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Adam-Darque A, Ptak R, Schneider S, Schnider A. Anatomical and functional predictors of disorientation after first-ever brain damage. Neuropsychologia 2023; 187:108601. [PMID: 37263576 DOI: 10.1016/j.neuropsychologia.2023.108601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/20/2023] [Accepted: 05/29/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Disorientation is a frequent consequence of acute brain injury or diffuse disorders, such as confusional states or dementia. Its anatomical correlates are debated. Impaired memory as its commonly assumed mechanism predicts that disorientation is associated with medial temporal damage. The alternative is that disorientation reflects defective orbitofrontal reality filtering (ORFi) - a specific failure to identify whether thoughts or memories refer to present reality or not. The latter is a function of the posterior orbitofrontal cortex and connected structures. This study examined the mechanisms and anatomical basis of disorientation in an unselected group of patients with first-ever subacute brain injury. METHODS Participants hospitalized for neurorehabilitation were asked to participate in this observational cohort study if they had first-ever organic hemispheric brain dysfunction as evident in a localizable brain lesion or verbal amnesia (often without localizable brain damage). Orientation to time, place, situation and person was tested with a 20-items questionnaire. To identify the mechanisms of disorientation, we determined its correlations with executive tasks, verbal episodic memory, and ORFi in all patients. ORFi was examined with a continuous recognition task, which measures learning and item recognition in the first run, and ORFi as reflected in the increase of false positive responses in the second run (temporal context confusion). Lesions of patients having localizable brain damage were manually delineated and normalized before entering multivariate lesion-symptom-mapping (LSM) to determine anatomical predictors of orientation. RESULTS Eighty-four patients (61.1 ± 14.4 years, 29 women) were included. Among measures of memory and executive functioning, a step-wise regression retained temporal context confusion (R = -0.71, p < 0.0001), item recognition (R = 0.67, p < 0.0001) and delayed free recall (R = 0.63, p < 0.0001) as significant predictors of orientation. LSM was possible in 67 participants; it revealed an association of disorientation with damage of the right OFC and the bilateral head of the caudate nucleus. CONCLUSION Disorientation in non-confused, non-demented patients with first-ever brain damage is associated with impaired orbitofrontal reality filtering and memory dysfunction, but not with executive dysfunction. Its main anatomical determinant is damage to the orbitofrontal cortex and its subcortical relay, the head of the caudate.
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Affiliation(s)
- Alexandra Adam-Darque
- Laboratory of Cognitive Neurorehabilitation, Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospital and University of Geneva, 1211, Geneva 14, Switzerland
| | - Radek Ptak
- Laboratory of Cognitive Neurorehabilitation, Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospital and University of Geneva, 1211, Geneva 14, Switzerland
| | - Stephan Schneider
- Laboratory of Cognitive Neurorehabilitation, Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospital and University of Geneva, 1211, Geneva 14, Switzerland
| | - Armin Schnider
- Laboratory of Cognitive Neurorehabilitation, Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospital and University of Geneva, 1211, Geneva 14, Switzerland.
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Weissberger GH, Melrose RJ, Fanale CM, Veliz JV, Sultzer DL. Cortical Metabolic and Cognitive Correlates of Disorientation in Alzheimer’s Disease. J Alzheimers Dis 2017; 60:707-719. [DOI: 10.3233/jad-170420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Gali H. Weissberger
- Brain Behavior and Aging Research Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Rebecca J. Melrose
- Brain Behavior and Aging Research Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Candace M. Fanale
- Brain Behavior and Aging Research Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Joseph V. Veliz
- Brain Behavior and Aging Research Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - David L. Sultzer
- Brain Behavior and Aging Research Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Brion M, de Timary P, Pitel AL, Maurage P. Source Memory in Korsakoff Syndrome: Disentangling the Mechanisms of Temporal Confusion. Alcohol Clin Exp Res 2017; 41:596-607. [DOI: 10.1111/acer.13318] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 12/17/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Mélanie Brion
- Laboratory for Experimental Psychopathology; Psychological Sciences Research Institute; Université catholique de Louvain; Louvain-la-Neuve Belgium
| | - Philippe de Timary
- Laboratory for Experimental Psychopathology; Psychological Sciences Research Institute; Université catholique de Louvain; Louvain-la-Neuve Belgium
- Department of Adult Psychiatry; St Luc Hospital and Institute of Neuroscience; Université catholique de Louvain; Brussels Belgium
| | - Anne-Lise Pitel
- INSERM; École Pratique des Hautes Études; Université de Caen-Basse Normandie; Unité U1077; GIP Cyceron; CHU Caen; Caen France
| | - Pierre Maurage
- Laboratory for Experimental Psychopathology; Psychological Sciences Research Institute; Université catholique de Louvain; Louvain-la-Neuve Belgium
