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Cognitive and Neuropsychological Aspects of Age-Associated Memory Dysfunction

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Cognitive and Neuropsychological Aspects of Age-Associated Memory Dysfunction COGNITIVE AND NEUROPSYCHOLOGICAL ASPECTS OF AGE-ASSOCIATED MEMORY DYSFUNCTION A k a d e m is k a v h a n d l in g som för avläggande av filosofie doktorsexamen med vederbörligt tillstånd av rektorsämbetet vid Umeå universitet framlägges för offentlig granskning vid Psykologiska institutionen, Umeå Universitet, Seminarierum 2, fredagen den 24 januari 1992, klockan 10.15 AV Th o m a s K a r l s s o n Psykologiska institutionen, Umeå Universitet, Umeå COGNITIVE AND NEUROPSYCHOLOGICAL ASPECTS OF AGE- ASSOCIATED MEMORY DYSFUNCTION BY Thom as K arlsson Doctoral Dissertation Department of Psychology, University of Umeå, Umeå, Sweden ABSTRACT Memory dysfunction is common in association with the course of normal aging. Memory dysfunction is also obligatory in age-associated neurological disorders, such as Alzheimer’s disease. However, despite the ubiquitousness of age-related memory decline, several basic questions regarding this entity remain unanswered. The present investigation addressed two such questions: (1) Can individuals suffering from memory dysfunction due to aging and amnesia due to Alzheimer’s disease improve memory performance if contextual support is provided at the time of acquisition of to-be- remembered material or reproduction of to-be-remembered material? (2) Are memory deficits observed in ‘younger’ older adults similar to the deficits observed in ‘older’ elderly subjects, Alzheimer’s disease, and memory dysfunction in younger subjects? The outcome of this investigation suggests an affirmative answer to the first question. Given appropriate support at encoding and retrieval, even densely amnesic patients can improve their memory performance. As to the second question, a more complex pattern emerges. When attentional demands are varied, subjects of varying ages perform qualitatively similar. However, when semantic aspects of the to-be- remembered material are manipulated, age-associated qualitative differences are observed. These qualitative differences show up between older and younger adults, as well as between ‘younger’ and ‘older’ elderly subjects. Key words: Aging, Alzheimer’s disease, Contextual support, Memory, Memory disorders Author’s address: Department of Psychology, University of Umeå, S-901 87 Umeå, Sweden. Umeå 1991; ISBN 91-7174-641-2 COGNITIVE AND NEUROPSYCHOLOGICAL ASPECTS OF AGE-ASSOCIATED MEMORY DYSFUNCTION BY T h o m a s K a r l s s o n 2 3 ABSTRACT Memory dysfunction is common in association with the course of normal aging. Memory dysfunction is also obligatory in age-associated neurological disorders, such as Alzheimer’s disease. However, despite the ubiquitousness of age-related memory decline, several basic questions regarding this entity remain unanswered. The present investigation addressed two such questions: (1) Can individuals suffering from memory dysfunction due to aging and amnesia due to Alzheimer’s disease improve memory performance if contextual support is provided at the time of acquisition of to-be-remembered material or reproduction of to-be-remembered material? (2) Are memory deficits observed in ‘younger’ older adults similar to the deficits observed in ‘older’ elderly subjects, Alzheimer’s disease, and memory dysfunction in younger subjects? The outcome of this investigation suggests an affirmative answer to the first question. Given appropriate support at encoding and retrieval, even densely amnesic patients can improve their memory performance. As to the second question, a more complex pattern emerges. When attentional demands are varied, subjects of varying ages perform qualitatively similar. However, when semantic aspects of the to-be-remembered material are manipulated, age-associated qualitative differences are observed. These qualitative differences show up between older and younger adults, as well as between ‘younger’ and ‘older’ elderly subjects. 4 The dissertation is based upon the following papers: I. Bäckman, L, & Karlsson, T. (1987). Effects of word fragment completion on free recall: A selective improvement of older adults.Comprehensive Gerontology, 7, 4-7. II. Karlsson, T., Bäckman, L., Herlitz, A., Nilsson, L.-G., Winblad, B., & Österlind, P.-O. (1989). Memory improvement at different stages of Alzheimer's disease. Neuropsychologia, 27,737-742. III. Karlsson, T., Adolfsson, R., Erstrand, B., Spiegel, R., Winblad, B., & Bucht, G. (1991). Somatostatin and glucose does not improve memory and cognition in Alzheimer’s disease. (Manuscript submitted for publication ). IV. Bäckman, L., & Karlsson, T. (1986). Episodic remembering in young adults, 73-year-olds, and 82-year-olds. Scandinavian Journal of Psychology, 27, 320-325. V. Nilsson, L-G., Bäckman, L., & Karlsson, T. (1989). Functionally similar memory deficits in old age, alcohol intoxication, and sleep deprivation. Psychological Medicine, 79, 423-433. VI. Karlsson, T. (1990). Attention and memory in normal aging. (Manuscript submitted for publication). 