Intact learning of new relations in amnesia as achieved through unitization

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

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

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

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

The effect of hippocampal subfield damage on rapid temporal integration through statistical learning and associative inference

INTRODUCTION

The hippocampus (HPC) supports integration of information across time, often indexed by associative inference (AI) and statistical learning (SL) tasks. In AI, an indirect association between stimuli that never appeared together is inferred, whereas SL involves learning item relationships by extracting regularities across experiences. A recent model of hippocampal function (Schapiro et al., 2017) proposes that the HPC can support temporal integration in both paradigms through its two distinct pathways.

METHODS

We tested this models' predictions in four patients with varying degrees of bilateral HPC damage and matched healthy controls, with two patients with complementary damage to either the monosynaptic or trisynaptic pathway. During AI, participants studied overlapping paired associates (AB, BC) and their memory was tested for premise pairs (AB) and for inferred pairs (AC). During SL, participants passively viewed a continuous picture sequence that contained an underlying structure of triplets that later had to be recognized.

RESULTS

Binomial distributions were used to calculate above chance performance at the individual level. For AI, patients with focal HPC damage were impaired at inference but could correctly infer pairs above chance once premise pair acquisition was equated to controls; however, the patient with HPC and cortical damage showed severe impairment at recalling premise and inferred pairs, regardless of accounting for premise pair performance. For SL, none of the patients performed above chance, but notably neither did most controls.

CONCLUSIONS

Associative inference of indirect relationships can be intact with HPC damage to either hippocampal pathways or the HPC more broadly, provided premise pairs can first be formed. Inference may remain intact through residual HPC tissue supporting premise pair acquisition, and/or through extra-hippocampal structures supporting inference at retrieval. Clear conclusions about hippocampal contributions to SL are precluded by low performance in controls, which we caution is not dissimilar to previous amnesic studies using the same task. This complicates interpretations of studies claiming necessity of hippocampal contributions to SL and warrants the use of a common and reliable task before conclusions can be drawn.

Drawing improves memory in patients with hippocampal damage

The hippocampus plays a critical role in the formation of declarative memories, and hippocampal damage leads to significant impairments in new memory formation. Drawing can serve as a form of multi-modal encoding that improves declarative memory performance relative to other multimodal encoding strategies such as writing. We examined whether, and to what extent, patients with hippocampal damage could benefit from the mnemonic strategy of drawing. Three patients with focal hippocampal damage, and one patient with both hippocampal and cortical lesions, in addition to 22 age-, sex-, and education-matched controls, were shown a list of words one at a time during encoding and instructed to either draw a picture or repeatedly write each word for 40 s. Following a brief filled delay, free recall and recognition memory for words from both encoding trial types were assessed. Controls showed enhanced recall and recognition memory for words drawn versus those that were written, an effect that was even more pronounced in patients with focal hippocampal damage. By contrast, the patient with both hippocampal and cortical lesions showed no drawing-mediated boost in either recall or recognition memory. These findings demonstrate that drawing is an effective encoding strategy, likely accruing from the engagement of extra-hippocampal processes including the integration of cortical-based motor, visual, and semantic processing, enabling more elaborative encoding.

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.

Temporary amnesia from sleep loss: A framework for understanding consequences of sleep deprivation

Throughout its modern history, sleep research has been concerned with both the benefits of sleep and the deleterious impact of sleep disruption for cognition, behavior, and performance. When more specifically examining the impact of sleep on memory and learning, however, research has overwhelmingly focused on how sleep following learning facilitates memory, with less attention paid to how lack of sleep prior to learning can disrupt subsequent memory. Although this imbalance in research emphasis is being more frequently addressed by current investigators, there is a need for a more organized approach to examining the effect of sleep deprivation before learning. The present review briefly describes the generally accepted approach to analyzing effects of sleep deprivation on subsequent memory and learning by means of its effects on encoding. Then, we suggest an alternative framework with which to understand sleep loss and memory in terms of temporary amnesia from sleep loss (TASL). The review covers the well-characterized properties of amnesia arising from medial temporal lobe lesions and shows how the pattern of preserved and impaired aspects of memory in amnesia may also be appearing during sleep loss. The view of the TASL framework is that amnesia and the amnesia-like deficits observed during sleep deprivation not only affect memory processes but will also be apparent in cognitive processes that rely on those memory processes, such as decision-making. Adoption of the TASL framework encourages movement away from traditional explanations based on narrowly defined domains of memory functioning, such as encoding, and taking instead a more expansive view of how brain structures that support memory, such as the hippocampus, interact with higher structures, such as the prefrontal cortex, to produce complex cognition and behavioral performance, and how this interaction may be compromised by sleep disruption.

