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Salmon E, Meyer F, Genon S, Collette F, Bastin C. Neural correlates of impaired cognitive processes underlying self-unawareness in Alzheimer's disease. Cortex 2024; 171:1-12. [PMID: 37977109 DOI: 10.1016/j.cortex.2023.10.009] [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: 05/03/2023] [Revised: 09/05/2023] [Accepted: 10/19/2023] [Indexed: 11/19/2023]
Abstract
Self-unawareness concerning current symptoms remains a clinical challenge in Alzheimer's disease. Reduced self-awareness likely depends on complex biopsychosocial mechanisms that comprise multiple cognitive processes, regulated by personal goals and values. We specifically reviewed the cognitive processes impaired in unaware participants with AD by emphasizing the related impaired brain activity observed during task-based fMRI. Unawareness can be explained by a failure in functioning of or in connection between brain regions that intervene in access, retrieval and updating of (present or extended) self-information (posterior midline, medial temporal, inferior parietal cortices), or in its monitoring, evaluation, or control (medial and lateral prefrontal cortices). Although one must be cautious when relating function to brain regions, impaired processes were tentatively related to the Cognitive Awareness Model. Although brain function depends on neural networks, impaired brain activity during cognitive processes was discussed according to previous studies reporting correlations between brain regions and scores of anosognosia. The review provides a framework to help clinicians considering processes that can explain unawareness in dementia. In patients at early stages of AD, different levels of awareness of cognitive or social clinical changes might be described as impairment in the interaction between specific cognitive processes and contents.
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Affiliation(s)
- Eric Salmon
- GIGA Cyclotron Research Centre in Vivo Imaging, University of Liege, Liege, Belgium.
| | - François Meyer
- GIGA Cyclotron Research Centre in Vivo Imaging, University of Liege, Liege, Belgium.
| | - Sarah Genon
- GIGA Cyclotron Research Centre in Vivo Imaging, University of Liege, Liege, Belgium; Institute of Systems Neuroscience, Heinrich Heine University Duesseldorf, Duesseldorf, Germany; Institute of Neuroscience and Medicine (INM-7), Research Centre Juelich, Juelich, Germany.
| | - Fabienne Collette
- GIGA Cyclotron Research Centre in Vivo Imaging, University of Liege, Liege, Belgium.
| | - Christine Bastin
- GIGA Cyclotron Research Centre in Vivo Imaging, University of Liege, Liege, Belgium.
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Andrade K, Guieysse T, Medani T, Koechlin E, Pantazis D, Dubois B. The dual-path hypothesis for the emergence of anosognosia in Alzheimer's disease. Front Neurol 2023; 14:1239057. [PMID: 38020610 PMCID: PMC10654627 DOI: 10.3389/fneur.2023.1239057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Although neurocognitive models have been proposed to explain anosognosia in Alzheimer's disease (AD), the neural cascade responsible for its origin in the human brain remains unknown. Here, we build on a mechanistic dual-path hypothesis that brings error-monitoring and emotional processing systems as key elements for self-awareness, with distinct impacts on the emergence of anosognosia in AD. Proceeding from the notion of anosognosia as a dimensional syndrome, varying between a lack of concern about one's own deficits (i.e., anosodiaphoria) and a complete lack of awareness of deficits, our hypothesis states that (i) unawareness of deficits would result from primary damage to the error-monitoring system, whereas (ii) anosodiaphoria would more likely result from an imbalance between emotional processing and error-monitoring. In the first case, a synaptic failure in the error-monitoring system, in which the anterior and posterior cingulate cortices play a major role, would have a negative impact on error (or deficits) awareness, preventing patients from becoming aware of their condition. In the second case, an impairment in the emotional processing system, in which the amygdala and the orbitofrontal cortex play a major role, would prevent patients from monitoring the internal milieu for relevant errors (or deficits) and assigning appropriate value to them, thus biasing their impact on the error-monitoring system. Our hypothesis stems on two scientific premises. One comes from preliminary results in AD patients showing a synaptic failure in the error-monitoring system along with a decline of awareness for cognitive difficulties at the time of diagnosis. Another comes from the somatic marker hypothesis, which proposes that emotional signals are critical to adaptive behavior. Further exploration of these premises will be of great interest to illuminate the foundations of self-awareness and improve our knowledge of the underlying paths of anosognosia in AD and other brain disorders.
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Affiliation(s)
- Katia Andrade
- Institute of Memory and Alzheimer’s Disease (IM2A), Department of Neurology, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France
- Frontlab, Paris Brain Institute (Institut du Cerveau, ICM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Thomas Guieysse
- Institute of Memory and Alzheimer’s Disease (IM2A), Department of Neurology, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France
| | - Takfarinas Medani
- Signal and Image Processing Institute, University of Southern California, Los Angeles, CA, United States
| | - Etienne Koechlin
- École Normale Supérieure, Laboratoire de Neurosciences Cognitives et Computationnelles, Paris, France
| | - Dimitrios Pantazis
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Bruno Dubois
- Institute of Memory and Alzheimer’s Disease (IM2A), Department of Neurology, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France
- Frontlab, Paris Brain Institute (Institut du Cerveau, ICM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
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Razafimahatratra S, Guieysse T, Lejeune FX, Houot M, Medani T, Dreyfus G, Klarsfeld A, Villain N, Pereira FR, La Corte V, George N, Pantazis D, Andrade K. Can a failure in the error-monitoring system explain unawareness of memory deficits in Alzheimer's disease? Cortex 2023; 166:428-440. [PMID: 37423786 DOI: 10.1016/j.cortex.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 03/13/2023] [Accepted: 05/11/2023] [Indexed: 07/11/2023]
Abstract
Unawareness of memory deficits is an early manifestation in patients with Alzheimer's disease (AD), which often delays diagnosis. This intriguing behavior constitutes a form of anosognosia, whose neural mechanisms remain largely unknown. We hypothesized that anosognosia may depend on a critical synaptic failure in the error-monitoring system, which would prevent AD patients from being aware of their own memory impairment. To investigate, we measured event-related potentials (ERPs) evoked by erroneous responses during a word memory recognition task in two groups of amyloid positive individuals with only subjective memory complaints at study entry: those who progressed to AD within the five-year study period (PROG group), and those who remained cognitively normal (CTRL group). A significant reduction in the amplitude of the positivity error (Pe), an ERP related to error awareness, was observed in the PROG group at the time of AD diagnosis (vs study entry) in intra-group analysis, as well as when compared with the CTRL group in inter-group analysis, based on the last EEG acquisition for all subjects. Importantly, at the time of AD diagnosis, the PROG group exhibited clinical signs of anosognosia, overestimating their cognitive abilities, as evidenced by the discrepancy scores obtained from caregiver/informant vs participant reports on the cognitive subscale of the Healthy Aging Brain Care Monitor. To our knowledge, this is the first study to reveal the emergence of a failure in the error-monitoring system during a word memory recognition task at the early stages of AD. This finding, along with the decline of awareness for cognitive impairment observed in the PROG group, strongly suggests that a synaptic dysfunction in the error-monitoring system may be the critical neural mechanism at the origin of unawareness of deficits in AD.
