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Alcoholic Korsakoff's Syndrome. An Information-Processing Approach to Amnesia PDF

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Alcoholic Korsakoff's Syndrome AN INFORMATION-PROCESSING APPROACH TO AMNESIA Nelson Butters Ί Laird S. Cermak Psychology Service Veterans Administration Medical Center and Neurology Department Boston University School of Medicine Boston, Massachusetts 1980 ACADEMIC PRESS A Subsidiary of Har court Brace Jovanovich, Publishers New York London Toronto Sydney San Francisco COPYRIGHT © 1980, BY ACADEMIC PRESS, INC. ALL RIGHTS RESERVED. NO PART OF THIS PUBLICATION MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM OR BY ANY MEANS, ELECTRONIC OR MECHANICAL, INCLUDING PHOTOCOPY, RECORDING, OR ANY INFORMATION STORAGE AND RETRIEVAL SYSTEM, WITHOUT PERMISSION IN WRITING FROM THE PUBLISHER. ACADEMIC PRESS, INC. Ill Fifth Avenue, New York, New York 10003 United Kingdom Edition published by ACADEMIC PRESS, INC. (LONDON) LTD. 24/28 Oval Road, London NW1 7DX Library of Congress Cataloging in Publication Data Butters, Nelson. Alcoholic Korsakoff s syndrome. Includes bibliographical references and index. 1. Korsakoff s syndrome. I. Cermak, Laird S. , joint author. II. Title. [DNLM: 1. Amnesia— Etiology. 2. Korsakoff's syndrome. WM173.7 B988a) RC394.K6B8 616.85'232 79-6779 ISBN 0-12-148380-0 PRINTED IN THE UNITED STATES OF AMERICA 80 81 82 83 9 8 7 6 5 4 3 2 1 To Arlene, Meryl, Paul, and Lisa for their love and encouragement. -N.B. Dedicated with lasting love to my wife Sharon and daughter Rendra and to Shawn Brendan whose life, although brief, will remain in our thoughts forever. -L. S. C. Preface The amount of investigation of the amnesic component of Korsa- koffs syndrome has increased considerably during the past decade and a half. Stimulated primarily by Talland's (1965) Deranged Memory, Victor, Adams, and Collins's (1971) treatise on The Wernicke Korsa- koff Syndrome, and Milner's work on hippocampectomized patients, investigators from diverse areas of expertise have focused on this prob- lem in recent years. Perhaps most active in investigating this area have been the neuropsychologists. But their investigations of amnesia have not been without controversy and, indeed, several theories have emerged to explain all or parts of the syndrome. These theoretical approaches have sometimes conflicted, sometimes complemented one another. But, throughout, they have created an environment that stimulates research and draws new investigators into the field in rapidly burgeoning numbers. This has made the study of amnesia one of the most exciting areas of investigation, not only within neuro- psychology, but within psychology in general. The primary purpose of this book is to present an overview of one of these theories of amnesia, namely, the extent to which it represents an information-processing deficit. This focus is not meant to ignore other theories and interpretations. In fact, wherever possible, we have tried to show how the data emanating from other viewpoints might fit into a "processing-deficits" framework, and we have contrasted other theoretical approaches to the major theme of this book. We do not wish to imply that our theoretical position is the only stance that should be taken. Rather, this book has been written to present a more concise and comprehensive overview of the "information-processing deficits'' theory of amnesia. The joint research program we designed to assess the extent of ix PREFACE information-processing deficits in alcoholic Korsakoff patients began about 1972 when we found a large area of overlap between Butters' interest in the neuropsychology of