Confabulation versus experimentally induced false memories in Korsakoff patients

The present study focuses on both the clinical symptom of confabulation and experimentally induced false memories in patients suffering from Korsakoff's syndrome. Despite the vast amount of case studies of confabulating patients and studies investigating false memories in the Deese-Roediger-McDermott (DRM) paradigm, the nature of Korsakoff patients' confabulatory behaviour and its association with DRM false memories have been rarely examined. Hence, the first aim of the present study was to evaluate confabulatory responses in a large sample of chronic Korsakoff patients and matched controls by means of the Dalla Barba Confabulation Battery. Second, the association between (provoked) confabulation and the patients' DRM false recognition performance was investigated. Korsakoff patients mainly confabulated in response to questions about episodic memory and questions to which the answer was unknown. A positive association was obtained between confabulation and the tendency to accept unstudied distractor words as being old in the DRM paradigm. On the other hand, there was a negative association between confabulation and false recognition of critical lures. The latter could be attributed to the importance of strategic retrieval at delayed memory testing.     

A positive emotional bias in confabulatory false beliefs about place

Some neurological patients with medial frontal lesions exhibit striking confabulations. Most accounts of the cause of confabulations are cognitive, though the literature has produced anecdotal suggestions that confabulations may not be emotionally neutral, having a ('wish-fulfilment') bias that shapes the patient's perception of reality in a more affectively positive direction. The present study reviewed every case (N = 16) of false beliefs about place reported in the neuroscientific literature from 1980 to 2000, with blind raters evaluating the 'pleasantness' of the patient's actual and confabulated locations. In each case the confabulated location was evaluated as more pleasant. This striking finding supports the claim that there may be a systematic affective bias in the false beliefs held by neurological patients with confabulation.     

Children's dietary recalls from three validation studies: types of intrusion vary with retention interval

Using previously collected data of fourth‐grade children observed eating school meals and then interviewed, we categorized intrusions (food items reported but not observed eaten) as stretches (on the child's tray) or confabulations (not on the child's tray). We investigated intrusions, confabulations, and stretches and the role of liking, at different retention intervals (morning interviews about the previous day's intake; evening interviews about that day's intake) and under different reporting‐ order prompts (forward; reverse). As retention interval between consumption and report increased, the likelihood (1) increased that reported items were intrusions, that reported items were confabulations and that intrusions were confabulations; and (2) was constant that reported items were stretches. Results concerning reporting‐order prompts were inconclusive. Liking ratings were higher for matches (reports of items observed eaten) than stretches, for confabulations than stretches, and for matches than omissions (unreported items observed eaten), but did not vary by retention interval or reporting‐order prompts. Copyright © 2007 John Wiley & Sons, Ltd.     

‘Faultless’ ignorance: Strengths and limitations of epistemic definitions of confabulation

There is no satisfactory account for the general phenomenon of confabulation, for the following reasons: (1) confabulation occurs in a number of pathological and non-pathological conditions; (2) impairments giving rise to confabulation are likely to have different neural bases; and (3) there is no unique theory explaining the aetiology of confabulations. An epistemic approach to defining confabulation could solve all of these issues, by focusing on the surface features of the phenomenon. However, existing epistemic accounts are unable to offer sufficient conditions for confabulation and tend to emphasise only its epistemic disadvantages. In this paper, we argue that a satisfactory epistemic account of confabulation should also acknowledge those features which are (potentially) epistemically advantageous. For example, confabulation may allow subjects to exercise some control over their own cognitive life which is instrumental to the construction or preservation of their sense of self.     

Episodic memory effects of gamma frequency precuneus transcranial magnetic stimulation in Alzheimer's disease: A randomized multiple baseline study