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Affiliation(s)
- Solofo Razafimahatratra
- Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Thomas Guieysse
- Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - François-Xavier Lejeune
- Sorbonne Université, Paris Brain Institute (ICM Institut du Cerveau), AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, Paris, France; Paris Brain Institute's Data and Analysis Core, University Hospital Pitié-Salpêtrière, Paris, France
| | - Marion Houot
- Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France; Centre of Excellence of Neurodegenerative Disease (CoEN), AP-HP, Pitié-Salpêtrière Hospital, Paris, France; Clinical Investigation Centre, Institut du Cerveau et de la Moelle épinière (ICM), Pitié-Salpêtrière Hospital Paris, France
| | - Takfarinas Medani
- Signal & Image Processing Institute, University of Southern California, Los Angeles, CA 90089, USA
| | | | - André Klarsfeld
- Laboratory of Brain Plasticity, CNRS UMR 8249, ESPCI Paris - PSL, Paris, France
| | - Nicolas Villain
- Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Filipa Raposo Pereira
- Brain & Spine Institute, ICM, INSERM U 1127, CNRS UMR 7225, Sorbonne Université, Centre MEG-EEG, F-75013, Paris, France
| | - Valentina La Corte
- Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Nathalie George
- Brain & Spine Institute, ICM, INSERM U 1127, CNRS UMR 7225, Sorbonne Université, Centre MEG-EEG, F-75013, Paris, France
| | - Dimitrios Pantazis
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Katia Andrade
- Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France; Laboratory of Brain Plasticity, CNRS UMR 8249, ESPCI Paris - PSL, Paris, France; FrontLab, Paris Brain Institute, ICM, Pitié Salpêtrière GH, 47 Bd de l'Hôpital, 75013, Paris, France.
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Guieysse T, Lamothe R, Houot M, Razafimahatratra S, Medani T, Lejeune FX, Dreyfus G, Klarsfeld A, Pantazis D, Koechlin E, Andrade K. Detecting Anosognosia from the Prodromal Stage of Alzheimer's Disease. J Alzheimers Dis 2023; 95:1723-1733. [PMID: 37718816 PMCID: PMC10578267 DOI: 10.3233/jad-230552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Though not originally developed for this purpose, the Healthy Aging Brain Care Monitor (HABC-M) seems a valuable instrument for assessing anosognosia in Alzheimer's disease (AD). OBJECTIVES Our study aimed at 1) investigating the validity of the HABC-M (31 items), and its cognitive, psychological, and functional subscales, in discriminating AD patients from controls; 2) exploring whether the HABC-M discrepancy scores between the self-reports of patients/controls in these different domains and the respective ratings provided by their caregivers/informants correlate with an online measure of self-awareness; 3) determining whether the caregiver burden level, also derived from the HABC-M, could add additional support for detecting anosognosia. METHODS The HABC-M was administered to 30 AD patients and 30 healthy controls, and to their caregivers/informants. A measure of online awareness was established from subjects' estimation of their performances in a computerized experiment. RESULTS The HABC-M discrepancy scores distinguished AD patients from controls. The cognitive subscale discriminated the two groups from the prodromal AD stage, with an AUC of 0.88 [95% CI: 0.78;0.97]. Adding the caregiver burden level raised it to 0.94 [0.86;0.99]. Significant correlations between the HABC-M and online discrepancy scores were observed in the patients group, providing convergent validity of these methods. CONCLUSIONS The cognitive HABC-M (six items) can detect anosognosia across the AD spectrum. The caregiver burden (four items) may corroborate the suspicion of anosognosia. The short-hybrid scale, built from these 10 items instead of the usual 31, showed the highest sensitivity for detecting anosognosia from the prodromal AD stage, which may further help with timely diagnosis.
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Affiliation(s)
- Thomas Guieysse
- Department of Neurology, Institute of Memory and Alzheimer’s Disease (IM2A), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Roxane Lamothe
- Department of Neurology, Institute of Memory and Alzheimer’s Disease (IM2A), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Marion Houot
- Department of Neurology, Institute of Memory and Alzheimer’s Disease (IM2A), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Centre of Excellence of Neurodegenerative Disease (CoEN), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Solofo Razafimahatratra
- Department of Neurology, Institute of Memory and Alzheimer’s Disease (IM2A), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Takfarinas Medani
- Signal & Image Processing Institute, University of Southern California, Los Angeles, CA, USA
| | - François-Xavier Lejeune
- Paris Brain Institute (Institut du Cerveau, ICM), Data Analysis Core, INSERM, CNRS, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France
| | | | - André Klarsfeld
- Laboratory of Brain Plasticity, CNRS UMR 8249, ESPCI Paris - PSL, Paris, France
| | - Dimitrios Pantazis
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Etienne Koechlin
- Laboratoire de Neurosciences Cognitives et Computationnelles, École Normale Supérieure, Paris, France
| | - Katia Andrade
- Department of Neurology, Institute of Memory and Alzheimer’s Disease (IM2A), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Laboratory of Brain Plasticity, CNRS UMR 8249, ESPCI Paris - PSL, Paris, France
- FrontLab, Paris Brain Institute, ICM, Pitié Salpêtrière GH, Paris, France
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Li Q, Pan FF, Huang Q, Lo CYZ, Xie F, Guo Q. Altered metamemory precedes cognitive impairment in subjective cognitive decline with positive amyloid-beta. Front Aging Neurosci 2022; 14:1046445. [PMID: 36389070 PMCID: PMC9640736 DOI: 10.3389/fnagi.2022.1046445] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/03/2022] [Indexed: 06/21/2024] Open
Abstract
Subjective cognitive decline (SCD) as an indicator of preclinical Alzheimer's disease (AD) may precede mild cognitive impairment (MCI) over several decades. Self-reported cognitive decline as a typical clinical manifestation is critical in preclinical AD. Metacognition represents a person's ability to accurately assess cognition. Our study aimed to examine (1) the alternations of metamemory in a cohort across the Alzheimer's continuum, (2) the association between metamemory and cognition, and (3) the relationship of cortical thickness in four regions of interest (ROI) with metamemory scores. Six hundred ninety-seven participants were classified as 79 AD dementia, 161 aMCI, 261 SCD, and 196 cognitively unimpaired (CU) individuals, in which 418 participants aged above 65, 131 participants with Aβ+ after receiving positron emission tomography, and 602 participants received sMRI. The degree of confidence (DOC) was measured by calculating discrepancies between judgments and memory performance. We assessed the relationships between DOC tertiles and cognition and analyzed the screening power, then investigated the partial correlation between DOC and ROIs, controlled by age, sex, and cognition. In the Aβ+ subgroup, SCD showed significantly higher DOC scores than the CU group. There was an increasing trend of overconfidence with the decline of cognition across the AD spectrum (P for trend < 0.001). After adjusting for age, sex, and education, the lower degree of confidence-long-term delay recall (DOC-LD) tertiles were associated with lower odds ratio in SCD, aMCI, and AD in the Aβ+ subgroup (all P for trend < 0.05). The area under the curves of DOC scores for screening SCD from CU in the Aβ+ subgroup was better than that in all participants and the age ≥65 subgroup. Partial correlation showed that in the Aβ+ subgroup, DOC-SD (degree of confidence-short-term delay recall) was negatively correlated with the anterior cingulate cortex; DOC-LD was negatively correlated with the cortices of parahippocampal, anterior cingulate, posterior cingulate, and medial orbitofrontal. In individuals with Aβ+, SCD exhibited a detectable metamemory alternation before objective cognitive impairment could be tested, indicated by the overestimation in the memory performance. The pattern of an increasing trend of overconfidence across SCD, aMCI, and AD dementia supports the view of a continuum in Alzheimer's disease.
