Associative recognition in a patient with selective hippocampal lesions and relatively normal item recognition

Visual short-term memory binding and attentional processes during object-scene integration are preserved in mild cognitive impairment

Binding, a critical cognitive process likely mediated by attention, is essential for creating coherent object representations within a scene. This process is vulnerable in individuals with dementia, who exhibit deficits in visual working memory (VWM) binding, primarily tested using abstract arrays of standalone objects. To explore how binding operates in more realistic settings across the lifespan, we examined the impact of object saliency and semantic consistency on VWM binding and the role of overt attention. Using an eye-tracking change detection task, we compared younger adults, healthy older adults, and individuals with Mild Cognitive Impairment (MCI). Participants were presented with naturalistic scenes and asked to detect changes in the identity and/or location of objects that were either semantically consistent or inconsistent with their scene context. Across all age groups, semantically inconsistent objects were prioritised during encoding, leading to better change detection than consistent objects. Highly salient objects decreased the inconsistency advantage while being detrimental to detection accuracy when inspected at longer latencies to the first fixation. Longer fixation durations on the critical object were beneficial for recognition. In contrast, delayed initial inspection or frequent subsequent fixations on other objects were detrimental to detection, regardless of age or cognitive impairment. These findings challenge the notion of generalised semantic memory impairment in the prodromal stages of dementia and highlight the importance of efficient attentional control in supporting VWM binding, even in the face of cognitive decline. Overall, preserved low-level and high-level mechanisms of object-scene integration can compensate for age-related cognitive decline, enabling successful binding in naturalistic contexts.

The hippocampus supports the representation of abstract concepts: Implications for the study of recognition memory

Words, unlike images, are symbolic representations. The associative details inherent within a word's meaning and the visual imagery it generates, are inextricably connected to the way words are processed and represented. It is well recognised that the hippocampus associatively binds components of a memory to form a lasting representation, and here we show that the hippocampus is especially sensitive to abstract word processing. Using fMRI during recognition, we found that the increased abstractness of words produced increased hippocampal activation regardless of memory outcome. Interestingly, word recollection produced hippocampal activation regardless of word content, while the parahippocampal cortex was sensitive to concreteness of word representations, regardless of memory outcome. We reason that the hippocampus has assumed a critical role in the representation of uncontextualized abstract word meaning, as its information-binding ability allows the retrieval of the semantic and visual associates that, when bound together, generate the abstract concept represented by word symbols. These insights have implications for research on word representation, memory, and hippocampal function, perhaps shedding light on how the human brain has adapted to encode and represent abstract concepts.

The beneficial effects of concept definition and interactive imagery tasks on associative memory: Evidence from event-related potentials

It is widely accepted that familiarity can support associative memory when the to-be-remember items are unitized into a new representation. However, there has been relatively little attention devoted to investigating the effects of different unitization manipulations on associative memory. The present study aimed to address this gap by examining the effects of varying levels of unitization through three tasks: Concept definition, interactive imagery, and sentence frame tasks. The behavioral results revealed that associative memory was significantly enhanced in the interactive imagery task compared to the sentence frame task. However, no significant differences were found between the sentence frame and concept definition tasks, or between the concept definition and interactive imagery tasks. In terms of the neural correlates, the event-related potential (ERP) results revealed that the sentence frame task only elicited a significant recollection-related LPC old/new effect, while the concept definition task only elicited a significant familiarity-related FN400 old/new effect. However, the interactive representation task elicited both of these distinct effects. These findings suggest that both the concept definition and interactive imagery tasks can enhance familiarity for supporting associative memory, but their beneficial effects on associative memory or LPC old/new effects may be different.

Converging diencephalic and hippocampal supports for episodic memory

To understand the neural basis of episodic memory it is necessary to appreciate the significance of the fornix. This pathway creates a direct link between those temporal lobe and medial diencephalic sites responsible for anterograde amnesia. A collaboration with Andrew Mayes made it possible to recruit and scan 38 patients with colloid cysts in the third ventricle, a condition associated with variable fornix damage. Complete fornix loss was seen in three patients, who suffered chronic long-term memory problems. Volumetric analyses involving all 38 patients then revealed a highly consistent relationship between mammillary body volume and the recall of episodic memory. That relationship was not seen for working memory or tests of recognition memory. Three different methods all supported a dissociation between recollective-based recognition (impaired) and familiarity-based recognition (spared). This dissociation helped to show how the mammillary body-anterior thalamic nuclei axis, as well as the hippocampus, is vital for episodic memory yet is not required for familiarity-based recognition. These findings set the scene for a reformulation of temporal lobe and diencephalic amnesia. In this revised model, these two regions converge on overlapping cortical areas, including retrosplenial cortex. The united actions of the hippocampal formation and the anterior thalamic nuclei on these cortical areas enable episodic memory encoding and consolidation, impacting on subsequent recall.

Cross-modal associative memory impairment in schizophrenia

Impaired associative memory function in patients with schizophrenia has received considerable attention. However, previous studies have primarily concentrated on unisensory materials, which limits our understanding of the broader implications of this impairment. In this study, we sought to expand on this knowledge by examining two types of associative memory domains in individuals with schizophrenia, leveraging both visual (Vis) and auditory (Aud) materials. A total of 32 patients with schizophrenia and 29 healthy controls were recruited to participate in the study. Each participant participated in an experiment composed of three paradigms in which different abstract materials (Aud-Aud, Aud-Vis, and Vis-Vis) were presented. Subsequently, the discriminability scores of the two groups were calculated and compared in different modal tasks. Results from the study indicated that individuals with schizophrenia demonstrated varying degrees of associative memory dysfunction in both the same and cross-modalities, with the latter having a significantly lower score than healthy controls (t = 4.120, p < 0.001). Additionally, the cross-modal associative memory function was significantly and negatively correlated with the severity of negative symptoms among individuals diagnosed with schizophrenia (r = -0.362, p = 0.042). This study provides evidence of abnormalities in the processing and memorization of information that integrates multiple sensory modalities in individuals with schizophrenia. This is of great significance for further understanding the cognitive symptoms and pathological mechanisms of schizophrenia, potentially guiding the development of relevant interventions and treatment methods.

