Functional focal retrograde amnesia: lost access to abstract autobiographical knowledge?

We describe three patients exhibiting an acute reversible amnesia characterised by an impaired recollection of past events with preserved anterograde memory, thus consistent with a focal retrograde amnesia (FRA). This occurred after variable events: state of fugue, road accident, post-traumatic headache. Retrograde amnesia affected autobiographical memory so severely as to cover all of the patients' lives and to erase knowledge of their own identity. The retrieval of public events was variably affected, ranging from normality to severe impairment. No lesions were found on neuroimaging, and neurophysiological findings were unimpressive. FRA subsided in a few days, leaving a gap for the onset. The hypothesis of a psychogenic amnesia is considered, but overcoming the organic/psychogenic dichotomy the episodes appear as examples of "functional" memory inhibition, potentially triggered by different conditions, including events classifiable as psychic trauma. The clinical and neuropsychological traits of functional FRA are discussed. According to a current theory of autobiographical memory, the memory profile may be explained by a lost access to abstract autobiographical knowledge. Given some analogies with the more common transient global amnesia, a mechanism of spreading depression may also be hypothesised for functional FRA.     

Functional focal retrograde amnesia: Lost access to abstract autobiographical knowledge?

We describe three patients exhibiting an acute reversible amnesia characterised by an impaired recollection of past events with preserved anterograde memory, thus consistent with a focal retrograde amnesia (FRA). This occurred after variable events: state of fugue, road accident, post-traumatic headache. Retrograde amnesia affected autobiographical memory so severely as to cover all of the patients' lives and to erase knowledge of their own identity. The retrieval of public events was variably affected, ranging from normality to severe impairment. No lesions were found on neuroimaging, and neurophysiological findings were unimpressive. FRA subsided in a few days, leaving a gap for the onset. The hypothesis of a psychogenic amnesia is considered, but overcoming the organic/psychogenic dichotomy the episodes appear as examples of “functional” memory inhibition, potentially triggered by different conditions, including events classifiable as psychic trauma. The clinical and neuropsychological traits of functional FRA are discussed. According to a current theory of autobiographical memory, the memory profile may be explained by a lost access to abstract autobiographical knowledge. Given some analogies with the more common transient global amnesia, a mechanism of spreading depression may also be hypothesised for functional FRA.     

Persistent autobiographical amnesia: a case report

We describe a 47-year-old man who referred to the Emergency Department for sudden global amnesia and left mild motor impairment in the setting of increased arterial blood pressure. The acute episode resolved within 24 hours. Despite general recovery and the apparent transitory nature of the event, a persistent selective impairment in recollecting events from some specific topics of his personal life became apparent. Complete neuropsychological tests one week after the acute onset and 2 months later demonstrated a clear retrograde memory deficit contrasting with the preservation of anterograde memory and learning abilities. One year later, the autobiographical memory deficit was unmodified, except for what had been re-learnt. Brain MRI was normal while H20 brain PET scans demonstrated hypometabolism in the right globus pallidus and putamen after 2 weeks from onset, which was no longer present one year later. The absence of a clear pathomechanism underlying focal amnesia lead us to consider this case as an example of functional retrograde amnesia.     

The anatomy of amnesia: neurohistological analysis of three new cases

The most useful information about the anatomy of human memory comes from cases where there has been extensive neuropsychological testing followed by detailed post-mortem neurohistological analysis. To our knowledge, only eight such cases have been reported (four with medial temporal lobe damage and four with diencephalic damage). Here we present neuropsychological and post-mortem neurohistological findings for one patient (NC) with bilateral damage to the medial temporal lobe and two patients (MG, PN) with diencephalic damage due to bilateral thalamic infarction and Korsakoff's syndrome, respectively. All three patients exhibited a similar phenotype of amnesia with markedly impaired declarative memory (anterograde and retrograde) but normal performance on tests of nondeclarative memory (e.g., priming and adaptation-level effects) as well as on tests of other cognitive functions. Patient NC had damage to the hippocampus (dentate gyrus and the CA1 and CA3 fields) and layer III of the entorhinal cortex, but with relative sparing of the CA2 field and the subiculum. Patient MG had damage to the internal medullary lamina and mediodorsal thalamic nuclei. Patient PN had damage to the mammillary nuclei, mammillothalamic tracts, and the anterior thalamic nuclei. These findings illuminate several issues regarding the relation between diencephalic and medial temporal lobe amnesia, the status of recognition memory in amnesia, and the neuroanatomy of memory.     