Episodic memory decline is the prominent neuropsychological feature of typical Alzheimer's Disease (AD), for which current treatments have a limited clinical response. Recently, gamma entrainment therapy has been used as a non-invasive treatment in AD, providing evidence that it may have the potential to alleviate brain pathology and improve cognitive function in AD patients. At the same time, the precuneus (PC) has been recognized as a key area involved in AD related memory deficits and as a key node of the Default Mode Network. This study aimed to investigate the effectiveness of a 40 Hz Transcranial Magnetic Stimulation (TMS) intervention, delivered bilaterally to the precuneus for 10 days, in improving the patients' episodic memory performance. Secondary outcome variables investigated included general cognitive function, semantic and spatial memory, as well as attention and executive function. A concurrent multiple baseline design across five cases was employed. Four patients completed the study. Visual analysis combined with effect size indices were used to evaluate changes across phases. An increase in the average level of immediate recalled words was observed in three out of four patients. Effect size indices indicated significant improvement of attention skills in two patients. No treatment effect was observed for semantic and visual memory, or for executive function. An immediate treatment effect was observed in all patients' general cognitive function as assessed with the Alzheimer's Disease Assessment Scale (mean reduction of 5 points), which was maintained and improved further three months post-treatment. The neuropsychological evaluations indicated improved performance three months post-treatment in immediate and delayed recall, attention, phonological verbal fluency, anxiety, and neuropsychiatric symptoms. This study provides preliminary evidence for the efficacy of a novel non-pharmacological treatment using gamma-band TMS in addressing cognitive dysfunction in AD.     

Nurses' Evaluations of Patient Attributions for the Cause and Future of Their Illness1

It was hypothesized that evaluations of patients' attributions for the cause and future of their illnesses would be seen as more realistic when these attributions coincided with subjects' views on the cause and future of the patients' illness. It was also thought that of the two, i.e., cause and future attributions, future attributions would be more pertinent for the observer when evaluating the adjustment of the patient. One hundred and twenty-eight female nurses assessed the health interviews of four patients through the use of questionnaires. The first hypothesis was supported in the case of causal attributions, but it was found that patients who accepted responsibility, regardless of nurses' views, were seen as more realistic. The second hypothesis was fully supported with future attributions indicating level of coping and causal attributions indicating level of emotional support needed. These findings have implications for caretakers' perceptions of the adaptiveness, for patients of serious illness, of control attributions.     

How to design an electronic memory aid for brain‐injured patients: Considerations on the basis of a model of prospective memory

There has been an enormous development in the field of electronic memory aids, such as mobile phones, organizers, or combinations of both. Nevertheless, these devices have hardly been useful in the neuropsychological therapy of memory‐impaired patients so far. The model of prospective remembering by Ellis (1996) is used as theoretical background in order to (1) analyse patients' needs concerning electronic memory aids, (2) evaluate the usefulness of electronic memory aids for patients described in the literature, as well as of two commercially available electronic memory aids, and (3) derive conclusions concerning demands on how to design a memory aid suitable for patients. While most of the devices designed for patients improve their reliability by compensating for lack of self‐initiated retrieval, most of them are not able to compensate for problems during execution or evaluation. Commercially available memory devices have the advantage of being available to everybody, but they can only support mildly impaired patients. Patients with more severe deficits, however, need a more suitable interface in order to facilitate data entry. In addition, interactive chains of actions should be implemented in order to support execution and evaluation of future intentions. MEMOS, a system in development that tries to realize these demands, is presented.     

Profile of cognitive deficits and associations with depressive symptoms and intelligence in chronic early‐onset schizophrenia patients

Cognitive deficits in several domains have been demonstrated in early‐onset schizophrenia patients but their profile and relation to depressive symptoms and intelligence need further characterization. The purpose was to characterize the profile of cognitive deficits in chronic, early‐onset schizophrenia patients, assess the potential associations with depressive symptom severity, and examine whether cognitive deficits within several domains reflect intelligence impairments. This study compared attention, visual‐construction, aspects of visual and verbal memory, and executive functions in chronic, early‐onset schizophrenia patients (mean age = 20.7 years) (N = 18) and healthy controls (N = 38). Schizophrenia diagnoses were established at the time of the patients' first clinical presentation during childhood or adolescence and were confirmed five years later. In the chronic phase of early‐onset schizophrenia, significant deficits were observed in all specific cognitive functions. The profile of cognitive deficits was jagged, and visual‐construction, attention, and one aspect of verbal memory (verbal stories recall) were differentially impaired. Deficits of visual recall, visual recognition, and executive functions were accounted for by deficits in intelligence, while this was not the case for deficits of verbal recall of stories or attention. No significant associations were observed between the severity of cognitive deficits and that of depressive symptoms. Chronic, early‐onset schizophrenia is characterized by a broad and jagged profile of cognitive deficits. Deficits of attention and verbal recall of stories appear not to be accounted for by deficits in intelligence, and the severity of cognitive deficits seems independent from that of depressive symptoms     

