Involvement Of Medial Temporal Structures Research Articles

Episodic memory in frontotemporal dementia: a critical review

This review offers a critical appraisal of the literature on episodic memory performance in frontotemporal dementia. Historically, description of patients diagnosed with what was then known as Pick's disease included the presence of memory deficits and an underlying amnestic syndrome was noted in some of these patients. Over the last 20 years, however, the clinical view has been that episodic memory processing is relatively intact in the frontotemporal dementia syndrome. In particular, patients with the subtypes of behavioural variant frontotemporal dementia and progressive non-fluent aphasia are reported to perform within normal limits on standard memory tests. In the third clinical presentation of frontotemporal dementia, semantic dementia, relatively intact episodic memory against a significantly impaired semantic memory was regarded as the hallmark. This position was instrumental in the development of clinical diagnostic criteria for frontotemporal dementia in which amnesia was explicitly listed as an exclusion criterion for the disease. The relative intactness of episodic memory, therefore, appeared to be a useful diagnostic marker to distinguish early frontotemporal dementia from Alzheimer's disease, in which early episodic memory disturbance remains the most common clinical feature. We argue that recent evidence questions the validity of preserved episodic memory in frontotemporal dementia, particularly in behavioural variant frontotemporal dementia. In semantic dementia, a complex picture emerges with preservation of some components of episodic memory, notably recognition-based visual memory and recall of recent autobiographical events. We propose a critical synthesis of recent neuropsychological evidence on retrograde and anterograde memory in light of neuroimaging and neuropathological findings, demonstrating involvement of medial temporal structures in frontotemporal dementia, structures known to be critical for episodic memory processing. We further argue that the multifactorial nature of most memory tests commonly used clinically fail to capture the memory deficits in frontotemporal dementia and that sensitive assessment tools of memory are needed. Together, recent clinical and experimental findings and the historical evidence represent a strong case for a re-evaluation of the importance of memory disturbance in the clinical diagnosis of frontotemporal dementia.

Involvement of medial temporal structures in reflexive attentional shift by gaze

Recent studies have revealed that eye gaze triggers reflexive shift of the observer's visuospatial attention to its direction even if it does not predict any events in the environment. To determine whether medial temporal structures are involved in this reflexive gaze processing, an experiment of the gaze-cuing paradigm was carried out in seven epileptic patients who had undergone unilateral temporal lobectomy and nine age- and IQ-matched epileptic controls who had not undergone any surgical treatments. Gaze cues were presented for 200 ms to the unilateral visual field, after which subjects were required to localize targets as quickly as possible. They were also instructed that gaze directions were not predictive of the location of the targets. When the gaze cues stimulated the intact hemisphere in lobectomized patients or either hemisphere in controls, reaction times for correct responses were significantly shorter when gaze directions were toward the targets than away from the targets. This cuing effect was not manifested following stimulation of the lesioned hemisphere in lobectomized patients. These findings suggest that the medial temporal structures, including the amygdala, play a crucial role in the reflexive shift of attention triggered by another person's gaze direction in humans.

Striatal activation during acquisition of a cognitive skill.

The striatum is thought to play an essential role in the acquisition of a wide range of motor, perceptual, and cognitive skills, but neuroimaging has not yet demonstrated striatal activation during nonmotor skill learning. Functional magnetic resonance imaging was performed while participants learned probabilistic classification, a cognitive task known to rely on procedural memory early in learning and declarative memory later in learning. Multiple brain regions were active during probabilistic classification compared with a perceptual-motor control task, including bilateral frontal cortices, occipital cortex, and the right caudate nucleus in the striatum. The left hippocampus was less active bilaterally during probabilistic classification than during the control task, and the time course of this hippocampal deactivation paralleled the expected involvement of medial temporal structures based on behavioral studies of amnesic patients. Findings provide initial evidence for the role of frontostriatal systems in normal cognitive skill learning.