Disorders of learning and memory after temporal lobe lesions in man

Transcranial direct-current stimulation of core language areas facilitates novel word acquisition

Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulation technique that can alter the state of the stimulated brain area and thereby affect neurocognitive processes and resulting behavioural performance. Previous studies using tDCS to address the language function have shown disparate results, particularly with respect to language learning and word acquisition. To fill this gap, this study aimed at systematically addressing the effects of tDCS of core left-hemispheric language cortices on the brain mechanisms underpinning two main neurocognitive strategies of word learning: implicit inference-based Fast Mapping (FM) and direct instruction-based Explicit Encoding (EE). Prior to a word-learning session, 160 healthy participants were given 15 min of either anodal or cathodal tDCS of Wernicke's or Broca's areas, or a control sham (placebo) stimulation, in a between-group design. Each participant then learned sixteen novel words (eight through FM and eight through EE) in a contextual word-picture association session. Moreover, these words were learnt either perceptually via auditory exposure combined with a graphical image of the novel object, or in an articulatory mode, where the participants additionally had to overtly articulate the novel items. These learning conditions were fully counterbalanced across participants, stimuli and tDCS groups. Learning outcomes were tested at both lexical and semantic levels using two tasks: recognition and word-picture matching. EE and FM conditions produced similar outcomes, indicating comparable efficiency of the respective learning strategies. At the same time, articulatory learning produced generally better results than non-articulatory exposure, yielding higher recognition accuracies and shorter latencies in both tasks. Crucially, real tDCS led to global outcome improvements, demonstrated by faster (compared to sham) reactions, as well as some accuracy changes. There was also evidence of more specific tDCS effects: better word-recognition accuracy for EE vs. FM following cathodal stimulation as well as more expressed improvements in recognition accuracy and reaction times for anodal Broca's and cathodal Wernicke's stimulation, particularly for unarticulated FM items. These learning mode-specific effects support the notion of partially distinct brain mechanisms underpinning these two learning strategies. Overall, numerically largest improvements were observed for anodal Broca's tDCS, whereas the least expressed benefits of tDCS for learning were measured after anodal Wernicke stimulation. Finally, we did not find any inhibitory effects of either tDCS polarity in any of the comparisons. We conclude that tDCS of core language areas exerts a general facilitatory effect on new word acquisition with some limited specificity to learning protocols - the result that may be of potential applied value for future research aimed at ameliorating learning deficits and language disorders.

Epilepsy and Neuropsychology

Neuropsychological evaluation is an essential component of clinical care for people with epilepsy and also has a specialized role in predicting cognitive outcome after epilepsy surgery. Neuropsychological research in the field of epilepsy has had a significant impact on our knowledge regarding memory and language systems, lateralization of cognitive functions, and the heterogeneity in cognitive phenotypes among people with epilepsy. Interventions that consider the impact of health disparities, cognition, psychological functioning, individual risk and resilience factors, and modifiable lifestyle factors, are critical for optimizing cognitive functioning, psychological health, and quality of life for people with epilepsy.

The cerebellum acts as the analog to the medial temporal lobe for sensorimotor memory

The cerebellum is critical for sensorimotor learning. The specific contribution that it makes, however, remains unclear. Inspired by the classic finding that for declarative memories, medial temporal lobe (MTL) structures provide a gateway to the formation of long-term memory but are not required for short-term memory, we hypothesized that for sensorimotor memories, the cerebellum may play an analogous role. Here, we studied the sensorimotor learning of individuals with severe ataxia from cerebellar degeneration. We dissected the memories they formed during sensorimotor learning into a short-term temporally-volatile component, that decays rapidly with a time constant of just 15 to 20 s and thus cannot lead to long-term retention, and a longer-term temporally-persistent component that is stable for 60 s or more and leads to long-term retention. Remarkably, we find that these individuals display dramatically reduced levels of temporally-persistent sensorimotor memory, despite spared and even elevated levels of temporally-volatile sensorimotor memory. In particular, we find both impairment that systematically worsens with memory window duration over shorter memory windows (<12 s) and near-complete impairment of memory maintenance over longer memory windows (>25 s). This dissociation uncovers a unique role for the cerebellum as a gateway for the formation of long-term but not short-term sensorimotor memories, mirroring the role of the MTL for declarative memories. It thus reveals the existence of distinct neural substrates for short-term and long-term sensorimotor memory, and it explains both the trial-to-trial differences identified in this study and long-standing study-to-study differences in the effects of cerebellar damage on sensorimotor learning ability.

Verbal learning in frontal patients: area 9 is critical for employing semantic strategies

INTRODUCTION

Learning is a long-term memory process heavily influenced by the control processes implemented by working memory, including recognition of semantic properties of items by which subjects generate a semantic structure of engrams.

AIM

The aim of this study is to investigate the verbal learning strategies of patients affected by a tumor in the left frontal lobe to highlight the role of area 9.

METHOD

Ten patients with frontal low-grade gliomas and ten healthy control subjects, matched for age, sex and education, were recruited and then evaluated with a two-part verbal learning test: multi-trial word list learning in free recall, and multi-trial word list learning preceded by an explicit semantic strategy cue. Frontal patients were divided into two groups: those either with frontal lesions involving or sparing area 9.

RESULTS

In comparison to healthy control subjects, frontal patients with lesions involving area 9 memorized fewer words and displayed difficulty in using semantic strategies. When the strategy was suggested by the examiner, their performance improved, but to a lesser extent than the healthy control. Conversely, frontal patients with lesions sparing area 9 showed similar results to healthy control subjects.

CONCLUSION

The results suggested that, while the identification of the categorical criterion requires the integrity of the entire dorsolateral prefrontal area, only area 9, and not the surrounding areas, could be responsible for the effective use of semantic strategies in learning tasks.

Comparison of the Diagnostic Accuracy of Five Cognitive Screening Tests for Diagnosing Mild Cognitive Impairment in Patients Consulting for Memory Loss

Objectives: We aimed to evaluate and compare the diagnostic capacity of five cognitive screening tests for the diagnosis of mild cognitive impairment (MCI) in patients consulting by memory loss. Methods: A cross-sectional study involving 140 participants with a mean age of 74.42 ± 7.60 years, 87 (62.14%) women. Patients were classified as MCI or cognitively unimpaired according to a comprehensive neuropsychological battery. The diagnostic properties of the following screening tests were compared: Mini-Mental State Examination (MMSE), Addenbrooke's Cognitive Examination III (ACE-III) and Mini-Addenbrooke (M-ACE), Memory Impairment Screen (MIS), Montreal Cognitive Assessment (MoCA), and Rowland Universal Dementia Assessment Scale (RUDAS). Results: The area under the curve (AUC) was 0.861 for the ACE-III, 0.867 for M-ACE, 0.791 for MoCA, 0.795 for MMSE, 0.731 for RUDAS, and 0.672 for MIS. For the memory components, the AUC was 0.869 for ACE-III, 0.717 for MMSE, 0.755 for MoCA, and 0.720 for RUDAS. Cronbach's alpha was 0.827 for ACE-III, 0.505 for MMSE, 0.896 for MoCA, and 0.721 for RUDAS. Correlations with Free and Cued Selective Reminding Test were moderate with M-ACE, ACE-III, and MoCA, and moderate for the other tests. The M-ACE showed the best balance between diagnostic capacity and time of administration. Conclusions: ACE-III and its brief version M-ACE showed better diagnostic properties for the diagnosis of MCI than the other screening tests. MoCA and MMSE showed adequate properties, while the diagnostic capacity of MIS and RUDAS was limited.

