Paired-associate learning and priming effects in amnesia: a neuropsychological study

Despite severe deficits of recall and recognition, amnesic patients can exhibit normal priming effects. Amnesic patients have also been reported to perform well on tests of paired-associate learning that involve related word pairs (e.g., table-chair). The present study investigated the role of priming effects in paired-associate learning. Experiment 1 illustrated the distinction between the memory impairment of amnesic patients and their intact priming ability. Amnesic patients were markedly deficient in learning unrelated word pairs, despite exhibiting normal priming as measured by a word-completion test involving the same words. In Experiment 2A, amnesic patients showed good paired-associate learning for related word pairs, though control subjects still performed significantly better. In addition, the good performance by amnesic patients was short-lived, and performance fell to baseline after a 2-hr delay. Control subjects performed well above baseline at all delay conditions. Experiment 2B showed that the forgetting of related word pairs by amnesic patients followed the same time course as the decay of word priming. Experiment 3 showed that amnesic patients were as good as control subjects at learning related word pairs when incidental learning and test procedures were used (a word-association test). The advantage of control subjects over amnesic patients in Experiments 2A and 2B could therefore be attributed to the explicit learning instructions that are standard in paired-associate tests. Finally, Experiment 4 showed that amnesic patients exhibited normal priming when they were asked to "free associate" to words (e.g., child) that were semantically related to previously presented words (e.g., baby). The results indicate that both priming effects and paired-associate learning of related word pairs depend on activation, a process that is preserved in amnesia. Activation can account for the findings of good performance by amnesic patients on tests of word priming (Experiments 1 and 2B), related paired associates (Experiments 2A and 2B), and word association (Experiments 3 and 4). Activation is a transient phenomenon presumed to operate on and facilitate access to preexisting representations. Control subjects can establish new associations and can strengthen preexisting associations by engaging processes that are impaired in amnesia. As a result, when explicit learning instructions are used to test paired-associate learning of related word pairs, control subjects can learn better and can remember longer than can amnesic patients (Experiments 2A and 2B).(ABSTRACT TRUNCATED AT 400 WORDS)     

Rote memory and arithmetic fact processing

The goal of the study was to examine the part played by skill in memorizing arbitrary sequences in the efficiency with which normal young adults perform simple arithmetic fact problems. The first experiment showed a clear independent role for sequence memory in all arithmetic fact processing, but a lesser role for semantic retrieval. This result was particularly true for large-answer multiplication problems and subtraction and division problems with large first operands. In a second experiment, which included a visuomotor processing control task, sequence memory predicted processing of all arithmetic problems apart from small additions independently of semantic retrieval, with the most robust independent contribution being to large-answer multiplication problems. The results, which are compatible with Dehaene and colleagues' triple-code model, suggest that rote learning may be a successful way for some people to process arithmetic facts efficiently.     

Focused memory search in fact retrieval

Several studies of fact retrieval have shown that the more facts a person learns about a concept, the longer it takes him or her to retrieve any of these facts. This result has been interpreted to mean that retrieval of a fact about a concept involves a search of all facts stored in memory with that concept. In the present study, it is suggested that retrieval involves not an unfocused search of all facts stored with a concept, but rather a focused memory search that examines relevant stored facts and ignores irrelevant information. This argument is supported by three experiments in which subjects first learned simple facts (e.g., “The banker likes horses”) and then made speeded true-false decisions for test probes le.g., “The banker likes elephants”). Specifically, results suggest that facts stored with a concept may be organized into subsets. For example, a person’s knowledge about Richard Nixon might be organized into subsets concerning Nixon’s resignation, his trips to China, his family, and so on. The data further suggest that a person attempting to retrieve a fact about a concept (e.g., the name of Nixon’s wife) may simply decide which subset is most likely to contain the desired fact (e.g., the subset concerning Nixon’s family) and search that subset. If the sought-for fact is found in this subset, the search process terminates. If, however, the desired information is not located, other subsets of facts may be searched before the retrieval attempt is given up. The notion that memory search focuses on relevant stored facts and ignores irrelevant information may help to explain why experts (i.e., people who know a large number of facts about a topic) do not experience great difficulty in retrieving facts in their areas of expertise.     

