Impaired event memory and recollection in a case of developmental amnesia

Perirhinal cortex automatically tracks multiple types of familiarity regardless of task-relevance

Perirhinal cortex (PrC) has long been implicated in familiarity assessment for objects and corresponding concepts. However, extant studies have focused mainly on changes in familiarity induced by recent exposure in laboratory settings. There is an increasing appreciation of other types of familiarity signals, in particular graded familiarity accumulated throughout one's lifetime. In prior work (Duke et al., 2017, Cortex, 89, 61-70), PrC has been shown to track lifetime familiarity ratings when participants make related judgements. A theoretically important characteristic of familiarity is its proposed automaticity. Support for automaticity comes from a documented impact of recent stimulus exposure on behavioral performance, and on PrC signals, under conditions in which this exposure is not task relevant. In the current fMRI study, we tested whether PrC also tracks lifetime familiarity of object concepts automatically, and whether this type of familiarity influences behavior even when it is not task relevant. During scanning, neurotypical participants (N = 30, age range 18-40, 7 males) provided animacy judgements about concrete object concepts presented at differing frequencies in an initial study phase. In a subsequent test phase, they made graded judgements of recent or lifetime familiarity. Behavioral performance showed sensitivity to lifetime familiarity even when it was not relevant for the task at hand. Across five sets of fMRI analyses, we found that PrC consistently tracked recent and lifetime familiarity of object concepts regardless of the task performed. Critically, while several other temporal-lobe regions also showed isolated familiarity effects, none of them tracked familiarity with the same consistency. These findings demonstrate that PrC automatically tracks multiple types of familiarity. They support models that assign a broad role in the representation of information about object concepts to this structure.

Semantic memory before episodic memory: How memory research can inform knowledge and belief representations

Knowledge and belief attribution are discussed in the context of episodic and semantic memory theory and research, with reference to patient-lesion and developmental studies under naturalistic conditions. Consideration of how episodic and semantic memory relate to each other and intersect in the real world, including how they fail, can illuminate the approach to studying how people represent others' minds.

Getting better without memory

Does the tendency to adjust appraisals of ourselves in the past and future in order to maintain a favourable view of ourselves in the present require episodic memory? A developmental amnesic person with impaired episodic memory (HC) was compared with two groups of age-matched controls on tasks assessing the Big Five personality traits and social competence in relation to the past, present and future. Consistent with previous research, controls believed that their personality had changed more in the past 5 years than it will change in the next 5 years (i.e. the end-of-history illusion), and rated their present and future selves as more socially competent than their past selves (i.e. social improvement illusion), although this was moderated by self-esteem. Despite her lifelong episodic memory impairment, HC also showed these biases of temporal self-appraisal. Together, these findings do not support the theory that the temporal extension of the self-concept requires the ability to recollect richly detailed memories of the self in the past and future.

Social cognition in an adult epilepsy patient with developmental amnesia

Reports on social cognition in patients with developmental amnesia resulting from bilateral hippocampal lesions are rare, although the link between social cognition and temporal lobe structures is well established. We present the case of a 23-year-old male epilepsy patient, BM, with developmental amnesia due to perinatal cerebral hypoxia. The patient was examined with neuroimaging and neuropsychological methods and compared to IQ-matched patients with epilepsy to control for effects of epilepsy. In addition, we used a test battery that evaluates emotion recognition and theory of mind to study his social cognition abilities. Structural high-resolution magnetic resonance imaging showed bilateral hippocampal atrophy. The comparison to controls showed that, in addition to the well-documented memory disorders in developmental amnesia, BM showed remarkable deficits in 9 out of 17 social cognitive tasks assessing emotion recognition and theory of mind. In contrast, BM's performance on tasks of executive functions was largely preserved. The relevance of deficits in social cognition for patients with developmental amnesia is discussed.

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.

