10/29/2019 Memory and Its Disorders Jason Brandt, Ph.D. Professor of Psychiatry & Behavioral Sciences Professor of Neurology The Johns Hopkins University School of Medicine 1 Memory • “Without memory, there is no identity, and without identity we are cast adrift into a sea of chance, without compass, map or destination.” » Lord Jonathan Sacks, Former Chief Rabbi of the U.K. 2 (C) Jason Brandt, Ph.D. 1 10/29/2019 Memory • “Without memory, our existence would be barren and opaque, like a prison cell into which no light penetrates; like a tomb which rejects the living. If anything can, it is memory that will save humanity. For me, hope without memory is like memory without hope…” »Elie Wiesel 3 Outline • Memory that is abnormally bad • Memory that is abnormally good • Malleability of memory • Memory for trauma • Common myths about memory 4 (C) Jason Brandt, Ph.D. 2 10/29/2019 Outline • Memory that is abnormally bad • Memory that is abnormally good • Malleability of memory • Memory for trauma • Common myths about memory 5 Theodore Ribot 1839-1916 6 (C) Jason Brandt, Ph.D. 3 10/29/2019 Amnesia • Severe impairment in the ability to: – create new, permanent memories • anterograde amnesia – retrieve old, previously acquired information • retrograde amnesia • Due to brain dysfunction 7 Amnesia • Can be seen in isolation – the amnestic syndrome • Can also be seen in combination with other cognitive impairments – dementia, delirium, etc. • Distinguish from “pseudoamnesia” – psychogenic, conversion disorder, dissociative disorder 8 (C) Jason Brandt, Ph.D. 4 10/29/2019 Some Causes of Amnesia • Traumatic brain injury • Cerebral anoxia (lack of oxygen) • Infections of the brain (encephalitis) •Strokes • Severe nutritional deficiencies • Degenerative brain disease – Alzheimer’s disease – Other dementias 9 Characteristics of the Amnestic Syndrome • Anterograde amnesia • Retrograde amnesia • Normal immediate memory • Normal intelligence – No dementia, mental retardation • + Confabulation 10 (C) Jason Brandt, Ph.D. 5 10/29/2019 The Experience of Amnesia • “Right now, I’m wondering. Have I done or said anything amiss? You see, at this moment, everything looks clear to me, but what happened just before? That’s what worries me. It’s like waking from a dream.” » Henry Molaison (“H.M.”) 11 Case Examples of Amnesic Patients •Patient R.J. – Viral (probably H. simplex) encephalitis •Patient O.N. – Alcoholic Korsakoff syndrome • Patient S.C. – Anterior communicating artery aneurysm 12 (C) Jason Brandt, Ph.D. 6 10/29/2019 Patient R.J. • Age 55; College graduate • Viral encephalitis (probably H. simplex) • Bilateral mesial temporal lobe lesions on MRI scan • MMSE=25 • WAIS-R: VIQ=122, PIQ=95, FSIQ=111 • Verbal Fluency: normal • Wisconsin Card Sorting Test: normal • WMS-R: A/C=111, Gen’l Mem.=89, Delayed=54 • Severely impaired on all other anterograde memory tests • Retrograde amnesia limited to few years immediately prior to illness 13 14 (C) Jason Brandt, Ph.D. 7 10/29/2019 15 Patient R.J. 16 (C) Jason Brandt, Ph.D. 8 10/29/2019 17 18 (C) Jason Brandt, Ph.D. 9 10/29/2019 19 Atrophy of Hippocampal Formation in Mild AD (Jack et al., 1997) 75 y.o. normal woman 73 y.o. woman with AD (CDR=1) Tail Body Head 20 (C) Jason Brandt, Ph.D. 10 10/29/2019 Patient O.N. • 82 year-old man • Highly accomplished attorney • Formerly, severe alcohol abuser • MMSE=27 • Full-Scale I.Q. = 132 on WAIS-R (99th percentile) • Wechsler Memory Scale – Revised – Attention Concentration Index = 131 (98th percentile) – General Memory Index = 81 (10th percentile) – Delayed Memory Index = 56 (< 1st percentile) • Severely impaired on all other anterograde memory tests • Extensive, temporally-graded retrograde amnesia 21 Patient O.N. 22 (C) Jason Brandt, Ph.D. 11 10/29/2019 Verbal Paired-Associates METAL -- IRON BABY -- CRIES CABBAGE -- PEN SCHOOL -- GROCERY FRUIT -- APPLE CRUSH -- DARK ROSE -- FLOWER OBEY -- INCH 23 Patient O.N. Verbal Paired-Associate Learning 24 (C) Jason Brandt, Ph.D. 12 10/29/2019 Patient O.N. Copy Recall at 5 min. 25 Patient O.N. Sketch of his former home from memory 26 (C) Jason Brandt, Ph.D. 13 10/29/2019 Wernicke-Korsakoff Syndrome • Named after Carl Wernicke (German neurologist) and S.S. Korsakoff (Russian psychiatrist), who described two related syndromes in the 1880’s 27 Wernicke-Korsakoff Syndrome • Acute onset of confusional state and ophthalmoplegia (Wernicke encephalopathy) • If patient survives, he is left with a severe and relatively permanent amnestic syndrome (Korsakoff syndrome) – Severe anterograde amnesia – Graded retrograde amnesia – Tendency to confabulate – Normal intellect • Caused by Vitamin B1 (thiamine) deficiency • Typically seen in severe, chronic alcoholics – But also in patients with malabsorption syndromes, stomach cancer, anorexia nervosa, etc. • Hemorrhagic lesions in thalamus (esp. dorsomedial nucleus) and mammillary bodies of hypothalamus 28 (C) Jason Brandt, Ph.D. 14 10/29/2019 29 Patient S.C. • Woman in early 60’s • Ph.D. in literature • Highly accomplished college professor • Acute onset of amnesia after surgery 30 (C) Jason Brandt, Ph.D. 15 10/29/2019 