Della Sala Memory MCI Patients

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Della Sala et al., Amnesia and Interference, Page 1

Just Lying There, Remembering: Improving Recall of Prose in Amnesic

Patients with Mild Cognitive Impairment By Minimizing Interference

Sergio Della Sala

Neuropsychology Research Group, Department of Psychology, University of Aberdeen, UK

Nelson Cowan

Department of Psychological Sciences, University of Missouri, Columbia, MO, USA

Nicoletta Beschin

Dipartimento di Riabilitazione, Azienda Ospedaliera Gallarate,

Ospedale Somma Lombardo (Va), Italy

Michele Perini

Dipartimento di Neurologia, Azienda Ospedaliera S. Antonio Abate Gallarate (Va), Italy

Corresponding author:

Nelson Cowan

Department of Psychological Sciences

University of Missouri

210 McAlester HallColumbia, MO 65211

E-mail: [email protected]: 573-882-4232


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Abstract

The hallmark of amnesia is poor explicit long-term memory along with normal short-term

memory. It is often stated that information encountered by amnesic patients is forgotten within 1 min

of presentation. However, previous work has not distinguished between forgetting as a function of

time vs. the interfering material occupying that time. We show that there is a marked benefit of

reduced interference in amnesic patients with Mild Cognitive Impairment (MCI), a condition that is

characterized by anterograde amnesia in the absence of other neuropsychological deficits and carries

an increased risk for Alzheimer disease. The result suggests that long-term memory is encoded in

these patients to a greater extent than had been realized but that their memory is highly vulnerable to

interference.


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Just Lying There, Remembering: Improving Recall of Prose in Amnesic

Patients with Mild Cognitive Impairment By Minimizing Interference

The hallmark of anterograde amnesia is fast forgetting of material to be remembered.

Typically amnesic patients retain verbal information for no longer than one minute. If the

forgetting were inevitable, it would allow the possibility that the event has not been encoded into

the memory system used for voluntary, conscious recollection. In contrast, if memory could be

retrieved under conditions of reduced interference, this would indicate that the encoding did

occur, at least in a weakened form.

The shallow encoding could take two forms. The information could remain in an active

or conscious form continually in memory (i.e., in working memory; see Baddeley, 1986; Cowan,

1995), from the time of its presentation until the time of recall. Alternatively, the information

could be encoded in a form that becomes dormant or inactive, leaving consciousness (i.e., in

long-term memory), and yet could remain available for retrieval so long as subsequent events are

too weak to interfere with the original encoding context.

Every seasoned clinician may notice that anterograde amnesic patients are vulnerable to

interference. However, there are few objective data on it and, in clinical situations, it is next to

impossible to determine the role of interference as opposed to the passage of time because

patients (like the rest of us) are rarely free of interference for more than a few minutes. To

examine this issue, we investigated the role of interference in verbal recall. To minimize the

possible role of active rehearsal we relied on prose memory with immediate and one-hour-

delayed recall. This was prompted by the recent report that amnesiacs show a relative good

performance on immediate recall of prose passages (Baddeley & Wilson, 2002). The critical


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manipulation was the use of ordinary interference and very-low-interference conditions during

the hour-long retention interval. If recall in amnesiacs can be improved by reducing interference,

that finding would show that amnesiacs do encode information into a system that can be used for

deliberate, verbal recall, despite the popular view to the contrary. The suggestion that amnesiacs

may suffer exaggerated effects of retroactive interference can be gleaned from the literature (e.g.,

Moscovitch, 1994; Shimamura, Jurica, Mangels, Gershberg & Knight, 1995). However, until

now, this hint has not been backed up empirically.

Cowan, Beschin, and Della Sala (work in preparation) used this type of test with six

amnesiacs who had a variety of brain lesions and found that four of them benefited profoundly

from reduced interference during a 1-hour retention interval, whereas the other two showed no

benefit. At this point it is unclear why only some amnesiacs benefited and it would help to

observe the effect in a defined subcategory of amnesia. For that purpose, patients with Mild

Cognitive Impairment (MCI) were recruited. They are well-suited to this test because they

display anterograde amnesia in the absence of overt dementia or other neuropsychological

deficits. Fortunately for this work, as well, their immediate recall appears to be fairly

comparable to that of normal control participants, allowing valid comparisons of forgetting (see

below). They are also of special practical concern because MCI carries an increased risk for

developing Alzheimer disease (Petersen, Smith, Waring, Ivnik, Tangalos, & Kokmen, 1999).

Methods

Participants

Ten patients with MCI (six women and four men, mean age = 67.40 years, SD = 8.96; mean

education = 5.60 years, SD = 1.26) are described in Table 1, which gives ages, education, and criterion

scores for the patients, and Table 2, which gives further psychometric test data for them. No MCI


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patients were included in Cowan et al. (submitted). A group of ten age-matched, healthy controls (five

women and five men, mean age = 68.30 years, SD = 5.79, mean education = 5.4 years, SD = 0.96) also

participated in this experiment. All MCI patients entering the study had a history of incipient

anterograde memory deficits as evinced from clinical notes, relatives reports, and interview with the

patients and their caregivers; no signs of focal lesions (computerized tomography or magnetic

resonance imaging); no signs of abnormalities in the neurological examination; normal Mini-Mental

