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This chapter looks at Alzheimer’s disease, the most common cause of dementia. Incidence and prevalence figures are reviewed, along with an explanation of the two abnormal proteins involved in the development of the disorder, and the ‘amyloid cascade’ hypothesis. Cognitive assessment of Alzheimer’s disease is considered in terms of where this fits within the diagnostic process and diagnostic criteria. The bulk of the chapter focuses on the typical form of Alzheimer’s disease, and the chapter concludes with discussion of some atypical variants, such as posterior cortical atrophy (PCA), logopenic primary progressive aphasia (lvPPA), and frontal variant.
In this chapter, we delve into the intriguing world of memory development, from infancy to adulthood. We begin by emphasizing the fundamental role memory plays in learning. We explore two distinct memory systems: one we are conscious of and another that operates behind the scenes. We examine various memory types, their testing methods, and the brain regions responsible for them. Our focus then shifts to episodic memory, questioning its exclusivity to humans. We dissect the brain structures involved in memory formation and their developmental changes. Additionally, we explore the interconnectedness of memory, thinking processes, and decision-making. Our goal in this chapter is to provide a comprehensive understanding of memory development across different life stages, laying the groundwork for a deeper grasp of this intricate cognitive process.
Most clinical and research investigations of memory focus on consolidation of information over relatively brief intervals of time (i.e., minutes, hours). However, in everyday life we are most interested in retaining experiences for much longer periods of time (days, weeks, years). Studies in cognitive psychology demonstrate that the survival of an engram is influenced by a variety of factors including contextual aspects at time of initial learning, the age of an event, frequency and distribution of exposure to the memory over time and, of course, the amnestic capacity of the learner. In the current symposium we examine the durability of new memories as well those from the past. Presentations focus on medical factors, such as epilepsy and stroke, that result in acceleration of memory loss. The longevity of old memories is examined in relation to age-related decline and the onset of dementia. Findings from these studies enhance our understanding of the cognitive and neural underpinnings of consolidation and, hence, they inform our ability to remember our past.
Long-term forgetting rates may be more sensitive for detecting memory decrements compared to short-delay memory assessments (e.g., after 20-30 minutes). To date, much research has been performed on accelerated long-term forgetting (ALF) in epilepsy patients, but research in other patient groups is lacking. ALF may be promising in the field of cerebrovascular disease, as many of these patients experience cognitive complaints, yet do not show impaired performances on neuropsychological assessments.
Participants and Methods:
Here, I will present empirical findings on ALF in individuals after a TIA/minor stroke (n=30) and after stroke (n=91) using short- (20-30 min) and long-delay (1-week) memory testing.
Results:
After TIA/minor stroke, short-delay (2030 min) memory testing was unimpaired, but 1-week delayed testing showed an impaired performance compared to stroke-free controls. In the stroke group, ALF was present in 17% of the patients, compared to stroke-free controls, but more prevalent than rapid forgetting after short-delay memory testing.
Conclusions:
ALF is present in patients with cerebrovascular disease, despite normal acquisition rates. The relation with neuroimaging findings and the clinical relevance of these results will be discussed.
Accelerated long-term forgetting (ALF) has been reported in healthy older individuals, and is a possible early marker for risk of developing Alzheimer’s disease (AD). The Verbal Associative Learning & Memory Test (VALMT; McGibbon & Jansari, 2013) addresses methodological weaknesses in existing clinical tests and has detected ALF in epilepsy within an hour. We used VALMT to investigate learning and forgetting in healthy older participants.
Participants and Methods:
Older (60-69yrs) and Younger (19-31yrs) participants were compared. Using VALMT, unrelated word-pairs were learned to criterion, then cued-recall was tested at delays of 5, 30 and 55 minutes. Unique pairs were tested at each delay. Subjective memory complaints data were gathered, and the Wechsler Memory Scale Logical Memory test (WMS-LM; a standard clinical measure) was administered.
