The neuropathology of amnesia

The contribution of mamillary body damage to Wernicke's encephalopathy and Korsakoff's syndrome

Histopathological alterations of the mamillary bodies are the most conspicuous and the most consistent neuropathological features of several disorders that occur after severe thiamine deficiency, such as Wernicke's encephalopathy and Korsakoff's syndrome. Moreover, they are among the few abnormalities that are visible to the naked eye in these disorders. With a lifetime prevalence of approximately 1.3%, Wernicke's encephalopathy is by far the most frequent cause of damage to the mamillary bodies in humans. Still, there is a persisting uncertainty with regard to the development and the clinical consequences of this damage, because it is virtually impossible to study in isolation. As a rule, it always occurs alongside neuropathology in other subcortical gray matter structures, notably the medial thalamus. Converging evidence from other pathologies and animal experiments is needed to assess the clinical impact of mamillary body damage and to determine which functions can be attributed to these structures in healthy subjects. In this chapter, we describe the history and the current state of knowledge with regard to thiamine deficiency disorders and the contribution of mamillary body damage to their clinical presentations.

Associations between Family Adversity and Brain Volume in Adolescence: Manual vs. Automated Brain Segmentation Yields Different Results

Associations between brain structure and early adversity have been inconsistent in the literature. These inconsistencies may be partially due to methodological differences. Different methods of brain segmentation may produce different results, obscuring the relationship between early adversity and brain volume. Moreover, adolescence is a time of significant brain growth and certain brain areas have distinct rates of development, which may compromise the accuracy of automated segmentation approaches. In the current study, 23 adolescents participated in two waves of a longitudinal study. Family aggression was measured when the youths were 12 years old, and structural scans were acquired an average of 4 years later. Bilateral amygdalae and hippocampi were segmented using three different methods (manual tracing, FSL, and NeuroQuant). The segmentation estimates were compared, and linear regressions were run to assess the relationship between early family aggression exposure and all three volume segmentation estimates. Manual tracing results showed a positive relationship between family aggression and right amygdala volume, whereas FSL segmentation showed negative relationships between family aggression and both the left and right hippocampi. However, results indicate poor overlap between methods, and different associations were found between early family aggression exposure and brain volume depending on the segmentation method used.

What are the links between maternal social status, hippocampal function, and HPA axis function in children?

The association of parental social status with multiple health and achievement indicators in adulthood has driven researchers to attempt to identify mechanisms by which social experience in childhood could shift developmental trajectories. Some accounts for observed linkages between parental social status in childhood and health have hypothesized that early stress exposure could result in chronic disruptions in hypothalamic-pituitary-adrenal (HPA) axis activation, and that this activation could lead to long-term changes. A robust literature in adult animals has demonstrated that chronic HPA axis activation leads to changes in hippocampal structure and function. In the current study, consistent with studies in animals, we observe an association between both maternal self-rated social status and hippocampal activation in children and between maternal self-rated social status and salivary cortisol in children.

Hippocampus in health and disease: An overview

Hippocampus is a complex brain structure embedded deep into temporal lobe. It has a major role in learning and memory. It is a plastic and vulnerable structure that gets damaged by a variety of stimuli. Studies have shown that it also gets affected in a variety of neurological and psychiatric disorders. In last decade or so, lot has been learnt about conditions that affect hippocampus and produce changes ranging from molecules to morphology. Progresses in radiological delineation, electrophysiology, and histochemical characterization have made it possible to study this archicerebral structure in greater detail. Present paper attempts to give an overview of hippocampus, both in health and diseases.

Association of crossword puzzle participation with memory decline in persons who develop dementia

Participation in cognitively stimulating leisure activities such as crossword puzzles may delay onset of the memory decline in the preclinical stages of dementia, possibly via its effect on improving cognitive reserve. We followed 488 initially cognitively intact community residing individuals with clinical and cognitive assessments every 12-18 months in the Bronx Aging Study. We assessed the influence of crossword puzzle participation on the onset of accelerated memory decline as measured by the Buschke Selective Reminding Test in 101 individuals who developed incident dementia using a change point model. Crossword puzzle participation at baseline delayed onset of accelerated memory decline by 2.54 years. Inclusion of education or participation in other cognitively stimulating activities did not significantly add to the fit of the model beyond the effect of puzzles. Our findings show that late life crossword puzzle participation, independent of education, was associated with delayed onset of memory decline in persons who developed dementia. Given the wide availability and accessibility of crossword puzzles, their role in preventing cognitive decline should be validated in future clinical trials.

Alcohol-related amnesia and dementia: animal models have revealed the contributions of different etiological factors on neuropathology, neurochemical dysfunction and cognitive impairment

Chronic alcoholism is associated with impaired cognitive functioning. Over 75% of autopsied chronic alcoholics have significant brain damage and over 50% of detoxified alcoholics display some degree of learning and memory impairment. However, the relative contributions of different etiological factors to the development of alcohol-related neuropathology and cognitive impairment are questioned. One reason for this quandary is that both alcohol toxicity and thiamine deficiency result in brain damage and cognitive problems. Two alcohol-related neurological disorders, alcohol-associated dementia and Wernicke-Korsakoff syndrome have been modeled in rodents. These pre-clinical models have elucidated the relative contributions of ethanol toxicity and thiamine deficiency to the development of dementia and amnesia. What is observed in these models--from repeated and chronic ethanol exposure to thiamine deficiency--is a progression of both neural and cognitive dysregulation. Repeated binge exposure to ethanol leads to changes in neural plasticity by reducing GABAergic inhibition and facilitating glutamatergic excitation, long-term chronic ethanol exposure results in hippocampal and cortical cell loss as well as reduced hippocampal neurotrophin protein content critical for neural survival, and thiamine deficiency results in gross pathological lesions in the diencephalon, reduced neurotrophic protein levels, and neurotransmitters levels in the hippocampus and cortex. Behaviorally, after recovery from repeated or chronic ethanol exposure there is impairment in working or episodic memory that can recover with prolonged abstinence. In contrast, after thiamine deficiency there is severe and persistent spatial memory impairments and increased perseverative behavior. The interaction between ethanol and thiamine deficiency does not produce more behavioral or neural pathology, with the exception of reduction of white matter, than long-term thiamine deficiency alone.