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Bajo A, Fleminger S, Metcalfe C, Kopelman MD. Confabulation: What is associated with its rise and fall? A study in brain injury. Cortex 2017; 87:31-43. [DOI: 10.1016/j.cortex.2016.06.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 06/03/2016] [Accepted: 06/10/2016] [Indexed: 10/21/2022]
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Schnider A, Nahum L, Ptak R. What does extinction have to do with confabulation? Cortex 2017; 87:5-15. [DOI: 10.1016/j.cortex.2016.10.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 07/31/2016] [Accepted: 10/21/2016] [Indexed: 10/20/2022]
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Hebscher M, Gilboa A. A boost of confidence: The role of the ventromedial prefrontal cortex in memory, decision-making, and schemas. Neuropsychologia 2016; 90:46-58. [PMID: 27150705 DOI: 10.1016/j.neuropsychologia.2016.05.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 04/15/2016] [Accepted: 05/02/2016] [Indexed: 11/20/2022]
Abstract
The ventromedial prefrontal cortex (vmPFC) has been implicated in a wide array of functions across multiple domains. In this review, we focus on the vmPFC's involvement in mediating strategic aspects of memory retrieval, memory-related schema functions, and decision-making. We suggest that vmPFC generates a confidence signal that informs decisions and memory-guided behaviour. Confidence is central to these seemingly diverse functions: (1) Strategic retrieval: lesions to the vmPFC impair an early, automatic, and intuitive monitoring process ("feeling of rightness"; FOR) often associated with confabulation (spontaneous reporting of erroneous memories). Critically, confabulators typically demonstrate high levels of confidence in their false memories, suggesting that faulty monitoring following vmPFC damage may lead to indiscriminate confidence signals. (2) Memory schemas: the vmPFC is critically involved in instantiating and maintaining contextually relevant schemas, broadly defined as higher level knowledge structures that encapsulate lower level representational elements. The correspondence between memory retrieval cues and these activated schemas leads to FOR monitoring. Stronger, more elaborate schemas produce stronger FOR and influence confidence in the veracity of memory candidates. (3) Finally, we review evidence on the vmPFC's role in decision-making, extending this role to decision-making during memory retrieval. During non-mnemonic and mnemonic decision-making the vmPFC automatically encodes confidence. Confidence signal in the vmPFC is revealed as a non-linear relationship between a first-order monitoring assessment and second-order action or choice. Attempting to integrate the multiple functions of the vmPFC, we propose a posterior-anterior organizational principle for this region. More posterior vmPFC regions are involved in earlier, automatic, subjective, and contextually sensitive functions, while more anterior regions are involved in controlled actions based on these earlier functions. Confidence signals reflect the non-linear relationship between first-order, posterior-mediated and second-order, anterior-mediated processes and are represented along the entire axis.
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Affiliation(s)
- Melissa Hebscher
- Department of Psychology, University of Toronto, Toronto, ON, Canada M5S 3G3; Rotman Research Institute at Baycrest, Toronto, ON, Canada M6A 2E1.
| | - Asaf Gilboa
- Department of Psychology, University of Toronto, Toronto, ON, Canada M5S 3G3; Rotman Research Institute at Baycrest, Toronto, ON, Canada M6A 2E1; Canadian Partnership for Stroke Recovery, Toronto, ON, Canada M6A 2E1.
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Liverani MC, Manuel AL, Nahum L, Guardabassi V, Tomasetto C, Schnider A. [Formula: see text]Children's sense of reality: The development of orbitofrontal reality filtering. Child Neuropsychol 2015; 23:408-421. [PMID: 26678872 DOI: 10.1080/09297049.2015.1120861] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Orbitofrontal reality filtering denotes a memory control mechanism necessary to keep thought and behavior in phase with reality. In adults, it is mediated by the orbitofrontal cortex and subcortical connections and its failure induces reality confusion, confabulations, and disorientation. Here we investigated for the first time the development of this mechanism in 83 children from ages 7 to 11 years and 20 adults. We used an adapted version of a continuous recognition task composed of two runs with the same picture set but arranged in different order. The first run measures storage and recognition capacity (item memory), the second run measures reality filtering. We found that accuracy and reaction times in response to all stimulus types of the task improved in parallel across ages. Importantly, at no age was there a notable performance drop in the second run. This means that reality filtering was already efficacious at age 7 and then steadily improved as item memory became stronger. At the age of 11 years, reality filtering dissociated from item memory, similar to the pattern observed in adults. However, performance in 11-year-olds was still inferior as compared to adults. The study shows that reality filtering develops early in childhood and becomes more efficacious as memory capacity increases. For the time being, it remains unresolved, however, whether this function already depends on the orbitofrontal cortex, as it does in adults, or on different brain structures in the developing brains of children.
