Memory Systems in Dementia

1. Memory Systems in Dementia Andrew E. Budson, M.D. Cognitive & Behavioral Neurology, VA Boston Boston University Alzheimer’s Disease Center Memory Disorders Unit, Brigham & Women’s Hospital Harvard Medical School

2. Disclosures • Royalties from Publishing for • Memory Loss, Alzheimer’s Disease, and Dementia: A Practical Guide for Clinicians, 2016 (Elsevier) • Seven Steps to Managing Your Memory: What’s Normal, What’s Not, and What to Do About It (Oxford University Press)

3. Long Term Memory • Episodic Memory • Semantic Memory • Procedural Memory

4. Episodic Memory • Personal, conscious, explicit recollection of experienced events framed in your own context • Where you parked your car • What you had for dinner last night • Anatomy: • Medial temporal lobe • limbic system • frontal lobes

5. Patient 1 • 81 M with memory difficulties. • 8 years ago got lost, began asking questions repetitively. • Gradual worsening, last 6-12 mos unable to learn new information • Remembers everything about his days during WWII Alzheimer’s disease

8. From Budson & Solomon, 2016

11. Other diseases which can disrupt Episodic Memory • Tumors • Strokes • Hypoxic/Ischemic • Head Trauma

12. Ribot’s Law

13. The Papez Circuit

14. Episodic memory system

15. Hippocampal anatomy

17. unique index assigned binding Dentate gyrus CA3 Hilus Entorhinal cortex

19. Subiculum Dentate gyrus CA3 CA1 Hilus Entorhinal cortex

21. Consolidation Sleep Dreams

22. Subiculum Dentate gyrus CA3 CA1 Hilus Entorhinal cortex

23. ½ way down, on left ½ way down, on right All way down, on left Red Blue 1 2 happy sad Day 1 Day 2 Day 3

24. Days 2 & 3 ½ way down, on left ½ way down, right OR All way down, left Red Blue 1 2 happy sad Day 1

26. Gist

27. Days 2 & 3 ½ way down, on left ½ way down, right OR All way down, left Red Blue 1 2 happy sad Day 1

28. Failure of source monitoring • Externally heard: sugar • Internally generated: sweet

29. B.G.

30. Frontal lobes in Episodic Memory • Memory for the temporal order of events • Memory for contextual information • Encoding information • Frontal and medial temporal lobes work together • Left brain for words, right for images

31. Left MTL & frontal lobes activated for words Wagner, Schacter, et al., Science 1998 281 1188-1191

33. Bilateral MTL & right frontal lobe for scenes

35. good idea good idea Other cortical regions Frontal Lobes Medial Temporal lobes

36. Frontal lobes damaged  more work to get information in and out of storage. • Hippocampus/parahippocampal cortex damaged  impossible to get information in and out of storage. • Hippocampus/parahippocampal cortex damaged  Remote information that has been consolidated is available from other cortical areas.

37. Patient 2 • 74M 6 yr history of “Small TIAs.” • Misattributes statements • Confuses order and context of events • Variable performance on memory testing: from above average to extremely poor recall with preservation of recognition. Vascular Dementia

41. Patient 3 • 78M with memory & behavior problems. • Frontal memory problems. • Extreme memory distortions: • Confused events on television with his own life Frontotemporal Dementia

43. Patient 4 • 76F with poor cognition • impaired attention • Very poor recall but preserved recognition • magnetic gait disorder • incontinence Normal Pressure Hydrocephalus

46. Patient 5 • 79 F with memory problems, delusions and possible hallucinations. • Believed that she has recently spoken with her parents, long since deceased. • Believes that people are breaking into her apartment, stealing her money, and moving around her stuff. Alzheimer’s disease

48. Red Blue 1 2 happy sad Days 1, 2 & 3 ½ way down, on left OR ½ way down, right OR All way down, left

49. “In NYC, the 53 bus will take you uptown: FALSE” “It takes 32 coffee beans to make a cup of espresso: TRUE” Neuropsychology 2006 20 185-192

50. Illusory Truth • Older Controls: • Remembered 77% of the true statements true • Remembered 39% of the false statements true • Patients with AD • Remembered 69% of the true statements true • Remembered 59% of the false statements true!! • Thus, if one tells a patient with AD, “The 53 bus will not take you to your sister’s house; take the 67 bus instead,” the patient will be likely to remember that the 53 bus is the one to take! Neuropsychology 2006 20 185-192