Successive memory test performance and priming in Alzheimer's disease: evidence from the word-fragment completion task

This study assessed the performance of patients with Alzheimer's disease and healthy controls in a successive memory test paradigm. Subjects studied lists of words. Following study, tests of recognition (an explicit memory task) and primed word fragment completion (an implicit memory task) were administered. Since the same words were used in the two tasks, we were able to calculate the degree of dependence between recognition performance and primed word fragment completion. AD patients evidenced impaired recognition memory. In contrast, priming was intact. The pattern of correlation between the two tasks was similar in healthy controls and in AD. Independence between recognition and fragment completion was obtained when recognition preceded the fragment completion task, but not when fragment completion preceded recognition.     

Role of the frontal lobes in implicit and explicit retrieval tasks

While the role of the frontal lobes in explicit retrieval tasks is well supported, the findings for implicit tasks are less conclusive. We investigated the role of the frontal lobes in perceptual and conceptual implicit priming. Three memory paradigms were given under both implicit and explicit retrieval instructions, using word fragment completion, picture fragment completion and category exemplar generation. Three groups of individuals with frontal lesions were compared to normal controls: Left dorsolateral lesions (n = 5), right dorsolateral lesions (n = 4), and medial lesions (n = 9). Word fragment completion priming was impaired by left dorsolateral lesions, with other priming tests unaffected by any lesion. Explicit performance showed a different pattern, with category exemplar cued recall impaired by left dorsolateral and medial lesions. These findings support the role of the frontal lobes in both implicit and explicit retrieval mechanisms under certain conditions requiring strategy application or lexical retrieval.     

Automatic and controlled uses of memory in Alzheimer's disease

This study used the process-dissociation procedure (Jacoby, 1991) to examine the contribution of automatic and controlled uses of memory to a stem completion task in 16 patients with Alzheimer's disease (AD) and a matched group of healthy elderly subjects (EC). In an inclusion task subjects attempted to use a studied word to complete three-letter word stems, in an exclusion task they were instructed to complete stems with unstudied words. Relative to patients with AD, EC subjects produced more target word completions under inclusion conditions, and less target word completions under exclusion conditions. The probability of the AD group using studied words to complete stems was invariant across inclusion and exclusion conditions. Estimates derived from the process-dissociation calculations, showed that the performance of the AD patients was mediated entirely by automatic uses of memory, whereas for EC subjects controlled and automatic processes codetermined task performance. Both estimates of controlled and to a lesser extent automatic uses of memory were greater for the EC than the AD subjects, indicating that the stem completion impairment in AD may not be entirely attributable to a deficiency in controlled memory processes but also due to reduced automatic processing.     

Sparing of perceptual implicit memory despite suppression of the electrophysiological word repetition effect: a study with general anesthetic isoflurane.

OBJECTIVE: Much effort has been devoted to the search for the neurophysiological correlates of implicit memory. A commonly held view is that the early portion (250-500 ms) of the event-related potential (ERP) word repetition effect reflects processes important for perceptual implicit memory whereas the latter portion reflects processes implicated in explicit memory. It is, however, difficult to disentangle with certainty the relative contributions of each form of memory on ERPs since both forms co-exist in normal subjects. To dissociate ERP effect related to implicit and explicit memory, we used isoflurane sedation in normal subjects to suppress explicit remembering while sparing implicit memory. These ERPs were compared with those of non-medicated control subjects. METHODS: Thirteen subjects performed an incidental encoding task for words presented auditorily during the inhalation of a subanesthetic dose of isoflurane. After termination of isoflurane administration, we assessed free recall and recorded ERPs during a syllable completion task (implicit memory) and during a passive listening task (ERP repetition effect). Eleven non-medicated control subjects were tested in a similar manner. RESULTS: The controls showed robust early and late ERP repetition effect. The isoflurane group had implicit memory without free recall and showed no ERP repetition effect. CONCLUSIONS: These findings failed to show an association between any part of the repetition effect and perceptual implicit memory. The results are consistent with the view that processes linked to explicit memory contribute to the ERP repetition effect since there was a marked difference in free recall between the control and isoflurane groups. SIGNIFICANCE: The present study shows that the reversible alterations of memory by general anesthetics can be used to study the neurophysiological correlates of memory processes.     