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Affiliation(s)
- Maria Chiara Liverani
- a Laboratory of Cognitive Neurorehabilitation, Medical School , University of Geneva , Switzerland
| | - Aurélie L Manuel
- a Laboratory of Cognitive Neurorehabilitation, Medical School , University of Geneva , Switzerland
| | - Louis Nahum
- a Laboratory of Cognitive Neurorehabilitation, Medical School , University of Geneva , Switzerland
| | | | - Carlo Tomasetto
- b Department of Psychology , University of Bologna , Bologna , Italy
| | - Armin Schnider
- a Laboratory of Cognitive Neurorehabilitation, Medical School , University of Geneva , Switzerland.,c Division of Neurorehabilitation, Department of Clinical Neurosciences , University Hospital and University of Geneva , Switzerland
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What does a comparison of the alcoholic Korsakoff syndrome and thalamic infarction tell us about thalamic amnesia? Neurosci Biobehav Rev 2015; 54:46-56. [DOI: 10.1016/j.neubiorev.2014.08.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 08/14/2014] [Accepted: 08/27/2014] [Indexed: 01/25/2023]
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Liverani MC, Manuel AL, Bouzerda-Wahlen A, Genetti M, Guggisberg AG, Nahum L, Schnider A. Memory in time: electrophysiological comparison between reality filtering and temporal order judgment. Neuroscience 2015; 289:279-88. [PMID: 25595982 DOI: 10.1016/j.neuroscience.2014.12.064] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 12/06/2014] [Accepted: 12/23/2014] [Indexed: 11/17/2022]
Abstract
Orbitofrontal reality filtering (ORF) denotes a little known but vital memory control mechanism, expressed at 200-300ms after stimulus presentation, that allows one to sense whether evoked memories (thoughts) refer to present reality and can be acted upon, or not. Its failure induces reality confusion evident in confabulations that patients act upon and disorientation. In what way ORF differs from temporal order judgment (TOJ), that is, the conscious knowledge about when something happened in the past, has never been explored. Here we used evoked potential analysis to compare ORF and TOJ within a combined experimental task and within a comparable time frame, close to the experienced present. Seventeen healthy human subjects performed an experiment using continuous recognition tasks that combined the challenges of ORF and TOJ. We found that the two mechanisms dissociated behaviorally: subjects were markedly slower and less accurate in TOJ than ORF. Both mechanisms evoked similar potentials at 240-280ms, when ORF normally occurs. However, they rapidly dissociated in terms of amplitude differences and electrical source from 310 to 360ms and again from 530 to 560ms. We conclude that the task of consciously ordering memories in the immediate past (TOJ) is effortful and slow in contrast to sensing memories' relation with the present (ORF). Both functions invoke similar early electrocortical processes which then rapidly dissociate and engage different brain areas. The results are consistent with the different consequences of the two mechanisms' dysfunction: while failure of ORF has a known clinical manifestation (reality confusion as evident in confabulation and disorientation), the failure of TOJ, as tested here, has no such known clinical correlate.
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Affiliation(s)
- M C Liverani
- Laboratory of Cognitive Neurorehabilitation, Medical School, University of Geneva, Switzerland
| | - A L Manuel
- Laboratory of Cognitive Neurorehabilitation, Medical School, University of Geneva, Switzerland
| | - A Bouzerda-Wahlen
- Laboratory of Cognitive Neurorehabilitation, Medical School, University of Geneva, Switzerland
| | - M Genetti
- Department of Fundamental Neurosciences, University of Geneva, Switzerland
| | - A G Guggisberg
- Laboratory of Cognitive Neurorehabilitation, Medical School, University of Geneva, Switzerland; Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospital and University of Geneva, Switzerland
| | - L Nahum
- Laboratory of Cognitive Neurorehabilitation, Medical School, University of Geneva, Switzerland
| | - A Schnider
- Laboratory of Cognitive Neurorehabilitation, Medical School, University of Geneva, Switzerland; Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospital and University of Geneva, Switzerland.
