The effects of repetition on allocation of study time and judgements of learning in Alzheimer's disease

Metamemory monitoring in Alzheimer's disease A systematic review

Metamemory is the awareness of one’s own knowledge and control of memory, and refers to the online ability to gather information about the current state of the memory system.

Appearances can be deceiving: instructor fluency increases perceptions of learning without increasing actual learning

The present study explored the effects of lecture fluency on students' metacognitive awareness and regulation. Participants watched one of two short videos of an instructor explaining a scientific concept. In the fluent video, the instructor stood upright, maintained eye contact, and spoke fluidly without notes. In the disfluent video, the instructor slumped, looked away, and spoke haltingly with notes. After watching the video, participants in Experiment 1 were asked to predict how much of the content they would later be able to recall, and participants in Experiment 2 were given a text-based script of the video to study. Perceived learning was significantly higher for the fluent instructor than for the disfluent instructor (Experiment 1), although study time was not significantly affected by lecture fluency (Experiment 2). In both experiments, the fluent instructor was rated significantly higher than the disfluent instructor on traditional instructor evaluation questions, such as preparedness and effectiveness. However, in both experiments, lecture fluency did not significantly affect the amount of information learned. Thus, students' perceptions of their own learning and an instructor's effectiveness appear to be based on lecture fluency and not on actual learning.

Eliciting the implicit: metacognition in Alzheimer's disease

The literature on metacognition in Alzheimer's disease points to there being implicit and explicit routes to the control and monitoring of memory. For instance, despite not being able to make predictions of performance which reflect future behavior, people with Alzheimer's disease can regulate effectively the amount of time they spend studying an item. Thus, empirical tasks from the metacognition literature shed some light on the idea of implicit awareness. But the complex pattern of preservation and impairment in metacognitive knowledge also points to other dimensions on which we need to consider patient awareness.

Metacognitive judgments-of-learning in adolescents with autism spectrum disorder

This study investigated metacognitive monitoring abilities in adolescents with autism spectrum disorder in two experiments using the judgment-of-learning paradigm. Participants were asked to predict their future recall of unrelated word pairs during the learning phase. Experiment 1 compared judgments-of-learning made immediately after learning and judgments-of-learning made after a delay. We found that both groups overestimated their memory performance but that overall there were no group differences in judgment-of-learning accuracy. Additionally, both groups displayed the standard delayed judgment-of-learning effect (yielding greater judgment accuracy in delayed compared to immediate judgments), suggesting that both groups were able to use appropriate information in making their judgments-of-learning. Experiment 2 assessed whether adolescents with autism spectrum disorder could regulate their study time according to their judgments-of-learning using a self-paced learning procedure. Results showed that both groups spent more time learning items given lower judgments-of-learning. Finally, Experiment 2 showed that judgments-of-learning and study time varied according to item difficulty in both groups. As a whole, these findings demonstrate that adolescents with autism spectrum disorder can accurately gauge their memory performance while learning new word associations and use these skills to control their study time at learning.

Metamemory in temporal lobe epilepsy: a study of sensitivity to repetition at encoding

The purpose of the current study was to determine whether the level of metacognitive sensitivity previously observed in global Judgments-of-Learning (JOLs) in temporal lobe epilepsy (TLE) patients could also be established when making item-by-item JOLs. Fourteen TLE patients and 14 control participants were compared on a memory task where 39 semantically unrelated word pairs were presented at three different levels of repetition. Thirteen word pairs were assigned to each level. A combined JOL and Feeling-of-Knowing (FOK) task was used to examine metamemory monitoring and control processes. The results showed that control participants outperformed TLE patients on recall and recognition. However, both groups were sensitive to repetition of the word pairs throughout the list, revealing intact online monitoring and control processes at encoding. These results are consistent with the findings of Howard et al. (2010) of intact metamemory in TLE patients and extend the findings of Andrés et al. (2010) of metamemory sensitivity from the global level to the item-by-item level. Finally, the current findings provide additional evidence of a dissociation between memory and metamemory in TLE patients.

An analysis of the determinants of the feeling of knowing

Research has demonstrated that feeling-of-knowing (FOK) judgments are affected by the amount of accessible information related to an inaccessible target. Further, studies have demonstrated that, in some situations, FOK judgment magnitude is not only related to the amount (quantity) of accessed features, but also the correctness of those features (Thomas, Bulevich, & Dubois, 2011). The present study examined the conditions under which the correctness of features would influence FOK judgment magnitude. We hypothesized that accuracy of retrieved features would influence FOK judgments, but only in situations where semantically meaningful information was accessible. In three experiments, we manipulated accessibility of semantic information. In all experiments, the quantity, or amount of retrieved partial information had a greater impact on FOK judgments than the accuracy of that information. However, in situations where semantic information was accessible, accuracy of retrieved semantic features also influenced FOK judgment magnitude, and later recognition.

