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.     

Preserved priming but insensitivity to perceptual fluency on recognition judgments in Alzheimer's disease

Background: Previous research on Alzheimer's disease (AD) has not yielded a consensus regarding the preservation of automatic memory processes, although there is a consensus that conscious recollection processes are impaired in AD. Methods: In the present study, we examined perceptual specificity effects (PSEs) in word recognition judgments (explicit memory task; Experiment 1) and word fragment completion (implicit memory task; Experiment 2) performed by individuals with mild AD and elderly adults without dementia (controls). Results: In recognition judgments, control subjects, but not individuals with AD, demonstrated PSEs (Experiment 1). In contrast, neither group showed PSEs on word fragment completion and their priming magnitudes were comparable (Experiment 2). Conclusions: The findings suggest that perceptually automatic processes in explicit memory judgments and implicit memory processes are different and that the former are specifically impaired in AD.     

Memory dissociation and metamemory in multiple sclerosis

A previous study by Scarrabelotti and Carroll [60] was the first to use Jacoby's process dissociation procedure [31] with an MS group to investigate memory function, and the first to obtain metamemory judgments about recall under inclusion and exclusion instructions. Twelve months later using different words, 49 MS and 39 matched controls were readministered a word stem completion task, and made metamemory judgments about their performance. The California Verbal Learning Test (CVLT) [18], Stroop [64], and Reitan's Word Finding Test (WFT) [57], tests considered to particularly rely on conscious processing, were also readministered. At year one testing no group differences were identified in word stem completion under indirect, inclusion, or exclusion instructions, nor in conscious and automatic estimates. By contrast in year two, MS subjects remembered significantly fewer words under inclusion, and employed significantly less conscious processing than the control group to achieve remembering. However, estimates of automatic memory processing were the same for both groups. MS subjects equalled controls in the prospective and retrospective monitoring of words they consciously recalled under inclusion instructions, in both years. By contrast, each group was poor at monitoring words completed automatically under exclusion instructions; and by year two, MS subjects were even less able to monitor such material than controls. Finally by the second year, reduced conscious processing was also related to reduced performance on the Stroop, WFT, and CVLT recall and use of semantic clustering. Taken together, these findings indicate that automatic memory processing is intact in MS, but impairment in memory, metamemory, and other cognitive tasks becomes evident over time when they rely on conscious processes.     

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.     

Word-stem completion task to investigate semantic network in patients with Alzheimer''s disease

Semantic impairment in patients with Alzheimer's disease (AD) is revealed by tasks of verbal naming, verbal fluency, and semantic knowledge. Causes of the deficit remain unclear in spite of many studies to investigate whether AD patients suffer from the inability to have voluntary access to an almost intact semantic store or from its break down. Word-stem completion (WSC) tasks have been utilized in healthy subjects in order to study semantic memory and network by exploiting the possibility of the involuntary access to them. Available conflicting data refer to the presence of semantic prime in AD patients. To explore the semantic network in AD, patients were requested to complete with the first word that sprang to their mind a stem submitted immediately after presentation of the word prime, as a WSC task. Stems consisted of the three beginning letters of words that were semantically related to primes. We compared data obtained with this task from patients with mild to moderate AD with those from normal controls (NC). AD patients completed less stems (P<0.001) with the expected words than NC, suggesting a break down of the semantic network rather than a deficit in the access to the semantic store.     

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.     

The neural substrates of visual implicit memory: do the two hemispheres play different roles?

Identification of visually presented words is facilitated by implicit memory, or visual priming, for past visual experiences with those words. There is disagreement over the neuro-anatomical substrates of this form of implicit memory. Several studies have suggested that this form of priming relies on a visual word-form system localized in the right occipital lobe, whereas other studies have indicated that both hemispheres are equally involved. The discrepancies may be related to the types of priming tasks that have been used because the former studies have relied primarily on word-stem completion tasks and the latter on tasks like word-fragment completion. The present experiments compared word-fragment and word-stem measurements of visual implicit memory in patients with right occipital lobe lesions and patients with complete callosotomies. The patients showed normal visual implicit memory on fragment completion tests, but essentially no visual priming on standard stem completion tests. However, when we used a set of word stems that had only one correct solution for each test item, as was true of the items in the fragment completion tests, the patients showed normal priming effects. The results indicate that visual implicit memory for words is not solely dependent upon the right hemisphere, rather it reflects changes in processing efficiency in bilateral visual regions involved in the initial processing of the items. However, under conditions of high lexical competition (i.e., multiple completion word stems), the lexical processes, which are dominant in the left hemisphere, overshadow the visual priming supported by the left hemisphere.     

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.     

The use of indirect and opposition tests to detect simulated amnesia

Two experiments investigated the effect of instruction to simulate memory impairment on performance on a word stem completion task. In addition to the standard control group, a second control group (divided-attention group) studied the target words concurrently with a digit-monitoring task. Experiment 1, using the indirect instruction, did not discriminate clearly between the groups. Experiment 2 used the opposition instruction in which participants were required to complete stems with words they had not seen earlier. It showed that simulators and controls withheld significantly more studied target items than did the divided-attention group. Increasing the number of study list presentations further increased the difference between the performance of the simulating and control groups and the divided-attention group. These results suggest that the opposition method may be useful in detecting feigned memory impairment.     