Examination score; and normal blood tests (e.g., cell counts, thyroid hormones levels, syphilis

serologic testing, vitamin B12 and folic acid levels). Moreover, none of the patients had a history of

psychiatric illness or was assuming psychoactive drugs at the time of testing; and they show no hints

of depression as assessed by the Beck Depression Inventory (Beck, 1961). They all had a Clinical

Dementia Rating Scale (CDR - Hughes, Berg, Danziger, Coben, & Martin, 1982) score equal to 0.5

indicating an overwhelming deficit of memory as compared to all other cognitive domains and

activities of daily living, and they scored above 9, i.e. within the normal range, in the Instrumental

Activity of Daily Living (IADL Lawson & Brody, 1969). Moreover, they scored below cut-off in the

delayed recall of the Rey-type Word List Recall Test (Carlesimo, Caltagirone, & Gainotti,1996). On

the other hand, all patients scored above cut-off in tests assessing language comprehension (including

normal performance with the long sentences of the Token Test) and production, verbal fluency,

immediate copy of a geometrical figure, Trail Making, and verbal and spatial short-term memory (see

Table 2). Finally, none of the patients showed signs of dementia when retested to this end after six

months.

----- Insert Tables 1 and 2 about here -----

Materials and Procedure

All participants were presented with four stories orally (selected from a pool of seven


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standardized passages), were asked for immediate verbatim recall, and then were asked for delayed

recall an hour later. The stories were in Italian, the mother tongue of all participants, and were derived

from the available literature (Spinnler & Tognoni, 1987; Brazzelli, Della Sala & Laiacona, 1993;

Capitani, Della Sala, Laiacona, Marchetti, & Spinnler, 1994). The length of the stories varied from 21

to 64 content words and verbatim recall was scored with credit for all function words conveying the

correct meanings. Cowan et al. (submitted) reported inter-rater reliabilities for recall scoring of >.95

for each condition. Proportion of retention (delayed recall as a proportion of the preceding immediate

recall on the same trial) was used in the analyses.

Two of the stories were followed by a 1-h test delay filled with various psychometric tasks to

create a standard amount of interference. The other two stories were followed by a delay in which the

participant reclined in a dark, quiet room for the entire 1-h period to minimize interference. They were

not told that delayed recall would be requested, although a participant theoretically might expect this

after the first trial. Experimental testing took place in two sessions carried out on different days. The

selection of stories for each condition and the order of conditions were random but proved to be well-

matched across groups and conditions.

Results

Average proportions of immediate recall (with standard errors of the mean) were similar across

groups: .49 (.05) and .46 (.04), respectively, for the healthy controls and the patient group. Retention

in delayed tests was measured on each trial as the amount recalled following the delay divided by the

amount recalled in the immediate test on the same trial (i.e., delayed / immediate). Healthy controls

showed an average retention of .80 (.03) with the usual interference and .89 (.05) with minimal

interference. The MCI patients showed a marked difference, from .20 (.03) with the usual interference

up to .55 (.05) with minimal interference (see Figure 1).


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In an analysis of variance of the retention with the patient group as a between-participant

factor and the interference condition as a within-participant factor, both main effects and the

interaction all were highly significant, p < .001 in each case. [Group: F(1, 18) = 80.48, MSE =

0.03; Interference, F(1, 18) = 76.96, MSE = 0.01; interaction, F(1, 18) = 27.19, MSE = 0.01.]

We do not interpret the interaction because of ceiling effects in the controls and the poorer

overall retention in amnesiacs simply reflects their amnesic deficit in delayed recall.

The key finding is that separate analyses for each of the two participant groups showed

that the retention was significantly larger for the minimal-interference condition than for the

usual-interference condition in both groups (p < .001 in both cases). The improvement of

retention by reducing interference perhaps would have been predicted by most investigators for

normal controls, but this improvement is newsworthy and informative for amnesic patients.

The performance characteristics of each patient on the story recall task are reported in

Table 3. There was a large amount of individual difference in the extent to which patients

benefited from minimization of interference. It is not yet clear why this difference occurs.

Notice, for example, that Patient 4 went from a retention score of 0 with the usual interference

to .38 with interference minimized, whereas Patient 6 went from 0 only to .08, and thus benefited

much less than Patient 4. This cannot be easily attributed to differences in their levels of

immediate recall, which were fairly similar as the table shows. Among all 10 patients, the

relation between retention in the minimal-interference and usual-interference conditions was

significant, r = .67. However, considering all of the variables presented in Tables 1 - 3, there

were no other correlations with retention in the minimal-interference condition. (There was an

almost-significant correlation between the level of immediate recall and retention in the usual


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interference condition, r = .61. Immediate recall also was significantly correlated with age, r =

-.72, and performance on the Token Test, r = .66.)

----- Insert Table 3 about here -----

A final, important issue is what patients did during the unfilled delay period. It is

possible that some of them reminisced about the story for at least part of the interval and thus

retained elements of the story in working memory. However, Patients 3 and 7 were observed to

snore throughout portions of both unfilled delays and therefore could not have maintained the

information in working memory, unless working memory is found to continue during sleep

(Jenkins & Dallenbach, 1924, attributed to lack of interference the savings from forgetting they

observed in two participants during sleeping periods compared to when they were awake). As

Table 3 shows, these patients nevertheless appeared to benefit from the reduction of interference.