Intact haptic priming in normal aging and Alzheimer's disease: evidence for dissociable memory systems

This study is the first to report complete priming in Alzheimer's disease (AD) patients and older control subjects for objects presented haptically. To investigate possible dissociations between implicit and explicit objects representations, young adults, Alzheimer's patients, and older controls performed a speeded object naming task followed by a recognition task. Similar haptic priming was exhibited by the three groups, although young adults responded faster than the two older groups. Furthermore, there was no difference in performance between the two healthy groups. On the other hand, younger and older healthy adults did not differ on explicit recognition while, as expected, AD patients were highly impaired. The double dissociation suggests that different memory systems mediate both types of memory tasks. The preservation of intact haptic priming in AD provides strong support to the idea that object implicit memory is mediated by a memory system that is different from the medial-temporal diencephalic system underlying explicit memory, which is impaired early in AD. Recent imaging and behavioral studies suggest that the implicit memory system may depend on extrastriate areas of the occipital cortex although somatosensory cortical mechanisms may also be involved.     

Implicit and explicit memory in Alzheimer's disease and Parkinson's disease

Several tasks examined implicit and explicit memory in demographically matched samples of Alzheimer's (AD) and Parkinson's disease (PD) patients, and healthy elderly subjects. A fragmented pictures test, word stem-completion repetition priming, and a pursuit-rotor tracking task, followed by explicit memory tests, were given. AD patients were impaired on all explicit tests and on word stem-completion priming, but were intact on pursuit-rotor tracking and the skill learning (SL) component of the fragmented pictures test. PD patients were significantly better than AD patients on all explicit memory tests, but were selectively impaired on the SL component of the fragmented pictures test. Finally, a mirror-reading test was given to the PD patients and control subjects, with no significant differences found in performances between the two groups. Results are discussed in terms of hypothetical cognitive processes and brain circuits underlying different implicit and explicit memory domains.     

Memory bias for health-related information in somatoform disorders

OBJECTIVE: Cognitive processes are considered to be relevant to the etiology and maintenance of somatoform disorders (SFDs). The aim of this study was to assess explicit and implicit information-processing bias for disorder-congruent information in SFDs. METHODS: A clinical sample of 33 patients suffering from multiple somatoform symptoms (SSI-3/5) and 25 healthy controls performed an encoding task with computer-presented word lists (illness related, negative, positive, neutral content), subsequently followed by explicit memory tests (free recall and recognition) and an implicit test (word-stem completion). RESULTS: The somatoform group showed a memory bias for illness-related stimuli in the word-stem completion task, whereas the two groups did not differ in explicit memory tests. This effect could not be explained by comorbid depression. CONCLUSION: These results provide some support for current theories on SFDs.     

A nonmusician with severe Alzheimer’s dementia learns a new song

The hallmark symptom of Alzheimer’s Dementia (AD) is impaired memory, but memory for familiar music can be preserved. We explored whether a non-musician with severe AD could learn a new song. A 91 year old woman (NC) with severe AD was taught an unfamiliar song. We assessed her delayed song recall (24 hours and 2 weeks), music cognition, two word recall (presented within a familiar song lyric, a famous proverb, or as a word stem completion task), and lyrics and proverb completion. NC’s music cognition (pitch and rhythm perception, recognition of familiar music, completion of lyrics) was relatively preserved. She recalled 0/2 words presented in song lyrics or proverbs, but 2/2 word stems, suggesting intact implicit memory function. She could sing along to the newly learnt song on immediate and delayed recall (24 hours and 2 weeks later), and with intermittent prompting could sing it alone. This is the first detailed study of preserved ability to learn a new song in a non-musician with severe AD, and contributes to observations of relatively preserved musical abilities in people with dementia.     