Pure amnestic seizure: A clinico-intracranial EEG study

OBJECTIVE

Enduring anterograde amnesia is caused by lesions in bilateral mesial temporal lobes. However, whether transient dysfunction of bilateral mesial temporal regions induces reversible amnesia has not been proven. We investigated this association in patients with epilepsy and analyzed the electroclinical correlation during pure amnestic seizures (PAS). PAS are defined as seizures with anterograde amnesia as the only ictal manifestation, accompanied by preserved responsiveness and other cognitive functions.

METHODS

We retrospectively searched our intracranial EEG database to find PAS. Pure ictal amnesia was confirmed by immediate and comprehensive ictal examinations.

RESULTS

Among 401 patients who underwent intracranial EEG recording, three patients with temporal lobe epilepsy (TLE) manifesting PAS were identified. The patients talked and behaved normally during seizure but did not remember the episodes afterwards. Ictal discharges were confined to bilateral mesial temporal regions, with no or mild involvement of surrounding structures. Spread of low-voltage fast activities to bilateral mesial temporal regions corresponded to onset of ictal anterograde amnesia. Two patients underwent unilateral mesial temporal resection and became seizure-free with improvement in cognitive functions.

SIGNIFICANCE

PAS is a rare ictal semiology in TLE. Bilateral mesial temporal regions that play a critical role in memory encoding are presumably the symptomatogenic zones for PAS.

Cortical and Subcortical Mechanisms of Orthographic Word-form Learning

We examined the initial stages of orthographic learning in real time as literate adults learned spellings for spoken pseudowords during fMRI scanning. Participants were required to learn and store orthographic word forms because the pseudoword spellings were not uniquely predictable from sound to letter mappings. With eight learning trials per word form, we observed changes in the brain's response as learning was taking place. Accuracy was evaluated during learning, immediately after scanning, and 1 week later. We found evidence of two distinct learning systems-hippocampal and neocortical-operating during orthographic learning, consistent with the predictions of dual systems theories of learning/memory such as the complementary learning systems framework [McClelland, J. L., McNaughton, B. L., & O'Reilly, R. C. Why there are complementary learning systems in the hippocampus and neocortex: Insights from the successes and failures of connectionist models of learning and memory. Psychological Review, 102, 419-457, 1995]. The bilateral hippocampus and the visual word form area (VWFA) showed significant BOLD response changes over learning, with the former exhibiting a rising pattern and the latter exhibiting a falling pattern. Moreover, greater BOLD signal increase in the hippocampus was associated with better postscan recall. In addition, we identified two distinct bilateral brain networks that mirrored the rising and falling patterns of the hippocampus and VWFA. Functional connectivity analysis revealed that regions within each network were internally synchronized. These novel findings highlight, for the first time, the relevance of multiple learning systems in orthographic learning and provide a paradigm that can be used to address critical gaps in our understanding of the neural bases of orthographic learning in general and orthographic word-form learning specifically.

A Magnetic Resonance Spectroscopy Study on Polarity Subphenotypes in Bipolar Disorder

Although magnetic resonance spectroscopy (MRS) has provided in vivo measurements of brain chemical profiles in bipolar disorder (BD), there are no data on clinically and therapeutically important onset polarity (OP) and predominant polarity (PP). We conducted a proton MRS study in BD polarity subphenotypes, focusing on emotion regulation brain regions. Forty-one euthymic BD patients stratified according to OP and PP and sixteen healthy controls (HC) were compared. 1H-MRS spectra of the anterior and posterior cingulate cortex (ACC, PCC), left and right hippocampus (LHIPPO, RHIPPO) were acquired at 3.0T to determine metabolite concentrations. We found significant main effects of OP in ACC mI, mI/tNAA, mI/tCr, mI/tCho, PCC tCho, and RHIPPO tNAA/tCho and tCho/tCr. Although PP had no significant main effects, several medium and large effect sizes emerged. Compared to HC, manic subphenotypes (i.e., manic-OP, manic-PP) showed greater differences in RHIPPO and PCC, whereas depressive suphenotypes (i.e., depressive-OP, depressive-PP) in ACC. Effect sizes were consistent between OP and PP as high intraclass correlation coefficients (ICC) were confirmed. Our findings support the utility of MRS in the study of the neurobiological underpinnings of OP and PP, highlighting that the regional specificity of metabolite changes within the emotion regulation network consistently marks both polarity subphenotypes.

The cerebellum acts as the analog to the medial temporal lobe for sensorimotor memory

The cerebellum is critical for sensorimotor learning. The specific contribution that it makes, however, remains unclear. Inspired by the classic finding that, for declarative memories, medial temporal lobe structures provide a gateway to the formation of long-term memory but are not required for short-term memory, we hypothesized that, for sensorimotor memories, the cerebellum may play an analogous role. Here we studied the sensorimotor learning of individuals with severe ataxia from cerebellar degeneration. We dissected the memories they formed during sensorimotor learning into a short-term temporally-volatile component, that decays rapidly with a time constant of just 15-20sec and thus cannot lead to long-term retention, and a longer-term temporally-persistent component that is stable for 60 sec or more and leads to long-term retention. Remarkably, we find that these individuals display dramatically reduced levels of temporally-persistent sensorimotor memory, despite spared and even elevated levels of temporally-volatile sensorimotor memory. In particular, we find both impairment that systematically increases with memory window duration over shorter memory windows (<12 sec) and near-complete impairment of memory maintenance over longer memory windows (>25 sec). This dissociation uncovers a new role for the cerebellum as a gateway for the formation of long-term but not short-term sensorimotor memories, mirroring the role of the medial temporal lobe for declarative memories. It thus reveals the existence of distinct neural substrates for short-term and long-term sensorimotor memory, and it explains both newly-identified trial-to-trial differences and long-standing study-to-study differences in the effects of cerebellar damage on sensorimotor learning ability.

Significance Statement

A key discovery about the neural underpinnings of memory, made more than half a century ago, is that long-term, but not short-term, memory formation depends on neural structures in the brain's medial temporal lobe (MTL). However, this dichotomy holds only for declarative memories - memories for explicit facts such as names and dates - as long-term procedural memories - memories for implicit knowledge such as sensorimotor skills - are largely unaffected even with substantial MTL damage. Here we demonstrate that the formation of long-term, but not short-term, sensorimotor memory depends on a neural structure known as the cerebellum, and we show that this finding explains the variability previously reported in the extent to which cerebellar damage affects sensorimotor learning.

Neuroligin-3-Mediated Synapse Formation Strengthens Interactions between Hippocampus and Barrel Cortex in Associative Memory

Memory traces are believed to be broadly allocated in cerebral cortices and the hippocampus. Mutual synapse innervations among these brain areas are presumably formed in associative memory. In the present study, we have used neuronal tracing by pAAV-carried fluorescent proteins and neuroligin-3 mRNA knockdown by shRNAs to examine the role of neuroligin-3-mediated synapse formation in the interconnection between primary associative memory cells in the sensory cortices and secondary associative memory cells in the hippocampus during the acquisition and memory of associated signals. Our studies show that mutual synapse innervations between the barrel cortex and the hippocampal CA3 region emerge and are upregulated after the memories of associated whisker and odor signals come into view. These synapse interconnections are downregulated by a knockdown of neuroligin-3-mediated synapse linkages. New synapse interconnections and the strengthening of these interconnections appear to endorse the belief in an interaction between the hippocampus and sensory cortices for memory consolidation.

