMD scores and NIRS results

Table 1. Scores reflecting a negative mood state were

before and after the reminiscence (data not shown).

significantly lower after reminiscence than before

Subjective health perception of the participants wasreminiscence (A-H : p＜0.001, C-B : p＜0.05, D-D : p＜measured by the Likert scale score. As shown in Fig. 4,

0.001, T-A : p＜0.001, TMD : p＜0.001). The F scorethe mean subjective health score after reminiscencereflects a positive mood state and was significantly(3.38±0.13) was higher than that before reminiscence

No. 1, 2023

67

Kobayashi・Ichikawa・Hirabayashi

Fig. 4 Changes of the subjective health scores
before and after reminiscence in all par­ticipants. P values were calculated using
paired t tests (＊＊p＜0.01). The verticalbars are standard errors.

Table 2

2

HF (ms )LF/HF

Comparison of heart rate variability before and after reminiscence (n＝21)
Baseline

Recalling

Storytelling

p-value

68.60 ± 16.77
4.54 ± 1.04

71.39 ± 16.56
4.62 ± 0.90

75.95 ± 18.60
5.59 ± 0.98

n.s.
n.s.

Data are presented as means ± standard errors.
Data analysis was performed using a paired t-test, comparing baseline and recalling and baseline andstorytelling. n.s. : not significant, LF : low frequency, HF : high frequency

palliative care6）14）.

(3.05±0.08) (p＜0.01).
HRV assesses the activity of the autonomic nervous

The positive effects of reminiscence therapy forsystem. The LF component reflects the sympathetic

patients with dementia, Alzheimer’s disease, and life-and parasympathetic nervous system activities, where­

limiting diseases have been demonstrated in several

as the HF component reflects the parasympathetic

studies, in terms of reducing depressive symptoms,

nervous system activity. LF/HF indicates sympathetic

promoting cognitive functions, and improving a pa­

nervous system activity. HF and LF/HF were nottient’s well-being. Following their meta-analysis,

significantly different during reminiscence (recalling

Park et al15）. concluded that reminiscence therapy forand storytelling) compared with before reminiscencepeople with dementia had a moderate effect on de­(Table 2).

pression and could be used to decrease depression asⅣDiscussion

an alternative to antipsychotic drugs.
Recently, Tam et al.5） showed the effectiveness ofReminiscence is a non-pharmacological interven­

reminiscence-based intervention on improving psy­tion. It is a narrative and reflective process of recall­chological well-being in cognitively intact older

ing past thoughts, feelings, and experiences to en­adults using a systematic review and meta-analysis.

12）
13）

. Reminiscence is recognized as

Their results demonstrated that a significant reduc­reminiscence therapy, which has been conducted bytion of depressive symptoms, improvement in life

professional practitioners such as psychologists, nurs­

satisfaction, enhancement of self-esteem, and im­

ing staff, and social workers in clinical settings andprovement in happiness were achieved through rem­

hance happiness

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Shinshu Med J

Vol. 71Effect of reminiscence on frontal lobe activation

iniscence-based intervention in cognitively intact

oxygenation in the frontal lobe has been suggested

older adults. In most cases, the effectiveness of remi­by several studies. Aoki et al20）. and Sato et al21）. re­niscence-based intervention was evaluated using

ported a negative correlation between negative POMS

outcome assessment tests, such as the Mini-Mental

mood scores and oxy-Hb concentrations in the pre­State Examination, Life Satisfaction Index A, andfrontal cortex during the verbal working memory

5）
15）
-17）

Geriatric Depression Scale 30. We were unabletask in healthy adults, measured using optical topog­

to find a study that evaluated the effectiveness ofraphy and NIRS. Miyata et al. examined the effect ofreminiscence-based intervention using the physio­

three nights of sleep restriction on frontal lobe oxy­

logical index of the brain.