Benefits of immediate repetition versus long study presentation on memory in amnesia

OBJECTIVE

This study aimed to resolve discrepant findings in the literature regarding the effects of massed repetition and a single long study presentation on memory in amnesia.

METHOD

Experiment 1 assessed recognition memory in 9 amnesic patients and 18 controls following presentation of a study list that contained items shown for a single short study presentation, a single long study presentation, and three massed repetitions. In Experiment 2, the same encoding conditions were presented in a blocked rather than intermixed format to all participants from Experiment 1.

RESULTS

In Experiment 1, control participants showed benefits associated with both types of extended exposure, and massed repetition was more beneficial than long study presentation, F(2, 34) = 14.03, p < .001, partial eta(2) = .45. In contrast, amnesic participants failed to show benefits of either type of extended exposure, F < 1. In Experiment 2, both groups benefited from repetition, but did so in different ways, F(2, 50) = 4.80, p = .012, partial eta(2) = .16. Amnesic patients showed significant and equivalent benefit associated with both types of extended exposure, F(2, 16) = 5.58, p = .015, partial eta(2) = .41, but control participants again benefited more from massed repetition than from long study presentation, F(2, 34) = 23.74, p < .001, partial eta(2) = .58.

CONCLUSIONS

The findings suggest that previous inconsistencies in the literature were due to procedural differences across studies. We discuss group differences in terms of the mechanisms by which both forms of extended exposure facilitate performance in each group.

Metacognition in schizophrenia: processes underlying patients' reflections on their own episodic memory

BACKGROUND

The aim of the study was to explore the processes underlying schizophrenia patients' reflections on their own memory. Cognitive deficits and insight problems are considered core symptoms of schizophrenia. Even when people fail to recall a solicited target, they can provide feeling of knowing (FOK) judgments that reflect their ability to judge the accessibility of the target in memory. The metamemory approach allows for direct and experimental quantification of the correspondence between the subjective judgments and the objective measures of memory performance. According to the accessibility hypothesis, FOK evaluations rely on the accessibility of partial and/or contextual information relevant to the memory target.

METHODS

The accessibility of partial information relating to a memory target was investigated in 21 patients and 21 healthy comparison subjects matched for age, gender, and level of education. The material to be learned consisted of four-letter nonsense tetragrams, with each letter providing partial information about the four-letter target.

RESULTS

The results show that despite memory recall (p < .01) and recognition impairments (p = .02) and lower FOK ratings (p < .05), patients' metamemory judgments increased linearly with the amount of partial information recalled (from one letter to four letters, p < .01). The products of memory retrieval were predictive of both their FOK judgments and their subsequent memory performance.

CONCLUSIONS

Schizophrenia patients are as capable as comparison subjects of relying on the products of memory retrieval to monitor accurately their awareness of what they do or do not know. The finding may be of interest for cognitive remediation.

Learners' choices and beliefs about self-testing

Students have to make scores of practical decisions when they study. We investigated the effectiveness of, and beliefs underlying, one such practical decision: the decision to test oneself while studying. Using a flashcards-like procedure, participants studied lists of word pairs. On the second of two study trials, participants either saw the entire pair again (pair mode) or saw the cue and attempted to generate the target (test mode). Participants were asked either to rate the effectiveness of each study mode (Experiment 1) or to choose between the two modes (Experiment 2). The results demonstrated a mismatch between metacognitive beliefs and study choices: Participants (incorrectly) judged that the pair mode resulted in the most learning, but chose the test mode most frequently. A post-experimental questionnaire suggested that self-testing was motivated by a desire to diagnose learning rather than a desire to improve learning.

Rehearsal strategy use in Alzheimer's disease

Memory strategy usage and awareness of memory performance are both crucial for memory rehabilitation. We explored Alzheimer's patients' ability to apply and control learning strategies and also their ability to predict the effect of these strategies on subsequent performance. In a rehearsal condition, participants were explicitly asked to overtly rehearse words and were given as long as they liked at study. In a control condition, participants read the words passively at a fixed presentation rate. In all groups, recall was superior in the rehearsal condition than in the reading condition. Alzheimer's patients showed different strategy usage. Overall, people with Alzheimer's disease spend longer studying to-be-remembered words under unpaced conditions, but they do not use this time to rehearse to the same extent as controls. We hypothesize that this failure to rehearse could be based on the inability to use effortful executive mechanisms involved during study.