Late positive complex in event-related potentials tracks memory signals when they are decision relevant

The Late Positive Complex (LPC) is an Event-Related Potential (ERP) consistently observed in recognition-memory paradigms. In the present study, we investigated whether the LPC tracks the strength of multiple types of memory signals, and whether it does so in a decision dependent manner. For this purpose, we employed judgements of cumulative lifetime exposure to object concepts, and judgements of cumulative recent exposure (i.e., frequency judgements) in a study-test paradigm. A comparison of ERP signatures in relation to degree of prior exposure across the two memory tasks and the study phase revealed that the LPC tracks both types of memory signals, but only when they are relevant to the decision at hand. Another ERP component previously implicated in recognition memory, the FN400, showed a distinct pattern of activity across conditions that differed from the LPC; it tracked only recent exposure in a decision-dependent manner. Another similar ERP component typically linked to conceptual processing in past work, the N400, was sensitive to degree of recent and lifetime exposure, but it did not track them in a decision dependent manner. Finally, source localization analyses pointed to a potential source of the LPC in left ventral lateral parietal cortex, which also showed the decision-dependent effect. The current findings highlight the role of decision making in ERP markers of prior exposure in tasks other than those typically used in studies of recognition memory, and provides an initial link between the LPC and the previously suggested role of ventral lateral parietal cortex in memory judgements.

Measuring mental time travel: Is the hippocampus really critical for episodic memory and episodic foresight?

Mental time travel is an adaptive capacity that enables humans to engage in deliberate, prudent action on the basis of remembering past episodes (episodic memory) and simulating future scenarios (episodic foresight). This capacity has become a popular and rapidly growing topic of interdisciplinary research. Perhaps the most influential and frequently tested neuroscientific hypothesis in this domain is that the hippocampus is a hub in a critical neural network for mental time travel, support for which is now commonly assumed by most researchers in the area. In light of recent findings revealing limitations with existing measures of episodic foresight, we critically evaluate the available evidence for this hypothesis and find that it is inconclusive. We suggest that this is due in significant part to the exclusive and widespread reliance on noisy verbal measures and discuss this case as an example of a more general issue pertaining to the measurement of episodic foresight. Accordingly, we suggest that an essential focus of future research should concern the development of objective measures that capture capacity differences by requiring people to put foresight not just into words, but into action.

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.

Ameliorating Episodic Memory Deficits in a Young Adult With Developmental (Congenital) Amnesia

OBJECTIVES

Although the spacing effect has been investigated extensively in a variety of populations, few studies have focused on individuals with hippocampal amnesia and none, to our knowledge, have investigated differences in performance as a function of spacing schedule in these cases. In the current study, we investigated the benefit of expanding and equal-interval, compared to massed, spacing schedules in a developmental amnesic person, H.C., who shows congenitally based abnormal development of the hippocampal memory system.

METHODS

Given the possibility of plasticity and reorganization in the developing brain, we investigated whether H.C. would benefit more from an expanding versus equal-interval schedule using a continuous recognition paradigm, even though this task has been shown to recruit structures within the medial temporal lobe, including the hippocampus.

RESULTS

H.C. and matched controls both showed a clear spacing effect, although neither group benefited more from an equal-interval or expanding spacing schedule.

CONCLUSIONS

The results of the current study show that the spacing effect is an effective and clinically meaningful memory intervention technique that may be applied to clinical conditions known to affect hippocampal function and episodic memory early in life. (JINS, 2018, 24, 1003-1012).

Refining understanding of working memory buffers through the construct of binding: Evidence from a single case informs theory and clinical practise

Binding operations carried out in working memory enable the integration of information from different sources during online performance. While available evidence suggests that working memory may involve distinct binding functions, whether or not they all involve the episodic buffer as a cognitive substrate remains unclear. Similarly, knowledge about the neural underpinnings of working memory buffers is limited, more specifically regarding the involvement of medial temporal lobe structures. In the present study, we report on the case of patient KA, with developmental amnesia and selective damage to the whole hippocampal system. We found that KA was unable to hold shape-colours associations (relational binding) in working memory. In contrast, he could hold integrated coloured shapes (conjunctive binding) in two different tasks. Otherwise, and as expected, KA was impaired on three relational memory tasks thought to depend on the hippocampus that are widely used in the early detection of Alzheimer's disease. Our results emphasize a dissociation between two binding processes within working memory, suggesting that the visuo-spatial sketchpad could support conjunctive binding, and may rely upon a large cortical network including sub-hippocampal structures. By contrast, we found evidence for a selective impairment of relational binding in working memory when the hippocampal system is compromised, suggesting that the long-term memory deficit observed in amnesic patients may be related to impaired short-term relational binding at encoding. Finally, these findings may inform research on the early detection of Alzheimer's disease as the preservation of conjunctive binding in KA is in sharp contrast with the impaired performance demonstrated very early in this disease.