genation and mood using NIRS and the POMS. TheyIn this study, we have demonstrated increased

reported that three nights of ＜ 4 h sleep significant­oxy-Hb concentrations in the right frontal lobe andly suppressed cortical oxygenation in the frontal lobe

decreased deoxy-Hb concentrations in both the fron­during a word frequency task. The POMS vigor

tal lobes during reminiscence compared with base­scores after nights of insufficient sleep were lower

line values in older participants, using NIRS. Althoughthan those after nights of sufficient sleep. The fa­

the oxy-Hb concentrations in the left frontal lobe

tigue and TMD scores of the POMS after nights ofduring reminiscence were not different from theinsufficient sleep were higher than those after nights

baseline concentrations, these results suggested thatof sufficient sleep22）. They suggested that a decrease

frontal lobe activation was observed during reminis­

in cortical oxygenation in the frontal lobe due tocence in cognitively intact older adults.

sleep deprivation might lead to mood disturbance.

Oxy-Hb concentrations in the right frontal lobe

Sato et al.21） reported that participants with higher

significantly increased during reminiscence, while

POMS TMD scores before the verbal working memo­

there was no significant difference in oxy-Hb con­ry task showed less PFC activity during the task.

centrations in the left frontal lobe. The right frontal

However, we were not able to show a direct corre­lobe appears to be more activated than the left fron­lation between mood improvement and frontal lobe

tal lobe. However, deoxy-Hb concentrations signifi­

activation in the present study. Our present datacantly decreased in the bilateral frontal lobes during

analyzed the association between the difference inreminiscence. The increase in oxy-Hb concentration

POMS TMD scores and the NIRS results before andin the left frontal lobe during the reminiscence wasafter the reminiscence, while Sato et al. analyzed thenot significant, but had a p-value of 0.09. Therefore,

association between POMS TMD scores before verbal

we think that there is no laterality in the activation

working memory and NIRS results.

of the frontal lobes during reminiscence.

Previous studies suggested that positive emotions

The POMS is one of the most popular mood state

are beneficial for health and that negative emotions

measures. The standard English version comprises

are detrimental to it23）24）. Considering that activation

65 items rated on a 5-point response format18）. Theof the frontal lobes correlates with emotional experi­

POMS is available for use in older adults, and theences, the increase in subjective health perception

questionnaire has been translated into many lan­scores after reminiscence may be related to activa­

19）

guages . In this study, we used the Japanese ver­tion of the frontal lobes of older participants in oursion of the POMS 2, and asked “How do you feel rightstudy.

now” to assess the acute effect of reminiscence. The

The important aspect of reminiscence is not only

results of the POMS in this study showed that theto recall pleasant memories from the past but also toolder participants had an improved mood status fol­talk about them in words to the listener. In the pres­lowing reminiscence compared with before reminis­

ent study, the average oxy-Hb levels continued tocence.

increase and deoxy-Hb levels continued to decrease

The complex interaction of mood with cortical
No. 1, 2023

between the time of recalling and storytelling. This
69

Kobayashi・Ichikawa・Hirabayashi

may indicate the importance of verbalizing theneurological diseases was based on self-report only.

recalled pleasant memories in reminiscence.

Considering that the cerebral blood flow has a signif­

In conclusion, reminiscence in cognitively intact

icant impact on NIRS data, a more precise method

older adults activated the frontal lobes and amelio­(such as MRI) to determine the exclusion of neuro­

rated negative mood states, but did not affect auto­

logical diseases may be needed. Lastly, we were

nomic nervous system activities.

unable to ask participants for information regarding
current medicines in the context of personal informa­

Limitations

tion protection.

NIRS data are suitable for measurement in struc­Acknowledgments

tured interviews, but may not be suitable for mea­
surement during semi-structured interviews such as

We would like to thank all the participants of thisthose prompting reminiscence. This may be thestudy and Editage (www. editage.com) for English

reason for the variability of the NIRS data. Further­language editing. This study was supported by JSPS

more, extracranial hemodynamic changes such as

KAKENHI (Grant Number : 20K10932).

skin blood flow influence the forehead NIRS data. We

Conflicts of Interest

need to take this phenomenon into account wheninterpreting the data. In this study, the exclusion of

The authors declare no conflict of interest.

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