amnesia and Cermak's interest in memory processes. Since that time we have continuously melded these two areas of interest through daily consultation and discussion. As a consequence, our present thinking, we believe, encompasses the most current theorizing within each discipline and continually seeks to in- corporate both into our overall program. That this combining of knowledge has been productive is evidenced primarily by the publi- cation of this book. Naturally, both our research program and the undertaking of the writing of this book would not have been accomplished without the support and efforts of others. We have been supported financially by the National Institute of Alcohol and Alcohol Abuse (NIAAA) through Grant No. AA00187 to Boston University School of Medicine and funds from the Medical Research Service of the Veterans Admin- istration. Numerous colleagues, collaborators, and research assistants have aided in the collection, tabulation, and interpretation of data over the years. Much of their efforts are cited throughout this text. We are particularly indebted, however, to Dr. Harold Goodglass, Di- rector of Psychology Research, for his support and supervision, to Dr. Ralph Fingar, Chief of Psychology, and to the entire Psychology Service at the Boston Veterans Administration Medical Center. Special appreciation is extended to Barbara Uhly, Kathy Montgomery, and Mary Cambell for their help in editing this book; and to Betty Norky, Nancy Hatley, Claire Sybertz, and Sharon Barry for typing various drafts of the manuscript. x Acknowledgments We are grateful to the following for permission to use the figures and tables indicated. Figure 1.1, 10.4, 10.5, and 10.6 (pp. 3, 164, 165, and 166): From Ryan, C, Butters, N., Montgomery, K., Adinolfi, B., and Didario, B., Memory deficits in chronic alcoholics: Continuities between the "in- tact" alcoholic and the alcoholic Korsakoff patient, in H. Begleiter and B. Kissin (Eds.), Alcohol intoxification and withdrawal, New York Plenum, 1979, Figures 3, 5, 6, and 7; Figures 1.2 and 1.3 (pp. 6 and 7): From Albert, M., Butters, N., and Levin, J., Temporal gradients in the retrograde amnesia of patients with alcoholic Korsakoff's syndrome, Archives of Neurology, 1979, 36, 211-216, Figures 2 and 3, Copyright 1979, American Medical Associa- tion. Figures 1.2, 1.3, 1.4, 6.7, 6.9, 8.2, 8.4, and 8.7 (pp. 6, 7, 9, 107, 108, 127, 134, and 138): From Heilman, K. M., and Valenstein, E., Clinical neuropsychology, New York, Oxford University Press, 1979, Figures 1-3, 5 and 7-11. Figures, 3.1, 4.4, 4.5, and 4.6 (pp. 35, 55, 56, and 57): From Cermak, L. S., Butters, N., and Goodglass, H., The extent of memory loss in Korsakoff patients, Neuropsychologia, 1971, 9, 307-315, Figures 1, 2, 3, and 6. Figures 3.3, 4.1, 4.2, and 4.3 (pp. 39, 51, 52, and 54): From Baddeley, A. D., and Warrington, E. K., Amnesia and the distinction between long- and short-term memory, Journal of Verbal Learning and Verbal Behavior, 1970, 9, 176-189, Figures 1, 2, and 3. Figures 3.4 and 4.7 (pp. 40 and 58): From Cermak, L. S., and But- ters, N., The role of interference and encoding in the short-term XI ACKNOWLEDGMENTS memory deficits of Korsakoff patients, Neuropsychologia, 1972, 10, 89-96, Figures 1 and 3. Figures 3.5, 3.6, and 3.7 (pp. 41 and 42): From Cermak, L. S., Naus, M. J., and Reale, L., Rehearsal strategies of alcoholic Korsakoff pa- tients, Brain and Language, 1976, 3, 375-385, Figures 1, 2, and 3. Figure 4.8 (p. 60): From DeLuca, D., Cermak, L. S., and Butters, N., The differential effects of semantic, acoustic, and nonverbal distraction on Korsakoff patients' verbal retention performance, International Journal of Neuroscience, 