Exploring the sociodemographic, clinical and neuropsychological factors associated with relational memory in schizophrenia

INTRODUCTION

The Transverse Patterning (TP) task has been used to measure episodic relational memory (RM) deficits in clinical populations. Individuals with schizophrenia often fail to learn TP with standard, and sometimes extensive training. Identifying the differences between TP learners and non-learners can improve our understanding of successful TP performance and its underlying mechanisms, which may help improve interventions aimed at ameliorating RM performance. We investigated sociodemographic, clinical and neuropsychological factors associated with TP performance in schizophrenia.

METHODS

Sixty-six participants with schizophrenia completed a semantically rich and a relational-binding dependent version of the TP task and reported on their task awareness and strategy use.

RESULTS

Twenty-six participants failed to learn the task rules after extensive training. Learners had superior verbal, visual and working memory, executive functions and overall cognitive functioning compared to non-learners. Learners also had superior awareness of task rules and pairs relationships and used elaborated cognitive strategies more often.

CONCLUSIONS

Our results support previous findings that some individuals with schizophrenia show RM impairment even with extensive TP training. We shed light on neuropsychological and metacognitive factors associated with TP performance. This knowledge could enhance interventions targeted to improve relational memory in schizophrenia when extensive training fails.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSION

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

No consolidation without representation: Correspondence between neural and psychological representations in recent and remote memory

Memory systems consolidation is often conceived as the linear, time-dependent, neurobiological shift of memory from hippocampal-cortical to cortico-cortical dependency. We argue that contrary to this unidirectional view of memory reorganization, information about events may be retained in multiple forms (e.g., event-specific sensory-near episodic memory, event-specific gist information, event-general schematic information, or abstract semantic memory). These representations can all form at the time of the event and may continue to coexist for long durations. Their relative strength, composition, and dominance of expression change with time and experience, with task demands, and through their dynamic interaction with one another. These different psychological mnemonic representations depend on distinct functional and structural neurobiological substrates such that there is a neural-psychological representation correspondence (NPRC) among them. We discuss how the dynamics of psychological memory representations are reflected in multiple levels of neurobiological markers and their interactions. By this view, there are only variations of synaptic consolidation and memory dynamics without assuming a distinct systems consolidation process.

The interaction of relational encoding and unitization: Effects on medial temporal lobe processing during retrieval

In retrieval of typical episodic memories, recollection leads to retrieval of context details whereas familiarity is only diagnostic for item memory. Unitization is an encoding strategy that allows context details to be processed as item features and therefore increases the involvement of familiarity-based recognition in retrieval of these context details. Relational encoding is a hippocampally-dependent process that stores items and contexts independently. Our previous study Tu and Diana [1] concluded that mixing unitized and non-unitized context details in the same episode reduced the contribution of familiarity to retrieval of any one detail. In the current study, we modified the paradigm by removing visual cues to the context details and the condition-specific blocking during test. Surprisingly, the behavioral data diverged from our 2016 study and indicated that the two manipulated context details in the modified paradigm were processed independently of one another. Neuroimaging data further revealed anterior hippocampal activation was associated with unitization of source information as compared to relational encoding. We also found the predicted increase in bilateral perirhinal cortex activation and decrease in parahippocampal cortex activation during retrieval of unitized color information when compared to relationally-encoded color information. We did not find that same predicted pattern of differences due to unitization of size information.