Cognitive and affective Theory of Mind in mild to moderate Alzheimer's disease

Theory of Mind (ToM) allows one's own and others' cognitive and emotional mental states to be inferred. Although many patients with Alzheimer's disease (AD) display impaired social functioning as their disease progresses, very few studies have investigated ToM in AD. Those that have done so suggest that patients' ToM deficits are the consequence of other cognitive impairments. The aim of this study was thus to investigate changes in both the cognitive and the affective dimensions of ToM in AD, using tasks designed to circumvent the patients' comprehension difficulties. Sixteen mild to moderate AD patients and 15 healthy controls matched on age, sex and education level underwent cognitive (preference judgment and first‐ and second‐order false belief) and affective (Reading the Mind in the Eyes) ToM assessments. Comprehension of false belief stories was verified and an additional neuropsychological examination was undergone. We observed impaired performances by AD patients on all the ToM tasks. While working memory and executive functioning impairments contributed to the deterioration in the more complex aspects of cognitive ToM abilities as highlighted by a correlation analysis, we failed to observe any comprehension difficulties in patients who performed poorly on simple cognitive ToM tasks, which suggests that AD truly affects cognitive ToM.     

A Multimethod Approach to Assessing Dependency: The Early Memory Dependency Probe

The construct validity and clinical utility of the early memory probe assessing aspects of dependency was investigated. Clinical patients' responses to the feeding, being fed, or eating probe were compared with Rorschach Oral Dependency (ROD) scale scores (Masling, Rabie, & Blondheim, 1967), as well as theoretically and empirically derived behavioral ratings. Sixty-five psychiatric patients and their therapists participated in the study. Results demonstrated moderate to strong correlations between the early memory scores and the ROD scores, thus demonstrating good concurrent validity. A moderate correlation between the early memory scores and therapists' ratings of key behavioral patterns in therapy support the predictive validity of the early memory probes. The earn memory scores also demonstrated discriminant validity when compared with Rorschach object-relational content scales.     

The feasibility and acceptability of assessing inhibitory control and working memory among adolescents via an ecological momentary assessment approach

Early adolescence is a critical period for the development of executive function (EF). EF deficits are associated with increased engagement in multiple health risk behaviors and may be influenced by momentary factors, such as state mindfulness and physical activity. Ecological momentary assessment (EMA) leverages the increasing ubiquity of smart-phones to assess moment-to-moment changes in neurocognition and behavior with minimal recall bias and high ecological validity. As such, EMA is a promising method for delivering performance-based EF tasks and assessing the degree to which EF is influenced by momentary variation in its putative antecedents (e.g. state mindfulness and PA). This study adapts the (1) State Mindfulness Attention Awareness Scale, (2) physical activity/sedentary behavior recall items, (3) complex symmetry span working memory task, and (4) the child flanker inhibitory control task into an EMA tool delivered via iPhone using Inquisit Web. This tool was piloted with a sample of 32 seventh graders over a 72 h period. Participants’ posttest survey responses indicated that they found these study activities to be enjoyable, non-burdensome, not overly difficult, and preferable to pencil-and-paper instruments. Baseline correlations between flanker task performance and both BRIEF inhibitory control (σ = .23) and working memory subscales (σ = .34) were moderate. Correlations between symmetry span working memory task performance and BRIEF inhibitory control (σabsolute = .28; σpartial = .16) and working memory subscales (σabsolute = .19; σpartial = .15) were slightly lower, demonstrating associations consistent with previous studies. This study supports the feasibility and acceptability of administering two common performance-based EF tasks to adolescents via an EMA approach.     

