Compensating for Language Deficits in Amnesia II: H.M.'s Spared versus Impaired Encoding Categories

The effect of repetition on pronoun resolution in patients with memory impairment

Referring to things in the world - that woman, her idea, she - is a central component of language. Understanding reference requires the listener to keep track of the unfolding discourse history while integrating multiple sources of information to interpret the speech stream as it unfolds in time. Pronouns are a common way to establish reference. But due to their impoverished form, to understand them listeners must relate features of the pronoun (e.g., gender, animacy) with existing representations of potential discourse referents. Successful referential processing seems to place demands on memory. In a previous study, patients with hippocampal amnesia and healthy participants listened to short stories as their eye movements were monitored. When interpreting ambiguous pronouns, healthy participants demonstrated order-of-mention effects, whereby ambiguous pronouns are interpreted as referring to the first-mentioned referent in the story. By contrast, memory-impaired patients exhibited significant disruptions in their ability to use information about which character had been mentioned first to interpret pronouns. Repetition of the most salient information is a common clinical recommendation for improving pronoun resolution and communication in individuals with memory disorders (e.g., Alzheimer's disease) but this recommendation lacks an evidentiary basis. The present study seeks to determine whether the pronoun resolution performance of hippocampal patients can be improved, by repetition of the target referent, increasing its salience. Results indicate that patients with hippocampal damage demonstrate improved processing of pronouns following repetition of the target referent, but benefit from this repetition to a significantly smaller degree compared to healthy participants. These results provide further evidence for the role of the hippocampal-dependent memory system in language processing and point to the need for empirically tested communication interventions.

Behavioral evidence suggestive of frontal lobe pathology in the amnesic H.M

From the earliest published reports, Henry Gustav Molaison-who until his death in 2008 was known simply by his initials H.M.-was characterized as having a profound anterograde amnesia subsequent to mid temporal lobe resection, and that this amnestic condition was uncomplicated by other cognitive or behavioral impairments. Post-mortem neuropathological examination has detected-in addition to the expected temporal lobe lesions-previously unreported frontal lobe and white matter pathology, inviting questions concerning the behavioral and cognitive consequences that might result from such lesions. The purpose of this article is to recount published descriptions of a range of anomalous behaviors by H.M. that can not be explained by the memory impairments typically associated with anterograde amnesia, to counter previous claims that these behaviors are attributable to amygdalar damage, and to advance the interpretation that these behaviors are instead consistent with well-documented effects of frontal lobe pathology. Transcripts of interviews with H.M. which feature disjointed, often contradictory, and arguably confabulatory responses are presented in support of this argument.

Creativity, Comprehension, Conversation and the Hippocampal Region: New Data and Theory

Present findings indicate that hippocampal region (HR) damage impairs aspects of everyday language comprehension and production that require creativity ^___ defined as the ability to form new internal representations that satisfy relevant constraints for being useful or valuable in the real world. In two studies, seventeen people participated in extensive face-to-face interviews: sixteen normal individuals and H.M., an amnesic with cerebellar and HR damage but virtually no neocortical damage. Study 1 demonstrated deficits in H.M.'s comprehension of creative but not routine aspects of the interviews ^___ extending to the real world twelve prior demonstrations that H.M. understands routine but not novel aspects of experimentally constructed sentences, deficits that reflected his HR damage, but not his cerebellar damage, his explicit or declarative memory problems, inability to comprehend or recall the instructions, forgetting, poor visual acuity, motoric slowing, time pressure, deficits in visual scanning or attentional allocation, lack of motivation, and excessive memory load in the tasks. Study 2 demonstrated similar deficits in H.M.'s ability to produce creative but not routine aspects of conversational discourse, extending findings in five prior sentence production experiments to real-world creativity. We discuss conceptual frameworks for explaining relations between new-and-useful creativity and the HR.

