Transcript document

Memory and its disorders Classic
cases and introduction
Chris Moulin & Céline Souchay
School of Psychology
University of Leeds
[email protected]
https://elgg.leeds.ac.uk/psccjam
Celine
• PhD, University of Tours, France
• Supervisor, Michel Isingrini
• Key papers:
Souchay, C., Moulin, C.J.A. (in press). Memory and consciousness in Alzheimer’s
disease. Current Alzheimer Research.
Souchay, C. (2007). Metamemory in Alzheimer's disease. Cortex, special issue on
Alzheimer's disease, 43, 987-1003.
Souchay, C., Bacon, E., Danion, J-M. (2006). Metamemory in Schizophrenia: an
exploration of the feeling-of-knowing state. Journal of Clinical and Experimental
Neuropsychology, 28(5): 828-840.
Souchay, C., Isingrini, M., Espagnet, L. (2000). Relations between Feeling-of-knowing
and Frontal lobe functioning in older adults. Neuropsychology, 14 (2), 299-309
Chris
• PhD, Bristol, UK
• Supervisors, Tim Perfect & Alan Baddeley
• Key papers:
Moulin, C.J.A., Perfect, T.J., Jones, R.W. (2000). Evidence for intact memory monitoring
in Alzheimer's disease: Metamemory sensitivity at encoding. Neuropsychologia, 38:
1242-1250.
Moulin, C.J.A., Conway, M.A., Thompson, R.G., James, N., Jones, R.W. (2005).
Disordered Memory Awareness: Recollective Confabulation in Two Cases of
Persistent Déjà vecu. Neuropsychologia, 43 :1362-1378
Moulin, C.J.A., Laine, M., Rinne, J.O., Kaasinen, V., Hiltunen, J., Sipilä, H. (2007). Brain
function during multi-trial learning in Mild Cognitive Impairment: A PET activation
study. Brain Research, 1136, 132-141.
Rathbone, C.J., Moulin, C.J.A., Conway, M.A. (2008). Self-centered memories: The
reminiscence bump and the self. Memory and Cognition, 36(8): 1403-1414.
Course Overview
• Lecture 1. Memory and its disorders. Classic cases in the study of
memory 2h CM & CS
• Lecture 2. An overview of models of memory function 2h CM
• Lecture 3. Memory and the self 2h CM & CS
• Lecture 4. Freud was right: Inhibitory processes in memory 2h CM
• Lecture 5. Metacognition 2h CS
• Lecture 6. Remembering and consciousness 2h CM
• Lecture 7. Recollection and the Brain 2h CS
• (Private Study, 4h)
• Final Session. Case studies in Memory, student led discussion
Content & Goals
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Describe the differences in disorders of memory due to neurological and psychiatric
disorders
Demonstrate a sound understanding of key contemporary concepts in Memory
Theory (as suggested by, but not restricted to the topics of the lecture list).
Connect theoretical concepts in the literature to clinical cases and novel special
populations
Describe both how models of memory have shaped our understanding of various
pathologies, and how special populations, especially single cases have informed
contemporary memory theory.
Offer an informed opinion as to the involvement of memory in several clinical
disorders.
Differentiate key areas of the literature: Long term versus short term memory,
semantic versus episodic memory, explicit versus implicit memory.
Assessment
• Private study will require students to search for
a case study in the literature and then present it
very briefly to the class detailing test
performance, anecdotal information, and what
the case suggests for the literature. Note that
pubmed enables you to restrict document types
to 'case reports', and other sources restrict all
publications to case reports, and journals such
as Neurocase.
‘a strange kind of illness seems to blame for this
gap in my life! Was this illness imposed upon
me by other people? The only way to find out is
to do a detailed examination of all the
magazines, newspapers and other published
material appearing during the last 6 months.
The results of an inquiry will release the causes
of my ‘now-living’ – despite apparently unlikely
connection between the subjects.’
9 Classic Cases
Patient RJ – bilateral-frontal lobes
Patient JB - no brain damage
Sharon - no brain damage
Mrs P – left temporal
Clive Waring – left temporal & frontal
Patient ELD – right frontal
Patient PV – left hemisphere lesion
Patient HM – hippocampus & surrounding temporal
lobes
• Patient JW – medial temporal lobe
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Case 1
• Herpes Simplex Encephalitis with fitting and loss of
consciousness
• extensive damage to the left temporal lobe extending to
the frontal lobe
• initially, could not answer simple questions such as
"What is a tree? Do you eat it, dress in it, or pick fruit
from it?"
