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Testing memory for self-generated items in dementia

Method makes a difference

From the Division of Neurology, Pennsylvania State University College of Medicine (Dr. Barrett); the Department of Neurology (Drs. Crucian and Heilman), University of Florida College of Medicine, Gainesville, FL; the Neurology Service (Dr. Heilman), Veteran’s Affairs Medical Center, Gainesville, FL, and Saint Barnabus Institute of Neurology and Neurosurgery (Dr. Schwartz), West Orange, NJ.

Address correspondence and reprint requests to Dr. Anna M. Barrett, Division of Neurology, POB 850, Penn State University College of Medicine, Hershey, PA 17033.

OBJECTIVE: To learn how pAD (probable Alzheimer’s disease), PD+ ("Parkinson’s Plus" syndrome), and control subjects remember internally generated material under different conditions.

BACKGROUND: "Self-discovered," or internally generated knowledge, prized by educators and therapists, can bring about considerable behavioral change. Both parietal-temporal-limbic (pAD) and frontal-subcortical dementia (e.g. PD+) cause dysmemory, but may cause different internal-external memory bias. pAD subjects, confusing internal and external information (confabulation) and reporting internal information during memory testing (intrusions), may be biased to remember internal material. PD+ subjects, impaired at generative tests, may be externally biased.

METHODS: Ten pAD, 5 PD+, and 10 control subjects generated words in a category without instruction to remember (INR), and took a list-learning test of incidental memory for internally and externally generated words. To test how INR influences memory, subjects then generated and attempted to recall four more words.

RESULTS: All three subject groups remembered more internally generated than externally provided words without INR. Recall versus recognition of internally generated words differed by group, with PD+ subjects showing greatest improvement with recognition. The pAD subjects performed worse with INR than without INR, had the most intrusion errors, and, rather than demonstrating a release from proactive inhibition, recalled fewer words outside the category. Groups differed in overall recall/recognition improvement (p = 0.015).

CONCLUSIONS: Aged subjects preferentially retained internally generated material. However, among demented subjects, memory for internally generated words was influenced by the testing method used. PD+ subjects have poor internal recall, but excellent internal recognition. In pAD, memory for internally generated words may exceed external memory, but only when subjects are not explicitly trying to remember.

Key words: Memory—Dementia—Generation effect—Internal—Endogenous.

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