Brain regions associated with episodic retrieval in normal aging and Alzheimer's disease.

OBJECTIVE: To examine patterns of brain activation during verbal episodic retrieval in normal elderly subjects and patients in an early phase of AD. BACKGROUND: It is established that 1) a profound episodic memory impairment is a cardinal symptom of AD; and 2) some of the earliest brain changes in this disease occur in regions critical to episodic memory, such as the hippocampus and neighboring regions. Yet, it remains largely unknown whether the episodic memory deficit seen in AD is paralleled by concomitant alterations in brain activity during actual task performance in these or other brain areas. METHODS: Using PET, blood flow was assessed in normal elderly subjects and patients with early AD during two retrieval conditions involving completion of word stems: baseline and cued recall. RESULTS: The patients with AD showed a marked performance deficit in cued recall, although the two groups were indistinguishable in the baseline task condition. Both groups showed bilateral activity in orbital and dorsolateral prefrontal cortex, left precuneus, and right cerebellum, as well as decreased activity in distinct left temporal regions during cued recall. The normal elderly alone activated the left parietal cortex and the left hippocampal formation during episodic retrieval. By contrast, AD-related increases in activity during cued recall were observed in the left orbital prefrontal cortex and left cerebellum. CONCLUSIONS: The similar patterns of activations in the two groups suggest that a large distributed network involved in episodic memory retrieval functions relatively normally in early AD. Those retrieval activations seen in the normal elderly, as opposed to the patients, may reflect AD-related failures in semantic processing and successful recollection of the target information, respectively. Finally, the AD-related increases in activity were interpreted in terms of compensatory reactions to the difficulties in performing the episodic memory task.     

Pupillary Responses Evoked during Verbal Fluency Tasks Indicate Semantic Network Dysfunction in Schizophrenia

Pupillary responses, which index task controlled processing load, were recorded during semantic and phonemic fluency tasks to examine controlled search and automatic semantic network deficits in patients with schizophrenia. Word retrieval was more impaired on semantic than on phonemic fluency, but only during the first 15 seconds of trials. Pupillary dilation was greater on phonemic than on semantic fluency in nonpsychiatric participants but was greater on semantic than on phonemic fluency in the patients, during the first 15 seconds of trials. Thus, early in semantic fluency trials, patients with schizophrenia showed poorer word retrieval and abnormally high demand for frontal lobe controlled search processes, suggesting impairments in the temporal lobe automatic semantic memory processes that normally facilitate word retrieval.     

Pupillary responses evoked during verbal fluency tasks indicate semantic network dysfunction in schizophrenia.

Pupillary responses, which index task controlled processing load, were recorded during semantic and phonemic fluency tasks to examine controlled search and automatic semantic network deficits in patients with schizophrenia. Word retrieval was more impaired on semantic than on phonemic fluency, but only during the first 15 seconds of trials. Pupillary dilation was greater on phonemic than on semantic fluency in nonpsychiatric participants but was greater on semantic than on phonemic fluency in the patients, during the first 15 seconds of trials. Thus, early in semantic fluency trials, patients with schizophrenia showed poorer word retrieval and abnormally high demand for frontal lobe controlled search processes, suggesting impairments in the temporal lobe automatic semantic memory processes that normally facilitate word retrieval.     

Neural correlates of word-stem priming

The purpose of this study was to identify the neural correlates of implicit memory in a word-stem completion task. Given that both explicit and implicit retrieval tend to occur in this type of memory task, conventional analyses of old/new event-related potential effects are equivocal. To overcome this problem, depth of processing was manipulated and subjective awareness measured. From 400 ms poststimulus, event-related potentials evoked by stems completed with studied words were more positive than those evoked by stems completed with unstudied items. This difference was maximal at parietooccipital electrode sites. Event-related potentials were not modulated by either depth of processing or awareness. Behavioral and event-related potential data converged to indicate that the old/new effect reflects processes either contributing to, or contingent upon, implicit memory retrieval.     

Lexical and semantic priming deficits in patients with Alzheimer's disease

Two experiments utilizing priming procedures examined the status of semantic memory in demented and amnesic patients. In the first investigation, lexical priming was assessed in patients with dementia of the Alzheimer type (DAT), Huntington's Disease (HD), alcoholic Korsakoff's syndrome (KS), and in intact control subjects. Subjects were first exposed to a list of words in a rating task and then required to complete three-letter stems with the "first word that comes to mind". Half of the stems could be completed with the previously presented words and the other half were used to assess baseline guessing rates. Recall and recognition of incidentally exposed words was also assessed. Although all three patient groups were impaired on tests of recall and recognition, only the DAT patients exhibited a priming deficit on the stem-completion task. In the second experiment, DAT, HD, and intact control subjects were administered a semantic priming test which required the subject to "free associate" to the first words of previously presented semantically associated word pairs. The results for this association task showed that DAT patients were significantly less likely to produce the second word of the semantically related pair than were the other subject groups. The results of these two experiments suggest that the memory capacities of DAT patients are characterized by a breakdown in the structure of semantic memory and that this impairment is evident on some "automatic" as well as "effortful" processing tasks.     