Objective metamemory testing captures awareness of deficit in Alzheimer's disease

For reasons that remain unknown, there is marked inter-person variability in awareness of episodic memory loss in patients with Alzheimer's disease (AD). Existing research designs, primarily subjective in nature, have been at a relative disadvantage for evaluating disordered metamemory and its relation to the clinical and neuropathological heterogeneity of AD, as well as its prognosis for various disease outcomes. The current study sought to establish an objective means of evaluating metamemory in AD by modifying traditional metacognitive paradigms in which participants are asked to make predictions regarding their own memory performance. Variables derived from this measure were analyzed in relation to clinically rated awareness for memory loss. As predicted, a range of awareness levels existed across patients with mild to moderate AD (n=24) and clinical ratings of awareness (CRA) were significantly associated with verbal episodic memory monitoring (r = .46, p = .03). Further, patients who were rated as aware of their memory loss remained well calibrated over the course of the task whereas those rated as relatively unaware grew over-confident in their predictions [F (1, 33) = 4.19, p = .02]. Findings suggest that over-confidence may be related to impaired online error recognition and compromised use of metamemory strategies such as the Memory for Past Test (MPT) heuristic. Importantly, clinically rated awareness did not vary as a function of demographic variables, global cognition, or verbal memory. However, participants characterized as relatively unaware were impaired on a nonverbal memory task as compared to aware participants [F (1, 20) = 6.98, p = .02]. The current study provides preliminary support for the use of a recognition-based verbal episodic memory monitoring task as a quantitative measure of awareness for memory loss in AD, and offers insight into the manner in which metamemory breaks down. Discrepancies in nonverbal memory across the two awareness groups provide preliminary support for the idea that metamemory variability in AD may be related to the neuroanatomic presentation of the disease, with disordered awareness potentially reflective of a critical level of right hemisphere involvement.

Preserved memory monitoring but impaired memory control during episodic encoding in patients with schizophrenia

Metamemory awareness refers to the ability to monitor and control how well information is processed depending on the loads and needs of the task at hand. There is some evidence that metamemory functions are impaired in schizophrenia at the time of memory retrieval. This study investigated whether patients with schizophrenia exhibit metamemory abnormalities during the encoding of new information. The frequency of item presentation was varied. Both memory control and memory monitoring were assessed using study-time allocation and Judgments of Learning (JOL), respectively. Repeated items were recalled better by both groups, but memory performance was lower in patients than controls. Patients' behavior patterns were abnormal in terms of the study-time allocated for each item according to presentation frequency. Patients' JOLs were lower than those of controls but remained sensitive to item repetition. Patients' predictive values on memory accuracy were no different to those measured in controls. In addition, none of the patients reported using efficient strategies to help memorize target items. The results show a dissociation between memory control, which was impaired, and memory monitoring, which was spared, in patients with schizophrenia during encoding of new information.

Study efficacy and the region of proximal learning framework

One of the most important reasons to investigate human metacognition is its role in directing how people study. However, limited evidence exists that metacognitively guided study benefits learning. Three experiments are presented that provide evidence for this link. In Experiment 1, participants' learning was enhanced when they were allowed to control what they studied. Experiments 2a-d replicated this finding and showed contributions of self-regulated study to learning. Experiments 3a and 3b showed that, when forced to choose among items they did not know, participants chose the easiest items and benefited from doing so, providing evidence for the link between metacognitive monitoring/control and learning, and supporting the region of proximal learning model of study-time allocation.

Are people with mild cognitive impairment aware of the benefits of errorless learning?

Mild cognitive impairment (MCI) has been described as a memory deficit in the absence of other cognitive dysfunction. It can be thought of as a pre-clinical dementia. Memory impairment in this group is not as severe as in early dementia and thus learning is still possible. We were interested to see if errorless learning, a widely used rehabilitation technique, was of benefit to people with MCI. Since it has been shown that successful rehabilitation is somewhat contingent on awareness of function, we were also interested to see if people with MCI were aware of the benefits of errorless learning. The present study employed an errorless learning procedure on 16 people with MCI and 16 older adult controls to learn two lists of 10 words in errorless and errorful learning conditions. We adopted a metacognitive approach measuring people's memory monitoring through judgements of learning (JOLs) a prediction of future memory performance. The results revealed errorless learning is an effective memory rehabilitation tool for people with MCI, with significant increases in recall performance for both groups relative to errorful learning. Most interestingly participants were aware of the benefits of errorless learning in their JOLs. MCI participants and controls both had significantly higher JOLs for words studied under errorless learning conditions. The learning performance in MCI and theories of metacognitive awareness are discussed.