Concordance of verbal memory and language fMRI lateralization in people with epilepsy

BACKGROUND AND PURPOSE

This work investigates verbal memory functional MRI (fMRI) versus language fMRI in terms of lateralization, and assesses the validity of performing word recognition during the functional scan.

METHODS

Thirty patients with a diagnosis of epilepsy underwent verbal memory, visuospatial memory, and language fMRI. We used word encoding, word recognition, image encoding, and image recognition memory tasks, and semantic description, reading comprehension, and listening comprehension language tasks. We used three common lateralization metrics: network spatial distribution, maximum statistical value, and laterality index (LI).

RESULTS

Lateralization of signal spatial distribution resulted in poor similarity between verbal memory and language fMRI tasks. Signal maximum lateralization showed significant (>.8) but not perfect (1) similarity. Word encoding LI showed significant correlation only with listening comprehension LI (p = .016). Word recognition LI was significantly correlated with expressive language semantic description LI (p = .024) and receptive language reading and listening comprehension LIs (p = .015 and p = .019, respectively). There was no correlation between LIs of the visuospatial tasks and LIs of the language tasks.

CONCLUSIONS

Our results support the association between language and verbal memory lateralization, optimally determined by LI quantification, and the introduction of quantitative means for language fMRI interpretation in clinical settings where verbal memory lateralization is imperative.

Complex visual discrimination is impaired after right, but not left, anterior temporal lobectomy

The prevailing view in human cognitive neuroscience associates the medial temporal lobes (MTLs) with declarative memory. Compelling experimental evidence has, however, demonstrated that these regions are specialized according to the representations processed, irrespective of the cognitive domain assessed. This account was supported by the study of patients with bilateral medial temporal amnesia, who exhibit impairments in perceptual tasks involving complex visual stimuli. Yet, little is known regarding the impact of unilateral MTL damage on complex visual abilities. To address this issue, we administered a visual matching task to 20 patients who underwent left (N = 12) or right (N = 8) anterior temporal lobectomy for drug-resistant epilepsy and to 38 healthy controls. Presentation viewpoint was manipulated to increase feature ambiguity, as this is critical to reveal impairments in perceptual tasks. Similar to control participants, patients with left-sided damage succeeded in all task conditions. In contrast, patients with right-sided damage had decreased accuracy compared with that of the other two groups, as well as increased response time. Notably, the accuracy of those with right-sided damage did not exceed chance level when feature ambiguity was high (i.e., when stimuli were presented from different viewpoints) for the most complex classes of stimuli (i.e., scenes and buildings, compared with single objects). The pattern reported in bilateral patients in previous studies was therefore reproduced in patients with right, but not left, resection. These results suggest that the complex visual-representation functions supported by the MTL are right-lateralized, and raise the question as to how the representational account of these regions applies to representations supported by left MTL regions.

Neuropsychological function in psychosis of epilepsy

OBJECTIVE

The neuropsychological profile of patients with psychosis of epilepsy (POE) has received limited research attention. Recent neuroimaging work in POE has identified structural network pathology in the default mode network and the cognitive control network. This study examined the neuropsychological profile of POE focusing on cognitive domains subserved by these networks.

METHODS

Twelve consecutive patients with a diagnosis of POE were prospectively recruited from the Comprehensive Epilepsy Programmes at The Royal Melbourne, Austin and St Vincent's Hospitals, Melbourne, Australia between January 2015 and February 2017. They were compared to 12 matched patients with epilepsy but no psychosis and 42 healthy controls on standardised neuropsychological tests of memory and executive functioning in a case-control design.

RESULTS

Mean scores across all cognitive tasks showed a graded pattern of impairment, with the POE group showing the poorest performance, followed by the epilepsy without psychosis and the healthy control groups. This was associated with significant group-level differences on measures of working memory (p = < 0.01); immediate (p = < 0.01) and delayed verbal recall (p = < 0.01); visual memory (p < 0.001); and verbal fluency (p = 0.02). In particular, patients with POE performed significantly worse than the healthy control group on measures of both cognitive control (p = .005) and memory (p < .001), whereas the epilepsy without psychosis group showed only memory difficulties (delayed verbal recall) compared to healthy controls (p = .001).

CONCLUSION

People with POE show reduced performance in neuropsychological functions supported by the default mode and cognitive control networks, when compared to both healthy participants and people with epilepsy without psychosis.

Using image reconstruction to investigate face perception in amnesia

Damage to the medial temporal lobe (MTL), which is traditionally considered to subserve memory exclusively, has been reported to contribute to impaired face perception. However, it remains unknown how exactly such brain lesions may impact face representations and in particular facial shape and surface information, both of which are crucial for face perception. The present study employed a behavioral-based image reconstruction approach to reveal the pictorial representations of face perception in two amnesic patients: DA, who has an extensive bilateral MTL lesion that extends beyond the MTL in the right hemisphere, and BL, who has damage to the hippocampal dentate gyrus (DG). Both patients and their respective matched controls completed similarity judgments for pairs of faces, from which facial shape and surface features were subsequently derived and synthesized to create images of reconstructed facial appearance. Participants also completed a face oddity judgment task (FOJT) that has previously been shown to be sensitive to MTL cortical damage. While BL exhibited an impaired pattern of performance on the FOJT, DA demonstrated intact performance accuracy. Notably, the recovered pictorial content of faces was comparable between both patients and controls, although there was evidence for atypical face representations in BL particularly with regards to color. Our work provides novel insight into the face representations underlying face perception in two well-studied amnesic patients in the literature and demonstrates the applicability of the image reconstruction approach to individuals with brain damage.

The hearing hippocampus

The hippocampus has a well-established role in spatial and episodic memory but a broader function has been proposed including aspects of perception and relational processing. Neural bases of sound analysis have been described in the pathway to auditory cortex, but wider networks supporting auditory cognition are still being established. We review what is known about the role of the hippocampus in processing auditory information, and how the hippocampus itself is shaped by sound. In examining imaging, recording, and lesion studies in species from rodents to humans, we uncover a hierarchy of hippocampal responses to sound including during passive exposure, active listening, and the learning of associations between sounds and other stimuli. We describe how the hippocampus' connectivity and computational architecture allow it to track and manipulate auditory information - whether in the form of speech, music, or environmental, emotional, or phantom sounds. Functional and structural correlates of auditory experience are also identified. The extent of auditory-hippocampal interactions is consistent with the view that the hippocampus makes broad contributions to perception and cognition, beyond spatial and episodic memory. More deeply understanding these interactions may unlock applications including entraining hippocampal rhythms to support cognition, and intervening in links between hearing loss and dementia.

Testing an Adapted Auditory Verbal Learning Test Paradigm for fMRI to Lateralize Verbal Memory in Patients with Epilepsy

BACKGROUND AND PURPOSE

fMRI is a noninvasive tool for predicting postsurgical deficits in candidates with pharmacoresistant temporal lobe epilepsy. We aimed to test an adapted paradigm of the Rey Auditory Verbal Learning Test to evaluate differences in memory laterality indexes between patients and healthy controls and its association with neuropsychological scores.