Distorted temporal consciousness and preserved knowing consciousness in confabulation: a case study

In this study we describe a patient, TA, who developed a chronic amnesic-confabulatory syndrome, following rupture of a right internal carotid siphon aneurysm. Our aim was to elucidate as fully as possible the nature of TA's impairment and to test the hypothesis of confabulation as reflecting a dysfunction of Temporal Consciousness, i.e., to become aware of something as part of a personal past, present or future. TA's confabulations were present in answers to questions tapping Temporal Consciousness, i.e., autobiographical episodic memory, orientation in time and place, and foresight of personal future. In contrast, confabulations were not observed in answers to questions tapping Knowing Consciousness, i.e., to become aware of something as a meaning or as an element of impersonal knowledge. In fact, he had normal access to semantic knowledge, including foresight of impersonal future. TA's brain MRI showed lesions involving the right hippocampus, parahippocampal gyrus, fornix, mammillary bodies, and thalamus. Moreover TA showed sub-cortical lesions involving the caudate and putamen nuclei bilaterally, a lesion site not commonly described in amnesic-confabulatory syndrome. We suggest that this pattern of results is better accounted for within the framework of the Memory, Consciousness and Temporality Theory and reflects a specific distortion of Temporal Consciousness.     

The Evaluation of Family Functioning by the Family Assessment Device: A Systematic Review of Studies in Adult Clinical Populations

A large body of research, documenting the impact of a family's functioning on health outcomes, highlights the importance of introducing the evaluation of patients' family dynamics into clinical judgment. The Family Assessment Device (FAD) is a self‐report questionnaire designed to assess specific dimensions of family functioning. This qualitative systematic review, which follows PRISMA guidelines, aimed to identify the FAD's clinimetric properties and to report the incremental utility of its inclusion in clinical settings. A thorough literature search was performed, using both computerized and manual searches, yielding a total of 148 studies that were included in this review. The FAD has been extensively used in a variety of research contexts. In the majority of studies it was able to discriminate between clinical populations and controls and among groups of patients with different illnesses. The FAD also showed good test–retest and concurrent reliability, and modest sensitivity to change after treatment. FAD‐dysfunctional family functioning was related to several patient clinical outcomes, including lower recovery rates and adherence to treatment, longer recovery time, poorer quality of life, and increased risk of relapse and drop‐out. The present review demonstrates that the FAD is a suitable instrument for the evaluation of family functioning both in clinical and research settings.     

Why did I do that? Explaining actions activated outside of awareness

We review the latest research investigating how people explain their own actions when they have been activated nonconsciously. We will discuss evidence that when nonconsciously activated behavior is unexpected (e.g., norm- violating, against self -standards), negative affect arises and triggers confabulations aimed to explain the behavior. Nonconsciously activated behaviors may provide a window into everyday confabulation of (erroneous) explanations for behavior, which may also affect self-knowledge. Implications for self-concept formation and intentionality are discussed.     

Confabulation in Alzheimer's disease.

Confabulation is present when memory is disturbed, but does it occur in Alzheimer's disease (AD) where memory abnormalities are often severe? In this study, confabulation was assessed prospectively in 26 AD patients and 15 normal elderly (NE) controls using a neuropsychological battery specifically designed to assess different types of memory errors. The results indicated that the AD group made significantly more verbal intrusions than the NE group. These findings provide evidence for the feasibility of eliciting confabulatory-type behavior during clinical assessment and support previous reports which have documented verbal intrusions as a common accompaniment of the memory impairment manifested by AD patients.     

Recognition,recollection, familiarity and executive function in medicated patients with moderate Parkinson's disease

There is conflicting evidence about whether Parkinson's disease (PD) is associated with deficiencies in recognition memory (RM) and the processes which underlie it, namely recollection (a form of recall) and familiarity (a feeling of memory in the absence of recall). The aims of the current study were to examine forced‐choice verbal RM (assessed with the Warrington Recognition memory Test), yes‐no RM, recollection, familiarity and executive functioning in 17 patients with moderate PD and 17 healthy volunteers matched for age and premorbid intelligence. We predicted that patients with moderate PD would display a significant recollection deficit on the yes‐no RM test, because their strategic memory processing that depends on executive functioning and is necessary for efficient encoding and/or retrieval, was disrupted. In contrast, familiarity memory, which is not dependent on these processes, and forced‐choice RM (which is largely dependent on familiarity) should show higher levels of preservation. We also predicted that recollection should be correlated with severity of executive dysfunction. Our findings revealed that the PD patients were as likely to accurately discriminate between targets and distractors as the healthy volunteers on both RM tests. However, the PD patients were significantly less reliant on recollection‐driven recognition decisions on the yes‐no RM test when compared with the healthy control group. The patients also displayed executive function deficits, but these were not correlated with recollection. The extent to which the PD patients' reliance on familiarity at the expense of recollection is explained by impairments in strategic memory processes/executive function and/or medial temporal lobe retrieval processes needs further exploration.     

