Medial Temporal Amnesia Research Articles

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

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

Acetylcholine Neuromodulation in Normal and Abnormal Learning and Memory: Vigilance Control in Waking, Sleep, Autism, Amnesia and Alzheimer's Disease.

Adaptive Resonance Theory, or ART, is a neural model that explains how normal and abnormal brains may learn to categorize and recognize objects and events in a changing world, and how these learned categories may be remembered for a long time. This article uses ART to propose and unify the explanation of diverse data about normal and abnormal modulation of learning and memory by acetylcholine (ACh). In ART, vigilance control determines whether learned categories will be general and abstract, or specific and concrete. ART models how vigilance may be regulated by ACh release in layer 5 neocortical cells by influencing after-hyperpolarization (AHP) currents. This phasic ACh release is mediated by cells in the nucleus basalis (NB) of Meynert that are activated by unexpected events. The article additionally discusses data about ACh-mediated tonic control of vigilance. ART proposes that there are often dynamic breakdowns of tonic control in mental disorders such as autism, where vigilance remains high, and medial temporal amnesia, where vigilance remains low. Tonic control also occurs during sleep-wake cycles. Properties of Up and Down states during slow wave sleep arise in ACh-modulated laminar cortical ART circuits that carry out processes in awake individuals of contrast normalization, attentional modulation, decision-making, activity-dependent habituation, and mismatch-mediated reset. These slow wave sleep circuits interact with circuits that control circadian rhythms and memory consolidation. Tonic control properties also clarify how Alzheimer’s disease symptoms follow from a massive structural degeneration that includes undermining vigilance control by ACh in cortical layers 3 and 5. Sleep disruptions before and during Alzheimer’s disease, and how they contribute to a vicious cycle of plaque formation in layers 3 and 5, are also clarified from this perspective.

From brain synapses to systems for learning and memory: Object recognition, spatial navigation, timed conditioning, and movement control

This article provides an overview of neural models of synaptic learning and memory whose expression in adaptive behavior depends critically on the circuits and systems in which the synapses are embedded. It reviews Adaptive Resonance Theory, or ART, models that use excitatory matching and match-based learning to achieve fast category learning and whose learned memories are dynamically stabilized by top-down expectations, attentional focusing, and memory search. ART clarifies mechanistic relationships between consciousness, learning, expectation, attention, resonance, and synchrony. ART models are embedded in ARTSCAN architectures that unify processes of invariant object category learning, recognition, spatial and object attention, predictive remapping, and eye movement search, and that clarify how conscious object vision and recognition may fail during perceptual crowding and parietal neglect. The generality of learned categories depends upon a vigilance process that is regulated by acetylcholine via the nucleus basalis. Vigilance can get stuck at too high or too low values, thereby causing learning problems in autism and medial temporal amnesia. Similar synaptic learning laws support qualitatively different behaviors: Invariant object category learning in the inferotemporal cortex; learning of grid cells and place cells in the entorhinal and hippocampal cortices during spatial navigation; and learning of time cells in the entorhinal–hippocampal system during adaptively timed conditioning, including trace conditioning. Spatial and temporal processes through the medial and lateral entorhinal–hippocampal system seem to be carried out with homologous circuit designs. Variations of a shared laminar neocortical circuit design have modeled 3D vision, speech perception, and cognitive working memory and learning. A complementary kind of inhibitory matching and mismatch learning controls movement.This article is part of a Special Issue entitled SI: Brain and Memory.

Initial memory deficit profiles in patients with a cerebrospinal fluid Alzheimer's disease signature.

Alzheimer's disease (AD) clinical onset is usually characterized by a memory complaint and a progressive memory deficit. The proportion of typical medial-temporal amnesia revealing AD remains unknown. The present study explores the episodic memory impairment profiles by the Free and Cued Selective Recall Reminding Test (FCSRT) in patients with initial memory complaint and a cerebrospinal fluid (CSF) biomarker signature of AD. Seventy-three patients referred for memory complaint to the Centers for Memory, Resource and Research of Lyon and Montpellier (France) were included consecutively. All patients underwent an extensive neuropsychological examination and had a Mini-Mental State Examination (MMSE) score ≥20 and a positive CSF AD signature. The patients were classified as having mild dementia or prodromal AD. Verbal episodic memory was assessed using the French version of the FCSRT exploring encoding, storage/consolidation, and cued delayed retrieval phases of memorization. Three different memory profiles were identified according to the results of FCSRT. The median age was 72 year-old [interquartiles: 65-76]. The median MMSE score was 23 [interquartiles: 21-25]. 88% of the patients (n = 64) presented with a medial temporal amnesia profile. The dysexecutive amnesia and normal verbal episodic memory profiles represented respectively 5% (n = 4) and 7% (n = 5). There were no significant differences in term of age, gender, and MMSE score between the three profile groups. In a population initially presenting with memory complaints and depicting a CSF AD signature, a high proportion of medial temporal amnesia is disclosed as expected, but also a proportion of dysexecutive amnesia and normal FCSRT.