• Subsequently, became extremely depressed, crying
endlessly. When his wife gave him a notebook to write
down why he was crying, he wrote: 'I am completely
incapable of thinking.'
• premorbid IQ of at least 122
Case 1
• Impaired delayed copying of figures, impaired
autobiographical memory, preserved STM and
implicit learning
• Musical abilities preserved - able to follow
complex repeats in a musical score
• He wrote over and over that he had just
regained consciousness for the first time. “It’s
like being dead, all the bloody time.”
• When his wife leaves the room, patient greets
her on her return as if he hasn't seen her for
years.
Case 2
• 62-year-old female presented complaining of not
remembering unusual words or people's names
• Marked atrophy to the left temporal lobe
• Still drove and kept up her hobbies as a country dancer
and a dressmaker
• Deteriorated to comprehension at the level of a fiveand-a-half year-old child
'Is a kitten young?'
'what on earth is a kitten?'
'who wrote Hamlet?'
'who is Hamlet?'
Case 2
• digit span of 7
• preserved autobiographical memory and
awareness of current affairs
• Over-regularises the pronunciation of words like
yacht and pint. Progressively more and more
familiar and frequently encountered words were
affected
• Eventually, complained that foods did not taste
the same as they used to. Misidentified objects
and only used items that were familiar to her
Case 3
• 49 year-old woman, educated to A-level
• right hemisphere aneurysm - heamatoma
subfrontally in Sylvian fissure
• good recovery, but difficulty in finding her way
around
• IQ normal - Normal LTM performance
• Corsi span of 3/4
• Impaired immediate serial recall of faces
• Good immediate serial recall of words
Case 4
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26 year-old woman, 11 years of schooling
Stroke with transient loss of consciousness
Left hemisphere lesion
Subsequently, good autonomous functioning - set up
a business
Free recall impaired - but due to an absence of
recency
Superior than controls at learning a story
Unimpaired delayed recall (drawing) of a visual figure
Corsi span (6), digit span (2/3)
Case 5
• Male, professional, aged 42
• Traffic accident. Unconscious for several weeks,
haemorrhaging to frontal lobes
"I was driving along in South Wales, coming back from the steel
company in Wales where I had been on business, and had an
accident in my car, I pulled out to pass a lorry and a lorry came the
other way and that lorry missed me; I then went to pull back in
when I passed the lorry I was overtaking and another lorry came
along and he actually hit me, so there I was in the middle of the
road with no car. He stopped and he said "I'm sorry mate," and I
said "Don't worry about it, it was as much my fault as yours," … so
we shook hands and said cheerio"
Case 5
Were you hurt?
"I went into Hereford hospital for that night … and they looked at me
and they said there's nothing wrong with you, you'd better bugger
off home"
How did you get to the clinic then?
"the sister in Hereford hospital said the best place for you to go is
Rivermead … She said "You should go to Rivermead, it's the best
place there is in the country for what you need … and while
you're down there take so-and-so with you," which is exactly what
I did.
So who did you bring with you?
"some girl, I can't remember her name, some big fat piece … and
then I went back and took her back with me. I rang the sister of
Hereford hospital and said, "I'm back now and I've brought
what's-her-name back with me".
Case 6
• Male, born in 1922. Aged 53, lost job because of severe
drinking problem
• disorientated for time and place
• Whilst living in hospital until his death he still believed
himself to be living at home and working as a fitter
• Memory Quotient of 62 (normal = 100), recognition
superior to recall
A retrograde memory problem that affected memories from well before the
1970s. 2 standard deviations below normal for people famous in the
1970s, but less impaired for faces from progressively earlier periods
Unimpaired STM, but accelerated forgetting - unable to retain information for
more than 30 seconds
Case 7
• The Most famous memory patient of all time
• Intact implicit memory, impaired explicit memory
• Intact short term memory, impaired long term
memory
Case 8
• 34 year-old woman
• Found naked, unconscious and near starvation in a
park, her skin covered with sores and rat-bites
• Could not identify herself and could not remember how
she had came to be in the park
• After seven months of hospitalisation, she was identified
by her family through a media campaign. She accepted
her family as her own, but never recognised them
• Face recognition comparable to a control participant of
the same age and IQ
Case 8
• When asked to generate personal memories to cue
words, virtually none of them came from the time period
before her discovery in the park, although the control
participant recalled most memories from a comparable
period.
