A neurophenomenological model for the role of the hippocampus in temporal consciousness. Evidence from confabulation

Network Localization of Spontaneous Confabulation

OBJECTIVE

Spontaneous confabulation is a symptom in which false memories are conveyed by the patient as true. The purpose of the study was to identify the neuroanatomical substrate of this complex symptom and evaluate the relationship to related symptoms, such as delusions and amnesia.

METHODS

Twenty-five lesion locations associated with spontaneous confabulation were identified in a systematic literature search. The network of brain regions functionally connected to each lesion location was identified with a large connectome database (N=1,000) and compared with networks derived from lesions associated with nonspecific (i.e., variable) symptoms (N=135), delusions (N=32), or amnesia (N=53).

RESULTS

Lesions associated with spontaneous confabulation occurred in multiple brain locations, but they were all part of a single functionally connected brain network. Specifically, 100% of lesions were connected to the mammillary bodies (familywise error rate [FWE]-corrected p<0.05). This connectivity was specific for lesions associated with confabulation compared with lesions associated with nonspecific symptoms or delusions (FWE-corrected p<0.05). Lesions associated with confabulation were more connected to the orbitofrontal cortex than those associated with amnesia (FWE-corrected p<0.05).

CONCLUSIONS

Spontaneous confabulation maps to a common functionally connected brain network that partially overlaps, but is distinct from, networks associated with delusions or amnesia. These findings lend new insight into the neuroanatomical bases of spontaneous confabulation.

Interventions for confabulation: A systematic literature review

OBJECTIVE

Confabulations are false memories which are expressedwithout the intention to deceive and arise following brain damage or psychological dysfunction. Confabulations can become a barrier to effective neuropsychological rehabilitation and consequently, intervention is required.The current review aimed to provide a detailed evaluative account of existing interventions for confabulation and their relative effectiveness.

METHOD

The search process found 11 studies conducive with the inclusion and exclusion criteria. A methodological quality assessment was then carried out and the majority of included studies demonstrated poor methodological quality.

RESULTS

Ten types of interventions were identified and the majority of theseled to a reduction or elimination of confabulations.

CONCLUSION

Since methodological quality of many included studies was deemed unsatisfactory, further large-scale experimental research and standardised measures are necessary to adequately compare the relative effectiveness of these interventions. Further research and clinical implications are also highlighted.

Episodic memory false recognition for familiar information in Alzheimer's disease

Patients with Alzheimer's disease (AD) suffer from various types of memory distortions. We showed that confabulations are plausible memories, mainly reflecting the recall of repeated personal events mistakenly considered by confabulating patients as specific and unique events. The aim of this study is to see whether the notion that over-learned information interferes in episodic memory recall, as it does in confabulation, can be extended to another type of memory distortion, namely false recognition (i.e., a claim to recognize something that was not encountered previously). If this is the case, it should be expected that in an episodic recognition memory task AD patients produce more false recognition for well known non-studied, non to-be-remembered material than for unknown non-studied, non to-be-remembered material. In order to verify this prediction, AD patients and normal controls (NC) were administered two experiments. In Experiment 1, we presented pictures, of which half were supposed to be well known and the other half unknown monuments. For each picture, participants were asked to say whether or not the monument was known or not to them. Immediately following this semantic encoding task, participants were administered an episodic recognition memory task in which, in the same way as in the previous phase, among the non-studied items, half were supposed to be well known and the other half unknown. In Experiment 2 the same procedure was used employing well known and unknown symbols. It was predicted that AD patients make more false recognitions for non-studied well-known items than for non-studied unknown items. The results show that this is actually the case, suggesting that confusion between "uniqueness," i.e., specific unique events, and "multiplicity," i.e., repeated events, is also involved in false recognition.

Mnemonic monitoring in anosognosia for memory loss

OBJECTIVE

Anosognosia, or unawareness, for memory loss has been proposed to underlie cognitive functions such as memory and executive function. However, there is an inconsistent association between these constructs. Recent studies have shown that compromise ongoing self-monitoring of one's memory associates with anosognosia for memory loss. Yet to date it is unclear which memory monitoring mechanisms are impaired in these patients. In this study, we examined the extent to which temporal monitoring or orbitofrontal reality filtering (e.g., ability to monitor the temporal relevance of a memory) and source monitoring (e.g., the ability to distinguish which memories stem from internal as opposed to external sources) are associated with awareness of memory deficits.

METHOD

A total of 35 patients (M = 69 years; M = 14 years of education) with memory difficulties following a stroke were recruited from outpatient clinics. Patients were assessed with measures of self-awareness of memory difficulties, cognitive abilities and 2 experimental paradigms assessing source and temporal monitoring.