逆行性遗忘、额叶与远期记忆的组织

通过对一例严重记忆障碍合并额叶损伤病人的逆行性遗忘的分析,对远期记忆的组织特点进行了探讨。被试的额叶功能受损较为明显。除顺行性遗忘外,患者的逆行性遗忘也较为严重。对病人进行的逆行性遗忘检测包括：著名人物测验、著名事件、一般知识测验和自传性记忆测验等。被试对著名人物、著名事件的回忆和再认成绩、以及有关个人的情节和语义记忆成绩均较低,但没有典型的随时间下降的趋势,而是呈平直斜率;患者儿童期的自传性记忆和公众事件记忆也受损。这两个特点均与内侧颞叶一间脑系统损伤的特点不同,提示额叶参与了远期记忆的提取等过程。     

Neuropsychological consequences of right thalamic haemorrhage: case study and review

The neuropsychological performance of a right-handed man is examined following haemorrhage from the anterior sections of the right thalamus. A pattern of temporally graded retrograde amnesia, global anterograde amnesia, impaired short-term memory, behavioural changes, and severe executive deficits were identified. The deficits evident in this case are discussed in reference to existing neuropsychological literature regarding the consequences of thalamic infarction. It is proposed that damage to the anterior thalamic nuclei results in a frontal dysexecutive syndrome and that such a dysexecutive syndrome can explain the neuropsychological deficits observed in this case.     

Preserved ability to recognize keywords related to remote events in the absence of retrieval of relevant knowledge: a case of postencephalitic amnesia

We describe a case of severe anterograde and retrograde amnesia resulting from herpes simplex encephalitis. Magnetic resonance imaging revealed pathological changes in the bilateral hippocampi, parahippocampal gyri, fusiform gyri, medial temporal poles, posterior part of the cingulate gyri, and insula. The patient showed severe amnesia for autobiographical episodic memory in relation to events that had occurred throughout her life, but temporally graded amnesia for autobiographical semantic memory, and severe amnesia without a temporal gradient for public events and famous people. However, using a multiple-choice method, she showed a high level of accuracy when choosing keywords related to public or personal events, although this did not prompt her recollection of the events. An important indication of these results is that, even with severe retrograde amnesia, memories of past events are not completely lost. We propose that an event may be stored in a fragmented form, consisting of many components, and that normal recall of an event may require recombination or reconstruction of these components.     

Retrograde amnesia in patients with hippocampal, medial temporal, temporal lobe, or frontal pathology

There is considerable controversy concerning the theoretical basis of retrograde amnesia (R.A.). In the present paper, we compare medial temporal, medial plus lateral temporal, and frontal lesion patients on a new autobiographical memory task and measures of the more semantic aspects of memory (famous faces and news events). Only those patients with damage extending beyond the medial temporal cortex into the lateral temporal regions showed severe impairment on free recall remote memory tasks, and this held for both the autobiographical and the more semantic memory tests. However, on t-test analysis, the medial temporal group was impaired in retrieving recent autobiographical memories. Within the medial temporal group, those patients who had combined hippocampal and parahippocampal atrophy (H+) on quantified MRI performed somewhat worse on the semantic tasks than those with atrophy confined to the hippocampi (H-), but scores were very similar on autobiographical episodic recall. Correlational analyses with regional MRI volumes showed that lateral temporal volume was correlated significantly with performance on all three retrograde amnesia tests. The findings are discussed in terms of consolidation, reconsolidation, and multiple trace theory: We suggest that a widely distributed network of regions underlies the retrieval of past memories, and that the extent of lateral temporal damage appears to be critical to the emergence of a severe remote memory impairment.     

Understanding anterograde amnesia: Disconnections and hidden lesions

Three emerging strands of evidence are helping to resolve the causes of the anterograde amnesia associated with damage to the diencephalon. First, new anatomical studies have refined our understanding of the links between diencephalic and temporal brain regions associated with amnesia. These studies direct attention to the limited numbers of routes linking the two regions. Second, neuropsychological studies of patients with colloid cysts confirm the importance of at least one of these routes, the fornix, for episodic memory. By combining these anatomical and neuropsychological data strong evidence emerges for the view that damage to hippocampal—mammillary body—anterior thalamic interactions is sufficient to induce amnesia. A third development is the possibility that the retrosplenial cortex provides an integrating link in this functional system. Furthermore, recent evidence indicates that the retrosplenial cortex may suffer “covert” pathology (i.e., it is functionally lesioned) following damage to the anterior thalamic nuclei or hippocampus. This shared indirect “lesion” effect on the retrosplenial cortex not only broadens our concept of the neural basis of amnesia but may also help to explain the many similarities between temporal lobe and diencephalic amnesia.     