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Affiliation(s)
- QinJie Li
- Department of Gerontology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feng-Feng Pan
- Department of Gerontology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qi Huang
- PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Chun-Yi Zac Lo
- Institute of Science and Technology for Brain Inspired Intelligence, Fudan University, Shanghai, China
| | - Fang Xie
- PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - QiHao Guo
- Department of Gerontology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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I remember it like it was yesterday: Age-related differences in the subjective experience of remembering. Psychon Bull Rev 2021; 29:1223-1245. [PMID: 34918271 DOI: 10.3758/s13423-021-02048-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 11/08/2022]
Abstract
It has been frequently described that older adults subjectively report the vividness of their memories as being as high, or even higher, than young adults, despite poorer objective memory performance. Here, we review studies that examined age-related differences in the subjective experience of memory vividness. By examining vividness calibration and resolution, studies using different types of approaches converge to suggest that older adults overestimate the intensity of their vividness ratings relative to young adults, and that they rely on retrieved memory details to a lesser extent to judge vividness. We discuss potential mechanisms underlying these observations. Inflation of memory vividness with regard to the richness of memory content may stem from age-differences in vividness criterion or scale interpretation and psycho-social factors. The reduced reliance on episodic memory details in older adults may stem from age-related differences in how they monitor these details to make their vividness ratings. Considered together, these findings emphasize the importance of examining age-differences in memory vividness using different analytical methods and they provide valuable evidence that the subjective experience of remembering is more than the reactivation of memory content. In this vein, we recommend that future studies explore the links between memory vividness and other subjective memory scales (e.g., ratings of details or memory confidence) in healthy aging and/or other populations, as it could be used as a window to better characterize the cognitive processes that underpin the subjective assessment of the quality of recollected events.
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Self-awareness in Dementia: a Taxonomy of Processes, Overview of Findings, and Integrative Framework. Curr Neurol Neurosci Rep 2021; 21:69. [PMID: 34817738 PMCID: PMC8613100 DOI: 10.1007/s11910-021-01155-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 12/28/2022]
Abstract
Purpose of Review Self-awareness, the capacity of becoming the object of one’s own awareness, has been a frontier of knowledge, but only recently scientific approaches to the theme have advanced. Self-awareness has important clinical implications, and a finer understanding of this concept may improve the clinical management of people with dementia. The current article aims to explore self-awareness, from a neurobiological perspective, in dementia. Recent Findings A taxonomy of self-awareness processes is presented, discussing how these can be structured across different levels of cognitive complexity. Findings on self-awareness in dementia are reviewed, indicating the relative preservation of capacities such as body ownership and agency, despite impairments in higher-level cognitive processes, such as autobiographical memory and emotional regulation. Summary An integrative framework, based on predictive coding and compensatory abilities linked to the resilience of self-awareness in dementia, is discussed, highlighting possible avenues for future research into the topic.
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Huntley JD, Fleming SM, Mograbi DC, Bor D, Naci L, Owen AM, Howard R. Understanding Alzheimer's disease as a disorder of consciousness. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 7:e12203. [PMID: 34877398 PMCID: PMC8630359 DOI: 10.1002/trc2.12203] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 06/28/2021] [Accepted: 07/28/2021] [Indexed: 11/07/2022]
Abstract
People with Alzheimer's disease (AD) demonstrate a range of alterations in consciousness. Changes in awareness of cognitive deficit, self-awareness, and introspection are seen early in AD, and dysfunction of awareness and arousal progresses with increasing disease severity. However, heterogeneity of deficits between individuals and a lack of empirical studies in people with severe dementia highlight the importance of identifying and applying biomarkers of awareness in AD. Impairments of awareness in AD are associated with neuropathology in regions that overlap with proposed neural correlates of consciousness. Recent developments in consciousness science provide theoretical frameworks and experimental approaches to help further understand the conscious experience of people with AD. Recognition of AD as a disorder of consciousness is overdue, and important to both understand the lived experience of people with AD and to improve care.
