Reality filtering and other monitoring processes in human memory

Behaviorally spontaneous confabulation is a syndrome characterized by reality confusion: patients act according to confabulations, are disoriented and amnesic. One theory, the "reality filtering", hold that patients suffering from such reality confusion have a specific failure of a mechanism supposed to verify whether upcoming memories pertain to the "now", or not. Other theories explain confabulations by a failure in the verification of the precise content of memories (content monitoring as described in the strategic retrieval model) or by a failure in the verification of the context associated with memories (context monitoring as described in the source monitoring framework). In the three studies of the present thesis, the electrophysiological basis and clinical correlates of reality filtering were compared with content and context monitoring. Results showed that reality filtering dissociated from the two monitoring mechanisms and was the strongest predictor of reality confusion as evident in confabulation and disorientation

Fake or fantasy: rapid dissociation between strategic content monitoring and reality filtering in human memory

Memory verification is crucial for meaningful behavior. Orbitofrontal damage may impair verification and induce confabulation and inappropriate acts. The strategic retrieval account explains this state by deficient monitoring of memories' precise content, whereas the reality filter hypothesis explains it by a failure of an orbitofrontal mechanism suppressing the interference of memories that do not pertain to reality. The distinctiveness of these mechanisms has recently been questioned. Here, we juxtaposed these 2 mechanisms using high-resolution evoked potentials in healthy subjects who performed 2 runs of a continuous recognition task which contained pictures that precisely matched or only resembled previous pictures. We found behavioral and electrophysiological dissociation: Strategic content monitoring was maximally challenged by stimuli resembling previous ones, whereas reality filtering was maximally challenged by identical stimuli. Evoked potentials dissociated at 200-300 ms: Strategic monitoring induced a strong frontal negativity and a distinct cortical map configuration, which were particularly weakly expressed in reality filtering. Recognition of real repetitions was expressed at 300-400 ms, associated with ventromedial prefrontal activation. Thus, verification of a memory's concordance with the past (its content) dissociates from the verification of its concordance with the present. The role of these memory control mechanisms in the generation of confabulations and disorientation is discussed

Mechanism of disorientation: reality filtering versus content monitoring

Disorientation is frequent after brain damage. It is a constituent component of post-traumatic amnesia and was part of the original definition of the Korsakoff syndrome, together with amnesia and confabulations. Orbitofrontal reality filtering is a pre-conscious memory control process that has been held accountable for disorientation and a specific type of confabulations that patients act upon. A recent study questioned the specificity of this process and suggested that confabulating patients who failed in orbitofrontal reality filtering similarly failed to monitor the precise content of memories, a critical step within the strategic retrieval account, which describes a series of processes leading up to the recollection of memories. In the present study we combined the proposed experimental requirements of both processes in a single continuous recognition task and tested a group of 21 patients with a matched deficit of delayed free recall. We found that only deficient reality filtering, but not content monitoring, significantly correlated with disorientation and distinguished between confabulators and non-confabulators. Thus, reality confusion, as evident in disorientation and behaviourally spontaneous confabulation, primarily reflects an inability to monitor memories' relation with ongoing reality rather than to monitor their precise content

Forms of confabulation: dissociations and associations

Confabulation denotes the emergence of memories of experiences and events which never took place. Whether there are distinct forms with distinct mechanisms is still debated. In this study, we explored 4 forms of confabulation and their mechanisms in 29 amnesic patients. Patients performed tests of explicit memory, executive functions, and two test of orbitofrontal reality filtering (memory selection and extinction capacity in a reversal learning task) previously shown to be strongly associated with confabulations that patients act upon and disorientation. Results indicated the following associations: (1) Intrusions in a verbal memory test (simple provoked confabulations) dissociated from all other forms of confabulation and were not associated with any specific cognitive measure. (2) Momentary confabulations, defined as confabulatory responses to questions and measured with a confabulation questionnaire, were associated with impaired mental flexibility, a tendency to fill gaps in memory, and with one measure of reality filtering. Momentary confabulations, therefore, may emanate from diverse causes. (3) Behaviourally spontaneous confabulation, characterized by confabulations that the patients act upon and disorientation, was strongly associated with failure in the two reality filtering tasks. Behaviourally spontaneous confabulation may be seen as a specific instance of momentary confabulations with a distinct mechanism. (4) A patient producing fantastic confabulations with nonsensical, illogical content had wide-spread cognitive dysfunction and failed in the reality filtering tasks. The results support the presence of truly or partially dissociable types of confabulation with different mechanisms

An electrophysiological dissociation between orbitofrontal reality filtering and context source monitoring

Memory influences behavior in multiple ways. One important aspect is to remember in what precise context in the past a piece of information was acquired (context source monitoring). Another important aspect is to sense whether an upcoming thought, composed of fragments of memories, refers to present reality and can be acted upon (orbitofrontal reality filtering). Whether these memory control processes share common underlying mechanisms is unknown. Failures of both have been held accountable for false memories, including confabulation. Electrophysiological and imaging studies suggest a dissociation but used very different paradigms. In this study, we juxtaposed the requirements of context source monitoring and reality filtering within a unique continuous recognition task, which healthy participants performed while high-resolution evoked potentials were recorded. The mechanisms dissociated both behaviorally and electrophysiologically: Reality filtering induced a frontal positivity, absence of a specific electrocortical configuration, and posterior medial orbitofrontal activity at 200-300 msec. Context source monitoring had no electrophysiological expression in this early period. It was slower and less accurate than reality filtering and induced a prolonged positive potential over frontal leads starting at 400 msec. The study demonstrates a hitherto unrecognized separation between orbitofrontal reality filtering and source monitoring. Whereas deficient orbitofrontal reality filtering is associated with reality confusion in thinking, the behavioral correlates of deficient source monitoring should be verified with controlled experimental exploration