Automatic memory processes in normal ageing and Alzheimer's disease

This study examined the contribution of automatic and controlled uses of memory to stem completion in young, middle-aged and older adults, and compared these data with a study involving patients with Alzheimer's disease (AD) who performed the same task (Hudson and Robertson, 2007). In an inclusion task participants aimed to complete three-letter word stems with a previously studied word, in an exclusion task the aim was to avoid using studied words to complete stems. Performances under inclusion and exclusion conditions were contrasted to obtain estimates of controlled and automatic memory processes using process-dissociation calculations (Jacoby, 1991). An age-related decline, evident from middle age was observed for the estimate of controlled processing, whereas the estimate of automatic processing remained invariant across the age groups. This pattern stands in contrast to what is observed in AD, where both controlled and automatic processes have been shown to be impaired. Therefore, the impairment in memory processing on stem completion that is found in AD is qualitatively different from that observed in normal ageing.     

Implicit and explicit memory in Alzheimer's disease and Parkinson's disease

Abstract

Several tasks examined implicit and explicit memory in demographically matched samples of Alzheimer's (AD) and Parkinson's disease (PD) patients, and healthy elderly subjects. A fragmented pictures test, word stem-completion repetition priming, and a pursuit-rotor tracking task, followed by explicit memory tests, were given. AD patients were impaired on all explicit tests and on word stem-completion priming, but were intact on pursuit-rotor tracking and the skill learning (SL) component of the fragmented pictures test. PD patients were significantly better than AD patients on all explicit memory tests, but were selectively impaired on the SL component of the fragmented pictures test. Finally, a mirror-reading test was given to the PD patients and control subjects, with no significant differences found in performances between the two groups. Results are discussed in terms of hypothetical cognitive processes and brain circuits underlying different implicit and explicit memory domains.     

A dissociation between implicit and explicit verbal memory in left temporal lobe epilepsy

PURPOSE: Temporal lobe epilepsy patients are well known to present deficits on explicit verbal memory procedures (e.g., recall, recognition). The integrity of implicit memory procedures in these patients is not established. Previous studies in this area used implicit memory measures contaminated by the effects of explicit memory. METHODS: We examined the integrity of verbal implicit and explicit memory in left temporal lobe epilepsy (LTLE) patients and hypothesized that a clear dissociation in performance would be found with a relative preservation of implicit memory. TLE patients (n = 15) and age- and education-matched healthy normal patients (n = 15) were shown a 40-word study list, followed by a test phase requiring completion of word stems based on the study words or new/unseen words. Experimental conditions involved instructions to provide either the old (study) words or novel/nonlist words when completing the stem. Measures of automaticity and recollection provided uncontaminated indices of implicit and explicit memory, respectively. RESULTS: The data showed a significant difference (p < 0.001) between the patients (Recollection, 0.12; SD, 0.18) and controls (0.50, SD, 0.15) on the measure of explicit memory. In contrast, the patients (Automaticity, 0.51; SD, 0.11) and controls (0.45, SD, 0.18) performed similarly on the implicit memory measure, with patient scores clearly at normative levels based on other Process Dissociation Procedure data. CONCLUSIONS: The data demonstrate the integrity of implicit memory in LTLE patients. Finding a dissociation between the two forms of verbal memory in LTLE patients provides evidence that they rely on different neuroanatomic systems.     

Memory bias for health-related information in somatoform disorders

ObjectiveCognitive processes are considered to be relevant to the etiology and maintenance of somatoform disorders (SFDs). The aim of this study was to assess explicit and implicit information-processing bias for disorder-congruent information in SFDs.MethodsA clinical sample of 33 patients suffering from multiple somatoform symptoms (SSI-3/5) and 25 healthy controls performed an encoding task with computer-presented word lists (illness related, negative, positive, neutral content), subsequently followed by explicit memory tests (free recall and recognition) and an implicit test (word-stem completion).ResultsThe somatoform group showed a memory bias for illness-related stimuli in the word-stem completion task, whereas the two groups did not differ in explicit memory tests. This effect could not be explained by comorbid depression.ConclusionThese results provide some support for current theories on SFDs.     

Implicit, explicit, and semantic memory functions in Alzheimer's disease and Huntington's disease.

