Brain reserve theory: Are adults with intellectual disability more vulnerable to age than peers with typical development?

BACKGROUND: Life expectancy is on rise and the intriguing question is: When does cognitive decline occur among adults with intellectual disability, compared to adults with typical development? This cross-sectional study examined cognitive performance of crystallised/fluid intelligence, working and long-term memory of adults with intellectual disability of etiologies other than Down syndrome (IQ 50-68) and adults with typical development (IQ 85-114) in four age cohorts (30-39; 40-49; 50-59; 60-69). METHOD: The WAIS IIIHEB and the Rey-AVLT were administered to both groups. RESULTS: Four patterns of cognitive performance were found: (a) Vocabulary (crystallised intelligence), Spatial Span Forward and Retention yielded similar scores across all four age cohorts in participants with typical development and with intellectual disability. (b) Similarities, Raven and Digit Span Backward exhibit lower scores only in 50-59 or 60-69 compared to the 30-39 age cohort in both groups, (c) Digit Span Forward, Spatial Span Backward and Total Leaning (LTM) yielded lower scores in the 50-59 or 60-69 age cohorts in the typical group, but similar scores in participants with intellectual disability along the age cohorts, (d) Block Design (fluid intelligence) yielded a lower score in the 50-59 cohort versus lower scores only at ages 60-69 in participants with typical development. CONCLUSIONS: Our findings suggest a possible parallel trajectory in age-related cognitive performance for individuals with and without intellectual disability in six measures, and a possible more preserved trajectory in fluid intelligence and some memory measures in adults with intellectual disability compared to their peers. Caution should be exercised regarding Digit and Spatial Span Backwards, which yielded a floor effect in participants with intellectual disability. The Cognitive Reserve Theory, the Safeguard Hypothesis and late maturation might serve as explanations for these findings.

Associative recognition memory for identity, spatial and temporal relations in healthy aging.

The ability to generate associative representations and to retrieve them from long-term episodic memory generally declines in healthy aging. However, it is unclear whether healthy aging has differential effects on associative memory for identity, spatial configuration, and temporal order relationships. In the current study, we assessed how healthy aging impacts on associative memory for identity, spatial, or temporal relationships between pairs of visual objects via discrimination of intact and rearranged pairs. Accuracy and response time performance of healthy older adults (aged 65-80) were compared with young adults (ages 19-30). Age-related declines in associative memory were observed equally for all types of associations, but these declines differed by associative status: aging most strongly affected ability to discriminate rearranged pairs. These results suggest that associative memory for identity, spatial, and temporal relationships are equally affected by healthy aging, and may all depend on a shared set of basic associative mechanisms.

The benefit of assessing implicit sequence learning in pianists with an eye-tracked serial reaction time task.

Playing piano professionally has been shown to benefit implicit motor sequence learning. The aim of the current study was to determine whether this advantage reflects generally enhanced implicit sequence learning unrelated to pianists' higher motor and/or visual-motor coordination abilities. We examined implicit sequence learning using the ocular serial reaction time (O-SRT) task, a manual-free eye-tracked version of the standard SRT, in 29 pianists and 31 controls. Reaction times (RT) and correct anticipations (CA) of several phases describing implicit sequence learning were analyzed. Furthermore, explicit sequence knowledge was compared between the groups, and relationships between implicit sequence learning with explicit sequence knowledge or demographic measures were evaluated. Pianists demonstrated superiority in all critical phases of implicit sequence learning (RT and CA). Moreover, pianists acquired higher explicit sequence knowledge, and only in pianists was explicit sequence knowledge related to implicit sequence learning. Our results demonstrate that pianists' superiority in implicit sequence learning is due to a higher general implicit sequence learning ability. Hence, we can exclude that higher motor and/or visual-motor coordination abilities are related to pianists' higher implicit sequence learning. Furthermore, the significant relationship of implicit sequence learning and explicit sequence knowledge suggests that pianists either used explicit strategies to support implicit sequence learning, had better explicit access to sequence knowledge, or both.

Day versus night consolidation of implicit sequence learning using manual and oculomotor activation versions of the serial reaction time task: reaction time and anticipation measures.

