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The Relationship Between Autobiographical Memory, Cognition, and Emotion in Older Adults: A Review

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The Relationship Between Autobiographical Memory, Cognition, and Emotion in Older Adults: A Review

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Aging, Neuropsychology, and Cognition

A Journal on Normal and Dysfunctional Development

ISSN: 1382-5585 (Print) 1744-4128 (Online) Journal homepage: http://www.tandfonline.com/loi/nanc20

The relationship between autobiographical


memory, cognition, and emotion in older adults: a
review

Yong-Chun Bahk & Kee-Hong Choi

To cite this article: Yong-Chun Bahk & Kee-Hong Choi (2017): The relationship between
autobiographical memory, cognition, and emotion in older adults: a review, Aging,
Neuropsychology, and Cognition, DOI: 10.1080/13825585.2017.1377681

To link to this article: https://doi.org/10.1080/13825585.2017.1377681

Published online: 12 Sep 2017.

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AGING, NEUROPSYCHOLOGY, AND COGNITION, 2017
https://doi.org/10.1080/13825585.2017.1377681

The relationship between autobiographical memory,


cognition, and emotion in older adults: a review
Yong-Chun Bahk and Kee-Hong Choi
Department of Psychology, Korea University, Seoul, Republic of Korea

ABSTRACT ARTICLE HISTORY


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Over the past 30 years, the concept of “autobiographical memory” Received 17 May 2017
has been highlighted in numerous behavioral and neuroanatomi- Accepted 4 September 2017
cal studies. Importantly, episodic autobiographical memory, an KEYWORDS
aspect of autobiographical memory, has been shown to decrease Aging; autobiographical
with age but can be improved by training. Autobiographical memory; cognition;
memory is deeply associated with the default mode network emotion; depression
(especially posterior cingulate cortex and medial prefrontal cor-
tex), which is particularly interesting in the context of better
understanding the relationship between autobiographical mem-
ory, cognition, and emotion in older adults. This article provides an
overview of the behavioral and neuroanatomical characteristics of
autobiographical memory, as well as its relationship with the
default mode network, cognition, emotion, and aging. This article
also provides an overall review of autobiographical memory
training.

Autobiographical memory and cognition in older adults


Autobiographical memory consists of semantic and episodic autobiographical memory.
Semantic autobiographical memory is the factual knowledge of an individual’s past and
episodic autobiographical memory comprises the specific personal events that an
individual experienced and can relive (Kopelman, Wilson, & Baddeley, 1989; Tulving,
Schacter, McLachlan, & Moscovitch, 1988). Episodic autobiographical memory also
includes associations of perceptual, emotional, spatial, temporal, and contextual details
that lead to a subjective experience of conscious memory (Conway, 2001; Conway &
Pleydell-Pearce, 2000).
There have been many studies on autobiographical memory in the last 30 years (see
Table 1). Several of these studies have investigated the effects of aging on autobiogra-
phical memory and found that the specificity of episodic autobiographical memory
decreases with age (Craik & Park, 2000; Levine, Svoboda, Hay, Winocur, & Moscovitch,
2002; Piolino, Desgranges, Benali, & Eustache, 2002) while semantic autobiographical
memory is relatively well preserved (Levine et al., 2002; Piolino et al., 2010, 2002; St.
Jacques & Levine, 2007). Compared to young individuals, older adults are relatively
having difficulty remembering the details of memories (Levine et al., 2002; McIntyre &
Craik, 1987; Spencer & Raz, 1995) and suppressing extraneous information (Arbuckle &

CONTACT Kee-Hong Choi [email protected]


© 2017 Informa UK Limited, trading as Taylor & Francis Group
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Table 1. Studies investigating autobiographical memory, cognition, and emotion in older adults.
Study (year) Subjects Main findings
Levine et al. (2002) 15 younger adults Younger adults recalled specific memories that included place and time, but older adults did not (recalled
(mean age = 23.5) semantic memories)
15 older adults
(mean age = 73.5)
Piolino et al. (2002) 52 healthy adults were divided into four age Episodic autobiographical memory became worse with age despite semantic autobiographical memory being
groups (40s, 50s, 60s, 70s) preserved
Y.-C. BAHK AND K.-H. CHOI

