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'Musical Memory in a Patient with Severe Anterograde Amnesia' Cavaco et al. (2012) - Overview

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'Musical Memory in a Patient with Severe Anterograde Amnesia' Cavaco et al. (2012) - Overview

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This case study followed Patient S.Z., a 51-year-old man who suffered from anterograde amnesia after contracting herpes simplex encephalitis at age 42. This describes an inflammation of the brain following the contraction of herpes virus, which caused life-changing brain damage to Patient S.Z., leading to his amnesia (Cermack & O'Connor, 1983). S.Z. was an amateur saxophonist before his amnesia, with this case study aiming to investigate whether he could retain this skill.

unable to recall/recognise declarative information (verbally and/or visually) <- knowing WHAT

however could acquire & retain new perceptual-motor skills <- knowing HOW

on occasions, S.Z. would demonstrate his severe amnesia by consecutively playing the same song

unpublished experiment: played song 'You Raise Me Up' 8 times in 22 min period, with a 30-60 second break in between

when asked if he recognised the song he had played, or as to whether he had played the song before, S.Z. said no every time

this example demonstrates his lack of declarative memory regarding the song (knowing WHAT), but the processes of HOW to play remained intact

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This type of amnesia describes patients who are unable to form and make new memories following the event that induced the amnesia (Markowitsch, 2008).

Using this, Patient S.Z. should be unable to curate new declarative memories regarding music and learning pieces from memory, as this falls under knowing WHAT.

declarative memory describes those that are factual

includes information about processes <- process of playing the saxophone?

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Previous studies

Patients with dense amnesia due to bilateral medial temporal lobe damage (e.g., Anderson et al., 2007) or due to dementia of the Alzheimer's type (e.g., Beatty et al., 1999) have suggested a remarkable ability to continue to perform certain types of activities before brain injury (e.g., driving, playing a musical instrument).

Cohen and Squire (1980) found that amnesic patients were able to acquire the mirror reading skill at a normal rate (despite poor memory for the words that they had read)

Case studies

Well-known case: Clive Wearing

A renowned musicologist with severe amnesia after sustaining bilateral medial temporal lobe damage due to herpes simplex encephalitis (Wilson et al., 1995, p.679-680)

Intact ability to "sight-read, …, play from a figured bass, transpose, and extemporize."

Unknown: whether or not Clive can learn how to play new songs

Two early cases (teach unfamiliar songs to piano players with dementia of the Alzheimer's type)

Sight-reading (Battey et al., 1988)

By ear (Beatty et al., 1999)

Both patients could play familiar songs that had been learned priorly. However, the ability to learn a new composition was rather limited

Fornazzari and colleagues (2006, p. 611)

Assessed the ability of a professional pianist with probable Alzheimer's disease to learn unfamiliar musical pieces

Gradual improvements in overall performance and in rhythm, field elements, harmony, melodic accuracy, and sophistication in the accompaniment of the left hand” over seven days

Baur and colleagues (2000)

Herpes simplex encephalitis patients (C.H.)

Did not have any premorbid sight-reading training; do not have any experience playing a musical instrument

Able to

Learn how to play 90 pieces of Austrian and German folk music after listening to the songs on the radio or tape

Play a song when cued with the song title

Provide the song title when cued with a recording of the music

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To investigate patient S.Z. and his declarative memories (his ability to recognise the names of songs, remember if he'd previously played the song, and his ability to understand WHAT the sheet music meant), and procedural memories (his ability to proficiently play the saxophone), Cavaco et al. (2012) employed the use of an experiment during the case study.

The experiment consisted of 11 songs (Blind to S.Z.) in the form of sheet music being given to an orchestra and S.Z. to later play. Researchers ensured that S.S. lacked awareness of these songs by conferring with his family.

5 songs were utilised as controls, and were only played during testing studies, but S.Z. didn't practice or play these between testing, to see if the researchers were measuring his memories or practice effects (getting better from multiple trials).

A further control of an examiner blind to the stimulus condition, rated the difficulty of the songs for an amateur to play (scale from 1-10).

