Arie J. Wester

Confabulation behavior and false memories in Korsakoff's syndrome: Role of source memory and executive functioning

Aims:  Confabulation behavior is common in patients with Korsakoffs syndrome. A distinction can be made between spontaneous and provoked confabulations, which may have different underlying cognitive mechanisms. Provoked confabulations may be related to intrusions on memory tests, whereas spontaneous confabulations may be due to executive dysfunction or a source memory deficit.

Spatial and temporal order memory in Korsakoff patients

This study directly compared how well Korsakoff patients can process spatial and temporal order information in memory under conditions that included presentation of only a single feature (i.e., temporal or spatial information), combined spatiotemporal presentation, and combined spatiotemporal order recall. Korsakoff patients were found to suffer comparable spatial and temporal order recall deficits. Of interest, recall of a single feature was the same when only spatial or temporal information was presented compared to conditions that included combined spatiotemporal, presentation and recall. In contrast, control participants performed worse when they have to recall both spatial and temporal order compared to when they have to recall only one of these features. These findings together indicate that spatial and temporal information are not automatically integrated. Korsakoff patients have profound problems in coding the feature at hand. Moreover, their lower recall of both features at the same time suggests that Korsakoff patients are impaired in binding different contextual attributes together in memory.

Spatial Working Memory and Contextual Cueing in Patients with Korsakoff Amnesia

The current study investigated the effect of Korsakoff syndrome on memory for spatial information and, in particular, the effect of contextual cueing on spatial memory retention. Twenty Korsakoff patients and a comparison group of 22 age- and education- matched participants were tested with a newly developed spatial search task (the Box task). Participants were asked to search through a number of boxes shown at different locations on a touch-sensitive computer screen to find a target object. In subsequent trials, new objects were hidden in boxes that were previously empty. Two conditions were used: the boxes were either completely identical or had different colors serving as a cue. Within-search errors were made if a participant returned to an already searched box; between-search errors occurred if a participant returned to a box that already contained a target item. Moreover, the use of a strategy to remember the locations of the target objects was calculated. The results show that Korsakoff patients make more within and between-search errors than the comparison group, and although they were able to apply a search strategy, it did not help them to remember the locations of the targets. Interestingly, whereas the comparison group benefited from color cues that were given to the boxes, Korsakoff patients failed to do so. The authors would like to thank Olga Keuper for her help with collection and Rob Broekmans for programming the Box Task. This research was supported by a grant (# 440-20-00) from the Netherlands Organization for Scientific Research (NWO). Roy Kessels was supported by a VENI grant from NWO (# 451-02-037).

Memory for object locations in Korsakoff's amnesia.

Deficits in spatial context memory are an important characteristic of Korsakoffs amnesia. In memory for spatial context information, there is evidence for a functional dissociation of three separate processes: (1) binding of object information to locations (i.e. binding complex memories), (2) exact, metric processing of Euclidean co-ordinates, and (3) an integration mechanism. In the present study, these sub-mechanisms were assessed experimentally in a group of Korsakoff patients (N = 20) and compared to healthy controls (N = 20) to see whether selective deficits can be demonstrated. It was found that Korsakoff patients display deficits on all three spatial-memory conditions, which are not the primary result of deficits in visuo-spatial construction and memory for object identity. No evidence for selective impairments could be observed. These impairments can be linked to damage of diencephalic regions and perhaps the parietal cortex.

Processing of emotional facial expressions in Korsakoff's syndrome.

Interpersonal contacts depend to a large extent on understanding emotional facial expressions of others. Several neurological conditions may affect proficiency in emotional expression recognition. It has been shown that chronic alcoholics are impaired in labelling emotional expressions. More specifically, they mislabel sad expressions, regarding them as more hostile. Surprisingly, there has been relatively little research on patients with Korsakoffs syndrome as a result of chronic alcohol abuse. The current study investigated 23 patients diagnosed with Korsakoffs syndrome compared to 23 matched control participants. This study is the first to make use of a newly developed sensitive paradigm to measure emotion recognition for several emotions (anger, disgust, fear, happiness, sadness and surprise). The results show that patients with Korsakoffs syndrome are impaired at recognizing angry, fearful and surprised facial emotional expressions. These deficits might be due to the reported sub-cortical brain dysfunction in Korsakoffs syndrome.

Route learning in amnesia: a comparison of trial-and-error and errorless learning in patients with the Korsakoff syndrome

Objective: To examine the errorless learning approach using a procedural memory task (i.e. learning of actual routes) in patients with amnesia, as compared to trial-and-error learning. Design: Counterbalanced self-controlled cases series. Setting: Psychiatric hospital (Korsakoff clinic). Subjects: A convenience sample of 10 patients with the Korsakoff amnestic syndrome. Intervention: All patients learned a route in four sessions on separate days using an errorless approach and a different route using trial-and-error. Main measures: Error rate was scored during route learning and standard neuro-psychological tests were administered (i.e. subtest route recall of the Rivermead Behavioural Memory Test (RBMT) and the Dutch version of the California Verbal Learning Test (VLGT)). Results: A significant learning effect was found in the trial-and-error condition over consecutive sessions (P = 0.006), but no performance difference was found between errorless and trial-and-error learning of the routes. VLGT performance was significantly correlated with a trial-and-error advantage (P < 0.05); no significant correlation was found between the RBMT subtest and the learning conditions. Conclusion: Errorless learning was no more successful than trial-and-error learning of a procedural spatial task in patients with the Korsakoff syndrome (severe amnesia).