St. Jacques and Levine (2007) 16 younger adults Young adults recalled a greater number of episodic details compared to older adults
(mean age = 26.19)
16 older adults
(mean age = 78.19)
Holland and Rabbitt (1990) 33 healthy adults divided into four age/IQ Older adults aged over 70 years showed less detail in memory recall compared to those over 60 years.
group (60s, 70s/high IQ, low IQ) Autobiographical memory specificity was predicted by measures of fluid intelligence
Addis et al. (2008) 16 younger adults Older adults recalled fewer details than young adults. The specificity of episodic autobiographical memory
(mean age = 25.31) positively correlated with a working memory measure (digit-span backward)
16 older adults
(mean age = 72.30)
Piolino et al. (2007) 13 frontotemporal dementia patients Age-related difficulties in autobiographical memory increased with the level of detail of episodic
(mean age = 67.2) autobiographical memory. Neurocognitive measures (Stroop test, integration test, and n-back test) largely
mediated the relationship between aging and decreased autobiographical memory
Gidron and Alon (2007) 25 older adults Autobiographical memory specificity was significantly correlated with depression
(mean age = 77.92)
Serrano et al. (2007) 95 older adults with depression Older adults with depression showed poorer autobiographical memory than older adults without depression
(mean age = 76.54)
90 older adults without depression
(mean age = 71.60)
Ricarte et al. (2011) 34 older adults with depression Older adults with depression showed less autobiographical memory specificity than those without
(mean age = 74.59) depression. Autobiographical memory specificity in older adults without depression was related to life
34 older adults without depression satisfaction
(mean age = 75.09)
Phillips and Williams (1997) 22 older adults Older adults with cognitive impairment did not show a significant relationship between autobiographical
(mean age = 73.7) memory specificity and depressive symptoms.
AGING, NEUROPSYCHOLOGY, AND COGNITION 3

Gold, 1993; Hasher & Zacks, 1988). These results are apparent not only when comparing
older adults to young adults, but also when comparing within older adults. For example,
Holland and Rabbitt (1990) reported that older adults aged over 70 years exhibit fewer
details in memory recall than those aged over 60 years.
Similar to autobiographical memory, several studies have reported that various
cognitive functions decrease with aging (Harada, Love, & Triebel, 2013). Processing
speed, which involves the speed required to perform cognitive tasks, has been reported
to be significantly lower in older adults (Carlson, Hasher, Connelly, & Zacks, 1995;
Salthouse, 2010; Salthouse, Fristoe, Lineweaver, & Coon, 1995). Declines in cognitive
processing, in turn, negatively affect performance on other neuropsychological mea-
sures, which results in age-related declines across various domains (Harada et al., 2013).
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With regard to executive functioning, older adults show a decrease in selective atten-
tion, which is the ability to focus on specific information and ignore unnecessary
information (Carlson et al., 1995; Salthouse et al., 1995). In addition, they exhibit con-
comitant decreases in response inhibition (Oosterman et al., 2010; Singh-Manoux et al.,
2012), mental flexibility (Oosterman et al., 2010; Wecker, Kramer, Hallam, & Delis, 2005),
and working memory (Salthouse, Mitchell, Skovronek, & Babcock, 1989). Several
researchers have suggested that these declines in cognitive functioning are associated
with reductions in autobiographical memory (Holland & Rabbitt, 1990; Levine et al.,
2002; Piolino et al., 2008). For example, Addis, Wong, and Schacter (2008) demonstrated
that the specificity of episodic autobiographical memory positively correlates with work-
ing memory as measured by digit-span backward. Dalgleish et al. (2007) also showed
that the specificity of autobiographical memory is associated with executive function as
assessed via verbal fluency. Especially, Piolino, Desgranges, and Eustache (2009) demon-
strated that age-related difficulties in autobiographical memory increase as a function of
the level of detail of the episodic autobiographical memory, and specific measures of
cognitive functioning (e.g., Stroop test, integration test, and n-back test) have been
found to largely mediate the relationship between aging and decreases in autobiogra-
phical memory (Piolino et al., 2007, 2009).
In particular, executive function has been known to have a more direct relationship
with the reduction of autobiographical memory specificity. Conway and Pleydell-Pearce
(2000) explained that the initial process of autobiographical memory retrieval requires
cognitive effort and uses central executive capacity. Williams (2006) proposed an inte-
grated model of autobiographical memory retrieval (i.e., CApture and Rumination,
Functional Avoidance and eXecutive control; CARFAX). In the CARFAX model, executive
function, one of the influencing factors, is explained as having a direct effect on the
reduction of the specificity of autobiographical memory. Individuals with reduced
executive functioning (e.g., a lack of cognitive resources to maintain goal-oriented
behaviors) are more likely to deviate from the instructions to “be specific” in autobio-
graphical memory tasks. In addition, not only individuals with a lack of cognitive
resources, but also individuals with a normal range of cognitive function, showed
reduced autobiographical memory specificity when their cognitive loading was
increased by additional tasks (see Williams, 2006). This view of the relationship between
reductions in executive functioning and autobiographical memory specificity is one
possible explanation for why older adults show decreases in autobiographical memory
specificity as executive functioning declines with natural aging.
4 Y.-C. BAHK AND K.-H. CHOI

