Neuropsychologia 43 (2005) 1362–1378 Disordered memory awareness: recollective confabulation in two cases of persistent dej´ a` vecu Christopher J.A. Moulin a,b,∗, Martin A. Conway b, Rebecca G. Thompson a, Niamh James a, Roy W. Jones a a The Research Institute for the Care of the Elderly, St. Martin’s Hospital, UK b Institute of Psychological Sciences, University of Leeds, Leeds LS2 9JT, UK Received 7 April 2004; received in revised form 10 December 2004; accepted 16 December 2004 Available online 11 March 2005 Abstract We describe two cases of false recognition in patients with dementia and diffuse temporal lobe pathology who report their memory difficulty as being one of persistent dej´ a` vecu—the sensation that they have lived through the present moment before. On a number of recognition tasks, the patients were found to have high levels of false positives. They also made a large number of guess responses but otherwise appeared metacognitively intact. Informal reports suggested that the episodes of dej´ a` vecu were characterised by sensations similar to those present when the past is recollectively experienced in normal remembering. Two further experiments found that both patients had high levels of recollective experience for items they falsely recognized. Most strikingly, they were likely to recollectively experience incorrectly recognised low frequency words, suggesting that their false recognition was not driven by familiarity processes or vague sensations of having encountered events and stimuli before. Importantly, both patients made reasonable justifications for their false recognitions both in the experiments and in their everyday lives and these we term ‘recollective confabulation’. Thus, the patients are characterised by false recognition, overextended recollective experience, and recollective confabulation. These features are accounted for in terms of disrupted control of memory awareness and recollective states, possibly following brain damage to fronto-temporal circuits and we extend this account to normally and abnormally occurring states of dej´ a` vu and vecu and related memory experiences. © 2005 Elsevier Ltd. All rights reserved. Keywords: Recollective experience; Episodic memory; Temporal lobe; Dementia; Metacognition; Dej´ avu` A comparatively recent and important development in the feelings, thoughts and verbal statements directly related to the study of human memory is the emergence of research pro- recalled episode also often come to mind during recollective grammes into consciousness and memory. In particular, this remembering. Familiarity (referred to here as “familiarity” research has considered states of memory awareness that oc- or “F” responses) on the other hand does not have these fea- cur in every day life. Two interesting forms of memory aware- tures and instead is mainly characterised by a strong sense of ness, which has been studied neuropsychologically as well having encountered a stimulus in the past. These two types as experimentally, are recollective experience and feelings of of memory awareness have powerful functional qualities and familiarity (Wheeler, Stuss, & Tulving, 1997; Tulving, 1985; many well established laboratory effects are differentially as- see Gardiner & Richardson-Klavehn, 2000, for a review). sociated with them. For example, levels of processing, gener- Recollective experience (operationally referred to here as “re- ation, self-reference, picture superiority, and many other ef- member” or “R” responses) occurs when a rememberer has a fects are only found in remember responses. Manipulations sense or feeling of the self in the past. Images (often visual), that bring about these effects do not influence memory ac- companied by feelings of familiarity (F responses), which ∗ Corresponding author. Tel.: +44 113 3436657; fax: +44 113 3435749. instead are responsive to speed of presentation of items, their E-mail address: [email protected] (C.J.A. Moulin). meaningfulness, and their long-term familiarity (Gardiner & 0028-3932/$ – see front matter © 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.neuropsychologia.2004.12.008 C.J.A. Moulin et al. / Neuropsychologia 43 (2005) 1362–1378 1363 Richardson-Klavehn, 2000). Clearly then, these are impor- seems to me that I have already lived through the entire situ- tant aspects of memory; their dysfunction following brain ation; with a feeling of strangeness and often fear” (Bancaud damage is likely to have major consequences, as we detail et al., 1994, p. 78). Eight of their 16 cases reported sensa- below in two new case studies. tions of having experienced the present situation before (see Disorders of memory awareness states have been re- Gloor, 1997, for a more detailed account of the phenomenol- ported