The case is clearest for Patient 7, who went from .31 retention with usual interference to .61

retention with minimal interference despite snoring under minimal interference.

Discussion

Minimal-interference conditions resulted in much better delayed recall than the usual-

interference condition in the MCI patients. Since patients with Alzheimer Disease (AD) perform at

floor in delayed retrieval of prose passages (e.g., Spinnler & Della Sala, 1987) and in our own pilot

studies they did not benefit from the minimal interference condition, this procedure may add to the

much sought (see e.g., Petersen et al., 1999) differential diagnosis between MCI and AD.

These findings could hardly be accounted for by postulating the use of subvocal rehearsal

during the no-interference condition on several grounds. First, the delay was long enough to

discourage the strategy of sheer rehearsal. Second, several participants fell asleep (and, as noted, some


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snored) during the retention interval, as testified by the experimenters regular checks. Third during

the debriefing session, only patient 7 volunteered that she used subvocal rehearsal as a strategy to

optimize recall (and that attempt would have been affected by short-term memory loss during sleep).

Hence, long-term retrieval, rather than only short-term rehearsal, seems improved by the lack of

interference.

In summary, we have shown that the deficit underlying amnesia in MCI is characterized

by increased vulnerability to interference and that reducing the interference can result in a

substantial increase in memory performance. These findings indicate that amnesia, at least that

characterizing MCI, does not necessarily imply an absence of memory encoding and that new

explicit memory representations can be constructed by MCI patients. However, these memory

traces are highly susceptible to interference from intervening events.


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Neurologia Psichiatria, 47, 209-237.

De Renzi, E., & Faglioni, P. (1978). Normative data and screening power of a shortened version

of the Token Test. Cortex, 14, 41-49.

Giovagnoli, A.R, Del Pesce, M., Mascheroni, S., Simoncelli, M., Laiacona, M., & Capitani, E. (1996).

Trail making test: normative values from 287 normal adult controls. Italian Journal

Neurological Sciences, 17, 305-309.

Hughes, C.P., Berg, L., Danziger, W.L., Coben, L.A., & Martin, R.L. (1982). A new clinical

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Jenkins, J.G., & Dallenbach, K.M. (1924) Oblivescence during sleep and waking. American

Journal of Psychology, 35, 605-612.

Lawson, M.P., & Brody, E.M. (1969). Assessment of older people: Self-maintaining and instrumental

activities of daily living. Gerontologist, 9, 179-186.

1Measso, G., Cavarzeran, F., Zappala, G., Lebowitz, B.D., Crook, T.H., Pirozzolo, F.J., Amaducci,

L.A., Massari, D. & Grigoletto, F. (1993). The Mini-Mental State Examination: Normative

study of Italian random sample. Developmental Neuropsychology, 9, 77-85.

1Moscovitch, M. (1994). Memory and working with memory: Evaluation of a component process

model and comparisons with other models. In D.L. Schacter & E. Tulving (Eds.), Memory

systems 1994 (pp. 269 310). Cambridge, MA: MIT Press.

1Orsini, A., Grossi, D., Capitani, E., Laiacona, M., Papagno, C., & Vallar, G. (1987). Verbal and

spatial immediate memory span: Normative data from 1355 adults and 1112 children. Italian

Journal of Neurological Science, 8, 539-548.


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Petersen R.C., Smith G.E., Waring S.C., Ivnik, R.J., Tangalos, E.G., & Kokmen, E. (1999). Mild

cognitive impairment. Clinical characterization and outcome. Archives of Neurology, 56, 303-

308.

11Shimamura, A.P., Jurica, P. J., Mangels, J. A., Gershberg, F. B., & Knight, R. T. (1995).

Susceptibility to memory interference effects following frontal lobe damage: Findings

from tests of paired-associate learning. Journal of Cognitive Neuroscience, 7, 144-152.

Spinnler, H., & Della Sala, S. (1988). The role of clinical neuropsychology in the neurological

diagnosis of Alzheimer's disease. Journal of Neurology, 235, 258-271.

Spinnler, H., & Tognoni, G. (Eds) (1987). Standardizzazione e Taratura italiana di test

neuropsicologici. The Italian Journal Neurological Sciences , Suppl 8 to No. 6: 1-120.


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Table 1.

Demographic Features of the MCI Patients Entering the Study and their Performance in theDiagnostic Tests.

MCI/ Pt. No. Age Education(years) MMSEscore1 Rey-typeWord List

Delayed2

1 73 8 30 3.9

2 66 5 30 1.8

3 68 5 30 2.4

4 80 5 26.03 3.1

5 72 5 27.03 2.4

6 76 5 30 3.1

7 50 8 29.07 2.6

8 56 5 28.24 0.7

9 66 5 28.99 2.810 67 5 30 4.4

Notes

1 Score range, 0-30; cut-off for normal performance, 23.8 (for the Italian population). Scores

adjusted for age and education (Measso et al., 1993).

2 Fifteen-word lists learning delayed recall. Score range, 0-15; cut-off for normal performance,

4.69 (Carlesimo et al., 1996).