MATERIALS AND METHODS

We performed a prospective study of 50 patients with temporal lobe epilepsy and 22 healthy controls. Participants underwent a block design language and memory fMRI. Laterality indexes and the hippocampal anterior-posterior index were calculated. Language and memory lateralization was organized into typical and atypical on the basis of laterality indexes. A neuropsychological assessment was performed with a median time from fMRI of 8 months and was compared with fMRI performance.

RESULTS

We studied 40 patients with left temporal lobe epilepsy and 10 with right temporal lobe epilepsy. Typical language occurred in 65.3% of patients and 90.9% of healthy controls (P = .04). The memory fMRI laterality index was obtained in all healthy controls and 92% of patients. The verbal memory laterality index was bilateral (24.3%) more frequently than the language laterality index (7.69%) in patients with left temporal lobe epilepsy. Atypical verbal memory was greater in patients with left temporal lobe epilepsy (56.8%) than in healthy controls (36.4%), and the proportion of bilateral laterality indexes (53.3%) was larger than right laterality indexes (46.7%). Atypical verbal memory might be associated with higher cognitive scores in patients. No relevant differences were seen in the hippocampal anterior-posterior index according to memory impairment.

CONCLUSIONS

The adapted Rey Auditory Verbal Learning Test paradigm fMRI might support verbal memory lateralization. Temporal lobe epilepsy laterality influences hippocampal memory laterality indexes. Left temporal lobe epilepsy has shown a higher proportion of atypical verbal memory compared with language, potentially to memory functional reorganization.

Association between toileting independence and higher brain functions in post-stroke inpatients: A cross-sectional study

OBJECTIVES

We aimed to cross-sectionally examine and clarify the types of higher brain functions associated with toileting independence in post-stroke inpatients.

MATERIALS AND METHODS

From November 2017 to October 2020, 51 participants were selected from a database of post-stroke inpatients in a Japanese hospital; the selected participants had missing data. The objective variable was the independence of toileting and toilet transfer in the Functional Independence Measure; independence was set at 6 points or more. The covariates were age, sex, and Berg balance scale score; the explanatory variables were higher brain functions of four items (forward digit span, visual cancelation task [VCT] correctness rate, symbol digit modalities test score, and Kohs block design test score). Logistic regression analysis was performed using multiple imputation and Bayesian modeling.

RESULTS

VCT correctness rate was significantly associated with toileting independence in the best model selected (odds ratio 1.16; 95% credible interval 1.02, 1.49).

CONCLUSION

Selective attention (assessed by VCT correctness rate) may be associated with, and predict, toileting independence in post-stroke inpatients.

Brain activity patterns underlying memory confidence

The primary aim of this review is to examine the brain activity patterns that are related to subjectively perceived memory confidence. We focus on the main brain regions involved in episodic memory: the medial temporal lobe (MTL), prefrontal cortex (PFC), and posterior parietal cortex (PPC), and relate activity in their subregions to memory confidence. How this brain activity in both the encoding and retrieval phase is related to (subsequent) memory confidence ratings will be discussed. Specifically, encoding related activity in MTL regions and ventrolateral PFC mainly shows a positive linear increase with subsequent memory confidence, while dorsolateral and ventromedial PFC activity show mixed patterns. In addition, encoding-related PPC activity seems to only have indirect effects on memory confidence ratings. Activity during retrieval in both the hippocampus and parahippocampal cortex increases with memory confidence, especially during high-confident recognition. Retrieval-related activity in the PFC and PPC show mixed relationships with memory confidence, likely related to post-retrieval monitoring and attentional processes, respectively. In this review, these MTL, PFC, and PPC activity patterns are examined in detail and related to their functional roles in memory processes. This insight into brain activity that underlies memory confidence is important for our understanding of brain-behaviour relations and memory-guided decision making.

Nomograms to Predict Verbal Memory Decline After Temporal Lobe Resection in Adults With Epilepsy

OBJECTIVE

To develop and externally validate models to predict the probability of postoperative verbal memory decline in adults after temporal lobe resection (TLR) for epilepsy using easily accessible preoperative clinical predictors.

METHODS

Multivariable models were developed to predict delayed verbal memory outcome on 3 commonly used measures: Rey Auditory Verbal Learning Test (RAVLT) and Logical Memory (LM) and Verbal Paired Associates (VPA) subtests from Wechsler Memory Scale-Third Edition. With the use of the Harrell step-down procedure for variable selection, models were developed in 359 adults who underwent TLR at the Cleveland Clinic and validated in 290 adults at 1 of 5 epilepsy surgery centers in the United States or Canada.

RESULTS

Twenty-nine percent of the development cohort and 26% of the validation cohort demonstrated significant decline on at least 1 verbal memory measure. Initial models had good to excellent predictive accuracy (calibration [c] statistic range 0.77-0.80) in identifying patients with memory decline; however, models slightly underestimated decline in the validation cohort. Model coefficients were updated with data from both cohorts to improve stability. The model for RAVLT included surgery side, baseline memory score, and hippocampal resection. The models for LM and VPA included surgery side, baseline score, and education. Updated model performance was good to excellent (RAVLT c = 0.81, LM c = 0.76, VPA c = 0.78). Model calibration was very good, indicating no systematic overestimation or underestimation of risk.

CONCLUSIONS

Nomograms are provided in 2 easy-to-use formats to assist clinicians in estimating the probability of verbal memory decline in adults considering TLR for treatment of epilepsy.

CLASSIFICATION OF EVIDENCE

This study provides Class II evidence that multivariable prediction models accurately predict verbal memory decline after TLR for epilepsy in adults.

Novelty processing depends on medial temporal lobe structures

OBJECTIVES

The goal of the present study was to identify the role of the medial temporal lobe (MTL) in the detection and later processing of novelty.

METHODS

Twenty-one epilepsy patients with unilateral MTL resection (10 left-sided; 11 right-sided) and 26 matched healthy controls performed an adapted visual novelty oddball task. In this task two streams of stimuli were presented on the left and right of fixation while the patients' electroencephalogram was measured. The participants had to respond to infrequent target stimuli, while ignoring frequent standard, and infrequent novel stimuli that were presented to the left or right, appearing either contra- or ipsilateral to the patients' resections.

RESULTS

Novelty detection, as indexed by the N2 ERP component elicited by novels, was reduced by the MTL resections, as evidenced by a smaller N2 for patients than healthy controls. Later processing of novels, as indexed by the novelty P3 ERP component, was reduced for novels presented contra- versus ipsilateral to the resected side. Moreover, at a frontal electrode site, the N2-P3 complex showed reduced novelty processing in patients with MTL resections compared to healthy controls. The ERP differences were specific for the novel stimuli, as target processing, as indexed by the P3b, was unaffected in the patients: No P3b differences were found between targets presented ipsi- or contralaterally to the resected side, nor between patients and healthy controls.

CONCLUSIONS

The current results suggest that MTL structures play a role in novelty processing. In contrast, target processing was unaffected by MTL resections.