100 day separation between the 2 testing conditions (time 1 and 2)-> see impact over time.

Time 1= One week before the orchestra played. Time 2= Testing 3 months after continuous rehearsals with the orchestra 2x a week, for an hour.

S.Z. = Practiced songs for 30 hours, before playing 16 songs alone using sheet music.

S.Z.'s performance= recorded using audio recorder, and rated by a professional saxophonist(blind to song order and song condition) on his; intonation, sound quality, rhythmic aware ness, notes awareness, and sheet-reading accuracy (rated on a 10-point performance scale).

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Significant improvement for unfamiliar songs between tests showing practice had an impact even if Patient S.Z. had no conscious memory of practicing

Sight-reading of practiced (target) songs much better than non-practiced (control) songs

Previous research suggests a person with anterograde amnesia should not be able to form new declarative memories, therefore S.Z. should not be able to learn unfamiliar songs and yet he can. However, the superior parietal cortex (Sergent et al., 1992; Stewart et al., 2003), the basal ganglia and the cerebellum (Parsons et al., 2005) have all been found to be activated during perceptual-motor processing of music

MRI scans of S.Z. show he does not suffer from lesions to any of these areas which could (with more research) indicate why he is able to use the perceptual-motor aspects of learning music

Criticism 1: S.Z. presumably progressed much slower in relation to how a healthy person would progress with the same amount of rehearsal. However, the study was not designed to measure his progress comparatively (hence the lack of control subjects) and therefore these conclusions would be inappropriate to draw

Criticism 2: change of environment may have impacted learning - all songs were rehearsed with an orchestra and tested alone in a different room, the loss of the external cues present in training could have resulted in worse performance from S.Z.

S.Z. improved his musical performances slowly and in stages which is likely a reflection of his lack of declarative memory of training - the typical reaction of a musician is to learn the generic progression of a song and therefore playing it becomes muscle memory as they recognise what they have played and can predict what is coming next. S.Z. not having these memories means his performances has to be learned much more slowly and in more stages to bypass the lacking cognitive processes

The areas S.Z. did not improve in were intonation and rhythmic awareness. He was described as "robotic" and "machine-like" - lack of emotional exploration

He displayed some levels of emotion in earlier songs and so need to conduct further research in order to establish why

Summary:

The procedural knowledge of how to play the saxophone survived the anterograde amnesia and was resilient to the disrupted declarative memory

The 3 months of intensive training highlighted the distinction between the ability to acquire new non-declarative memories for musical material and the inability to learn any declarative information about the songs

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S.Z. did not recognise any of the target or control songs at either test

The only exception was target song 7 (If Thou Be Near by Bach) which he claimed to recognise meaning he "thinks" he may have played it before - a level of uncertainty throughout

His parents reiterated he had not seen or played the song before and thus concluded the recognition is due to a recognition of the composer rather than recalling playing the music

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Time 1: one week before the orchestra started rehearsing

Time 2: after three months of intensive rehearsal

The Mann-Whitney U test - compared the performance on the target songs and the control songs at Time 1

No significant differences in performance between the target and control songs across several measures, including the level of difficulty between the target and the control songs.

S.Z. patient

Improvements in specific musical abilities for the target songs

No significant improvements were found on the other measures (i.e., intonation, sound quality, and rhythm awareness)

Wilcoxon test - compare the expert's scoring of each song at Time 1 and Time 2

After three months of intense practice, patient S.Z. showed significant improvement on the performance of the target songs

Comparison between Time 1 and Time 2 for the control songs did not reveal any significant changes

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Cavaco, S., Feinstein, J. S., van Twillert, H., & Tranel, D. (2012). Musical memory in a patient with severe anterograde amnesia. Journal of Clinical and Experimental Neuropsychology, 34(10), 1089–1100. https://doi.org/10.1080/13803395.2012.728568

Cermak, L. S., & O'Connor, M. (1983). The anterograde and retrograde retrieval ability of a patient with amnesia due to encephalitis. Neuropsychologia, 21(3), 213-234.

Markowitsch, H. J. (2008). Anterograde amnesia. Handbook of clinical neurology, 88, 155-183.