This study presents two experiments that explored consolidation of implicit sequence learning based on two dependent variables-reaction time (RT) and correct anticipations to clarify the role of sleep, and whether the manual component is necessary for consolidation processes. Experiment 1 (n = 37) explored the performance of adults using an ocular variant of the serial reaction time task (O-SRT) with manual activation (MA), and Experiment 2 (n = 37) used the ocular activation (OA) version of the task. Each experiment consisted of a Day and a Night group that performed two sessions of the O-SRT with an intervening 12-h offline period (morning/evening in Day group, evening/following morning in Night group). Night offline had an advantage only when manual response was required and when correct anticipations (i.e., accuracy) but not RT (i.e., speed) were measured. We associated this finding with the dual-learning processes required in the MA O-SRT that led to increased sequence specific learning overnight. When using the OA O-SRT, both groups demonstrated similar rates after offline in RT and correct anticipations. We interpreted this finding to reflect stabilization, which confirmed our hypothesis. As expected, all the groups demonstrated reduced performance when another sequence was introduced, thus reflecting sequence-specific learning. This study used a powerful procedure that allows measurement of implicit sequence learning in several ways: by evaluating two different measures (RT, correct anticipations) and by isolating different aspects of the task (i.e., with/without the manual learning component, more/less general skill learning), which are known to affect learning and consolidation.

Life span strategy implementation in verbal learning: size and type of cluster adoption.

Temporal and semantic associative processes during the acquisition of new verbal information undergo various changes across the life span. Temporal order clusters and subjective clusters were monitored during verbal learning trials using the Rey (Auditory Verbal Learning Task) for 1471 participants aged 8-91. Pairs, three-word, and four-word clusters were measured. Subjective clusters were generated at similar frequency across the whole life span. By contrast, a clear inverted-U curve across life span was indicated for temporal clusters. More words were subjectively clustered than clustered by temporal presentation order. The number of words clustered increased across trials, and cluster types showed a different increase profile across trials. The subjective cluster increment was faster and steeper than the temporal cluster increment in most of the age segments. Life span trajectory tendencies in the formation of temporal and semantic associations in recall were interpreted in relation to different frameworks of cognitive life span changes.

The adapted symbol digit modalities test: Examining the impact of response modality.

BACKGROUND: Information processing speed is often impaired in neurological disorders, as well as with healthy aging. Thus, being able to accurately assess information processing speed is of high importance. One of the most commonly used tests to examine information processing speed is the Symbol Digit Modalities Test (SDMT), which has been shown to have good psychometric properties. OBJECTIVES: The current study aims to examine differences between two response modalities, written and oral, on the performance of an adapted version of the Symbol Digit Modalities Test. METHODS: Ninety-nine individuals completed two alternate forms of the adapted version of the SDMT (aSDMT). Participants were instructed to complete the five lines of the task as quickly and accurately as possible. On one form participants were instructed to provide their response in writing and on the other one, orally. Form and response modality (oral vs. written) were counterbalanced to control for practice effects. RESULTS: On average, there was a significant difference between response modalities, such that participants needed more time to respond when the response modality was written. For both response modalities, time to complete each line of stimuli decreased as the task progressed. While changes in response time on the first four lines of stimuli on the oral version were not found, there was a substantial improvement in response time on the fifth line. In contrast, on the written version a gradual learning effect was observed, in which response time was the slowest on the first two lines, an intermediate response time was noted on line 3, and the fastest response time was achieved on lines four and five. CONCLUSION: The current study demonstrates that response modality, oral versus written, can significantly impact performance efficiency (the length of time it takes to complete a task), but not accuracy (total correct responses), on a new adaptation of the SDMT, the aSDMT.

The effectiveness of memory remediation strategies after traumatic brain injury: Systematic review and meta-analysis.