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Affiliation(s)
- Jonathan D. Huntley
- Division of PsychiatryUniversity College LondonLondonUK
- Wellcome Centre for Human NeuroimagingUniversity College LondonLondonUK
| | - Stephen M. Fleming
- Wellcome Centre for Human NeuroimagingUniversity College LondonLondonUK
- Department of Experimental PsychologyUniversity College LondonLondonUK
- Max Planck‐UCL Centre for Computational Psychiatry and Ageing ResearchUniversity College LondonLondonUK
| | - Daniel C. Mograbi
- Department of PsychologyPontifical Catholic University of Rio de JaneiroRio de JaneiroBrazil
- Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Daniel Bor
- Department of PsychologyUniversity of CambridgeCambridgeUK
| | - Lorina Naci
- School of PsychologyGlobal Brain Health InstituteTrinity College DublinDublinIreland
| | - Adrian M. Owen
- Brain and Mind InstituteDepartment of Physiology and Pharmacology and Department of PsychologyUniversity of Western OntarioLondonOntarioCanada
| | - Robert Howard
- Division of PsychiatryUniversity College LondonLondonUK
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Lenzoni S, Morris RG, Mograbi DC. The Petrified Self 10 Years After: Current Evidence for Mnemonic anosognosia. Front Psychol 2020; 11:465. [PMID: 32256435 PMCID: PMC7090331 DOI: 10.3389/fpsyg.2020.00465] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 02/27/2020] [Indexed: 12/14/2022] Open
Abstract
Lack of awareness about disease, its symptoms and consequences, also termed anosognosia, is a common feature of Alzheimer's disease (AD). It has been hypothesized that memory disorder may be a key contributing factor to anosognosia, with people with AD not being able to update their personal information about performance and relying on older consolidated material about ability. This potentially outdated sense of self has been named, as a metaphor, the petrified self. In the current review, evidence from the past 10 years in relation to this concept is critically appraised. In particular, focus is given to empirical evidence produced on anterograde memory deficits about performance, the profile of autobiographical retrograde memory loss and the role of frontal lobes in anosognosia in AD. Finally, wider consequences of this metaphor for the understanding of selfhood in dementia are discussed.
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Affiliation(s)
- Sabrina Lenzoni
- Department of Psychology, Pontifícia Universidade Católica, Rio de Janeiro, Brazil
| | - Robin G Morris
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Daniel C Mograbi
- Department of Psychology, Pontifícia Universidade Católica, Rio de Janeiro, Brazil.,Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Poptsi E, Tsardoulias E, Moraitou D, Symeonidis AL, Tsolaki M. REMEDES for Alzheimer-R4Alz Battery: Design and Development of a New Tool of Cognitive Control Assessment for the Diagnosis of Minor and Major Neurocognitive Disorders. J Alzheimers Dis 2019; 72:783-801. [DOI: 10.3233/jad-190798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Eleni Poptsi
- Laboratory of Psychology, Section of Cognitive and Experimental Psychology, Faculty of Philosophy, School of Psychology, Aristotle University of Thessaloniki (AUTh), Thessaloniki, Greece
- Greek Association of Alzheimer’s Disease and Related Disorders, Thessaloniki (GAADRD), Greece
| | - Emmanouil Tsardoulias
- School of Electrical and Computer Engineering, Faculty of Engineering, Aristotle University of Thessaloniki (AUTh), Thessaloniki, Greece
| | - Despina Moraitou
- Laboratory of Psychology, Section of Cognitive and Experimental Psychology, Faculty of Philosophy, School of Psychology, Aristotle University of Thessaloniki (AUTh), Thessaloniki, Greece
- Greek Association of Alzheimer’s Disease and Related Disorders, Thessaloniki (GAADRD), Greece
| | - Andreas L. Symeonidis
- School of Electrical and Computer Engineering, Faculty of Engineering, Aristotle University of Thessaloniki (AUTh), Thessaloniki, Greece
| | - Magda Tsolaki
- Greek Association of Alzheimer’s Disease and Related Disorders, Thessaloniki (GAADRD), Greece
- 1st Department of Neurology, School of Medicine, Aristotle University of Thessaloniki (AUTh), Thessaloniki, Greece
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Ryals AJ, O’Neil JT, Mesulam MM, Weintraub S, Voss JL. Memory awareness disruptions in amnestic mild cognitive impairment: comparison of multiple awareness types for verbal and visuospatial material. NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2019; 26:577-598. [PMID: 30080435 PMCID: PMC6453739 DOI: 10.1080/13825585.2018.1503994] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 07/09/2018] [Indexed: 12/12/2022]
Abstract
Successful memory is normally accompanied by explicit awareness of retrieval and confidence in the accuracy of the retrieval product. Prior findings suggest that these features of metamemory can be dissociated from retrieval accuracy in Amnestic Mild Cognitive Impairment (aMCI). However, the literature on this question contains variable and conflicting results, likely because of differences in experimental conditions. We sought to systematically evaluate memory awareness disruptions in aMCI using multiple measures and stimulus formats within the same individuals. Memory awareness was tested with global predictions and postdictions, judgments of learning, confidence level ratings, and modified feeling-of-knowing ratings in tasks of visuospatial and verbal memory. These tests were administered to 14 individuals with aMCI and 15 healthy, age-matched controls. Memory awareness accuracy was calculated as the correspondence between subjective judgments and memory performance.Individuals with aMCI demonstrated impaired global and trial-level retrospective task awareness for visuospatial and verbal stimuli. Additionally, modified feeling-of-knowing awareness was impaired selectively for verbal stimuli. Statistical effect sizes for global awareness impairments were comparable to impairments in several objective neuropsychological memory assessments.Memory awareness (metamemory) disruptions in aMCI were most evident for a subset of subjective judgment types and task input modalities. These findings advance understanding of the nature of memory impairments in aMCI and support the utility of incorporating memory awareness testing to better characterize memory integrity in older adults.
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Affiliation(s)
| | - Jonathan T. O’Neil
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago IL
| | - M.-Marsel Mesulam
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago IL
- Cognitive Neurology and Alzheimer’s Disease Center, Northwestern University Feinberg School of Medicine, Chicago IL
| | - Sandra Weintraub
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago IL
- Cognitive Neurology and Alzheimer’s Disease Center, Northwestern University Feinberg School of Medicine, Chicago IL
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago IL
| | - Joel L. Voss
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago IL
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago IL
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago IL
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Malone C, Deason RG, Palumbo R, Heyworth N, Tat M, Budson AE. False memories in patients with mild cognitive impairment and mild Alzheimer's disease dementia: Can cognitive strategies help? J Clin Exp Neuropsychol 2019; 41:204-218. [PMID: 30179518 PMCID: PMC6399077 DOI: 10.1080/13803395.2018.1513453] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 08/05/2018] [Indexed: 02/07/2023]
Abstract
Alzheimer's disease (AD) is a progressive neurodegenerative disorder that presents predominantly with impairments in learning and memory. Patients with AD are also susceptible to false memories, a clinically relevant memory distortion where a patient remembers an incorrect memory that they believe to be true. The use of cognitive strategies to improve memory performance among patients with AD by reducing false memories has taken on added importance given the lack of disease-modifying agents for AD. However, existing evidence suggests that cognitive strategies to reduce false memories in patients with AD are of limited effectiveness, although these strategies may be useful at earlier stages of the disease. The purpose of this review is to examine experimental findings of false memories and associated memory processes in patients with mild cognitive impairment due to AD and mild AD dementia. Cognitive strategies to reduce false memories in these patient populations are also reviewed. Approaches to clinically relevant future research are suggested and discussed.