RESULTS AND CONCLUSION

Results showed that patients unaware of their memory difficulties were more likely to externalize the source of their memories. Specifically, those unaware of their deficits were more likely to assign an external source to memories that were internally produced (e.g., imagined). No differences were observed in relation to temporal monitoring between patients aware and unaware of their deficits. This study informs current theoretical models of self-awareness of memory loss. Future studies should attempt to replicate these findings and explore different memory monitoring mechanisms in relation to anosognosia for memory loss. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Confabulation affecting Temporal Consciousness significantly more than Knowing Consciousness

Confabulation, defined as the production of statements and actions that are unintentionally incongruous to the patient's history, background, present and future situation, is a rather infrequent memory disorder, which usually affects patients with significant memory impairment, but may be also observed in patients with normal memory and learning abilities. Confabulation may be selective affecting some cognitive, memory domains while relatively sparing others. In particular, it may affect more Temporal Consciousness, i.e. a specific form of consciousness that allows individuals to remember their personal past, to be oriented in their present world and to predict their personal future, than Knowing Consciousness, i.e. a specific form of consciousness allowing individuals to be aware of past, present and future impersonal knowledge and information. In this study we evaluated confabulations in TC and KC in a group of confabulatory amnesics of various aetiologies. Based on previous studies, it was predicted that confabulations affect significantly more TC than KC. It was also predicted that "Habits Confabulations", i.e. habits and repeated personal events mistaken as specific, unique past and future personal episodes, is the more frequently observed type of confabulation. The results confirmed these predictions and are discussed within the framework of the Memory, Consciousness and Temporality Theory.

Neuroimaging correlates of false memory in 'Alzheimer's disease: A preliminary systematic review

Alzheimer's disease (AD) is characterised by episodic memory impairment, but people also experience memory distortions, including false memories, which can impact on safety and reduce functioning. Understanding the neural networks that underpin false memories could help to predict the need for intervention and guide development of cognitive strategies to reduce memory errors. However, there is a relative absence of research into how the neuropathology of AD contributes to false memory generation. This paper systematically reviews the methodology and outcomes of studies investigating the neuroimaging correlates of false memory in AD. Four studies using structural imaging and three studies using functional imaging were identified. Studies were heterogenous in methodology and received mostly 'weak' quality assessment ratings. Combined, and consistent with neuroimaging findings in non-AD populations, results from identified studies provide preliminary support for the hypothesis that medial temporal lobe and prefrontal cortex dysfunction may lead to generation of false memories in AD. However, the small number of studies and significant heterogeneity within them means further study is necessary to assess replicability of results.

J. Janssen S, Gallouj K, Lenoble Q. Autobiographical Memory Increases Pupil Dilation

BACKGROUND

Pupil activity has been widely considered as a "summed index" of physiological activities during cognitive processing.

METHODOLOGY

We investigated pupil dilation during retrieval of autobiographical memory and compared pupil diameter with a control condition in which participants had to count aloud. We also measured pupil diameters retrieval of free (i.e., first memory that comes to mind), positive, and negative memories (memories associated, respectively, with the words "happy" and "sad").

RESULTS

Analyses demonstrated larger pupil diameters during the free, positive, and negative autobiographical memory retrieval than during the control task. Analyses also demonstrated no significant differences in pupil diameters across the three autobiographical memory conditions.

CONCLUSION

These outcomes demonstrate that, compared with counting, autobiographical retrieval results in a larger pupil size. However, the emotional valence of memories yields non-significant effect on pupil diameters. Our findings demonstrate how autobiographical memory retrieval yields pupil dilation.

Anomalies of Autobiographical Memory

OBJECTIVES

In this paper, I review three 'anomalies' or disorders in autobiographical memory: neurological retrograde amnesia (RA), spontaneous confabulation, and psychogenic amnesia.

METHODS

Existing theories are reviewed, their limitations considered, some of my own empirical findings briefly described, and possible interpretations proposed and interspersed with illustrative case-reports.

RESULTS

In RA, there may be an important retrieval component to the deficit, and factors at encoding may give rise to the relative preservation of early memories (and the reminiscence bump) which manifests as a temporal gradient. Spontaneous confabulation appears to be associated with a damaged 'filter' in orbitofrontal and ventromedial frontal regions. Consistent with this, an empirical study has shown that both the initial severity of confabulation and its subsequent decline are associated with changes in the executive function (especially in cognitive estimate errors) and inversely with the quantity of accurate autobiographical memories retrieved. Psychogenic amnesia can be 'global' or 'situation-specific'. The former is associated with a precipitating stress, depressed mood, and (often) a past history of a transient neurological amnesia. In these circumstances, frontal control mechanisms can inhibit retrieval of autobiographical memories, and even the sense of 'self' (identity), while compromised medial temporal function prevents subsequent retrieval of what occurred during a 'fugue'. An empirical investigation of psychogenic amnesia and some recent imaging studies have provided findings consistent with this view.

CONCLUSIONS

Taken together, these various observations point to the importance of frontal 'control' systems (in interaction with medial temporal/hippocampal systems) in the retrieval and, more particularly, the disrupted retrieval of 'old' memories.