Consideration of different scoring approaches for a verbal incidental learning measure from the WAIS-IV using hippocampal volumes

Objective: While Spencer's verbal incidental learning (IL) task-from Vocabulary and Similarities subtests of the WAIS-has been validated relative to traditional memory measures and Alzheimer's disease (AD) pathology, the effectiveness of the particular scoring method used has not been assessed relative to alternative scoring weightings. The purpose of this study was to compare original and alternative scoring methods of this IL task by using an AD biomarker-benchmark to arrive at an optimal approach. Methods: Fifty-five memory-clinic patients aged 59-87 received neuropsychological assessment, measures of IL, and quantitative brain imaging. Partial correlation coefficients with total hippocampal volume-controlling for age, sex, and intracranial volume-were assessed across several IL scoring methods, and partial correlations with measures of memory were examined to evaluate convergent validity.Results: IL scoring methods maximizing the contribution of paired-associate-recall-performance were significantly correlated with both hippocampal volumes and traditional memory measures, whereas discrimination-emphasized scoring methods were not.Conclusions: IL scoring methods emphasizing memory paired-associate recall appeared to be preferable to those emphasizing memory discrimination. Administration of the IL- Similarities subtest alone, without IL- Vocabulary, may strike a balance between strength of relationships with both hippocampal volumes and standard memory measures, while also limiting administration time.

The hearing hippocampus

The hippocampus has a well-established role in spatial and episodic memory but a broader function has been proposed including aspects of perception and relational processing. Neural bases of sound analysis have been described in the pathway to auditory cortex, but wider networks supporting auditory cognition are still being established. We review what is known about the role of the hippocampus in processing auditory information, and how the hippocampus itself is shaped by sound. In examining imaging, recording, and lesion studies in species from rodents to humans, we uncover a hierarchy of hippocampal responses to sound including during passive exposure, active listening, and the learning of associations between sounds and other stimuli. We describe how the hippocampus' connectivity and computational architecture allow it to track and manipulate auditory information - whether in the form of speech, music, or environmental, emotional, or phantom sounds. Functional and structural correlates of auditory experience are also identified. The extent of auditory-hippocampal interactions is consistent with the view that the hippocampus makes broad contributions to perception and cognition, beyond spatial and episodic memory. More deeply understanding these interactions may unlock applications including entraining hippocampal rhythms to support cognition, and intervening in links between hearing loss and dementia.

Representations of Temporal Community Structure in Hippocampus and Precuneus Predict Inductive Reasoning Decisions

Our understanding of the world is shaped by inferences about underlying structure. For example, at the gym, you might notice that the same people tend to arrive around the same time and infer that they are friends that work out together. Consistent with this idea, after participants are presented with a temporal sequence of objects that follows an underlying community structure, they are biased to infer that objects from the same community share the same properties. Here, we used fMRI to measure neural representations of objects after temporal community structure learning and examine how these representations support inference about object relationships. We found that community structure learning affected inferred object similarity: When asked to spatially group items based on their experience, participants tended to group together objects from the same community. Neural representations in perirhinal cortex predicted individual differences in object grouping, suggesting that high-level object representations are affected by temporal community learning. Furthermore, participants were biased to infer that objects from the same community would share the same properties. Using computational modeling of temporal learning and inference decisions, we found that inductive reasoning is influenced by both detailed knowledge of temporal statistics and abstract knowledge of the temporal communities. The fidelity of temporal community representations in hippocampus and precuneus predicted the degree to which temporal community membership biased reasoning decisions. Our results suggest that temporal knowledge is represented at multiple levels of abstraction, and that perirhinal cortex, hippocampus, and precuneus may support inference based on this knowledge.

The temporal lobes and memory

Since the first description of the case of H.M. in the mid-1950s, the debate over the contribution of the mesial temporal lobe (MTL) to human memory functioning has not ceased to stimulate new experimental work and the development of new theoretical models. The early demonstration that despite their devastating memory loss patients with hippocampal damage are still able to learn a number of visuo-motor and visuo-perceptual skills at a normal rate and to be normally primed by verbal and visual material suggested that the term "memory" is actually an umbrella concept that includes very different brain plasticity phenomena and that MTL damage actually impairs only one of these. Subsequent research, which capitalized on a detailed anatomical description of MTL structures and on the close analysis of memory-related phenomena, tried to define the unique role of the MTL structures in brain plasticity and in the government of human behavior. A first hypothesis identified this role in the conscious forms of memory as opposed to implicit ones. In the last two decades, the emphasis has moved to the relational role of the hippocampus in binding together different pieces of unimodal information to provide unitary, multimodal representations of personal experiences.

Sex differences in cortisol and memory following acute social stress in amnestic mild cognitive impairment

OBJECTIVE

Older adults with amnestic mild cognitive impairment (aMCI) develop Alzheimer's type dementia approximately 10 times faster annually than the normal population. Adrenal hormones are associated with aging and cognition. We investigated the relationship between acute stress, cortisol, and memory function in aMCI with an exploratory analysis of sex.

METHOD

Salivary cortisol was sampled diurnally and during two test sessions, one session with the Trier Social Stress Test (TSST), to explore differences in the relationship between cortisol and memory function in age-normal cognition (NA) and aMCI. Participants with aMCI (n = 6 women, 9 men; mean age = 75) or similarly aged NA (n = 9 women, 7 men, mean age = 75) were given tests of episodic, associative, and spatial working memory with a psychosocial stressor (TSST) in the second session.

RESULTS

The aMCI group performed worse on the memory tests than NA as expected, and males with aMCI had elevated cortisol levels on test days. Immediate episodic memory was enhanced by social stress in NA but not in the aMCI group, indicating that stress-induced alterations in memory are different in individuals with aMCI. High cortisol was associated with impaired performance on episodic memory in aMCI males only. Cortisol in Session 1 moderated the relationship with spatial working memory, whereby higher cortisol was associated with worse performance in NA, but better spatial working memory in aMCI. In addition, effects of aMCI on perceived anxiety in response to stress exposure were moderated by stress-induced cortisol in a sex-specific manner.

CONCLUSIONS

We show effects of aMCI on Test Session cortisol levels and effects on perceived anxiety, and stress-induced impairments in memory in males with aMCI in our exploratory sample. Future studies should explore sex as a biological variable as our findings suggest that effects at the confluence of aMCI and stress can be obfuscated without sex as a consideration.

