Further Exploration of Controlled and Automatic Memory Processes in Early Alzheimer's Disease

Subjectively-defined optimal/non-optimal time of day modulates controlled but not automatic retrieval processes in verbal memory

Performance for controlled, resource-demanding retrieval in episodic memory has been consistently found to be better at an optimal compared with non-optimal time of the day, evidencing a synchrony effect. However, performance in memory tasks in which retrieval is mostly based on automatic processes was inconclusively found either to be better at a non-optimal time of day or independent of synchrony effects. A caveat in most prior studies is that optimal/non-optimal time of day is based on morningness-eveningness composite scores derived from chronotype questionnaires, which might not efficiently predict subjectively-defined cognitive efficiency periods. An additional caveat is that separate tasks are used to assess explicit and implicit retrieval in verbal memory. Indeed, no task is process-pure, and both controlled and automatic retrieval processes may potentially contribute to retrieval scores in different types of memory tasks. In the present study, we investigated the impact of individually defined subjective optimal/non-optimal time of day on verbal memory retrieval, using an adaptation of the Process-Dissociation Procedure that allows estimating the respective contributions of automatic and controlled memory retrieval processes within the same memory task. Our results disclose a higher involvement of controlled processes at subjectively optimal compared with non-optimal time of day, but no differences for automatic processes. Synchrony effects and subjectively-defined peaks and troughs of performance for controlled components of memory retrieval should be considered in the evaluation of episodic memory.

Negative Bias in the Perception and Memory of Emotional Information in Alzheimer Disease

BACKGROUND

There is some controversy about the ability of patients with Alzheimer disease (AD) to experience and remember emotional stimuli. This study aims to assess the emotional experience of patients with AD and the existence of emotional enhancement of memory. We also investigated the influence of affective state on these processes.

METHODS

Sixty pictures from the International Affective Picture System were administered to 106 participants (72 patients with AD and 54 controls). Participants performed immediate free recall and recognition tasks. Positive and Negative Affect Schedule was used to assess the participants' current affect.

RESULTS

Patients identified the valence of unpleasant pictures better than of others pictures and experienced them as more arousing. Patients and controls recalled and recognized higher number of emotional pictures than of neutral ones. Patients discriminated better the unpleasant pictures. A mood congruent effect was observed on emotional experience but not on memory. Positive affect was associated with better immediate recall and with a more liberal response bias.

CONCLUSION

Patients with AD can identify the emotional content of the stimuli, especially of the unpleasant ones, and the emotional enhancement of memory is preserved. Affective state does not explain the differences in the processing and memory of emotional items between patients and controls.

Repetition-lag training to improve recollection memory in older people with amnestic mild cognitive impairment. A randomized controlled trial

The results of a randomized controlled trial of repetition-lag training in older adults with amnestic mild cognitive impairment (aMCI) are reported. A modified repetition-lag training procedure with extended encoding time and strategy choice was used. The training required discriminating studied words from non-studied lures that were repeated at varying intervals during the test phase. Participants were assessed pre/post using untrained measures of cognition and self-report questionnaires. Primary outcome measures were recall of unrelated word pairs both immediately following presentation and following a delay. Secondary outcomes were a measure of attention, cognitive flexibility, and visual working memory. Participants were also asked to report on the frequency of cognitive failures and mood before and after training. Participants (N = 31) were randomized into either the treatment or a no-contact control group and attended the clinic twice per week over a four week period. Twenty-four participants completed the study (twelve in each group). Results indicated that the training group improved at recalling unrelated word pairs after a delay. There were no significant effects of training on other outcomes, self-reported cognitive failures or mood. The results are discussed along with suggestions for future research.

Development of the ubiquitous spaced retrieval-based memory advancement and rehabilitation training program

OBJECTIVE

The Ubiquitous Spaced Retrieval-based Memory Advancement and Rehabilitation Training (USMART) program was developed by transforming the spaced retrieval-based memory training which consisted of 24 face-to-face sessions into a self-administered program with an iPAD app. The objective of this study was to evaluate the feasibility and efficacy of USMART in elderly subjects with mild cognitive impairment (MCI).

METHODS

Feasibility was evaluated by checking the satisfaction of the participants with a 5-point Likert scale. The efficacy of the program on cognitive functions was evaluated by the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Assessment Battery before and after USMART.

RESULTS

Among the 10 participants, 7 completed both pre- and post-USMART assessments. The overall satisfaction score was 8.0±1.0 out of 10. The mean Word List Memory Test (WLMT) scores significantly increased after USMART training after adjusting for age, educational levels, baseline Mini-Mental Status Examination scores, and the number of training sessions (pre-USMART, 16.0±4.1; post-USMART, 17.9±4.5; p=0.014, RM-ANOVA). The magnitude of the improvements in the WLMT scores significantly correlated with the number of training sessions during 4 weeks (r=0.793; p=0.033).

