Unitization supports lasting performance and generalization on a relational memory task: Evidence from a previously undocumented developmental amnesic case

Comparing two unitisation manipulations: effects on familiarity, recollection-based recognition, and semantic interference

The recognition of associative memory can be significantly influenced by the use of an encoding strategy known as unitisation, which has been implemented through various manipulations. However, [Shao, H., Opitz, B., Yang, J., & Weng, X. (2016). Recollection reduces unitised familiarity effect. Memory (Hove, England), 24(4), 535-547. https://doi.org/10.1080/09658211.2015.1021258] found intriguing distinctions between two common manipulations, the compound task and the imagery task, leading to a dispute. We propose that differences in levels of processing in the imagery task may account for these discrepancies. This study tested our hypothesis using two approaches. The first two experiments utilised the R/K paradigm to investigate the effects of these methods on familiarity-based and recollection-based recognition. The results demonstrated that familiarity was increased in the compound task, while recollection was increased in the imagery task. In the subsequent two experiments, an interference paradigm was employed to examine differences in semantic processing within the two tasks. The results showed that the compound task did not impact participants' inclination towards lures, while the imagery task led to a bias towards semantic lures over episodic lures, suggesting that the two encodings in the imagery task involve different levels of semantic processing. These results support our hypothesis and underscore the importance of carefully choosing comparisons that account for other variables in the study of unitisation.

Effects of extended practice and unitization on relational memory in older adults and neuropsychological lesion cases

Unitization - the fusion of objects into a single unit through an action/consequence sequence - can mitigate relational memory impairments, but the circumstances under which unitization is effective are unclear. Using transverse patterning (TP), we compared unitization (and its component processes of fusion, motion, and action/consequence) with extended practice on relational learning and transfer in older adults and neuropsychological cases with lesions (to varying extents) in the medial prefrontal cortex (mPFC) or hippocampus/medial temporal lobe (HC/MTL). The latter included a person with bilateral HC lesions primarily within the dentate gyrus. For older adults, TP accuracy increased, and transfer benefits were observed, with extended practice and unitization. Broadly, the lesion cases did not benefit from either extended practice or unitization, suggesting the mPFC and dentate gyrus play important roles in relational memory and in unitization. The results suggest that personalized strategy interventions must align with the cognitive and neural profiles of the user.

Threat learning impairs subsequent associative inference

Despite it being widely acknowledged that the most important function of memory is to facilitate the prediction of significant events in a complex world, no studies to date have investigated how our ability to infer associations across distinct but overlapping experiences is affected by the inclusion of threat memories. To address this question, participants (n = 35) encoded neutral predictive associations (A → B). The following day these memories were reactivated by pairing B with a new aversive or neutral outcome (B → C_{THREAT/NEUTRAL}) while pupil dilation was measured as an index of emotional arousal. Then, again 1 day later, the accuracy of indirect associations (A → C?) was tested. Associative inferences involving a threat learning memory were impaired whereas the initial memories were retroactively strengthened, but these effects were not moderated by pupil dilation at encoding. These results imply that a healthy memory system may compartmentalize episodic information of threat, and so hinders its recall when cued only indirectly. Malfunctioning of this process may cause maladaptive linkage of negative events to distant and benign memories, and thereby contribute to the development of clinical intrusions and anxiety.

The Relational Trip Task, a novel ecological measure of relational memory: data from a schizophrenia sample

INTRODUCTION

Relational memory (RM) is severely impaired in schizophrenia. Unitisation can circumvent RM impairments in clinical populations as measured by the transverse-patterning (TP) task, a well-established measure of RM capacity. We compared memory performance on a new ecological RM measure, the Relational Trip Task (RTT), to that of TP at baseline and examined the effects of a unitisation intervention in RTT performance. RTT involves learning relational information of real-life stimuli, such as the relationship between people and places or objects.

METHODS

TP and RTT performances were examined in 45 individuals with schizophrenia. TP-impaired participants (n = 22) were randomised to either the intervention or an active control group. TP and RTT were administered again after unitisation training. Task validity and reliability were assessed. Intervention group's pre- and post-RTT accuracies were compared and contrasted to that in the control group.