Examining the Relationship between a Verbal Incidental Learning Measure from the WAIS-IV and Neuroimaging Biomarkers for Alzheimer's Pathology

Convergent validation of a verbal incidental learning (IL) task from the WAIS-IV using neuroimaging biomarkers is warranted to understand its sensitivity to Alzheimer's disease (AD) pathology. Fifty-five memory clinic patients aged 59 to 87 years received neuropsychological assessment, and measures of IL and quantitative brain imaging. Worse IL-Total Score and IL-Similarities performances were significantly associated with smaller hemispheric hippocampal volumes. IL measures were not significantly correlated with cerebral β-amyloid burden, though a trend was present and effect sizes were mild. These hippocampal volume results suggest that this IL task may be sensitive to AD pathology along the AD continuum.

Task-dependent effects of intracranial hippocampal stimulation on human memory and hippocampal theta power

BACKGROUND

Despite its potential to revolutionize the treatment of memory dysfunction, the efficacy of direct electrical hippocampal stimulation for memory performance has not yet been well characterized. One of the main challenges to cross-study comparison in this area of research is the diversity of the cognitive tasks used to measure memory performance.

OBJECTIVE

We hypothesized that the tasks that differentially engage the hippocampus may be differentially influenced by hippocampal stimulation and the behavioral effects would be related to the underlying hippocampal activity.

METHODS

To investigate this issue, we recorded intracranial EEG from and directly applied stimulation to the hippocampus of 10 epilepsy patients while they performed two different verbal memory tasks - a word pair associative memory task and a single item memory task.

RESULTS

Hippocampal stimulation modulated memory performance in a task-dependent manner, improving associative memory performance, while impairing item memory performance. In addition, subjects with poorer baseline cognitive function improved much more with stimulation. iEEG recordings from the hippocampus during non-stimulation encoding blocks revealed that the associative memory task elicited stronger theta oscillations than did item memory and that stronger theta power was related to memory performance.

CONCLUSIONS

We show here for the first time that stimulation-induced associative memory enhancement was linked to increased theta power during retrieval. These results suggest that hippocampal stimulation enhances associative memory but not item memory because it engages more hippocampal theta activity and that, in general, increasing hippocampal theta may provide a neural mechanism for successful memory enhancement.

Cross-Situational Statistical Learning of New Words Despite Bilateral Hippocampal Damage and Severe Amnesia

Word learning requires learners to bind together arbitrarily-related phonological, visual, and conceptual information. Prior work suggests that this binding can be robustly achieved via incidental cross-situational statistical exposure to words and referents. When cross-situational statistical learning (CSSL) is tested in the laboratory, there is no information on any given trial to identify the referent of a novel word. However, by tracking which objects co-occur with each word across trials, learners may acquire mappings through statistical association. While CSSL behavior is well-characterized, its brain correlates are not. The arbitrary nature of CSSL mappings suggests hippocampal involvement, but the incremental, statistical nature of the learning raises the possibility of neocortical or procedural learning systems. Prior studies have shown that neurological patients with hippocampal pathology have word-learning impairments, but this has not been tested in a statistical learning paradigm. Here, we used a neuropsychological approach to test whether patients with bilateral hippocampal pathology (N = 3) could learn new words in a CSSL paradigm. In the task, patients and healthy comparison participants completed a CSSL word-learning task in which they acquired eight word/object mappings. During each trial of the CSSL task, participants saw two objects on a computer display, heard one novel word, and selected the most likely referent. Across trials, words were 100% likely to co-occur with their referent, but only 14.3% likely with non-referents. Two of three amnesic patients learned the associations between objects and word forms, although performance was impaired relative to healthy comparison participants. Our findings show that the hippocampus is not strictly necessary for CSSL for words, although it may facilitate such learning. This is consistent with a hybrid account of CSSL supported by implicit and explicit memory systems, and may have translational applications for remediation of (word-) learning deficits in neurological populations with hippocampal pathology.

The hippocampus contributes to temporal duration memory in the context of event sequences: A cross-species perspective

Although a large body of research has implicated the hippocampus in the processing of memory for temporal duration, there is an exigent degree of inconsistency across studies that obfuscates the precise contributions of this structure. To shed light on this issue, the present review article surveys both historical and recent cross-species evidence emanating from a wide variety of experimental paradigms, identifying areas of convergence and divergence. We suggest that while factors such as time-scale (e.g. the length of durations involved) and the nature of memory processing (e.g. prospective vs. retrospective memory) are very helpful in the interpretation of existing data, an additional important consideration is the context in which the duration information is experienced and processed, with the hippocampus being preferentially involved in memory for durations that are embedded within a sequence of events. We consider the mechanisms that may underpin temporal duration memory and how the same mechanisms may contribute to memory for other aspects of event sequences such as temporal order.

Unitization modulates recognition of within-domain and cross-domain associations: Evidence from event-related potentials

Although it is often assumed that memory of episodic associations requires recollection, it has been suggested that, when stimuli are experienced as a unit, earlier memory processes might contribute to their subsequent associative recognition. We investigated the effects of associative relations and perceptual domain during episodic encoding on the ability to utilize early memory processes to retrieve associative information. During the study phase, participants encoded compound and noncompound words pairs, presented either to the same sensory modality (visual presentation) or to different sensory modalities (audiovisual presentation). At the test phase, they discriminated between old, rearranged, and new pairs while ERPs were recorded. In an early ERP component, differences related to associative memory emerged only for compounds, regardless of their encoding modality. These findings indicate that episodic retrieval of compound words can be supported by early-onset recognition processes regardless of whether both words were presented to the same or different sensory modalities, and suggests that unitization can operate at an abstract level, across a broad range of materials.

Hippocampal Engagement during Recall Depends on Memory Content

The hippocampus is considered pivotal to recall, allowing retrieval of information not available in the immediate environment. In contrast, neocortex is thought to signal familiarity, contributing to recall only when called upon by the hippocampus. However, this view is not compatible with representational accounts of memory, which reject the mapping of cognitive processes onto brain regions. According to representational accounts, the hippocampus is not engaged by recall per se, rather it is engaged whenever hippocampal representations are required. To test whether hippocampus is engaged by recall when hippocampal representations are not required, we used functional imaging and a non-associative recall task, with images (objects, scenes) studied in isolation, and image patches as cues. As predicted by a representational account, hippocampal activation was modulated by the content of the recalled memory, increasing during recall of scenes-which are known to be processed by hippocampus-but not during recall of objects. Object recall instead engaged neocortical regions known to be involved in object-processing. Further supporting the representational account, effective connectivity analyses revealed that changes in functional activation during recall were driven by increased information flow from neocortical sites, rather than by the spreading of recall-related activation from hippocampus back to neocortex.