Results:
VALMT identified a significant difference in delayed recall between Younger and Older groups by 55 minutes (d = 1.32). While 'fast-learning’ Older participants scored similarly to Younger participants, 'slow-learning’ Older participants were impaired at all delays. Forgetting rates suggested degradation of memory starts during early synaptic consolidation rather than later system-level consolidation. Increased subjective memory complaints were associated with reduced VALMT scores. By contrast, WMS-LM failed to identify significant differences between any groups, and did not correlate with memory complaints.
Conclusions:
We conclude VALMT may be better able than WMS-LM to identify subtle impairments in healthy older adults within a single clinical visit, and VALMT results better reflect subjective experience. Older slow-learners forget faster and report more subjective memory complaints, which may indicate a group at risk of developing AD.
Health providers frequently probe patients’ recall of current and/or remote news items to determine the extent of memory loss. Impaired memory for transient events (i.e., in the news for a circumscribed time) may provide information regarding the onset of cognitive impairment. We utilized the Transient News Events Test (TNET) to explore how memory changes over time in older adults with cognitive impairment (CI) and non-cognitively impaired (NCI) individuals. We hypothesized that CI individuals would demonstrate reduced memory for transient events. We investigated the role of semantic and episodic memory on TNET performance.
Participants and Methods:
Participants completed the TNET as part a comprehensive neuropsychological evaluation. Analyses included t tests to evaluate group differences for TNET performance, and correlations between TNET and neuropsychological measures, including episodic and semantic memory tests.
Results:
NCI adults demonstrated better memory than CI participants for TNET items. The NCI and CI groups did not differ regarding memory for remote items; however, CI participants had worse memory for recent items. There was a significant association between TNET performance and capacity for episodic and semantic memory in people with CI. In the NCI group, the TNET was associated only with episodic memory.
Conclusions:
Findings support the use of news events to assess remote memories in older adults. Novel remote memory measures broaden the scope of memory assessment far beyond what is feasible within traditional neuropsychological assessment and provide insight into the onset of memory changes. Results enhance understanding of memory decline in older adults with cognitive impairment.
The intricacies and difficulties in measuring forgetting rates, both in healthy participants and in clinical patients, have been intensively investigated since the 1970s. In recent years, there has been a revival of interest in ‘long-term’ forgetting rates, particularly in transient epileptic amnesia (TEA) and temporal lobe epilepsy (TLE), and some ‘old’ lessons have had to be re-learned.
Participants and Methods:
Studies of long-term forgetting in patient groups will be reviewed, together with variables that influence different patterns of forgetting. In particular, I will report findings from two recent studies of TLE, as well as other related investigations.
Results:
Studies indicate that an impairment in memory ‘acquisition’, rather than differences in ‘long-term’ forgetting, appear critical in amnesic disorders, sometimes associated with differences in ‘early’ forgetting on recall memory measures only. An exception may be the effect of seizures, whether in consequence of epilepsy or ECT, which sometimes, but not always, appears to accelerate forgetting rates. Another important finding has been the pronounced variability in forgetting rates, both between individuals within a patient group and within individuals tested on separate occasions, making inferences from single-case studies problematical.
Conclusions:
Findings will be interpreted in the light of these observations.
The purpose of this chapter is to give a brief overview of some of the clinical features of dementia. A level of knowledge is assumed and there are other texts that comprehensively examine general aspects of dementia diagnosis, neurobiology, current interventions, etc. We will provide an overview of the range of cognitive systems and how impairments in these systems relate to the clinical presentation. While decision-making capacity and cognitive abilities are related, they are not the same thing. The first refers to the patient’s ability to make a particular decision (at a particular point in time) and the latter encompasses a broad range of processes, including a person’s memory, problem-solving, language, attention and visuospatial abilities. Understanding different cognitive domains and how they interact is necessary for accurate clinical assessment and in determining disease severity. Also, in relation to legal considerations, characterising specific deficits may also help to explain why decision-making capacity is impaired or, just as importantly, in identifying how to apply measures to support an individual’s decision-making.
