Understanding failure of visual paired associate learning in amnestic mild cognitive impairment

Comparison of Cognitive Functions Between Patients with Alzheimer Disease, Patients with Mild Cognitive Impairment, and Healthy People

Background: There is a growing need for predicting Alzheimer disease (AD) based on emerging neurocognitive dysfunction before the onset of the disease. Objectives: According to neuropathological changes in the mesial temporal lobe (MTL) before the onset of clinical symptoms and the relationship between the function of these structures and cognitive functions (such as visual memory, working memory, and new learning), we aimed to investigate the possibility of these cognitive functions as markers of transition from mild cognitive impairment (MCI) to AD. Methods: In this case-control study, 15 patients with AD, 18 patients with MCI (from memory clinics of Tehran University of Medical Sciences), and 15 healthy people were compared using the 3 subtests of the Cambridge Neuropsychological Test Automated Battery (CANTAB), including spatial working memory (SWM), pattern recognition memory (PRM), and paired-associate learning (PAL). The tests were performed between 9 AM and 12 noon. The scores were compared by a 1-way analysis of variance (ANOVA). Results: The mean ages of AD, MCI, and healthy groups were 68.66, 68.22, and 64.26 years, respectively. In terms of the SWM test, in 2 of 3 variables, there were significant differences between the 3 groups (P = 0.000 and P = 0.001). Regarding the PRM test, there were significant differences between the 3 groups in accuracy and response time (P = 0.000 and P = 0.004, respectively). Regarding PAL, there were significant differences between the 3 groups in all 3 variables (P = 0.000). The Mini-mental State Examination (MMSE) scores were associated with almost all variable scores (P = 0.000). Conclusions: Dysfunction in new learning and recognition memory can be indicators of MCI and its progression to AD, whereas the assessment of SWM can only be used to assess the progression of MCI to AD.

Computerized paired associate learning performance and imaging biomarkers in older adults without dementia

This cross-sectional study examined whether performance on the computerized Paired Associate Learning (PAL) task from the Cambridge Neuropsychological Test Automated Battery is associated with amyloid positivity as measured by Positron Emission Tomography, regional volume composites as measured by Magnetic Resonance Imaging, and cognitive impairment. Participants from the BIOCARD Study (N = 73, including 62 cognitively normal and 11 with mild cognitive impairment; M age = 70 years) completed the PAL task, a comprehensive clinical and neuropsychological assessment, and neuroimaging as part of their annual study visit. In linear regressions covarying age, sex, years of education and diagnosis, higher PAL error scores were associated with amyloid positivity but not with medial temporal or cortical volume composites. By comparison, standard neuropsychological measures of episodic memory and global cognition were unrelated to amyloid positivity, but better performance on the verbal episodic memory measures was associated with larger cortical volume composites. Participants with mild cognitive impairment demonstrated worse cognitive performance on all of the cognitive measures, including the PAL task. These findings suggest that this computerized visual paired associate learning task may be more sensitive to amyloid positivity than standard neuropsychological tests, and may therefore be a promising tool for detecting amyloid positivity in non-demented participants.

Improvement of encoding and retrieval in normal and pathological aging with word-picture paradigm

OBJECTIVES

During the aging process, there is a progressive deficit in the encoding of new information and its retrieval. Different strategies are used in order to maintain, optimize or diminish these deficits in people with and without dementia. One of the classic techniques is paired-associate learning (PAL), which is based on improving the encoding of memories, but it has yet to be used to its full potential in people with dementia. In this study, our aim is to corroborate the importance of PAL tasks as instrumental tools for creating contextual cues, during both the encoding and retrieval phases of memory. Additionally, we aim to identify the most effective form of presenting the related items.

METHOD

Pairs of stimuli were shown to healthy elderly people and to patients with moderate and mild Alzheimer's disease. The encoding conditions were as follows: word/word, picture/picture, picture/word, and word/picture.

RESULTS

Associative cued recall of the second item in the pair shows that retrieval is higher for the word/picture condition in the two groups of patients with dementia when compared to the other conditions, while word/word is the least effective in all cases.

CONCLUSION

These results confirm that PAL is an effective tool for creating contextual cues during both the encoding and retrieval phases in people with dementia when the items are presented using the word/picture condition. In this way, the encoding and retrieval deficit can be reduced in these people.

Spatial sequence memory and spatial error monitoring in the Groton Maze Learning Task (GMLT): A validation study of GMLT sub-measures in healthy children

The stepping-stone variant of the hidden pathway maze learning (HPML) task paradigm has been extensively used to investigate cognitive functions in neuropsychology and neuropharmacology. Previous studies have used total error across trials, as well as rule-break errors and learning errors, to define spatial memory and/or executive function in healthy and impaired adults and children. However, the construct validity of performance measures on HPML tasks has not been established in healthy children. To assess the construct validity of measures of exploratory and rule-break errors on the Groton Maze Learning Task (GMLT) measures of spatial sequence memory (Corsi Blocks Task) and spatial error monitoring (Continuous Paired Associate Learning; CPAL) were used. The results indicate that Corsi span predicted GMLT spatial sequence memory and CPAL accuracy predicted GMLT spatial error monitoring. The construct validity of the GMLT as a measure of spatial memory and executive function are discussed with regard to prior research using HPML tasks in neuropsychological contexts.