Semantic memory in developmental amnesia

•

Profile of patients with developmental amnesia and dissociations in cognitive memory.

•

Variables affecting semantic learning in developmental amnesia.

•

Differences between adult-onset versus early-onset amnesia.

Patients with developmental amnesia resulting from bilateral hippocampal atrophy associated with neonatal hypoxia-ischaemia typically show relatively preserved semantic memory and factual knowledge about the natural world despite severe impairments in episodic memory. Understanding the neural and mnemonic processes that enable this context-free semantic knowledge to be acquired throughout development without the support of the contextualised episodic memory system is a serious challenge. This review describes the clinical presentation of patients with developmental amnesia, contrasts its features with those reported for adult-onset hippocampal amnesia, and analyses the effects of variables that influence the learning of new semantic information.

What versus Where: Investigating how Autobiographical Memory Retrieval Differs when Accessed with Thematic versus Spatial Information

Autobiographical memory research has investigated how cueing distinct aspects of a past event can trigger different recollective experiences. This research has stimulated theories about how autobiographical knowledge is accessed and organized. Here, we test the idea that thematic information organizes multiple autobiographical events whereas spatial information organizes individual past episodes by investigating how retrieval guided by these two forms of information differs. We used a novel autobiographical fluency task in which participants accessed multiple memory exemplars to event theme and spatial (location) cues followed by a narrative description task in which they described the memories generated to these cues. Participants recalled significantly more memory exemplars to event theme than to spatial cues; however, spatial cues prompted faster access to past memories. Results from the narrative description task revealed that memories retrieved via event theme cues compared to spatial cues had a higher number of overall details, but those recalled to the spatial cues were recollected with a greater concentration on episodic details than those retrieved via event theme cues. These results provide evidence that thematic information organizes and integrates multiple memories whereas spatial information prompts the retrieval of specific episodic content from a past event.

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.

The relationship between eye movements and subsequent recognition: Evidence from individual differences and amnesia

There is consistent agreement regarding the positive relationship between cumulative eye movement sampling and subsequent recognition, but the role of the hippocampus in this sampling behavior is currently unknown. It is also unclear whether the eye movement repetition effect, i.e., fewer fixations to repeated, compared to novel, stimuli, depends on explicit recognition and/or an intact hippocampal system. We investigated the relationship between cumulative sampling, the eye movement repetition effect, subsequent memory, and the hippocampal system. Eye movements were monitored in a developmental amnesic case (H.C.), whose hippocampal system is compromised, and in a group of typically developing participants while they studied single faces across multiple blocks. The faces were studied from the same viewpoint or different viewpoints and were subsequently tested with the same or different viewpoint. Our previous work suggested that hippocampal representations support explicit recognition for information that changes viewpoint across repetitions (Olsen et al., 2015). Here, examination of eye movements during encoding indicated that greater cumulative sampling was associated with better memory among controls. Increased sampling, however, was not associated with better explicit memory in H.C., suggesting that increased sampling only improves memory when the hippocampal system is intact. The magnitude of the repetition effect was not correlated with cumulative sampling, nor was it related reliably to subsequent recognition. These findings indicate that eye movements collect information that can be used to strengthen memory representations that are later available for conscious remembering, whereas eye movement repetition effects reflect a processing change due to experience that does not necessarily reflect a memory representation that is available for conscious appraisal. Lastly, H.C. demonstrated a repetition effect for fixed viewpoint faces but not for variable viewpoint faces, which suggests that repetition effects are differentially supported by neocortical and hippocampal systems, depending upon the representational nature of the underlying memory trace.