A priming task involving a word-stem completion paradigm was administered to patients with Alzheimer's disease (AD), patients with Huntington's disease (HD), and normal control subjects. The task was done under conditions of both implicit and explicit recall. Explicit and implicit recall were positively correlated in all three groups. After controlling for explicit recall ability through ANCOVA, AD patients were found to be normally susceptible to the effects of priming on implicit recall. HD patients, however, exhibited significantly increased susceptibility to priming, suggesting that they may have carried out the implicit task in a manner different from that of normals and AD patients. In a second experiment, AD patients were found to supply words of significantly lower association strength than the other two groups in a "free association" task using words from a published list of word association norms. This apparent degradation of semantic memory was found to be strongly correlated with explicit recall performance, suggesting that explicit, implicit, and semantic memory functions decline in parallel in AD. Results are discussed with respect to the difficulties inherent in attempts to demonstrate selective impairments of conceptually distinct forms of memory.     

Assessment of nondeclarative learning in severe Alzheimer dementia: the Implicit Memory Test (IMT)

Although patients with Alzheimer dementia (AD) have impaired explicit memory, more automatic, implicit aspects of learning and memory may be relatively preserved. However, neuropsychological tests for the assessment of implicit memory are lacking. This study examines a newly developed test, the Implicit Memory Test, in 28 patients with severe AD (mini-mental state examination 5 to 12) and 22 cognitively unimpaired matched controls (mini-mental state examination 25 to 29). The Implicit Memory Test consists of visually presented word (stem-completion) and picture (fragmented picture identification) subtests, each comprising 3 learning trials and a delayed test. Explicit memory was also assessed, using the verbal paired-associate learning subtest from the Wechsler Memory Scale and the Visual Association Test. Patients with AD obtained a floor performance on both explicit memory tests, whereas a significant learning curve was found for both the stem-completion and the fragmented pictures subtests of the Implicit Memory Test. Delayed testing on the fragmented pictures subtest showed a preserved performance that may have been mediated by implicit learning. Delayed performance on the stem-completion subtest, however, showed clear memory decay that suggests contamination by explicit memory function, at least in the controls. These findings extend the earlier results on word-stem completion and fragmented picture identification in patients with mild-to-moderate AD and indicate that residual learning capacity can be assessed in severe AD.     

Impaired production priming and intact identification priming in Alzheimer's disease.

This study examined the distinction between identification and production processes in repetition priming for 16 patients with Alzheimer's disease (AD) and 16 healthy old control participants (NC). Words were read in three study phases. In three test phases, participants (1) reread studied words, along with unstudied words, in a word-naming task (identification priming); (2) completed 3-letter stems of studied and unstudied words into words in a word-stem completion task (production priming); and (3) answered yes or no to having read studied and unstudied words in a recognition task (explicit memory). Explicit memory and word-stem completion priming were impaired in the AD group compared to the NC group. After correcting for baseline slowing, word-naming priming magnitude did not differ between the groups. The results suggest that the distinction between production and identification processes has promise for explaining the pattern of preservation and failure of repetition priming in AD.     

INS Workshop program Antwerp,Belguium July 5, 1989

Abstract

While patients with Huntington's disease (HD) and Korsakoff's syndrome (KS) demonstrate “preserved” performance on implicit word-stem completion tasks, patients with Alzheimer's disease (AD) are typically found to be impaired. It has been hypothesized that AD patients do poorly as a result of degenerative changes in posterior cortoil association areas thought to mediate performance on this type of implicit memory task, and that the relative sparing of these areas in KS and HD results in their “preserved” performance. The present study was undertaken to examine the implicit memory performance of AD patients on this task after equating their explicit performance to that of normal controls by manipulating the number of encoding exposures. When this was accomplished, the implicit memory performance of AD patients was equivalent to that of controls. The results are discussed within the context of a critical review of the evidence for the existence of separable neural systems in mediating implicit and explicit memory.     