Experience Transforms Conjunctive Object Representations: Neural Evidence for Unitization After Visual Expertise

Certain transformations must occur within the brain to allow rapid processing of familiar experiences. Complex objects are thought to become unitized, whereby multifeature conjunctions are retrieved as rapidly as a single feature. Behavioral studies strongly support unitization theory, but a compelling neural mechanism is lacking. Here, we examined how unitization transforms conjunctive representations to become more “feature-like” by recruiting posterior regions of the ventral visual stream (VVS) whose architecture is specialized for processing single features. We used functional magnetic resonance imaging to scan humans before and after visual training with novel objects. We implemented a novel multivoxel pattern analysis to measure a conjunctive code, which represented a conjunction of object features above and beyond the sum of the parts. Importantly, a multivoxel searchlight showed that the strength of conjunctive coding in posterior VVS increased posttraining. Furthermore, multidimensional scaling revealed representational separation at the level of individual features in parallel to the changes at the level of feature conjunctions. Finally, functional connectivity between anterior and posterior VVS was higher for novel objects than for trained objects, consistent with early involvement of anterior VVS in unitizing feature conjunctions in response to novelty. These data demonstrate that the brain implements unitization as a mechanism to refine complex object representations over the course of multiple learning experiences.

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.

Scale-invariant Characteristics of Forgetting: Toward a Unifying Account of Hippocampal Forgetting across Short and Long Timescales

After over 100 years of relative silence in the cognitive literature, recent advances in the study of the neural underpinnings of memory-specifically, the hippocampus-have led to a resurgence of interest in the topic of forgetting. This review draws a theoretically driven picture of the effects of time on forgetting of hippocampus-dependent memories. We review evidence indicating that time-dependent forgetting across short and long timescales is reflected in progressive degradation of hippocampal-dependent relational information. This evidence provides an important extension to a growing body of research accumulated in recent years, showing that-in contrast to the once prevailing view that the hippocampus is exclusively involved in memory and forgetting over long timescales-the role of the hippocampus also extends to memory and forgetting over short timescales. Thus, we maintain that similar rules govern not only remembering but also forgetting of hippocampus-dependent information over short and long timescales.

Recalling the firedog: Individual differences in associative memory for unitized and nonunitized associations among older adults

Memory deficits in aging are characterized by impaired hippocampus-mediated relational binding-the formation of links between items in memory. By reducing reliance on relational binding, unitization of two items into one concept enhances associative recognition among older adults. Can a similar enhancement be obtained when probing memory with recall? This question has yet to be examined, because recall has been assumed to rely predominantly on relational binding. Inspired by recent evidence challenging this assumption, we investigated individual differences in older adults' recall of unitized and nonunitized associations. Compared with successfully aging individuals, older adults with mild memory deficits, typically mediated by the hippocampus, were impaired in recall of paired-associates in a task which relies on relational binding (study: "PLAY-TUNNEL"; test: PLAY-T?). In stark contrast, the two groups showed similar performance when items were unitized into a novel compound word (study: "LOVEGIGGLE"; test: LOVEG?). Thus, boosting nonrelational aspects of recall enhances associative memory among aging individuals with subtle memory impairments to comparable levels as successfully aging older adults.

Associative memory for conceptually unitized word pairs in mild cognitive impairment is related to the volume of the perirhinal cortex

Unitization, that is, the encoding of an association as one integrated entity, has been shown to improve associative memory in populations presenting with associative memory deficit due to hippocampal dysfunction, such as amnesic patients with focal hippocampal lesions and healthy older adults. One reason for this benefit is that encoding of unitized associations would rely on the perirhinal cortex (PrC) and thus minimize the need for hippocampal recruitment. Mild cognitive impairment (MCI) is accompanied by a deficit in associative memory. However, unitization has never been studied to explore the potential benefit in associative memory in MCI, maybe because MCI is characterized by PrC pathology. However, the PrC may potentially still function sufficiently to allow for the successful adoption of unitization. In this study, we aimed at assessing whether unitization could attenuate MCI patients' associative memory deficit, and whether the ability to remember unitized associations would be modulated by the integrity of the PrC in MCI patients. Unitization was manipulated at a conceptual level, by encouraging participants to encode unrelated word pairs as new compound words. Participants also underwent a structural MRI exam, and measures of PrC were extracted (Brodmann Areas [BA] 35 and 36). Results showed that, contrary to healthy controls, MCI patients did not benefit from unitization. Moreover, their memory performance for unitized associations was related to the measure of PrC integrity (BA35), while it was not the case in controls. This finding thus suggests that unitization does not help to attenuate the associative deficit in MCI patients, and brings support to the literature linking unitization to the PrC function.

