Journal of Clinical Neuropsychology Cued recall in Amnesia

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Cued recall in Amnesia Herman Buschke

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Albert Einstein College of Medicine , Bronx, N.Y. Published online: 04 Jan 2008.

To cite this article: Herman Buschke (1984) Cued recall in Amnesia, Journal of Clinical Neuropsychology, 6:4, 433-440, DOI: 10.1080/01688638408401233 To link to this article: http://dx.doi.org/10.1080/01688638408401233

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Journal of Clinical Neuropsychology 1984, Vol. 6, NO. 4, pp. 433-440

0165-0475/84/0604-0433 $3.00 @ Swets & Zeitlinger

METHODOLOGICAL COMMENTARY

Cued Recall in Amnesia* Herman Buschke Albert Einstein College of Medicine, Bronx, N.Y.

Downloaded by [New York University] at 18:50 15 April 2015

ABSTRACT Use of a search procedure to control processingduring learning results in apparently normal cued recall by some amnesic patients with impaired free-recall learning. This suggests that their ability to encode and retrieve may be relatively intact when they are induced to carry out effective processing during learning. When processing is controlled during learning, cued recall should be useful for neuropsychological evaluation of residual learning and memory capacity. Impaired learning and memory is a n important finding in neuropsychological evaluation. Since learning and memory depend o n attention, cognitive processing, and use of effective strategies, it is desirable to control processing during learning and recall. This note describes one way to control processing so that verbal learning and memory can be evaluated when the same kind of effective processing is used by patients and control subjects, by different patients, or by the same patient at different times. The method used here relies on cued recall, which makes it possible to control processing by manipulation of encoding as well as retrieval through specified concurrent processing of cues and to-be-remembered target items during learning. Processing during learning can be controlled by a search procedure in which the patient first uses specific cues to identify each of the target items. Processing during recall can be controlled by presentation of the appropriate cues. Control of encoding is needed to investigate the effects of cognitive processing o n learning and to achieve effective cued recall (Fisher & Craik, 1977; Thompson & Tulving, 1970; Tulving & Osler, 1968; Tulving & Thompson, 1973), as well as for effective encoding (Cermak, 1980; Craik & Lockhart, 1972; Fisher & Craik, 1977). Cued recall itself is needed to assess storage and retention because free recall alone does not recover all items available in storage (Tulving & Pearlstone, 1966).

* This work was supported by USPHS Grants NS43356, HD-O1799from NIH,and AGO2478 from NIA. Reprint requests should be addressed to Herman Buschke, Department of Neurology, Kennedy Center, Room 327, Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY 10461, USA. Accepted for publication: February 27, 1984.

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METHOD The to-be-remembered target items are placed in front of the patient so that all are visible throughout learning. Each item should belong to a different category so that each can be uniquely specified by its category. Each item should be easily identified as a member of its category, but should not be so common that it could be guessed, since the category label will be used later to elicit cued recall. The items used here were produced by 50% or less of the subjects in the category norms of Battig and Montague (1969). Descriptive phrases can be used to indicate the category, such as “something to wear” for the category of “clothing.” The items can be pictures, words, or objects. The 12 items used here were easily identified outline pictures (Snodgrass & Vanderwart, 1980): sweater (clothing), hand (part of the body), basket (something for carrying), elephant (animal), bed (furniture), carrot (vegetable), guitar (musical instrument), banana (fruit), hammer (tool), gun (weapon), bus (vehicle), frying pan (used for cooking). The patient is asked to search for and identify each of the target items when the category label for that item is presented verbally by the examiner. The patient is asked to SUJ what “tool”, what “animal”, etc. is in the array, identifying each of the items in a random order to induce repeated search of the entire array. Successful identification of the items shows that the patient did the specified kind of processing, can understand and use the category labels to name the items, and makes it possible to use the same category labels for effective cued recall later. After interference by 60 s filled with distracting activity such as counting backwards, the patient is asked for verbal.fiee recall of the target items in any order (which is recorded by the examiner). Suficient time and encouragement are given toobtain maximum free recall. Finally, the category labels for those items that were not retrieved by free recall are presented verbally, one at a time, to elicit verbal cued recall of other items still available in storage. Cued recall is tested only for items not retrieved by free recall, since items retrieved by free recall should also be retrieved by cued recall. This use of cued recall permits concurrent testing of free and cued recall. The total recall resulting from the addition of cued recall to free recall provides a minimal estimate of the number of recallable items available in storage on each trial. Before the next recall trial, the patient again searches the array on/v for any items that were nor retrieved by cued recall. If all of the items were retrieved by either free or cued recall, there is no further presentation and the subject proceeds tothenext tnaloffree recall followed by cued recall. This procedure is a kind of selective reminding (Buschke, 1973) in which the patient is reminded only of items that were not recalled, so that learning can be shown by recall without further presentation. Each item therefore occurs just once before each trial, either in free recall or in cued recall or by selective search. This procedure was repeated for six recall trials, but any appropriate number of trials can be used. The main data resultingfrom this procedureare free recalland total recall. Free recall is the number of items retrieved by free recall on each trial. Total recall is the numberofitems retrieved in each trial by either free or cued recall. given by the addition ofcued recall to free reca 11.