Metacognitive theory and assessment in dementia: do we recognize our areas of weakness?

Anosognosia, disordered awareness of cognitive and behavioral deficits, is a striking and common symptom of Alzheimer's disease (AD), yet its etiology, clinical correlates, and prognostic value are unclear. Historically, disordered awareness has been a conceptually challenging phenomenon, evidenced by the numerous and diverse theories that aim to explain the manner in which this syndrome arises. We review many of these theories, focusing on the neuroanatomic substrates of awareness, and highlighting the potential roles of critical regions such as the right prefrontal and parietal cortices in enabling self-awareness. We then address methodological limitations such as use of subjective measurement tools that likely contribute to the conceptual ambiguity surrounding anosognosia. We argue that metacognitive techniques used in healthy adults, such as the Feeling of Knowing task, offer models for dissecting awareness into clear and identifiable cognitive components in patients with AD. We critique several studies that have pioneered such tasks in AD, and offer guidelines for future implementation of such methods. A final goal of this review is to advocate for a multidimensional approach to studying metacognitive skills that will facilitate the objective investigation of deficit awareness as it relates to a variety of disease variables such as prognosis, neuropsychological profile, neuropathological distribution, psychiatric symptoms, and clinical course.

Awareness in dementia: A review of assessment methods and measures

A comprehensive range of literature on awareness in dementia published in peer-reviewed journals during the last 15 years was reviewed with the aim of extracting details of the methods and measurement instruments adopted for the purposes of assessing awareness. Assessment approaches fell into five categories: clinician rating methods, questionnaire-based methods, performance-based methods, phenomenological methods, and multidimensional or combined methods. Ranges of objects of awareness assessment were identified both within and across domains. Strengths and limitations of methods in each category were identified. Reasons for the inconclusive findings from research using the methods described here were considered, and suggestions for future directions were made.

Specific effects of an amnesic drug: effect of lorazepam on study time allocation and on judgment of learning

We investigated the effects of lorazepam, a benzodiazepine, on the allocation of study time, memory, and judgment of learning, in a cognitive task where the repetition of word presentation was manipulated. The aim was to assess whether lorazepam would affect the learning processes and/or whether the participants would be aware of the amnesic difficulty. A total of 30 healthy volunteers participated in the study, 15 of whom received a capsule containing the lorazepam drug (0.038 mg/kg) and 15 a placebo capsule. First, the accuracy of delayed judgments of learning (JOL) was measured in both groups. For the JOL ratings, results showed that all the participants benefited from word repetition. Although the overall performance was lower in the lorazepam than in the placebo group, the accuracy of the JOL ratings was preserved by the drug. Second, all the participants benefited from the repetition of learning, although the performances of the lorazepam-treated subjects remained lower than those of the placebo participants. The repetition of learning had an effect on JOL in both groups. Finally, the time spent learning each (allocation study time) pair of words was measured. For the placebo group, results revealed that study time decreased significantly with the frequency of presentation. For the lorazepam group, no effect of presentation frequency was found. Overall, our findings suggest that the lorazepam drug has a differential effect on the monitoring and the control processes involved in a learning task. The implications of these findings are discussed within the theoretical framework of metacognition.

Metacognition and False Recognition in Alzheimer's Disease: Further Exploration of the Distinctiveness Heuristic

The distinctiveness heuristic is a response mode in which participants expect to remember vivid details of an experience and make recognition decisions on the basis of this metacognitive expectation. The authors examined whether the distinctiveness heuristic could be engaged to reduce false recognition in a repetition-lag paradigm in patients with Alzheimer's disease (AD). Patients with AD were able to use the distinctiveness heuristic--though not selectively--and thus they showed reduction of both true and false recognition. The authors suggest that patients with AD can engage in decision strategies on the basis of the metacognitive expectation associated with use of the distinctiveness heuristic, but the patients' episodic memory impairment limits both the scope and effectiveness of such strategies.

