Implicit and explicit memory in young, old, and demented adults

Age and processing effects on perceptual and conceptual priming

Explicit (declarative) memory declines with age, but age effects on implicit (nondeclarative) memory are debated. Some studies have reported null changes in implicit memory (e.g., priming in word-fragment completion, perceptual identification, category exemplar generation) with age, while others have uncovered declines. One factor that may account for these discrepancies is processing. Evidence suggests that conceptual and perceptual processes are not equally affected by ageing, yet processing requirements have varied greatly between studies. Processing may moderate age effects on priming, but no study has systematically examined this issue. This registered report presents an experiment to manipulate processing (conceptual / perceptual) during incidental encoding of words, prior to measures of perceptual (perceptual identification) and conceptual (category verification) priming. The perceptual and conceptual priming tasks were matched on all characteristics except processing, making them highly comparable. The four orthogonal conditions (perceptual encoding, perceptual test [PP]; conceptual encoding, perceptual test [CP]; perceptual encoding, conceptual test [PC]; conceptual encoding, conceptual test [CC]) were designed to clarify situations in which age effects on implicit memory emerge, which holds important practical and theoretical implications. Significant effects of Age, Test, and an Age × Processing interaction emerged. Priming was greater in young than older adults and on the perceptual than the conceptual test, but in contrast to the predictions, the age difference was only significant when prior encoding was perceptual (i.e., in the PP and CP conditions).

Nucleus Basalis of Meynert Stimulation for Lewy Body Dementia: A Phase I Randomized Clinical Trial

OBJECTIVES

Nucleus basalis of Meynert deep brain stimulation (NBM-DBS) has been proposed for patients with dementia. Here, we aim to assess the safety and effects of NBM-DBS in patients with Lewy body dementia (LBD), in a randomized, double-blind, crossover clinical trial.

METHODS

Six patients with mild to moderate LBD (mean [SD] age, 62.2 [7.8] years) were included, operated on for bilateral NBM-DBS, and assigned to receive either active or sham NBM-DBS followed by the opposite condition for 3 months. The primary outcome was the difference in the total free recalls of the Free and Cued Selective Reminding Test (FCSRT) between active and sham NBM-DBS. Secondary outcomes were assessments of the safety and effects of NBM-DBS on cognition, motor disability, sleep, and PET imaging.

RESULTS

There was no significant difference in the FCSRT score with active vs sham NBM-DBS. The surgical procedures were well tolerated in all patients, but we observed significant decreases in Stroop and Benton scores after electrode implantation. We observed no significant difference in other scales between active and sham NBM-DBS. With active NBM-DBS relative to baseline, phonemic fluency and motor disability significantly decreased. Lastly, the superior lingual gyrus metabolic activity significantly increased with active NBM-DBS.

CONCLUSIONS

NBM-DBS does not appear to be totally safe for patients with LBD with no evidence of cognitive benefit.

CLINICALTRIALSGOV IDENTIFIER

NCT01340001.

CLASSIFICATION OF EVIDENCE

This study provides Class II evidence that, for patients with LBD operated on for bilateral NBM-DBS, active NBM-DBS stimulation compared to sham stimulation did not significantly change selective recall scores.

Lesion evolution and neurodegeneration in RVCL-S: A monogenic microvasculopathy

Objective

To characterize lesion evolution and neurodegeneration in retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations (RVCL-S) using multimodal MRI.

Methods

We prospectively performed MRI and cognitive testing in RVCL-S and healthy control cohorts. Gray and white matter volume and disruption of white matter microstructure were quantified. Asymmetric spin echo acquisition permitted voxel-wise oxygen extraction fraction (OEF) calculation as an in vivo marker of microvascular ischemia. The RVCL-S cohort was included in a longitudinal analysis of lesion subtypes in which hyperintense lesions on fluid-attenuated inversion recovery (FLAIR), T1-postgadolinium, and diffusion-weighted imaging were delineated and quantified volumetrically.

Results

Twenty individuals with RVCL-S and 26 controls were enrolled. White matter volume and microstructure declined faster in those with RVCL–S compared to controls. White matter atrophy in RVCL-S was highly linear (ρ = −0.908, p < 0.0001). Normalized OEF was elevated in RVCL-S and increased with disease duration. Multiple cognitive domains, specifically those measuring working memory and processing speed, were impaired in RVCL-S. Lesion volumes, regardless of subtype, progressed/regressed with high variability as a function of age, while FLAIR lesion burden increased near time to death (p < 0.001).