Functional amnesia: clinical description and neuropsychological profile of 10 cases

We carried out the first neuropsychological study of a series of patients with functional amnesia. We evaluated 10 patients, first with a neurological examination and then with three tests of anterograde amnesia and four tests of retrograde amnesia. Excluding one patient who later admitted to malingering, all patients had a significant premorbid psychiatric history and one or more possible precipitating factors for their amnesia. Eight of the 10 patients still had persistent retrograde amnesia at our last contact with them (median = 14 mo after the onset of amnesia). On tests of anterograde amnesia, the patients performed normally as a group, though some patients scored poorly on tests of verbal memory. On tests of retrograde amnesia, all patients had difficulty re-collecting well-formed autobiographical memories of specific events from their past. In contrast, patients performed as well as controls at distinguishing the names of cities from fictitious city names. On remote memory tests for past public events and famous faces, different patients exhibited different but internally consistent patterns of impaired and spared performance. The variability in the clinical and neuropsychological findings among our patients may be understood by supposing that memory performance is poor in proportion to how directly a test appears to assess a patient's common sense concept of memory. The presentation of patients with functional amnesia is as variable as humankind's concept of what memory is and how it works.     

Drug-induced amnesia impairs implicit relational memory

Amnesic patients have difficulty consciously recollecting past events, but they perform normally on implicit memory measures that do not require conscious access. Now, an innovative study offers compelling evidence that even implicit memory can be impaired during amnesia, temporarily induced in healthy subjects using a neuropharmacological manipulation (midazolam). Importantly, midazolam impaired implicit, relational memory, whereas non-relational memory was preserved, supporting the characterization of conscious memory in terms of relational encoding.     

Midazolam amnesia and short-term/working memory processes

We examined whether midazolam impairs short-term/working memory processes. We hypothesize that prior dissociations in midazolam's effects on short-term/working memory tasks and episodic memory tasks arise because midazolam has a larger effect on episodic memory processes than on short-term/working memory processes. To examine these issues, .03 mg/kg of participant's bodyweight of midazolam was administered in a double-blind placebo-controlled within-participant design. Performance on the digit span and category generation/recall tasks was examined. The results of Experiment 1 demonstrated that: (1) midazolam impaired performance on the digit span task; (2) midazolam did not impair performance on the category generation task; (3) midazolam impaired performance on the category recall task; and (4) midazolam's effect on category recall was four times as large as its effect on digit span. The results of Experiment 2 demonstrated that midazolam did not impair digit span performance when the digit span task was administered at a later time. These results suggest that midazolam can impair short-term/working memory processes, but these effects are substantially smaller than midazolam's effect on episodic memory processes. Moreover, they demonstrate that conscious awareness of materials during study is not sufficient to produce episodic memory.     

Age,context, and spatial memory: A neuropsychological approach

Abstract

The hypothesis that a reduction in age differences in spatial location memory in the presence of distinctive cues reflects a decreased dependence on a hippocampally based memory system was tested in three experiments. In Experiments 1 and 2 the presence of distinctive cues did not reduce age differences in spatial location memory nor did these cues eliminate the significant relation between spatial location memory and a measure of hippocampal function. Distinctive cues did, however, place additional demands on processing resources and spatial visualization abilities. In Experiment 3 the relevance of prior knowledge was manipulated. With irrelevant prior knowledge there was a strong unique association between the hippocampal measure and outcome measure. With relevant prior knowledge there was no such association. the implications of these findings for understanding the role of the hippocampus in age-related decline in memory for locations are discussed.     