previously. In an important study, Schacter, Curran, ogy of epileptic experience; and Ide, Mizukami, Suzuki, & Galluccio, Milberg, and Bates (1996) described patient BG Shiraishi, 2000 for a case with recurrent dej´ a` vu). who following an infarction of the right frontal lobe showed Some difficulty comes in discussing the sensations sur- pathologically high levels of false recognition accompanied rounding memory retrieval and states of awareness. Whereas by chronically over extended recollective experience (see also the operational definitions of remembering and knowing are Curran, Schacter, Norman, & Galluccio, 1997 for a further well established, and are empirically supported by more discussion of patient BG). Thus, BG not only incorrectly objective measures, difficulties arise when discussing erro- recognised items (words, pictures and sounds) he had not pre- neous sensations of remembering usually encompassed in the viously studied, but he also recollectively experienced these generic term dej´ a` vu (for a full account of the range of dej´ a` items. Interestingly BG did not show this pattern when re- vu experiences, see Funkhouser, 1995 and Brown, 2003). Al- quired to learn a categorised list. Schacter et al. (1996) con- though cognitive psychology has often overlooked sensations cluded that BG was only aware, when tested on uncategorised of dej´ a` vu, since it is so difficult to induce experimentally, it lists, that he had previously studied a list consisting of some has been conceptualised as: ‘any subjectively inappropriate words, pictures, or sounds. When presented with a recog- impression of familiarity of a present experience with an un- nition test containing old and new items, he over-extended defined past’ (Neppe, 1983). Other theorists have attempted his ‘recognition’ to new items, perhaps on the inference that to classify different forms of dej´ a` vu. Sno and Linszen (1990), as these were similar to the previously studied items they for example, describe major and minor forms of dej´ a` vu. Mi- must all, or a majority, be old. However, if more structure nor dej´ a` vu is transient and has a rapid onset, and can be was present in the encoding environment, i.e. semantic cate- thought of as a non-pathological, everyday memory error. gories, then he was able to use this to discriminate old from Major dej´ a` vu is ‘clearly pathological and prolonged’, and new items at test. From the present perspective, the critical can be thought of as the chronic difficulties described in the point was that when BG falsely recognised an item, he recol- temporal lobe epileptic patients above, for example. Whilst lectively experienced that item (in contrast, see Ward et al., this distinction offers a good framework for discussing vari- 1999 and Parkin, Ward, Bindschaedler, Squires, & Powell, eties of experience, it is unclear how it maps onto theories of 1999, for cases of abnormal familiarity). In other words, BG memory, in particular, recollective experience. In this paper, had a strong feeling of remembering even for new items and we would like to distinguish between a dej´ a` vu sensation, it is this phenomenon we focus on in the present study. Also, operationalised as an erroneous sense of familiarity, with an we note at this point that this abnormal recollective experi- episodically mediated, erroneous sensation of recollection, ence may be related to disrupted connections between frontal dej´ a` vecu. This definition of dej´ a` vecu is somewhat novel, executive control systems and memory circuits in the tempo- but based on Funkhouser’s (1995) use of the term, emphasis- ral lobes—neuroanatomical pathways which were damaged ing the sensation of having lived through the present moment following BG’s injuries. before. Given that there are two states of awareness driven by A related and equally interesting dysfunction of mem- familiarity and recollection, it seems logical that there could ory awareness has often been reported by patients suffering be two separate disruptions of these states, and these are not from temporal lobe epilepsy. It has long been known that well captured in the generic term dej´ a` vu. To foreshadow the seizures in the temporal lobe region give rise to memory- discussion in this paper, we believe this distinction is impor- like hallucinations and the sensation of dej´ avu(` Jackson & tant, since we argue that the patients presented here show Colman, 1898). Bancaud, Brunet-Bourgin, Chauvel, & inappropriate recollection but not inappropriate familiarity. Halgren (1994) investigated the ‘dreamy state’ associated Bancaud et al.’s epileptic patients generally had experi- with spontaneous seizure and electrical stimulation of the ences of dej´ a` vecu, that is of having ‘lived through’ or al- temporal