A review of adversity, the amygdala and the hippocampus: a consideration of developmental timing

A review of the human developmental neuroimaging literature that investigates outcomes following exposure to psychosocial adversity is presented with a focus on two subcortical structures – the hippocampus and the amygdala. Throughout this review, we discuss how a consideration of developmental timing of adverse experiences and age at measurement might provide insight into the seemingly discrepant findings across studies. We use findings from animal studies to suggest some mechanisms through which timing of experiences may result in differences across time and studies. The literature suggests that early life may be a time of heightened susceptibility to environmental stressors, but that expression of these effects will vary by age at measurement.

[An unusual case of anterior communicating artery syndrome]

We describe the case of a 51-year-old man who developed acute partial anterior communicating artery syndrome (ACoAS) due to a nonruptured aneurysm of that artery. The patient presented with anterograde memory deficits, particularly impaired delayed recall, whereas his declarative learning and retrograde memory were relatively spared. Full ACoAS is usually associated with confabulations and personality change, which did not present in the case reported here. However, the patient presented with the flat affect and reduced drive typical of frontal lobe disorder. Clinical and neuropsychological assessment largely ruled out other causal factors involved in the symptomatology. Upon follow-up 2 years after onset of the AcoAS, the patient's neuropsychological performance had remained stable, yet his affective resonance and, in part, his spatial orientation had improved. We conclude that malformations of the intracranial arterial system ought to be taken into account as differential diagnosis of acute memory disorders.

Impaired, spared, and enhanced ACh efflux across the hippocampus and striatum in diencephalic amnesia is dependent on task demands

Diencephalic amnesia manifests itself through a host of neurological and memory impairments. A commonly employed animal model of diencephalic amnesia, pyrithiamine-induced thiamine deficiency (PTD), results in brain lesions and impairments similar in nature and distribution to those observed in humans with Wernicke-Korsakoff syndrome (WKS). In the current investigation, 2 separate experiments were conducted in which acetylcholine (ACh) efflux was assessed in the hippocampus and striatum of PTD-treated and pair-fed (PF) control male Sprague-Dawley rats. The goal was to determine under what behavioral conditions and in which brain structures ACh efflux was spared, impaired, or adaptively enhanced. In Experiment 1, rats were assessed on a spontaneous alternation task; in Experiment 2, rats were tested on a T-maze discrimination task that could be learned via a hippocampal- or striatal-based strategy. In Experiment 1, PTD-treated rats were impaired on the spontaneous alternation task and ACh efflux in the hippocampus during testing was significantly reduced, but spared in the striatum. In Experiment 2, PTD- and PF-treated rats did not differ in the number of trials to criterion, but PTD-treated rats demonstrated greater reliance upon egocentric cues to solve the task. Furthermore, ACh efflux in the striatum was greater during maze learning in the PTD-treated animals when compared to the PF animals. These results suggest that there is behavioral and systems level plasticity that can facilitate the use of alternative strategies to solve a task following diencephalic damage and WKS.

H.M.'s personal crossword puzzles: understanding memory and language

The amnesic patient H.M. has been solving crossword puzzles nearly all his life. Here, we analysed the linguistic content of 277 of H.M.'s crossword-puzzle solutions. H.M. did not have any unusual difficulties with the orthographic and grammatical components inherent to the puzzles. He exhibited few spelling errors, responded with appropriate parts of speech, and provided answers that were, at times, more convincing to observers than those supplied by the answer keys. These results suggest that H.M.'s lexical word-retrieval skills remain fluid despite his profound anterograde amnesia. Once acquired, the maintenance of written language comprehension and production does not seem to require intact medial temporal lobe structures.

Selective septohippocampal - but not forebrain amygdalar - cholinergic dysfunction in diencephalic amnesia

A rodent model of diencephalic amnesia, pyrithiamine-induced thiamine deficiency (PTD), was used to investigate diencephalic-limbic interactions. In-vivo acetylcholine (ACh) efflux, a marker of memory-related activation, was measured in the hippocampus and the amygdala of PTD-treated and pair-fed (PF) control rats while they were tested on a spontaneous alternation task. During behavioral testing, all animals displayed increases in ACh efflux in both the hippocampus and amygdala. However, during spontaneous alternation testing ACh efflux in the hippocampus and the alternation scores were higher in PF rats relative to PTD-treated rats. In contrast, ACh efflux in the amygdala was not suppressed in PTD treated rats, relative to PF rats, prior to or during behavioral testing. In addition, unbiased stereological estimates of the number of choline acetyltransferase (ChAT) immunopositive neurons in the medial septal/diagonal band (MS/DB) and nucleus basalis of Meynert (NBM) also reveal a selective cholinergic dysfunction: In PTD-treated rats a significant loss of ChAT-immunopositive cells was found only in the MS/DB, but not in the NBM. Significantly, these results demonstrate that thiamine deficiency causes selective cholinergic dysfunction in the septo-hippocampal pathway.

Categorization in the monkey hippocampus: a possible mechanism for encoding information into memory

The mammalian hippocampus processes sensory information into memory. The neurobiological basis of this representation, as well as the type of information that is encoded, is central to understanding how memories are formed. Normally, there is an infinite amount of information that could be encoded for any given stimulus. Thus, the question arises as to how the hippocampus selects and encodes features of a given stimulus. Here, we show that neurons in the hippocampus of the monkey appear to categorize types of visual stimuli presented in a delayed-match-to-sample memory task. By extracting unique combinations of features, these category cells are able to encode aspects of behaviorally important images instead of encoding all visual details. The subject is then able to rapidly select an appropriate response to that stimulus when distracting stimuli are presented simultaneously, thereby facilitating performance. Moreover, across animals, this specific type of encoding differed considerably. Just as in humans, different monkeys attended to and selected different aspects of the same stimulus image, most likely reflecting different histories, strategies, and expectations residing within individual hippocampal networks.