Hippocampal and diencephalic pathology in developmental amnesia

Developmental amnesia (DA) is a selective episodic memory disorder associated with hypoxia-induced bilateral hippocampal atrophy of early onset. Despite the systemic impact of hypoxia-ischaemia, the resulting brain damage was previously reported to be largely limited to the hippocampus. However, the thalamus and the mammillary bodies are parts of the hippocampal-diencephalic network and are therefore also at risk of injury following hypoxic-ischaemic events. Here, we report a neuroimaging investigation of diencephalic damage in a group of 18 patients with DA (age range 11-35 years), and an equal number of controls. Importantly, we uncovered a marked degree of atrophy in the mammillary bodies in two thirds of our patients. In addition, as a group, patients had mildly reduced thalamic volumes. The size of the anterior-mid thalamic (AMT) segment was correlated with patients' visual memory performance. Thus, in addition to the hippocampus, the diencephalic structures also appear to play a role in the patients' memory deficit.

Using fMRI to understand event construction in developmental amnesia

Recently, neuroimaging and patient-lesion methods have been combined to explain anomalies such as patients' intact performance on tasks on which they would be predicted to perform poorly. In some cases, preserved performance has been attributed to activation of residual tissue within the damaged region. However, activation of remnant tissue can also occur in relation to impaired performance and, thus, may not necessarily correspond to successful recruitment. To constrain these neuroimaging interpretations, what is needed is a paradigm with closely matched conditions that yields intact and impaired performance in the same patient. We investigated this in H.C., an amnesic person with congenital abnormalities of the hippocampus and its connections, who was scanned during remembering and imagining, abilities known to depend on the hippocampus. Specifically, we examined whether differences in activation and/or functional connectivity would explain H.C.'s compromised ability to construct events relating to herself in autobiographical memory (SELF condition) and events relating to personally familiar others (FAMILIAR condition) versus her intact ability to construct events relating to unknown others (UNFAMILIAR condition). Despite behavioral dissociations in H.C., the pattern of activation and functional connectivity supporting her performance was strikingly similar to that of controls across conditions. Most notably, like controls, H.C. showed robust hippocampal activation and functional connectivity to the hippocampus, both when her performance was intact and impaired. Across all conditions, H.C. activated several extra-hippocampal regions to a greater extent than did controls, and modest differences were observed in functional connectivity between extra-hippocampal regions. Taken together, these findings urge caution when drawing conclusions about the functional integrity of a structurally compromised brain region even when it is activated and/or co-activated with other regions.

The role of relational binding in item memory: evidence from face recognition in a case of developmental amnesia

Current theories state that the hippocampus is responsible for the formation of memory representations regarding relations, whereas extrahippocampal cortical regions support representations for single items. However, findings of impaired item memory in hippocampal amnesics suggest a more nuanced role for the hippocampus in item memory. The hippocampus may be necessary when the item elements need to be bound within and across episodes to form a lasting representation that can be used flexibly. The current investigation was designed to test this hypothesis in face recognition. H.C., an individual who developed with a compromised hippocampal system, and control participants incidentally studied individual faces that either varied in presentation viewpoint across study repetitions or remained in a fixed viewpoint across the study repetitions. Eye movements were recorded during encoding and participants then completed a surprise recognition memory test. H.C. demonstrated altered face viewing during encoding. Although the overall number of fixations made by H.C. was not significantly different from that of controls, the distribution of her viewing was primarily directed to the eye region. Critically, H.C. was significantly impaired in her ability to subsequently recognize faces studied from variable viewpoints, but demonstrated spared performance in recognizing faces she encoded from a fixed viewpoint, implicating a relationship between eye movement behavior in the service of a hippocampal binding function. These findings suggest that a compromised hippocampal system disrupts the ability to bind item features within and across study repetitions, ultimately disrupting recognition when it requires access to flexible relational representations.