BACKGROUND: Traumatic brain injury (TBI) is a steadily rising health concern associated with significant risk of emotional, behavioral and cognitive impairments. Cognitive memory impairment is one of the most concerning outcomes after TBI, affecting a wide range of everyday activities, social interactions and employment. Several comparative and comprehensive reviews on the effects of cognitive interventions in individuals with TBI have been conducted but usually with a qualitative rather than quantitative approach. Thus, evidence synthesis of the effects of TBI interventions on memory difficulties is limited. OBJECTIVE: In this meta-analysis, we examined the memory-remediating effects of internal and external interventions, injury severity and the interaction of both factors for patients with TBI. METHODS: Data were extracted from studies published between 1980 and 2020 that used objective memory measures (computerized or pencil-and-paper), and multiple meta-analyses were conducted to compare effectiveness across these interventions. Publication bias was assessed, as was quality of evidence using the Cochrane Risk of Bias tool for randomized controlled studies. Our final meta-analysis included 16 studies of 17 interventions classified into 3 categories: internal, external and mixed. RESULTS: Mixed interventions demonstrated the highest average effect size for memory difficulties (Morris d=0.79). An evaluation of injury severity yielded 2 categories: mild-moderate and moderate-severe. Analyses demonstrated a homogenous medium effect size of improvement across injury severity, with moderate-severe injury with the largest average effect size (Morris d=0.65). Further evaluation of injury severity interaction with intervention type revealed a mediating effect for both factors, demonstrating the largest effect size for mixed interventions with moderate-severe injury (Morris d=0.81). CONCLUSION: This study highlights the effectiveness of memory remediation interventions on memory impairment after TBI. A wide range of interventions are more effective because they address individual variability for severity and memory deficits. The study further supports and expands existing intervention standards and guidelines.

Oculomotor anticipation reveals a multitude of learning processes underlying the serial reaction time task.

Sequence learning is the cognitive faculty enabling everyday skill acquisition. In the lab, it is typically measured in speed of response to sequential stimuli, whereby faster responses are taken to indicate improved anticipation. However, response speed is an indirect measure of anticipation, that can provide only limited information on underlying processes. As a result, little is known about what is learned during sequence learning, and how that unfolds over time. In this work, eye movements that occurred before targets appeared on screen in an ocular serial reaction time (O-SRT) task provided an online indication of where participants anticipated upcoming targets. When analyzed in the context of the stimuli preceding them, oculomotor anticipations revealed several simultaneous learning processes. These processes influenced each other, as learning the task grammar facilitated acquisition of the target sequence. However, they were dissociable, as the grammar was similarly learned whether a repeating sequence inhabited the task or not. Individual differences were found in how the different learning processes progressed, allowing for similar performance to be produced for different latent reasons. This study provides new insights into the processes subserving sequence learning, and a new method for high-resolution study of it.

New insights in implicit sequence learning of adults with traumatic brain injury: As measured by an ocular serial reaction time (O-SRT) task.

Objective: We investigated the effect of traumatic brain injury (TBI) on implicit sequence learning (ISL) and its relation with demographic, clinical, and working memory (WM) capacity using an eye-tracked variant of the standard serial reaction time (RT; SRT) task. Besides RT, this ocular SRT (O-SRT) task enables generation of correct anticipations (CA) and stucks, reflecting other critical aspects of ISL. Method: ISL was tested in 26 individuals with TBI and 28 healthy controls using the O-SRT task. Mixed analyses of variance were conducted to analyze RT and CA in three phases: learning, interference, and recovery from interference. The average number of stucks was compared with an independent-samples t test. Finally, Pearson correlation analyses of ISL with demographic, clinical, and WM capacity measures were performed. Results: Based on RT, ISL was impaired in the TBI group. However, CA demonstrated improved learning, but with deficits in the interference and recovery from interference phases. Stucks were more frequent in the TBI group, which affected RT and CA measures. Neither demographic nor clinical factors were associated with ISL. Verbal, but not spatial, WM capacity was impaired in the TBI group, and spatial WM capacity positively correlated with ISL in controls only. Conclusion: We suggest that the high TBI group stuck rate can be attributed to lack of initiative and/or conservative response bias associated with TBI, and view it as a main cause leading to deficits in ISL. Unlike controls, the TBI group could not muster their relatively preserved spatial WM capacity to support their ISL performance. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Implicit sequence learning in individuals with Parkinson's disease: The added value of using an ocular version of the serial reaction time (O-SRT) task.

INTRODUCTION: Though the majority of studies reported impaired sequence learning in individuals with Parkinson's disease (PD) tested with the Serial Reaction Time (SRT) task, findings are inconclusive. To elucidate this point, we used an eye tracker in an ocular SRT task version (O-SRT) that in addition to RT, enables extraction of two measures reflecting different cognitive processes, namely, Correct Anticipation (CA) and number of Stucks. METHODS: Individuals with PD (n = 29) and matched controls (n = 31) were tested with the O-SRT task, consisting of a repeated sequence of six blocks, then a block with an interference sequence followed by an original sequence block. RESULTS: Unlike controls, patients with PD did not improve in CA rate across learning trials, did not show an increase in RT when presented with the interference sequence, and showed a significantly higher rate of Stucks. CONCLUSIONS: Low CA rate and high Stucks rate emerge as the cardinal deficits leading to impaired sequence learning following PD. These are viewed as reflecting difficulty in exploration for an efficient learning strategy. This study highlights the advantage in using the O-SRT task, which enables the generation of several informative measures of learning, allowing better characterization of the PD effect on sequence learning.