When Never Let Me Go was published in 2005, Ishiguro indicated that he ‘remain[ed] fascinated by memory’, and that his next challenge was to examine the themes of national memory and forgetting. The Buried Giant, published in 2015, represents Ishiguro’s unique meditations on collective memory, understanding, and the complexities of forgetting. Utilizing a third-person narrative voice, Ishiguro orchestrates a post-Arthurian landscape of buried slaughter and collective amnesia, whilst engaging in a critical enquiry into the nature of shared memories in relationships. This chapter will begin by considering Ishiguro’s memory work in his earlier novels, before an investigation into the fallibility of memory and understanding precipitated by the enigmatic mist. This is followed by an exploration of the question of culpability and the complexities of collective memory. The chapter concludes by reflecting on the figure of the boatman, the island of forgetting, and the implications of an enforced forgetting.
There are several examples from human neuropsychology of the intact preservation of processes and capacities in the absence of conscious awareness by the patients. These include loss of visual awareness (blindsight), episodic memory (amnesic syndrome), attention (unilateral neglect) and language (aphasia). The implication of these and other clinical phenomena is that descriptions of ongoing behaviour are necessary but quite insufficient for making inferences about conscious awareness, because even quite ‘high level’ behaviour can be run off in the absence of awareness. A commentary, or independent off-line response, is a prerequisite for determining whether the subject is consciously aware. Whether or not the commentary allows an inference about awareness in animals rests ultimately on an argument from analogy, just as is the case when we make judgements about fellow humans. But when parallel disjunctions between on-line behaviour and off-line classifications are found for both human and infrahuman subjects, as is demonstrable for blindsight and amnesia, not only do they bolster inferences about common neural mechanisms, but they strengthen inferences for analogous processing and hence for conscious experience.
In the year when France commemorated the sixtieth anniversary of the liberation of its territory from Nazi rule by the Allied Forces, President Abdoulaye Wade of Senegal initiated a commemoration of the contribution that the Tirailleurs sénégalais made to this military victory. Inviting the heads of different African states whose colonial subjects had joined the colonial army of Tirailleurs, the Day of the Tirailleur was celebrated on 23 August 2004 to commemorate the day of the landing at Toulon. In the Senegalese media, the ‘blood debt’ of France to its African liberators was widely debated, and the discrimination in pensions that African veterans have experienced since political independence was widely condemned. During the day, a statue of the soldiers Demba and Dupont was unveiled at its new location to recognize the contribution Africans have made to France’s military history. This colonial statue was first inaugurated in 1923 to recognize the role played by Tirailleurs in the First World War; it is now recycled to remind France of its colonial debt. The Day of the Tirailleur reminded France of its obligations towards the Senegalese migrants in France whose legal status was very much debated at the time. By reinstating a colonial statue and recycling the social capital made by sacrifice, the Senegalese government appropriated and reinterpreted African history, recycling its colonial legacy as a technique of repair.
Alcohol amnesia and palimpsests belong to understudied areas in addictology concerning the pathogenesis, risk factors, and development of effective integrated, targeted modalities of therapy, prevention, and after-treatment care.
Objectives
Development of a new integrated, pathogenetically grounded approach to the emergency and routine therapy for immediate and long-term consequences of amnestic alcohol intoxication.
Methods
Modern complex clinical-psychopathological, pathopsychological, laboratory, electrophysiological, biochemical examination; method of analogues and prototype analytical examination.