Autobiographical memory and emotion in older adults


It is widely known that autobiographical memory has a strong relationship with emo-
tion, and there have been numerous studies regarding the relationship between auto-
biographical memory and depression in particular (Brewin, Reynolds, & Tata, 1999;
Brittlebank, Scott, Williams, & Ferrier, 1993; Kuyken & Brewin, 1995; Wessel, Meeren,
Peeters, Arntz, & Merckelbach, 2001). For example, Brittlebank et al. (1993) reported that
reductions in autobiographical memory are not simply a symptom of depression, but
can also be used to predict the prognosis of depression. In addition, individuals who
recover from depression still show reductions in autobiographical memory (Mackinger,
Pachinger, Leibetseder, & Fartacek, 2000). These findings have been supported by
subsequent studies as well (Mackinger et al., 2000; Raes et al., 2006).
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Autobiographical memory and depression also have a strong relationship among


older adults (Gidron & Alon, 2007; Ricarte et al., 2011; Serrano, Latorre, & Gatz, 2007).
Gidron and Alon (2007) found that autobiographical memory specificity significantly
correlated with depression in a sample of 25 older adults, even after controlling for age
and education. Another study by Serrano et al. (2007), which compared older adults with
and without depression, found that older adults with depression exhibit poorer auto-
biographical memory than those without depression. Similarly, Ricarte et al. (2011)
reported that older adults with depression exhibit less autobiographical memory speci-
ficity than those without depression and suggested that these differences are attribu-
table to increased life satisfaction among those without a history of depression. In
contrast, Phillips and Williams (1997) reported that older adults with cognitive impair-
ment do not show a significant relationship between autobiographical memory speci-
ficity and depressive symptoms.
Several studies have suggested that the relationship between autobiographical
memory and depression can be explained in the context of emotional regulation.
Namely, Williams (2006) has suggested that the specificity of reduced autobiographical
memory is closely related to the control of negative emotions, particularly the suppres-
sion and avoidance of negative emotions. Hermans, Defranc, Raes, Williams, and Eelen
(2005) also demonstrated that reduced autobiographical memory specificity represents
a cognitive style to avoid negative emotions, which explains the association between
autobiographical memory and depression. Reduced autobiographical memory deepens
maladaptive emotion regulation styles, such as avoidance and suppression, which leads
to depression (Hermans et al., 2005). This is the same for older adults, among whom
reduced autobiographical memory specificity is strongly related to depression (Ricarte
et al., 2011).
Regarding the relationship between autobiographical memory and emotional proces-
sing, several researchers have reported that emotional cues make retrieval of autobio-
graphical memories easier because the retrieval of emotional memories (e.g.,
autobiographical memories with emotional cues) requires less cognitive effort compared
to neutral memories (Conway, 1990; St. Jacques & Levine, 2007; Zajonc, 1980). In
addition, Holland, Ridout, Walford, and Geraghty (2012) showed that the tendency of
older adults to focus on positive cues acts as a buffer against reduction in the specificity
of autobiographical memory due to diminished executive function.
AGING, NEUROPSYCHOLOGY, AND COGNITION 5