Auditory priming within and across modalities: evidence from positron emission tomography.

Previous neuroimaging studies of perceptual priming have reported priming-related decreases in the extrastriate cortex. However, because these experiments have used visual stimuli, it is unclear whether the observed decreases are associated specifically with some aspect of visual perceptual processing or with more general aspects of priming. We studied within- and cross-modality priming using an auditory word stem completion paradigm. Positron emission tomography (PET) images were obtained during stem completion and a fixation task. Within-modality auditory priming was associated with blood flow decreases in the extrastriate cortex (bilateral), medial/right anterior prefrontal cortex, right angular gyrus, and precuneus. In cross-modality priming, the study list was presented visually, and subjects completed auditory word stems. Cross-modality priming was associated with trends for blood flow decreases in the left angular gyrus and increases in the medial/right anterior prefrontal cortex. Results thus indicate that reduced activity in the extrastriate cortex accompanies within-modality priming in both visual and auditory modalities.     

Dissociation of memory and awareness in young and older adults

Young (mean age = 23.41 years) and older (mean age = 69.41 years) adults studied a list of 80 words. They were tested immediately and 7 days later for both yes/no recognition and for ability to complete fragments such as E D L M, with words, some of which had been studied previously. The fragment completion task was not described as a memory test and subjects were encouraged to respond to all word fragments. Younger adults scored higher on recognition than older adults but not on fragment completion. These results, similar to those obtained with amnesics, suggest that older adults are impaired on tasks which require a conscious effort to recognize an event but that memory without awareness is unaffected by age.     

The neural basis of perceptual and conceptual word priming--a PET study

Positron emission tomography scans were obtained in 13 normal subjects during perceptual and conceptual word priming tasks with the aim to investigate the neural system specific to the two priming conditions. In the prescan phase, subjects were primed perceptually or conceptually with two separate procedures, while in the scan phase, they performed the same stem completion task. Therefore we could compare the results of the two priming tasks in a direct manner. A fixation control task and a baseline task (completion of stems that did not correspond to previously seen words) were also given. A specific blood flow decrease was found in the left inferior temporal cortex in the perceptual word priming condition and in the left superior temporal / inferior parietal cortex in the conceptual word priming condition. Each blood flow change may reflect transient changes in the cortical areas subserving the processing of the perceptual and conceptual components of word priming.     

Dissociation of memory and awareness in young and older adults

Abstract

Young (mean age=23.41 years) and older (mean age=69.41 years) adults studied a list of 80 words. They were tested immediately and 7 days later for both yes/no recognition and for ability to complete fragments such as _E_D_L_M, with words, some of which had been studied previously. The fragment completion task was not described as a memory test and subjects were encouraged to respond to all word fragments. Younger adults scored higher on recognition than older adults but not on fragment completion. These results, similar to those obtained with amnesics, suggest that older adults are impaired on tasks which require a conscious effort to recognize an event but that memory without awareness is unaffected by age.     

Visual word stem completion priming within and across modalities: a PET study.

Using positron emission tomography, we studied changes in the regional cerebral blood flow (rCBF) associated with cross modality (auditory to visual) and within modality visual priming in a word stem completion task. Compared to baseline completion performance and to within modality visual priming, cross modality priming was associated with increased rCBF in prefrontal cortex and decreased rCBF in the left angular gyrus. The results confirm and complement trends observed in a previous study concerning visual to auditory cross modality priming, and suggest that distinct cortical mechanisms may mediate within- and cross modality priming on the stem completion task. The findings are consistent with the neuropsychological data concerning auditory to visual cross modality priming, and indicate involvement of aspects of explicit retrieval and lexical processes in cross modality priming.     

Perseverations in Alzheimer's disease: Memory slips?

Previous studies of verbal fluency tasks reported higher rates of repeated responses in Alzheimer's disease (AD) compared to elderly controls. The present investigation aimed at determining if perseverations are caused by word retrieval deficits or working memory deficits, both of which are commonly observed in AD. Based on current theories of lexical processing and working memory, we derived specific predictions concerning the lag between the first occurrence of a word and its repetition. With word retrieval deficits, repetitions are expected to be progressively less frequent at greater lags; conversely, with working memory deficits, repetitions should occur especially after long lags. These predictions were tested analyzing the performance of 392 AD individuals in verbal fluency tasks. The finding of lags that were significantly longer than would be expected by chance is consistent with the hypothesis that perseverations are primarily caused by working memory deficits. Specifically, we propose that perseverations stem from an impairment affecting the working memory mechanisms that control response monitoring. We also investigated the relationship between perseverations and other cognitive deficits observed in AD. We discuss the implications of our findings for understanding the nature of perseverations, the effects of working memory deficits in AD, and the neural correlates of working memory components.