Dissociating medial temporal and basal ganglia memory systems with a latent learning task

The medial temporal (MT) lobes and basal ganglia have both been implicated as brain substrates of associative learning. Here, we show a dissociation between medial temporal and basal ganglia damage using a latent learning task, in which prior exposure to cues, uncorrelated with each other, slows subsequent learning of an association between them. Consistent with prior work, we found a robust exposure effect in healthy controls, with exposed controls learning more slowly than non-exposed controls. This effect was abolished in medial temporal amnesia: both exposed and non-exposed amnesic patients learned at the same speed. A group of patients with basal ganglia damage due to Parkinson’s disease showed a reversal of the effect: exposed subjects learned faster than non-exposed subjects. Our findings point to distinct and dissociable contributions of medial temporal lobe and basal ganglia structures to learning and memory.

Dissociating basal forebrain and medial temporal amnesic syndromes: insights from classical conditioning.

In humans, anterograde amnesia can result from damage to the medial temporal (MT) lobes (including hippocampus), as well as to other brain areas such as basal forebrain. Results from animal classical conditioning studies suggest that there may be qualitative differences in the memory impairment following MT vs. basal forebrain damage. Specifically, delay eyeblink conditioning is spared after MT damage in animals and humans, but impaired in animals with basal forebrain damage. Recently, we have likewise shown delay eyeblink conditioning impairment in humans with amnesia following anterior communicating artery (ACoA) aneurysm rupture, which damages the basal forebrain. Another associative learning task, a computer-based concurrent visual discrimination, also appears to be spared in MT amnesia while ACoA amnesics are slower to learn the discriminations. Conversely, animal and computational models suggest that, even though MT amnesics may learn quickly, they may learn qualitatively differently from controls, and these differences may result in impaired transfer when familiar information is presented in novel combinations. Our initial data suggests such a two-phase learning and transfer task may provide a double dissociation between MT amnesics (spared initial learning but impaired transfer) and ACoA amnesics (slow initial learning but spared transfer). Together, these emerging data suggest that there are subtle but dissociable differences in the amnesic syndrome following damage to the MT lobes vs. basal forebrain, and that these differences may be most visible in non-declarative tasks such as eyeblink classical conditioning and simple associative learning.

Temporally graded semantic memory loss in amnesia and semantic dementia: Further evidence for opposite gradients

The consolidation theory of long-term memory (e.g., Squire, 1992) predicts that damage to the medial temporal lobes will result in temporally graded retrograde memory loss, with a disproportionate impairment of recent relative to remote knowledge; in contrast, severe atrophy of the temporal neocortex is predicted to result in the reverse temporally graded pattern, with a selective sparing of recent memory (K.S. Graham & Hodges, 1997). Previously, we reported evidence that autobiographical episodic memory does not follow this temporal pattern (Westmacott, Leach, Freedman, & Moscovitch, 2001). In the present study, we found evidence suggesting that semantic memory loss does follow the predicted temporal pattern. We used a set of tasks that tap implicit and explicit memory for famous names and English vocabulary terms from across the 20th century. KC, a person with medial temporal amnesia, consistently demonstrated across tasks a selective deficit for famous names and vocabulary terms from the 5-year period just prior to injury; this deficit was particularly profound for elaborated semantic knowledge (e.g., word definitions, occupation of famous person). However, when asked to guess on unfamiliar items, KC's performance for names and words from this 5-year time period increased substantially, suggesting that he retains some of this knowledge at an implicit or rudimentary level. Conversely, EL, a semantic dementia patient with temporal neocortical atrophy and relative sparing of the medial temporal lobe, demonstrated a selective sparing of names and words from the most recent time period. However, this selective sparing of recent semantic memory was demonstrated in the implicit tasks only; performance on explicit tasks suggested an equally severe impairment of semantics across all time periods. Unlike the data from our previous study of autobiographical episodic memory, these findings are consistent with the predictions both of consolidation theory (Hodges & Graham, 1998; Squire, 1992) and multiple trace theory (Nadel & Moscovitch, 1999) that the hippocampus plays a timelimited role in the acquisition and representation of long-term semantic memories. Moreover, our findings suggest that tasks requiring minimal verbal production and explicit recall may provide a more sensitive and comprehensive assessment of intact memory capacity in brain-damaged individuals.

Temporal order memory in patients with Korsakoff’s syndrome and medial temporal amnesia

Two groups of patients with global amnesia resulting either from Korsakoff’s syndrome (KS) or from medial temporal lobe (MTL) damage were compared with groups of matched healthy control subjects on a list discrimination paradigm. Item recognition memory was matched across the amnesic and control groups in order to determine whether KS, but not MTL amnesics are disproportionately impaired on list discrimination as predicted by Parkin’s [Functional significance of etiological factors in human amnesia. In: Squire LR, Butters N, editors. Neuropsychology of memory, 2nd ed. New York: The Guilford Press, 1992] hypothesis. However, both patient groups were impaired disproportionately on the temporal order memory task, which is inconsistent with Parkin’s hypothesis. It remains possible that the KS patients are more disproportionately impaired than those with MTL damage because both patient groups performed at floor on the list discrimination task. The results are consistent with theories that postulate a critical role for the hippocampus in the kind of associative memory which underlies memory for temporal order, but not in recognition of single items or arbitrary associations between items of similar kinds.