RESULTS

Figure 1 shows free recall and total recall b y 10 normal subjectsand seven patients over six trials. Total recall is obtained by the addition of cued recall t o free recall. All o f these normal subjects and patients were able to carry o u t the search

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Ten Controls (61)

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Fig. I . Verbal learning by free recall (closed circles) and total recall (open circles) of 12 unrelated pictures by normal subjects, patients with Alzheimer’s disease (AD) or senile dementia of the Alrheimer’s type (SDAT), and three patients with amnesia due to other etiologies. Total recall is obtained by the addition of cued recall to free recall, providing a minimal estimate of the number of items available for recall.

procedure and name the target items when given the category labels, although the patients did so more slowly. Since these patients were able to identify and name these items correctly, their deficits in recall were not due to inattention or anomia. Panel A shows free and total recall by 10 normal subjects (8 women and 2 men) ranging in age from 53 to 73 years with a mean of 61.2 years (SD= 6.4). All items were available in storage on Trial 1, as shown by total recall of all 12 items. Any items not recovered by free recall were retrieved by cued recall. Because all items


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were recalled on each trial from the beginning, there were no more presentations after the initial search procedure. Free and cued recall alone were sufficient for normal free-recall learning, shown by the rapid increase of free recall over trials (Thompson, Wenger, & Bartling, 1978). Free recall on Trial 1 ranged from 7 to 11 items with a mean of 9.0 (SD = 1.7). Five subjects retrieved all 12 items in free recall by Trial 5. Thus all 12 items were available for recall on the first trial, and free recall learning increased rapidly without additional presentations. Such learning by an individual is illustrated in Panel B by the free and total recall of an additional normal 72-year-old man whose free recall increased to recall of all 12 by Trial 4. Panels C through F show total recall and free recall by four patients with early Alzheimer’s disease (AD) or senile dementia of the Alzheimer’s type (SDAT). They are patients of Drs. Robert Katzman and Leon Thal, with minimal dementia shown by less than 12 errors on the mental status test of Blessed, Tomlinson, and Roth (1968). While AD and SDAT are diagnoses which can only be confirmed neuropathologically, their diagnoses are highly probable by the usual criteria, including the exclusion of other causes of dementia. In any case, their final diagnosis is not critical for this report because, as will be seen, the findings which they illustrate are not limited to patients with AD or SDAT. The same basic findings were obtained from all four of these patients. Although free-recall learning was severely limited by comparison with that of normal subjects (Panels A and B), total recall by these patients was excellent because they were able to retrieve essentially all of the remaining items by cued recall. While it is possible that these patients might have some limitation of cued recall that is obscured by ceiling effects, it is still clear that their free recall did not bear the same relation to cued recall as in normal subjects and improved very slowly despite the availability of items shown by cued recall. It is interesting that the improvement of free recall on Trial 4 in Panel F was associated with explicit self-cuing, according to Dr. Katzman who tested this patient. Panels G through I at the bottom of Figure 1 show that these findings are not restricted to patients with AD or SDAT. Panel Gshows recall by a43-year-oldman with severe amnesia following intraoperative hypotension and hypoxia. Panel H shows recall by a 46-year-old man with severe amnesia following hemorrhage of an arterio-venous malformation of the medial dominant left temporal lobe with hydrocephalus. Both of these patients, who were tested by Dr. Richard Kovner, were highly trained professionals who are incapacitated by their amnesia but retain good cognitive function otherwise, as reported by Kovner, Mattis, and Goldmeier (1983). Panel I shows recall by a 36-year-old woman with a verbal IQ of 116 and full-scale IQ of 102 six months after severe head trauma. This patient was tested by Tania Zazula in the Comprehensive Neurotrauma Center directed by Dr. K. Tabaddor. Recatl b y these patients is similar to those of the patients with AD or SDAT. Total recall is excellent,reflecting the availability of all items shown by the addition of cued recall, but free-recall learning is severely limited. These

