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

196 Pages·1980·9.63 MB·English

by  Nelson Butters and Laird S. Cermak (Auth.)

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
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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