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Affiliation(s)
- Christopher Malone
- Center for Translational Cognitive Neuroscience, VA Boston Healthcare System, Boston, MA, USA
| | - Rebecca G. Deason
- Department of Psychology, Texas State University, San Marcos, TX, USA
| | - Rocco Palumbo
- Center for Translational Cognitive Neuroscience, VA Boston Healthcare System, Boston, MA, USA
- Department of Neurology, Boston University Alzheimer’s Disease Center, Boston University School of Medicine, Boston, MA, USA
| | - Nadine Heyworth
- Center for Translational Cognitive Neuroscience, VA Boston Healthcare System, Boston, MA, USA
| | - Michelle Tat
- Center for Translational Cognitive Neuroscience, VA Boston Healthcare System, Boston, MA, USA
- Department of Neurology, Boston University Alzheimer’s Disease Center, Boston University School of Medicine, Boston, MA, USA
| | - Andrew E. Budson
- Center for Translational Cognitive Neuroscience, VA Boston Healthcare System, Boston, MA, USA
- Department of Neurology, Boston University Alzheimer’s Disease Center, Boston University School of Medicine, Boston, MA, USA
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13
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Deason RG, Tat MJ, Flannery S, Mithal PS, Hussey EP, Crehan ET, Ally BA, Budson AE. Response bias and response monitoring: Evidence from healthy older adults and patients with mild Alzheimer's disease. Brain Cogn 2017; 119:17-24. [PMID: 28926752 PMCID: PMC5798457 DOI: 10.1016/j.bandc.2017.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 08/25/2017] [Accepted: 09/05/2017] [Indexed: 11/23/2022]
Abstract
Patients with Alzheimer's disease (AD) often exhibit an abnormally liberal response bias in recognition memory tests, responding "old" more frequently than "new." Investigations have shown patients can to shift to a more conservative response bias when given instructions. We examined if patients with mild AD could alter their response patterns when the ratio of old items is manipulated without explicit instruction. Healthy older adults and AD patients studied lists of words and then were tested in three old/new ratio conditions (30%, 50%, or 70% old items). A subset of participants provided estimates of how many old and new items they saw in the memory test. We demonstrated that both groups were able to change their response patterns without the aid of explicit instructions. Importantly, AD patients were more likely to estimate seeing greater numbers of old than new items, whereas the reverse was observed for older adults. Elevated estimates of old items in AD patients suggest their liberal response bias may be attributed to their reliance on familiarity. We conclude that the liberal response bias observed in AD patients is attributable to their believing that more of the test items are old and not due to impaired meta-memorial monitoring abilities.
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Affiliation(s)
- Rebecca G Deason
- Department of Psychology, Texas State University, San Marcos, TX, United States; Center for Translational Cognitive Neuroscience, VA Boston Healthcare System, Boston, MA, United States; Boston University Alzheimer's Disease Center, Boston University School of Medicine, Boston, MA, United States.
| | - Michelle J Tat
- Center for Translational Cognitive Neuroscience, VA Boston Healthcare System, Boston, MA, United States; Boston University Alzheimer's Disease Center, Boston University School of Medicine, Boston, MA, United States
| | - Sean Flannery
- Center for Translational Cognitive Neuroscience, VA Boston Healthcare System, Boston, MA, United States; Boston University Alzheimer's Disease Center, Boston University School of Medicine, Boston, MA, United States
| | - Prabhakar S Mithal
- Center for Translational Cognitive Neuroscience, VA Boston Healthcare System, Boston, MA, United States; Boston University Alzheimer's Disease Center, Boston University School of Medicine, Boston, MA, United States
| | - Erin P Hussey
- Center for Translational Cognitive Neuroscience, VA Boston Healthcare System, Boston, MA, United States; Boston University Alzheimer's Disease Center, Boston University School of Medicine, Boston, MA, United States
| | - Eileen T Crehan
- Center for Translational Cognitive Neuroscience, VA Boston Healthcare System, Boston, MA, United States; Boston University Alzheimer's Disease Center, Boston University School of Medicine, Boston, MA, United States
| | - Brandon A Ally
- Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
| | - Andrew E Budson
- Center for Translational Cognitive Neuroscience, VA Boston Healthcare System, Boston, MA, United States; Boston University Alzheimer's Disease Center, Boston University School of Medicine, Boston, MA, United States
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14
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Chen X, McNamara TP, Kelly JW, Wolbers T. Cue combination in human spatial navigation. Cogn Psychol 2017; 95:105-144. [PMID: 28478330 DOI: 10.1016/j.cogpsych.2017.04.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 04/09/2017] [Accepted: 04/12/2017] [Indexed: 11/28/2022]
Abstract
This project investigated the ways in which visual cues and bodily cues from self-motion are combined in spatial navigation. Participants completed a homing task in an immersive virtual environment. In Experiments 1A and 1B, the reliability of visual cues and self-motion cues was manipulated independently and within-participants. Results showed that participants weighted visual cues and self-motion cues based on their relative reliability and integrated these two cue types optimally or near-optimally according to Bayesian principles under most conditions. In Experiment 2, the stability of visual cues was manipulated across trials. Results indicated that cue instability affected cue weights indirectly by influencing cue reliability. Experiment 3 was designed to mislead participants about cue reliability by providing distorted feedback on the accuracy of their performance. Participants received feedback that their performance with visual cues was better and that their performance with self-motion cues was worse than it actually was or received the inverse feedback. Positive feedback on the accuracy of performance with a given cue improved the relative precision of performance with that cue. Bayesian principles still held for the most part. Experiment 4 examined the relations among the variability of performance, rated confidence in performance, cue weights, and spatial abilities. Participants took part in the homing task over two days and rated confidence in their performance after every trial. Cue relative confidence and cue relative reliability had unique contributions to observed cue weights. The variability of performance was less stable than rated confidence over time. Participants with higher mental rotation scores performed relatively better with self-motion cues than visual cues. Across all four experiments, consistent correlations were found between observed weights assigned to cues and relative reliability of cues, demonstrating that the cue-weighting process followed Bayesian principles. Results also pointed to the important role of subjective evaluation of performance in the cue-weighting process and led to a new conceptualization of cue reliability in human spatial navigation.