Consolidation theory and retrograde amnesia in humans

Recent research on the cognitive dysfunctions experienced by human anmesic patients indicates that very long term (multidecade) changes may occur in memory. Flat retrograde amnesia (RA), consisting of a uniform memory deficit for information from all preamnesia time periods, indicates a simple, monolithic retrieval problem, whereas graded RA, with greater memory deficits for information from recent as opposed to remote time periods, suggests the presence of a gradual long-term encoding, or consolidation, process. An evaluation of 247 outcomes from 61 articles provides strong evidence of graded RA across different cerebral injuries, materials, and test procedures, as well as in measures of both absolute and relative (patient vs. control) performance. Future conceptualizations of human memory should address the possibility that memories increase in resistance to forgetting, or reduction in trace fragility, across many decades.

Therapeutic effects of an acetylcholinesterase inhibitor (donepezil) on memory in Wernicke-Korsakoff's disease

Wernicke-Korsakoff's disease (WKD) is cognitively an amnestic state resulting from strategic lesions in the limbic system subserving the episodic memory network and resulting from thiamine deficiency. Neurochemical deficits have been implicated in the pathophysiology of amnesia based on the pathologic observations that various brainstem and basal forebrain nuclei are also affected. Previous treatment attempts with serotoninergic, noradrenergic, and cholinergic drugs have given controversial results. The objective of this study was to assess the effects of a cholinesterase inhibitor, donepezil, on memory, attention, and executive functions in patients with nonalcoholic WKD. Seven patients who developed WKD after a hunger strike were included in this single, blind, placebo-controlled, one-way, crossover study. The patients were administered donepezil during the first 30 days, and were administered placebo during the following 30 days. Neuropsychological tests to evaluate verbal and visual memory, and attention and executive function were performed on days 0, 31, and 61. All patients completed both phases of the study. There were no statistically significant differences between the three evaluations, except for a difference between active treatment and the placebo phase during recall of the Rey-Osterrieth complex figure, which was in favor of the placebo phase. There were no significant changes in favor of the active treatment. Cholinergic treatment with the cholinesterase inhibitor donepezil does not seem to provide marked beneficial effects in patients with WKD in this small, descriptive study. This may be because pathways mediating channel and state-dependent functions are impaired in this disease, and enhancement of state-dependent cholinergic transmission may not be sufficient. Subtle benefits, however, cannot be excluded because of the small sample size and the relatively short duration of the treatment.

Expression of one group of genes maintains one unit of long-term memory in a brain model

In a brain model, a unit of long-term memory is stored in the encoding synapses of a neuron as a presynaptic axonal 'on-off' pattern through the establishment of long-term potentiation (LTP) and long-term depression (LTD). Repetitive activation of one presynaptic axonal 'on-off' pattern speeds up the subsequent re-activation of the same pattern by inducing expression of a corresponding group of genes in support of the enzymes, protein substrates, and second messengers for the LTP and LTD that encode the unit of long-term memory. Phantom limb pains are memorized and re-activated through the expression of the corresponding group of genes, and re-experiencing the stressful event in post traumatic stress syndrome results from the expression of another group of genes. The sense of requiring less time to experience the content of a successfully retrieved long-term memory reflects an increased speed of re-activating the presynaptic axonal 'on-off' patterns of the memory, or an increased speed of thinking. Giving rise to a sense of familiarity with new things, déjà vu may also be a mental state with increased speed of thinking. The speed of thinking may be decreased in jamais vu that is opposite to déjà vu. Progressive increases in the speed of thinking when engaging in a hobby may open up a previously unused neural pathway that turns a previously happy feeling into an aversive one.

EEG alpha and theta oscillations reflect cognitive and memory performance: a review and analysis

Evidence is presented that EEG oscillations in the alpha and theta band reflect cognitive and memory performance in particular. Good performance is related to two types of EEG phenomena (i) a tonic increase in alpha but a decrease in theta power, and (ii) a large phasic (event-related) decrease in alpha but increase in theta, depending on the type of memory demands. Because alpha frequency shows large interindividual differences which are related to age and memory performance, this double dissociation between alpha vs. theta and tonic vs. phasic changes can be observed only if fixed frequency bands are abandoned. It is suggested to adjust the frequency windows of alpha and theta for each subject by using individual alpha frequency as an anchor point. Based on this procedure, a consistent interpretation of a variety of findings is made possible. As an example, in a similar way as brain volume does, upper alpha power increases (but theta power decreases) from early childhood to adulthood, whereas the opposite holds true for the late part of the lifespan. Alpha power is lowered and theta power enhanced in subjects with a variety of different neurological disorders. Furthermore, after sustained wakefulness and during the transition from waking to sleeping when the ability to respond to external stimuli ceases, upper alpha power decreases, whereas theta increases. Event-related changes indicate that the extent of upper alpha desynchronization is positively correlated with (semantic) long-term memory performance, whereas theta synchronization is positively correlated with the ability to encode new information. The reviewed findings are interpreted on the basis of brain oscillations. It is suggested that the encoding of new information is reflected by theta oscillations in hippocampo-cortical feedback loops, whereas search and retrieval processes in (semantic) long-term memory are reflected by upper alpha oscillations in thalamo-cortical feedback loops.

Synaptic loss reflected by secretoneurin-like immunoreactivity in the human hippocampus in Alzheimer's disease

Secretoneurin is a recently described peptide derived by endoproteolytic processing from secretogranin II, previously named chromogranin C. In this study, we have investigated the distribution of secretoneurin-like immunoreactivity in the human hippocampus in controls and in Alzheimer's disease patients, and compared the staining pattern to that of calretinin. Secretoneurin-like immunoreactivity is present throughout the hippocampal formation. At the border of the dentate molecular layer and the granule cell layer, a band of dense secretoneurin immunostaining appeared. In this part, as in the area of the CA2 sector, the high density of secretoneurin-immunoreactivity coincided with calretinin-like immunoreactivity. The mossy fibre system displayed a moderate density of secretoneurin-immunoreactivity. In the entorhinal cortex, a particularly high density of secretoneurin-immunoreactivity was observed. The density of secretoneurin-like immunoreactivity was significantly reduced in the innermost part of the molecular layer and in the outer molecular layer of the dentate gyrus in Alzheimer's disease. For calretinin-like immunoreactivity, a less pronounced decrease was found in the innermost part of the molecular layer. About 40-60% of neuritic plaques were secretoneurin-immunopositive. This study shows that secretoneurin is distinctly distributed in the human hippocampus and that significant changes of secretoneurin-like immunoreactivity occur in Alzheimer's disease, reflecting synaptic loss.