Conclusion

RVCL-S is a monogenic microvasculopathy affecting predominantly the white matter with regard to atrophy and cognitive impairment. White matter volumes in RVCL-S declined linearly, providing a potential metric against which to test the efficacy of future therapies. Progressive elevation of white matter OEF suggests that microvascular ischemia may underlie neurodegeneration in RVCL-S.

Selective Reminding and Free and Cued Selective Reminding in Mild Cognitive Impairment and Alzheimer Disease

The Selective Reminding Test (SRT) and the Free and Cued Selective Reminding Test (FCSRT) are multitrial memory tests that use a common "selective reminding" paradigm that aims to facilitate learning by presenting only the missing words from the previous recall trial. While in the FCSRT semantic cues are provided to elicit recall, in the SRT, participants are merely reminded of the missing items by repeating them. These tests have been used to assess age-related memory changes and to predict dementia. The performance of healthy elders on these tests has been compared before, and results have shown that twice as many words were retrieved from long-term memory in the FCSRT compared with the SRT. In this study, we compared the tests' properties and their accuracy in discriminating amnestic mild cognitive impairment (aMCI; n = 20) from Alzheimer disease (AD; n = 18). Patients with AD performed significantly worse than patients with aMCI on both tests. The percentage of items recalled during the learning trials was significantly higher for the FCSRT in both groups, and a higher number of items were later retrieved, showing the benefit of category cueing. Our key finding was that the FCSRT showed higher accuracy in discriminating patients with aMCI from those with AD.

The free and cued selective reminding test distinguishes frontotemporal dementia from Alzheimer's disease

Memory impairment is often present in frontotemporal dementia (FTD) as a result of an inefficient use of learning strategies, sometimes leading to a misdiagnosis of Alzheimer's disease (AD). The Free and Cued Selective Reminding Test (FCSRT) is a memory test that controls attention and acquisition, by providing category cues in the learning process. The main goal of this study was to show the usefulness of the FCSRT in the distinction between behavioral (bv-) FTD and AD. Three matched subgroups of participants were considered: bv-FTD (n = 32), AD (n = 32), and a control group of healthy adults (n = 32). Results proved that while AD patients exhibited an overall impairment in FCSRT, bv-FTD subjects showed to benefit more from the controlled learning through category cues. AD patients were 25 times more likely to have an impaired FCSRT. The FCSRT has shown its utility in the distinction between bv-FTD and AD, therefore increasing the diagnostic accuracy.

Pharmacological models in Alzheimer's disease research

Wider use of pharmacological models would facilitate the development of new drugs for Alzheimer's disease (AD), The two main models currently used are based on the cholinergic and glutamatergic hypotheses of AD, Although they lead to some of the attention and memory impairment observed in AD, they do not fully reproduce the AD pattern. The few studies that used a combination modeling approach, ie, the simultaneous administration of several drugs with the aim of impairing several neurotransmitters or different aspects of a single system, have reported no or marginal cumulative effect. On the basis of current understanding of glutamate and acetylcholine involvement in AD pathophysiology, we suggest that models using selective muscarinic-1 (M(1)) receptor blockers would better mimic the status of the cholinergic system in AD, This kind of model might be suitable for the assessment of drugs that do not act directly on the cholinergic system.

Immediate recall of short stories depends on educational level

Memory complaints are frequent in the elderly but the confirmation of memory decline is challenging. Tests employing the recall of paragraphs or short stories have been proposed for the diagnosis of Alzheimer’s disease and amnestic mild cognitive impairment.

Effects of Age and Divided Attention on Memory Components Derived for the Category Exemplar Generation Task

Age differences in memory performances on a conceptually driven task, the category exemplar generation (CEG) test, were investigated. Thirty-six younger adults and 36 healthy older adults studied word lists in full and divided attention conditions. Recall was tested with category names. The process-dissociation procedure was used to derive estimates of controlled and automatic memory. Old-old adults (70-84 years) exhibited poorer conscious recollection than both younger (18-24) and young-old adults (59-69). In contrast, no age differences were found in estimates of automatic memory. For the younger and older adults, the divided encoding manipulation reduced both the consciously controlled and automatic estimates of memory. The results suggest that the few prior findings of age deficits in priming on the CEG may have been an artifact of contamination from conscious retrieval processes. They also indicate that the opportunity for greater semantic processing enhances the conceptual priming of both younger and older adults.

Ageing affects conceptual but not perceptual memory processes

Whereas age effects commonly occur in tests of explicit memory, tests of implicit memory often show age invariance. In two experiments, the traditional confound between test type (implicit vs explicit) and retrieval process (conceptually driven vs perceptually driven) was removed by using conceptually driven and perceptually driven tests of both implicit and explicit memory. Experiment 1 revealed a significant age effect for conceptually driven retrieval and no age effect for perceptually driven retrieval, regardless of the type of memory being measured. Experiment 2 highlighted a difference between the two age groups in their ability to utilise semantic encoding in a nominally perceptually driven explicit memory test. The paper concludes that although perceptually driven processing is stable over age, particular care must be taken to minimise contamination from conceptually driven retrieval processes in such investigations.