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Table 2

Neuropsychological Profile of the MCI Patients

MCI

Patient

Number

Naming Token

Test

Phonetic

Fluency

Semantic

Fluency

Word List

Learning

Immediate

Digit

Span

Spatial

Span

Rey Figure

Immediate

Rey

Figure

Delayed

Trail

Making

1 9 35 31.7 16.75 28.9 9.25 7.25 36 9.75 1362 9 33 34.9 21.25 18.1* 5.5 5.5 36 6.75* 145

3 9 35 32.6 20.0 38.0 6.5 6.5 35 6.75* 92

4 9 31 25.7 14.25 36.2 4.75 4.75 36 7.75* 81

5 9 32 26.6 19.6 28.0* 4.5 4.5 36 9.75 116

6 9 31 30.4 16.75 30.0 4.5 4.5 32.75 11.75 168

7 9 35 24.1 18.5 23.3* 6.0 6.0 35.25 3.5* 124

8 9 32 24.8 16.75 17.8* 4.5 4.25 36 5.5* 81

9 9 32 21.25 10.25 20.1* 5.5 4.25 33.25 6.75* 122

10 9 34 28.9 14.25 33.1 5.5 6.25 36 5.5* 114

Note. Scores are age- and education-adjusted. Asterisk (*) indicates performances below the

normal cut-off score. Naming test from theAachener Aphasie Test AAT, 120 stimuli, cut-off:8 (De Bleser et al., 1986). Token Test, score range: 0-36, cut-off score: 26.5 (De Renzi &

Faglioni, 1978). Phonemic Verbal Fluency, words beginning with F, A or S, cut-off score: 17.35

(Carlesimo et al., 1996). Semantic Verbal Fluency, names of colors, animals, fruit, cities, cut-offscore: 7.25 (Spinnler & Tognoni, 1987). Rey-Type Word List Learning(15 word list, repeated 5

times), score range: 0-75, cut-off score: 28.53 (Carlesimo et al., 1996). Digit Span (Orsini et al.,

1987), cut-off score: 3.5 (digit span in Italian is generally lower than in English due to the longerpronunciation times of the digits). Spatial Span (Orsini et al., 1987), cut-off score: 3.25. Rey

Figure Immediate, score range: 0-36, cut-off score: 28.87 (Caffarra et al., 2002). Rey Figure

Delayed, score range 0-36, cut-off score: 9.46 (Caffarra et al., 2002). Trail Making, time in

seconds, section A section B, the higher the worse, cut-off score: 187 (Giovagnoli et al., 1996).


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Table 3.

Individual Mean Performance Characteristics of the MCI Patients in the Experimental Prose

Recall Tasks

Patient Immediate

Recall:Proportion

Correct

Interference:

Retention(Delayed/

Immediate)

No

Interference:Retention

(Del./Imm.)

1 .52 .14 .54

2 .54 .25 .48

3 .58 .40 .59

4 .20 .00 .38

5 .50 .33 .67

6 .32 .00 .08

7 .57 .31 .61

8 .61 .11 .62

9 .40 .32 .8810 .46 .14 .67


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Figure Caption

Figure 1. Proportion retention in the experimental story recall task following usual

interference (left) and minimal interference (right) for normal control participants (dark bars) and

MCI patients (white bars). Retention is calculated on each trial as the proportion of correct

verbatim recall in 1-hour-delayed recall relative to (divided by) immediate recall. Error bars are

standard errors.


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Figure 1

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

Usual Minimal

Amount of Interference

Proportion

Retentio

n

Normal Control

MCI Patient


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Hanya Berbaring sana, Mengingat: Meningkatkan Recall of Prosa di amnesic

Pasien dengan Penurunan Mild Cognitive

Hanya Berbaring sana, Mengingat: Meningkatkan Recall of Prosa di amnesicPasien dengan Penurunan Mild Cognitive Dengan Meminimalkan Interferensi

Sergio Della Sala

Neuropsikologi Research Group, Departemen Psikologi, University of Aberdeen, InggrisNelson Cowan

Departemen Ilmu Psikologi, Universitas Missouri, Columbia, MO, USA

Nicoletta Beschin

Dipartimento di Riabilitazione, Azienda Ospedaliera Gallarate,Ospedale Somma Lombardo (Va), Italia

Michele Perini

Dipartimento di Neurologia, Azienda Ospedaliera S. Antonio Abate Gallarate (Va), Italia

Sesuai penulis:

Nelson Cowan

Departemen Ilmu PsikologiUniversity of Missouri

210 McAlester Balai

Columbia, MO 65211

E-mail: [email protected]

Telepon: 573-882-4232

Abstrak

Ciri dari amnesia adalah miskin eksplisit memori jangka panjang bersama dengan normalmemori jangka pendek. Hal ini sering menyatakan bahwa informasi yang dihadapi oleh pasien

amnesic dilupakan dalam 1 menit presentasi. Namun, pekerjaan sebelumnya belum dibedakan

antara melupakan sebagai fungsi waktu vs bahan campur menempati waktu itu. Kami

menunjukkan bahwa ada manfaat ditandai gangguan berkurang pada pasien amnesic denganPenurunan Mild Cognitive (MCI), suatu kondisi yang ditandai dengan amnesia anterograde tanpa

adanya defisit neuropsikologi lainnya dan membawa peningkatan risiko untuk penyakit

Alzheimer. Hasilnya menunjukkan bahwa memori jangka panjang dikodekan pada pasiendengan tingkat yang lebih besar daripada yang telah menyadari tetapi memori mereka sangat

rentan terhadap gangguan.

