Alzheimer's disease and memory-monitoring impairment: Alzheimer's patients show a monitoring deficit that is greater than their accuracy deficit

Department of Psychology, P.O. Box 400400, 102 Gilmer Hall, University of Virginia, Charlottesville, VA 22904-4400, USA.
Neuropsychologia (Impact Factor: 3.3). 05/2011; 49(9):2609-18. DOI: 10.1016/j.neuropsychologia.2011.05.008
Source: PubMed


We assessed the ability of two groups of patients with mild Alzheimer's disease (AD) and two groups of older adults to monitor the likely accuracy of recognition judgments and source identification judgments about who spoke something earlier. Alzheimer's patients showed worse performance on both memory judgments and were less able to monitor with confidence ratings the likely accuracy of both kinds of memory judgments, as compared to a group of older adults who experienced the identical study and test conditions. Critically, however, when memory performance was made comparable between the AD patients and the older adults (e.g., by giving AD patients extra exposures to the study materials), AD patients were still greatly impaired at monitoring the likely accuracy of their recognition and source judgments. This result indicates that the monitoring impairment in AD patients is actually worse than their memory impairment, as otherwise there would have been no differences between the two groups in monitoring performance when there were no differences in accuracy. We discuss the brain correlates of this memory-monitoring deficit and also propose a Remembrance-Evaluation model of memory-monitoring.

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    • "It is also notable that retrospective confidence ratings were similarly impaired in bvFTD and AD. This is consistent with prior findings from our group and others indicating that bvFTD and AD patients are impaired in retrospectively evaluating their performance (Banks & Weintraub, 2008; Dodson et al., 2011; Eslinger et al., 2005; Williamson et al., 2010), as well as studies indicating that retrospective confidence ratings, in contrast to feeling of knowing judgments, are closely associated with memory abilities and thus may be dependent on different brain structures than feeling of knowing (Modirrousta & Fellows, 2008; Shimamura & Squire, 1988). "
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    • "The first measure was the Somer's d correlation (symmetrical), which represents the extent that a participant's confidence judgments differentiated accurate from inaccurate 2AFC test trials (maximum accuracy¼ 1). Much like the Goodman–Kruskal gamma correlation often used in metamemory research (Gonzalez & Nelsons, 1996), this correlation is recommended for ordinal-scaled variables and we report it here because it was the measure used in Dodson et al. (2011). (Note that we found similar results using the gamma correlation). "
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    ABSTRACT: Alzheimer's disease (AD) can impair metacognition in addition to more basic cognitive functions like memory. However, while global metacognitive inaccuracies are well documented (i.e., low deficit awareness, or anosognosia), the evidence is mixed regarding the effects of AD on local or task-based metacognitive judgments. Here we investigated local metacognition with respect to the confidence-accuracy relationship in episodic memory (i.e., metamemory). AD and control participants studied pictures of common objects and their verbal labels, and then took forced-choice picture recollection tests using the verbal labels as retrieval cues. We found that item-based confidence judgments discriminated between accurate and inaccurate recollection responses in both groups, implicating relatively spared metamemory in AD. By contrast, there was evidence for global metacognitive deficiencies, as AD participants underestimated the severity of their everyday problems compared to an informant's assessment. Within the AD group, individual differences in global metacognition were related to recollection accuracy, and global metacognition for everyday memory problems was related to task-based metacognitive accuracy. These findings suggest that AD can spare the confidence-accuracy relationship in recollection tasks, and that global and local metacognition measures tap overlapping neuropsychological processes.
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    • "A possible concern using ROC methodology in patients with aMCI may be the ability of these patients to assess confidence for memory decisions. However, research investigating the ability to retrieve and monitor stored general knowledge in patients with aMCI and very mild AD has shown that these patients can successfully make confidence ratings regarding the certainty of their answers (Ally et al., 2009b; Dodson et al., 2011). "
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    ABSTRACT: Understanding how memory breaks down in the earliest stages of Alzheimer's disease (AD) process has significant implications, both clinically and with respect to intervention development. Previous work has highlighted a robust picture superiority effect in patients with amnestic mild cognitive impairment (aMCI). However, it remains unclear as to how pictures improve memory compared to words in this patient population. In the current study, we utilized receiver operating characteristic (ROC) curves to obtain estimates of familiarity and recollection for pictures and words in patients with aMCI and healthy older controls. Analysis of accuracy shows that even when performance is matched between pictures and words in the healthy control group, patients with aMCI continue to show a significant picture superiority effect. The results of the ROC analysis showed that patients demonstrated significantly impaired recollection and familiarity for words compared controls. In contrast, patients with aMCI demonstrated impaired recollection, but intact familiarity for pictures, compared to controls. Based on previous work from our lab, we speculate that patients can utilize the rich conceptual information provided by pictures to enhance familiarity, and perceptual information may allow for post-retrieval monitoring or verification of the enhanced sense of familiarity. Alternatively, the combination of enhanced conceptual and perceptual fluency of the test item might drive a stronger or more robust sense of familiarity that can be accurately attributed to a studied item.
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