Prolegomena to a neurocomputational architecture for human grammatical encoding and decoding

This study develops a neurocomputational architecture for grammatical processing in language production and language comprehension (grammatical encoding and decoding, respectively). It seeks to answer two questions. First, how is online syntactic structure formation of the complexity required by natural-language grammars possible in a fixed, preexisting neural network without the need for online creation of new connections or associations? Second, is it realistic to assume that the seemingly disparate instantiations of syntactic structure formation in grammatical encoding and grammatical decoding can run on the same neural infrastructure? This issue is prompted by accumulating experimental evidence for the hypothesis that the mechanisms for grammatical decoding overlap with those for grammatical encoding to a considerable extent, thus inviting the hypothesis of a single "grammatical coder." The paper answers both questions by providing the blueprint for a syntactic structure formation mechanism that is entirely based on prewired circuitry (except for referential processing, which relies on the rapid learning capacity of the hippocampal complex), and can subserve decoding as well as encoding tasks. The model builds on the "Unification Space" model of syntactic parsing developed by Vosse and Kempen (Cognition 75:105-143, 2000; Cognitive Neurodynamics 3:331-346, 2009a). The design includes a neurocomputational mechanism for the treatment of an important class of grammatical movement phenomena.

Hippocampal contributions to language: evidence of referential processing deficits in amnesia

A growing body of work suggests the hippocampus contributes to a variety of cognitive domains beyond its traditional role in memory. We propose that the hippocampus, in its capacity for relational binding, representational flexibility, and online maintenance and integration of multimodal relational representations, is a key contributor to language processing. Here we test the hypothesis that the online interpretation of pronouns is hippocampus-dependent. We combined eye tracking with neuropsychological methods, where participants (4 patients with bilateral hippocampal damage and severe declarative memory impairment, 4 patients with ventromedial prefrontal cortex [vmPFC] damage, and healthy comparison participants) viewed a scene while listening to short dialogues introducing 2 characters; for example, Melissa is playing violin for Debbie/Danny as the sun is shining overhead. She is wearing a blue/purple dress. Consistent with previous work, analysis of eye gaze showed that younger and older healthy comparison participants and the vmPFC patients rapidly identified the intended referent of the pronoun when gender uniquely identified the referent, and when it did not, they showed a preference to interpret the pronoun as referring to the first-mentioned character. By contrast, hippocampal patients, while exhibiting a similar gender effect, exhibited significant disruptions in their ability to use information about which character had been mentioned first to interpret the pronoun. This finding suggests that the hippocampus plays a role in maintaining and integrating information even over a very short discourse history. These observed disruptions in referential processing demonstrate how promiscuously the hallmark processing features of the hippocampus are used in service of a variety of cognitive domains including language.

Compensating for Language Deficits in Amnesia I: H.M.'s Spared Retrieval Categories

Three studies examined amnesic H.M.’s use of words, phrases, and propositions on the Test of Language Competence (TLC). In Study 1, H.M. used 19 lexical categories (e.g., common nouns, verbs) and one syntactic category (noun phrases) with the same relative frequency as memory-normal controls, he used no lexical or syntactic category with less-than-normal frequency, and he used proper names (e.g., Melanie) and coordinative conjunctions (e.g., and) with reliably greater-than-normal frequency. In Study 2, H.M. overused proper names relative to controls when answering episodic memory questions about childhood experiences in speech and writing, replicating and extending Study 1 results for proper names. Based on detailed analyses of the use (and misuse) of coordinating conjunctions on the TLC, Study 3 developed a syntax-level “compensation hypothesis” for explaining why H.M. overused coordinating conjunctions relative to controls in Study 1. Present results suggested that (a) frontal mechanisms for retrieving word-, phrase-, and propositional-categories are intact in H.M., unlike in category-specific aphasia, (b) using his intact retrieval mechanisms, H.M. has developed a never-previously-observed proposition-level free association strategy to compensate for the hippocampal region damage that has impaired his mechanisms for encoding novel linguistic structures, and (c) H.M.’s overuse of proper names warrants further research.