A comparison of implicit memory tasks in Korsakoff and alcoholic patients

Korsakoff patients generally perform at a normal level on implicit memory tasks in contrast to explicit memory tasks. While this difference is sometimes explained in terms of different memory systems underlying the tasks, the different roles of perceptual and conceptual/semantic processes in these tasks have also been emphasized: explicit tasks require mainly conceptual/semantic processes and implicit tasks are based principally on perceptual processes. However, it has been suggested recently that conceptual/semantic processes may also be involved in some implicit memory tasks (e.g. a Free Association task). Therefore, the performance of Korsakoff and alcoholic patients is here compared in three implicit memory tasks (Stem Completion, Word Identification and Free Association) and one explicit memory task (Cued Recall), allowing us to disentangle what really matters: the nature of the task (implicit or explicit), or the underlying processes (perceptual or conceptual/semantic). The results show only semantic priming in the Free Association and Cued Recall tasks of the alcoholic patients, suggesting that Korsakoff patients have problems particularly with conceptually-driven processing. The implicit or explicit nature of the memory task is not critical.     

Normal mere exposure effect with impaired recognition in Alzheimer's disease

We investigated the mere exposure effect and the explicit memory in Alzheimer's disease (AD) patients and elderly control subjects, using unfamiliar faces. During the exposure phase, the subjects estimated the age of briefly flashed faces. The mere exposure effect was examined by presenting pairs of faces (old and new) and asking participants to select the face they liked. The participants were then presented with a forced-choice explicit recognition task. Controls subjects exhibited above-chance preference and recognition scores for old faces. The AD patients also showed the mere exposure effect but no explicit recognition. These results suggest that the processes involved in the mere exposure effect are preserved in AD patients despite their impaired explicit recognition. The results are discussed in terms of Seamon et al.'s (1995) proposal that processes involved in the mere exposure effect are equivalent to those subserving perceptual priming. These processes would depend on extrastriate areas which are relatively preserved in AD patients.     

Implicit and explicit memory for spatial information in Alzheimer's disease

There is abundant evidence that memory impairment in dementia in patients with Alzheimer's disease (AD) is related to explicit, conscious forms of memory, whereas implicit, unconscious forms of memory function remain relatively intact or are less severely affected. Only a few studies have been performed on spatial memory function in AD, showing that AD patients' explicit spatial memory is impaired, possibly related to hippocampal dysfunction. However, studies on implicit spatial memory in AD are lacking. The current study set out to investigate implicit and explicit spatial memory in AD patients (n=18) using an ecologically valid computer task, in which participants had to remember the locations of various objects in common rooms. The contribution of implicit and explicit memory functions was estimated by means of the process dissociation procedure. The results show that explicit spatial memory is impaired in AD patients compared with a control group (n=21). However, no group difference was found on implicit spatial function. This indicates that spared implicit memory in AD extends to the spatial domain, while the explicit spatial memory function deteriorates. Clinically, this finding might be relevant, in that an intact implicit memory function might be helpful in overcoming problems in explicit processing.     

Attentional and memory bias in persecutory delusions and depression

BACKGROUND: Previous research has indicated that persecutory delusions and depression may share similar cognitive biases at implicit levels of processing, but differentiate at explicit levels, supporting the theory that paranoia may have a protective function against underlying negative schemata. The study aimed to investigate attentional bias and both implicit and explicit memory biases for personally salient and standardised emotional stimuli in persecutory delusions and depression. SAMPLING: 36 participants, with 12 in each group, were interviewed in order to generate personally salient stimuli to be employed within the cognitive tests. Standardised emotional stimuli were additionally employed as a control. Participants completed two probe detection tasks, one including personally salient stimuli and one including standard emotional stimuli. Memory for the stimuli presented in this task was assessed by a free recall task (explicit memory) followed by a word completion task (implicit memory). RESULTS: On an implicit memory task, both the deluded and depressed groups displayed comparable retrieval of positive and negative words. However, on the explicit memory task, the depressed group demonstrated a bias for negative stimuli, whereas the deluded group demonstrated a bias for positive stimuli. The groups did not demonstrate an attentional bias for personally salient information. However, an attentional bias for standardised emotional stimuli was found in the depressed group, although this was not specific to either negative or positive stimuli. CONCLUSION: The results indicate that depression and persecutory delusions may share similar patterns of processing at an implicit level but differentiate at the explicit level, which may be indicative of cognitive avoidance of threatening stimuli in psychosis. However, this does not seem to be a feature of automatic attentional processes in people with persecutory delusions. Implications for further research are discussed.