Dissociation Of working memory from decision making within the human prefrontal cortex

We tested the hypothesis that cognitive functions related to working memory (assessed with delay tasks) are distinct from those related to decision making (assessed with a gambling task), and that working memory and decision making depend in part on separate anatomical substrates. Normal controls (n = 21), subjects with lesions in the ventromedial (VM) (n = 9) or dorsolateral/high mesial (DL/M) prefrontal cortices (n = 10), performed on (1) modified delay tasks that assess working memory and (2) a gambling task designed to measure decision making. VM subjects with more anterior lesions (n = 4) performed defectively on the gambling but not the delay task. VM subjects with more posterior lesions (n = 5) were impaired on both tasks. Right DL/M subjects were impaired on the delay task but not the gambling task. Left DL/M subjects were not impaired on either task. The findings reveal a cognitive and anatomic double dissociation between deficits in decision making (anterior VM) and working memory (right DL/M). This presents the first direct evidence of such effects in humans using the lesion method and underscores the special importance of the VM prefrontal region in decision making, independent of a direct role in working memory.

Two circuits to convert short-term memory into long-term memory

According to a brain model, encoding synapses record presynaptic axonal 'on-off' patterns as memory, and modulating synapses convert short-term memory into long-term memory by helping encoding synapses develop long-term potentiation and depression. Sensory organs conduct sounds and images as series of axonal 'on-off' patterns to encoding synapses of perceptive cortices where the patterns are recorded, computed, and rerouted to mesotemporal lobes, hippocampal formations and higher cortical centers. Mesotemporal lobes and hippocampal formations compute and convey the 'on-off' patterns to dorsomedial thalamic nuclei (circuit A), septal nuclei and mammillary bodies (circuit B), where the patterns are computed and conveyed to prefrontal lobes (circuit A) and anterior thalamic nuclei (circuit B) respectively. Anterior thalamic nuclei project axonal 'on-off' patterns to cingulate gyri that compute and convey the patterns to prefrontal lobes. Finally, prefrontal lobes send modulating axons to encoding synapses of perceptive cortices. Amnesia of Korsakoff's syndrome results from unilateral dysfunction of circuit A and contralateral dysfunction of circuit B, or bilateral dysfunction of either. The fact that there is more severe memory deficit in Alzheimer's disease than in Korsakoff's syndrome suggests that the former has a wider spread of failing synapses besides circuit A and circuit B.

Is memory loss without anatomical damage tantamount to a psychogenic deficit? The case of pure retrograde amnesia

Following a car accident, a patient remained unconscious for approximately 20 min and confused for a few hours. When he could be questioned, he was found to have lost all past memories. The retrograde amnesia covered his whole life and concerned autobiographic events as well as famous facts and encyclopaedic knowledge. It also partially involved the verbal and visual lexicon. Reading, writing and counting were no longer possible. The profound impairment of retrograde memory contrasted with the preservation of anterograde memory, which permitted the patient to reacquire some of the notions he had lost, without, however, recovering the feeling of a personal experience of autobiographical information. Four years later, the retrograde deficit was unmodified, except for what had been relearnt. The search for data in support of an organic or psychological aetiology was negative. No signs of brain damage were apparent at the neurological examination and on CT, MRI and SPECT. On the other hand, there was no evidence of a psychiatric history, psychological stress or emotional precipitants that could substantiate the hypothesis that the patient derived a primary or secondary gain from amnesia. We propose that cases of focal retrograde amnesia, similar to the present one, deserve to be classified separately from organic and psychogenic forms under the label of 'functional' retrograde amnesia, a syndrome in which the threshold of activation of premorbid memories is abnormally raised by the trauma, leaving the encoding and retrieval of new memories unaffected.

A brain model with the circuit to convert short-term memory into long-term memory

Assuming the existence of encoding synapses which record presynaptic axonal 'on-off' patterns as the contents of memory, and the existence of modulating synapses which help encoding synapses develop long-term potentiation and depression so as to convert short-term memory into long-term memory, it is possible to outline a brain model according to neuroanatomy. The loop of memory-conversion consists of the axons connecting the perceptive cortices, mesotemporal lobes, dorsomedial nuclei of thalamus (which also receive axons from septohippocampal complex and, indirectly, fornices), and prefrontal lobes. The contents of thought, feeling, dreaming, hallucination, and delusion all result from activation of different axonal 'on-off' patterns in many sets of synapses, and retrieval of memory, reactivation of the presynaptic axonal 'on-off' patterns in the correlating sets of synapses. In this model, degenerated synapses may be responsible for the thought disorder of schizophrenia.

Memory processes, brain oscillations and EEG synchronization

This article tries to integrate results in memory research from divergent disciplines such as cognitive psychology, neuroanatomy, and neurophysiology. The integrating link is seen in more recent findings that provide strong arguments for the assumption that oscillations are a basic form of communication between cortical cell assemblies. It is assumed that synchronous oscillations of large cell assemblies--termed type 1 synchronization--reflect a resting state or possibly even a state of functional inhibition. On the other hand, during mental activity, when different neuronal networks may start to oscillate with different frequencies, each network may still oscillate synchronously (this is termed type 2 synchronization), but as a consequence, the large scale type 1 oscillation disappears. It is argued that these different types of synchronization can be observed in the scalp EEG by calculating event-related power changes within comparatively narrow but individually adjusted frequency bands. Experimental findings are discussed which support the hypothesis that short-term (episodic) memory demands lead to a synchronization (increase in band power) in the theta band, whereas long-term (semantic) memory demands lead to a task-specific desynchronization (decrease or suppression of power) in the upper alpha band. Based on these and other findings, a new memory model is proposed that is described on three levels: cognitive, anatomical and neurophysiological. It is suggested that short-term (episodic) memory processes are reflected by oscillations in an anterior limbic system, whereas long-term (semantic) memory processes are reflected by oscillations in a posterior-thalamic system. Oscillations in these frequency bands possibly provide the basis for encoding, accessing, and retrieving cortical codes that are stored in the form of widely distributed but intensely interconnected cell assemblies.