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Affiliation(s)
- Xiaoli Chen
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany.
| | | | | | - Thomas Wolbers
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
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15
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Relating pessimistic memory predictions to Alzheimer's disease brain structure. Cortex 2016; 85:151-164. [PMID: 27773357 DOI: 10.1016/j.cortex.2016.09.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 06/24/2016] [Accepted: 09/15/2016] [Indexed: 11/21/2022]
Abstract
Patients with Alzheimer's disease (AD) show impairment of episodic memory and related metacognitive processes. The present study examined subjective metacognitive judgments preceding objective memory retrieval and investigated the neural correlates of pessimistic predictions for successfully retrieved memories in AD patients. AD patients and healthy older (HO) participants provided predictive judgments on their recognition performance before retrieval of famous (semantic) and recently learned (episodic) names. Correlations between gray matter volume (GMV) in T1 images and behavioral scores were examined with multivariate (partial least square - PLS) and univariate (general linear model - GLM) analyses in AD patients. AD patients showed a significant proportion of successful name recognition preceded by pessimistic prediction in episodic memory. PLS revealed that the behavioral pattern in AD patients was related with a mainly right lateralized pattern of GMV decrease including medial temporal lobe and posterior cingulate cortex (PCC), but also right ventrolateral prefrontal cortex (VLPFC). GLM further confirmed that pessimistic prediction negatively correlated with GMV in VLPFC. Thus, impaired monitoring processes (possibly influenced by inaccurate beliefs) allowing inferences about one's own memory performance are primarily related to decrease GMV in VLPFC in AD patients.
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16
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Assessing a Metacognitive Account of Associative Memory Impairments in Temporal Lobe Epilepsy. EPILEPSY RESEARCH AND TREATMENT 2016; 2016:6746938. [PMID: 27721992 PMCID: PMC5046021 DOI: 10.1155/2016/6746938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/15/2016] [Accepted: 08/01/2016] [Indexed: 11/30/2022]
Abstract
Previous research has pointed to a deficit in associative recognition in temporal lobe epilepsy (TLE). Associative recognition tasks require discrimination between various combinations of words which have and have not been seen previously (such as old-old or old-new pairs). People with TLE tend to respond to rearranged old-old pairs as if they are “intact” old-old pairs, which has been interpreted as a failure to use a recollection strategy to overcome the familiarity of two recombined words into a new pairing. We examined this specific deficit in the context of metacognition, using postdecision confidence judgements at test. We expected that TLE patients would show inappropriate levels of confidence for associative recognition. Although TLE patients reported lower confidence levels in their responses overall, they were sensitive to the difficulty of varying pair types in their judgements and gave significantly higher confidence ratings for their correct answers. We conclude that a strategic deficit is not at play in the associative recognition of people with TLE, insofar as they are able to monitor the status of their memory system. This adds to a growing body of research suggesting that recollection is impaired in TLE, but not metacognition.
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Cosentino S, Zhu C, Bertrand E, Metcalfe J, Janicki S, Cines S. Examination of the metacognitive errors that contribute to anosognosia in Alzheimer's disease. Cortex 2016; 84:101-110. [PMID: 27750070 DOI: 10.1016/j.cortex.2016.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 07/27/2016] [Accepted: 08/05/2016] [Indexed: 11/16/2022]
Abstract
Disordered awareness of memory loss (i.e., anosognosia) is a frequent and clinically relevant symptom of Alzheimer's disease (AD). The metacognitive errors which characterize anosognosia in AD, however, have not been fully articulated. The current study examined metamemory performance as a function of clinically defined awareness groups using different task conditions to examine the extent to which specific metacognitive deficits (i.e., detecting, integrating, or being explicitly aware of errors) contribute to anosognosia in AD (n = 49). In the prospective condition of the metamemory task, analyses examining the association between awareness group, confidence (i.e., FOK) ratings, and memory performance demonstrated an interaction effect F (1, 43) = 5.16, p = .028 with only the aware group (n = 22) providing higher FOK ratings for correct responses compared to incorrect responses (p < .001). The unaware group (n = 27) did not show this dissociation (p = .167), and also made higher FOK ratings for incorrect responses than the aware group (p = .048). There was no main effect of task condition on FOK [F (2, 66) = 1.51, p = .228] with all participants providing comparable FOK ratings for memory performance whether ratings were made prospectively, retrospectively, or in the context of examiner feedback. The overall pattern of performance in the unaware group, whereby individuals did not sufficiently lower confidence ratings in the context of memory errors, and did not benefit from either retrospective assessment or examiner feedback, appears most consistent with a primary anosognosia in which memory failures are not available in explicit awareness.
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Affiliation(s)
- Stephanie Cosentino
- Cognitive Neuroscience Division of the Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY, United States; Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States; Cognitive Neuroscience Division of the Department of Neurology, Columbia University Medical Center, New York, NY, United States.
| | - Carolyn Zhu
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Elodie Bertrand
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States
| | - Janet Metcalfe
- Department of Psychology, Columbia University, New York, NY, United States
| | - Sarah Janicki
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States; Cognitive Neuroscience Division of the Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Sarah Cines
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States
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18
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19
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O'Connor MK, Deason RG, Reynolds E, Tat MJ, Flannery S, Solomon PR, Vassey EA, Budson AE. The imagination inflation effect in healthy older adults and patients with mild Alzheimer's disease. Neuropsychology 2015; 29:550-60. [PMID: 25893972 DOI: 10.1037/neu0000195] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE The imagination inflation effect is a type of memory distortion defined as an increased tendency to falsely remember that an item has been seen, or an action has been performed, when it has only been imagined. For patients with very mild Alzheimer's disease (AD), susceptibility to the imagination inflation effect could have significant functional consequences in daily life. METHOD We assessed whether patients with very mild AD were more or less susceptible to the imagination inflation effect when compared with healthy older adults. In the first session, participants were read an action statement such as "fill the pillbox" and engaged in 1 of 3 activities: listened to the statement being read, performed the action, or imagined performing the action. During the second session, participants imagined action statements from the first session, as well as new action statements. During the recognition test, participants were asked to determine whether action statements were or were not performed during the first session. RESULTS We found that imagining performing actions increased the tendency of patients with very mild AD to falsely recall the action as having been performed to an extent similar to that of healthy older adults. CONCLUSION We concluded that, similar to healthy older adults, patients with very mild AD were susceptible to the imagination inflation effect, which we attributed to difficulties with source monitoring and reliance on familiarity.