Different patterns of confabulation in left visuo-spatial neglect

Confabulating patients produce statements and actions that are unintentionally incongruous to their history, background, present and future situation. Here we present the very unusual case of a patient with right hemisphere damage and signs of left visual neglect, who, when presented with visual stimuli, confabulated both for consciously undetected and for consciously detected left-sided details. Advanced anatomical investigation suggested a disconnection between the parietal and the temporal lobes in the right hemisphere. A disconnection between the ventral cortical visual stream and the dorsal fronto-parietal networks in the right hemisphere may contribute to confabulatory behaviour by restricting processing of left-sided stimuli to pre-conscious stages in the ventral visual stream.

Screening for confabulations with the confabulation screen

The objective of this work is to devise and validate a sensitive and specific test for confabulatory impairment. We conceived a screening test for confabulation, the Confabulation Screen (CS), a brief test using 10 questions of episodic memory (EM), where confabulators most frequently confabulate. It was postulated that the CS would predict confabulations not only in EM, but also in the other subordinate structures of personal temporality, namely the present and the future. Thirty confabulating amnesic patients of various aetiologies and 97 normal controls entered the study. Participants were administered the CS and the Confabulation Battery (Dalla Barba, G., & Decaix, C. (2009). "Do you remeber what you did on March 13 1985?" A case study of confabulatory hypermnesia. Cortex, 45(5), 566-574). Confabulations in the CS positively and significantly correlated with confabulations in personal temporality domains of the CB, namely EM, orientation in time and place and episodic plans. Conversely, as expected, they did not correlate with confabulations in impersonal temporality domains of the CB. Consistent with results of previous studies, the most frequently observed type of confabulation in the CS was Habits Confabulation. The CS had high construct validity and good discriminative validity in terms of sensitivity and specificity. Cut-off scores for clinical and research purposes are proposed. The CS provides efficient and valid screening for confabulatory impairment.

Autobiographical memory, the ageing brain and mechanisms of psychological interventions

Elucidating the impact of healthy cognitive ageing and dementia on autobiographical memory (AM) may help deepen our theoretical understanding of memory and underlying neural changes. The distinction between episodic and semantic autobiographical memory is particularly informative in this regard. Psychological interventions, particularly those involving reminiscence or music, have led to differential effects on episodic and semantic autobiographical memory. We propose that executive function is a key mediator of psychological therapies on autobiographical memory. We also highlight that interventions that alleviate stress and improve mood, including in major depression, can enhance autobiographical memory. Future research employing more longitudinal approaches and examining moderating factors such as gender and education level will deepen our understanding of changes in AM in later life, enhance our theoretical understanding of the neuroscience of AM and ageing, and help to develop better targeted interventions for preserving AM in older adults.

Confabulation in children with autism

Some children with high-functioning autistic spectrum conditions (ASC) have been noted clinically to produce accounts and responses akin to confabulations in neurological patients. Neurological confabulation is typically associated with abnormalities of the frontal lobes and related structures, and some forms have been linked to poor performance on source monitoring and executive function tasks. ASC has also been linked to atypical development of the frontal lobes, and impaired performance on source monitoring and executive tasks. But confabulation in autism has not to our knowledge previously been examined experimentally. So we investigated whether patterns of confabulation in autism might share similarities with neurologically-based confabulation. Tests of confabulation elicitation, source monitoring (reality monitoring, plus temporal and task context memory) and executive function were administered to four adolescents with ASC who had previously been noted to confabulate spontaneously in everyday life. Scores were compared to a typically developing (TD) and an ASC control group. One confabulating participant was significantly impaired at reality monitoring, and one was significantly worse at a task context test, relative to both the ASC and TD controls. Three of the confabulators showed impairment on measures of executive function (Brixton test; Cognitive Estimates test; Hayling Test B errors) relative to both control groups. Three were significantly poorer than the TD controls on two others (Hayling A and B times), but the ASC control group was also significantly slower at this test than the TD controls. Compared to TD controls, two of the four confabulating participants produced an abnormal number of confabulations during a confabulation elicitation questionnaire, where the ASC controls and TD controls did not differ from each other. These results raise the possibility that in at least some cases, confabulation in autism may be less related to social factors than it is to impaired source memory or poor executive function.

Different patterns of recollection impairment in confabulation reveal different disorders of consciousness: A multiple case study

Recollection is used to refer to the active process of setting up retrieval cues, evaluating the outcome, and systematically working toward a representation of a past experience that we find acceptable. In this study we report on three patients showing different patterns of confabulation affecting recollection and consciousness differentially. All patients confabulated in the episodic past domain. However, whereas in one patient confabulation affected only recollection of events concerning his personal past, present and future, in another patient confabulation also affected recollection of impersonal knowledge. The third patient showed an intermediate pattern of confabulation, which affected selectively the retrieval of past information, both personal and impersonal. We suggest that our results are in favor of a fractionation of processes involved in recollection underling different disorders of consciousness.