The mammillary bodies and memory: more than a hippocampal relay

Although the mammillary bodies were one of the first neural structures to be implicated in memory, it has long been assumed that their main function was to act primarily as a hippocampal relay, passing information on to the anterior thalamic nuclei and from there to the cingulate cortex. This view not only afforded the mammillary bodies no independent role in memory, it also neglected the potential significance of other, nonhippocampal, inputs to the mammillary bodies. Recent advances have transformed the picture, revealing that projections from the tegmental nuclei of Gudden, and not the hippocampal formation, are critical for sustaining mammillary body function. By uncovering a role for the mammillary bodies that is independent of its subicular inputs, this work signals the need to consider a wider network of structures that form the neural bases of episodic memory.

Patterns of preserved and impaired spatial memory in a case of developmental amnesia

The hippocampus is believed to have evolved to support allocentric spatial representations of environments as well as the details of personal episodes that occur within them, whereas other brain structures are believed to support complementary egocentric spatial representations. Studies of patients with adult-onset lesions lend support to these distinctions for newly encountered places but suggest that with time and/or experience, schematic aspects of environments can exist independent of the hippocampus. Less clear is the quality of spatial memories acquired in individuals with impaired episodic memory in the context of a hippocampal system that did not develop normally. Here we describe a detailed investigation of the integrity of spatial representations of environments navigated repeatedly over many years in the rare case of H.C., a person with congenital absence of the mammillary bodies and abnormal hippocampal and fornix development. H.C. and controls who had extensive experience navigating the residential and downtown areas known to H.C. were tested on mental navigation tasks that assess the identity, location, and spatial relations among landmarks, and the ability to represent routes. H.C. was able to represent distances and directions between familiar landmarks and provide accurate, though inefficient, route descriptions. However, difficulties producing detailed spatial features on maps and accurately ordering more than two landmarks that are in close proximity to one another along a route suggest a spatial representation that includes only coarse, schematic information that lacks coherence and that cannot be used flexibly. This pattern of performance is considered in the context of other areas of preservation and impairment exhibited by H.C. and suggests that the allocentric-egocentric dichotomy with respect to hippocampal and extended hippocampal system function may need to be reconsidered.

Recollection, not familiarity, decreases in healthy ageing: Converging evidence from four estimation methods

Although it is generally accepted that ageing is associated with recollection impairments, there is considerable disagreement surrounding how healthy ageing influences familiarity-based recognition. One factor that might contribute to the mixed findings regarding age differences in familiarity is the estimation method used to quantify the two mnemonic processes. Here, this issue is examined by having a group of older adults (N = 39) between 40 and 81 years of age complete remember/know (RK), receiver-operating characteristic (ROC) and process dissociation (PD) recognition tests. Estimates of recollection, but not familiarity, showed a significant negative correlation with chronological age. Inconsistent with previous findings, the estimation method did not moderate the relationship between age and estimates of recollection and familiarity. In a final analysis, recollection and familiarity were estimated as latent factors in a confirmatory factor analysis that modelled the covariance between measures of free recall and recognition, and the results converged with the results from the RK, PD and ROC tasks. These results are consistent with the hypothesis that episodic memory declines in older adults are primary driven by recollection deficits, and also suggest that the estimation method plays little to no role in age-related decreases in familiarity.

Congenital absence of the mammillary bodies: a novel finding in a well-studied case of developmental amnesia

Individuals with developmental amnesia experience compromised development of episodic memory for details of personal life events, believed to relate to changes to the hippocampus after birth. Here we report the very rare discovery of aplasia of the mammillary bodies, hypogenesis of the fornix, and abnormal hippocampal shape and orientation in H.C., a well-documented case of selectively compromised episodic memory development who is the subject of numerous published empirical articles. These anatomical abnormalities are highly suggestive of disrupted extended hippocampal system development very early in gestation, despite an original diagnosis of developmental amnesia and assumed perinatal hypoxia. These findings provide a unique window into the normal function of the mammillary bodies, fornices, and related anterior nuclei of the thalamus bilaterally. The results also encourage re-examination of the pathological basis of developmental amnesia in other cases reported in the literature.

