Response bias for picture recognition in patients with Alzheimer disease

AMES: An Automated Self-Administered Scale to Detect Incipient Cognitive Decline in Primary Care Settings

Early identification and intervention of cognitive decline could be effective to prevent progression to dementia. We developed a self-delivered cognitive screening tool, Automated Memory and Executive Screening (AMES), to assess cognitive domains including memory, language, and executive function. 189 participants with diagnoses of mild cognitive impairment (MCI, n = 43), subjective cognitive decline (SCD, n = 29), objectively-defined subtle cognitive decline (obj-SCD, n = 18), and normal controls (NC, n = 99) completed the study. AMES had good convergent validity with conventional scales, and was good to discriminate patients with MCI (area under the curve [AUC] = 0.88; sensitivity = 86%; specificity = 80%) and obj-SCD (AUC = 0.78; sensitivity = 89%; specificity = 63%) from NC. These findings support that AMES is an easy to administer and effective instrument to screen for early cognitive impairment in community-based settings.

Verbal Encoding Deficits Impact Recognition Memory in Atypical “Non-Amnestic” Alzheimer’s Disease

Memory encoding and retrieval deficits have been identified in atypical Alzheimer’s disease (AD), including posterior cortical atrophy (PCA) and logopenic variant primary progressive aphasia (lvPPA), despite these groups being referred to as “non-amnestic”. There is a critical need to better understand recognition memory in atypical AD. We investigated performance on the California Verbal Learning Test (CVLT-II-SF) in 23 amyloid-positive, tau-positive, and neurodegeneration-positive participants with atypical “non-amnestic” variants of AD (14 PCA, 9 lvPPA) and 14 amnestic AD participants. Recognition memory performance was poor across AD subgroups but trended toward worse in the amnestic group. Encoding was related to recognition memory in non-amnestic but not in amnestic AD. We also observed cortical atrophy in dissociable subregions of the distributed memory network related to encoding (left middle temporal and angular gyri, posterior cingulate and precuneus) compared to recognition memory (anterior medial temporal cortex). We conclude that recognition memory is not spared in all patients with atypical variants of AD traditionally thought to be “non-amnestic”. The non-amnestic AD patients with poor recognition memory were those who struggled to encode the material during the learning trials. In contrast, the amnestic AD group had poor recognition memory regardless of encoding ability.

Bayesian modeling of item heterogeneity in dichotomous recognition memory data and prospects for computerized adaptive testing

Most current models of recognition memory fail to separately model item and person heterogeneity which makes it difficult to assess ability at the latent construct level and prevents the administration of adaptive tests. Here we propose to employ a General Condorcet Model for Recognition (GCMR) in order to estimate ability, response bias and item difficulty in dichotomous recognition memory tasks. Using a Bayesian modeling framework and MCMC inference, we perform 3 separate validation studies comparing GCMR to the Rasch model from IRT and the 2-High-Threshold (2HT) recognition model. First, two simulations demonstrate that recovery of GCMR ability estimates with varying sparsity and test difficulty is more robust and that estimates improve from the two other models under common test scenarios. Then, using a real dataset, face validity is confirmed by replicating previous findings of general and domain-specific age effects (Güsten et al. in Cortex 137:138-148, https://doi.org/10.1016/j.cortex.2020.12.017 , 2021). Using cross-validation we show better out-of-sample prediction for the GCMR as compared to Rasch and 2HT model. In addition, we present a hierarchical extension of the model that is able to estimate age- and domain-specific effects directly, without recurring to a two-stage procedure. Finally, an adaptive test using the GCMR is simulated, showing that the test length necessary to obtain reliable ability estimates can be significantly reduced compared to a non-adaptive procedure. The GCMR allows to model trial-by-trial performance and to increase the efficiency and reliability of recognition memory assessments.