Resting-state functional connectivity of the human hippocampus in periadolescent children: Associations with age and memory performance

The hippocampus is necessary for declarative (relational) memory, and the ability to form hippocampal‐dependent memories develops through late adolescence. This developmental trajectory of hippocampal‐dependent memory could reflect maturation of intrinsic functional brain networks, but resting‐state functional connectivity (rs‐FC) of the human hippocampus is not well‐characterized for periadolescent children. Measuring hippocampal rs‐FC in periadolescence would thus fill a gap, and testing covariance of hippocampal rs‐FC with age and memory could inform theories of cognitive development. Here, we studied hippocampal rs‐FC in a cross‐sectional sample of healthy children (N = 96; 59 F; age 9–15 years) using a seed‐based approach, and linked these data with NIH Toolbox measures, the Picture‐Sequence Memory Test (PSMT) and the List Sorting Working Memory Test (LSWMT). The PSMT was expected to rely more on hippocampal‐dependent memory than the LSWMT. We observed hippocampal rs‐FC with an extensive brain network including temporal, parietal, and frontal regions. This pattern was consistent with prior work measuring hippocampal rs‐FC in younger and older samples. We also observed novel, regionally specific variation in hippocampal rs‐FC with age and hippocampal‐dependent memory but not working memory. Evidence consistent with these findings was observed in a second, validation dataset of similar‐age healthy children drawn from the Philadelphia Neurodevelopment Cohort. Further, a cross‐dataset analysis suggested generalizable properties of hippocampal rs‐FC and covariance with age and memory. Our findings connect prior work by describing hippocampal rs‐FC and covariance with age and memory in typically developing periadolescent children, and our observations suggest a developmental trajectory for brain networks that support hippocampal‐dependent memory.

The clinical utility of a memory specialization index in epilepsy surgery patients with unilateral hippocampal sclerosis

OBJECTIVE

Although group studies provide some support for the material-specific model of memory function, there are considerable individual variations in memory function in people with temporal lobe epilepsy, even in those with the same underlying pathology. In this proof-of-concept study, we examined the sensitivity and specificity of a single measure of an individual's relative strength for the encoding of verbal or visual learning.

METHODS

Six hundred ninety-two patients with left hemisphere language dominance and unilateral hippocampal sclerosis completed verbal and visual encoding tasks with similar test structures as part of their presurgical evaluation. Three hundred one patients had right hippocampal sclerosis (RHS), and 391 patients had left hippocampal sclerosis (LHS). A memory specialization index (MSI) was calculated by subtracting the Visual Learning z-score from the Verbal Learning z-score. A positive value on the MSI indicates a relative strength in verbal learning. A negative score indicates a relative strength in visual learning.

RESULTS

Employing cut-offs of ±1, the MSI had a positive predictive value of 71% (confidence interval [CI] 95% 0.64-0.77) for LHS and 64% (CI 95% 0.55-0.74) for RHS and was superior to the standalone z-scores from the verbal and visual tests in each respect. In the LHS group, the MSI was significantly correlated with age and duration of epilepsy. Older patients who had a longer duration of epilepsy were more likely to demonstrate a similar level of impairment in both verbal and visual learning, with a decreasing discrepancy between the scores on the two tasks over time.

SIGNIFICANCE

Our MSI provides a measure with high specificity for RHS. The pattern of strengths and weaknesses in visual and verbal encoding may evolve with age and duration of epilepsy, and clinicians should be aware of these factors when interpreting the lateralizing significance of test scores, particularly in a presurgical setting.

Investigating the Effects of Seizures on Procedural Memory Performance in Patients with Epilepsy

Memory complaints are frequently reported by patients with epilepsy and are associated with seizure occurrence. Yet, the direct effects of seizures on memory retention are difficult to assess given their unpredictability. Furthermore, previous investigations have predominantly assessed declarative memory. This study evaluated within-subject effects of seizure occurrence on retention and consolidation of a procedural motor sequence learning task in patients with epilepsy undergoing continuous monitoring for five consecutive days. Of the total sample of patients considered for analyses (N = 53, M_age = 32.92 ± 13.80 y, range = 18–66 y; 43% male), 15 patients experienced seizures and were used for within-patient analyses. Within-patient contrasts showed general improvements over seizure-free (day + night) and seizure-affected retention periods. Yet, exploratory within-subject contrasts for patients diagnosed with temporal lobe epilepsy (n = 10) showed that only seizure-free retention periods resulted in significant improvements, as no performance changes were observed following seizure-affected retention. These results indicate general performance improvements and offline consolidation of procedural memory during the day and night. Furthermore, these results suggest the relevance of healthy temporal lobe functioning for successful consolidation of procedural information, as well as the importance of seizure control for effective retention and consolidation of procedural memory.

Neuropsychological and neuropathological observations of a long-studied case of memory impairment

We report neuropsychological and neuropathological findings for a patient (A.B.), who developed memory impairment after a cardiac arrest at age 39. A.B. was a clinical psychologist who, although unable to return to work, was an active participant in our neuropsychological studies for 24 y. He exhibited a moderately severe and circumscribed impairment in the formation of long-term, declarative memory (anterograde amnesia), together with temporally graded retrograde amnesia covering ∼5 y prior to the cardiac arrest. More remote memory for both facts and autobiographical events was intact. His neuropathology was extensive and involved the medial temporal lobe, the diencephalon, cerebral cortex, basal ganglia, and cerebellum. In the hippocampal formation, there was substantial cell loss in the CA1 and CA3 fields, the hilus of the dentate gyrus (with sparing of granule cells), and the entorhinal cortex. There was also cell loss in the CA2 field, but some remnants remained. The amygdala demonstrated substantial neuronal loss, particularly in its deep nuclei. In the thalamus, there was damage and atrophy of the anterior nuclear complex, the mediodorsal nucleus, and the pulvinar. There was also loss of cells in the medial and lateral mammillary nuclei in the hypothalamus. We suggest that the neuropathology resulted from two separate factors: the initial cardiac arrest (and respiratory distress) and the recurrent seizures that followed, which led to additional damage characteristic of temporal lobe epilepsy.

Actigraphy-recorded sleep efficiency and hippocampal volume are related to visual and verbal rate of forgetting in older adults

This study aimed to determine if older adults "at-risk" for dementia (those with MCI or SMC) exhibit accelerated long-term forgetting (ALF) and whether rate of forgetting (RoF) is associated with sleep efficiency, hippocampal volume and demographic/clinical features. Forty-nine "at-risk" participants and eighteen controls underwent examination. Memory was assessed using the Scene Memory Task (SMT) and WMS-III Logical Memory (LM) subtest. Tests were administered at baseline, 24 hours and 2 weeks. While our study did not find ALF in those "at-risk" for dementia, on the SMT, RoF over 24 hours and 2 weeks was negatively correlated with sleep efficiency. For LM, RoF at 2 weeks was moderately associated with left hippocampal volume. Neither visual or verbal RoF was correlated with demographic or clinical variables (age, MMSE, IQ, GDS-15). While ALF was not observed in this sample, our results suggest that visual and verbal forgetting have differential predictors.

Detection and Prediction of Mild Cognitive Impairment in Alzheimer's Disease Mice

Background:

The recent failure of clinical trials to treat Alzheimer’s disease (AD) indicates that the current approach of modifying disease is either wrong or is too late to be efficient. Mild cognitive impairment (MCI) denotes the phase between the preclinical phase and clinical overt dementia. AD mouse models that overexpress human amyloid-β (Aβ) are used to study disease pathogenesis and to conduct drug development/testing. However, there is no direct correlation between the Aβ deposition, the age of onset, and the severity of cognitive dysfunction.