Reduction of regional brain glucose metabolism following different durations of chronic ethanol consumption in mice: a selective effect on diencephalic structures

The effects of chronic alcohol consumption on regional brain glucose metabolism were examined in Balb/c mice using the [14C]2-deoxyglucose autoradiographic technique. Animals were given a solution of 12% v/v ethanol as their only source of fluid for either 6, 12 or 18 months and compared to control groups receiving either an isocaloric solution or saccharose or tap water. Alterations of cerebral brain glucose metabolism were assessed in mice who were returned to a non-alcoholic diet and allowed to freely explore a T-maze. The results showed that chronic ethanol consumption induced reductions of regional metabolic activity which were functions both of the duration of alcohol treatment and of the structure studied. Whereas a six month period of alcoholization did not induce any significant effects on metabolic activity, 12 months of treatment were necessary to induce the first observable and significant reductions in [14C]2-deoxyglucose labelling. These effects were mainly limited to diencephalic structures such as the lateral mammillary nuclei and the anterodorsal thalamic nuclei. The cerebellum was also affected but to a lesser degree. After 18 months of alcoholization, a generalized spread of the metabolic reduction to the entire mammillary complex (lateral, medial and posterior nuclei) and to the thalamic nuclei was observed. This same duration of treatment was necessary to induce the first detectable decrease of metabolic activity in the hippocampus. In agreement with data from human neuropathology, these findings confirm the particular vulnerability of diencephalic structures to ethanol and suggest that damage limited to diencephalic regions rather than to hippocampal or cortical areas could be primarily responsible for the memory disorders observed in Korsakoff's syndrome.

Studies of working memory using 18FDG-positron emission tomography in normal controls and subjects with epilepsy

We have studied three groups of subjects with a working memory paradigm, using 18FDG-PET. Controls show the greatest increase on uptake in dorsolateral prefrontal cortex, basal forebrain and angular gyrus. A group of subjects with focal frontal epilepsy did not show increases compared to a control task of attention. Primary generalized epilepsy subjects show the greatest changes in angular gyrus, dorsal temporal, medial frontal and parietal regions. Factor and regression analyses extend these observations and show reliance of both patient groups on the medial and inferior temporal lobe. We propose that the normal network of working memory is disrupted by these two forms of epilepsy and different networks are accessed. Declarative memory may be used as a compensatory system, which results in decreased performance.

Severe global amnesia presenting as Wernicke-Korsakoff syndrome but resulting from atypical lesions

A female alcoholic presented with Wernicke's encephalopathy subsequent to administration of diazepam and glucose (without thiamine) for treatment of withdrawal seizures. Nystagmus and cerebellar ataxia quickly resolved when administered thiamine, although severe global amnesia consistent with Korsakoff's syndrome persisted. Magnetic resonance imaging (MRI) revealed infarction of the right temporal lobe with hippocampal atrophy, but no lesions of thalamus or atrophy of mammillary bodies. Positron emission tomography (PET) confirmed decreased cerebral metabolic rates for glucose (CMRglu) in the right temporal lobe corresponding to MRI findings, but also significant metabolic asymmetry of dorsal thalamus, i.e. reduced CMRglu in left versus right. This patient is unique in that neuroradiological findings revealed intact mammillary bodies and suggest asymmetrical dysfunctions (structural right temporal and functional left diencephalic) to produce her profound amnesia.

Memory dysfunction and autonomic neuropathy in non-insulin-dependent (type 2) diabetic patients

Considering the nervous system as a unit, it might be expected that diabetic patients with autonomic neuropathy could have a central abnormality expressed as cognitive dysfunction. To determine whether autonomic neuropathy is independently associated with cognitive dysfunction, we studied a cross-section of 20 non-insulin-dependent diabetic patients with autonomic neuropathy (14 males and six females; age (mean) = 60 + or - 1 years); 29 non-insulin-dependent diabetic patients without autonomic neuropathy (14 males and 15 females; age = 59 + or - 1 years) and 34 non-diabetic patients (10 males and 24 females; age = 58 + or - 1 years), matched by age, education and duration of disease. Cognitive function was evaluated by tests of immediate, recent and remote memory: verbal (digit span; word span) and visual (recognition of towers and famous faces). Diabetic patients with autonomic neuropathy scored (median) lower in visual memory tests than diabetic patients without autonomic neuropathy and controls (towers immediate = 5 versus 7 and 6; towers recent = 4 versus 6 and 6; faces = 16 versus 18 and 18; respectively; Kruskal-Wallis; P < 0.05). There was no difference in verbal memory performance (Kruskal-Wallis; P > 0.05). Entering age, education, duration of disease and fasting plasma glucose in a stepwise multiple regression, the performance in these tests remained associated with autonomic neuropathy (towers immediate, P = 0.0054, partial r2 = 0.166; towers recent, P = 0.0076, partial r2 = 0.163). Scores in visual tests correlated negatively with the number of abnormal cardiovascular tests (faces, r = -0.25; towers recent, r = -0.24; Spearman; P < 0.05). Decreased visual cognitive function in non-insulin-dependent diabetic patients is associated with the presence and degree of autonomic neuropathy.

Calretinin immunoreactive structures in the human hippocampal formation

The calcium-binding protein calretinin is present in an intrinsic GABAergic and an extrinsic non-GABAergic system in the rat and monkey hippocampal formation. Important species differences have been noted in hippocampal cell types immunostained for calretinin and the termination pattern of calretinin containing hypothalamic afferents in the hippocampus. In the present study, calretinin-containing neurons were visualized using immunocytochemistry in the human hippocampal formation of individuals which showed no significant neuropathological alterations. Calretinin-immunoreactivity was present exclusively in non-granule cells of the dentate gyrus and in non-pyramidal cells of Ammon's horn. Calretinin-positive neurons were found most frequently in the hilus of the fascia dentata and in strata radiatum and lacunosum-moleculare of CA1, whereas neurons in CA2 and CA3 were rarely immunostained. The majority of calretinin-immunoreactive neurons were small, bipolar or fusiform neurons. The dendritic trees of the calretinin-positive neurons were, for the most part, parallel to the dendrites of the principal cells. In the hilus, however, we observed cells with dendrites restricted to the hilar area. These dendrites were parallel to the granule cell layer. In the stratum lacunosum-moleculare, neurons with dendrites oriented parallel to the hippocampal fissure were frequently detected. In general, dendrites were smooth or sparsely spiny, displaying small conventional spines. The axons usually emerged from the proximal dendrite and could be followed over long distances. Axons were thin, had small varicosities and displayed only few collaterals which branched relatively far away from the cell body. Distinct bands of darkly stained calretinin-positive fibers occupied the innermost portion of the dentate molecular layer and the pyramidal cell layer of CA2. This distribution of calretinin-immunoreactive structures in the human hippocampus is similar to that observed in other primates but differs from that described in lower mammals, i.e., the rat. Our findings suggest that primates may share a common hippocampal calretinin-containing system, presumably both the intrinsic GABAergic and the extrinsic hypothalamic non-GABAergic components.