An additive factor analysis of the effect of depression on the reaction time of old patients

Depressed participants display longer reaction times (RTs) than control participants. The present study was aimed at deciphering which stages of processing are affected by depression in old adults. Sixteen old depressed patients and 16 old healthy volunteers performed a two-choice visual RT task. Signal intensity, stimulus-response mapping and foreperiod duration were manipulated so as to affect the stages of stimulus preprocessing, response selection and motor adjustment, respectively. Reaction time data suggest that depression spares the stage of stimulus preprocessing but affects the stage of motor adjustment. An analysis of the error rate leaves open the possibility that depression alters the stage of response selection.

Exploring the Identification-Production Hypothesis of Repetition Priming in Young and Older Adults

The identification-production hypothesis of age-related differences in repetition priming predicts reduced priming in older adults on indirect memory measures that require stimulus production (production priming) together with age constancy on indirect measures that require stimulus identification, verification, or classification processes (identification priming). Although some evidence is consistent with this hypothesis, comparisons of identification and production priming in young and older adults often confound stimulus, subject, and dependent measure factors across tasks. Consequently, repetition priming has yet to be assessed in healthy young and healthy older adults using identification and production tasks that control for these factors. The identification-production hypothesis was tested using verb generation as a measure of production priming (Experiments 1-3) and semantic classification (Experiment 1) or semantic verification (Experiments 2 and 3) as the measure of identification priming. Contrary to the identification-production hypothesis, no age-related diminutions in identification or production forms of priming were found.

Disturbances of consciousness in dementia with Lewy bodies associated with alteration in nicotinic receptor binding in the temporal cortex

Disturbances of consciousness, including fluctuations in attention and awareness, are a common and clinically important symptom in dementia with Lewy bodies (DLB). In the present study we investigate potential mechanisms of such disturbances of consciousness (DOC) in a clinicopathological study evaluating specific components of the cholinergic system. [3H]Epibatidine binding to the high-affinity nicotinic receptor in the temporal cortex (Brodmann's areas 20 and 36) differentiated DLB cases with and without DOC, being 62-66% higher in those with DOC (F=4.5,p=.025). The were no differences between DLB patients with or without DOC in 125I-labeled alpha-bungaratoxin binding to the low-affinity nicotinic receptor, [3H]pirenzepine binding to the muscarinic M1 receptor, or in choline acetyltransferase activity. These findings provide support for the hypothesis that cholinergic activity is an important neural correlate if consciousness and suggest a mechanism of DOC in DLB involving alterations in the nicotinic receptor, composed of predominantly alpha4 and beta2 subunits.

Divided attention, aging, and priming in exemplar generation and category verification

Transfer-appropriate processing theories differentiate between conceptual- and perceptual-priming tasks. The former are said to be influenced by the nature of processing engaged in at study, but not by changes in modality between study and test; the latter are sensitive to changes in format between study and test, but not to variations in the extent of semantic processing at study. In the present experiments, we examined the effects of divided attention and aging on priming in exemplar generation and category verification, two tasks that require access to semantic information at test. Manipulations of attention during encoding affected the extent of priming in exemplar generation, but not in category verification. Priming effects were similar in young and older adults in exemplar generation following study in both full and divided attention. Although older adults did not demonstrate priming in category verification in one experiment, no effects of age or divided attention were observed in a second experiment. In addition, priming in category verification was unaffected by varying the level of processing at encoding. However, the absence of levels-of-processing and attention effects in category verification does not signal that priming in this task has a perceptual basis; priming in category verification was insensitive to modality shifts between study and test. The implications of these findings for theories of priming and cognitive aging are considered.

Priming for new associations in normal aging and in mild dementia of the Alzheimer type

Recent data suggest that patients with Alzheimer's disease (AD) are able to show perceptual priming and, to some extent, conceptual priming for material which has preexisting representations in memory, and that normal elderly subjects are able to automatically activate pre-existing representations in both perceptual and conceptual priming tasks. An important question concerns the capacity of showing priming for materials without pre-existing representations in memory in normal and pathological aging. In order to address this issue, 20 patients with mild AD, 20 elderly controls and 20 young controls subjects were assessed with a paradigm of priming for new verbal associations. Neither the patients nor the normal elderly subjects demonstrated priming effects for new associations, while young subjects showed significant priming effects. These results suggest that the absence of priming for new verbal associations is attributable more to an effect of aging than to a specific effect of Alzheimer's disease.