United we fall: All-or-none forgetting of complex episodic events

Do complex event representations fragment over time, or are they instead forgotten in an all-or-none manner? For example, if we met a friend in a café and they gave us a present, do we forget the constituent elements of this event (location, person, and object) independently, or would the whole event be forgotten? Research suggests that item-based memories are forgotten in a fragmented manner. However, we do not know how more complex episodic, event-based memories are forgotten. We assessed both retrieval accuracy and dependency—the statistical association between the retrieval successes of different elements from the same event—for complex events. Across 4 experiments, we show that retrieval dependency is found both immediately after learning and following a 12-hr and 1-week delay. Further, the amount of retrieval dependency after a delay is greater than that predicted by a model of independent forgetting. This dependency was only seen for coherent “closed-loops,” where all pairwise associations between locations, people, and objects were encoded. When “open-loops” were learned, where only 2 out of the 3 possible associations were encoded, no dependency was seen immediately after learning or after a delay. Finally, we also provide evidence for higher retention rates for closed-loops than for open-loops. Therefore, closed-loops do not fragment as a function of forgetting and are retained for longer than are open-loops. Our findings suggest that coherent episodic events are not only retrieved, but also forgotten, in an all-or-none manner.

A Roadmap for Understanding Memory: Decomposing Cognitive Processes into Operations and Representations

Thanks to patients Phineas Gage and Henry Molaison, we have long known that behavioral control depends on the frontal lobes, whereas declarative memory depends on the medial temporal lobes (MTL). For decades, cognitive functions-behavioral control, declarative memory-have served as labels for characterizing the division of labor in cortex. This approach has made enormous contributions to understanding how the brain enables the mind, providing a systems-level explanation of brain function that constrains lower-level investigations of neural mechanism. Today, the approach has evolved such that functional labels are often applied to brain networks rather than focal brain regions. Furthermore, the labels have diversified to include both broadly-defined cognitive functions (declarative memory, visual perception) and more circumscribed mental processes (recollection, familiarity, priming). We ask whether a process-a high-level mental phenomenon corresponding to an introspectively-identifiable cognitive event-is the most productive label for dissecting memory. For example, recollection conflates a neurocomputational operation (pattern completion-based retrieval) with a class of representational content (associative, high-dimensional memories). Because a full theory of memory must identify operations and representations separately, and specify how they interact, we argue that processes like recollection constitute inadequate labels for characterizing neural mechanisms. Instead, we advocate considering the component operations and representations of processes like recollection in isolation. For the organization of memory, the evidence suggests that pattern completion is recapitulated widely across the ventral visual stream and MTL, but the division of labor between sites within this pathway can be explained by representational content.

Enhancing memory with stress: Progress, challenges, and opportunities

Stress can strongly influence what we learn and remember, including by making memories stronger. Experiments probing stress effects on hippocampus-dependent memory in rodents have revealed modulatory factors and physiological mechanisms by which acute stress can enhance long-term memory. However, extending these findings and mechanisms to understand when stress will enhance declarative memory in humans faces important challenges. This review synthesizes human and rodent studies of stress and memory, examining translational gaps related to measurements of declarative memory and stress responses in humans. Human studies diverge from rodent research by assessing declarative memories that may not depend on the hippocampus and by measuring peripheral rather than central stress responses. This highlights opportunities for future research across species, including assessing stress effects on hippocampal-dependent memory processes in humans and relating peripheral stress responses to stress effects on the function of memory-related brain regions in rodents. Together, these investigations will facilitate the translation of stress effects on memory function from rodents to humans and inform interventions that can harness the positive effects of stress on long-term memory.

Verbal Paired Associates and the Hippocampus: The Role of Scenes

It is widely agreed that patients with bilateral hippocampal damage are impaired at binding pairs of words together. Consequently, the verbal paired associates (VPA) task has become emblematic of hippocampal function. This VPA deficit is not well understood and is particularly difficult for hippocampal theories with a visuospatial bias to explain (e.g., cognitive map and scene construction theories). Resolving the tension among hippocampal theories concerning the VPA could be important for leveraging a fuller understanding of hippocampal function. Notably, VPA tasks typically use high imagery concrete words and so conflate imagery and binding. To determine why VPA engages the hippocampus, we devised an fMRI encoding task involving closely matched pairs of scene words, pairs of object words, and pairs of very low imagery abstract words. We found that the anterior hippocampus was engaged during processing of both scene and object word pairs in comparison to abstract word pairs, despite binding occurring in all conditions. This was also the case when just subsequently remembered stimuli were considered. Moreover, for object word pairs, fMRI activity patterns in anterior hippocampus were more similar to those for scene imagery than object imagery. This was especially evident in participants who were high imagery users and not in mid and low imagery users. Overall, our results show that hippocampal engagement during VPA, even when object word pairs are involved, seems to be evoked by scene imagery rather than binding. This may help to resolve the issue that visuospatial hippocampal theories have in accounting for verbal memory.

Small Sets of Novel Words Are Fully Retained After 1-Week in Typically Developing Children and Down Syndrome: A Fast Mapping Study

OBJECTIVES

Down syndrome (DS) is a population with known hippocampal impairment, with studies showing that individuals with DS display difficulties in spatial navigation and remembering arbitrary bindings. Recent research has also demonstrated the importance of the hippocampus for novel word-learning. Based on these data, we aimed to determine whether individuals with DS show deficits in learning new labels and if they may benefit from encoding conditions thought to be less reliant on hippocampal function (i.e., through fast mapping).

METHODS

In the current study, we examined immediate, 5-min, and 1-week delayed word-learning across two learning conditions (e.g., explicit encoding vs. fast mapping). These conditions were examined across groups (twenty-six 3- to 5-year-old typically developing children and twenty-six 11- to 28-year-old individuals with DS with comparable verbal and nonverbal scores on the Kaufman Brief Intelligence Test - second edition) and in reference to sleep quality.

RESULTS

Both individuals with and without DS showed retention after a 1-week delay, and the current study found no benefit of the fast mapping condition in either group contrary to our expectations. Eye tracking data showed that preferential eye movements to target words were not present immediately but emerged after 1-week in both groups. Furthermore, sleep measures collected via actigraphy did not relate to retention in either group.

CONCLUSIONS

This study presents novel data on long-term knowledge retention in reference to sleep patterns in DS and adds to a body of knowledge helping us to understand the processes of word-learning in typical and atypically developing populations. (JINS, 2018, 24, 955-965).

How do memory systems detect and respond to novelty?