RESULTS

RTT and TP were moderately correlated. TP non-learners had inferior performance in RTT at baseline. Improvement in RTT performance after unitisation training was observed in the intervention group; no pre-post improvement was observed in the control group.

CONCLUSION

RTT has an acceptable criterion validity and excellent alternate-form reliability. Unitisation seemed to be successfully generalized to support associations of real-life stimuli.

Reconciling the object and spatial processing views of the perirhinal cortex through task-relevant unitization

The perirhinal cortex is situated on the border between sensory association cortex and the hippocampal formation. It serves an important function as a transition area between the sensory neocortex and the medial temporal lobe. While the perirhinal cortex has traditionally been associated with object coding and the "what" pathway of the temporal lobe, current evidence suggests a broader function of the perirhinal cortex in solving feature ambiguity and processing complex stimuli. Besides fulfilling functions in object coding, recent neurophysiological findings in freely moving rodents indicate that the perirhinal cortex also contributes to spatial and contextual processing beyond individual sensory modalities. Here, we address how these two opposing views on perirhinal cortex-the object-centered and spatial-contextual processing hypotheses-may be reconciled. The perirhinal cortex is consistently recruited when different features can be merged perceptually or conceptually into a single entity. Features that are unitized in these entities include object information from multiple sensory domains, reward associations, semantic features and spatial/contextual associations. We propose that the same perirhinal network circuits can be flexibly deployed for multiple cognitive functions, such that the perirhinal cortex performs similar unitization operations on different types of information, depending on behavioral demands and ranging from the object-related domain to spatial, contextual and semantic information.

A Feasibility Study on the Use of the Method of Loci for Improving Episodic Memory Performance in Schizophrenia and Non-clinical Subjects

We investigated the feasibility of a short intervention using the Method of Loci (MoL), a well-known visuospatial mnemonic, to improve episodic memory recall performance in schizophrenia. The MoL training protocol comprised encoding and recall of two lists of items (words and images), a training session and practice with MoL. Then, participants had the opportunity to put into practice the newly learned MoL and were instructed to encode and recall two new lists of items using. This approach was first validated with healthy individuals (N = 71). Subsequently, five individuals with schizophrenia completed the protocol. Improvement in healthy individuals was observed for the word list (Wilcoxon effect size r = 0.15). No significant memory improvement was denoted in the schizophrenia group, possibly due to participants' difficulties using the method efficiently and due to fatigue. The MoL seems to require episodic memory, working memory monitoring and executive functions, making it suboptimal for a population with impairments in all those domains. Future research should examine the use of other strategies, better suited for individuals with cognitive impairments like those found in schizophrenia.

Representation of viewed and recalled film clips in patterns of brain activity in a person with developmental amnesia

As clear memories transport us back into the past, the brain also revives prior patterns of neural activity, a phenomenon known as neural reactivation. While growing evidence indicates a link between neural reactivation and typical variations in memory performance in healthy individuals, it is unclear how and to what extent reactivation is disrupted by a memory disorder. The current study characterizes neural reactivation in a case of amnesia using Multivoxel Pattern Analysis (MVPA). We tested NC, an individual with developmental amnesia linked to a diencephalic stroke, and 19 young adult controls on a functional magnetic resonance imaging (fMRI) task during which participants viewed and recalled short videos multiple times. An encoding classifier trained and tested to identify videos based on brain activity patterns elicited at perception revealed superior classification in NC. The enhanced consistency in stimulus representation we observed in NC at encoding was accompanied by an absence of multivariate repetition suppression, which occurred over repeated viewing in the controls. Another recall classifier trained and tested to identify videos during mental replay indicated normal levels of classification in NC, despite his poor memory for stimulus content. However, a cross-condition classifier trained on perception trials and tested on mental replay trials-a strict test of reactivation-revealed significantly poorer classification in NC. Thus, while NC's brain activity was consistent and stimulus-specific during mental replay, this specificity did not reflect the reactivation of patterns elicited at perception to the same extent as controls. Fittingly, we identified brain regions for which activity supported stimulus representation during mental replay to a greater extent in NC than in controls. This activity was not modeled on perception, suggesting that compensatory patterns of representation based on generic knowledge can support consistent mental constructs when memory is faulty. Our results reveal several ways in which amnesia impacts distributed patterns of stimulus representation during encoding and retrieval.