1976, 6, 279-284, Figure 2. Figure 4.9 (p. 61): From Cermak, L. S., Reale, L., and DeLuca, D., Korsakoff patients' nonverbal versus verbal memory: Effects of inter- ference and mediation on rate of information loss, Neuropsychologia, 1977, 15, 303-310, Figure 1. Figure 4.10 (p. 63): From Butters, N. and Grady, M., Effect of pre- distractor delays on the short-term memory performance of patients with Korsakoffs and Huntington^ disease, Neuropsychologia, 1977, 15, 701-706, Figure 1, Copyright 1977, Pergamon Press, Ltd. Figure 4.11 (p. 67): From Cermak, L. S., and Uhly, B., Short-term motor memory in Korsakoff patients, Perceptual and Motor Skills, 1975, 40, 278, Figure 1. Figures 5.1 and 5.2 (pp. 73 and 75): From Cermak, L. S., Butters, N., and Gerrein, J., The extent of the verbal encoding ability of Korsakoff patients, Neuropsychologia, 1973,11, 85-94, Figures 1 and 2. Figure 5.3 (p. 78): From Cermak, L. S., and Moreines, J., Verbal retention deficits in aphasie and amnesic patients, Brain and Lan- guage, 1976, 3, 16-27, Figure 5. Figures 5.4, 5.5, 5.6, and 5.7 (pp. 80, 81, and 82): From Cermak, L. S., Butters, N., and Moreines, J., Some analyses of the verbal en- coding deficit of alcoholic Korsakoff patients, Brain and Language, 1974, 1, 141-150, Figures 1-4. Figure 6.1 (p. 97): From Glosser, G., Butters, N., and Kaplan, E. Visuoperceptual processes in brain damaged patients on the digit sym- bol substitution test, International Journal of Neuroscience, 1977, 7, 59-66, Figure 1. Figures 6.5 and 6.6 (pp. 102 and 103): From Kapur, N., and Butters, N., Visuoperceptive deficits in long-term alcoholics and alcoholics with Korsakoffs psychosis, Journal of Studies on Alcohol, 1977, 38, 2025- 2035, Figures 1 and 2, Copyright by Journal of Studies on Alcohol, Inc., New Brunswick, N.J. 08903. Figures 6.7, 6.8, and 6.9 (pp. 107 and 108): From Dricker, J., Butters, xii ACKNOWLEDGMENTS N., Berman, G., Samuels, I., and Carey, S., Recognition and encoding of faces by alcoholic Korsakoff and right hemisphere patients, Neuro- psychologia, 1978, 16, 683-695, Figures 1, 2, and 3, Copyright 1978, Pergamon Press, Ltd. Table 7.1 (p. 115): From Warrington, E., and Weiskrantz, L., Am- nesic syndrome: Consolidation or retrieval? Nature, 1970, 228, 628- 630, Table 3. Figures 8.1 and 8.6 (pp. 126 and 136): From Goldstein, G., and Neuringer, C. (Eds.), Empirical studies of alcoholism, 1976, Cam- bridge, Mass., Ballinger, Figures 6.15 and 6.19, Copyright 1976, Bal- linger Publishing Company. Figures 8.3 and 8.5 (pp. 133 and 135): From Butters, N., Tarlow, S., Cermak, L. S., and Sax, D., A comparison of the information pro- cessing deficits of patients with Huntington^ Chorea or Korsakoff s syndrome, Cortex, 1976, xii, 134-144, Figures 1 and 4. Figure 8.8 (p. 139): From Butters, N., Albert, M., and Sax, D., Some investigations of patients with Huntington^ disease, In Chase, T., Barbeau, A., and Wexler, N., Huntington^ Chorea: 1972-1978, New York, Raven Press, Figures 4 and 5. Figure 9.1 (p. 145): From Jones, B. P., Moskowitz, H. R., and Butters, N., Olfactory discrimination in alcoholic Korsakoff patients, Neuropsychologia, 1975, 13, 173-179, Figure 2, Copyright 1975, Perga- mon Press, Ltd. Figures 9.2, 9.3, and 9.4 (pp. 146 and 147): Jones, B. P., Moscowitz, H. R., Butters, N., and Glosser, G., Psychophysical scaling of olfac- tory, visual, and auditory stimuli by alcoholic Korsakoff patients, Neuropsychologia 1975, 13, 387-393, Figures 1, 2, and 3, Copyright 1975, Pergamon Press, Ltd. Figures 9.5, 9.6, 9.7, 9.8, and 9.9 (pp. 151, 152, 153, and 154): From Jones, B. P., Butters, N., Moskowitz, H. R., and Montgomery, K., Ol- factory and gustatory capacities of alcoholic