Response bias and response monitoring: Evidence from healthy older adults and patients with mild Alzheimer's disease

Recognition memory decline is associated with the progression to prodromal Alzheimer's disease in asymptomatic at-risk individuals

Episodic memory (EM) alterations are a hallmark of Alzheimer's disease (AD). We assessed EM longitudinally in cognitively normal elders at-risk for AD (with subjective memory complaints), as a function of amyloid-β (Aβ) burden, neurodegeneration (N), and progression to prodromal AD. We stratified 264 INSIGHT-preAD study subjects in controls (Aβ-/N-), stable/N- or N + (Aβ +), and progressors/N- or N + (Aβ +) groups (progressors were included only until AD-diagnosis). We used linear mixed-effect models with Aβ and N status, or progression to AD as factors, to analyze behavioral performance in an old/new word-recognition task based on the free and cued selective reminding test (FCSRT). The controls and stable/N- groups showed near-ceiling accuracy and RT improvement across follow-up. The stable/N + group showed accuracy reduction and no RT improvement, i.e., Aβ + /N + cumulative effect. The progressors showed a marked performance decline. EM alterations may constitute early preclinical markers of progression to prodromal AD, while individuals are cognitively normal according to neuropsychological standards.

Oscillatory and aperiodic neuronal activity in working memory following anesthesia

OBJECTIVE

Anesthesia and surgery are associated with cognitive impairment, particularly memory deficits. So far, electroencephalography markers of perioperative memory function remain scarce.

METHODS

We included male patients >60 years scheduled for prostatectomy under general anesthesia. We obtained neuropsychological assessments and a visual match-to-sample working memory task with simultaneous 62-channel scalp electroencephalography 1 day before and 2 to 3 days after surgery.

RESULTS

Twenty-six patients completed both pre- and postoperative sessions. Compared with preoperative performance, verbal learning deteriorated after anesthesia (California Verbal Learning Test total recall; t₂₅ = -3.25, p = 0.015, d = -0.902), while visual working memory performance showed a dissociation between match and mismatch accuracy (match*session F_1,25 = 3.866, p = 0.060). Better verbal learning was associated with an increase of aperiodic brain activity (total recall r = 0.66, p = 0.029, learning slope r = 0.66, p = 0.015), whereas visual working memory accuracy was tracked by oscillatory theta/alpha (7 - 9 Hz), low beta (14 - 18 Hz) and high beta/gamma (34 - 38 Hz) activity (matches: p < 0.001, mismatches: p = 0.022).

CONCLUSIONS

Oscillatory and aperiodic brain activity in scalp electroencephalography track distinct features of perioperative memory function.

SIGNIFICANCE

Aperiodic activity provides a potential electroencephalographic biomarker to identify patients at risk for postoperative cognitive impairments.

Lower cognitive function attenuates the convergence between self-ratings and observer ratings of depressive symptoms in late-life cognitive impairment

OBJECTIVES

Assessment of depressive symptoms in older adults is challenging especially in the presence of risks in cognitive impairment. We aimed to examine whether the convergence between two measures of depressive symptoms (self-report and observer ratings) is affected by varying levels of cognitive function in older adults.

METHODS

Self-reported scale of depression, informant-based rating of affective symptoms, and global cognitive function were assessed in 2533 older adults with no impairment, mild cognitive impairment, and Alzheimer's disease. The strength of rank-order correlation between the Geriatric Depression Scale (GDS) and behavioral ratings of the Neuropsychiatric Inventory (NPI) was examined as the metric of convergent validity.

RESULTS

The results showed that the strength of convergence between the two measurements gradually decreased as a function of lowered cognitive function. Overall tendency showed that diagnoses of cognitive impairment and lower levels of cognitive function were associated with lower correspondence between the two depression measurements. The loss of convergent validity is especially evident in the behavioral symptom of apathy.

CONCLUSIONS

Utilizing self-report scales of depression in older adults requires a cautious approach even with minimal or mild levels of cognitive impairment.

The Effectiveness of Item-Specific Encoding and Conservative Responding to Reduce False Memories in Patients with Mild Cognitive Impairment and Mild Alzheimer's Disease Dementia

OBJECTIVE

Patients with mild Alzheimer's disease dementia are more susceptible to false memories than healthy older adults. Evidence that these patients can use cognitive strategies to reduce false memory is inconsistent.

METHOD

In the present study, we examined the effectiveness of conservative responding and item-specific deep encoding strategies, alone and in combination, to reduce false memory in a categorized word list paradigm among participants with mild Alzheimer's disease dementia (AD), amnestic single-domain mild cognitive impairment (MCI), and healthy age-matched older controls (OCs). A battery of clinical neuropsychological measures was also administered.