Cavernous malformation of the mammillary bodies: neuropsychological implications. Case report

The authors present the first documented case of a cavernous malformation of the mammillary bodies. A 34-year-old woman presented with a 2-month history of headaches and acute memory changes. Magnetic resonance imaging studies demonstrated a retrochiasmatic interpeduncular lesion that was initially thought to be a craniopharyngioma. Operative resection confirmed the diagnosis of a cavernous malformation. This particular case is unique in its destruction of the mammillary bodies and presents further evidence of the relationship of these regions to memory. This report is also the first to document results of pre- and postoperative neuropsychological evaluations that specifically address the memory deficits created by destruction of the mammillary bodies.

Episodic and semantic memory: an analysis in the EEG theta and alpha band

This study examines the hypothesis that in contrast to semantic memory processes that are assumed to be reflected primarily within the alpha band, episodic memory processes are related to activity within the theta band. EEG signals were recorded from subjects as they performed a semantic congruency and an episodic recognition task. In the semantic task, subjects had to judge whether or not sequentially presented concept-feature pairs (such as "eagle-claws" or "pea-huge") are semantically congruent. In the episodic task, which followed the semantic task without prior warning, the same word pairs were presented together with new distractors (generated by repairing known concept-feature pairs). Here, subjects judged whether or not a particular concept-feature pair was already presented during the semantic task. EEG data were analyzed using event-related desynchronization (ERD) as a measure for the amount of event-related changes in band power in the theta band and in the upper and lower alpha bands. The alpha band was determined individually, using the alpha peak frequency during the resting period as the cut-off point to separate the lower from the upper alpha band. The results, which are based on those identical word pairs that demanded a yes response in both tasks, showed that semantic memory processes are indeed primarily reflected in the upper alpha band whereas episodic memory processes are reflected in the theta band. The possible relationship between hippocampal theta activity and the encoding of episodic information is discussed.

Hippocampal sclerosis: a common pathological feature of dementia in very old (> or = 80 years of age) humans

In a neuropathological study of 81 brains of prospectively studied subjects of 80 years of age or older at the time of death, 13 cases (16%), including 4 men and 9 women, had hippocampal sclerosis (HpScl) affecting the vulnerable region of the hippocampus. In demented subjects of 80 years of age or older, the frequency of HpScl was even higher, 26%. Cases with HpScl had significantly fewer hippocampal senile plaques (SP) and neurofibrillary tangles (NFT) and parahippocampal NFT than cases without HpScl, but did not differ significantly in any of the other measured pathological parameters. Enzyme-linked analysis of synaptic protein immunoreactivity in a subset of 33 cases demonstrated significant decreases in the hippocampus, but not in frontal, temporal, parietal or parahippocampal cortices. All but 1 of the cases with HpScl had Blessed information, memory and concentration scores (BIMC) of 8 or more, and all were considered to be demented. In some patients memory disturbance was disproportionate to deficits in other cognitive areas. All but 4 of the cases with HpScl had many non-neuritic, amyloid plaques in the neocortex meeting NIA criteria for Alzheimer's disease (AD); however, given the advanced age of the subjects, amyloid plaques were considered to represent age-related cerebral amyloid deposition ("pathological aging") in most cases. Only 3 cases had both many SP and NFT in multiple cortical regions consistent with AD. Another case had brain stem and cortical Lewy bodies consistent with diffuse Lewy body disease (DLBD). A few ballooned neurons were present in the limbic cortices in 3 cases, including one case of dementia with argyrophilic grains (DAG) in limbic and orbital frontal and temporal cortices. The 8 cases without AD, DLBD or DAG included 4 cases in which no other obvious cause of dementia was detected and 4 cases in which HpScl was accompanied by either multiple cerebral infarcts or leukoencephalopathy, or both, that could have contributed to dementia. Patients with HpScl had risk factors, clinical signs and post-mortem pathological findings of cardiovascular disease, but due to the high prevalence of these conditions in very old humans, no significant correlation with HpScl was detected. This study demonstrates that HpScl is a common post-mortem finding in demented, but not normal, elderly subjects. It may contribute to. or be a marker for, the increased risk of dementia in subjects with documented cardiovascular disease or a history of myocardial infarction.

Contralateral thalamic projections predominantly reach transitional cortices in the rhesus monkey