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Affiliation(s)
| | | | - Erin Reynolds
- Department of Orthopaedic Surgery, University of Pittsburgh
| | - Michael J Tat
- Center for Translational Cognitive Neuroscience, VA Boston Healthcare System
| | - Sean Flannery
- Center for Translational Cognitive Neuroscience, VA Boston Healthcare System
| | | | - Elizabeth A Vassey
- Boston University Alzheimer's Disease Center, Department of Neurology, Boston University School of Medicine
| | - Andrew E Budson
- Center for Translational Cognitive Neuroscience, VA Boston Healthcare System
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20
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Rosa NM, Deason RG, Budson AE, Gutchess AH. Source Memory for Self and Other in Patients With Mild Cognitive Impairment due to Alzheimer's Disease. J Gerontol B Psychol Sci Soc Sci 2014; 71:59-65. [PMID: 24904049 DOI: 10.1093/geronb/gbu062] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 04/22/2014] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The present study examined the role of enactment in source memory in a cognitively impaired population. As seen in healthy older adults, it was predicted that source memory in people with mild cognitive impairment due to Alzheimer's disease (MCI-AD) would benefit from the self-reference aspect of enactment. METHOD Seventeen participants with MCI-AD and 18 controls worked in small groups to pack a picnic basket and suitcase and were later tested for their source memory for each item. RESULTS For item memory, self-referencing improved corrected recognition scores for both MCI-AD and control participants. The MCI-AD group did not demonstrate the same benefit as controls in correct source memory for self-related items. However, those with MCI-AD were relatively less likely to misattribute new items to the self and more likely to misattribute new items to others when committing errors, compared with controls. DISCUSSION The enactment effect and self-referencing did not enhance accurate source memory more than other referencing for patients with MCI-AD. However, people with MCI-AD benefited in item memory and source memory, being less likely to falsely claim new items as their own, indicating some self-reference benefit occurs for people with MCI-AD.
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Affiliation(s)
- Nicole M Rosa
- Department of Psychology, Brandeis University, Waltham, Massachusetts. Department of Psychology, Harvard University, Cambridge, Massachusetts.
| | - Rebecca G Deason
- Center for Translational Cognitive Neuroscience, Veterans Affairs Boston Healthcare System, Massachusetts. Department of Psychology, Texas State University, San Marcos, Texas
| | - Andrew E Budson
- Center for Translational Cognitive Neuroscience, Veterans Affairs Boston Healthcare System, Massachusetts. Boston University Alzheimer's Disease Center, Boston University School of Medicine, Massachusetts
| | - Angela H Gutchess
- Department of Psychology, Brandeis University, Waltham, Massachusetts
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21
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Rosen HJ, Alcantar O, Zakrzewski J, Shimamura AP, Neuhaus J, Miller BL. Metacognition in the behavioral variant of frontotemporal dementia and Alzheimer's disease. Neuropsychology 2014; 28:436-47. [PMID: 24548124 DOI: 10.1037/neu0000012] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Impaired self-awareness is characteristic of nearly all dementias, including Alzheimer's disease (AD), but the deficit is most severe in the behavioral variant of frontotemporal dementia (bvFTD). The prominence of frontal pathology in bvFTD suggests that failure of online monitoring, the process by which individuals monitor their own cognitive processing in real time, is an important contributor. Metacognitive research offers several approaches to measure self-assessment, some more and others less sensitive to online monitoring. The goal of this study was to assess metacognition in bvFTD using several approaches, and to compare the results with those in AD. METHOD We examined metacognition in 12 patients with bvFTD, 14 with AD, and 35 healthy controls using feeling of knowing (FOK), ease of learning (EOL), judgment of learning (JOL), and retrospective confidence rating (CR) tasks, as well as response to feedback about performance. RESULTS BvFTD and AD were both impaired at FOK compared with controls, although AD showed some sparing. Both groups were similarly impaired at CR and neither group was impaired at JOL after accounting for memory performance. Most striking, bvFTD patients failed to appropriately adjust their predictions about future memory performance even after receiving explicit feedback that they had performed worse than they expected. CONCLUSIONS Both bvFTD and AD show deficits in online monitoring, although the deficit appears more severe in bvFTD. The insensitivity of bvFTD patients to overt feedback may point to unique mechanisms, possibly frontally mediated, that add to their severe lack of self-awareness.
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Affiliation(s)
- Howard J Rosen
- Department of Neurology, University of California San Francisco
| | - Oscar Alcantar
- Department of Neurology, University of California San Francisco
| | | | | | - John Neuhaus
- Department of Epidemiology and Biostatistics, University of California San Francisco
| | - Bruce L Miller
- Department of Neurology, University of California San Francisco
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22
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Jedidi H, Feyers D, Collette F, Bahri MA, Jaspar M, d'Argembeau A, Salmon E, Bastin C. Dorsomedial prefrontal metabolism and unawareness of current characteristics of personality traits in Alzheimer's disease. Soc Cogn Affect Neurosci 2013; 9:1458-63. [PMID: 23946004 DOI: 10.1093/scan/nst132] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Anosognosia is a complex symptom corresponding to a lack of awareness of one's current clinical status. Anosognosia for cognitive deficits has frequently been described in Alzheimer's disease (AD), while unawareness of current characteristics of personality traits has rarely been considered. We used a well-established questionnaire-based method in a group of 37 AD patients and in healthy controls to probe self- and hetero-evaluation of patients' personality and we calculated differential scores between each participant's and his/her relative's judgments. A brain-behavior correlation was performed using 18-fluorodeoxyglucose positron emission tomography (FDG-PET) images. The behavioral data showed that AD patients presented with anosognosia for current characteristics of their personality and their anosognosia was primarily explained by impaired third perspective taking. The brain-behavior correlation analysis revealed a negative relationship between anosognosia for current characteristics of personality and dorsomedial prefrontal cortex (dMPFC) activity. Behavioral and neuroimaging data are consistent with the view that impairment of different functions subserved by the dMPFC (self-evaluation, inferences regarding complex enduring dispositions of self and others, confrontation of perspectives in interpersonal scripts) plays a role in anosognosia for current characteristics of personality in AD patients.