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Bouzerda-Wahlen A, Nahum L, Liverani MC, Guggisberg AG, Schnider A. An Electrophysiological Dissociation between Orbitofrontal Reality Filtering and Context Source Monitoring. J Cogn Neurosci 2015; 27:164-74. [DOI: 10.1162/jocn_a_00686] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Abstract
Memory influences behavior in multiple ways. One important aspect is to remember in what precise context in the past a piece of information was acquired (context source monitoring). Another important aspect is to sense whether an upcoming thought, composed of fragments of memories, refers to present reality and can be acted upon (orbitofrontal reality filtering). Whether these memory control processes share common underlying mechanisms is unknown. Failures of both have been held accountable for false memories, including confabulation. Electrophysiological and imaging studies suggest a dissociation but used very different paradigms. In this study, we juxtaposed the requirements of context source monitoring and reality filtering within a unique continuous recognition task, which healthy participants performed while high-resolution evoked potentials were recorded. The mechanisms dissociated both behaviorally and electrophysiologically: Reality filtering induced a frontal positivity, absence of a specific electrocortical configuration, and posterior medial orbitofrontal activity at 200–300 msec. Context source monitoring had no electrophysiological expression in this early period. It was slower and less accurate than reality filtering and induced a prolonged positive potential over frontal leads starting at 400 msec. The study demonstrates a hitherto unrecognized separation between orbitofrontal reality filtering and source monitoring. Whereas deficient orbitofrontal reality filtering is associated with reality confusion in thinking, the behavioral correlates of deficient source monitoring should be verified with controlled experimental exploration.
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Affiliation(s)
| | | | | | | | - Armin Schnider
- 1University of Geneva
- 2University Hospital, Geneva, Switzerland
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11
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Brion M, Pitel AL, Beaunieux H, Maurage P. Revisiting the continuum hypothesis: toward an in-depth exploration of executive functions in korsakoff syndrome. Front Hum Neurosci 2014; 8:498. [PMID: 25071526 PMCID: PMC4081760 DOI: 10.3389/fnhum.2014.00498] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 06/19/2014] [Indexed: 11/24/2022] Open
Abstract
Korsakoff syndrome (KS) is a neurological state mostly caused by alcohol-dependence and leading to disproportionate episodic memory deficits. KS patients present more severe anterograde amnesia than Alcohol-Dependent Subjects (ADS), which led to the continuum hypothesis postulating a progressive increase in brain and cognitive damages during the evolution from ADS to KS. This hypothesis has been extensively examined for memory but is still debated for other abilities, notably executive functions (EF). EF have up to now been explored by unspecific tasks in KS, and few studies explored their interactions with memory. Exploring EF in KS by specific tasks based on current EF models could thus renew the exploration of the continuum hypothesis. This paper will propose a research program aiming at: (1) clarifying the extent of executive dysfunctions in KS by tasks focusing on specific EF subcomponents; (2) determining the differential EF deficits in ADS and KS; (3) exploring EF-memory interactions in KS with innovative tasks. At the fundamental level, this exploration will test the continuum hypothesis beyond memory. At the clinical level, it will propose new rehabilitation tools focusing on the EF specifically impaired in KS.
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Affiliation(s)
- Mélanie Brion
- Laboratory for Experimental Psychopathology, Institute of Psychology, Université Catholique de Louvain , Louvain-la-Neuve , Belgium
| | - Anne-Lise Pitel
- INSERM, École Pratique des Hautes Études, Université de Caen-Basse Normandie, Unité U1077, GIP Cyceron, CHU Caen , Caen , France
| | - Hélène Beaunieux
- INSERM, École Pratique des Hautes Études, Université de Caen-Basse Normandie, Unité U1077, GIP Cyceron, CHU Caen , Caen , France
| | - Pierre Maurage
- Laboratory for Experimental Psychopathology, Institute of Psychology, Université Catholique de Louvain , Louvain-la-Neuve , Belgium
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Manuel A, David A, Bikson M, Schnider A. Frontal tDCS modulates orbitofrontal reality filtering. Neuroscience 2014; 265:21-7. [DOI: 10.1016/j.neuroscience.2014.01.052] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 01/27/2014] [Accepted: 01/27/2014] [Indexed: 11/30/2022]
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