Accelerated long-term forgetting (ALF) and the role of sleep in memory consolidation

Accelerated long-term forgetting (ALF) is a recently described memory impairment associated with epilepsy. Patients with ALF appear to learn and initially retain new information normally, but forget it at an accelerated rate over subsequent days. ALF can have a profound impact on the lives of the people who suffer from it, but it is also of theoretical interest. In particular, the study of this disorder may provide insight into the mechanisms of memory consolidation. ALF is especially prevalent in transient epileptic amnesia (TEA), an epileptic syndrome in which the seizure focus is thought to be the medial temporal lobes (MTL). The MTL house the hippocampus and a number of other structures critical for declarative memory function. The aims of this doctoral thesis were to investigate which aspects of memory function are disrupted in patients with TEA-associated ALF, and to shed light on the neural basis of the memory impairment. Slow wave sleep (i.e. deep sleep) is known to exacerbate epileptic activity. It is also thought to play a key role in the consolidation of declarative memory. The most commonly posited explanation of ALF is the disruption of sleep- dependent memory consolidation. However, it remains possible that ALF is caused by a subtle problem with encoding that usually goes undetected until delayed memory tests. The results of this thesis demonstrate that sleep can actually benefit memory retention in TEA ALF patients just as much as it does in healthy people, and that it is not necessary for the retention interval to contain sleep in order for ALF to be seen. However, the relationship between slow wave sleep and memory was found to be abnormal in these patients. The amount of slow wave sleep, and the power in the slow oscillation frequency range, during the post-learning night correlated negatively with the benefit of that night of sleep for memory retention. Furthermore, resting-state brain activity patterns thought to reflect post-encoding memory reprocessing were found to correlate negatively with subsequent memory performance in these patients. Another chapter of this thesis provides evidence that TEA ALF patients encode memories abnormally; these patients showed reduced activity in the left hippocampus while viewing stimuli that they went on to forget. Furthermore, this encoding-related brain activity correlated with their long-term forgetting. The final experimental chapter reports a correlation in these patients between grey matter in the left hippocampus and long-term forgetting, which cannot entirely account for the encoding-related brain activity results. The hippocampus and its surrounding structures are thought to be critical to our ability to discriminate between similar stimuli and events. An intriguing hypothesis consistent with the pattern of results in this thesis is that ALF is caused by a functional impairment of the MTL that results in a diminished capacity to distinguish between similar experiences, ultimately causing memory problems; abnormally formed memories may interact with new material and memory consolidation processes in an aberrant manner, leading to retrieval deficits.