Encoding of novel picture pairs activates the perirhinal cortex: an fMRI study

It is well established in nonhuman primates that the medial temporal lobe (MTL) structures, the hippocampus and the entorhinal and perirhinal cortices, are necessary for declarative memory encoding. In humans, the neuropathological and neuropsychological changes in early Alzheimer's disease (AD) further support a role for the rhinal cortex in the consolidation of new events into long-term memory. Little is known, however, regarding the function of the rhinal cortex in humans in vivo. To examine the participation of the interconnected MTL structures as well as the whole-brain network of activated brain areas in visual associative long-term memory, functional magnetic resonance imaging (fMRI) was used to determine the brain regions that are activated during encoding and retrieval of paired pictures in 12 young control subjects. The most striking finding in the MTL activation pattern was the consistent activation of the perirhinal cortex in the encoding-baseline and encoding-retrieval comparisons with a strict statistical threshold (P < 0.00001). In contrast, no perirhinal cortex activation was detected in the retrieval-baseline or retrieval-encoding comparisons even with a low statistical threshold (P < 0.05). The location of the perirhinal activation area was in the transentorhinal part of the perirhinal cortex, in the medial bank of the collateral sulcus. The hippocampus and the more posterior parahippocampal gyrus were activated in both encoding and retrieval conditions. During the encoding processing, MTL activations were more consistent and the hippocampal activation area located more anteriorly than during retrieval. The frontal, parietal, temporal, and occipital association cortices were also activated in the encoding-baseline and retrieval-baseline comparisons. The data suggest that encoding, but not retrieval, of novel picture pairs activates the perirhinal cortex. To our knowledge, this is the first fMRI study reporting encoding activation in this transentorhinal part of the perirhinal cortex, the site of the very earliest neuropathological changes in AD.

Effects of Alzheimer's disease on the recognition of novel versus familiar words: neuropsychological and clinico-metabolic data

This study explored recognition memory performance for novel versus familiar words in Alzheimer's disease (AD) patients and normal controls (NCs), using an adaptation of E. Tulving and N. Kroll's (1995) procedure. Results showed that both groups exhibited more hits and more false alarms for familiar than for novel words. The groups did not differ in the recognition of familiar words, reflecting preserved familiarity processes in AD. However, AD patients made more false alarms than NCs in the recognition of novel words, reflecting impairment of recollection processes in AD. A positron emission tomography analysis of clinico-metabolic correlations in AD patients showed a correlation between recognition of novel words and right hippocampal activity, whereas recognition of familiar words was more related to metabolic activity in the left posterior orbitofrontal cortex.

Local-global processing in Alzheimer's disease: an examination of interference, inhibition and priming

Impairments of memory, praxis, gnosis, language and executive functioning are well documented in Alzheimer's disease (AD). Functions, such as attention, however, have only recently been systematically investigated. We used Navon-type stimuli (large "global" digits composed of smaller "local" digits) to assess 12 AD participants' plus age-matched controls' ability to focus and alter the scale of their spatial attention. In the first experiment, participants responded to either the global or local characters within a block, ignoring characters at the other spatial scale. Healthy young adults (n=12) demonstrated the normal 'global precedence' effect on this task. In contrast, participants with AD and their age-matched controls were significantly faster on the local task than on the global task, suggesting in these groups a 'local precedence' effect. This consisted of both a local advantage and a local-on-global interference effect. In a second experiment, participants searched for designated targets which occurred unpredictably at either the local or global spatial scale. Participants with AD were significantly slower and more error-prone than older controls. In addition, participants with AD showed a greater cost in reaction time (RT) when required to switch spatial scales on consecutive trials, compared to no switch responses at the same spatial scale on consecutive trials. Thus, AD may impair the ability to process global figures, due perhaps to involvement of posterior parietal areas. Further, participants with AD were poor at inhibiting irrelevant stimuli and at inhibiting attentional allocation to an irrelevant spatial scale, which may relate to prefrontal pathology.

Evidence for intact memory monitoring in Alzheimer's disease: metamemory sensitivity at encoding

Previous research claiming that there is a metamemory deficit in Alzheimer's Disease (AD) has been based on paradigms in which metamemory judgements are compared with performance. These methods confound predictive accuracy with very poor memory performance. In the experiments presented here this confound is removed by focusing on the sensitivity of metamemory judgements to item differences at encoding, rather than on predictive accuracy. In Experiment 1 participants studied words of high or low recallability, and either made judgements of learning (JOLs) or declared recall readiness. It was found that the AD group discriminate between items in their metamemory judgements to the same extent as age matched controls. Both groups rated the highly recallable words as being more likely to be recalled, and allocated more study time to low recallability items. In Experiment 2 participants were asked to rank the likelihood of recall of items that varied in objective recallability. Once again, AD patients were as sensitive to objective differences in stimuli as controls. Therefore, using measures based on sensitivity to item differences, we find no evidence of a metamemory deficit at encoding in AD. The findings are discussed in terms of metamemory functioning in AD, and its relationship with memory performance.