RESULTS

Although use of conservative responding alone tended to reduce performance in the MCI and OC groups, both deep encoding alone and deep encoding combined with conservative strategies led to improved discrimination for both gist memory and item-specific recollection for these two groups. In the AD group, only gist memory benefited from the use of strategies, boosted equally by deep encoding alone and deep encoding combined with conservative strategies; item-specific recollection was not improved. No correlation between the use of these strategies and performance on neuropsychological measures was found.

CONCLUSIONS

These results suggest that further evaluation of these strategies is warranted as they have the potential to reduce related and unrelated memory errors and increase both gist memory and item-specific recollection in healthy older adults and individuals with amnestic MCI. Patients with AD were less able to benefit from such strategies, yet were still able to use them to reduce unrelated memory errors and increase gist memory.

False memories in patients with mild cognitive impairment and mild Alzheimer's disease dementia: Can cognitive strategies help?

Alzheimer's disease (AD) is a progressive neurodegenerative disorder that presents predominantly with impairments in learning and memory. Patients with AD are also susceptible to false memories, a clinically relevant memory distortion where a patient remembers an incorrect memory that they believe to be true. The use of cognitive strategies to improve memory performance among patients with AD by reducing false memories has taken on added importance given the lack of disease-modifying agents for AD. However, existing evidence suggests that cognitive strategies to reduce false memories in patients with AD are of limited effectiveness, although these strategies may be useful at earlier stages of the disease. The purpose of this review is to examine experimental findings of false memories and associated memory processes in patients with mild cognitive impairment due to AD and mild AD dementia. Cognitive strategies to reduce false memories in these patient populations are also reviewed. Approaches to clinically relevant future research are suggested and discussed.

Explicit and implicit memory for music in healthy older adults and patients with mild Alzheimer's disease

Introduction: Previous studies have found that music paired with lyrics at encoding may improve the memory performance of patients with mild Alzheimer's disease (AD). To further explore memory for different types of musical stimuli, the current study examined both implicit and explicit memory for music with and without lyrics compared to spoken lyrics. Method: In this mixed design, patients with probable mild AD (n = 15) and healthy older adults (n = 13) listened to auditory clips (song, instrumental, or spoken lyrics varied across three sessions) and then had their memory tested. Implicit memory was measured by the mere exposure effect. Explicit recognition memory was measured using a confidence-judgment receiver operating characteristic (ROC) paradigm, which allowed examination of the separate contributions made by familiarity and recollection. Results: A significant implicit memory mere exposure effect was found for both groups in the instrumental and song but not the spoken condition. Both groups had the best explicit memory performance in the spoken condition, followed by song, and then instrumental conditions. Healthy older adults demonstrated more recollection than patients with AD in the song and spoken conditions, but both groups performed similarly in the instrumental condition. Patients with AD demonstrated more familiarity in the instrumental and song conditions than in the spoken condition. Conclusions: The results have implications for memory interventions for patients with mild AD. The implicit memory findings suggest that patients with AD may still show a preference for information familiar to them. The explicit memory results support prior findings that patients with AD rely heavily on familiarity, but also suggest that there may be limitations on the benefits that music can provide to recognition memory performance.

Failure to Affect Decision Criteria During Recognition Memory With Continuous Theta Burst Stimulation

A decision criterion establishes the minimum amount of memory evidence required for recognition. When a liberal criterion is set, items are recognized based on weak evidence whereas a conservative criterion requires greater memory strength for recognition. The decision criterion is a fundamental aspect of recognition memory but little is known about the underlying neural mechanisms of maintaining a criterion. We used continuous theta burst stimulation (cTBS) with the goal of inhibiting prefrontal cortex excitability while participants performed recognition tests. We hypothesized that inhibiting the right inferior frontal gyrus (rIFG), right middle frontal gyrus (rMFG), and right dorsolateral prefrontal cortex (rDLPFC) would cause participants to establish less conservative decision criteria without affecting recognition memory performance. Participants initially performed recognition memory tests while maintaining conservative decision criteria during fMRI scanning. Peak activity in the successful retrieval effect contrast (Hits > Correct Rejections) provided subject-specific cTBS target sites. During three separate sessions, participants completed the same recognition memory paradigm while maintaining conservative and liberal decision criteria both before and after cTBS. Across two experiments we failed to significantly alter decision criteria placement by applying cTBS to the rIFG, rMFG, and rDLPFC despite efforts to precisely target individualized brain areas. However, we unexpectedly improved discriminability following cTBS to the rDLPFC specifically when participants maintained a liberal criterion. Although this finding may guide future studies investigating the neural mechanisms underlying discriminability in recognition memory, cTBS proved ineffective at altering decision criteria.