How sequence learning unfolds: Insights from anticipatory eye movements.

The acquisition of sequential knowledge is pivotal in forming skilled behavior. Despite extensive research of sequence learning, much remains unknown regarding what knowledge participants learn in such studies, and how that knowledge takes form over time. By tracking eye-movements made before stimuli appear on screen during a serial reaction time (SRT) task, we devised a method for assessing learning at the individual participant level in an item-based resolution. Our method enables uncovering what participants actually learn about the sequence presented to them, and when. Results demonstrate that learning is more heterogeneous than previously thought, driven by learning both of chunks and of statistics embedded in the sequence. Also, learning develops rapidly, but in a fragmented and non-sequential manner, eventually encompassing only a subset of available regularities. The tools developed in this work may aid in further dissociating processes and mechanisms underlying sequence learning and its impairments, in normal and in clinical populations.

Examining implicit procedural learning in tetraplegia using an oculomotor serial reaction time task.

BACKGROUND AND OBJECTIVE: Clinical observations indicate that implicit procedural learning, a central component of physical and psychosocial rehabilitation, is impeded following spinal cord injury. In accordance, previous research has revealed a specific deficit in implicit sequence learning among individuals with paraplegia using a standard, manual version of the serial reaction time task. To extend these findings and shed light on the underlying sources of potential spinal cord injury-related deficits in sequence learning, we used an ocular activated serial reaction time task to compare sequence learning performance between individuals with tetraplegia and healthy controls. PARTICIPANTS AND MEASURES: Twelve participants with spinal cord injury in C5-T1 were compared to 12 matched control participants on measures derived from an ocular activated serial reaction time task. Depression and additional cognitive measures were assessed to explore the source and specificity of potential sequence learning deficits. RESULTS: Like controls, and in contrast with previous findings in paraplegia, the spinal cord injury group showed intact implicit sequence learning, evidenced by declining reaction times and improved anticipation over the first six blocks of the serial reaction time task, and an advantage for the initial learning sequence over a novel interference sequence. CONCLUSIONS: The ocular activated serial reaction time task elicited a performance pattern similar to standard motor versions, such that participants with tetraplegia demonstrated unimpaired sequence learning. This suggests that previously reported implicit sequence learning deficits in spinal cord injury directly involved motor functioning rather than cognitive aspects of the task, and that the ocular activated sequence learning task could be a valid alternative for assessing implicit sequence learning in populations that cannot perform spinal-cord dependent motor tasks. Implications for post-spinal cord injury rehabilitation and adjustment are discussed.

Selective Procedural Memory Impairment but Preserved Declarative Memory in Spinocerebellar Ataxia Type 3.

Spinocerebellar ataxia type 3 (SCA3), also known as Machado-Joseph disease, is an autosomal dominant neurodegenerative disorder that affects mainly the cerebellum and less other brain areas. While the ataxic/motor features of the disease have been well described, the cognitive consequences of the degeneration require additional testing. The aim of this study was to evaluate learning abilities in SCA3. We tested 13 SCA3 patients and 14 age-matched healthy controls, all of Yemenite origin, on a neuropsychological battery of procedural and declarative memory tests. SCA3 patients demonstrated impaired sequence learning on the procedural Serial Reaction Time test (SRTt) but normal learning on the procedural Weather Prediction Probabilistic Classification test (WPPCt). SCA3 patients showed normal learning on the declarative Rey Auditory Verbal Learning test (Rey-AVLt). The correlations between the learning measures of the SRTt, WPPCt, and Rey-AVLt tests in SCA3 and controls separately were not significant. These results imply that the cerebellar degeneration in SCA3 causes selective impairment in procedural sequence learning while the procedural probabilistic learning and declarative memory were mostly preserved. These findings support the assumption that procedural learning is not a homogeneous function and could be dissociated in cerebellar neurodegenerative disease.

Medical Help-Seekers with Anxiety from Deterioration in Memory are Characterized with Risk Factors for Cognitive Decline.