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Affiliation(s)
- Haroun Jedidi
- Cyclotron Research Center, University of Liège, 4000 Liège, Belgium, National Fund for Scientific Research-FNRS, Belgium, and Department of Cognitive and Behavioral Neuroscience, University of Liège, 4000 Liège, Belgium Cyclotron Research Center, University of Liège, 4000 Liège, Belgium, National Fund for Scientific Research-FNRS, Belgium, and Department of Cognitive and Behavioral Neuroscience, University of Liège, 4000 Liège, Belgium
| | - Dorothée Feyers
- Cyclotron Research Center, University of Liège, 4000 Liège, Belgium, National Fund for Scientific Research-FNRS, Belgium, and Department of Cognitive and Behavioral Neuroscience, University of Liège, 4000 Liège, Belgium
| | - Fabienne Collette
- Cyclotron Research Center, University of Liège, 4000 Liège, Belgium, National Fund for Scientific Research-FNRS, Belgium, and Department of Cognitive and Behavioral Neuroscience, University of Liège, 4000 Liège, Belgium Cyclotron Research Center, University of Liège, 4000 Liège, Belgium, National Fund for Scientific Research-FNRS, Belgium, and Department of Cognitive and Behavioral Neuroscience, University of Liège, 4000 Liège, Belgium Cyclotron Research Center, University of Liège, 4000 Liège, Belgium, National Fund for Scientific Research-FNRS, Belgium, and Department of Cognitive and Behavioral Neuroscience, University of Liège, 4000 Liège, Belgium
| | - Mohamed Ali Bahri
- Cyclotron Research Center, University of Liège, 4000 Liège, Belgium, National Fund for Scientific Research-FNRS, Belgium, and Department of Cognitive and Behavioral Neuroscience, University of Liège, 4000 Liège, Belgium Cyclotron Research Center, University of Liège, 4000 Liège, Belgium, National Fund for Scientific Research-FNRS, Belgium, and Department of Cognitive and Behavioral Neuroscience, University of Liège, 4000 Liège, Belgium
| | - Mathieu Jaspar
- Cyclotron Research Center, University of Liège, 4000 Liège, Belgium, National Fund for Scientific Research-FNRS, Belgium, and Department of Cognitive and Behavioral Neuroscience, University of Liège, 4000 Liège, Belgium
| | - Arnaud d'Argembeau
- Cyclotron Research Center, University of Liège, 4000 Liège, Belgium, National Fund for Scientific Research-FNRS, Belgium, and Department of Cognitive and Behavioral Neuroscience, University of Liège, 4000 Liège, Belgium Cyclotron Research Center, University of Liège, 4000 Liège, Belgium, National Fund for Scientific Research-FNRS, Belgium, and Department of Cognitive and Behavioral Neuroscience, University of Liège, 4000 Liège, Belgium Cyclotron Research Center, University of Liège, 4000 Liège, Belgium, National Fund for Scientific Research-FNRS, Belgium, and Department of Cognitive and Behavioral Neuroscience, University of Liège, 4000 Liège, Belgium
| | - Eric Salmon
- Cyclotron Research Center, University of Liège, 4000 Liège, Belgium, National Fund for Scientific Research-FNRS, Belgium, and Department of Cognitive and Behavioral Neuroscience, University of Liège, 4000 Liège, Belgium
| | - Christine Bastin
- Cyclotron Research Center, University of Liège, 4000 Liège, Belgium, National Fund for Scientific Research-FNRS, Belgium, and Department of Cognitive and Behavioral Neuroscience, University of Liège, 4000 Liège, Belgium
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Using pictures and words to understand recognition memory deterioration in amnestic mild cognitive impairment and Alzheimer's disease: a review. Curr Neurol Neurosci Rep 2013; 12:687-94. [PMID: 22927024 DOI: 10.1007/s11910-012-0310-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Difficulty recognizing previously encountered stimuli is one of the earliest signs of incipient Alzheimer's disease (AD). Work over the last 10 years has focused on how patients with AD and those in the prodromal stage of amnestic mild cognitive impairment make recognition decisions for visual and verbal stimuli. Interestingly, both groups of patients demonstrate markedly better memory for pictures over words, to a degree that is significantly greater in magnitude than their healthy older counterparts. Understanding this phenomenon not only helps to conceptualize how memory breaks down in AD, but also potentially provides the basis for future interventions. This review critically examines recent recognition memory work using pictures and words in the context of the dual-process theory of recognition and current hypotheses of cognitive breakdown in the course of very early AD.
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Gallo DA, Cramer SJ, Wong JT, Bennett DA. Alzheimer's disease can spare local metacognition despite global anosognosia: revisiting the confidence-accuracy relationship in episodic memory. Neuropsychologia 2012; 50:2356-64. [PMID: 22722068 DOI: 10.1016/j.neuropsychologia.2012.06.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 06/07/2012] [Accepted: 06/09/2012] [Indexed: 11/18/2022]
Abstract
Alzheimer's disease (AD) can impair metacognition in addition to more basic cognitive functions like memory. However, while global metacognitive inaccuracies are well documented (i.e., low deficit awareness, or anosognosia), the evidence is mixed regarding the effects of AD on local or task-based metacognitive judgments. Here we investigated local metacognition with respect to the confidence-accuracy relationship in episodic memory (i.e., metamemory). AD and control participants studied pictures of common objects and their verbal labels, and then took forced-choice picture recollection tests using the verbal labels as retrieval cues. We found that item-based confidence judgments discriminated between accurate and inaccurate recollection responses in both groups, implicating relatively spared metamemory in AD. By contrast, there was evidence for global metacognitive deficiencies, as AD participants underestimated the severity of their everyday problems compared to an informant's assessment. Within the AD group, individual differences in global metacognition were related to recollection accuracy, and global metacognition for everyday memory problems was related to task-based metacognitive accuracy. These findings suggest that AD can spare the confidence-accuracy relationship in recollection tasks, and that global and local metacognition measures tap overlapping neuropsychological processes.
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Affiliation(s)
- David A Gallo
- University of Chicago, Department of Psychology, University Ave., Chicago, IL 60637, USA.
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25
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Embree LM, Budson AE, Ally BA. Memorial familiarity remains intact for pictures but not for words in patients with amnestic mild cognitive impairment. Neuropsychologia 2012; 50:2333-40. [PMID: 22705441 DOI: 10.1016/j.neuropsychologia.2012.06.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Revised: 06/01/2012] [Accepted: 06/02/2012] [Indexed: 12/01/2022]
Abstract
Understanding how memory breaks down in the earliest stages of Alzheimer's disease (AD) process has significant implications, both clinically and with respect to intervention development. Previous work has highlighted a robust picture superiority effect in patients with amnestic mild cognitive impairment (aMCI). However, it remains unclear as to how pictures improve memory compared to words in this patient population. In the current study, we utilized receiver operating characteristic (ROC) curves to obtain estimates of familiarity and recollection for pictures and words in patients with aMCI and healthy older controls. Analysis of accuracy shows that even when performance is matched between pictures and words in the healthy control group, patients with aMCI continue to show a significant picture superiority effect. The results of the ROC analysis showed that patients demonstrated significantly impaired recollection and familiarity for words compared controls. In contrast, patients with aMCI demonstrated impaired recollection, but intact familiarity for pictures, compared to controls. Based on previous work from our lab, we speculate that patients can utilize the rich conceptual information provided by pictures to enhance familiarity, and perceptual information may allow for post-retrieval monitoring or verification of the enhanced sense of familiarity. Alternatively, the combination of enhanced conceptual and perceptual fluency of the test item might drive a stronger or more robust sense of familiarity that can be accurately attributed to a studied item.
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