The efficiency of the memory system lies not only in its readiness to detect and retrieve old stimuli but also in its ability to detect and integrate novel information. In this review, we discuss recent evidence suggesting that the neural substrates sensitive to detecting familiarity and novelty are not entirely overlapping. Instead, these partially distinct familiarity and novelty signals are integrated to support recognition memory decisions. We propose here that the mediodorsal thalamus is critical for familiarity detection, and for combining novelty signals from the medial temporal lobe cortex with the relative familiarity outputs of computations performed in other cortical structures, especially the prefrontal cortex. Importantly, we argue that the anterior hippocampus has a prominent role in detecting novelty and in communicating this with midbrain and striatal structures. We argue that different types of novelty (absolute or contextual) engage different neurotransmitter systems that converge in the hippocampus. We suggest that contextual or unexpected novelty triggers dopaminergic hippocampal-midbrain coupling and noradrenergic-mediated pupil dilation. In contrast, absolute novelty triggers cholinergic-mediated hippocampal encoding accompanied by diminished pupil dilation. These two, distinct hippocampal encoding mechanisms both lead to later recollection but are sensitive to different types of novelty. We conclude that this neurotransmitter-mediated hippocampal encoding establishes the hippocampus in an encoding mode that briefly prevents the engagement of retrieval.

The Contribution of the Human Medial Temporal Lobe to Perception: Bridging the Gap between Animal and Human Studies

The medial temporal lobe (MTL) has been considered traditionally to subserve declarative memory processes only. Recent studies in nonhuman primates suggest, however, that the MTL may also be critical to higher order perceptual processes, with the hippocampus and perirhinal cortex being involved in scene and object perception, respectively. The current article reviews the human neuropsychological literature to determine whether there is any evidence to suggest that these same views may apply to the human MTL. Although the majority of existing studies report intact perception following MTL damage in human amnesics, there have been recent studies that suggest that when scene and object perception are assessed systematically, signifi-cant impairments in perception become apparent. These findings have important implications for current mnemonic theories of human MTL function and our understanding of human amnesia as a result of MTL lesions.

A Mini-Review of fMRI Studies of Human Medial Temporal Lobe Activity Associated with Recognition Memory

This review considers event-related functional magnetic resonance imaging (fMRI) studies of human recognition memory that have or have not reported activations within the medial temporal lobes (MTL). For comparisons both between items at study (encoding) and between items at test (recognition), MTL activations are characterized as left/right, anterior/posterior, and hippocampus/surrounding cortex, and as a function of the stimulus material and relevance of item/source information. Though no clear pattern emerges, there are trends suggesting differences between item and source information, and verbal and spatial information, and a role for encoding processes during recognition tests. Important future directions are considered.

Multifactorial context effects on visual recognition memory

While effects of contextual change or constancy on memory are widely found when tested by free and cued recall, there is greater inconsistency in context effects on recognition. This study employed a paradigm maximizing target–context interactivity and specificity to reveal three levels of context effects on successful retrieval, as well as context effects on the generation of false alarms, thereby revealing separable contributions of target–context binding, additive familiarity, and configural constancy. The separability of these factors enables the use of memory context effects as tools for investigating associative memory.

Neuropsychological Investigations of Human Amnesia: Insights Into the Role of the Medial Temporal Lobes in Cognition

The past 30 years of research on human amnesia has yielded important changes in our understanding of the role of the medial temporal lobes (MTL) in memory. On the one hand, this body of evidence has highlighted that not all types of memory are impaired in patients with MTL lesions. On the other hand, this research has made apparent that the role of the MTL extends beyond the domain of long-term memory, to include working memory, perception, and future thinking. In this article, we review the discoveries and controversies that have characterized this literature and that set the stage for a new conceptualization of the role of the MTL in cognition. This shift toward a more nuanced understanding of MTL function has direct relevance for a range of clinical disorders in which the MTL is implicated, potentially shaping not only theoretical understanding but also clinical practice. (JINS, 2017, 23, 732-740).

Emotional arousal impairs association-memory: Roles of amygdala and hippocampus

Emotional arousal is well-known to enhance memory for individual items or events, whereas it can impair association memory. The neural mechanism of this association memory impairment by emotion is not known: In response to emotionally arousing information, amygdala activity may interfere with hippocampal associative encoding (e.g., via prefrontal cortex). Alternatively, emotional information may be harder to unitize, resulting in reduced availability of extra-hippocampal medial temporal lobe support for emotional than neutral associations. To test these opposing hypotheses, we compared neural processes underlying successful and unsuccessful encoding of emotional and neutral associations. Participants intentionally studied pairs of neutral and negative pictures (Experiments 1-3). We found reduced association-memory for negative pictures in all experiments, accompanied by item-memory increases in Experiment 2. High-resolution fMRI (Experiment 3) indicated that reductions in associative encoding of emotional information are localizable to an area in ventral-lateral amygdala, driven by attentional/salience effects in the central amygdala. Hippocampal activity was similar during both pair types, but a left hippocampal cluster related to successful encoding was observed only for negative pairs. Extra-hippocampal associative memory processes (e.g., unitization) were more effective for neutral than emotional materials. Our findings suggest that reduced emotional association memory is accompanied by increases in activity and functional coupling within the amygdala. This did not disrupt hippocampal association-memory processes, which indeed were critical for successful emotional association memory formation.

The hippocampus is particularly important for building associations across stimulus domains

The medial temporal lobe (MTL) is critical for binding together different attributes that together form memory for prior episodes, but whether it is preferentially involved in supporting specific types of associations is a topic of much debate. Some have argued that the MTL, specifically the hippocampus, may be specialized for binding information from different stimulus domains (e.g., linking visual and auditory stimuli). In the current study, we examined the role of the MTL in memory for associations within- vs. across-domains. Patients with either selective hippocampal lesions or more extensive MTL lesions studied pairs of items within the same stimulus domain (i.e., image-image or sound-sound pairs) or across different domains (i.e., image-sound pairs). Associative memory was subsequently tested by having participants discriminate between previously studied and rearranged pairs. Compared to healthy controls, the patients were significantly more impaired in the across-domain condition than the within-domain conditions. Similar deficits were observed for patients with hippocampal lesions and those with more extensive MTL lesions, suggesting that the hippocampus itself is particularly important for binding associations across stimulus domains.