When twice is better than once: increased liking of repeated items influences memory in younger and older adults

BACKGROUND

Numerous studies have reported that the repeated presentation of a stimulus leads to an increase in positive affect towards the stimulus itself (the so-called mere exposure effect). Here, we evaluate whether changes in liking due to repetition may have a differential impact on subsequent memories in younger and older adults.

METHOD

In two experiments, younger and older adults were asked to rate a series of nonwords (Experiment 1) or unfamiliar neutral faces (Experiment 2) in terms of how much they like them and then presented with a surprise yes-no recognition memory task. At study, items were repeated either consecutively (massed presentation) or with a lag of 6 intervening items (spaced presentation).

RESULTS

In both experiments, participants rated spaced repeated items more positively than massed items, i.e. they liked them most. Moreover, older adults remembered spaced stimuli that they liked most better than younger adults.

CONCLUSIONS

The findings are discussed in accordance with the mechanisms underlying positivity effects in memory and the effect of repetition on memory encoding.

Long-Term Impact of Intelligent Monitoring Technology on People with Cognitive Impairment: An Observational Study

BACKGROUND

Interactive smart home systems are particularly useful for people with cognitive impairment.

OBJECTIVE

To investigate the long-term effects of Assistive Technology (AT) combined with tailored non-pharmacological interventions for people with cognitive impairment.

METHODS

18 participants (12 with mild cognitive impairment and 6 with Alzheimer's disease) took part in the study that we evenly allocated in one of three groups: 1) experimental group (EG), 2) control group 1 (CG1), and 3) control group 2 (CG2). EG received the system installed at home for 4 to 12 months, during which they received tailored non-pharmacological interventions according to system observations. CG1 received tailored interventions for the same period, but only according to state-of-the-art self-reporting methods. Finally, CG2 neither had a system installation nor received interventions. All groups underwent neuropsychological assessment before and after the observational period.

RESULTS

After several months of continuously monitoring at home and deployment of tailored interventions, the EG showed statistically significant improvement in cognitive function, compared to the CG1 and CG2. Moreover, EG participants, who received the sensor-based system, have shown improvement in domains such as sleep quality and daily activity, as measured by the multi-sensor system. In addition, the feedback collected from the participants concludes that the long-term use of the multi-sensor system by people with cognitive impairment can be both feasible and beneficial.

CONCLUSION

Deploying a sensor-based system at real home settings of people with cognitive limitations living alone and maintaining its use long-term is not only possible, but also beneficial for clinical decision making in order to tackle cognitive, functional, and behavioral related problems.

Differences in Discriminability and Response Bias on Rey Auditory Verbal Learning Test Delayed Recognition in Behavioral Variant Frontotemporal Dementia and Alzheimer's Disease

OBJECTIVE

Episodic memory is impaired in Alzheimer's disease (AD) dementia but thought to be relatively spared in behavioral variant frontotemporal dementia (bvFTD). This view is challenged by evidence of memory impairment in bvFTD. This study investigated differences in recognition memory performance between bvFTD and AD.

METHOD

We performed a retrospective analysis on the recognition trial of the Rey Auditory Verbal Learning Test in patients with bvFTD (n = 85), AD (n = 55), and control participants (n = 59). Age- and education-adjusted between-group analysis was performed on the total score and indices of discriminative ability and response bias. Correlations between recognition and measures of memory, language, executive functioning, and construction were examined.

RESULTS

Patients with AD had a significantly lower total recognition score than patients with bvFTD (control 28.8 ± 1.5; bvFTD 24.8 ± 4.5; AD 23.4 ± 3.6, p < .01). Both bvFTD and AD had worse discriminative ability than controls (A' control 0.96 ± 0.03; bvFTD 0.87 ± 0.03; AD 0.84 ± 0.10, p < .01), but there was no difference in response bias (B" control 0.9 ± 0.2; bvFTD 1.6 ± 1.47; AD 1.4± 1.4, p < .01). AD had worse discriminability than bvFTD (p < .05). Discriminability was associated with memory for both patient groups (median correlation coefficient r = .34) and additionally associated with language (r = .31), but not executive functioning (r = -.03) in bvFTD. Response bias was unrelated to other cognitive functions (r = -.02).