The development of associate learning in school age children

Associate learning is fundamental to the acquisition of knowledge and plays a critical role in the everyday functioning of the developing child, though the developmental course is still unclear. This study investigated the development of visual associate learning in 125 school age children using the Continuous Paired Associate Learning task. As hypothesized, younger children made more errors than older children across all memory loads and evidenced decreased learning efficiency as memory load increased. Results suggest that age-related differences in performance largely reflect continued development of executive function in the context of relatively developed memory processes.

Effect of cholinergic neurotransmission modulation on visual spatial paired associate learning in healthy human adults

RATIONALE

Use of cross-species neuropsychological paradigms such as visual-spatial paired associate learning (PAL) may allow for a better understanding of underlying neural substrates of memory. Such paradigms, which are often used to guide models of memory in animals, can then be carried forward into humans to provide a basis for evaluation of pharmacologic compounds designed to ameliorate learning and memory impairments in neurologic and psychiatric morbidities.

OBJECTIVES

This double-blind, randomized, crossover trial investigated effects of donepezil, an acetylcholinesterase (AChE) inhibitor, in attenuating scopolamine-induced cognitive impairment using a novel, "process-based" computerized measure of visual-spatial PAL.

RESULTS

In healthy male volunteers, scopolamine (0.6 mg) induced a time-dependent reduction in visual-spatial PAL, with the greatest impairment (Cohen's d = 1.37) observed 2 h after dosing. Cotreatment with donepezil (10 mg) significantly ameliorated scopolamine-induced impairment at the 2-h time point (Cohen's d = 0.66). Process-based analyses revealed a significant impairment in both memory (Cohen's d = 1.37 to 0.50) and executive (Cohen's d = 1 .21 to 0.62) aspects of visual-spatial PAL performance following acute scopolamine challenge, and these reductions were ameliorated by donepezil.

CONCLUSIONS

Acute scopolamine challenge can produce large and robust deficits in visual-spatial PAL, which reflect impairments in both memory and executive processes. Coadministration of a single dose of donepezil can ameliorate these deficits. These results provide support for the use of a visual-spatial PAL test as a pharmacodynamic cognitive marker of central nervous system (CNS)-mediating compounds in humans.

Differences in learning rates for item and associative memories between amnestic mild cognitive impairment and healthy controls

BACKGROUND

It has been established that the overall performance of associative memory was disproportionately impaired in contrast to item memory in aMCI (Amnestic mild cognitive impairment) patients, but little is known about the specific aspects of the memory process that show differences between aMCI and healthy controls. By comparing an item-item associative learning test with an individual item learning test, the present study investigated whether the rate of learning was slower in associative memory than in item memory in aMCI. Furthermore, we examined whether deficits in intertrial acquisition and consolidation contributed to the potential disproportionate impairments in the learning rate of associative memory for aMCI patients. In addition, we further explored whether the aMCI-discriminative power of the associative memory test increases more than that of the item memory test when the number of learning-test trials increases.

METHODS

A group of 40 aMCI patients and 40 matched control participants were administered a standardized item memory test (Auditory Verbal Learning Test, AVLT) and a standardized associative memory test (Paired Associative Learning Test, PALT), as well as other neuropsychological tests and clinical assessments.

RESULTS

The results indicated that the learning rate deficits in aMCI patients were more obvious for associative memory than for item memory and that the deficits resulted from impairments in both intertrial acquisition and consolidation. In addition, the receiver operating characteristic curve and logistical regression analysis revealed that the discriminative power of the associative memory test for aMCI was larger than that of the item memory test, especially with more than one learning-test trials.

CONCLUSIONS

Due to more deficits in learning rate of associative memory than that of item memory, the discriminative power for aMCI tended to be larger in associative memory than in item memory when the number of learning-test trials increased. It is suggested that associative memory tests with multiple trials may be particularly useful for early detection of aMCI.

A process-based approach to characterizing the effect of acute alprazolam challenge on visual paired associate learning and memory in healthy older adults

OBJECTIVE

Alprazolam is a benzodiazepine that, when administered acutely, results in impairments in several aspects of cognition, including attention, learning, and memory. However, the profile (i.e., component processes) that underlie alprazolam-related decrements in visual paired associate learning has not been fully explored.

METHODS

In this double-blind, placebo-controlled, randomized cross-over study of healthy older adults, we used a novel, "process-based" computerized measure of visual paired associate learning to examine the effect of a single, acute 1-mg dose of alprazolam on component processes of visual paired associate learning and memory.

RESULTS

Acute alprazolam challenge was associated with a large magnitude reduction in visual paired associate learning and memory performance (d = 1.05). Process-based analyses revealed significant increases in distractor, exploratory, between-search, and within-search error types. Analyses of percentages of each error type suggested that, relative to placebo, alprazolam challenge resulted in a decrease in the percentage of exploratory errors and an increase in the percentage of distractor errors, both of which reflect memory processes.

CONCLUSIONS

Results of this study suggest that acute alprazolam challenge decreases visual paired associate learning and memory performance by reducing the strength of the association between pattern and location, which may reflect a general breakdown in memory consolidation, with less evidence of reductions in executive processes (e.g., working memory) that facilitate visual paired associate learning and memory.