Hanya Berbaring sana, Mengingat: Meningkatkan Recall of Prosa di amnesic

Pasien dengan Penurunan Mild Cognitive Dengan Meminimalkan Interferensi

Ciri amnesia anterograde cepat melupakan bahan untuk diingat. Biasanya pasien amnesic


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menyimpan informasi verbal untuk tidak lebih dari satu menit. Jika lupa tidak bisa dihindarkan,

akan memungkinkan kemungkinan bahwa acara tersebut belum dikodekan ke dalam sistem

memori yang digunakan untuk sukarela, ingatan sadar. Sebaliknya, jika memori dapat diambildalam kondisi gangguan berkurang, ini akan menunjukkan bahwa pengkodean itu terjadi,

setidaknya dalam bentuk lemah.

Pengkodean dangkal bisa mengambil dua bentuk. Informasi bisa tetap dalam bentuk aktif atausadar terus-menerus dalam memori (yaitu, dalam memori kerja, lihat Baddeley, 1986; Cowan,

1995), dari saat presentasi sampai saat recall. Atau, informasi dapat dikodekan dalam bentuk

yang menjadi aktif atau tidak aktif, meninggalkan kesadaran (yaitu, dalam memori jangkapanjang), namun bisa tetap tersedia untuk pengambilan selama kejadian setelah terlalu lemah

untuk mengganggu konteks pengkodean asli .

Setiap dokter berpengalaman mungkin memperhatikan bahwa pasien amnesic anterograde rentan

terhadap gangguan. Namun, ada beberapa data yang obyektif di atasnya dan, dalam situasi klinis,itu adalah mustahil untuk menentukan peran interferensi yang bertentangan dengan berlalunya

waktu karena pasien (seperti sisa dari kita) jarang bebas dari gangguan selama lebih dari

beberapa menit. Untuk memeriksa masalah ini, kami meneliti peran gangguan ingat verbal.

Untuk meminimalkan kemungkinan peran aktif latihan kita bergantung pada memori prosadengan recall langsung dan satu-jam-tertunda. Hal ini dipicu oleh laporan terbaru bahwa amnesia

menunjukkan kinerja yang baik relatif pada ingat segera bagian prosa (Baddeley & Wilson,2002). Manipulasi penting adalah penggunaan gangguan biasa dan sangat-rendah-gangguan

kondisi selama interval retensi selama satu jam. Jika recall di amnesia dapat ditingkatkan dengan

mengurangi gangguan, yang menemukan akan menunjukkan bahwa amnesia yang mengkodekaninformasi ke dalam sistem yang dapat digunakan untuk disengaja, ingat verbal, meskipun

pandangan populer yang bertentangan. Saran yang amnesia mungkin menderita efek berlebihan

gangguan retroaktif dapat diperoleh dari literatur (misalnya, Moscovitch, 1994; Shimamura,

Jurica, Mangels, Gershberg & Knight, 1995). Namun, sampai sekarang, petunjuk ini belumdidukung secara empiris.

Cowan, Beschin, dan Della Sala (pekerjaan dalam persiapan) menggunakan jenis uji dengan

enam amnesia yang memiliki berbagai lesi otak dan menemukan bahwa empat dari merekamanfaat mendalam dari gangguan berkurang selama interval retensi 1 jam, sedangkan dua

lainnya menunjukkan tidak bermanfaat. Pada titik ini tidak jelas mengapa hanya beberapa

amnesia manfaat dan akan membantu untuk mengamati efek dalam subkategori didefinisikanamnesia. Untuk itu, pasien dengan Penurunan Mild Cognitive (MCI) direkrut. Mereka cocok

untuk tes ini karena mereka menampilkan amnesia anterograde tanpa adanya demensia terang-

terangan atau defisit neuropsikologi lainnya. Untungnya untuk pekerjaan ini, juga, ingat

langsung mereka tampaknya cukup sebanding dengan peserta kontrol normal, memungkinkanperbandingan yang valid lupa (lihat di bawah). Mereka juga menjadi perhatian khusus karena

praktis MCI membawa peningkatan risiko untuk mengembangkan penyakit Alzheimer (Petersen,

Smith, Waring, Ivnik, Tangalos, & Kokmen, 1999).

Metode

PesertaSepuluh pasien dengan MCI (enam perempuan dan empat laki-laki, usia rata-rata = 67.40 tahun,

SD = 8.96, pendidikan rata-rata = 5,60 tahun, SD = 1,26) dijelaskan pada Tabel 1, yang

memberikan usia, pendidikan, dan skor kriteria untuk pasien, dan Tabel 2, yang memberikan

data uji lanjut psikometri untuk mereka. Tidak ada pasien MCI dimasukkan dalam Cowan et al.