CONCLUSIONS

Discriminability, but not response bias, differentiated patients with bvFTD from AD. The presence of an impaired discrimination index suggests a "pure" (recognition) memory deficit in bvFTD.

Increasing word distinctiveness eliminates the picture superiority effect in recognition: Evidence for the physical-distinctiveness account

A well-established phenomenon in the memory literature is the picture superiority effect-the finding that, all else being equal, memory is better for pictures than for words (Paivio & Csapo, 1973). Theorists have attributed pictures' mnemonic advantage to dual coding (Paivio, 1971), conceptual distinctiveness (Hamilton & Geraci, 2006), and physical distinctiveness (Mintzer & Snodgrass, 1999). Here, we present a novel test of the physical-distinctiveness account of picture superiority: If the greater physical variability of pictures relative to words is responsible for their mnemonic benefit, then increasing the distinctiveness of words and/or reducing the physical variability of pictures should reduce or eliminate the picture superiority effect. In the present experiments we increased word distinctiveness by varying font style, font size, color, and capitalization. Additionally, in Experiment 3 we reduced the distinctiveness of pictures by presenting black-and-white pictures with similar orientations. In Experiment 4, a forced choice procedure was used in which subjects were asked to identify the form that each probe had taken during the study phase. The results were consistent with the distinctiveness prediction and, notably, were inconsistent with dual coding.

Response bias, recollection, and familiarity in individuals with Highly Superior Autobiographical Memory (HSAM)

The current study focused on individuals with Highly Superior Autobiographical Memory (HSAM) and had two main objectives: 1) investigate whether HSAMs have increased recollection performance compared to controls, and 2) investigate whether HSAMs have a reliably different response bias than controls. While previous lab-based recognition tests have shown that HSAMs have normal memory performance, these tests were based on a mixture of both recollection and familiarity. Here, we employed recognition tests specifically designed to separate recollected responses from those based on familiarity. Additionally, we were interested in how HSAMs make their memory decisions. Several studies have shown a great deal of variability between individuals in their response bias. Here, individuals with HSAM and age- matched controls completed a remember/know and a source memory test. HSAMs behaved like controls in both overall and recollection-based memory discrimination. However, HSAMs showed a significantly more liberal response bias, endorsing more items as "old" than controls. These findings contribute to our understanding of how memory processes - especially those related to decision-making - function in those with superior memory abilities and may help elucidate how other (non-HSAM) memory experts make decisions.

Listening to the Picture-Superiority Effect

The picture-superiority effect (PSE) refers to the finding that, all else being equal, pictures are remembered better than words ( Paivio & Csapo, 1973 ). Dual-coding theory (DCT; Paivio, 1991 ) is often used to explain the PSE. According to DCT, pictures are more likely to be encoded imaginally and verbally than words. In contrast, distinctiveness accounts attribute the PSE to pictures' greater distinctiveness compared to words. Some distinctiveness accounts emphasize physical distinctiveness ( Mintzer & Snodgrass, 1999 ) while others emphasize conceptual distinctiveness ( Hamilton & Geraci, 2006 ). We attempt to distinguish among these accounts by testing for an auditory analog of picture superiority. Although this phenomenon, termed the auditory PSE, occurs in free recall ( Crutcher & Beer, 2011 ), we were unable to extend it to recognition across four experiments. We propose a new framework for understanding the PSE, wherein dual coding underpins the free-recall PSE, but conceptual distinctiveness underpins the recognition PSE.

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.

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.

Usefulness of Discriminability and Response Bias Indices for the Evaluation of Recognition Memory in Mild Cognitive Impairment and Alzheimer Disease

BACKGROUND

Most studies examining episodic memory in Alzheimer disease (AD) have focused on patients' impaired ability to remember information. This approach provides only a partial picture of memory deficits since other factors involved are not considered.