EPS Mid-Career Award 2006. Understanding anterograde amnesia: disconnections and hidden lesions

Three emerging strands of evidence are helping to resolve the causes of the anterograde amnesia associated with damage to the diencephalon. First, new anatomical studies have refined our understanding of the links between diencephalic and temporal brain regions associated with amnesia. These studies direct attention to the limited numbers of routes linking the two regions. Second, neuropsychological studies of patients with colloid cysts confirm the importance of at least one of these routes, the fornix, for episodic memory. By combining these anatomical and neuropsychological data strong evidence emerges for the view that damage to hippocampal-mammillary body-anterior thalamic interactions is sufficient to induce amnesia. A third development is the possibility that the retrosplenial cortex provides an integrating link in this functional system. Furthermore, recent evidence indicates that the retrosplenial cortex may suffer "covert" pathology (i.e., it is functionally lesioned) following damage to the anterior thalamic nuclei or hippocampus. This shared indirect "lesion" effect on the retrosplenial cortex not only broadens our concept of the neural basis of amnesia but may also help to explain the many similarities between temporal lobe and diencephalic amnesia.     

Remote Memory Function and Dysfunction in Korsakoff’s Syndrome

Korsakoff's syndrome (KS) is a pervasive disorder of memory characterized by both anterograde and retrograde amnesia. Although retrograde memory impairment in KS has been less frequently studied, the status of remote memory in KS has been tested across a number of different tasks that measure knowledge of public information (e.g., famous faces/news events), general semantic information (e.g., vocabulary words), personal semantic information (e.g., facts about oneself), and autobiographical events (e.g., events from one's personal past). In each of these domains, Korsakoff patients demonstrate remote memory impairments that can extend back many years or decades. In addition, a majority of studies report that the extensive remote memory impairment in KS is temporally graded, with relative preservation of memories from childhood and early adulthood. The current paper reviews published experimental studies of remote memory in KS, with particular attention paid to (a) the selectivity of the deficit with respect to the age of the memory and (b) the relationship of memory impairment to underlying neuropathology. We discuss the significance of the reported pattern and extent of remote memory impairment with respect to theories about the nature of the underlying cognitive deficits in KS.     

Transient global amnesia

Transient global amnesia (TGA) is a memory dysfunction characterized by a sudden onset of dense anterograde amnesia (AA) that gradually resolves across several hours. TGA is typically accompanied by repeated questions (concerning present circumstances) with retrograde amnesia for events preceding the attack, and it usually strikes individuals in their late 50s and early 60s. The etiology of TGA remains unclear, although it probably reflects a temporary disruption of the blood supply to the temporal lobe. The physical and psychological events preceding the attack are diverse, but they often include acute emotional and physical stressors. TGA appears to be benign, with low risk for recurrence or residual complications. While systematic memory research on TGA patients is rare, these individuals present a unique opportunity to study amnestic behaviors in otherwise normal individuals. A guide to conducting future research is provided.     

Exploring mechanisms that affect retrograde memory for public events in amnestic mild cognitive impairment: A longitudinal update

Here, we examined mechanisms that affect retrograde memory in amnestic mild cognitive impairment (a-MCI) as a function of longitudinal clinical outcome. 8 a-MCI who converted to Alzheimer's dementia (AD) during the subsequent 3-year follow-up (converter a-MCI) and 10 a-MCI who remained clinically stable during the same period (stable a-MCI) were compared at the baseline evaluation (i.e., when they were diagnosed as a-MCI) using a remote memory questionnaire for public events that allows disentangling the differential contribution of storage and retrieval mechanisms to performance accuracy. Results suggest that deficits in remote memory are primarily explained by impaired retrieval abilities in stable a-MCI and by impaired storage in converter-to-AD a-MCI. This distinction between retrograde amnesia due to defective trace utilisation in stable a-MCI and trace storage in converter a-MCI is consistent with the temporal unfolding of declining anterograde memory over the course of disease progression to AD.     

The retrieval hypothesis as an explanation of induced retrograde amnesia

The present experiment tested the hypothesis that retrograde induced amnesia is due to retrieval failure and anterograde induced amnesia to encoding failure by providing recall cues which were expected to eliminate retrograde amnesia but worsen or have no effect on anterograde amnesia. The 80 subjects received auditory presentation of 10 lists, each composed of 15 four-letter words presented at a rate of 2s/item at 75 dB in a free-recall task, followed by a 72 s recall period. The amnesia-producing event was an outstanding item in serial position 8 presented at 115 dB (about the intensity of a loud shout) on half the lists. During the first half of the recall period subjects free-recalled, but during the last half they were given a list of the first (single cue) or the first two (double cue) letters of each word, to be used as aids to recall. To demonstrate induced amnesia, lists containing a loud item were compared to those not containing one. First half free recall performance indicated that large retrograde and anterograde effects were present for both cue conditions. Second half cued recall performance indicated that in the double cue condition retrograde amnesia disappeared and anterograde amnesia became larger. Cueing had much smaller effects in the single cue condition.     