Gradual learning and inflexible strategy use in amnesia: Evidence from case H.C

The value of case studies in informing our understanding of dissociations and interactions in memory was recognized early on by Endel Tulving, whose comprehensive work with the amnesic case K.C. helped to confirm distinctions between episodic and semantic memory. Following in this tradition, we examined memory and the use of cognitive strategies in the developmental amnesic case H.C., a young woman with structural abnormalities in the extended hippocampal system (Rosenbaum et al., 2014). H.C. was tested on two tasks, transitivity and transverse patterning, that each required learning the relations among items, and for the former, also examined the ability to make inferences across sets of relations. H.C. was tested across multiple sessions and demonstrated two seemingly contradictory patterns of performance: evidence of gradual learning, yet an inability to flexibly switch to a cognitive strategy that may otherwise benefit performance. Specifically, on the transitivity task, H.C. showed gradual learning of novel relations that led to successful inferential performance. On transverse patterning, H.C. showed some gradual learning of the relations among the objects across sessions, and expressed knowledge that the task followed 'rock-paper-scissors' rules. However, H.C. did not benefit from a unitization strategy, which had shown previous success with other amnesic cases (D'Angelo et al., 2015; Ryan, Moses, Barense, & Rosenbaum, 2013). H.C.'s over-reliance on 'rock-paper-scissors' rules, even in the face of alternate strategies, is suggestive of an inability to enact cognitive flexibility. Poor performance thus may have resulted from interference from the experimentally presented strategy on her self-imposed strategy. The present findings echo work reported by Tulving in case K.C. (Tulving, Hayman, & Macdonald, 1991). Whereas neurologically intact individuals may rely on the functions of the hippocampal system to rapidly learn new information and resolve interference, some individuals with hippocampal amnesia may learn information gradually, but such learning is particularly prone to interference, resulting in an inability to flexibly adapt to changes in the learning conditions in order to optimize performance.

Visual integration of objects and scenes increases recollection-based responding despite differential MTL recruitment in young and older adults

Unitization, the process of encoding previously independent units as one coherent representation, improves associative memory in both young and older adults, or in some cases, differentially benefits older adults. Unitization of verbal associative pairs may reduce reliance on the hippocampus (HC) for successful encoding and recognition by shifting to familiarity-based processing mediated by perirhinal cortex (PRC). However, this shift was not observed in a recent study of visual associative memory, with equivalent activation in HC and PRC during encoding of visually integrated (unitized) and nonintegrated object and scene pairs. Furthermore, behavioral findings from this study suggested an increase in recollection rather than familiarity during recognition of visually integrated pairs. The present study extends our previous work by focusing on the influence of visual integration on fMRI activation during associative recognition, rather than encoding and these patterns between young and older adults. In contrast to our findings from encoding, visual integration reduced HC and PRC activation during retrieval of object and scene associative pairs across both age groups. However, visual integration increased the correlation between bilateral HC and left parahippocampal (PHC) activation and behavioral performance among older adults, consistent with an increased reliance on recollection. In contrast, visual integration reduced the correlation between HC activation and behavioral performance in young adults, more consistent with findings from the verbal unitization literature. Taken together, these results suggest that associative memory for visually integrated pairs may involve differential recruitment of medial temporal regions in young and older adults.