OBJECTIVE

To evaluate the recognition memory performance by using a yes/no procedure to examine the effect of discriminability and response bias measures in amnestic mild cognitive impairment (a-MCI), AD dementia, and normal-aging subjects.

METHODS

We included 43 controls and 45 a-MCI and 51 mild AD dementia patients. Based on the proportions of correct responses (hits) and false alarms from the Rey Auditory Verbal Learning Test (RAVLT), discriminability (d') and response bias (C) indices from signal detection theory (SDT) were calculated.

RESULTS

Results showed significant group differences for d' (F (2) = 83.26, p < 0.001), and C (F (2) = 6.05, p = 0.00). The best predictors of group membership were delayed recall and d' scores. The d' measure correctly classified subjects with 82.98% sensitivity and 91.11% specificity.

CONCLUSIONS

a-MCI and AD dementia subjects exhibit less discrimination accuracy and more liberal response bias than controls. Furthermore, combined indices of delayed recall and discriminability from the RAVLT are effective in defining early AD. SDT may help enhance diagnostic specificity.

Semantic Feature Disturbance in Alzheimer Disease: Evidence from an Object Decision Task

BACKGROUND AND OBJECTIVE

It is widely held that semantic disturbance in Alzheimer disease (AD) involves the loss of distinctive features but the relative sparing of nondistinctive features. Many previous studies of semantic feature disturbance have used cognitively challenging tasks with verbal stimuli that allow for potential cognitive confounds. Our objective was to use a task with lower memory demands to investigate distinctive feature disturbance in AD.

METHODS

We used an object decision task to compare the processing of distinctive and nondistinctive semantic features in people with AD and age-matched controls. The task included six conditions based on the relationship between each prime and target object. We tested the processing of distinctive and nondistinctive features by selectively altering distinctive and nondistinctive semantic features between prime and target pairs.

RESULTS

Performance accuracy was significantly lower for participants with AD than for age-matched controls when distinctive features were manipulated, but no difference was found when nondistinctive features were manipulated.

CONCLUSIONS

Our results provide evidence of semantic content disturbance in AD in the context of a task with low cognitive demands.

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

Patients with Alzheimer's disease (AD) often exhibit an abnormally liberal response bias in recognition memory tests, responding "old" more frequently than "new." Investigations have shown patients can to shift to a more conservative response bias when given instructions. We examined if patients with mild AD could alter their response patterns when the ratio of old items is manipulated without explicit instruction. Healthy older adults and AD patients studied lists of words and then were tested in three old/new ratio conditions (30%, 50%, or 70% old items). A subset of participants provided estimates of how many old and new items they saw in the memory test. We demonstrated that both groups were able to change their response patterns without the aid of explicit instructions. Importantly, AD patients were more likely to estimate seeing greater numbers of old than new items, whereas the reverse was observed for older adults. Elevated estimates of old items in AD patients suggest their liberal response bias may be attributed to their reliance on familiarity. We conclude that the liberal response bias observed in AD patients is attributable to their believing that more of the test items are old and not due to impaired meta-memorial monitoring abilities.

Cross-task and cross-manipulation stability in shifting the decision criterion

In recognition memory experiments participants must discriminate between old and new items, a judgment influenced by response bias. Research has shown substantial individual differences in the extent to which people will strategically adjust their response bias to diagnostic cues such as the prior probability of an old item. Despite this significant between subject variability, shifts in bias have been found to be relatively predictive within individuals across memory tests. Experiment 1 sought to determine whether this predictability extends beyond memory. Results revealed that the amount a subject shifted response bias in a recognition memory task was significantly predictive of shifting in a visual perception task, suggesting that shifting can generalise outside of a specific testing domain. Experiment 2 sought to determine how predictive shifting would be across two manipulations well known to induce shifts in bias: a probability manipulation and a response payoff manipulation. A modest positive relationship between these two methods was observed, suggesting that shifting behaviour is relatively predictive across different manipulations of shifting. Overall, results from both experiments suggest that response bias shifting, like response bias setting, is a relatively stable behaviour within individuals despite changes in test domain and test manipulation.