Plasticity of hippocampal memories in humans

The human hippocampus is a brain region that supports episodic and spatial memory. Recent experiments have drawn on animal research and computational modelling to reveal how the unique computations and representations of the hippocampus support episodic and spatial memory. Invasive electrophysiological recordings and non-invasive functional brain imaging have provided evidence for the rapid formation of hippocampal representations, as well as the ability of the hippocampus to both pattern-separate and pattern-complete input from the neocortex. Further, recent evidence has shown that hippocampal representations are in constant flux, undergoing a continual process of strengthening, weakening and altering. This research offers a glimpse into the highly plastic and flexible nature of the human hippocampal system in relation to episodic memory.

The effects of item familiarity on the neural correlates of successful associative memory encoding

Associative memory is considered to be resource-demanding, requiring individuals to learn individual items and the specific relationships between those items. Previous research has shown that prior studying of items aids in associative memory for pairs composed of those same items, as compared to pairs of items that have not been prelearned (e.g., Kilb & Naveh-Benjamin, 2011). In the present study, we sought to elucidate the neural correlates mediating this memory facilitation. After being trained on individual items, participants were scanned while encoding item pairs composed of items from the pretrained phase (familiarized-item pairs) and pairs whose items had not been previously learned (unfamiliarized-item pairs). Consistent with previous findings, the overall subsequent recollection showed the engagement of bilateral parahippocampal gyrus (PHG) and hippocampus, when compared to subsequent forgetting. However, a direct comparison between familiarized- and unfamiliarized-item pairs showed that subsequently recollected familiarized-item pairs were associated with decreased activity across much of the encoding network, including bilateral PHG, hippocampus, prefrontal cortex, and regions associated with item-specific processing within occipital cortex. Increased activity for familiarized-item pairs was found in a more limited set of regions, including bilateral parietal cortex, which has been associated with the formation of novel associations. Additionally, activity in the right parietal cortex correlated with associative memory success in the familiarized condition. Taken together, these results suggest that prior exposure to items can reduce the demands incurred on neural processing throughout the associative encoding network and can enhance associative memory performance by focusing resources within regions supporting the formation of associative links.

Detecting and discriminating novel objects: The impact of perirhinal cortex disconnection on hippocampal activity patterns

Perirhinal cortex provides object‐based information and novelty/familiarity information for the hippocampus. The necessity of these inputs was tested by comparing hippocampal c‐fos expression in rats with or without perirhinal lesions. These rats either discriminated novel from familiar objects (Novel‐Familiar) or explored pairs of novel objects (Novel‐Novel). Despite impairing Novel‐Familiar discriminations, the perirhinal lesions did not affect novelty detection, as measured by overall object exploration levels (Novel‐Novel condition). The perirhinal lesions also largely spared a characteristic network of linked c‐fos expression associated with novel stimuli (entorhinal cortex→CA3→distal CA1→proximal subiculum). The findings show: I) that perirhinal lesions preserve behavioral sensitivity to novelty, whilst still impairing the spontaneous ability to discriminate novel from familiar objects, II) that the distinctive patterns of hippocampal c‐fos activity promoted by novel stimuli do not require perirhinal inputs, III) that entorhinal Fos counts (layers II and III) increase for novelty discriminations, IV) that hippocampal c‐fos networks reflect proximal‐distal connectivity differences, and V) that discriminating novelty creates different pathway interactions from merely detecting novelty, pointing to top‐down effects that help guide object selection. © 2016 The Authors Hippocampus Published by Wiley Periodicals, Inc.

Old-new ERP effects and remote memories: the late parietal effect is absent as recollection fails whereas the early mid-frontal effect persists as familiarity is retained

Understanding the electrophysiological correlates of recognition memory processes has been a focus of research in recent years. This study investigated the effects of retention interval on recognition memory by comparing memory for objects encoded four weeks (remote) or 5 min (recent) before testing. In Experiment 1, event related potentials (ERPs) were acquired while participants performed a yes-no recognition memory task involving remote, recent and novel objects. Relative to correctly rejected new items, remote and recent hits showed an attenuated frontal negativity from 300–500 ms post-stimulus. This effect, also known as the FN400, has been previously associated with familiarity memory. Recent and remote recognition ERPs did not differ from each other at this time-window. By contrast, recent but not remote recognition showed increased parietal positivity from around 500 ms post-stimulus. This late parietal effect (LPE), which is considered a correlate of recollection-related processes, also discriminated between recent and remote memories. A second, behavioral experiment confirmed that remote memories unlike recent memories were based almost exclusively on familiarity. These findings support the idea that the FN400 and LPE are indices of familiarity and recollection memory, respectively and show that remote and recent memories are functionally and anatomically distinct.

Memory Retrieval in Mice and Men

Retrieval, the use of learned information, was until recently mostly terra incognita in the neurobiology of memory, owing to shortage of research methods with the spatiotemporal resolution required to identify and dissect fast reactivation or reconstruction of complex memories in the mammalian brain. The development of novel paradigms, model systems, and new tools in molecular genetics, electrophysiology, optogenetics, in situ microscopy, and functional imaging, have contributed markedly in recent years to our ability to investigate brain mechanisms of retrieval. We review selected developments in the study of explicit retrieval in the rodent and human brain. The picture that emerges is that retrieval involves coordinated fast interplay of sparse and distributed corticohippocampal and neocortical networks that may permit permutational binding of representational elements to yield specific representations. These representations are driven largely by the activity patterns shaped during encoding, but are malleable, subject to the influence of time and interaction of the existing memory with novel information.

Remembering Preservation in Hippocampal Amnesia

The lesion-deficit model dominates neuropsychology. This is unsurprising given powerful demonstrations that focal brain lesions can affect specific aspects of cognition. Nowhere is this more evident than in patients with bilateral hippocampal damage. In the past 60 years, the amnesia and other impairments exhibited by these patients have helped to delineate the functions of the hippocampus and shape the field of memory. We do not question the value of this approach. However, less prominent are the cognitive processes that remain intact following hippocampal lesions. Here, we collate the piecemeal reports of preservation of function following focal bilateral hippocampal damage, highlighting a wealth of information often veiled by the field's focus on deficits. We consider how a systematic understanding of what is preserved as well as what is lost could add an important layer of precision to models of memory and the hippocampus.