Coherence and congruency mediate medial temporal and medial prefrontal activity during event construction

The precise roles of the hippocampus (HPC) and medial prefrontal cortex (mPFC) in initially constructing imagined events remains unclear. HPC activity during imagination may be modulated by mnemonic load, given its role in working memory for complex materials, and/or by the semantic relatedness (i.e. congruency) between items and their context. MPFC activation may track with congruency or mnemonic load, given the role of ventral mPFC in schema processing and the dorsal mPFC in working memory for social information. Sixteen healthy adults (M age = 22.3) underwent an event construction task, wherein participants were provided with a context and item words and imagined an event, forming as many inter-item associations as possible among the items. The stimuli varied by set size and by normatively-defined congruence (normative congruency) to explore their effects on HPC and mPFC activity and functional connectivity. We observed HPC connectivity during event construction in general, whereas dorsal mPFC connectivity occurred during imagining only at higher set sizes. Moreover, anterior hippocampal activity correlated positively with increasing coherence between items during imagining, suggesting that the anterior HPC is sensitive to the relational demands of constructing a novel event. Parahippocampal, hippocampal, temporal pole, and mPFC activity tracked only with individual differences in subjective ratings of congruency of imagined events, which may contribute to construction by retrieving existing schema-related information. Collectively, these findings provide new insights into the factors that modulate HPC and mPFC activity when constructing mental simulations.

The hippocampus is critical for value-based decisions guided by dissociative inference

The hippocampus supports flexible decision-making through memory integration: bridging across episodes and inferring associations between stimuli that were never presented together ('associative inference'). A pre-requisite for memory integration is flexible representations of the relationships between stimuli within episodes (AB) but also of the constituent units (A,B). Here we investigated whether the hippocampus is required for parsing experienced episodes into their constituents to infer their re-combined within-episode associations ('dissociative inference'). In three experiments male rats were trained on an appetitive conditioning task using compound auditory stimuli (AB+, BA+, CD-, DC-). At test either the compound or individual stimuli were presented as well as new stimuli. Rats with hippocampal lesions acquired and retained the compound discriminations as well as controls. Single constituent stimuli (A, B, C, D) were presented for the first time at test, so the only value with which they could be associated was the one from the compound to which they belonged. Controls inferred constituent tones' corresponding values while hippocampal rats did not, treating them as merely familiar stimuli with no associated value. This finding held whether compound training occurred before or after hippocampal lesions, suggesting that hippocampus-dependent inferential processes more likely occur at retrieval. The findings extend recent discoveries about the role of the hippocampus in intrinsic value representation, demonstrating hippocampal contributions to allocating value from primary rewards to individual stimuli. Importantly, we discovered that dissociative inferences serve to restructure or reparse patterns of directly acquired associations when animals are faced with environmental changes and need to extract relevant information from a multiplex memory. The hippocampus is critical for this fundamental flexible use of associations.

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

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

The missing link? Testing a schema account of unitization

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

Impaired perceptual integration and memory for unitized representations are associated with perirhinal cortex atrophy in Alzheimer's disease

