Memory and executive functions in amnesic and non-amnesic patients with aneurysms of the anterior communicating artery

Ruptured and repaired anterior communicating artery (ACoA) aneurysm can result in devastating impairments involving memory, executive function, confabulation and personality change. Importantly, traditional cerebral areas implicated in amnesia are not damaged, yet amnesia can still be manifested. While ACoA patients show normal visual-constructional skills (i.e. copy scores) on the Rey-Osterrieth complex figure test, recall is often impaired. What is unclear is whether impaired recall is attributable to problems in encoding, accelerated rates of forgetting, retrieval or some combination. To disentangle these issues, we examined 10 patients with ruptured aneurysms of the ACoA, using the Rey-organizational and extended memory procedure which uses an organizational procedure for enhancing immediate recall and provides added sensitivity by combining recall with non-recall measures (e.g. recognition, spatial discrimination and spatial assembly). The major findings were: (i) immediate recall in amnesics was improved by providing an organizational strategy; (ii) following the organization trials, amnesics and non-amnesics retained information to a comparable extent over a 30-min delay; (iii) two subgroups of amnesics emerged, those subjects impaired in acquisition and a second group with impaired retrieval; (iv) all subjects showed preserved memory on non-recall measures. These findings have important implications with respect to using organizational strategies in cognitive treatments and in using non-recall measures in improving the validity and reliability of patient assessment.