Learning and generalization deficits in patients with memory impairments due to anterior communicating artery aneurysm rupture or hypoxic brain injury.

Human anterograde amnesia can result from a variety of etiologies, including hypoxic brain injury and anterior communicating artery (ACoA) aneurysm rupture. Although each etiology can cause a similarly severe disruption in declarative memory for verbal and visual material, there may be differences in incrementally acquired, feedback-based learning, as well as generalization. Here, 6 individuals who survived hypoxic brain injury, 7 individuals who survived ACoA aneurysm rupture, and 13 matched controls were tested on 2 tasks that included a feedback-based learning phase followed by a transfer phase in which familiar information is presented in new ways. In both tasks, the ACoA group was slow on initial learning, but those patients who completed the learning phase went on to transfer as well as controls. In the hypoxic group, 1 patient failed to complete either task; the remaining hypoxic group did not differ from controls during learning of either task, but was impaired on transfer. These results highlight a difference in feedback-based learning in 2 amnesic etiologies, despite similar levels of declarative memory impairment.

Neurocognitive performance in unmedicated patients with hoarding disorder.

OBJECTIVE: Hoarding disorder (HD) is an often incapacitating psychiatric illness associated with a wide range of neurocognitive abnormalities. Some prior neuropsychological studies have found executive dysfunction in HD, but no clear pattern has emerged. One potential reason for discrepant results in previous studies might be the inclusion of patients on psychotropic and other medications that can affect neurocognitive performance. Therefore, we examined neurocognitive functioning in medication-free HD patients. We also added a novel investigation of implicit learning, which has been found to be abnormal in obsessive-compulsive disorder (OCD) and related disorders. METHOD: Twenty-six participants meeting the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013) diagnostic criteria for HD and 23 normal controls were administered a battery of neuropsychological tests and symptom rating scales. All participants were free of psychotropic medications for at least 6 weeks prior to the study. RESULTS: HD participants showed no significant differences from normal controls on measures of verbal memory, attention, or executive functioning, including response inhibition, planning, organization, and decision making. However, HD participants demonstrated a trend toward less implicit learning and greater use of explicit learning strategies during perceptual categorization compared to normal controls. HD participants who used an implicit strategy performed significantly worse than controls who used an implicit strategy. Hoarding symptom severity was not associated with neurocognitive performance. CONCLUSIONS: HD patients may have a tendency to use explicit rather than implicit learning strategies for perceptual categorization but perform as well as normal controls on many other neurocognitive measures. Future studies should assess unmedicated participants and examine test strategies, not just outcomes.