Korsakoff patients, Neuro- psychologia, 1978, 16, 323-327, Figures 1, 2, 3, 5, and 6, Copyright 1978, Pergamon Press, Ltd. Figures 10.1, 10.2, and 10.3 (pp. 159, 160, and 161): From Butters, N., Cermak, L. S., Montgomery, K. M., and Adinolfi, A., Some com- parisons of the memory and visuoperceptive deficits of chronic alco- holics and patients with KorsakofFs disease, Alcoholism: Clinical and Experimental Research, 1977, 1, 73-80, Figures 1, 3, 6. Figure 10.7 (p. 168): From Albert, M., Butters, N., and Levin, J., Memory for remote events in chronic alcoholics and alcoholic Korsa- xiii ACKNOWLEDGMENTS koff patients. In H. Begleiter and B. Kissin (Eds.), Biological effects of alcohol, New York, Plenum, 1980, Figures 2 and 4. Figure 2.2 (p. 26): From Sperling, G., The information available in brief visual presentations, Psychological Monographs, 1960, 74, Whole No. 498. Copyright 1960 by the American Psychological Asso- ciation. Reprinted by permission. Figure 2.1 (p. 22): From Peterson, L. R., and Peterson, M. J., Short-term retention of individual items, Journal of Experimental Psychology, 1959, 58, 193-198. Copyright 1959 by the American Psy- chological Association. Reprinted by permission. Figures 5.8-5.14 (pp. 85, 86, 88, 89, and 90): From Cermak, L. S., and Reale, L., Depth of processing and retention of words by alcoholic Korsakoff patients, Journal of Experimental Psychology, 1978, 4, 165- 174. Copyright 1978 by the American Psychologcial Association. Re- printed by permission. xiv 1 Clinical Symptoms, Neuropathology, and Etiology In 1881, Carl Wernicke described a neurological syndrome in three patients (two male alcoholics, one woman with sulfuric acid poisoning) that included ataxia, optic abnormalities, and a confusional state. Post- mortem examination of these three patients showed small punctate hemorrhages that were symmetrically located in the gray matter around the third and fourth ventricles of their brains. Wernicke characterized these findings, which now bears his name, as an acute inflammatory disease of the ocular-motor nuclei, and noted that the symptoms were progressive and led to death in approximately 2 weeks. Six years following the publication of Wernicke's paper, S. S. Korsakoff published the first of a series of reports in which he detailed the amnesic and confabulatory symptoms that often accompanied disorders involving polyneuropathy. Although long-term alcoholism often preceded these mental changes, Korsakoff noted that the symp- toms also followed a number of other conditions, such as persistent vomiting, typhoid fever, and intestinal obstruction. On the basis of his observations, he concluded that the presence of a substance toxic to the peripheral and central nervous systems must have been the common denominator in his reported cases. Although neither Wernicke nor Korsakoff could be specific with regard to etiology, and both seemed unaware that their two syndromes often occurred sequentially in the same patients, their clinical descriptions of the symptomatology were accurate and represented important initial steps in the identi- fication and understanding of the Wernicke-Korsakoff syndrome. The major symptoms of the Wernicke stage include a global confusional state, opthalmoplegia, nystagmus, ataxia, and a poly- neuropathy (e.g., pain, loss of sensation, weakness) of the legs and arms. Of these neurological symptoms, the global confusional state 1

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• Edit date: 1980 • Publisher: Academic Press. Inc • ISBN: 0-12-148380-0 • Author: Nelson Butters/Laird S. Cermak • Preface/Forward: by the authors • No. Pages: 188
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