Objective:

To detect and predict MCI when Aβ plaques start to appear in the hippocampus of an AD mouse.

Methods:

We trained wild-type and AD mice in a Morris water maze (WM) task with different inter-trial intervals (ITI) at 3 months of age and assessed their WM performance. Additionally, we used a classification algorithm to predict the genotype (APPtg versus wild-type) of an individual mouse from their respective WM data.

Results:

MCI can be empirically detected using a short-ITI protocol. We show that the ITI modulates the spatial learning of AD mice without affecting the formation of spatial memory. Finally, a simple classification algorithm such as logistic regression on WM data can give an accurate prediction of the cognitive dysfunction of a specific mouse.

Conclusion:

MCI can be detected as well as predicted simultaneously with the onset of Aβ deposition in the hippocampus in AD mouse model. The mild cognitive impairment prediction can be used for assessing the efficacy of a treatment.

Anatomy and Function of the Primate Entorhinal Cortex

The entorhinal cortex (EC) is a critical element of the hippocampal formation located within the medial temporal lobe (MTL) in primates. The EC has historically received attention for being the primary mediator of cortical information going into and coming from the hippocampus proper. In this review, we highlight the significance of the EC as a major player in memory processing, along with other associated structures in the primate MTL. The complex, convergent topographies of cortical and subcortical input to the EC, combined with short-range intrinsic connectivity and the selective targeting of EC efferents to the hippocampus, provide evidence for subregional specialization and integration of information beyond what would be expected if this structure were a simple conduit of information for the hippocampus. Lesion studies of the EC provide evidence implicating this region as critical for memory and the flexible use of complex relational associations between experienced events. The physiology of this structure's constituent principal cells mirrors the complexity of its anatomy. EC neurons respond preferentially to aspects of memory-dependent paradigms including object, place, and time. EC neurons also show striking spatial representations as primates explore visual space, similar to those identified in rodents navigating physical space. In this review, we highlight the great strides that have been made toward furthering our understanding of the primate EC, and we identify paths forward for future experiments to provide additional insight into the role of this structure in learning and memory.

Apathy and depression during the recovery stage after stroke

Background/Aims

Both apathy and depression occur during the recovery period following stroke; however, the relationship between post-stroke apathy and depression is still unclear. The present study investigated the clinical course of apathy and its association with depression, cognitive function and daily function during the recovery period after stroke.

Methods

A total of 42 patients (29 male and 13 female, aged 69.1 ± 12.4 years) who had experienced stroke participated in this study. Each participant was assessed using the Apathy Scale, Self-rating Depression Scale, Mini-Mental State Examination, Clinical Assessment of Attention and Trail-Making-Test parts A and B. Quality of life was evaluated using the Stroke Specific Quality of Life Scale. Physical function and functional status were assessed using the Brunnstrom Stages of Stroke Recovery and Functional Independence Measure respectively.

Results

The incidence of apathy did not change from the time of admission to discharge. Apathy Scale score did not correlate with Self-rating Depression Scale score at admission, but it did correlate at the time of discharge. Patients with apathy after stroke suffered from greater cognitive disturbance and attention and executive dysfunctions than those without apathy. Total Functional Independence Measure score did not correlate with Apathy Scale or Self-rating Depression Scale score, but there was an association between Self-rating Depression Scale score and the Functional Independence Measure motor and Brunnstrom scores at discharge.

Conclusions

Apathy and depression had different relationships with cognitive and physical function during the recovery stage after stroke. The prevalence of apathy and depression changed, with the interrelationship between apathy and depression altering during the recovery period. Symptoms of apathy and depression should be distinguished from each other and appropriately evaluated to provide effective intervention to support physical and mental recovery after stroke.

Impaired emotional biases in visual attention after bilateral amygdala lesion

It is debated whether the amygdala is critical for the emotional modulation of attention. While some studies show reduced attentional benefits for emotional stimuli in amygdala-damaged patients, others report preserved emotional effects. Various factors may account for these discrepant findings, including the temporal onset of the lesion, the completeness and severity of tissue damage, or the extent of neural plasticity and compensatory mechanisms, among others. Here, we investigated a rare patient with focal acute destruction of bilateral amygdala and adjacent hippocampal structures after late-onset herpetic encephalitis in adulthood. We compared her performance in two classic visual attention paradigms with that of healthy controls. First, we tested for any emotional advantage during an attentional blink task. Whereas controls showed better report of fearful and happy than neutral faces on trials with short lags between targets, the patient showed no emotional advantage, but also globally reduced report rates for all faces. Second, to ensure that memory disturbance due to hippocampal damage would not interfere with report performance, we also used a visual search task with either emotionally or visually salient face targets. Although the patient still exhibited efficient guided search for visually salient, non-emotional faces, her search slopes for emotional versus neutral faces showed no comparable benefit. In both tasks, however, changes in the patient predominated for happy more than fear stimuli, despite her normal explicit recognition of happy expressions. Our results provide new support for a causal role of the amygdala in emotional facilitation of visual attention, especially under conditions of increasing task-demands, and not limited to negative information. In addition, our data suggest that such deficits may not be amenable to plasticity and compensation, perhaps due to sudden and late-onset damage occurring in adulthood.

Hippocampal vascular reserve associated with cognitive performance and hippocampal volume

Medial temporal lobe dependent cognitive functions are highly vulnerable to hypoxia in the hippocampal region, yet little is known about the relationship between the richness of hippocampal vascular supply and cognition. Hippocampal vascularization patterns have been categorized into a mixed supply from both the posterior cerebral artery and the anterior choroidal artery or a single supply by the posterior cerebral artery only. Hippocampal arteries are small and affected by pathological changes when cerebral small vessel disease is present. We hypothesized, that hippocampal vascularization patterns may be important trait markers for vascular reserve and modulate (i) cognitive performance; (ii) structural hippocampal integrity; and (iii) the effect of cerebral small vessel disease on cognition. Using high-resolution 7 T time-of-flight angiography we manually classified hippocampal vascularization patterns in older adults with and without cerebral small vessel disease in vivo. The presence of a mixed supplied hippocampus was an advantage in several cognitive domains, including verbal list learning and global cognition. A mixed supplied hippocampus also was an advantage for verbal memory performance in cerebral small vessel disease. Voxel-based morphometry showed higher anterior hippocampal grey matter volume in mixed, compared to single supply. We discuss that a mixed hippocampal supply, as opposed to a single one, may increase the reliability of hippocampal blood supply and thereby provide a hippocampal vascular reserve that protects against cognitive impairment.

Familiarity impairments after anterior temporal-lobe resection with hippocampal sparing: Lessons learned from case NB

We review evidence from an extensive single case study in an individual (NB) who underwent a rare left-sided anterior temporal-lobe resection with sparing of the hippocampus. Our study aimed to determine whether memory functions of perirhinal cortex, which was largely removed in the resection, can be impaired against a background of preserved hippocampus-dependent memory processing. This research was guided by the proposal that item-based familiarity assessment relies on contributions of perirhinal cortex, and that the hippocampus plays a unique role in the relational binding of items to episodic contexts, which is critical for recollection. Seven sets of findings have emerged from our research on NB (synthesized from five primary research articles), and from follow-up work in other patients: (i) Familiarity impairments can be selective and be revealed with multiple methods; (ii) selective familiarity and selective recollection impairments can be double dissociated; (iii) selective familiarity impairments show material specificity; (iv) selective familiarity impairments extend to assessment of cumulative lifetime experience; (v) selective familiarity impairments are sensitive to degree of feature overlap between object concepts; (vi) selective familiarity impairments are associated with preserved task-related fMRI signals in the hippocampus; (vii) selective familiarity impairments can be observed in other lesion cases. Despite our main focus on the dual-process framework, we also discuss implications for the functional organization of the medial temporal lobes in broader terms. We argue that our findings shed light on this organization even if the functional specialization of different medial temporal structures is ultimately not fully captured with reference to the cognitive distinction between familiarity and recollection.