Memory improvement via slow-oscillatory stimulation during sleep in older adults

We examined the intriguing but controversial idea that disrupted sleep-dependent consolidation contributes to age-related memory decline. Slow-wave activity during sleep may help strengthen neural connections and provide memories with long-term stability, in which case decreased slow-wave activity in older adults could contribute to their weaker memories. One prediction from this account is that age-related memory deficits should be reduced by artificially enhancing slow-wave activity. In young adults, applying transcranial current oscillating at a slow frequency (0.75 Hz) during sleep improves memory. Here, we tested whether this procedure can improve memory in older adults. In 2 sessions separated by 1 week, we applied either slow-oscillatory stimulation or sham stimulation during an afternoon nap in a double-blind, crossover design. Memory tests were administered before and after sleep. A larger improvement in word-pair recall and higher slow-wave activity was observed with slow-oscillatory stimulation than with sham stimulation. This is the first demonstration that this procedure can improve memory in older adults, suggesting that declarative memory performance in older adults is partly dependent on slow-wave activity during sleep.

Atypical spatiotemporal signatures of working memory brain processes in autism

Working memory (WM) impairments may contribute to the profound behavioural manifestations in children with autism spectrum disorder (ASD). However, previous behavioural results are discrepant as are the few functional magnetic resonance imaging (fMRI) results collected in adults and adolescents with ASD. Here we investigate the precise temporal dynamics of WM-related brain activity using magnetoencephalography (MEG) in 20 children with ASD and matched controls during an n-back WM task across different load levels (1-back vs 2-back). Although behavioural results were similar between ASD and typically developing (TD) children, the between-group comparison performed on functional brain activity showed atypical WM-related brain processes in children with ASD compared with TD children. These atypical responses were observed in the ASD group from 200 to 600 ms post stimulus in both the low- (1-back) and high- (2-back) memory load conditions. During the 1-back condition, children with ASD showed reduced WM-related activations in the right hippocampus and the cingulate gyrus compared with TD children who showed more activation in the left dorso-lateral prefrontal cortex and the insulae. In the 2-back condition, children with ASD showed less activity in the left insula and midcingulate gyrus and more activity in the left precuneus than TD children. In addition, reduced activity in the anterior cingulate cortex was correlated with symptom severity in children with ASD. Thus, this MEG study identified the precise timing and sources of atypical WM-related activity in frontal, temporal and parietal regions in children with ASD. The potential impacts of such atypicalities on social deficits of autism are discussed.

The importance of unitization for familiarity-based learning

It is often assumed that recollection is necessary to support memory for novel associations, whereas familiarity supports memory for single items. However, the levels of unitization framework assumes that familiarity can support associative memory under conditions in which the components of an association are unitized (i.e., treated as a single coherent item). In the current study we tested two critical assumptions of this framework. First, does unitization reflect a specialized form of learning or is it simply a form of semantic or elaborative encoding, and, second, can the beneficial effects of unitization on familiarity be observed for across-domain associations or are they limited to creating new associations between items that are from the same stimulus domains? Unitization was found to increase associative recognition but not item recognition. It affected familiarity more than recollection, increased associative but not item priming, and was dissociable from levels of processing effects. Moreover, unitization effects were found to be particularly effective in supporting face-word and fractal-sound pairs. The current results indicate that unitization reflects a specialized form of learning that supports associative familiarity of within- and across-domain associations.

Memory integration in amnesia: prior knowledge supports verbal short-term memory

Short-term memory (STM) and long-term memory (LTM) have traditionally been considered cognitively distinct. However, it is known that STM can improve when to-be-remembered information appears in contexts that make contact with prior knowledge, suggesting a more interactive relationship between STM and LTM. The current study investigated whether the ability to leverage LTM in support of STM critically depends on the integrity of the hippocampus. Specifically, we investigated whether the hippocampus differentially supports between-domain versus within-domain STM-LTM integration given prior evidence that the representational domain of the elements being integrated in memory is a critical determinant of whether memory performance depends on the hippocampus. In Experiment 1, we investigated hippocampal contributions to within-domain STM-LTM integration by testing whether immediate verbal recall of words improves in MTL amnesic patients when words are presented in familiar verbal contexts (meaningful sentences) compared to unfamiliar verbal contexts (random word lists). Patients demonstrated a robust sentence superiority effect, whereby verbal STM performance improved in familiar compared to unfamiliar verbal contexts, and the magnitude of this effect did not differ from that in controls. In Experiment 2, we investigated hippocampal contributions to between-domain STM-LTM integration by testing whether immediate verbal recall of digits improves in MTL amnesic patients when digits are presented in a familiar visuospatial context (a typical keypad layout) compared to an unfamiliar visuospatial context (a random keypad layout). Immediate verbal recall improved in both patients and controls when digits were presented in the familiar compared to the unfamiliar keypad array, indicating a preserved ability to integrate activated verbal information with stored visuospatial knowledge. Together, these results demonstrate that immediate verbal recall in amnesia can benefit from two distinct types of semantic support, verbal and visuospatial, and that the hippocampus is not critical for leveraging stored semantic knowledge to improve memory performance.

The effects of unitization on the contribution of familiarity and recollection processes to associative recognition memory: evidence from event-related potentials

Familiarity and recollection are two independent cognitive processes involved in recognition memory. It is traditionally believed that both familiarity and recollection can support item recognition, whereas only recollection can support associative recognition. Here, using a standard associative recognition task, we examined whether associative retrieval of unitized associations involved differential patterns of familiarity and recollection processes relative to non-unitized associations. The extent of engagement of familiarity and recollection processes during associative retrieval was estimated by using event-related potentials (ERPs). Twenty participants studied compound words and unrelated word pairs during encoding. Subsequently, they were asked to decide whether a presented word pair was intact, rearranged, or a new pair while electroencephalogram (EEG) was recorded. ERP results showed that compound words evoked a significant early frontal old/new effect (associated with familiarity) between ERPs to intact and rearranged word pairs, whereas this effect disappeared for the unrelated word pairs. In addition, the left parietal old/new effect (associated with recollection) between ERPs to intact and rearranged word pairs was greater for compounds than for unrelated word pairs. These findings suggest that unitization enhances the contribution of both familiarity and recollection processes to associative recognition.