Patient S.C. INTELLECT LEARNING & MEMORY 31 Patient S.C. Verbal Paired-Associate Learning Semantically Semantically Related Unrelated 32 (C) Jason Brandt, Ph.D. 16 10/29/2019 33 34 (C) Jason Brandt, Ph.D. 17 10/29/2019 35 36 (C) Jason Brandt, Ph.D. 18 10/29/2019 37 Patient S.C. Working Memory and Procedural Learning “What do I do?” 38 (C) Jason Brandt, Ph.D. 19 10/29/2019 Varieties of Amnesia • Mesial Temporal/Limbic – Pathology in hippocampal formation – Severe anterograde amnesia – Limited retrograde amnesia – Seen post-encephalitis, anoxia, post ECT (time-limited) • Diencephalic – Pathology in dorsomedial thalamus and/or mammillary bodies – Severe anterograde amnesia – Can have extensive retrograde amnesia (esp. if cortex is involved) – Seen in Korsakoff syndrome, thalamic strokes, tumors, etc. • Frontal Lobe – Pathology in prefrontal cortex, anterior cingulate and/or basal forebrain – Forgetting to remember – Poor source memory – Impaired working memory 39 Memory for the Past • As opposed to capacity for new learning • Physicians (and others) often refer to this as “long term memory” • Impairment of acute or subacute onset is called “retrograde amnesia” • Rarely assessed systematically in routing clinical practice 40 (C) Jason Brandt, Ph.D. 20 10/29/2019 Assessing Memory for the Past • Recent past and remote past • Autobiographical events or public events • Challenges: – How to verify initial learning and storage – How to equate items for difficulty • Across time periods • Across individuals 41 Outline • Memory that is abnormally bad • Memory that is abnormally good • Malleability of memory • Memory for trauma • Common myths about memory 42 (C) Jason Brandt, Ph.D. 21 10/29/2019 3 Types of Extraordinary Memory • Natural Mnemonists – Luria’s Sheveshevskii (“S”) (1968) • Intellectually gifted; very pronounced synesthesia • Learned a nonsensical mathematical formula of 50 elements in 7 minutes – Recalled it 15 years later • Little capacity for abstraction or metaphorical thinking; occupationally disabled – Hunt’s Professor Aitken (1977) • Brilliant mathematician and accomplished violinist • Learned list of 25 high-imagery words in 1.67 min. – Retained 25 at 1 week, 22 at 3 months, 24 at 15 months, 25 at 27 years • For fun, he learned pi to 1,000 decimal places • Used no specific mnemonics, except for chunking and pacing/rhythm 43 3 Types of Extraordinary Memory • Memory Champions – People who work on improving their memories, often for competitions – Chase & Ericsson’s S.F. (1982) • Undergraduate at Carnegie-Mellon University • Trained on digit span for hundreds of hours over two years – Resulted in digit span of 82 – Transferred to recall of visually-presented matrix of 25 or 50 digits – No transfer to non-numeric tasks; letter span = 6 • Encoded chunks of 3-4 digits into foot-race times (he was an amateur runner), ages or dates • Other undergraduates of Chase & Ericsson were less successful – Brain imaging studies find no systematic neuroanatomic differences between memory champions and others (Maguire et al. 2003) 44 (C) Jason Brandt, Ph.D. 22 10/29/2019 Highly Superior Autobiographical Memory (HSAM) • Originally described by Parker, Cahill & McGaugh (2006) – Called “hyperthymesia” • from the Greek thymesis, meaning remembering • Extraordinary ability to describe, in detail, events from their personal past (including days and dates) • Do not engage in extensive practice or rehearsal, or employ specific mnemonic strategies – Distinguishes them from mnemonists (such as Luria’s patient S) and memory champions (such as contestants at annual Memory Olympics) 45 Highly Superior Autobiographical Memory (HSAM) • Previously described cases… – are few in number • largest series of confirmed cases is 11 (James McGaugh and colleagues at U.C. Irvine) – including actress Marilu Henner – do not have autism and are not “savants” – do not have synesthesia – often have obsessional traits – are not immune from memory distortions – perform in the average range on clinical tests and laboratory tasks involving new learning and memory 46 (C) Jason Brandt, Ph.D. 23 10/29/2019 Highly Superior Autobiographical Memory (HSAM) 47 Subject M.M • 63 year-old, right-handed, Caucasian man • Reported an uncanny ability to remember historical facts and dates, sports statistics, and popular culture trivia, as well as events from his own life • Was dubbed “The Amazing Memory Man” by a local newspaper when he came to public attention in 1980’s – Pointed out an erroneous date on Baltimore’s Washington Monument • Special interests in – Professional athletics, Olympic games – British history, American history • Remembers the dates of every one of the many concerts and sporting event he has attended – Recalls performers, players, scores, etc. • Unlike other people with HSAM, does not recall virtually every day of adult life in vivid detail 48 (C) Jason Brandt, Ph.D. 24 10/29/2019 Some Examples of M.M.’s Extraordinary Memory • Historical Significance of Random Dates: – May 18th: “That was the birthdate of Pope John Paul II, in 1920, and Baltimore Oriole Brooks Robinson, in Arkansas, in 1937.