Intelligence and epilepsy: The early era

This contribution to the commemoration of the 20th anniversary of Epilepsy & Behavior addresses the topic of epilepsy and intelligence, an early focus of interest in the history of the neuropsychology of epilepsy. The path through which the earliest measures of intelligence found their way to epilepsy research is reviewed followed by an overview of the subsequent themes of research, points of disagreement, advances in research using measures of intelligence, and developing awareness of the limitations associated with reliance on intelligence tests. Special Issue: Epilepsy & Behavior's 20th Anniversary.

Mind the Gap: Gap Affordance Judgments of Children, Teens, and Adults in an Immersive Virtual Environment

Affordances are possibilities for action that depend on both an observer's capabilities and the properties of the environment. Immersive Virtual Environments (IVEs) have been used to examine affordances in adults, demonstrating that judgments about action capabilities are made similarly to the real world. However, less is known about affordance judgments in middle-aged children and adolescents in IVEs. Differences in rate of growth, decision criteria, and perceived risk could influence affordance judgments for children. In Experiment 1, children, teens, and adults stood in an IVE at ground level or at a height of 15 m, and were asked to view gaps of different widths. Across all age groups, estimates of gap crossing were underestimated at the higher height compared to the ground, consistent with reports of fear and risk of falling. Children, compared to adults, underestimated their maximum crossable gap compared to their actual crossable gap. To test whether this difference was specific to IVEs or a more generalized age effect, children and adults were tested on gap estimates in the real world in Experiment 2. This real world study showed no difference between children and adults, suggesting a unique contribution of the IVE to children's affordance judgments. We discuss the implications for using IVEs to study children's affordances.

Preserved capacity for learning statistical regularities and directing selective attention after hippocampal lesions

Prior knowledge about the probabilistic structure of visual environments is necessary to resolve ambiguous information about objects in the world. Expectations based on stimulus regularities exert a powerful influence on human perception and decision making by improving the efficiency of information processing. Another type of prior knowledge, termed top-down attention, can also improve perceptual performance by facilitating the selective processing of relevant over irrelevant information. While much is known about attention, the mechanisms that support expectations about statistical regularities are not well-understood. The hippocampus has been implicated as a key structure involved in or perhaps necessary for the learning of statistical regularities, consistent with its role in various kinds of learning and memory. Here, we tested this hypothesis using a motion discrimination task in which we manipulated the most likely direction of motion, the degree of attention afforded to the relevant stimulus, and the amount of available sensory evidence. We tested memory-impaired patients with bilateral damage to the hippocampus and compared their performance with controls. Despite a modest slowing in response initiation across all task conditions, patients performed similar to controls. Like controls, patients exhibited a tendency to respond faster and more accurately when the motion direction was more probable, the stimulus was better attended, and more sensory evidence was available. Together, these findings demonstrate a robust, hippocampus-independent capacity for learning statistical regularities in the sensory environment in order to improve information processing.

Perirhinal circuits for memory processing

The perirhinal cortex (PRC) serves as the gateway to the hippocampus for episodic memory formation and plays a part in retrieval through its backward connectivity to various neocortical areas. First, I present the evidence suggesting that PRC neurons encode both experientially acquired object features and their associative relations. Recent studies have revealed circuit mechanisms in the PRC for the retrieval of cue-associated information, and have demonstrated that, in monkeys, PRC neuron-encoded information can be behaviourally read out. These studies, among others, support the theory that the PRC converts visual representations of an object into those of its associated features and initiates backward-propagating, interareal signalling for retrieval of nested associations of object features that, combined, extensionally represent the object meaning. I propose that the PRC works as the ventromedial hub of a 'two-hub model' at an apex of the hierarchy of a distributed memory network and integrates signals encoded in other downstream cortical areas that support diverse aspects of knowledge about an object.

The nature of recollection across months and years and after medial temporal lobe damage

We studied the narrative recollections of memory-impaired patients with medial temporal lobe (MTL) damage who took a 25-min guided walk during which 11 planned events occurred. The recollections of the patients, recorded directly after the walk, were compared with the recollections of controls tested directly after the walk (C1), after one month (C2), or after 2.6 years (C3). With respect to memory for the walk, the narrative recollections of the patients were impoverished compared with C1 but resembled the recollections of volunteers tested after long delays (C2 and C3). In addition, how language was used by the patients in their recollections resembled how language was used by groups C2 and C3 (higher-frequency words, less concrete words, fewer nouns, more adverbs, more pronouns, and more indefinite articles). These findings appear to reflect how individuals, either memory-impaired patients or controls, typically speak about the past when memory is weak and lacks detail and need not have special implications about language use and MTL function beyond the domain of memory. A notable exception to the similarity between patient narratives and the narratives of C2 and C3 was that the control groups reported the events of the walk in correct chronological order, whereas the order in which patients reported events bore no relationship to the order in which events occurred. We suggest that the MTL is especially important for accessing global information about events and the relationships among their elements.

Test-specific differences in verbal memory assessments used prior to surgery in temporal lobe epilepsy

OBJECTIVE

To study the relationship between two commonly used verbal memory tests in presurgical evaluation for temporal lobe epilepsy (TLE) in Sweden, the Claeson-Dahl Test for verbal learning and retention (CDT) and the Swedish version of the Rey Auditory Verbal Learning Test (RAVLT).

METHODS

Fifty-nine patients with TLE (male: 41%, mean: age 41.7 ± 12.3 years; epilepsy onset at mean age: 18.3 ± 13.1 years) previously tested with the CDT, the RAVLT, and three nonverbal memory tests on the same occasion were included. We performed (1) a principal component analysis (PCA) on test performances in the CDT and the RAVLT as well as in nonverbal memory tests; (2) a Pearson's correlation analysis for memory components, biological age, education, age at epilepsy onset, and self-rating scores for depression and anxiety; and (3) an estimation of clinically significant verbal memory impairment in patients with left TLE and left-sided hippocampal sclerosis.

RESULTS

The PCAs showed coherence between the learning variables of the CDT and the RAVLT and divergence between the recall variables of the two tests. The RAVLT delayed recall variable was correlated to four out of five nonverbal memory measures. Both tests showed 70-80% clinically significant impairment of verbal memory in patients with left TLE, with or without hippocampal sclerosis, similar to other cohorts with resistant TLE.

CONCLUSIONS

The construct structure of the two verbal memory differs. It was shown that the RAVLT correlated with visuospatial memory, whereas the CDT did not. The study highlights that there are important nonoverlapping features regarding verbal recall of the two tests, indicating that these tests cannot fully replace one another.