Adaptive reorganization of cortical networks in Alzheimer's disease

OBJECTIVE: The impact of neuronal cell loss associated with Alzheimer's disease (AD) on the network organization of the brain is poorly understood. Here we investigated whether modifications in resting-state functional connectivity (FC) are associated with cognitive function of AD patients. METHODS: High-density electroencephalograms (EEGs) were obtained from patients with early stages of AD and elderly healthy controls. Cortical oscillations were reconstructed with an adaptive spatial filter. Maps of imaginary coherence (IC) between brain areas were compared between groups and correlated with cognitive performance. RESULTS: Parietal and medial temporal lobes of AD patients showed a disruption of alpha band FC to the rest of the brain. However, an adaptive extension of the language network to the right hemisphere could be observed in AD patients and was correlated with better verbal fluency. A shift of FC from alpha frequencies to theta frequencies could be observed in a memory network and was associated with better verbal memory performance. CONCLUSIONS: Not only dysfunctional but also adaptive network reorganization occurs in early AD. SIGNIFICANCE: The network mechanisms for preserved cognitive functioning may inform novel treatment strategies for AD in the future

Memory in time: Electrophysiological comparison between reality filtering and temporal order judgment

Orbitofrontal reality filtering (ORF) denotes a little known but vital memory control mechanism, expressed at 200-300ms after stimulus presentation, that allows one to sense whether evoked memories (thoughts) refer to present reality and can be acted upon, or not. Its failure induces reality confusion evident in confabulations that patients act upon and disorientation. In what way ORF differs from temporal order judgment (TOJ), that is, the conscious knowledge about when something happened in the past, has never been explored. Here we used evoked potential analysis to compare ORF and TOJ within a combined experimental task and within a comparable time frame, close to the experienced present. Seventeen healthy human subjects performed an experiment using continuous recognition tasks that combined the challenges of ORF and TOJ. We found that the two mechanisms dissociated behaviorally: subjects were markedly slower and less accurate in TOJ than ORF. Both mechanisms evoked similar potentials at 240-280ms, when ORF normally occurs. However, they rapidly dissociated in terms of amplitude differences and electrical source from 310 to 360ms and again from 530 to 560ms. We conclude that the task of consciously ordering memories in the immediate past (TOJ) is effortful and slow in contrast to sensing memories' relation with the present (ORF). Both functions invoke similar early electrocortical processes which then rapidly dissociate and engage different brain areas. The results are consistent with the different consequences of the two mechanisms' dysfunction: while failure of ORF has a known clinical manifestation (reality confusion as evident in confabulation and disorientation), the failure of TOJ, as tested here, has no such known clinical correlate

Neural Correlate of Anterograde Amnesia in Wernicke-Korsakoff Syndrome

The neural correlate of anterograde amnesia in Wernicke-Korsakoff syndrome (WKS) is still debated. While the capacity to learn new information has been associated with integrity of the medial temporal lobe (MTL), previous studies indicated that the WKS is associated with diencephalic lesions, mainly in the mammillary bodies and anterior or dorsomedial thalamic nuclei. The present study tested the hypothesis that amnesia in WKS is associated with a disrupted neural circuit between diencephalic and hippocampal structures. High-density evoked potentials were recorded in four severely amnesic patients with chronic WKS, in five patients with chronic alcoholism without WKS, and in ten age matched controls. Participants performed a continuous recognition task of pictures previously shown to induce a left medial temporal lobe dependent positive potential between 250 and 350ms. In addition, the integrity of the fornix was assessed using diffusion tensor imaging (DTI). WKS, but not alcoholic patients without WKS, showed absence of the early, left MTL dependent positive potential following immediate picture repetitions. DTI indicated disruption of the fornix, which connects diencephalic and hippocampal structures. The findings support an interpretation of anterograde amnesia in WKS as a consequence of a disconnection between diencephalic and MTL structures with deficient contribution of the MTL to rapid consolidation

Neural Correlate of Anterograde Amnesia in Wernicke-Korsakoff Syndrome

The neural correlate of anterograde amnesia in Wernicke-Korsakoff syndrome (WKS) is still debated. While the capacity to learn new information has been associated with integrity of the medial temporal lobe (MTL), previous studies indicated that the WKS is associated with diencephalic lesions, mainly in the mammillary bodies and anterior or dorsomedial thalamic nuclei. The present study tested the hypothesis that amnesia in WKS is associated with a disrupted neural circuit between diencephalic and hippocampal structures. High-density evoked potentials were recorded in four severely amnesic patients with chronic WKS, in five patients with chronic alcoholism without WKS, and in ten age matched controls. Participants performed a continuous recognition task of pictures previously shown to induce a left medial temporal lobe dependent positive potential between 250 and 350 ms. In addition, the integrity of the fornix was assessed using diffusion tensor imaging (DTI). WKS, but not alcoholic patients without WKS, showed absence of the early, left MTL dependent positive potential following immediate picture repetitions. DTI indicated disruption of the fornix, which connects diencephalic and hippocampal structures. The findings support an interpretation of anterograde amnesia in WKS as a consequence of a disconnection between diencephalic and MTL structures with deficient contribution of the MTL to rapid consolidation