Unitization, the capacity to encode associations as one integrated entity, can enhance associative memory in populations with an associative memory deficit by promoting familiarity-based associative recognition. Patients with Alzheimer's disease (AD) are typically impaired in associative memory compared with healthy controls but do not benefit from unitization strategies. Using fragmented pictures of objects, this study aimed at assessing which of the cognitive processes that compose unitization is actually affected in AD: the retrieval of unitized representations itself, or some earlier stages of processing, such as the integration process at a perceptual or conceptual stage of representation. We also intended to relate patients' object unitization capacity to the integrity of their perirhinal cortex (PrC), as the PrC is thought to underlie unitization and is also one of the first affected regions in AD. We evaluated perceptual integration capacity and subsequent memory for those items that have supposedly been unitized in 23 mild AD patients and 20 controls. We systematically manipulated the level of perceptual integration during encoding by presenting object pictures that were either left intact, separated into 2 fragments, or separated into 4 fragments. Subjects were instructed to unitize the fragments into a single representation. Success of integration was assessed by a question requiring the identification of the object. Participants also underwent a structural magnetic resonance imaging examination, and measures of PrC, posterior cingulate cortex volume and thickness, and hippocampal volume, were extracted. The results showed that patients' perceptual integration performance decreased with the increased fragmentation level and that their memory for unitized representations was impaired whatever the demands in terms of perceptual integration at encoding. Both perceptual integration and memory for unitized representations were related to the integrity of the PrC, and memory for unitized representations was also related to the volume of the hippocampus. We argue that, globally, this supports representational theories of memory that hold that the role of the PrC is not only perceptual nor mnemonic but instead underlies complex object representation.

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.

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

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

Hand gestures support word learning in patients with hippocampal amnesia

Co-speech hand gesture facilitates learning and memory, yet the cognitive and neural mechanisms supporting this remain unclear. One possibility is that motor information in gesture may engage procedural memory representations. Alternatively, iconic information from gesture may contribute to declarative memory representations mediated by the hippocampus. To investigate these alternatives, we examined gesture's effects on word learning in patients with hippocampal damage and declarative memory impairment, with intact procedural memory, and in healthy and in brain-damaged comparison groups. Participants learned novel label-object pairings while producing gesture, observing gesture, or observing without gesture. After a delay, recall and object identification were assessed. Unsurprisingly, amnesic patients were unable to recall the labels at test. However, they correctly identified objects at above chance levels, but only if they produced a gesture at encoding. Comparison groups performed well above chance at both recall and object identification regardless of gesture. These findings suggest that gesture production may support word learning by engaging nondeclarative (procedural) memory.

Dynamic functional connectivity shapes individual differences in associative learning

Current neuroscientific research has shown that the brain reconfigures its functional interactions at multiple timescales. Here, we sought to link transient changes in functional brain networks to individual differences in behavioral and cognitive performance by using an active learning paradigm. Participants learned associations between pairs of unrelated visual stimuli by using feedback. Interindividual behavioral variability was quantified with a learning rate measure. By using a multivariate statistical framework (partial least squares), we identified patterns of network organization across multiple temporal scales (within a trial, millisecond; across a learning session, minute) and linked these to the rate of change in behavioral performance (fast and slow). Results indicated that posterior network connectivity was present early in the trial for fast, and later in the trial for slow performers. In contrast, connectivity in an associative memory network (frontal, striatal, and medial temporal regions) occurred later in the trial for fast, and earlier for slow performers. Time-dependent changes in the posterior network were correlated with visual/spatial scores obtained from independent neuropsychological assessments, with fast learners performing better on visual/spatial subtests. No relationship was found between functional connectivity dynamics in the memory network and visual/spatial test scores indicative of cognitive skill. By using a comprehensive set of measures (behavioral, cognitive, and neurophysiological), we report that individual variations in learning-related performance change are supported by differences in cognitive ability and time-sensitive connectivity in functional neural networks. Hum Brain Mapp 37:3911-3928, 2016. © 2016 Wiley Periodicals, Inc.

Learning and using knowledge about what other people do and don't know despite amnesia

Successful communication requires keeping track of what other people do and do not know, and how this differs from our own knowledge. Here we ask how knowledge of what others know is stored in memory. We take a neuropsychological approach, comparing healthy adults to patients with severe declarative memory impairment (amnesia). We evaluate whether this memory impairment disrupts the ability to successfully acquire and use knowledge about what other people know when communicating with them. We tested participants in a referential communication task in which the participants described a series of abstract "tangram" images for a partner. Participants then repeated the task with the same partner or a new partner. Findings show that much like healthy individuals, individuals with amnesia successfully tailored their communicative language to the knowledge shared with their conversational partner-their common ground. They produced brief descriptions of the tangram images for the familiar partner and provided more descriptive, longer expressions for the new partner. These findings demonstrate remarkable sparing in amnesia of the acquisition and use of partner-specific knowledge that underlies common ground, and have important implications for understanding the memory systems that support conversational language.