Subjective experience of episodic memory and metacognition: a neurodevelopmental approach

Episodic retrieval is characterized by the subjective experience of remembering. This experience enables the co-ordination of memory retrieval processes and can be acted on metacognitively. In successful retrieval, the feeling of remembering may be accompanied by recall of important contextual information. On the other hand, when people fail (or struggle) to retrieve information, other feelings, thoughts, and information may come to mind. In this review, we examine the subjective and metacognitive basis of episodic memory function from a neurodevelopmental perspective, looking at recollection paradigms (such as source memory, and the report of recollective experience) and metacognitive paradigms such as the feeling of knowing). We start by considering healthy development, and provide a brief review of the development of episodic memory, with a particular focus on the ability of children to report first-person experiences of remembering. We then consider neurodevelopmental disorders (NDDs) such as amnesia acquired in infancy, autism, Williams syndrome, Down syndrome, or 22q11.2 deletion syndrome. This review shows that different episodic processes develop at different rates, and that across a broad set of different NDDs there are various types of episodic memory impairment, each with possibly a different character. This literature is in agreement with the idea that episodic memory is a multifaceted process.

Autobiographical memory in children with temporal lobe epilepsy

Autobiographical memory involves the recall of personal facts (semantic memory) and re-experiencing of specific personal events (episodic memory). Although impairments in autobiographical memory have been found in adults with unilateral temporal lobe epilepsy (TLE) and attributed to compromised hippocampal integrity, it is not yet known whether this occurs in children with TLE. In the current study, 21 children with TLE and 24 healthy controls of comparable age, sex, and socioeconomic status were administered the Children's Autobiographical Interview. Compared to controls, children with TLE recalled fewer episodic details, but only when no retrieval prompts were provided. There was no difference between the groups for semantic autobiographic details. Interestingly, the number of episodic details recalled increased significantly from 6 to 16 years of age in healthy control children, but not in children with TLE. Exploratory analyses revealed that, within the group of children with TLE, epilepsy factors, including presence or absence of structural hippocampal abnormalities, did not relate to the richness of episodic recall. Our results provide first evidence of autobiographical episodic memory deficits in children with TLE.

Volumetric analysis of medial temporal lobe subregions in developmental amnesia using high-resolution magnetic resonance imaging

There is great interest in the cognitive consequences of hippocampal volume loss in developmental amnesia (DA). In many DA cases, volume loss occurs before the hippocampus is fully developed, and yet little is known about the locus, extent, and distribution of damage in these cases. We used high-resolution MRI to manually segment the medial temporal lobe (MTL) subregions in H.C., an adult with DA, and a group of sex-, age- and education-matched control participants (n = 10). The hippocampus was defined and divided into anterior (head) and posterior (body and tail) segments. Within the body of the hippocampus, the subregions (CA₁, DG/CA_2/3, and subiculum) were defined. Finally, the entorhinal (ERC), perirhinal (PRC), and parahippocampal (PHC) cortices were segmented. Anterior hippocampus was reduced bilaterally and posterior hippocampus was significantly reduced on the right. In the body of the hippocampus, all three subregions were reduced in the left hemisphere, whereas CA₁ and subiculum were reduced in the right hemisphere. No group differences were observed in the PRC and ERC, whereas left PHC volume was marginally increased in H.C. compared to controls. These results can be used to inform patterns of spared and impaired cognitive abilities in DA and perhaps in amnesia more generally. © The Authors. Hippocampus Published by Wiley Periodicals, Inc.

Social cognition in a case of amnesia with neurodevelopmental mechanisms

Episodic-autobiographical memory (EAM) is considered to emerge gradually in concert with the development of other cognitive abilities (such as executive functions, personal semantic knowledge, emotional knowledge, theory of mind (ToM) functions, language, and working memory). On the brain level its emergence is accompanied by structural and functional reorganization of different components of the so-called EAM network. This network includes the hippocampal formation, which is viewed as being vital for the acquisition of memories of personal events for long-term storage. Developmental studies have emphasized socio-cultural-linguistic mechanisms that may be unique to the development of EAM. Furthermore it was hypothesized that one of the main functions of EAM is the social one. In the research field, the link between EAM and social cognition remains however debated. Herein we aim to bring new insights into the relation between EAM and social information processing (including social cognition) by describing a young adult patient with amnesia with neurodevelopmental mechanisms due to perinatal complications accompanied by hypoxia. The patient was investigated medically, psychiatrically, and with neuropsychological and neuroimaging methods. Structural high resolution magnetic resonance imaging revealed significant bilateral hippocampal atrophy as well as indices for degeneration in the amygdalae, basal ganglia, and thalamus, when a less conservative threshold was applied. In addition to extensive memory investigations and testing other (non-social) cognitive functions, we employed a broad range of tests that assessed social information processing (social perception, social cognition, social regulation). Our results point to both preserved (empathy, core ToM functions, visual affect selection, and discrimination, affective prosody discrimination) and impaired domains of social information processing (incongruent affective prosody processing, complex social judgments). They support proposals for a role of the hippocampal formation in processing more complex social information that likely requires multimodal relational handling.