5 ACKNOWLEDGMENT My supervisor, Lars-Göran Nilsson, has not only provided financial backing during the initial stages of this project, but also been an excellent reviewer during the process of writing the individual papers, as well as the dissertation. In particular, though, Lars-Göran has been able to convey an interest in experimental psychology, which I did not anticipate when I started my graduate studies. I clearly acknowledge that this contribution can not be valued highly enough. In addition to Lars-Göran Nilsson, a number of persons have contributed to the investigations discussed in this dissertation, and I thank them all for their assistance. However, the contributions made, by Lars Bäckman and Rolf Adolfsson during various stages of this research clearly deserves special recognition. I also want to thank my wife, Katharina, for her support during the process of writing of this dissertation. 6 CONTENTS Chapter One: Introduction....................................................................................................... 7 Prevalence of amnesia and memory dysfunction ............................ 7 Etiologies of amnesia................................................................................................... 8 The biochemical basis of memory............................................................................ 10 Mild to moderate memory dysfunction....................................................................12 Chapter Two: Experimental psychology of pure’ amnesia ................................................ 13 Experimental investigations of the amnesic syndrome.......................................... 13 Theories about the amnesic syndrome......................................................................17 Summary ......................................................................................................................25 Chapter Three: Age-associated memory dysfunction .........................................................26 Theories of age-associated amnesia ........................................................................ 35 The neurobiology of normal aging and dementia................................................... 36 Chapter Four: Amnesia in neurodegenerative disorders and other conditions................43 Alzheimer’s disease ................................................................................................... 43 Huntington’s disease.................................................................................................. 61 Cerebro-vascular disorders....................................................................................... 63 Chapter Five: Summary of current investigation ................................................................63 Experiment 1: Generation..........................................................................................67 Experiment 2: Memory improvement in Alzheimer’s disease..............................69 Experiment 3: Somatostatin treatment in Alzheimer’s disease .............................71 Experiment 4: Encoding-retrieval interactions in old age..................................... 75 Experiment 5: Effects of priming and cued recall in elderly, sleep deprived and alcohol intoxicated subjects...................................................................................... 79 Experiment 6: Working memory in old age............................................................84 Discussion and conclusions...................................................................................... 88 References................................................................................................................................92 INTRODUCTION 7 CHAPTER ONE: INTRODUCTION In recent years, the interest in memory dysfunction has increased steadily. Partly, this interest is due to the awareness that memory dysfunction is a common cognitive problem, particularly in adults. Partly, there is an interest in memory dysfunction because fundamental insights in human memory have been gained through the study of memory dysfunction. Despite this interest, and despite several important discoveries, many basic questions still remain unanswered. In particular, the cognitive mechanisms that are damaged in amnesia remain to be understood. Similarly, the manner in which memories are represented, is still unknown. Obviously, these questions are vital, not only for students of amnesia, but also for students of memory in normal individuals. Briefly, the dissertation comprises two parts. The first part (chapters one to four) contains
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