Results
Integrated anti-amnestic pharmacotherapeutic triad: Noobut IC (Phenibut) orally, before meals, for 6 days, twice a day: 250 mg in the morning, 500 mg at night, within days 7-14 250 mg twice: in the morning and at night; Vitaxon 2.0 ml daily, intramuscularly, No10 totally; ozone therapy for 10 days (ozone dissolved in olive oil, 6 mg/100 ml concentration), 5 ml orally 3 times a day. Complex therapy is concurrent with synergistic psychotherapeutic potentiation. Supportive anti-relapse prevention of alcohol-induced amnesia, palimpsests with Noobut IC: 1 tablet (250 mg) orally in the morning for 2 months. The pathogenetic support of the pharmacotherapeutic triad in treatment for alcohol addiction, comorbid with amnestic disorders, is pathogenetically focused on pharmacological properties of each component of the triad and their potentiating effects, involving most pathogenetic mechanisms of this disease.
Conclusions
Relieving and prophylactic efficacy of the proposed pharmacological triad (Noobut, Vitaxon, ozone and concurrent psychotherapeutic potentiation) is proven by the statistical reliability method and illustrated by clinical examples of patient-specific research.
Wearable cameras have been shown to improve memory in people with hippocampal amnesia and Alzheimer's disease. It is not known whether this benefit extends to people with amnesia of complex or uncertain origin.
Method:
This case study examined the effect of wearable camera use on memory and occupational performance in a patient with memory loss and complex mental health problems following a severe neurological incident. With the help of his occupational therapist (OT), Mr A used a wearable camera to record a series of eight personally significant events over a 6-week period. During visits from his OT, Mr A was asked to report what he could remember about the events, both before (baseline) and during the review of time-lapsed photographs captured automatically by the camera.
Results:
The results showed striking improvements in recall while reviewing the photographs, relative to baseline recall, but the additional details recalled during review did not appear to be maintained at later tests, after several days. Across the study period, there were moderate increases in occupational performance, measured using the Canadian Occupational Performance Measure. However, after the study period ended, Mr A ceased to use the wearable camera due to technological difficulty.
Conclusion:
There was a clear benefit of wearable camera use, but the real-world impact of the technology was limited by the complexity of the system. The results of the study are discussed alongside novel clinical insights and suggestions for developing wearable camera support systems that can be used independently by people with memory problems.
This chapter examines the concept of the self. It begins by looking at the work of Hume, and the distinction between ego and bundle theories of the self. We consider the distinction between the knower and the known, and the idea of the homunculus. The chapter examines Damasio’s model of three levels of self, and other ‘types’ of self. It looks at how the self is related to psychological models of control and executive processing. It then looks at our perception of our continuity of existence, and how it can be disrupted by age, sleep and amnesia. The chapter examines the neuroscience of the self, and which neurological structures give rise to our sense of self. We look in detail at split-brain studies and what we can learn from them. It then looks at dissociative states and dissociative identity disorders (multiple personalities). It also looks at the boundaries of the self, and phantom limbs and the rubber hand illusion. The chapter concludes by asking whether the self is just another illusion.
To allow identification of stimuli, sensory input is initially held briefly in sensory memory. It is then held in a short-term store (STS), where it can receive the additional processing required to form a permanent memory. The existence of separate short- and long-term stores is supported by research on amnesia, demonstrating that brain damage can affect one but not the other. Forgetting in STS may be caused by decay, and by interference from other memories. STS can hold information retrieved from long-term memory when required for activities such as reading; to reflect this, it is now called working memory. Baddeley proposed that working memory has 3 components: the phonological loop, visuo-spatial sketch pad, and central executive. Consolidation theory suggests that the formation of a permanent memory requires time for the strengthening of synaptic connections; there also appears to be a consolidation process that can occur over years. We cannot attend to all the stimuli that seek entry into working memory; change blindness provides a striking example. Some theories suggest that selection occurs early in processing, others that attention can be allocated flexibly after stimuli have been identified. With practice, processing can become automatic, so that stimuli no longer require attention.
Physical evaluation and ancillary testing need to be interpreted in a context. Here, we focus on the relevance of history taking and how missing or misinterpreting clues in the history can affect diagnosis.