The effects of lesions to the rat hippocampus or rhinal cortex on olfactory and spatial memory: retrograde and anterograde findings

The role of the hippocampal system in retrograde and anterograde amnesia was investigated by using a novel olfactory-guided paradigm and a traditional test of spatial learning. In the retrograde study, rats were trained on a sequence of two-choice olfactory discriminations in the weeks prior to receiving neurotoxic lesions of the hippocampus or aspiration lesions of the perirhinal-entorhinal cortex. Memory tests for preoperatively learned discriminations revealed no statistical impairment for subjects with damage to the hippocampus on a problem learned remote in time from surgery (i.e., 4 weeks +) or on the two recently learned discriminations (i.e., 1–3 weeks prior to surgery). The performance of subjects with perirhinal-entorhinal damage provided an important comparison for subjects with specific hippocampal lesions. Despite showing intact memory for the remotely learned problem, perirhinalentorhinal damage resulted in numerically (although not significantly) weaker performance on postoperative tests of retention for the discriminations learned in the 3 weeks prior to surgery. In the anterograde portion of the study, long-term memory for newly acquired discriminations was spared in subjects with damage to the hippocampus, whereas subjects in the perirhinal-entorhinal lesion group again showed the weakest memory performance on these tests of 5-day retention. Postoperative water maze learning was uniformly impaired in subjects with damage to the hippocampus and perirhinalentorhinal cortex, thus confirming the effect of these lesions and supporting the involvement of these brain areas in spatial processes. These findings further dissociate the specific involvement of the hippocampus in tasks of a spatial-relational nature versus nonrelational tasks, such as discrimination learning and recognition memory (e.g., Duva et al., 1997; Eichenbaum, 1997; Eichenbaum, Schoenbaum, Young, & Bunsey, 1996). Moreover, the results suggest that damage to the hippocampus itself does not contribute to retrograde or anterograde memory impairments for all types of information, whereas the data suggest a more important role for the perirhinal-entorhinal cortex in recognition memory, irrespective of modality.     

Growth points in research on memory and hippocampus.

We present an overview of two of our on-going projects relating processes in the hippocampus to memory. We are trying to understand why retrograde amnesia occurs after damage to the hippocampus. Our experiments establish the generality of several new retrograde amnesia phenomena that are at odds with the consensus view of the role of the hippocampus in memory. We show in many memory tasks that complete damage to the hippocampus produces retrograde amnesia that is equivalent for recent and remote memories. Retrograde amnesia affects a much wider range of memory tasks than anterograde amnesia. Normal hippocampal processes can interfere with retention of a long-term memory stored outside the hippocampus. We conclude that the hippocampus competes with nonhippocampal systems during memory encoding and retrieval. Finally, we outline a project to understand and manipulate adult hippocampal neurogenesis in order to repair damaged hippocampal circuitry to recover lost cognitive functions.     

Context Memory in Korsakoff’s Syndrome

Memory for contextual information and target-context integration are crucial for successful episodic memory formation and are impaired in patients with Korsakoff's syndrome. In this paper we review the evidence for the notion that a context memory deficit makes an important contribution to the amnesia in these patients. First, we focus on anterograde memory for contextual (spatial and temporal) information. Next, the use of contextual cues in memory retrieval is examined and their role in retrograde amnesia and confabulation. Evidence on the role of contextual cues and associations in working memory is discussed in relation to the underlying neurocognitive mechanisms and their dissociation from long-term encoding. Finally, we focus on implicit learning of contextual information in Korsakoff patients. It can be concluded that Korsakoff patients are impaired in the explicit processing of contextual information and in target-context binding, both in long-term (retrograde and anterograde) memory and in working memory. These results extend the context memory deficit hypothesis. In contrast, implicit contextual learning is relatively preserved in these patients. These findings are discussed in relation to evidence of dysfunction of the extended diencephalic-hippocampal memory circuit in Korsakoff's syndrome.     

Temporal order judgments with amnesia

The hypothesis that patients with anterograde amnesia fail to recognize the temporal relations among recognizable past events was evaluated. Experiment 1 showed that order recognition for words in a list was at chance levels even though event recognition was significantly above chance. The same pattern did not obtain for intact adults. Experiment 2 examined event and order recognition for news events. Amnesics' event recognition for news events was quite accurate and comparable to controls, yet their order recognition was significantly below that of controls, again at chance levels. It is argued that the failure to encode the temporal relations among events has broad consequences for memory performance in general.