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(Disampaikan). Sekelompok sepuluh usia-cocok, kontrol sehat (lima perempuan dan lima laki-

laki, usia rata-rata = 68,30 tahun, SD = 5,79, berarti pendidikan = 5,4 tahun, SD = 0,96) juga

berpartisipasi dalam penelitian ini. Semua pasien MCI memasuki studi itu memiliki sejarah barujadi defisit memori anterograde seperti yang tampak dari catatan klinis, laporan kerabat ', dan

wawancara dengan pasien dan pengasuh mereka, tidak ada tanda-tanda lesi fokal (computerized

tomography atau magnetic resonance imaging), tidak ada tanda-tanda kelainan pada pemeriksaanneurologis, yang normal Mini-Mental nilai Ujian, dan tes darah normal (misalnya, jumlah sel,

kadar hormon tiroid, sifilis pengujian serologi, vitamin B12 dan kadar asam folat). Selain itu,

tidak ada pasien memiliki riwayat penyakit jiwa atau berasumsi obat psikoaktif pada saatpengujian, dan mereka tidak menunjukkan petunjuk depresi sebagaimana dinilai oleh Beck

Depression Inventory (Beck, 1961). Mereka semua memiliki Penilaian Skala Demensia Klinis

(CDR - Hughes, Berg, Danziger, Coben, & Martin, 1982) skor sebesar 0,5 menunjukkan defisit

besar memori dibandingkan dengan semua domain kognitif lainnya dan aktivitas sehari-hari, danmereka mencetak gol diatas 9, yaitu dalam kisaran normal, dalam Kegiatan Instrumental Hidup

Harian (IADL - Lawson & Brody, 1969). Selain itu, mereka mencetak gol di bawah cut-off di

recall tertunda dari Uji Rey-jenis Daftar kata Recall (Carlesimo, Caltagirone, & Gainotti, 1996).

Di sisi lain, semua pasien mencetak di atas cut-off dalam tes menilai pemahaman bahasa(termasuk kinerja normal dengan kalimat panjang Test Token) dan produksi, kefasihan lisan,

copy langsung dari sebuah figur yang geometris, Trail Making, dan verbal dan spasial memorijangka pendek (lihat Tabel 2). Akhirnya, tidak ada pasien menunjukkan tanda-tanda demensia

ketika diuji ulang untuk tujuan ini setelah enam bulan.

----- Insert Tabel 1 dan 2 tentang di sini -----Bahan dan Prosedur

Semua peserta disajikan dengan empat cerita lisan (dipilih dari kolam dari tujuh bagian standar),

diminta untuk mengingat verbatim segera, dan kemudian diminta untuk mengingat tertunda satu

jam kemudian. Cerita-cerita itu dalam bahasa Italia, bahasa ibu dari semua peserta, dan berasaldari literatur yang tersedia (Spinnler & Tognoni, 1987; Brazzelli, Della Sala & Laiacona, 1993;

Capitani, Della Sala, Laiacona, Marchetti, & Spinnler, 1994) . Panjang cerita bervariasi 21-64

kata konten dan mengingat verbatim itu mencetak gol dengan kredit untuk semua kata fungsimenyampaikan makna yang benar. Cowan et al. (Disampaikan) melaporkan reliabilitas antar-

penilai untuk mencetak penarikan kembali> .95 untuk setiap kondisi. Proporsi retensi (recall

tertunda sebagai proporsi dari recall langsung sebelumnya pada sidang yang sama) yangdigunakan dalam analisis.

Dua dari cerita diikuti oleh penundaan uji 1-h diisi dengan tugas psikometri berbagai membuat

sejumlah standar gangguan. Dua cerita lainnya yang diikuti dengan penundaan di mana peserta

berbaring di ruangan gelap, tenang untuk periode 1-h keseluruhan untuk meminimalkangangguan. Mereka tidak diberitahu bahwa recall tertunda akan diminta, meskipun peserta secara

teoritis mungkin berharap ini setelah sidang pertama. Pengujian eksperimental berlangsung

dalam dua sesi dilakukan pada hari yang berbeda. Pemilihan cerita untuk setiap kondisi danurutan kondisi yang acak tetapi terbukti sangat cocok di seluruh kelompok dan kondisi.

Hasil

Proporsi rata recall langsung (dengan kesalahan standar dari mean) adalah serupa di seluruhkelompok: .49 (.05) dan .46 (.04), masing-masing, untuk kontrol yang sehat dan kelompok

pasien. Retensi dalam tes tertunda diukur pada setiap percobaan karena jumlahnya ingat

menyusul keterlambatan dibagi dengan jumlah ingat dalam tes langsung pada sidang yang sama

(yaitu, tertunda / langsung). Kontrol yang sehat menunjukkan retensi rata-rata .80 (.03) dengan


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gangguan biasa dan .89 (.05) dengan gangguan minimal. Para pasien MCI menunjukkan

perbedaan yang nyata, dari .20 (.03) dengan gangguan yang biasa sampai .55 (.05) dengan

gangguan minimal (lihat Gambar 1).Dalam analisis varians dari retensi dengan kelompok pasien sebagai faktor-antara peserta dan

kondisi gangguan sebagai faktor dalam-peserta, baik efek utama dan interaksi semua sangat

signifikan, p


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minimal, prosedur ini dapat menambah banyak dicari (lihat misalnya, Petersen et al, 1999.)

diferensial diagnosis antara MCI dan AD.

