Memory for familiar environments learned in the remote past: fMRI studies of healthy people and an amnesic person with extensive bilateral hippocampal lesions

Preserved remote spatial memory in amnesic people with bilateral hippocampal damage, including the well-studied case K.C., challenges spatial theories, which assume that the hippocampus is needed to support all allocentric spatial representations, old or new. It remains possible, however, that residual hippocampal tissue is functional and contributes to successful performance. Here, we examine brain activity with fMRI during the retrieval of spatial information in K.C. and in healthy controls using landmark and route stimuli from a premorbidly familiar neighborhood that K.C. can navigate normally. In all participants, activity was found in the parahippocampal cortex, but not in the hippocampus itself, during all navigational tasks on which K.C. performs well, even though part of his hippocampus remains viable. The opposite pattern was observed on a house recognition task, which is inconsequential to navigation, and on which K.C. performed poorly. On that task, K.C. recruited the right hippocampus presumably because even "familiar" houses were treated as novel by him, whereas controls recruited occipitotemporal cortex, including parahippocampal cortex. The distinction between recent and remote memory, therefore, may apply as much to spatial theories of hippocampal function as it does to theories emphasizing the role of the hippocampus in other types of explicit memory.