• During hypnotherapy, recovered memories from before
her admission to hospital and of the events leading up
to being found in the park. She had run away with her
boss and he had held her as a prisoner for virtually five
years. She had escaped – to the park where she was
found
Case 9
• Patient JB
• 54-year-old male
• presented at casualty complaining of inability to
remember anything of the last few days
• extremely severe retrograde and anterograde amnesia
• high levels of Gamma GT in blood, an indication of
alcoholism
• Disorientated in time, but not in space
• No language or problem solving impairments
• significantly below chance on a forced-choice
recognition task
Case 9
• STM for lists of five digits equally poor with a
filled or unfilled delay.
• Implicit memory functioning in the normal range,
• Working memory seriously impaired.
• Equally impaired on recall and recognition
• Aware of memory difficulties
• Did not recall his name or address for several
days, until he was identified by a friend.
Who is who?
Mrs P
left temporal
Semantic Dementia
Clive Waring
left temporal & frontal
Dense Amnesic
Patient ELD
right frontal
Visuospatial STM
Patient PV
left hemisphere lesion
Verbal STM
Patient JB
no brain damage
Malingerer
Patient HM
hippocampus & surrounding
temporal lobes
Very Dense Amnesic
Patient JW
medial temporal lobe
Korsakoff’s Amnesia
Patient RJ
bilateral-frontal lobes
Frontal lobe confabulator
Sharon
no brain damage
Psychogenic Fugue
Korsakoff’s amnesia; Malingerer; Psychogenic Fugue; Verbal STM; Very Dense
Amnesic; Semantic Dementia; Visuospatial STM; Dense Amnesic; Frontal lobe
confabulator
Who is who?
Mrs P
Case 2
left temporal
Semantic Dementia
Clive Waring
Case 1
left temporal & frontal
Very Dense Amnesic
Patient ELD
Case 3
right frontal
Visuospatial STM
Patient PV
Case 4
left hemisphere lesion
Verbal STM
Patient JB
Case 9
no brain damage
Malingerer
Patient HM
Case 7
hippocampus & surrounding
temporal lobes
Dense Amnesic
Patient JW
Case 6
medial temporal lobe
Korsakoff’s amnesia
Patient RJ
Case 5
bilateral-frontal lobes
Frontal lobe confabulator
Sharon
Case 8
no brain damage
Psychogenic Fugue
References
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Clive Wearing in chapter 2 of: Campbell, R. & Conway, M. A. (1995). Broken memories:
case studies in memory impairment. Oxford: Blackwell.
Mrs P in chapter 16 of: Campbell, R. & Conway, M. A. (1995). Broken memories: case
studies in memory impairment. Oxford: Blackwell.
ELD in: Hanley, J. R., Young, A. W. & Pearson, N. A. (1991). Impairment of the visuospatial sketch pad. The Quarterly Journal of Experimental Psychology, 43A, 101-125.
JB is a composite of patients reported in chapter 15 of: Baddeley, A. D., Wilson, B. A. &
Watts, F. M. (1995). Handbook of memory disorders. Chichester: John Wiley & Sons.
PV in: Basso, A., Spinnler, H., Vallar, G. & Zanobio, M. E. (1982). Left hemisphere
damage and selective impairment of auditory-verbal short-term memory.
Neuropsychologia, 20, 263-274.
JW in chapter 9 of: Campbell, R. & Conway, M. A. (1995). Broken memories: case
studies in memory impairment. Oxford: Blackwell.
RJ in: Baddeley, A. & Wilson, B. (1986). Amnesia, autobiographical memory, and
confabulation. In D. C. Rubin (Ed.), Autobiographical memory Cambridge: Cambridge
University Press.
Sharon in chapter 14 of: Baddeley, A. D., Wilson, B. A. & Watts, F. M. (1995). Handbook
of memory disorders. Chichester: John Wiley & Sons.
Patient HM: Everywhere
Clive Wearing
• http://www.youtube.com/watch?v=coZK-t7lbp8
What does all that mean?
• Many different forms of memory dysfunction
• Most of which map onto brain structures
• Need for different systems and different tests
• Memory is not a monolithic entity
• Each error, each case is evidence for some
system or other at work