Disturbed memory and amnesia related to intensive care

Patients, when admitted to an intensive care unit (ICU), have one thing in common: their illness is life-threatening. Patients may remain on ICU in a critical condition, needing support with their breathing, circulation, and/or kidneys for varying lengths of time, from days to weeks. During that time the patients will receive sedative and analgesic drugs to ensure compliance with artificial ventilation. Patients recovering from critical illness frequently have little or no recall of their period in ICU, or remember nightmare, hallucinations, or paranoid delusions. The nature, extent and reason for these difficulties, have been under-reported and consequently our purpose was to conduct a review of memory problems experienced by ICU patients. A systematic literature review of computer databases (Medline, PsycLit, and CINAHL) identified 25 relevant papers. In addition, other relevant articles were obtained, citation lists and associated articles retrieved. Due to lack of research on processes underlying memory problems in ICU patients all articles that introduced an insight into possible mechanisms were included in the review. There seem to be two possible processes contributing to memory problems in ICU patients. First the illness and treatment may have a general dampening effect on memory. Delirium and sleep disturbance are both common in ICU patients. Delirium can result in a profound amnesia for the period of confusion. Sleep deprivation exacerbates the confusional state. Slow wave sleep is important for the consolidation of episodic memories. Treatment administered to patients in ICU can have effects on memory. Opiates, benzodiazepines, sedative drugs such as propofol, adrenaline, and corticosteroids can all influence memory. In addition, the withdrawal of drugs, such as benzodiazepines, can cause profound withdrawal reactions, which may contribute to delirium. Second, we hypothesise that there is a process that affects memory negatively for external events but enhances memory for internal events. The physical constraints and social isolation experienced by ICU patients and the life-threatening nature of the illness may increase the experience of hypnagogic hallucinations. Attentional shift during hypnagogic images from external stimuli to internally generated images would explain why ICU patients have such poor recall of external ICU events, but can clearly remember hallucinations and nightmares. Patients describe these memories as being very vivid and this is explored in terms of flashbulb memory formation. The absence of memories for real events on ICU can result in ICU patients remembering paranoid delusions of staff trying to kill them, with little information to reject these vivid memories as unreal. This has implications for patients' future psychological health.     

Disturbed memory and amnesia related to intensive care

Patients, when admitted to an intensive care unit (ICU), have one thing in common: their illness is life-threatening. Patients may remain on ICU in a critical condition, needing support with their breathing, circulation, and/or kidneys for varying lengths of time, from days to weeks. During that time the patients will receive sedative and analgesic drugs to ensure compliance with artificial ventilation. Patients recovering from critical illness frequently have little or no recall of their period in ICU, or remember nightmare, hallucinations, or paranoid delusions. The nature, extent and reason for these difficulties, have been under-reported and consequently our purpose was to conduct a review of memory problems experienced by ICU patients. A systematic literature review of computer databases (Medline, PsycLit, and CINAHL) identified 25 relevant papers. In addition, other relevant articles were obtained, citation lists and associated articles retrieved. Due to lack of research on processes underlying memory problems in ICU patients all articles that introduced an insight into possible mechanisms were included in the review. There seem to be two possible processes contributing to memory problems in ICU patients. First the illness and treatment may have a general dampening effect on memory. Delirium and sleep disturbance are both common in ICU patients. Delirium can result in a profound amnesia for the period of confusion. Sleep deprivation exacerbates the confusional state. Slow wave sleep is important for the consolidation of episodic memories. Treatment administered to patients in ICU can have effects on memory. Opiates, benzodiazepines, sedative drugs such as propofol, adrenaline, and corticosteroids can all influence memory. In addition, the withdrawal of drugs, such as benzodiazepines, can cause profound withdrawal reactions, which may contribute to delirium. Second, we hypothesise that there is a process that affects memory negatively for external events but enhances memory for internal events. The physical constraints and social isolation experienced by ICU patients and the life-threatening nature of the illness may increase the experience of hypnagogic hallucinations. Attentional shift during hypnagogic images from external stimuli to internally generated images would explain why ICU patients have such poor recall of external ICU events, but can clearly remember hallucinations and nightmares. Patients describe these memories as being very vivid and this is explored in terms of flashbulb memory formation. The absence of memories for real events on ICU can result in ICU patients remembering paranoid delusions of staff trying to kill them, with little information to reject these vivid memories as unreal. This has implications for patients' future psychological health.     