Increasing relational memory in childhood with unitization strategies

Young children often experience relational memory failures, which are thought to result from immaturity of the recollection processes presumed to be required for these tasks. However, research in adults has suggested that relational memory tasks can be accomplished using familiarity, a process thought to be mature by the end of early childhood. The goal of the present study was to determine whether relational memory performance could be improved in childhood by teaching young children memory strategies that have been shown to increase the contribution of familiarity in adults (i.e., unitization). Groups of 6- and 8-year-old children were taught to use visualization strategies that either unitized or did not unitize pictures and colored borders. Estimates of familiarity and recollection were extracted by fitting receiver operator characteristic curves (Yonelinas, Journal of Experimental Psychology: Learning, Memory, and Cognition 20, 1341-1354, 1994, Yonelinas, Memory & Cognition 25, 747-763, 1997) based on dual-process models of recognition. Bayesian analysis revealed that strategies involving unitization improved memory performance and increased the contribution of familiarity in both age groups.

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.

Transverse patterning, aging, and neuropsychological correlates in humans

Transverse patterning is a learning and memory adaptation of the 'rock/paper/scissors' problem that has been though to depend on the hippocampus, is sensitive to aging, and requires pattern separation to solve. Previous investigators dichotomized cognitively normal older adults who passed a cognitive screening into impaired and unimpaired subsets, and found that impaired older adults were disproportionately deficient in pattern separation abilities. However, this variability in pattern separation ability has not been examined using a transverse patterning task. Our aims, then, were two-fold: First, to determine if impaired older adults were inferior on transverse patterning compared to unimpaired older adults and young adults; second, to identify the neuropsychological correlates of transverse patterning. Our findings revealed that impaired older adults required more trials to criterion on the transverse patterning task than both young adults and unimpaired older adults. Unimpaired older adults also required more trials to criterion than young adults. A detailed analysis of the transverse patterning task confirmed that the aforementioned group differences were only observed in high interference conditions when pattern separation demands were at their peak. Finally, regression analyses showed that both memory and executive functioning neuropsychological composite scores were related to different indices of transverse patterning performance. Consistent with the pattern separation literature, and despite passing a cognitive screening, we found disproportionate transverse patterning deficits in impaired older adults. Forthcoming work should determine if transverse patterning performance is similar between impaired older adults and patients with Mild Cognitive Impairment. © 2016 Wiley Periodicals, Inc.

Impaired inference in a case of developmental amnesia

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

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

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

Novel sensory preconditioning procedures identify a specific role for the hippocampus in pattern completion

Successful retrieval of a memory for an entire pattern of stimulation by the presentation of a fragment of that pattern is a critical facet of memory function. We examined processes of pattern completion using novel sensory preconditioning procedures in rats that had either received sham lesions (group Sham) or lesions of the hippocampus (group HPC). After exposure to two audio-visual patterns (AX and BY) rats received fear conditioning with X (but not Y). Subsequent tests assessed fear to stimulus compounds (e.g., AX versus BX; Experiment 1) or elements (A versus B; Experiment 2). There was more fear to AX than BX in group Sham but not group HPC, while there was more fear to A than B in group HPC, but not in group Sham. This double dissociation suggests that pattern completion can be based upon separable processes that differ in their reliance on the hippocampus.

Episodic Memory and Beyond: The Hippocampus and Neocortex in Transformation

The last decade has seen dramatic technological and conceptual changes in research on episodic memory and the brain. New technologies, and increased use of more naturalistic observations, have enabled investigators to delve deeply into the structures that mediate episodic memory, particularly the hippocampus, and to track functional and structural interactions among brain regions that support it. Conceptually, episodic memory is increasingly being viewed as subject to lifelong transformations that are reflected in the neural substrates that mediate it. In keeping with this dynamic perspective, research on episodic memory (and the hippocampus) has infiltrated domains, from perception to language and from empathy to problem solving, that were once considered outside its boundaries. Using the component process model as a framework, and focusing on the hippocampus, its subfields, and specialization along its longitudinal axis, along with its interaction with other brain regions, we consider these new developments and their implications for the organization of episodic memory and its contribution to functions in other domains.