Temuan ini hampir tidak bisa dipertanggungjawabkan oleh mendalilkan penggunaan latihansubvocal selama kondisi no-gangguan pada beberapa alasan. Pertama, penundaan itu cukup lama

untuk mencegah strategi latihan belaka. Kedua, beberapa peserta tertidur (dan, seperti telah

disebutkan, beberapa mendengkur) selama interval retensi, sebagaimana dibuktikan olehpemeriksaan reguler eksperimen itu. Ketiga selama sesi tanya jawab, hanya pasien 7 sukarela

bahwa dia menggunakan latihan subvocal sebagai strategi untuk mengoptimalkan recall (dan

upaya yang akan telah dipengaruhi oleh jangka pendek kehilangan memori saat tidur). Olehkarena itu, dalam jangka panjang pengambilan, bukan hanya jangka pendek latihan, tampaknya

ditingkatkan dengan kurangnya gangguan.

Singkatnya, kami telah menunjukkan bahwa amnesia defisit yang mendasari di MCI ditandai

dengan meningkatnya kerentanan terhadap gangguan dan mengurangi gangguan dapatmengakibatkan peningkatan yang substansial dalam kinerja memori. Temuan ini menunjukkan

bahwa amnesia, setidaknya itu mencirikan MCI, tidak selalu berarti tidak adanya pengkodean

memori dan bahwa representasi eksplisit memori baru dapat dibangun oleh pasien MCI. Namun,

jejak-jejak memori sangat rentan terhadap gangguan dari intervensi peristiwa.

ReferensiBaddeley, M (1986). Memori kerja. Oxford Psikologi Seri # 11. Oxford: Clarendon Press.

Baddeley, A., & Wilson, B.A. (2002). Prosa recall dan amnesia: Implikasi untuk struktur memori

kerja. Neuropsychologia, 40, 1.737-1.743.

Beck, A. T. A (1961). Sistematis penyelidikan depresi. Komprehensif Psychiatry, 2, 163-170.Brazzelli, M., Della Sala, S., & Laiacona, M. (1993). Taratura della versione Italiana del

Rivermead Perilaku Memory Test: Un tes di valutazione ecologica della memoria. Supplemento

al manuale del TMCR. Firenze (Florence, Italia): Organizzazioni Speciali.Caffarra, P., Vezzadini, G., Dieci, F., Zonato, F., & Venneri, A. (2002) angka Rey-Osterrieth

kompleks: normatif nilai dalam suatu sampel populasi Italia. Neurologis Ilmu, 22, 443-447.

Capitani, E., Della Sala, S., Laiacona, M., Marchetti, C., & Spinnler, H. (1994).Standardizzazione ed uso Clinico di un tes di memoria di PROSA. Bollettino di Psicologia

Applicata, 209, 47-63

Carlesimo, GA, Caltagirone, C., & Gainotti, G. (1996). Baterai kemunduran mental: normatif

data, keandalan diagnostik dan analisis kualitatif penurunan kognitif. Kelompok untukstandarisasi Baterai Penurunan Mental. Eropa Neurologi 36: 378-384.

Cowan, N. (1995). Perhatian dan memori: Sebuah kerangka kerja terpadu. Oxford Psikologi

Series, No 26. New York: Oxford University Press.De Bleser, R., Denes, F., Luzzatti, C., Mazzucchi, A., Poeck, K., Spinnler, H., & WILLMES, K.

(1986). L'Aachener Aphasie Test (AAT). Problemi e soluzioni per versione una uji italiana del e

per lo studio crosslinguistico dei disturbi afasici. Archivio di Psicologia Neurologia Psichiatria,47, 209-237.

De Renzi, E., & Faglioni, P. (1978). Normatif data dan daya pemutaran versi singkat dari Uji

Token. Cortex, 14, 41-49.

Giovagnoli, AR, Del Pesce, M., Mascheroni, S., Simoncelli, M., Laiacona, M., & Capitani, E.


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(1996). Trail membuat tes: normatif nilai dari 287 kontrol dewasa normal. Italia Jurnal Ilmu

Neurologis, 17, 305-309.

Hughes, CP, Berg, L., Danziger, WL, Coben, LA, & Martin, RL (1982). Sebuah skala klinis baruuntuk demensia pementasan. British Journal of Psychiatry, 140, 566-572.

Jenkins, J.G., & Dallenbach, K.M. (1924) Oblivescence saat tidur dan bangun. American Journal

of Psychology,, 35 605-612.Lawson, M.P., & Brody, E.M. (1969). Penilaian orang tua: aktivitas Self-Memelihara dan

instrumental dari kehidupan sehari-hari. Gerontologist, 9, 179-186.

Measso, G., Cavarzeran, F., 'Zappala, G., Lebowitz, BD, Crook, TH, Pirozzolo, FJ, Amaducci,LA, Massari, D. & Grigoletto, F. (1993). State Examination Mini-Mental: Normatif studi sampel

acak Italia. Pembangunan Neuropsikologi, 9, 77-85.

Moscovitch, M. (1994). Memori dan bekerja dengan memori: Evaluasi dari model proses

komponen dan perbandingan dengan model lainnya. Dalam D.L. Schacter & E. Tulving (Eds.),Memory sistem 1994 (hal. 269-310). Cambridge, MA: MIT Press.