Connections between the thalamus and the cortex are generally regarded as ipsilateral, even though contralateral connections exist as well in several adult mammalian species. It is not known, however, whether contralateral thalamocortical projections reach particular cortices or whether they emanate from specific nuclei. In the rhesus monkey different types of cortices, ranging from transitional to eulaminate, vary in their cortical connectional pattern and may also differ in their thalamic connections. Because olfactory and transitional prefrontal cortices receive widespread projections, we investigated whether they are the target of projections from the contralateral thalamus as well. With the aid of retrograde tracers, we studied the thalamic projections of primary olfactory (olfactory tubercle and prepiriform cortex) and transitional orbital (areas PAII, Pro, 13) and medial (areas 25, 24, 32) areas, and of eulaminate (areas 11, 12, 9) cortices for comparison. To determine the prevalence of neurons in the contralateral thalamus, we compared them with the ipsilateral in each case. The pattern of ipsilateral thalamic projections differed somewhat among orbital, medial, and olfactory cortices. The mediodorsal nucleus was the predominant source of projections to orbital areas, midline nuclei included consistently about 25% of the thalamic neurons directed to medial transitional cortices, and primary olfactory areas were distinguished by receiving thalamic projections predominantly from neurons in midline and intralaminar nuclei. Notwithstanding some broad differences in the ipsilateral thalamofrontal projections, which appeared to depend on cortical location, the pattern of contralateral projections was consistent with cortical type rather than location. Labeled neurons in the contralateral thalamus were noted in midline, the magnocellular sector of the mediodorsal nucleus, the anterior medial and intralaminar nuclei, and ranged from 0 to 14% of the ipsilateral; they were directed primarily to olfactory and transitional orbital and medial cortices but rarely projected to eulaminate areas. Several thalamic nuclei projected from both sides to olfactory and transitional areas, but issued only ipsilateral projections to eulaminate areas. Though ipsilateral thalamocortical projections predominate in adult mammalian species, crossed projections are a common feature in development. The results suggest differences in the persistence of contralateral thalamocortical interactions between transitional and eulaminate cortices.

The possible contribution of the septal region to memory

A particularly well-documented, intelligent patient (H.I.) with very selective, minute, but most likely bilateral damage of the basal forebrain including the septal region is presented. Though behavioral progress was found for a number of areas, she remained deficient, especially in long-term memory. The severest and largely modality-nonspecific deficits were observed in recall (as opposed to recognition) situations. As a peculiar finding which we would attribute to septal damage, H.I. was mainly affected in tests containing emotional (especially emotionally negative) stimuli, or certain flavours. While this involvement might have helped her in memorizing material judged as positive, it was of negative influence under other circumstances. The septal area may serve as an interface contributing a specific combination of emotional flavour and evaluating (feedback) judgement to a larger (septo-hippocampal-amygdalar) memory and learning processing network.

Searching for the anatomical basis of retrograde amnesia

The case of a patient with profound retrograde and minor anterograde amnesia is described and used to discuss the kind of brain damage which will most likely result in persistent retrograde amnesia as the principal symptom. The patient was an industrial manager who had fallen off a horse four years prior to the present neuropsychological and neuroradiological investigation. MRI examination revealed an injury to both temporal poles and to the latero-ventral portion of the right prefrontal cortex. The prefrontal and temporal cortical damage on the right side deeply invaded the white matter while the temporal cortical damage on the left side was much smaller; here, however, portions of the temporo-parietal transition zone were affected as well. The patient was of average intelligence. His attention, short-term memory, and learning ability were average or somewhat below average. His old memories were severely affected in the personal-episodic domain, and much less so in that of semantic remote memory. We conclude from this case that the necessary anatomical substrate for the retrieval of old episodic memories lies within the anterior temporal regions (including deeper situated fiber projections) and possibly involves an interaction with the prefrontal cortex, and that this damage is dissociable from the medial temporal-lobe damage leading to anterograde amnesia.

Mnestic performance profile of a bilateral diencephalic infarct patient with preserved intelligence and severe amnesic disturbances

The case of a patient with above-average intelligence and educational background, high motivation, and an approximate IQ-MQ difference of 40 points is documented. The patient has been examined repeatedly for nearly a decade. Extensive neuroradiological material of his focal bilateral brain damage in the dorsal diencephalon is available. A widespread range of cognitive tests was used to investigate his actual performance on all relevant aspects of intelligence, attention, subjective memory, immediate retention, learning, skill and problem solving abilities, concept formation, cognitive flexibility, priming, constructional ability, retrograde memory, and long-term retention. The total of more than 50 tests included German-language forms of the revised Wechsler Memory Scale and of the Rivermead Behavioural Memory Test. The patient's short-term memory and attention were, in spite of his advanced years, average or well above average. He gave a number of examples of still intact skills and implicit memory abilities, though there was no uniformity in his performance on implicit memory tests (e.g., with respect to stored vs. new implicit information). He had no awareness of his severe anterograde and retrograde amnesia, documented over a large range of verbal and figural tests. Taken together, the results from our patient confirm the principal dichotomy between declarative and nondeclarative mnestic functions, but give evidence for some restrictions as well. They furthermore demonstrate that focal diencephalic damage may result in profound anterograde and selective retrograde amnesia, especially with respect to data-based material, and that disconnecting portions of the medial and basolateral limbic circuits has devastating consequences on memory.

Selective fimbria and thalamic lesions differentially impair forms of working memory in rats

Several series of experiments were designed to compare the effects of selective lesions of the fimbria or of thalamic nuclei on three different tasks involving working memory in rats: object recognition, place recognition, and the radial arm maze test. The main effects of fimbria lesions were as follows: they produced deficits in the radial maze; object recognition was spared or even facilitated, whereas place recognition was impaired. Electrolytic lesions of either centromedian-parafascicularis (CM-Pf) or dorsomedialis (DM) nuclei produced highly significant deficits in the radial maze test but spared object and place recognition. Ibotenate lesions of the CM-Pf had no effect on any test, which means that the critical structure in the effects of the electrolytic lesions of the CM-Pf was the fasciculus retroflexus (FR). These data may contribute two main points to animal models of hippocampal and thalamic amnesia: (1) different forms of working memory in rats might have different neural bases and (2) the FR may be involved in learning and memory processes.

Long-term cognitive deficits in patients after surgery on aneurysms of the anterior communicating artery

The long term recovery of a series of 27 patients who had undergone rupture and repair of an aneurysm of the anterior communicating artery was assessed using a number of neuropsychological measures. Testing took place 12 to 84 months post surgery. On the basis of the results from tests of intellect, memory, and conceptual learning, three subgroups of patients were identified: those with persuasive cognitive defects, those with evidence of residual frontal lobe damage and those who showed no evidence of dysfunction. The occurrence of cerebral vasospasm was the most consistent predictor of long term cognitive deficit.