Free and cued selective reminding and selective reminding in the elderly

Free and Cued Selective Reminding (FCSR) differs from Selective Reminding (SR) because of a study procedure which controls cognitive processing and a reminding procedure which allows for cued recall. Performance on FCSR and SR was compared in two studies to determine which test produces better recall and to identify the factors that account for the superior recall. When the tests were administered to very elderly normal subjects using the standard clinical protocol, twice as many words were retrieved from long-term memory in FCSR than SR. The second experiment, which manipulated study and reminding conditions in a younger sample of normal elderly, suggests that the improvement in free recall was due to the study procedure and the method of reminding.

Dissociation between declarative and procedural learning in dementia and depression

Declarative and procedural learning were assessed in patients with probable Alzheimer's Disease (AD) and major depression, patients with AD and no depression, patients with major depression but no dementia, and a group of age-comparable nondemented and nondepressed normal controls. AD patients showed significant deficits in declarative but not in procedural learning, while depressed nondemented patients showed the opposite pattern (i.e., a significantly worse procedural than declarative learning). Patients with both AD and major depression showed a similar learning pattern to the AD nondepressed group (relatively preserved procedural learning but severe deficits in declarative memory). These findings provide further evidence for the independence between declarative and procedural learning, and demonstrate their different vulnerability in dementia and depressive-like states.

Cross-form priming in normal aging and in mild dementia of the Alzheimer type

Twenty patients at early stages of Alzheimer's disease (AD), 20 elderly control subjects and 20 young subjects completed a cross-form priming task, followed by a free recall task. Results show that patients with mild AD display priming effects, and that these priming effects are strictly comparable to those obtained by elderly and young control subjects. Moreover, while the patients' performances are normal in the implicit part of the task, they are massively impaired in the explicit free recall task. These results don't support the hypothesis of a dissociation of performances between identification tasks and generation tasks in Alzheimer's disease, and show that conceptual priming can be observed at early stages of the disease, despite semantic memory impairments.

Dissociation of implicit and explicit memory tests: effect of age and divided attention on category exemplar generation and cued recall

In this article, we report an experiment that provides further evidence concerning the differences between explicit and implicit measures of memory. The effects of age and divided attention on the implicit conceptual test of category exemplar generation (CEG) were compared with their effects on the explicit test of cued, recall, where the category names served as cues in both tasks. Four age groups (20-35, 40-55, 60-75, and 76-90) were compared. Half of the subjects were also required to carry out a secondary letter-detection task during the learning phase. Cued recall performance was significantly impaired by increased age and imposition of the secondary task. In contrast, the CEG task was unaffected by these two factors. These results suggest that implicit conceptual tasks and explicit memory tasks are mediated by different processes. This conclusion opposes those of previous studies that showed that experimental manipulations (level of processing, generation, organization) influenced these two kinds of memory tests in a similar way.

Toward the neural basis of verbal priming: a cognitive-neuropsychological synthesis

Repetition priming is a mnemonic phenomenon that has attracted considerable attention from neuropsychologists and cognitive scientists. In an attempt at elucidating the putative mechanisms of priming, the present review draws on evidence from both domains. The review is restricted to verbal priming of visually presented stimuli--an area that accounts for the majority of empirical studies of priming. A number of theoretical accounts are presented. The interim conclusion is that neither multiple systems nor unitary system-multiple process theories can adequately explain the data on priming, although both contain many valid components. An integrative model is proposed to improve the explanation of the empirical evidence. The central assertion of the proposed model is that repetition priming depends on perceptual processes that can be mapped on specific neural systems. It is postulated that individual differences in perceptual processing ability predict variability in memory performance. It is proposed that data-driven priming of verbal stimuli critically depends on the activity of primary and secondary visual cortices in the right hemisphere, whereas conceptually-driven priming is hypothesized to rely on the activities of higher order tertiary association cortices in language areas and more anterior neocortical areas.

Skill learning and repetition priming in Alzheimer's disease

While perceptual-motor learning occurs normally in Alzheimer's disease (AD) patients, their ability to acquire the skill of reading transformed text has not been well delineated. AD patients and matched controls were timed as they read two blocks of words presented in mirror image. Control subjects displayed both skill learning and repetition priming, whereas AD patients displayed only repetition priming. Skill learning in AD patients was associated with their ability to complete verbal analogies. They displayed the expected impairment in recognition for the words from the mirror reading task. The failure of AD patients to acquire the mirror reading skill can be understood through a task analysis and may reflect an underlying deficit in abstract reasoning that precludes the development of appropriate pattern analyzing strategies needed to transform rotated text.