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The present study used quantitative volume estimates of the hippocampus based on structural magnetic resonance imaging (MRI) to predict memory performance of individuals with epilepsy of temporal lobe origin (TLE). Twenty individuals with TLE completed standardized neuropsychological tests and a quality of life inventory, and participated in a brain MRI protocol designed to obtain high-resolution images of the hippocampus. The combined volume of the left and right hippocampi was found to be the best predictor of objective verbal memory performance. This finding is consistent with the functional adequacy model of hippocampal function. In contrast, the asymmetry between right and left hippocampal volume was the best predictor of subjective ratings of cognitive functioning, which is consistent with the functional reserve model. The collective and complementary functions of the left and right hippocampi merit further exploration in prospective studies of memory function and TLE.

Background: Moral distress is a pervasive reality of palliative care practice. An existing framework for understanding it has been proposed as a way to begin to address moral distress's detrimental effects on clinicians. Objective: The objective was to illustrate the application of this adapted conceptual framework to a clinical case and to offer recommendations for enlarging the professional repertoire for responding to challenging cases involving moral distress. Analysis: In the clinical case, clinicians are expected to respond to the patient's suffering based on four factors: empathy (emotional attunement), perspective taking (cognitive attunement), memory (personal experience), and moral sensitivity (ethical attunement). Each of these interrelated and iterative factors may become activated as clinicians care for patients with life-limiting conditions. This creates the foundations for clinicians' responses. When responses risk becoming aversive in the face of moral dilemmas, strategies are needed to foster principled compassion instead of unregulated moral outrage. A number of cognitive, attentional, affective, and somatic approaches derived from contemplative traditions are consistent with the framework. Combined with a systems-focused approach that incorporates organizational factors, they offer a means of improving professional repertoires for responding to difficult situations. Conclusion: Application of the proposed framework to a clinical case provides opportunities for understanding mechanisms of response that may be amenable to intervention and for suggesting appropriate alternative strategies and practices. A full understanding of the process can help to mitigate or to avoid the progression of distress and concurrently to appraise the situation that leads to moral distress or moral outrage. [ABSTRACT FROM AUTHOR]

Previous neuropsychological studies have demonstrated an association between false recognition and frontal lobe dysfunction. In the experiments reported here we explore the contribution of memory impairment and executive dysfunction to the pathogenesis of false facial recognition in patients with focal frontal lobe damage. Memory illusions in response to novel faces were observed in both anterograde and retrograde tests of face recognition memory. However, in neither memory domain could false recognition be accounted for by face memory loss. Instead, our findings suggest that false facial recognition in frontal patients reflects the breakdown of strategic memory retrieval, monitoring, and decision functions critical for attributing the experience of familiarity to a specific source. Frontal executive memory functions are primarily recruited under conditions of uncertainty when the face cue does not automatically elicit relevant contextual information, leaving the source of familiarity unspecified. Our results indicate that frontal patients do not spontaneously engage in effortful recollection of specific contexts that can normally be used to oppose and inhibit recognition decisions based on general or context-free familiarity. However, frontal patients can use context recollection to suppress false recognition once this strategy is pointed out to them. In some frontal patients false recognition may be material-specific. [ABSTRACT FROM AUTHOR]

The hypothesis that prefrontal cortex plays a critical role in accurate predictions of episodic memory performance was tested using the feeling-of-knowing (FOK) paradigm. Fourteen patients with a broad spectrum of damage to the frontal cortex and matched controls read sentences and later were tested for recall memory, confidence judgments, and FOK accuracy using as cues the sentences with the final word missing. While frontal patients were impaired at recall and recognition memory, they were able to make accurate confidence judgments about their recall attempts. By contrast, as a group, the patients were markedly impaired in the accuracy of their prospective FOK judgments. Lesion analysis of frontal patients with clear FOK impairment revealed an overlapping region of damage in right medial prefrontal cortex. These findings provide functional and anatomical evidence for a dissociation between recall confidence and prospective memory monitoring and are discussed in terms of familiarity and access theories of FOK predictions. [Copyright &y& Elsevier]