Spatial and non-spatial contextual working memory in patients with diencephalic or hippocampal dysfunction

Damage to the medial temporal lobe (MTL) and diencephalon results in impaired long-term memory, which relies on the binding of multiple, mostly contextual, features. Recent neuroimaging and patient studies have suggested that impairments may also be present in working memory after MTL or diencephalic damage. To examine whether patients with damage to these brain structures have impairments in working memory for contextual information, 15 patients with damage to the diencephalon due to Korsakoffs syndrome and 12 patients with unilateral MTL lesions, and 30 age-matched healthy controls performed a delayed match-to-sample (DMS) task in which they had to maintain either object-location associations, color-number associations, single colors or single locations. Compared to their age-matched controls, performance on the DMS task was generally impaired in both patient groups, whereas no deficits were found on standard neuropsychological span tasks that do not rely on maintenance aspects of working memory. The patients did not show disproportionate impairments on the binding condition. In all, the results clearly show that impairments in working memory maintenance are present in patients with MTL or diencephalic lesions. However, we did not find a disproportionate inability in maintaining spatial or non-spatial associations within working memory as previously demonstrated in long-term memory.

Intact memory for implicit contextual information in Korsakoff's amnesia.

Implicit contextual learning is the ability to acquire contextual information from our surroundings without conscious awareness. Such contextual information facilitates the localization of objects in space. In a typical implicit contextual learning paradigm, subjects need to find a target among a number of distractors during visual search. Some of the configurations of stimuli are repeated during the experiment resulting in faster responses than for novel configurations, without subjects being aware of their repetition. Patients with Korsakoffs syndrome (KS) have been found to show devastating explicit spatial amnesia. Less is know about their implicit spatial memory abilities. The aim of the present research was to examine whether implicit contextual learning is intact in KS. Therefore, eighteen KS patients and twenty-two age-IQ- and education-matched controls performed the Implicit Contextual Learning task and a paradigm intended to assess explicit, spatial working memory, i.e. the Box task. Intact implicit contextual learning was observed in both the control group and the KS patients. In turn KS patients did have markedly lower explicit spatial working memory scores. The implicit learning effect was not related to the spatial working memory scores. Together these results clearly suggest that implicit and explicit spatial memory have a different neurocognitive basis.

Spared unconscious influences of spatial memory in diencephalic amnesia

Spatial memory is crucial to our daily lives and in part strongly depends on automatic, implicit memory processes. This study investigates the neurocognitive basis of conscious and unconscious influences of object–location memory in amnesic patients with Korsakoff’s syndrome (N = 23) and healthy controls (N = 18) using a process-dissociation procedure in a computerized spatial memory task. As expected, the patients performed substantially worse on the conscious memory measures but showed even slightly stronger effects of unconscious influences than the controls. Moreover, a delayed test administered after 1 week revealed a strong decline in conscious influences in the patients, while unconscious influences were not affected. The presented results suggest that conscious and unconscious influences of spatial memory can be clearly dissociated in Korsakoff’s syndrome.

The interaction of working memory performance and episodic memory formation in patients with Korsakoff's amnesia

Both neuroimaging work and studies investigating amnesic patients have shown involvement of the medial temporal lobe during working memory tasks, especially when multiple items or features have to be associated. However, so far no study has examined the relationship between working memory and subsequent episodic memory in patients using similar tasks. In this study, we compared patients with amnesia due to Korsakoffs syndrome (n=19) with healthy controls (n=18) on an associative working memory task followed by an unexpected subsequent episodic memory task. The computerized working memory task required participants to maintain two pairs of faces and houses for either short (3s) or long (6s) delays. Approximately 5 minutes after completion of the working memory task, an unexpected subsequent recognition task with a two-alternative forced choice paradigm was administered. By directly comparing working memory and subsequent episodic memory, we were able to examine long-term encoding processes that may take place after longer delays. As expected, patients performed at chance level on the episodic memory task. Interestingly, patients also showed significantly impaired working memory performance (p<.01), even at short delays. Longer delays did not result in better subsequent memory, indicating that they do not facilitate long-term encoding processes. Our results are discussed in relation to Baddeleys working memory model as the episodic buffer is assumed to be a short-term store for maintaining bound representations. In light of these results, the long-standing view that working memory and long-term memory are strictly dissociated may need to be revisited.