Orsini, A., Grossi, D., Capitani, E., Laiacona, M., Papagno, C., & Vallar, G. (1987). Rentang

memori verbal dan spasial langsung: Normatif data dari 1.355 orang dewasa dan 1.112 anak-

anak. Italia Jurnal Ilmu Neurologis, 8, 539-548.Petersen RC, Smith GE, Waring SC, Ivnik, RJ, Tangalos, EG, & Kokmen, E. (1999). Kerusakan

kognitif ringan. Klinis karakterisasi dan hasil. Archives of Neurology,, 56 303-308.Shimamura, AP, Jurica, PJ, Mangels, JA, Gershberg, FB, & Knight, RT (1995). Kerentanan

terhadap efek interferensi memori menyusul kerusakan lobus frontal: Temuan dari tes

berpasangan-asosiasi belajar. Journal of Cognitive Neuroscience,, 7 144-152.Spinnler, H., & Della Sala, S. (1988). Peran neuropsikologi klinis dalam diagnosis neurologis

penyakit Alzheimer. Journal of Neurology,, 235 258-271.

Spinnler, H., & Tognoni, G. (Eds) (1987). Standardizzazione e Taratura italiana di tes

neuropsicologici. The Journal Italia Neurologis Ilmu, Suppl 8 sampai No 6: 1-120.

Tabel 1.Fitur demografi dari Pasien MCI Memasuki Studi dan Kinerja mereka di Tes Diagnostik.

MCI / Pt. No Umur Pendidikan(Tahun) MMSE

score1 Rey-jenis

Daftar kata

Delayed21 73 8 30 3,9

2 66 5 30 1,8

3 68 5 30 2,44 80 5 26,03 3,1

5 72 5 27,03 2,4

6 76 5 30 3,17 50 8 29,07 2,6

8 56 5 28,24 0,7

9 66 5 28,99 2,8

10 67 5 30 4,4


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Catatan

1 Skor kisaran, 0-30, cut-off untuk kinerja normal, 23,8 (untuk populasi Italia). Skor disesuaikan

dengan usia dan pendidikan (Measso et al., 1993).

2 Lima belas-kata daftar recall belajar tertunda. Jarak skor, 0-15, cut-off untuk kinerja normal,

4,69 (Carlesimo et al, 1996.).

Tabel 2

Neuropsikologi Profil Pasien MCI

MCI

Pasien Nomor Penamaan

Uji Fonetik Token Kefasihan Semantic Kefasihan Daftar kata Belajar

Span Segera Digit Span Spatial Rey Gambar Segera Rey Trail Gambar Tertunda Membuat1 9 35 31,7 16,75 28,9 9,25 7,25 36 9,75 136

2 9 33 34,9 21,25 18,1 * 5,5 5,5 36 6,75 * 1453 9 35 32,6 20,0 38,0 6,5 6,5 35 6,75 * 92

4 9 31 25,7 14,25 36,2 4,75 4,75 36 7,75 * 81

5 9 32 26,6 19,6 28,0 * 4,5 4,5 36 9,75 1166 9 31 30,4 16,75 30,0 4,5 4,5 32,75 168 11,75

7 9 35 24,1 18,5 23,3 * 6,0 6,0 35,25 3,5 * 124

8 9 32 24,8 16,75 17,8 * 4,5 4,25 36 5,5 * 81

9 9 32 21,25 10,25 20,1 * 5,5 4,25 33,25 6,75 * 12210 9 34 28,9 14,25 33,1 5,5 6,25 36 5,5 * 114

Catatan. Skor adalah usia dan pendidikan-disesuaikan. Asterisk (*) menunjukkan kinerja dibawah nilai cut-off normal. Penamaan uji dari uji Aphasie Aachener - AAT, 120 rangsangan,

cut-off: 8 (De Bleser et al, 1986.). Token Test, rentang skor: 0-36, cut-off score: 26,5 (De Renzi

& Faglioni, 1978). Fonemik Verbal Kefasihan, kata-kata yang dimulai dengan F, A atau S, cut-off score: 17.35 (Carlesimo et al, 1996.). Semantic Verbal Kefasihan, nama-nama warna,

binatang, buah, kota, cut-off score: 7.25 (Spinnler & Tognoni, 1987). Rey-Type Daftar kata

Belajar (15 daftar kata, diulang 5 kali), rentang skor: 0-75, cut-off score: 28,53 (Carlesimo et al,

1996.). Digit Span (Orsini et al, 1987.), Cut-off score: 3,5 (rentang digit dalam bahasa Italiaumumnya lebih rendah daripada dalam bahasa Inggris karena semakin lama waktu pengucapan

digit). Spasial Span (Orsini et al, 1987.), Cut-off skor: 3,25. Rey Gambar Segera, jarak skor: 0-

36, cut-off score: 28.87 (Caffarra et al, 2002.). Rey Gambar Tertunda, jarak skor 0-36, cut-offscore: 9,46 (Caffarra et al, 2002.). Pembuatan Trail, waktu dalam detik, bagian A - Bagian B,

semakin tinggi, buruk cut-off score: 187 (Giovagnoli et al, 1996.).

Tabel 3.

Kinerja Individu Karakteristik mean dari Pasien MCI dalam Tugas Recall Prosa Eksperimental


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Pasien Segera Recall: Proporsi Interferensi Benar:

Retensi (Tertunda / Segera) No Interferensi: (.. Del / Imm) Retensi

1 .52 .14 .542 .54 .25 .48

3 .58 .40 .59

4 .20 .00 .385 .50 .33 .67

6 .32 .00 .08

7 .57 .31 .618 .61 .11 .62

9 .40 .32 .88

10 .46 .14 .67

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