The Effects of Feedback on Memory Strategies of Younger and Older Adults

Existing literature suggests that feedback could effectively reduce false memories in younger adults. However, it is unclear whether memory performance in older adults also might be affected by feedback. The current study tested the hypothesis that older adults can use immediate feedback to adjust their memory strategy, similar to younger adults, but after feedback is removed, older adults may not be able to maintain using the memory strategy. Older adults will display more false memories than younger adults due to a reduction in attentional resources. In Study 1, both younger and older adults adjusted gist processing and item-specific processing biases based on the feedback given (i.e., biased and objective feedback). In Study 2 after the feedback was removed, only younger adults with full attention were able to maintain the feedback-shaped memory strategy; whereas, both younger adults with divided attention and older adults had increased false memories after feedback was removed. The findings suggest that environmental support helps older adults as well as younger adults to adopt a memory strategy that demands high attentional resources, but when the support is removed, older adults can no longer maintain such a strategy.

Preserved conceptual implicit memory for pictures in patients with Alzheimer's disease

The current study examined different aspects of conceptual implicit memory in patients with mild Alzheimer's disease (AD). Specifically, we were interested in whether priming of distinctive conceptual features versus general semantic information related to pictures and words would differ for the mild AD patients and healthy older adults. In this study, 14 healthy older adults and 15 patients with mild AD studied both pictures and words followed by an implicit test section, where they were asked about distinctive conceptual or general semantic information related to the items they had previously studied (or novel items). Healthy older adults and patients with mild AD showed both conceptual priming and the picture superiority effect, but the AD patients only showed these effects for the questions focused on the distinctive conceptual information. We found that patients with mild AD showed intact conceptual picture priming in a task that required generating a response (answer) from a cue (question) for cues that focused on distinctive conceptual information. This experiment has helped improve our understanding of both the picture superiority effect and conceptual implicit memory in patients with mild AD in that these findings support the notion that conceptual implicit memory might potentially help to drive familiarity-based recognition in the face of impaired recollection in patients with mild AD.

Dubious decision evidence and criterion flexibility in recognition memory

When old–new recognition judgments must be based on ambiguous memory evidence, a proper criterion for responding “old” can substantially improve accuracy, but participants are typically suboptimal in their placement of decision criteria. Various accounts of suboptimal criterion placement have been proposed. The most parsimonious, however, is that subjects simply over-rely on memory evidence – however faulty – as a basis for decisions. We tested this account with a novel recognition paradigm in which old–new discrimination was minimal and critical errors were avoided by adopting highly liberal or conservative biases. In Experiment 1, criterion shifts were necessary to adapt to changing target probabilities or, in a “security patrol” scenario, to avoid either letting dangerous people go free (misses) or harming innocent people (false alarms). Experiment 2 added a condition in which financial incentives drove criterion shifts. Critical errors were frequent, similar across sources of motivation, and only moderately reduced by feedback. In Experiment 3, critical errors were only modestly reduced in a version of the security patrol with no study phase. These findings indicate that participants use even transparently non-probative information as an alternative to heavy reliance on a decision rule, a strategy that precludes optimal criterion placement.

Response bias in recognition memory as a cognitive trait

According to signal detection theory, old-new recognition decisions can be affected by response bias, a general proclivity to respond either "old" or "new." In recognition experiments, response bias is usually analyzed at a group level, but substantial individual differences in bias can underlie group means. These differences suggest that, independent of any experimental manipulation, some people require more memory evidence than do others before they are willing to call an item "old." In four experiments, we investigated the possibility that recognition response bias is a partial function of a trait-like predisposition. Bias was highly correlated across two recognition study-test cycles separated by 10 min (Experiment 1). A nearly identical correlation was observed when the tasks were separated by one week (Experiment 2). Bias correlations remained significant even when the stimuli differed sharply between the first and second study-test cycles (Experiment 3). No relationship was detected between bias and response strategies in two general knowledge tests (Experiments 2 and 4), but bias did weakly predict frequency of false recall in the Deese/Roediger-McDermott (DRM) paradigm (Experiment 4). This evidence of trait-like stability suggests an entirely different aspect of response bias than that studied by examining its modulation by task variables, one for which complete theories of recognition memory may need to account.