CONCLUSION

USMART was effective in improving memory and was well tolerated by most participants with MCI, suggesting that it may be a convenient and cost-effective alternative for the cognitive rehabilitation of elderly subjects with cognitive impairments. Further studies with large numbers of participants are necessary to examine the relationship between the number of training sessions and the improvements in memory function.

Cognitive and neuroimaging evidence of impaired interaction between self and memory in Alzheimer's disease

In human cognition, self and memory processes strongly interact, as evidenced by the memory advantage for self-referential materials [Self-Reference Effect (SRE) and Self-Reference Recollection Effect (SRRE)]. The current study examined this interaction at the behavioural level and its neural correlates in patients with Alzheimer's disease (AD). Healthy older controls (HC) and AD patients performed trait-adjectives judgements either for self-relevance or for other-relevance (encoding phase). In a first experiment, the encoding and subsequent yes-no recognition phases were administrated in a Magnetic Resonance Imaging (MRI) scanner. Brain activation as measured by functional MRI (fMRI) was examined during self-relevance judgements and anatomical images were used to search for correlation between the memory advantage for self-related items and grey matter density (GMD). In a second experiment, participants described the retrieval experience that had driven their recognition decisions (familiarity vs recollective experience). The behavioural results revealed that the SRE and SRRE were impaired in AD patients compared to HC participants. Furthermore, verbal reports revealed that the retrieval of self-related information was preferentially associated with the retrieval of contextual details, such as source memory in the HC participants, but less so in the AD patients. Our imaging findings revealed that both groups activated the medial prefrontal cortex (MPFC) at encoding during self-relevance judgements. However, the variable and limited memory advantage for self-related information was associated with GMD in the lateral prefrontal cortex in the AD patients, a region supporting high-order processes linking self and memory. These findings suggest that even if AD patients engage MPFC during self-referential judgements, the retrieval of self-related memories is qualitatively and quantitatively impaired in relation with altered high-order processes in the lateral PFC.

Item familiarity and controlled associative retrieval in Alzheimer's disease: an fMRI study

Typical Alzheimer's disease (AD) is characterized by an impaired form of associative memory, recollection, that includes the controlled retrieval of associations. In contrast, familiarity-based memory for individual items may sometimes be preserved in the early stages of the disease. This is the first study that directly examines whole-brain regional activity during one core aspect of the recollection function: associative controlled episodic retrieval (CER), contrasted to item familiarity in AD patients. Cerebral activity related to associative CER and item familiarity in AD patients and healthy controls (HCs) was measured with functional magnetic resonance imaging during a word-pair recognition task to which the process dissociation procedure was applied. Some patients had null CER estimates (AD-), whereas others did show some CER abilities (AD+), although significantly less than HC. In contrast, familiarity estimates were equivalent in the three groups. In AD+, as in controls, associative CER activated the inferior precuneus/posterior cingulate cortex (PCC). When performing group comparisons, no region was found to be significantly more activated during CER in HC than AD+ and vice versa. However, during associative CER, functional connectivity between this region and the hippocampus, the inferior parietal and dorsolateral prefrontal cortex (DLPFC) was significantly higher in HC than in AD+. In all three groups, item familiarity was related to activation along the intraparietal sulcus (IPS). In conclusion, whereas the preserved automatic detection of an old item (without retrieval of accurate word association) is related to parietal activation centred on the IPS, the inferior precuneus/PCC supports associative CER ability in AD patients, as in HC. However, AD patients have deficient functional connectivity during associative CER, suggesting that the residual recollection function in these patients might be impoverished by the lack of some recollection-related aspects such as autonoetic quality, episodic details and verification.

Perceptual and motor inhibitory abilities in normal aging and Alzheimer disease (AD): a preliminary study

Deficits in inhibitory abilities are frequently observed in normal aging and AD. However, few studies have explored the generality of these deficits in a single group of participants. A battery of tasks assessing perceptual and motor inhibitory functioning was administered to young and older healthy participants (Study 1), as well as to mild Alzheimer patients (Study 2). Results did not agree with a selective impairment of motor or perceptual inhibition in either AD or normal aging but rather suggest that a decrease in cognitive resources available in working memory could explain inhibitory performance both in normal aging and AD.

The utility of placing recollection in opposition to familiarity in early discrimination of healthy aging and very mild dementia of the Alzheimer's type

This study explored the ability to control familiarity-based information in a memory exclusion paradigm in healthy young, older adults, and early stage DAT individuals. We compared the predictive power of memory exclusion performance to standard psychometric performance in discriminating between aging and the earliest stage of DAT and between APOe4-present and APOe4-absent genotype in healthy control individuals. Participants responded "yes" to words that were previously semantically encoded, and "no" to words that were previously read aloud and to new words. The number of targets and distractors on the read "distractor" list was manipulated to investigate the degree to which aging and DAT influence the ability to recollect in the face of distractor familiarity due to repetition. Memory exclusion performance was better for healthy older adults than very mild DAT individuals and better for healthy control individuals with APOe4 allele than those without APOe4 allele even after controlling for standard psychometric performance. Discussion focuses on the importance of attentional control systems in memory retrieval and the utility of the opposition paradigm for discriminating healthy versus pathological aging.