Impairments in precision, rather than spatial strategy, characterize performance on the virtual Morris Water Maze: A case study

Damage to the medial temporal lobes produces profound amnesia, greatly impairing the ability of patients to learn about new associations and events. While studies in rodents suggest a strong link between damage to the hippocampus and the ability to navigate using distal landmarks in a spatial environment, the connection between navigation and memory in humans remains less clear. Past studies on human navigation have provided mixed findings about whether patients with damage to the medial temporal lobes can successfully acquire and navigate new spatial environments, possibly due, in part, to issues related to patient demographics and characterization of medial temporal lobe damage. Here, we report findings from a young, high functioning patient who suffered severe medial temporal lobe damage. Although the patient is densely amnestic, her ability to acquire and utilize new, but coarse, spatial "maps" appears largely intact. Specifically, a novel computational analysis focused on the precision of her spatial search revealed a significant deficit in spatial precision rather than spatial search strategy. These findings argue that an intact hippocampus in humans is not necessary for representing multiple external landmarks during spatial navigation of new environments. We suggest instead that the human hippocampus may store and represent complex high-resolution bindings of features in the environment as part of a larger role in perception, memory, and navigation.

Relational learning and transitive expression in aging and amnesia

Aging has been associated with a decline in relational memory, which is critically supported by the hippocampus. By adapting the transitivity paradigm (Bunsey and Eichenbaum (1996) Nature 379:255‐257), which traditionally has been used in nonhuman animal research, this work examined the extent to which aging is accompanied by deficits in relational learning and flexible expression of relational information. Older adults' performance was additionally contrasted with that of amnesic case DA to understand the critical contributions of the medial temporal lobe, and specifically, the hippocampus, which endures structural and functional changes in healthy aging. Participants were required to select the correct choice item (B versus Y) based on the presented sample item (e.g., A). Pairwise relations must be learned (A‐>B, B‐>C, C‐>D) so that ultimately, the correct relations can be inferred when presented with a novel probe item (A‐>C?Z?). Participants completed four conditions of transitivity that varied in terms of the degree to which the stimuli and the relations among them were known pre‐experimentally. Younger adults, older adults, and DA performed similarly when the condition employed all pre‐experimentally known, semantic, relations. Older adults and DA were less accurate than younger adults when all to‐be‐learned relations were arbitrary. However, accuracy improved for older adults when they could use pre‐experimentally known pairwise relations to express understanding of arbitrary relations as indexed through inference judgments. DA could not learn arbitrary relations nor use existing knowledge to support novel inferences. These results suggest that while aging has often been associated with an emerging decline in hippocampal function, prior knowledge can be used to support novel inferences. However, in case DA, significant damage to the hippocampus likely impaired his ability to learn novel relations, while additional damage to ventromedial prefrontal and anterior temporal regions may have resulted in an inability to use prior knowledge to flexibly express indirect relational knowledge. © 2015 The Authors Hippocampus Published by Wiley Periodicals, Inc.

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

Recently, the amnesic case D.A. was shown to circumvent his relational memory impairments, as observed in the transverse patterning (TP) task, using a self-generated unitization strategy, and such performance benefits were maintained over extended delays (Ryan et al., 2013). "Unitization" encourages fusing of distinct items, through an action, into a single unit from which the relations among the items may then be derived. Here, we provide the first documentation of the developmental amnesic case, N.C., who presents with relatively circumscribed lesions to the extended hippocampal system, and with impaired episodic memory. Despite impairments on standard versions of TP, N.C. benefited from unitization, showed evidence of transfer to novel stimuli, and maintained his performance over extended delays. These findings suggest that self-generation is not a requirement for the successful implementation of unitization, and further provides the first evidence of rapid transfer and long-lasting success of a learning strategy in a human amnesic case.