Superior explicit memory despite severe developmental amnesia: In-depth case study and neural correlates

The acquisition of new semantic memories is sometimes preserved in patients with hippocampal amnesia. Robust evidence for this comes from case reports of developmental amnesia suggesting that low-to-normal levels of semantic knowledge can be achieved despite compromised episodic learning. However, it is unclear whether this relative preservation of semantic memory results from normal acquisition and retrieval or from residual episodic memory, combined with effortful repetition. Furthermore, lesion studies have mainly focused on the hippocampus itself, and have seldom reported the state of structures in the extended hippocampal system. Preserved components of this system may therefore mediate residual episodic abilities, contributing to the apparent semantic preservation. We report an in-depth study of Patient KA, a 27-year-old man who had severe hypoxia at birth, in which we carefully explored his residual episodic learning abilities. We used novel speeded recognition paradigms to assess whether KA could explicitly acquire and retrieve new context-free memories. Despite a pattern of very severe amnesia, with a 44-point discrepancy between his intelligence and memory quotients, KA exhibited normal-to-superior levels of knowledge, even under strict time constraints. He also exhibited normal-to-superior recognition memory for new material, again under strict time constraints. Multimodal neuroimaging revealed an unusual pattern of selective atrophy within each component of the extended hippocampal system, contrasting with the preservation of anterior subhippocampal cortices. A cortical thickness analysis yielded a pattern of thinner but also thicker regional cortices, pointing toward specific temporal lobe reorganization following early injury. We thus report the first case of superior explicit learning and memory in a severe case of amnesia, raising important questions about how such knowledge can be acquired.

The missing link? Testing a schema account of unitization

Unitization refers to the creation of a new unit from previously distinct items. The concept of unitization has been used to explain how novel pairings between items can be remembered without requiring recollection, by virtue of new, item-like representations that enable familiarity-based retrieval. We tested an alternative account of unitization - a schema account - which suggests that associations between items can be rapidly assimilated into a schema. We used a common operationalization of "unitization" as the difference between two unrelated words being linked by a definition, relative to two words being linked by a sentence, during an initial study phase. During the following relearning phase, a studied word was re-paired with a new word, either related or unrelated to the original associate from study. In a final test phase, memory for the relearned associations was tested. We hypothesized that, if unitized representations act like schemas, then we would observe some generalization to related words, such that memory would be better in the definition than sentence condition for related words, but not for unrelated words. Contrary to the schema hypothesis, evidence favored the null hypothesis of no difference between definition and sentence conditions for related words (Experiment 1), even when each cue was associated with multiple associates, indicating that the associations can be generalized (Experiment 2), or when the schematic information was explicitly re-activated during Relearning (Experiment 3). These results suggest that unitized associations do not generalize to accommodate new information, and therefore provide evidence against the schema account.

Breaking down unitization: Is the whole greater than the sum of its parts?

Memory impairments are often observed in aging. Specifically, older adults have difficulty binding together disparate elements (relational memory). We have recently shown that a cognitive strategy known as unitization can mitigate impaired relational learning in the transverse patterning task (TP) in both amnesia and healthy aging. This strategy allows items to be fused together through an interaction such that one item acts upon another. In the context of TP, unitization is comprised of three component processes: (1) fusion, (2) motion, and (3) semantic comprehension of action/consequence sequences. Here, we examine which of these components are sufficient to mitigate age-related impairments. Four groups of older adults were given either the full unitization strategy or one of the three component strategies. Each group of older adults showed impairments in memory for the relations among items under standard training instructions relative to a threshold that marks learning of a winner-take-all rule (elemental threshold). However, participants who were given either the full unitization strategy or the action/consequence-only strategy showed improved performance, which was maintained following the 1-hour delay. Therefore, semantically rich action/consequence interactions are sufficient to mitigate age-related relational memory impairments.