Perspective taking to assess self-personality: what's modified in Alzheimer's disease?

Personality changes are frequently described by caregivers of patients with Alzheimer's disease, while they are less often reported by the patients. This relative anosognosia of Alzheimer disease (AD) patients for personality changes might be related to impaired self-judgment and to decreased ability to understand their caregiver's perspective. To investigate this issue, we explored the cerebral correlates of self-assessment and perspective taking in patients with mild AD, elderly and young volunteers. All subjects assessed relevance of personality traits adjectives for self and a relative, taking either their own or their relative's perspective, during a functional imaging experiment. The comparison of subject's and relative's answers provided congruency scores used to assess self-judgment and perspective taking performance. The self-judgment "accuracy" score was diminished in AD, and when patients assessed adjectives for self-relevance, they predominantly activated bilateral intraparietal sulci (IPS). Previous studies associated IPS activation with familiarity judgment, which AD patients would use more than recollection when retrieving information to assess self-personality. When taking a third-person perspective, patients activated prefrontal regions (similarly to young volunteers), while elderly controls recruited visual associative areas (also activated by young volunteers). This suggests that mild AD patients relied more on reasoning processes than on visual imagery of autobiographical memories to take their relative's perspective. This strategy may help AD patients to cope with episodic memory impairment even if it does not prevent them from making some mind-reading errors.

Automatic memory processes in normal ageing and Alzheimer's disease

This study examined the contribution of automatic and controlled uses of memory to stem completion in young, middle-aged and older adults, and compared these data with a study involving patients with Alzheimer's disease (AD) who performed the same task (Hudson and Robertson, 2007). In an inclusion task participants aimed to complete three-letter word stems with a previously studied word, in an exclusion task the aim was to avoid using studied words to complete stems. Performances under inclusion and exclusion conditions were contrasted to obtain estimates of controlled and automatic memory processes using process-dissociation calculations (Jacoby, 1991). An age-related decline, evident from middle age was observed for the estimate of controlled processing, whereas the estimate of automatic processing remained invariant across the age groups. This pattern stands in contrast to what is observed in AD, where both controlled and automatic processes have been shown to be impaired. Therefore, the impairment in memory processing on stem completion that is found in AD is qualitatively different from that observed in normal ageing.

Functional imaging of cognition in Alzheimer's disease using positron emission tomography

Positron emission tomography in Alzheimer's disease (AD) demonstrates a metabolic decrease, predominantly in associative posterior cortices (comprising the posterior cingulate cortex), and also involving medial temporal structures and frontal regions at a lesser degree. The level of activity in this wide network is roughly correlated with dementia severity, but several confounds (such as age, education or subcortical ischemic lesions) may influence the brain-behaviour relationship. Univariate analyses allow one to segregate brain regions that are particularly closely related to specific neuropsychological performances. For example, a relationship was established between the activity in lateral associative cortices and semantic performance in AD. The role of semantic capacities (subserved by temporal or parietal regions) in episodic memory tasks was also emphasized. The residual activity in medial temporal structures was related to episodic memory abilities, as measured by free recall performance, cued recall ability and recognition accuracy. More generally, AD patients' performance on episodic memory tasks was correlated with the metabolism in several structures of Papez's circuit (including the medial temporal and posterior cingulate regions). Multivariate analyses should provide complementary information on impaired metabolic covariance in functional networks of brain regions and the consequences for AD patients' cognitive performance. More longitudinal studies are being conducted that should tell us more about the prognostic value of initial metabolic impairment and the neural correlates of progressive deterioration of cognitive performance in AD.

Two aspects of impaired consciousness in Alzheimer's disease

Alzheimer's disease (AD) is a degenerative dementia characterized by different aspects of impaired consciousness. For example, there is a deficit of controlled processes that require conscious processing of information. Such an impairment is indexed by decreased performances at controlled cognitive tasks, and it is related to reduced brain metabolic activity in a network of frontal, posterior associative, and limbic regions. Another aspect of impaired consciousness is that AD patients show variable levels of anosognosia concerning their cognitive deficits. A discrepancy score between patient's and caregiver's assessment of cognitive functions is one of the most frequently used measures of anosognosia. A high discrepancy score has been related to impaired activity in the superior frontal sulcus and the parietal cortex in AD. Anosognosia for cognitive deficits in AD could be partly explained by impaired metabolism in parts of networks subserving self-referential processes (e.g., the superior frontal sulcus) and perspective-taking (e.g., the temporoparietal junction). We hypothesize that these patients are impaired in the ability to see themselves with a third-person perspective (i.e., being able to see themselves as other people see them).