Memory and its disorders Classic cases and introduction

Chris Moulin & Céline Souchay School of PsychologyUniversity of Leeds

c.j.a.moulin@leeds.ac.ukhttps://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• 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

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

five-and-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

• 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 recallA 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• 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

visuo-spatial 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