Midazolam amnesia and conceptual processing in implicit memory

Prominent theories of implicit memory (D. Schacter, B. Church, & J. Treadwell, 1994) emphasize the dominant role of perceptual processing in mediating priming on perceptual implicit memory tests. Examinations of the effects of conceptual processing on perceptual implicit memory tests have produced ambiguous results. Although a number of investigations (e.g., J. Toth & R. Hunt, 1990) have demonstrated that variations in conceptual processing affect priming on perceptual implicit memory tests, these effects may arise because of the contaminating effects of explicit memory. The current experiment examined this controversy using midazolam, a benzodiazepine that produces a dense, albeit temporary, anterograde amnesia when injected prior to study. The experiment examined whether the effects of generation found on the implicit memory test of perceptual identification were affected by a midazolam injection prior to study. Results demonstrated that midazolam substantially diminished generation effects in free and cued recall, as well as overall performance on these tests, but had no detectable effect on the generation effect in perceptual identification.     

A comparison of recollective memory and source monitoring

Participants in recognition memory experiments are often asked for additional information about their memories after each positive recognition response. Two experiments were conducted that were identical, except that the first asked participants to make remember/familiar judgments about the items they recognized, and the second asked them to make source judgments. The similarity between the recollection and source judgment data has implications for measurement issues and theory development.     

Impaired semantic memory during acute transient global amnesia

As a clinical model of hippocampal dysfunction, transient global amnesia (TGA) causes reversible memory disturbance. While episodic memory deficits in TGA patients have been extensively described, data regarding semantic memory involvement are sparse and contradictory. We report impaired semantic fluency performance in 16 patients with hippocampal lesions on MRI during acute TGA compared to their performance one day later and to that of 20 healthy subjects. Our findings support the involvement of the hippocampus in semantic retrieval.     

Implicit memory for novel conceptual associations in amnesia

In two experiments, we evaluated the status of implicit memory for novel associations in amnesia. Experiment 1 assessed priming in a category exemplar generation task in which contextual information associated with a target could increase the likelihood of target generation. Control participants, but not amnesic patients, showed associative priming. Amnesics’ impairment was not due to the use of explicit memory by control subjects but reflected a genuine impairment in implicit memory for novel conceptual associations. Experiment 2 assessed priming in a relatedness judgment task, in which associative priming was manifest as longer latencies for old than for recombined pairs of unrelated words. Amnesic patients showed intact associative priming in this task. We discuss differences in the status of implicit memory for novel conceptual associations in amnesia, with reference to the nature of the representation that supports priming in the two tasks and the type of processing that is required at test.     

Remote memory in a patient with circumscribed amnesia

It has been suggested that extensive and severe remote memory loss is not a component of a circumscribed amnesic syndrome but may be attributable to problem solving and retrieval deficiencies associated with the frontal lobe damage which is present in some amnesic patients. In order to assess this notion, retrograde amnesia was studied in a patient, W.H., who had no apparent cortical damage revealed by radiological examination, and who evidenced no major cognitive deficiency other than amnesia. Regardless of whether remote memory was measured by recall or recognition procedures, patient W.H. exhibited impaired memory for information from the 1960s, 1970s, and 1980s, but was unimpaired in retrieving information from the 1940s and 1950s. These results demonstrate that retrograde amnesia can occur in patients who have a circumscribed memory deficit.     

Long-term memory in amnesia: cued recall, recognition memory, and confidence ratings

We explored what kind of information is acquired when amnesic patients are able to exhibit significant retention on tests of cued recall and recognition memory. Amnesic patients and control subjects attempted to learn sets of sentences. Memory for the last word in each sentence was tested after 1 hr in the case of the amnesic patients, or after 1 to 2 weeks in the case of (delayed) control subjects. Amnesic patients and (delayed) control subjects performed at similar levels on tests of cued recall and recognition memory. Amnesic patients were just as confident of their correct answers as were control subjects. However, amnesic patients were no more disadvantaged than control subjects when they were cued indirectly by presenting paraphrases of the original sentences. These findings demonstrate that the residual knowledge retained by amnesic patients can be as flexible, as accessible to indirect cues, and as available to awareness as the knowledge retained by (delayed) control subjects.