Firing of human hippocampal units in relation to voluntary movements

During certain movements (termed "type I," "instrumental," or "voluntary"), the rodent hippocampal EEG is dominated by regular 7-10 Hz waves. This "theta rhythm" is accompanied by increased firing of hippocampal interneurons and dentate gyrus granule cells. No obvious theta rhythm is present in comparable situations in humans or other primates. However, a widespread scalp negativity (the "readiness potential") starts approximately 1 second before spontaneous key presses at long intervals. The readiness potential has been recorded in the monkey hippocampus. In this study, action potentials were recorded in the human hippocampus in relation to various movements. During a broadly ranging interview including various movements and memory tests, hippocampal units were found that fired during movements of the tongue and/or hands. Only movements that required a high degree of effort were effective. Other hippocampal units appeared to be correlated with either the transitions between tasks or the interruptions within tasks. In a second experiment, hippocampal units were found to change their firing in the seconds preceding spontaneous key presses. These data indicate that, like the rodent hippocampus, human hippocampal neuronal activity is strongly influenced by movement.

Verbal memory deterioration after unilateral infarct of the internal capsule in an adolescent

After an infarction in the territory of the anterior perforating arteries, a 15-year-old, previously healthy, left-handed patient developed considerable verbal long term memory disturbances which could be followed up and tested for more than nine months. An extensive memory test battery was used to determine spared and impaired functions. The patient had remote memory disturbances with respect to personal events for the last 5 years and problems in all verbal task tested which required remembering items over time periods exceeding an hour. The patient was indistinguishable from control subjects on short-term memory tests and on a number of nonverbal learning and recognition tests. The crucial lesion for the observed deficits in the genu of the left internal capsule was assumed to have disrupted the anterior and inferior thalamic peduncles, fornix (column), stria terminalis, anterior commissure and the medial part of the globus pallidus. This infarct, therefore, most likely damaged traversing fibres which intercommunicate within the Papez circuit and the basolateral limbic circuit and which in part provide access to cortical memory representing areas.

The effects of mammillary body and combined amygdalar-fornix lesions on tests of delayed non-matching-to-sample in the rat

A series of experiments compared the effects of mammillary body lesions with those of combined damage to the amygdala and fornix on 2 tests of working memory, both of which used the delayed non-matching-to-sample rule. This comparison was based on evidence of the involvement of these regions in anterograde amnesic syndromes. The mammillary body lesions had no effect on the acquisition or subsequent performance of a non-spatial recognition task and had only a mild effect on the acquisition of a spatial forced-alternation task. Although the animals with combined amygdalar plus fornix lesions were able to master the non-spatial recognition task they were impaired when the levels of proactive interference were increased. The same animals were also severely impaired on the forced-choice alternation task. The overall pattern of results is seen as mirroring those found in primates and points to an underlying similarity in the mnemonic roles of these limbic regions.

Large-scale neurocognitive networks and distributed processing for attention, language, and memory

Cognition and comportment are subserved by interconnected neural networks that allow high-level computational architectures including parallel distributed processing. Cognitive problems are not resolved by a sequential and hierarchical progression toward predetermined goals but instead by a simultaneous and interactive consideration of multiple possibilities and constraints until a satisfactory fit is achieved. The resultant texture of mental activity is characterized by almost infinite richness and flexibility. According to this model, complex behavior is mapped at the level of multifocal neural systems rather than specific anatomical sites, giving rise to brain-behavior relationships that are both localized and distributed. Each network contains anatomically addressed channels for transferring information content and chemically addressed pathways for modulating behavioral tone. This approach provides a blueprint for reexploring the neurological foundations of attention, language, memory, and frontal lobe function.

Temporal gradient in the remote memory impairment of amnesic patients with lesions in the basal forebrain

Recall and recognition of premorbid public events were studied in four groups of subjects. Dementia patients showed equal losses from all time periods compared to normal controls. In contrast, two groups of amnesic patients showed extensive remote memory losses, which were most marked for the last few years prior to onset. The difference between recall and recognition was similar in the groups. The results indicate that the retrograde amnesia associated with aneurysms of the anterior communicating artery cannot be distinguished from that of amnesia with other etiologies. Implications of the finding of a temporal gradient in the retrograde amnesia of non-alcoholic amnesics are discussed.

Impairment of memory in a delayed non-matching to place task following mamillary body lesions in mice

This study assessed the effects of a mamillary body (MM) lesion on memory measured in a delayed non-matching to place task performed in an 8-arm radial maze using BALB/c mice as subjects. In this task, the subjects had to recognize (test-phase) a non-visited arm from a previously visited arm (the sample-place) and were required to enter the non-visited arm in order to get reward. In the first experiment, the difficulty of the recognition was increased by interpolating forced visits (1 to 5; i.e. the study-phase) between the sample-place and the test-phase. In the second experiment, the number of interpolated visits which followed the study-phase was kept constant (5) but the sample-place was placed either before and after the interfering visits. Our results showed that MM subjects were dramatically impaired as compared to controls when required to recognize after 5 but not after 1 interpolated visits (first experiment). However, this deficit was observed only when the sample-place preceded but not when it followed the interpolated visits (second experiment). Our data emphasize the importance of the MM in memory and amnesia.

Selective posterior cerebral artery injection of amytal: new method of preoperative memory testing

The carotid Amytal test (Wada test) was introduced, in 1948 by Wada, to localize speech function before temporal lobectomy in patients with medically refractory epilepsy, and it remains the standard for that purpose. The same test has also been used since 1962 to evaluate memory function; however, the adequacy of the test in this application has been viewed with increasing skepticism in recent years. Therefore, we developed an alternative to the Wada test. It consists of selective injection of Amytal into the posterior cerebral artery (PCA). This PCA Amytal test is designed to test only memory function (not language). We present several anatomic and functional reasons why this approach should be superior to the Wada test for this purpose. We also present preliminary data in support of this hypothesis. To date, we have had successful results of the PCA Amytal test in 38 of 45 patients (84%), and one major complication has occurred (2%).

Unilateral temporal lobe lesions alter P300 scalp topography

Event related potentials were recorded from patients with unilateral temporal lobe lesions and healthy volunteers. Subjects were required to silently count on infrequent target tone interspersed among presentations of a non-target tone, with an interval between tones that was relatively long and variable (6-10s). Under these task conditions, the patients were found to have P300 amplitudes that were smaller on the lesioned side relative to the non-lesioned side. This finding is interpreted as evidence that temporal lobe lesions affect the configuration of intracranial sources generating the P300 component of event-related potentials.