Effects of early thyroid hormone deficiency on children's autobiographical memory performance

Memory deficits and hippocampal abnormalities have been described in individuals with thyroid hormone (TH) insufficiencies; however, no study has yet examined their autobiographical memory (AM) abilities, which are known to be compromised by hippocampal damage. Investigations in adults have shown that AM consists of both episodic and semantic components and that the hippocampus is preferentially involved in episodic AM. The present study used the Children's Autobiographical Interview (CAI) to study episodic and semantic AM in 79 children aged 9 to 14 years, including 26 with early-treated congenital hypothyroidism (CH), 23 born to women with inadequately treated hypothyroidism during pregnancy (HYPO), and 30 typically developing controls. Results showed that relative to controls, CH and HYPO groups both exhibited weaknesses in episodic AM, but not semantic AM. In particular, CH and HYPO groups showed difficulty in recalling event details (i.e., the main happenings) and visual details from past experiences. Overall, this study highlights the importance of TH for early neurodevelopment and provides critical new insight into the effects of early treated TH deficiency on long-term memory performance. Furthermore, the present study indicates that the CAI is an effective tool for investigating episodic AM impairment in clinical pediatric populations.

Imagining Other People's Experiences in a Person with Impaired Episodic Memory: The Role of Personal Familiarity

Difficulties remembering one’s own experiences via episodic memory may affect the ability to imagine other people’s experiences during theory of mind (ToM). Previous work shows that the same set of brain regions recruited during tests of episodic memory and future imagining are also engaged during standard laboratory tests of ToM. However, hippocampal amnesic patients who show deficits in past and future thinking, show intact performance on ToM tests, which involve unknown people or fictional characters. Here we present data from a developmental amnesic person (H.C.) and a group of demographically matched controls, who were tested on a naturalistic test of ToM that involved describing other people’s experiences in response to photos of personally familiar others (“pToM” condition) and unfamiliar others (“ToM” condition). We also included a condition that involved recollecting past experiences in response to personal photos (“EM” condition). Narratives were scored using an adapted Autobiographical Interview scoring procedure. Due to the visually rich stimuli, internal details were further classified as either descriptive (i.e., details that describe the visual content of the photo) or elaborative (i.e., details that go beyond what is visually depicted in the photo). Relative to controls, H.C. generated significantly fewer elaborative details in response to the pToM and EM photos and an equivalent number of elaborative details in response to the ToM photos. These data converge with previous neuroimaging results showing that the brain regions underlying pToM and episodic memory overlap to a greater extent than those supporting ToM. Taken together, these results suggest that detailed episodic representations supported by the hippocampus may be pivotal for imagining the experiences of personally familiar, but not unfamiliar, others.

Memory as social glue: close interpersonal relationships in amnesic patients

Memory may be crucial for establishing and/or maintaining social bonds. Using the National Social life, Health, and Aging Project questionnaire, we examined close interpersonal relationships in three amnesic people: K.C. and D.A. (who are adult-onset cases) and H.C. (who has developmental amnesia). All three patients were less involved than demographically matched controls with neighbors and religious and community groups. A higher-than-normal percentage of the adult-onset (K.C. and D.A.) cases’ close relationships were with family members, and they had made few new close friends in the decades since the onset of their amnesia. On the other hand, the patient with developmental amnesia (H.C.) had forged a couple of close relationships, including one with her fiancé. Social networks appear to be winnowed, but not obliterated, by amnesia. The obvious explanation for the patients’ reduced social functioning stems from their memory impairment, but we discuss other potentially important factors for future study.