Pattern separation and pattern completion in Alzheimer's disease: evidence of rapid forgetting in amnestic mild cognitive impairment

Over the past four decades, the characterization of memory loss associated with Alzheimer's disease (AD) has been extensively debated. Recent iterations have focused on disordered encoding versus rapid forgetting. To address this issue, we used a behavioral pattern separation task to assess the ability of the hippocampus to create and maintain distinct and orthogonalized visual memory representations in patients with amnestic mild cognitive impairment (aMCI) and mild AD. We specifically used a lag-based continuous recognition paradigm to determine whether patients with aMCI and mild AD fail to encode visual memory representations or whether these patients properly encode representations that are rapidly forgotten. Consistent with the rapid forgetting hypothesis of AD, we found that patients with aMCI demonstrated decreasing pattern separation rates as the lag of interfering objects increased. In contrast, patients with AD demonstrated consistently poor pattern separation rates across three increasingly longer lags. We propose a continuum that reflects underlying hippocampal neuropathology whereby patients with aMCI are able to properly encode information into memory but rapidly lose these memory representations, and patients with AD, who have extensive hippocampal and parahippocampal damage, cannot properly encode information in distinct, orthogonal representations. Our results also revealed that whereas patients with aMCI demonstrated similar behavioral pattern completion rates to healthy older adults, patients with AD showed lower pattern completion rates when we corrected for response bias. Finally, these behavioral pattern separation and pattern completion results are discussed in terms of the dual process model of recognition memory.

Distinct medial temporal contributions to different forms of recognition in amnestic mild cognitive impairment and Alzheimer's disease

The simplest expression of episodic memory is the experience of familiarity, the isolated recognition that something has been encountered previously. Brain structures of the medial temporal lobe (MTL) make essential contributions to episodic memory, but the distinct contributions from each MTL structure to familiarity are debatable. Here we used specialized tests to assess recognition impairments and their relationship to MTL integrity in people with amnestic mild cognitive impairment (aMCI, n=19), people with probable Alzheimer's disease (AD; n=10), and age-matched individuals without any neurological disorder (n=20). Recognition of previously presented silhouette objects was tested in two formats-forced-choice recognition with four concurrent choices (one target and three foils) and yes/no recognition with individually presented targets and foils. Every foil was extremely similar to a corresponding target, such that forced-choice recognition could be based on differential familiarity among the choices, whereas yes/no recognition necessitated additional memory and decision factors. Only yes/no recognition was impaired in the aMCI group, whereas both forced-choice and yes/no recognition were impaired in the AD group. Magnetic resonance imaging showed differential brain atrophy, as MTL volume was reduced in the AD group but not in the aMCI group. Pulsed arterial spin-labeled scans demonstrated that MTL blood flow was abnormally increased in aMCI, which could indicate physiological dysfunction prior to the emergence of significant atrophy. Regression analyses with data from all patients revealed that regional patterns of MTL integrity were differentially related to forced-choice and yes/no recognition. Smaller perirhinal cortex volume was associated with lower forced-choice recognition accuracy, but not with lower yes/no recognition accuracy. Instead, smaller hippocampal volumes were associated with lower yes/no recognition accuracy. In sum, familiarity memory can be specifically assessed using the forced-choice recognition test, it declines later than other MTL-dependent memory functions as AD progresses, and it has distinct anatomical substrates.