Community as Outsider Witness: Utilising Community Members in the Reconstitution of Problem-Saturated Identities

This study explored community members' ability to enlist discourses affirming of psychiatric patients' quest for generative identities. The participants were members of the public who attended an exhibition of psychiatric patients' artwork (n = 7, age range 18–55). A Foucauldian discourse analysis was used to analyse the research interviews. Results revealed that the majority of community members used dominant cultural discourses to speak about psychiatric patient-artists. These discourses conferred a problem-saturated identity on to psychiatric patients. We conclude that community members can be recruited as outsider witnesses to support psychiatric patients' search for generative identities, provided community members resist discourses that produce problem-saturated identity conclusions.     

The use of a wearable camera improves autobiographical memory in patients with Alzheimer's disease

Despite the marked impairment of recent episodic memories in Alzheimer's disease, there have been few attempts to rehabilitate these deficits. We used a novel external memory aid to promote recall of episodic memories in patients with mild to moderate Alzheimer's disease. SenseCam, a small wearable camera, recorded significant events in the lives of six Alzheimer's disease patients. Every two days for two weeks each patient's memory for an event was assessed, followed by a structured review of the SenseCam images. Longer-term recall was tested one and three months later. A written diary control condition followed the same procedure. Across 40 events the SenseCam review method resulted in significantly more details of an event being recalled over two weeks than the written diary method in five out of the six patients. At three months post event, four out of five patients (one had dropped out) recalled significantly more details of events in the SenseCam condition while the other patient showed no significant difference. Viewing SenseCam images of personally experienced events may significantly improve autobiographical memory in patients with even moderate Alzheimer's disease.     

Inhibitory control of threat remembering in PTSD

ABSTRACT

Intrusive traumatic recollections suggest an inability in Posttraumatic Stress Disorder (PTSD) to control and notably to inhibit memories for trauma-related information. Supported by inhibitory deficits found on experimental settings in PTSD, memory functioning and memory biases in the disorder were usually explained through inhibitory and control deficits in the processing of trauma-related information. The present study aimed to directly assess this hypothesis by investigating memory control abilities for emotional information in PTSD. For this purpose, 34 patients diagnosed with PTSD were compared to 37 non-PTSD controls on an item-cued directed forgetting paradigm for emotional words combined with a Remember/Know recognition procedure. Results revealed enhanced amounts of Remember recognitions for trauma-related words in PTSD. Moreover, we replicated findings of memory control impairments in the disorder. However, such impairments only occurred for non-trauma-related words. Accordingly, it appeared that PTSD patients presented preserved memory control abilities for trauma-related words, at the expenses of other emotional valences. Surprisingly, PTSD patients presented a preserved ability to control and notably to inhibit their memory functioning for trauma-related material. In addition to potential theoretical and clinical relevance, these results are discussed in the light of resource reallocation hypotheses and vigilant-avoidant theories of information processing in PTSD.     

Stress, Coping and Cognitive Deficits in Women After Surgery for Breast Cancer

Research on neuropsychological difficulties among cancer patients has focused on chemotherapy as a primary cause, yet several studies have now shown that some patients evidence cognitive weaknesses prior to chemotherapy. As an alternative to the ‘chemo–brain’ theory, this study examined the hypothesis that stress and coping style may be associated with observed neuropsychological difficulties among female cancer patients. Thirty-six women completed neuropsychological testing and psychological questionnaires following surgery for breast cancer and prior to any subsequent treatments. Twenty-seven percent of participants evidenced deficits on at least one measure of verbal fluency, and 14% of participants were impaired on at least one memory measure. Self-reported stress was correlated with deficits in memory, verbal fluency, and attention. Subsequent mediational analyses indicated that use of passive coping styles may underlie this relationship between stress and neuropsychological deficits. These findings highlight the potential relevance of psychological mechanisms, such as coping style, in cancer patients’ experience of neuropsychological deficits.