Dense amnesia in the monkey after transection of fornix, amygdala and anterior temporal stem

The traditional explanation of dense amnesia after medial temporal lesions is that the amnesia is caused by damage to the hippocampus and related structures. An alternative view is that dense amnesia after medial temporal lesions is caused by the interruption of afferents to the temporal cortex from the basal forebrain. These afferents travel to the temporal cortex through three pathways, namely the anterior temporal stem, the amygdala and the fornix-fimbria, and all these three pathways are damaged in dense medial temporal amnesia. In four experiments using different memory tasks, we tested the effects on memory of sectioning some or all of these three pathways in macaque monkeys. In a test of scene-specific memory for objects, which is analogous in some ways to human episodic memory, section of fornix alone, or section of amygdala and anterior temporal stem sparing the fornix, each produced a significant but mild impairment. When fornix section was added to the section of anterior temporal stem and amygdala in this task, however, a very severe impairment resulted. In an object recognition memory task (delayed matching-to-sample) a severe impairment was seen after section of anterior temporal stem and amygdala alone, with or without the addition of fornix section; this impairment was significantly more severe than that which was seen in the same task after amygdalectomy leaving the temporal stem intact, with or without fornix section. Animals with combined section of anterior temporal stem, amygdala and fornix were also impaired in object–reward association learning. However, the retention of pre-operatively acquired object–reward associations was at a high level. These results show that the pattern of impairments after section of anterior temporal stem, amygdala and fornix in the monkey, leaving hippocampus intact, resembles human dense amnesia and is different from the effects of hippocampal lesions in the monkey.

Latent learning in medial temporal amnesia: evidence for disrupted representational but preserved attentional processes.

Damage to the hippocampus and medial temporal (MT) structures can lead to anterograde amnesia and may also impair latent learning, in which prior exposure to cues affects their subsequent associability. Normally, latent learning may reflect both representational and attentional mechanisms. Prior work has suggested that individuals with MT amnesia have specific deficits in representational processing; thus, latent learning that invokes primarily representational mechanisms might be especially impaired in MT amnesia. The current results provide preliminary confirmation of this prediction. In Experiment 1, a latent learning paradigm expected to invoke representational mechanisms was impaired in individuals with MT amnesia, whereas in Experiment 2, a paradigm expected to invoke other attentional mechanisms was spared in individuals with MT amnesia. This suggests the representational and attentional components of latent learning are dissociable and differentially affected in anterograde amnesia.

Latent learning in medial temporal amnesia: Evidence for disrupted representational but preserved attentional processes.

Latent learning in medial temporal amnesia: Evidence for disrupted representational but preserved attentional processes.

Impaired trace eyeblink conditioning in bilateral, medial-temporal lobe amnesia.

Trace eyeblink classical conditioning was assessed in patients with bilateral medial-temporal amnesia and matched control participants who had previously shown equivalent delay eyeblink conditioning (J. D. E. Gabrieli et al., 1995). The silent trace interval varied for durations of 500, 750, or 1,000 ms in successive sessions separated by at least 2 weeks; extinction trials followed each session. Patients with amnesia produced significantly fewer conditioned responses (CRs) than did control participants at all trace intervals. Both groups produced fewer CRs as the trace interval lengthened. Thus, the temporal lobe memory system in humans makes an essential contribution to normal acquisition in trace, but not delay, classical eyeblink conditioning.

Impaired trace eyeblink conditioning in bilateral, medial-temporal lobe amnesia.

Trace eyeblink classical conditioning was assessed in patients with bilateral medial-temporal amnesia and matched control participants who had previously shown equivalent delay eyeblink conditioning (J. D. E. Gabrieli et al., 1995). The silent trace interval varied for durations of 500, 750, or 1,000 ms in successive sessions separated by at least 2 weeks; extinction trials followed each session. Patients with amnesia produced significantly fewer conditioned responses (CRs) than did control participants at all trace intervals. Both groups produced fewer CRs as the trace interval lengthened. Thus, the temporal lobe memory system in humans makes an essential contribution to normal acquisition in trace, but not delay, classical eyeblink conditioning.

Normal and amnesic learning, recognition and memory by a neural model of cortico-hippocampal interactions

The processes by which humans and other primates learn to recognize objects have been the subject of many models. Processes such as learning, categorization, attention, memory search, expectation and novelty detection work together at different stages to realize object recognition. In this article, Gail Carpenter and Stephen Grossberg describe one such class of model (Adaptive Resonance Theory, ART) and discuss how its structure and function might relate to known neurological learning and memory processes, such as how inferotemporal cortex can recognize both specialized and abstract information, and how medial temporal amnesia might be caused by lesions in the hippocampal formation. This model also suggests how hippocampal and inferotemporal processing might be linked during recognition learning.