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findings indicate that cued recall may remain relatively intact when free recall is limited by amnesia due to various etiologies. Multitrial free recall may be needed to appreciate limitation of free recall, since some patients (such as those in Panels E and H) may retrieve as many items on the first trial of free recall as some normal subjects but show impaired free recall learning over repeated trials. Although cued recall by some patients is excellent, it should be noted that cued recall can be impaired even when processing is controlled. This is illustrated in Figure 2, which shows learning of 12 unrelated ii*ol-dsby the same 55-year-old man with Alzheimer's disease whose recall of pictures is shown in Panel D of Figure 1.

Fig. 2. Verbal learning shown by total recall (open circles) and free recall (closed circles) of 12 unrelated words by a 55-year-old man with Alzheimer's disease (same patient as shown in Panel D of Figure 1).

The words were: canoe, elm, kite, window, slippers, candle, golf, penny, teacher, scissors, chicken, tulip. Despite correct identification of all items by their category labels on searching a list of these printed words, his total recall was limited, though still greater than his free recall. The increase of his total recall was due mainly to

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increasing cued recall, illustrating how the addition of cued recall can reveal learning not shown by free recall alone. The better cued recall of pictures than words illustrated by this patient may be due to several factors, including presentation by the pictures of information about an item that must be retrieved from semantic memory when only the name is presented, retrieval of the names by the patient, and the opportunity for encoding visual as well as semantic information when items are represented as pictures (Klatzky, 1982). Better recall of pictures suggests that it may be preferable to use pictures for testing patients to obtain maximal estimates of their learning and memory.

DISCUSSION The addition of cued recall reveals learning and memory that is not shown by free recall alone. Use of the search procedure to control processing of items and their cues during learning induces encoding of information about target items sufficient for effectivecued recall by at least some patients with apparent memory disorders. The finding of essentially normal cued recall by some patients when processing is controlled suggests that their capacity for encoding, retention, and retrieval may still be relatively intact. Apparent limitations of their learning and memory in other circumstances when processing is not controlled may result from inattention or ineffective processing which can be ameliorated by effective control of processing (Belmont & Butterfield, 1977). Free recall by the normal subjects increased rapidly, showing that effectivefreerecall learning is possible under these conditions. Free recall by these patients was limited, increasing slowly or not at all, even though the search procedure showed that these patients processed each item semantically and could name each item. This limitation of free recall could be due to ineffective encoding, lack of effective self-generated cues, or both. Although the finding that these patients could retrieve by cued recall items that were not retrieved by free recall indicates that at least some retrievalspecific information about such items was encoded and suggests that free-recall failure was due to ineffective self-cuing, it is possible that encoding by these patients was not sufficient for free recall through other selfgenerated cues. This would not be surprising, since the search procedure used here focused attention only on certain features of the target items related to specific cues. Tulving and Bower (1974) point out that memory tritces are determined not only by the elements of the to-be-remembered event but also by the context and by processing of the “elements-incontext” (Tulving & Bower, 1974, p. 269). Limited free recall by. these patients might reflect insufficient processing for free recall, which probably requires encoding of additional information relating the items to each other so that they can be retrieved together (Tulving, 1968). Although successful cued recall shows that encoding is sufficient for cued recall by a specific cue, additional testing with multiple cues would be needed to determine whether

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patients have encoded as much of the same kinds of information as normal subjects (Tulving & Bower, 1974; Tulving & Watkins, 1975; Watkins, 1979). The potential value of cued recall for neuropsychological evaluation and investigation of learning and memory is generally appreciated, but its usefulness seems to have been limited by difficulty achieving the control of processing during learning that is needed for effective cuing at recall. This difficulty may account for the limited effectiveness of cued recall by normal control subjects as well as patients in some studies. The search procedure used here provides sufficient control of processing during learning for effective cued recall by some patients as well as by control subjects. When prmessing is controlled during learning, cuLd recall can be useful for neuropsychdogical evaluation of residual learning and memory ability (Parkin, 1982).

