Brain, Vol 121, Issue 10 1951-1973, Copyright © 1998 by Oxford University Press
B Levine, SE Black, R Cabeza, M Sinden, AR Mcintosh, JP Toth, E Tulving and DT Stuss
Isolated retrograde amnesia is defined as impaired recollection of
experiences pre-dating brain injury with relatively preserved anterograde
learning and memory. We present findings from a patient (M.L.) with
isolated retrograde amnesia following severe traumatic brain injury (TBI)
that address hypotheses of the interrelationships of focal neuropathology,
episodic memory and the self. M.L. is densely amnesic for experiences
predating his injury, but shows normal anterograde memory performance on a
variety of standard tests of recall and recognition. The cognitive
processes underlying this performance were examined with the remember/know
technique, which permits separation of episodic from non-episodic
contributions to memory tests by quantifying subjects' reports of
re-experiencing aspects of the encoding episode. The results demonstrated
that M.L. does not episodically re-experience post-injury events to the
same extent as control subjects, although he can use familiarity or other
non-episodic processes to distinguish events he has experienced from those
he has not experienced. M.L.'s MRI showed damage to the right ventral
frontal cortex and underlying white matter, including the uncinate
fasciculus, a frontotemporal band of fibres previously hypothesized to
mediate retrieval of specific events from one's personal past. Recent
functional neuroimaging evidence of an association between right frontal
lobe functioning and episodic retrieval demands suggest that M.L.'s memory
deficits are related to this focal injury. This hypothesis was supported by
right frontal polar hypoactivation in M.L. in response to episodic
retrieval demands when he was examined with a cognitive activation H2(15)O
PET paradigm that reliably activated this frontal region in both healthy
controls and patients with TBI carefully matched to M.L. (but without
isolated retrograde amnesia). He also showed increased left inferomedial
temporal activation relative to control subjects, suggesting that his
spared anterograde memory is mediated through increased reliance on medial
temporal lobe structures. Re-experiencing events as part of one's past is
based on autonoetic awareness, i.e. awareness of oneself as a continuous
entity across time. This form of awareness also supports the formulation of
future goals and the implementation of a behavioural guidance system to
achieve them. The findings from this study converge to suggest that M.L.
has impaired autonoetic awareness attributable to right ventral frontal
lobe injury, including right frontal-temporal disconnection. Reorganized
brain systems mediate certain preserved cognitive operations in M.L., but
without the normal complement of information concerning the self with
respect to both past and future events.
ARTICLES
Episodic memory and the self in a case of isolated retrograde amnesia
Rotman Research Institute, Baycrest Centre for Geriatric Care, North York, Ontario, Canada. levine@psych.utoronto.ca
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