Spared perception of object geometry and object components after hippocampal damage

We tested the proposal that medial temporal lobe (MTL) structures support not just memory but also high-level object perception. In one task, participants decided whether a line drawing could represent an object in three-dimensional space and, in another task, they saw the components of an object and decided what object could be formed if the components were assembled. Patients with hippocampal lesions were intact, indicating that the hippocampus is not needed for perceiving the structural coherence of objects or appreciating the relations among object parts. Patients with large MTL lesions were moderately impaired, likely due to damage outside the MTL.

Verbal learning and memory outcome in selective amygdalohippocampectomy versus temporal lobe resection in patients with hippocampal sclerosis

PURPOSE

With the advent of new very selective techniques like thermal laser ablation to treat drug-resistant focal epilepsy, the controversy of resection size in relation to seizure outcome versus cognitive deficits has gained new relevance. The purpose of this study was to test the influence of the selective amygdalohippocampectomy (SAH) versus nonselective temporal lobe resection (TLR) on seizure outcome and cognition in patients with mesial temporal lobe epilepsy (MTLE) and histopathological verified hippocampal sclerosis (HS).

METHODS

We identified 108 adults (>16years) with HS, operated between 1995 and 2009 in Denmark. Exclusion criteria are the following: Intelligence below normal range, right hemisphere dominance, other native languages than Danish, dual pathology, and missing follow-up data. Thus, 56 patients were analyzed. The patients were allocated to SAH (n=22) or TLR (n=34) based on intraoperative electrocorticography. Verbal learning and verbal memory were tested pre- and postsurgery.

RESULTS

Seizure outcome did not differ between patients operated using the SAH versus the TLR at 1year (p=0.951) nor at 7years (p=0.177). Verbal learning was more affected in patients resected in the left hemisphere than in the right (p=0.002). In patients with left-sided TLR, a worsening in verbal memory performance was found (p=0.011). Altogether, 73% were seizure-free for 1year and 64% for 7years after surgery.

CONCLUSION

In patients with drug-resistant focal MTLE, HS and no magnetic resonance imaging (MRI) signs of dual pathology, selective amygdalohippocampectomy results in sustained seizure freedom and better memory function compared with patients operated with nonselective temporal lobe resection.

Hippocampal theta phase-contingent memory retrieval in delay and trace eyeblink conditioning

Hippocampal theta oscillations (3-12Hz) play a prominent role in learning. It has been suggested that encoding and retrieval of memories are supported by different phases of the theta cycle. Our previous study on trace eyeblink conditioning in rabbits suggests that the timing of the conditioned stimulus (CS) in relation to theta phase affects encoding but not retrieval of the memory trace. Here, we directly tested the effects of hippocampal theta phase on memory retrieval in two experiments conducted on adult female New Zealand White rabbits. In Experiment 1, animals were trained in trace eyeblink conditioning followed by extinction, and memory retrieval was tested by presenting the CS at troughs and peaks of the theta cycle during different stages of learning. In Experiment 2, animals were trained in delay conditioning either contingent on a high level of theta or at a random neural state. Conditioning was then followed by extinction conducted either at a random state, contingent on theta trough or contingent on theta peak. Our current results indicate that the phase of theta at CS onset has no effect on the performance of the behavioral learned response at any stage of classical eyeblink conditioning or extinction. In addition, theta-contingent trial presentation does not improve learning during delay eyeblink conditioning. The results are consistent with our earlier findings and suggest that the theta phase alone is not sufficient to affect learning at the behavioral level. It seems that the retrieval of recently acquired memories and consequently performing a learned response is moderated by neural mechanisms other than hippocampal theta.

Temporal and spectral characteristics of dynamic functional connectivity between resting-state networks reveal information beyond static connectivity

Estimation of functional connectivity (FC) has become an increasingly powerful tool for investigating healthy and abnormal brain function. Static connectivity, in particular, has played a large part in guiding conclusions from the majority of resting-state functional MRI studies. However, accumulating evidence points to the presence of temporal fluctuations in FC, leading to increasing interest in estimating FC as a dynamic quantity. One central issue that has arisen in this new view of connectivity is the dramatic increase in complexity caused by dynamic functional connectivity (dFC) estimation. To computationally handle this increased complexity, a limited set of dFC properties, primarily the mean and variance, have generally been considered. Additionally, it remains unclear how to integrate the increased information from dFC into pattern recognition techniques for subject-level prediction. In this study, we propose an approach to address these two issues based on a large number of previously unexplored temporal and spectral features of dynamic functional connectivity. A Generalized Autoregressive Conditional Heteroskedasticity (GARCH) model is used to estimate time-varying patterns of functional connectivity between resting-state networks. Time-frequency analysis is then performed on dFC estimates, and a large number of previously unexplored temporal and spectral features drawn from signal processing literature are extracted for dFC estimates. We apply the investigated features to two neurologic populations of interest, healthy controls and patients with temporal lobe epilepsy, and show that the proposed approach leads to substantial increases in predictive performance compared to both traditional estimates of static connectivity as well as current approaches to dFC. Variable importance is assessed and shows that there are several quantities that can be extracted from dFC signal which are more informative than the traditional mean or variance of dFC. This work illuminates many previously unexplored facets of the dynamic properties of functional connectivity between resting-state networks, and provides a platform for dynamic functional connectivity analysis that facilitates its usage as an investigative measure for healthy as well as abnormal brain function.

Current Topics Regarding the Function of the Medial Temporal Lobe Memory System

The first clear insight that the medial temporal lobe of the human brain was in fact a system of anatomically connected structures that were organized into a memory system came in 1957 from the observations by Brenda Milner of the noted amnesic patient H.M. Subsequent work in humans, monkeys, and rodents has identified all of the components of the medial temporal lobe (MTL) that formed the memory system. Currently, work is ongoing to identify the specific contributions each structure in the medial temporal lobe makes towards the formation and storage of long-term declarative memory. The historical background of this work is described including what insights the study of noted neurologic patients H.M. and E.P. provided for understanding the function of the medial temporal lobe. The development of an animal model of medial temporal lobe function is described. Additionally, the insights that lead to the understanding that the brain contains multiple, anatomically discrete, memory systems are described. Finally, three current topics of debate are addressed: First, does the perirhinal cortex exclusively support memory, or does it support both memory and higher order visual perception? Second, is there an anatomical separation between recollection and familiarity ? Third, is the organization of spatial memory different between humans and rats, or perhaps the difference is between the working memory capacities of the two species?

Current Topics Regarding the Function of the Medial Temporal Lobe Memory System

The first clear insight that the medial temporal lobe of the human brain was in fact a system of anatomically connected structures that were organized into a memory system came in 1957 from the observations by Brenda Milner of the noted amnesic patient H.M. Subsequent work in humans, monkeys, and rodents has identified all of the components of the medial temporal lobe (MTL) that formed the memory system. Currently, work is ongoing to identify the specific contributions each structure in the medial temporal lobe makes towards the formation and storage of long-term declarative memory. The historical background of this work is described including what insights the study of noted neurologic patients H.M. and E.P. provided for understanding the function of the medial temporal lobe. The development of an animal model of medial temporal lobe function is described. Additionally, the insights that lead to the understanding that the brain contains multiple, anatomically discrete, memory systems are described. Finally, three current topics of debate are addressed: First, does the perirhinal cortex exclusively support memory, or does it support both memory and higher order visual perception? Second, is there an anatomical separation between recollection and familiarity? Third, is the organization of spatial memory different between humans and rats, or perhaps the difference is between the working memory capacities of the two species?