China's emergence as a great power has been accompanied by the official rhetoric of the China Dream of Great Rejuvenation (weida fuxing 伟大复兴). Although there are conflicting views among academics and political elites about the exact content of the China Dream, one of its features is the nostalgia for China's past and its five-thousand-year-old civilization. Xi Jinping's current rhetoric of a China Dream of Great Rejuvenation uses a reinvented history as an asset for the future, linking China's natural progress as a global power with a selective re-reading of its millennial history. While much existing literature already discusses China's Great Rejuvenation, this article looks more specifically at the role of historical memory and deconstructs the key interconnected components that support Xi's rhetoric, namely, the chosen trauma, glory, and amnesia. The conclusion offers some general remarks about the effect of this rhetoric on China's domestic and foreign policy and some of the risks that accompany it. This article contributes to the debates on the influence of memory in International Relations (IR), showing how constructed memories of history can significantly impact both national identity and foreign policy.
There have been reports of long-term subjective memory worsening after electroconvulsive therapy (ECT).
Aims
To study the prevalence and risk factors of long-term subjective memory worsening among patients receiving ECT in routine clinical practice.
Method
Patients (n = 535, of whom 277 were included in the final analysis) were recruited from eight Swedish hospitals. Participants' subjective memory impairment was assessed before ECT and a median of 73 days after ECT using the memory item from the Comprehensive Psychopathological Rating Scale. Participants also rated their pre-ECT expectations and post-ECT evaluations of the effect of ECT on memory on a 7-point scale. We used ordinal regression to identify variables associated with subjective memory worsening and negative evaluations of the effect of ECT on memory.
Results
Comparisons of pre- and post-ECT assessments showed that subjective memory worsened in 16.2% of participants, remained unchanged in 52.3% and improved in 31.4%. By contrast, when asked to evaluate the effect of ECT on memory after treatment 54.6% reported a negative effect. Subjective memory worsening was associated with negative expectations before ECT, younger age and shorter duration of follow-up.
Conclusions
Although subjective memory improved more often than it worsened when assessed before and after ECT, a majority of patients reported that ECT had negative effects on their memory when retrospectively asked how ECT had affected it. This might suggest that some patients attribute pre-existing subjective memory impairment to ECT. Clinicians should be aware that negative expectations are associated with subjective worsening of memory after ECT.
This chapter argues that one can have some memory loss over time but remain the same person and be held responsible for one’s earlier actions. Amnesia following an action does not entail that the agent had no cognitive or volitional control when he acted. Amnesia as such is not a mitigating or excusing condition. But an individual who had undergone a substantial identity change from extensive memory loss could not be held responsible or punished because he would have become a different person. The chapter also considers dissociative disorders such as somnambulism. The main question regarding these states is whether they impair a person’s capacity to form and translate an intention into a criminal act. Dissociation comes in degrees. A person in a dissociative state may have enough behavior control to be at least partly responsible for her actions. In addition, the chapter examines memory loss in omissions and whether it can be a mitigating factor in cases involving negligence causing death. The chapter also argues that a victim of an assault does not have an obligation to retain a memory of it to testify against the perpetrator. Her cognitive liberty gives her the right to erase the memory.
The past 30 years of research on human amnesia has yielded important changes in our understanding of the role of the medial temporal lobes (MTL) in memory. On the one hand, this body of evidence has highlighted that not all types of memory are impaired in patients with MTL lesions. On the other hand, this research has made apparent that the role of the MTL extends beyond the domain of long-term memory, to include working memory, perception, and future thinking. In this article, we review the discoveries and controversies that have characterized this literature and that set the stage for a new conceptualization of the role of the MTL in cognition. This shift toward a more nuanced understanding of MTL function has direct relevance for a range of clinical disorders in which the MTL is implicated, potentially shaping not only theoretical understanding but also clinical practice. (JINS, 2017, 23, 732–740)