REFERENCES Battig, W. F., & Montague, W. E. (1969). Categorical norms for verbal items in 56 categories. Jouinalof Experimental Psycholog): 80, 146. Belmont, J. M., & Butterfield, E. C. (1977). The instructional approach to cognitive research. In R. V. Kail & J. V. Hagen (Eds.), Perspectives on the development of rtternuq. aiidcognitioii (pp. 437-481). Hillsdale, N.J.: Lawrence Erlbaum Associates. Blessed, G., Tomlinson, B. E., & Roth, M. (1968). The association between quantitative measures of dementia and of senile changes in the cerebral gray matter of elderly subjects. British Journal of Ps).cliiatr)., 114, 797-8 11. Buschke, H. (1973). Selective reminding for analysis of memory and learning. Journal of Verbal Leprning and Verbal Behavior. 12, 543-550. Cermak, L. S. (1980). Memory as a processing continuum. In L. W. Poon, J. 1.. Fozard, L. S. Cermak, D. Arenberg, & L. Thompson (Eds.), Neii. directions iiz nieniorj*aridaging (pp. 261-278). Hillsdale, N.J.: Lawrence Erlbaum Associates. Craik, F. I. M., & Lockhart, R. S. (1972). Levels of processing; A framework for memory research. Journal of Verbal Leartiing and Verbal Behavior, 11. 671-684. Fisher, R. P., & Craik, F. I. M. (1977). The interaction between encoding and retrieval operations in cued recall. Journal of Esperiniental Psychologj-: Human Learning and Meniorj-,3, 70 1-71 1. Klatzky, R. L. (1982). Huriiari rireniory. San Francisco: W. H. Freeman & Co. Kovner, R., Mattis, S., & Goldmeier, E. (1983). A technique for promoting robust free recall in chronic organic amnesia. Journal of Clinical hleuropsj~ctiolog):5. 65-7 1. Parkin, A. J. (1982). Residual learning capability in organic amnesia. Corter, 18. 417-440. Snodgrass, J. G., & Vanderwart, M. (1980). A standardized set of 260 pictures: Norms for name agreement, image agreement, familiarity, and visual complexity. Jouriial qf E.~peririientalPsjrhologj:. Huriiari Learning arid Menior:1~,6, 174-215. Thompson, C. P., Wenger, S. K., & Bartling, C. A. (1978). How recall facilitates subsequent recall: A reappraisal. Journal of E.xperiiireiiralPsj,c/iologj,:Hunian Learning and Menioi:~,, 4.210-221. Thompson, D. M., & Tulving, E. (1970). Associative encoding and retrieval: Weak and Psjdiologj: 86. 255-262. - strong cues. Jouriial of E.~perii~iental 1 ulving, E. (1968). Theoretical issues in free recall. In T. R. Dixon & D. L. Horton (Eds.), Vei,hal behavior arid general behavior. t/ieor:i. (pp. 2-36). Englewood Cliffs, N.J.: Prentice-Hall.

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Tulving, E., & Bower, G. H. (1974). The logic of memory representations. In G. H.Bower (Ed.), The psychology oflearning and motivation. Vol. 8 (pp. 265-301). New York: Academic Press. Tulving, E., & Osier, S. (1968). Effectiveness of retrieval cues in memory for words. Journal of Experimental Psychology, 77.593-601. Tulving, E., & Pearlstone, Z. (1966). Availability versus accessibility of information in memory for words. Journal of Verbal Learning and Verhi Behavior, 5, 38 1-391. Tulving, E., & Thompson, E. M. (1973). Encoding specificity and retrieval processes in episodic memory. Psychological Review, 80, 352-373. Tulving, E., & Watkins, M. J. (1975). Structure ofmemory traces. PsychologicalReview, 82, 26 1-275. Watkins, M. J. (1979). Engrams as cuegrams and forgetting as cue overload: A cueing approach to the structure of memory. In C. R. Puff (Ed.), Memory organization andstructure (pp. 347-372). New York:Academic Press.