Using pictures and words to understand recognition memory deterioration in amnestic mild cognitive impairment and Alzheimer's disease: a review

Difficulty recognizing previously encountered stimuli is one of the earliest signs of incipient Alzheimer's disease (AD). Work over the last 10 years has focused on how patients with AD and those in the prodromal stage of amnestic mild cognitive impairment make recognition decisions for visual and verbal stimuli. Interestingly, both groups of patients demonstrate markedly better memory for pictures over words, to a degree that is significantly greater in magnitude than their healthy older counterparts. Understanding this phenomenon not only helps to conceptualize how memory breaks down in AD, but also potentially provides the basis for future interventions. This review critically examines recent recognition memory work using pictures and words in the context of the dual-process theory of recognition and current hypotheses of cognitive breakdown in the course of very early AD.

Figural memory performance and functional magnetic resonance imaging activity across the adult lifespan

We examined performance and functional magnetic resonance imaging activity in participants (n = 235) aged 17-81 years on a nonverbal recognition memory task, figural memory. Reaction time, error rate, and response bias measures indicated that the youngest and oldest participants were faster, made fewer errors, and showed a more conservative response bias than participants in the median age ranges. Encoding and Recognition phases activated a distributed bilateral network encompassing prefrontal, subcortical, lateral, and medial temporal and occipital regions. Activation during Encoding phase did not correlate with age. During Recognition, task-related activation for correctly identified targets (Hit-Targets) correlated linearly positively with age; nontask related activity correlated negative quadratically with age. During correctly identified distractors (Hit-Distractors) activity in task-related regions correlated positive linearly with age, nontask activity showed positive and negative quadratic relationships with age. Missed-Targets activity did not correlate with age. We concluded that figural memory performance and functional magnetic resonance imaging activity during Recognition but not Encoding was affected both by continued maturation of the brain in the early 20s and compensatory recruitment of additional brain regions during recognition memory in old age.

Changes in response bias with different study-test delays: evidence from young adults, older adults, and patients with Alzheimer's disease

OBJECTIVE

Along with impaired discrimination, patients with Alzheimer's disease (AD) often show an abnormally liberal response bias (greater tendency to respond "old"). Previously we matched discrimination by varying study-test list length and found that participants' usual bias is maintained, such that patients with AD were more liberal than healthy controls. However, this pattern could be a result of the way in which discrimination was matched. In this experiment, we examined whether matching discrimination with the use of a delay would lead to a liberal response bias in healthy younger and older adults as it might lead to the use of more similar memorial processing to the patients with AD.

METHOD

Younger adults, older adults, and patients with AD were run in 2 study-test sessions, with study and recognition test separated by either a 1-min or 1-day delay.

RESULTS

With the 1-min delay, both younger adults and healthy older adults showed a conservative response bias, while patients with AD showed a liberal response bias. When discrimination was matched between patients with AD and controls by the use of a delay, response bias was also matched, with all participants showing a more liberal response bias.

CONCLUSIONS

The current study suggests that how discrimination is matched between patients with AD and controls matters greatly. Potentially, this liberal bias is a result of healthy younger and older adults relying primarily on familiarity at the longer delay, thus using more similar memorial processes to patients with AD who are dependent on familiarity at any delay.

Interplay of the production and picture superiority effects: a signal detection analysis

Three experiments explored the interaction between the production effect (greater memory for produced compared to non-produced study items) and the picture superiority effect (greater memory for pictures compared to words). Pictures and words were presented in a blocked (E1) or mixed (E2, E3) design, each accompanied by an instruction to silently name (non-produced condition) or quietly mouth (produced condition) the corresponding referent. Memory was then tested for all study items as well as an equal number of foil items using a speeded (E1, E2) or self-paced (E3) yes-no recognition task. Experiments 1, 2, and 3 all revealed a small but reliable production × stimulus interaction. Production was also found to result in a liberal shift in response bias that could result in the overestimation of the production effect when measured using hits instead of sensitivity. Together our findings suggest that the application of multiple distinctive processes at study produces an especially discriminative memory trace at test, more so than the summation of each process individually.