Objectives: Anxiety and subjective memory complaints (SMC) are major risk factors for Mild Cognitive Impairment (MCI) and dementia. However, the association between anxiety, SMC and medical help-seeking due to complaints is not clear. Here, we assessed anxiety which rose specifically by memory examination and compared it between help-seekers in memory clinics (HS) and non-help seekers (NHS).Methods: Twenty HS (60% female) were recruited from a memory Clinic, and 55 NHS (63% female) were recruited from the community. Participants (aged 59-82) completed objective memory assessment, Subjective Memory questionnaire, depression questionnaire and State-Trait Anxiety questionnaire. State-anxiety was assessed immediately following memory testing (indicating anxiety triggered by testing memory). For statistical evaluation, we used non-parametric tests.Results: HS participants reported significantly higher levels of state-anxiety and had more SMC compared to the NHS. No differences in objective memory tests and trait-anxiety were found.Conclusions: People who are seeking help in memory clinics (even those who do not meet any criteria for memory decline) are liable to be at high risk for MCI and dementia.Clinical Implications: We recommend that HS with SMC should be treated as a high-risk group, even if they do not show objective memory deficits.

Traumatic brain injury hinders learning of road hazard awareness by repeated exposure to video-based hazards.

OBJECTIVE: To better understand hazard awareness abilities among traumatic brain injury (TBI) survivors of which little is currently known. TBI survivors express degradation in driving abilities, particularly the proactive strategy in which indicators of potentially hazardous situations are sought and identified. The current study examined differences in hazard awareness learning between TBI survivors and noninjured control individuals matched for age and driving experience. METHOD: Forty individuals equally divided among the 2 groups were assessed by exposure to repetitive video-based hazard scenarios, which have been shown to improve hazard awareness in noninjured individuals. Differences in participants' eye movements and behavioral response while watching video clips of genuine traffic scenes were recorded. RESULTS: Although survivors of TBI demonstrated relatively intact hazard awareness abilities under baseline conditions, they failed to learn from repetitive presentation of the same hazardous situation (i.e., they did not improve hazard detection) and thus failed to adjust their scanning and behavioral reaction (e.g., time to reaction, adapt of scanning behavior). Differences were more prominent for hidden hazards. Our results show impoverished anticipation abilities in driving simulation tasks performed in the subacute recovery phase after TBI and that differences in materialized hazards awareness are distinguishable between TBI survivors and noninjured drivers of similar age and driving experience. CONCLUSIONS: Our findings signal the need for further research to clarify the relationship between TBI and hazard awareness training that might be supportive of driving rehabilitation after TBI. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Effect of eye movement reactivation on visual memory among individuals with moderate-to-severe traumatic brain injury (TBI).

Objective: Previous research has shown that when individuals are asked questions referring to previously seen visual stimuli, their eye movements spontaneously return to the visual area where the stimuli were first seen. This recurring eye movement phenomenon has been shown to assist the memory retrieval of visual images. Individuals with moderate-to-severe traumatic brain injury (TBI) typically suffer from visual memory deficits as well as difficulty in spontaneously initiating mnemonic strategies. Perhaps TBI patients have trouble employing the eye movement reactivation strategy, thus further contributing to the visual memory deficits so prevalent among this population.Method: In this study, 27 healthy individuals and 27 patients with moderate-to-severe TBI from the Lowenstein Rehabilitation Hospital participated in a memory task. Participants were first exposed to stimuli and were then asked questions about the displayed stimuli. The testing session was conducted for each participant under two conditions: (1) while eyes were free to move over the screen; (2) while eyes were fixated.Results: Study findings show that the control group significantly benefitted from the free viewing in comparison to the fixed viewing condition, while this effect was absent among the TBI group. This was corroborated by eye tracking data showing that participants with TBI showed a minimal tendency to reactivate eye movements effectively, as occurs among the healthy group.Conclusions: The research findings expand our comprehension of visual memory among the TBI population, presenting rehabilitation health clinicians with new directions in understanding visual memory deficits.

The Effects of Moderate-to-Severe Traumatic Brain Injury on Episodic Memory: a Meta-Analysis.