Theory of mind development can withstand compromised episodic memory development

As humans, we are consciously aware of unobservable mental states, including our own during episodic memory and other people's by having a "theory of mind" (ToM). Episodic memory and ToM are closely related: they share a neural substrate and emerge close in time in ontogenetic development. This relationship is central to prominent child development and cognitive neuroscience theories of ToM, but its causal nature has not been tested empirically. The current study examined whether normal episodic memory development is necessary for normal ToM development. To investigate this, we tested H.C., a young woman with impaired episodic memory development due to early hippocampal damage, on a wide range of ToM measures. H.C.'s performance was indistinguishable from that of controls on all tests of ToM suggesting that, contrary to theoretical claims in the literature, normal episodic memory development and hippocampal function are not essential for the development of ToM.

The hippocampus and imagining the future: where do we stand?

Recent neuroimaging work has demonstrated that the hippocampus is engaged when imagining the future, in some cases more than when remembering the past. It is possible that this hippocampal activation reflects recombining details into coherent scenarios and/or the encoding of these scenarios into memory for later use. However, inconsistent findings have emerged from recent studies of future simulation in patients with memory loss and hippocampal damage. Thus, it remains an open question as to whether the hippocampus is necessary for future simulation. In this review, we consider the findings from patient studies and the neuroimaging literature with respect to a new framework that highlights three component processes of simulation: accessing episodic details, recombining details, and encoding simulations. We attempt to reconcile these discrepancies between neuroimaging and patient studies by suggesting that different component processes of future simulation may be differentially affected by hippocampal damage.

Working memory and amnesia: the role of stimulus novelty

Despite the traditional view that damage to the hippocampus and/or surrounding areas of the medial temporal lobe (MTL) does not impair short-term or working memory (WM), recent research has shown MTL amnesics to be impaired on WM tasks that require maintaining a small amount of information over brief retention intervals (e.g., maintenance of a single face for one second). However, the types of tasks that have demonstrated WM impairments in amnesia tend to have involved novel stimuli. We hypothesized that WM may be impaired in amnesia for tasks that require maintaining novel information, but may be preserved for more familiar material, particularly if the material can be easily rehearsed. To test this hypothesis, patient HC, a 22-year-old developmental amnesic with relatively preserved semantic memory and 20 age and education matched controls performed a delayed match-to-sample task that required maintaining a single famous or non-famous face for 1-8s, digit span and reading span tasks, and a modified Brown-Peterson task that required maintaining a single high- or low-frequency word or a non-word for 4-8s. HC's performance was impaired for non-famous faces but preserved for famous faces, impaired for the reading span task but preserved for digit span, and it was impaired for non-words and unfamiliar low-frequency words but preserved for familiar words. These results support the hypothesis that an intact hippocampus is necessary for maintaining a single novel stimulus in WM. However, stimulus familiarity and rehearsal support WM via cortical regions independent of the MTL.

Patient HC with developmental amnesia can construct future scenarios

Deficits in recalling the past and imagining fictitious and future scenarios have been documented in patients with hippocampal damage and amnesia that was acquired in adulthood. By contrast patients with very early hippocampal damage and developmental amnesia are not impaired relative to control participants when imagining fictitious/future experiences. Recently, however, a patient (HC) with developmental amnesia, resulting from bilateral hippocampal atrophy, was reported to be impaired, thus raising a question about the true nature of event construction in the context of developmental amnesia. Here, we assessed HC on a test of imagination which explored her ability to construct fictitious events or personal plausible future events. Her scenario descriptions were analysed in detail along a range of parameters, using two different scoring methods. HC's performance was comparable to matched control participants on all measures relating to the imagination of fictitious and future scenarios. We then considered why she was reported as impaired in the previous study. We conclude that various features of the previous testing methodology may have contributed to the underestimation of HC's ability in that instance. Patients like HC with developmental amnesia may be successful at future-thinking tasks because their performance is not based on true visualisation or scene construction supported by the hippocampus, but rather on preserved world knowledge and semantic representations.