Dissociable contributions of thalamic nuclei to recognition memory: novel evidence from a case of medial dorsal thalamic damage

The thalamic nuclei are thought to play a critical role in recognition memory. Specifically, the anterior thalamic nuclei and medial dorsal nuclei may serve as critical output structures in distinct hippocampal and perirhinal cortex systems, respectively. Existing evidence indicates that damage to the anterior thalamic nuclei leads to impairments in hippocampal-dependent tasks. However, evidence for the opposite pattern following medial dorsal nuclei damage has not yet been identified. In the present study, we investigated recognition memory in NC, a patient with relatively selective medial dorsal nuclei damage, using two object recognition tests with similar foils: a yes/no (YN) test that requires the hippocampus, and a forced choice corresponding test (FCC) that is supported by perirhinal cortex. NC performed normally in the YN test, but was impaired in the FCC test. Critically, FCC performance was impaired only when the study-test delay period was filled with interference. We interpret these results in the context of the representational–hierarchical model, which predicts that memory deficits following damage to the perirhinal system arise due to increased vulnerability to interference. These data provide the first evidence for selective deficits in a task that relies on perirhinal output following damage to the medial dorsal nuclei, providing critical evidence for dissociable thalamic contributions to recognition memory.

Abnormal semantic knowledge in a case of developmental amnesia

An important theory holds that semantic knowledge can develop independently of episodic memory. One strong source of evidence supporting this independence comes from the observation that individuals with early hippocampal damage leading to developmental amnesia generally perform normally on standard tests of semantic memory, despite their profound impairment in episodic memory. However, one aspect of semantic memory that has not been explored is conceptual structure. We built on the theoretically important distinction between intrinsic features of object concepts (e.g., shape, colour, parts) and extrinsic features (e.g., how something is used, where it is typically located). The accrual of extrinsic feature knowledge that is important for concepts such as chair or spoon may depend on binding mechanisms in the hippocampus. We tested HC, an individual with developmental amnesia due to a well-characterized lesion of the hippocampus, on her ability to generate semantic features for object concepts. HC generated fewer extrinsic features than controls, but a similar number of intrinsic features than controls. We also tested her on typicality ratings. Her typicality ratings were abnormal for nonliving things (which more strongly depend on extrinsic features), but normal for living things (which more strongly depend on intrinsic features). In contrast, NB, who has MTL but not hippocampal damage due to surgery, showed no impairments in either task. These results suggest that episodic and semantic memory are not entirely independent, and that the hippocampus is important for learning some aspects of conceptual knowledge.

Impaired inference in a case of developmental amnesia

Amnesia is associated with impairments in relational memory, which is critically supported by the hippocampus. By adapting the transitivity paradigm, we previously showed that age-related impairments in inference were mitigated when judgments could be predicated on known pairwise relations, however, such advantages were not observed in the adult-onset amnesic case D.A. Here, we replicate and extend this finding in a developmental amnesic case (N.C.), who also shows impaired relational learning and transitive expression. Unlike D.A., N.C.'s damage affected the extended hippocampal system and diencephalic structures, and does not extend to neocortical areas that are affected in D.A. Critically, despite their differences in etiology and affected structures, N.C. and D.A. perform similarly on the task. N.C. showed intact pairwise knowledge, suggesting that he is able to use existing semantic information, but this semantic knowledge was insufficient to support transitive expression. The present results suggest a critical role for regions connected to the hippocampus and/or medial prefrontal cortex in inference beyond learning of pairwise relations. © 2016 The Authors Hippocampus Published by Wiley Periodicals, Inc.

The effectiveness of unitization in mitigating age-related relational learning impairments depends on existing cognitive status

Binding relations among items in the transverse patterning (TP) task is dependent on the integrity of the hippocampus and its extended network. Older adults have impaired TP learning, corresponding to age-related reductions in hippocampal volumes. Unitization is a training strategy that can mitigate TP impairments in amnesia by reducing reliance on hippocampal-dependent relational binding and increasing reliance on fused representations. Here we examined whether healthy older adults and those showing early signs of cognitive decline would also benefit from unitization. Although both groups of older adults had neuropsychological performance within the healthy range, their TP learning differed both under standard and unitized training conditions. Healthy older adults with impaired TP learning under standard training benefited from unitized training. Older adults who failed the Montreal Cognitive Assessment (MoCA) showed greater impairments under standard conditions, and showed no evidence of improvement with unitization. These individuals' failures to benefit from unitization may be a consequence of early deficits not seen in older adults who pass the MoCA.