Memorial familiarity remains intact for pictures but not for words in patients with amnestic mild cognitive impairment

Understanding how memory breaks down in the earliest stages of Alzheimer's disease (AD) process has significant implications, both clinically and with respect to intervention development. Previous work has highlighted a robust picture superiority effect in patients with amnestic mild cognitive impairment (aMCI). However, it remains unclear as to how pictures improve memory compared to words in this patient population. In the current study, we utilized receiver operating characteristic (ROC) curves to obtain estimates of familiarity and recollection for pictures and words in patients with aMCI and healthy older controls. Analysis of accuracy shows that even when performance is matched between pictures and words in the healthy control group, patients with aMCI continue to show a significant picture superiority effect. The results of the ROC analysis showed that patients demonstrated significantly impaired recollection and familiarity for words compared controls. In contrast, patients with aMCI demonstrated impaired recollection, but intact familiarity for pictures, compared to controls. Based on previous work from our lab, we speculate that patients can utilize the rich conceptual information provided by pictures to enhance familiarity, and perceptual information may allow for post-retrieval monitoring or verification of the enhanced sense of familiarity. Alternatively, the combination of enhanced conceptual and perceptual fluency of the test item might drive a stronger or more robust sense of familiarity that can be accurately attributed to a studied item.

Gist-based conceptual processing of pictures remains intact in patients with amnestic mild cognitive impairment

OBJECTIVE

The picture superiority effect, better memory for pictures compared to words, has been found in young adults, healthy older adults, and, most recently, in patients with Alzheimer's disease and mild cognitive impairment. Although the picture superiority effect is widely found, there is still debate over what drives this effect. One main question is whether it is enhanced perceptual or conceptual information that leads to the advantage for pictures over words. In this experiment, we examined the picture superiority effect in healthy older adults and patients with amnestic mild cognitive impairment (MCI) to better understand the role of gist-based conceptual processing.

METHOD

We had participants study three exemplars of categories as either words or pictures. In the test phase, participants were again shown pictures or words and were asked to determine whether the item was in the same category as something they had studied earlier or whether it was from a new category.

RESULTS

We found that all participants demonstrated a robust picture superiority effect, better performance for pictures than for words.

CONCLUSIONS

These results suggest that the gist-based conceptual processing of pictures is preserved in patients with MCI. While in healthy older adults preserved recollection for pictures could lead to the picture superiority effect, in patients with MCI it is most likely that the picture superiority effect is a result of spared conceptually based familiarity for pictures, perhaps combined with their intact ability to extract and use gist information.

Using stimulus form change to understand memorial familiarity for pictures and words in patients with mild cognitive impairment and Alzheimer's disease

Although it is generally accepted that patients with amnestic mild cognitive impairment (aMCI) and patients with Alzheimer's disease (AD) have significantly impaired recollection, recent evidence has been mixed as to whether these patients demonstrate impaired memorial familiarity. Recent work suggests that familiarity may remain intact for pictures, but not for words. Further, a recent event-related potential (ERP) study suggests that enhanced conceptual processing of pictures may underlie this intact familiarity. However, to date there has been no direct comparison of perceptual and conceptual-based familiarity for pictures and words in patients with aMCI and AD. To investigate this issue, patients with aMCI, patients with AD, and healthy older adults underwent four study-test conditions of word-word, picture-picture, word-picture, and picture-word. When stimuli undergo form change, it has been suggested that only conceptual processing can help support recognition in the absence of recollection. Our results showed that patients successfully relied on perceptual and conceptual-based familiarity to improve recognition for the within format conditions over the across format conditions. Further, results suggested that patients with aMCI and AD are able to use enhanced conceptual processing of pictures compared to words to allow them to overcome the deleterious effects of form change in a similar manner as controls. These results help us begin to understand which aspects of memory are impaired and which remain relatively intact in patients with aMCI and AD. This understanding can then in turn help us to assess, conceptualize, and build behavioral interventions to help treat these patients.