Memory impairment following Traumatic Brain Injury (TBI) is among its most pronounced effects. The present meta-analysis focused only on studies of episodic memory (n = 73) conducted with adult patients with moderate-to-severe TBI. The results indicate that verbal Memory, and more specifically Verbal Recall, is most sensitive to the effects of moderate-to-severe TBI. Furthermore, verbal more than visual memory and recall more than recognition are sensitive to the effects of TBI. These effects are more pronounced in delayed than in immediate testing. Several moderating factors were found: age at testing - the younger the age, the greater the effect size of verbal recall. A greater effect size of delayed story recall was related to an older age of testing and longer time since the injury. The higher the educational level, the smaller is the effect size of visual recall. The clinical implications are discussed.

Direct and indirect measures of context in patients with mild-to-severe traumatic brain injury (TBI): The additive contribution of eye tracking.

Introduction: The facilitation of memory for target stimuli due to the similarity of context in the learning and testing phases is known as the "Context-Effect" (CE). Previous studies reported that TBI affects memory for contextual information when tested directly. However, the indirect effect of contextual information on memory of target (i.e., CE) is preserved. Several studies have demonstrated that CE is composed of multiple, distinct cognitive processes. The present study includes four context conditions to enable identification of the exact process affected by TBI. In addition, eye movements were monitored to test three hypotheses: first, that the TBI group's dwell time on target (DTOT) at encoding would be less than that of controls. Second, that DTOT at encoding would be more highly associated with recognition at test for the control group than for the TBI group. Third, that overall DTOT at encoding on new, as compared to old items ("repetition effect"), would be less pronounced for the TBI group as compared to controls. Methods: Twenty-four patients with mild-to-severe TBI and 23 matched controls participated in this study. We presented participants with photographs of male faces shown wearing distinctive, trial-unique hats (yielding specific Target-Context pairing). Eye movements were recorded throughout the test task. Results: Memory for faces following TBI is impaired compared to that of controls. The magnitude and pattern of CE are the same for both groups. The TBI group has a lower DTOT compared to that of controls. However, the relative length of DTOT in the various conditions is similar in both groups. Conclusions: Behavioral results indicate that although the TBI group has impaired memory for faces, the CE pattern is similar to that of controls. Similarly, in terms of eye movements, although the TBI group focuses less on target, relations between the various conditions are similar in both groups.

Cognitive Reserve Protects Against Memory Decrements Associated With Neuropathology in Traumatic Brain Injury.

OBJECTIVE: To evaluate whether cognitive reserve (CR) moderates the relationship between neuropathology and cognitive outcomes after traumatic brain injury (TBI). SETTING: Outpatient research organization. PARTICIPANTS: Patients with complicated mild (n = 8), moderate (n = 9), and severe (n = 44) TBI. DESIGN: Prospective, cross-sectional study. MAIN MEASURES: Cognitive reserve was estimated using a test of word reading (Wechsler Test of Adult Reading). Diffusion tensor imaging (functional anisotropy) was used to quantify neuropathology. Neuropsychological test scores were submitted to principal components analyses to create cognitive composites for memory, attention, executive function, and processing speed domains. RESULTS: At lower levels of neuropathology, people with higher CR exhibited better memory than those with lower CR. This benefit diminished as neuropathology increased and disappeared at the highest levels of neuropathology. Cognitive reserve ceased exerting a protective effect at premorbid intelligence levels below average. CONCLUSION: Cognitive reserve may differentially protect some cognitive domains against neuropathology relative to others. A clinical cutoff below which CR is no longer protective, together with a possible neuropathology ceiling effect, may be instructive for prognostication and clinical decision-making in cognitive rehabilitation.

Conceptual processes involved in words and scenes context effect in face recognition.

Several studies have established the impact of conceptually similar context on the emergence of "Context-Effect" (CE). None of these studies included the Re-pair/rearrange condition at the test, which prevented them from being conclusive about the exact process (binding/ensemble or familiarity) that was affected by the conceptually similar context. To this end, in the present study faces (target to be remembered) were presented in the context of either words (W) or picture (P) scenes, and at test Re-pair was added as one of the context conditions. At test two groups were presented with the same context as in study (consistent condition) (WW & PP), and two groups with the inconsistent condition (WP & PW). Results showed no familiarity effect when only the conceptual match was preserved (i.e., inconsistent condition) and both effects of binding and familiarity when both conceptual and perceptual match were present (i.e., consistent condition). Thus, the semantic association between a face and context could serve as recognition cues even when modality has been changed, but the label remained constant.