Relational and conjunctive binding functions dissociate in short-term memory

Remembering complex events requires binding features within unified objects (conjunctions) and holding associations between objects (relations). Recent studies suggest that the two functions dissociate in long-term memory (LTM). Less is known about their functional organization in short-term memory (STM). The present study investigated this issue in patient AE affected by a stroke which caused damage to brain regions known to be relevant for relational functions both in LTM and in STM (i.e., the hippocampus). The assessment involved a battery of standard neuropsychological tasks and STM binding tasks. One STM binding task (Experiment 1) presented common objects and common colors forming either pairs (relations) or integrated objects (conjunctions). Free recall of relations or conjunctions was assessed. A second STM binding task used random polygons and non-primary colors instead (Experiment 2). Memory was assessed by selecting the features that made up the relations or the conjunctions from a set of single polygons and a set of single colors. The neuropsychological assessment revealed impaired delayed memory in AE. AE's pronounced relational STM binding deficits contrasted with his completely preserved conjunctive binding functions in both Experiments 1 and 2. Only 2.35% and 1.14% of the population were expected to have a discrepancy more extreme than that presented by AE in Experiments 1 and 2, respectively. Processing relations and conjunctions of very elementary nonspatial features in STM led to dissociating performances in AE. These findings may inform current theories of memory decline such as those linked to cognitive aging.

Development and evaluation of a self-administered on-line test of memory and attention for middle-aged and older adults

There is a need for rapid and reliable Internet-based screening tools for cognitive assessment in middle-aged and older adults. We report the psychometric properties of an on-line tool designed to screen for cognitive deficits that require further investigation. The tool is composed of measures of memory and executive attention processes known to be sensitive to brain changes associated with aging and with cognitive disorders that become more prevalent with age. Measures included a Spatial Working Memory task, Stroop Interference task, Face-Name Association task, and Number-Letter Alternation task. Normative data were collected from 361 healthy adults age 50–79 who scored in the normal range on a standardized measure of general cognitive ability. Participants took the 20-minute on-line test on their home computers, and a subset of 288 participants repeated the test 1 week later. Analyses of the individual tasks indicated adequate internal consistency, construct validity, test-retest reliability, and alternate version reliability. As expected, scores were correlated with age. The four tasks loaded on the same principle component. Demographically-corrected z-scores from the individual tasks were combined to create an overall score, which showed good reliability and classification consistency. These results indicate the tool may be useful for identifying middle-aged and older adults with lower than expected scores who may benefit from clinical evaluation of their cognition by a health care professional.

Medial temporal lobe contributions to intra-item associative recognition memory in the aging brain

Aging is associated with a decline in episodic memory function. This is accompanied by degradation of and functional changes in the medial temporal lobe (MTL) which subserves mnemonic processing. To date no study has investigated age-related functional change in MTL substructures during specific episodic memory processes such as intra-item associative memory. The aim of this study was to characterize age-related change in the neural correlates of intra-item associative memory processing. Sixteen young and 10 older subjects participated in a compound word intra-item associative memory task comprising a measure of associative recognition memory and a measure of recognition memory. There was no difference in performance between groups on the associative memory measure but each group recruited different MTL regions while performing the task. The young group recruited the left anterior hippocampus and posterior parahippocampal gyrus whereas the older participants recruited the hippocampus bilaterally. In contrast, recognition memory was significantly worse in the older subjects. The left anterior hippocampus was recruited in the young group during successful recognition memory whereas the older group recruited a more posterior region of the left hippocampus and showed a more bilateral activation of frontal brain regions than was observed in the young group. Our results suggest a reorganization of the neural correlates of intra-item associative memory in the aging brain.

Reversible information flow across the medial temporal lobe: the hippocampus links cortical modules during memory retrieval

A simple cue can be sufficient to elicit vivid recollection of a past episode. Theoretical models suggest that upon perceiving such a cue, disparate episodic elements held in neocortex are retrieved through hippocampal pattern completion. We tested this fundamental assumption by applying functional magnetic resonance imaging (fMRI) while objects or scenes were used to cue participants' recall of previously paired scenes or objects, respectively. We first demonstrate functional segregation within the medial temporal lobe (MTL), showing domain specificity in perirhinal and parahippocampal cortices (for object-processing vs scene-processing, respectively), but domain generality in the hippocampus (retrieval of both stimulus types). Critically, using fMRI latency analysis and dynamic causal modeling, we go on to demonstrate functional integration between these MTL regions during successful memory retrieval, with reversible signal flow from the cue region to the target region via the hippocampus. This supports the claim that the human hippocampus provides the vital associative link that integrates information held in different parts of cortex.

The associative structure of memory for multi-element events

The hippocampus is thought to be an associative memory “convergence zone,” binding together the multimodal elements of an experienced event into a single engram. This predicts a degree of dependency between the retrieval of the different elements comprising an event. We present data from a series of studies designed to address this prediction. Participants vividly imagined a series of person–location–object events, and memory for these events was assessed across multiple trials of cued retrieval. Consistent with the prediction, a significant level of dependency was found between the retrieval of different elements from the same event. Furthermore, the level of dependency was sensitive both to retrieval task, with higher dependency during cued recall than cued recognition, and to subjective confidence. We propose a simple model, in which events are stored as multiple pairwise associations between individual event elements, and dependency is captured by a common factor that varies across events. This factor may relate to between-events modulation of the strength of encoding, or to a process of within-event “pattern completion” at retrieval. The model predicts the quantitative pattern of dependency in the data when changes in the level of guessing with retrieval task and confidence are taken into account. Thus, we find direct behavioral support for the idea that memory for complex multimodal events depends on the pairwise associations of their constituent elements and that retrieval of the various elements corresponding to the same event reflects a common factor that varies from event to event.

Impaired retention is responsible for temporal order memory deficits in mild cognitive impairment

Temporal order memory, or remembering the order of events, is critical for everyday functioning and is difficult for patients with mild cognitive impairment (MCI). It is currently unclear whether these patients have difficulty acquiring and/or retaining such information and whether deficits in these patients are in excess of "normal" age-related declines. Therefore, the current study examined age and disease-related changes in temporal order memory as well as whether memory load played a role in such changes. Young controls (n=25), older controls (n=34), and MCI patients (n=32) completed an experimental task that required the reconstruction of sequences that were 3, 4, or 5 items in length both immediately after presentation (i.e., immediate recall) and again after a 10-min delay (i.e., delayed recall). During the immediate recall phase, there was an effect of age largely due to reduced performance at the two longest span lengths. Older controls and MCI patients only differed during the five span (controls>MCI). During the delayed recall, however, there were significant effects of both age and MCI regardless of span length. In MCI patients, immediate recall was significantly correlated with measures of executive functioning, whereas delayed recall performance was only related to other memory tests. These findings suggest that MCI patients experience initial temporal order memory deficits at the point when information begins to exceed working memory capacity and become dependent on medial temporal lobe functioning. Longer-term deficits are due to an inability to retain information, consistent with the characteristic medial temporal lobe dysfunction in MCI.