Although these studies provide behavioral data regarding the association of auto-
biographical memory with cognition and emotion, it is still difficult to get a clear
understanding of the relationship between autobiographical memory and cognitive
function. To better elucidate these relationships, it is necessary to first gain an under-
standing of their neuroanatomical bases. As the present paper focuses on autobiogra-
phical memory in older adults and its relationship with cognitive functioning, it will refer
to the default mode network (DMN), as it includes regions known to be the most
sensitive to the neurodegenerative processes.

The neuroanatomical basis of autobiographical memory: focusing on the


DMN
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Several studies have been conducted regarding the neuroanatomical basis of autobio-
graphical memory. In particular, several functional neuroimaging studies have found
that the brain regions involved in autobiographical memory – such as the medial
prefrontal cortex (mPFC), posterior cingulate cortex (PCC), inferior parietal lobule (IPL),
hippocampus, and medial temporal lobe (MTL) – overlap significantly with regions of the
DMN (Andreasen, Leary, Cizadlo, & Arndt, 1995; Buckner, 2012; Buckner & Carroll, 2007;
Philippi, Tranel, Duff, & Rudrauf, 2015; Spreng, Mar, & Kim, 2009). The DMN is a network
of brain regions that interact with each other at a high level and is distinct from other
networks in the brain. More specifically, this network is a set of brain regions that are
anatomically distinct from each other and show temporal correlations in spontaneous
fluctuations, which indicates that they exhibit functional connectivity. A special feature
of the DMN is that it is activated during resting state and deactivated during externally
focused, cognitively demanding tasks (Buckner, Andrews-Hanna, & Schacter, 2008;
Gusnard, Akbudak, Shulman, & Raichle, 2001; Raichle et al., 2001; Shulman et al.,
1997). As a result of this feature, the DMN has long since been considered a task-
negative network. However, recent studies have shown that increased DMN activity is
observed when attention is directed internally. In particular, several studies have shown
that the DMN plays an important role in performing cognitive process that require
internal focus, such as recalling one’s past or imagining one’s personal future
(Andreasen et al., 1995; Schacter, Addis, & Buckner, 2007; Spreng et al., 2009), “mind
wandering” (Christoff, Gordon, Smallwood, Smith, & Schooler, 2009; Maguire, 2001;
Mason et al., 2007), self-reference (Argembeau, Comblain, & Linden, 2005; Gusnard
et al., 2001), and social cognition (Iacoboni et al., 2004; Spreng & Grady, 2010; Spreng
et al., 2009). These studies suggest that the DMN does not simply represent a “task-
negative” network (Spreng & Mar, 2012). A number of studies have also provided
consistent evidence that the brain regions that are active during the process of memory
retrieval overlap with core areas of the DMN (Andreasen et al., 1995; Buckner, 2012;
Philippi et al., 2015; Spreng et al., 2009). In particular, a quantitative meta-analysis of
functional magnetic resonance imaging (fMRI) studies using the activation likelihood
estimation approach revealed that autobiographical memory and the DMN exhibit
reliable involvement of the mPFC, PCC, and MTL (Spreng et al. (2009). Similarly, a
study that examined patients with brain lesions demonstrated that damage to key
areas of the DMN (e.g., mPFC, MTL, PCC) is associated with deficits in autobiographical
memory (Philippi et al. (2015).
6 Y.-C. BAHK AND K.-H. CHOI

One of the major brain regions associated with autobiographical memory in the DMN is
the PCC (Maddock, Garrett, & Buonocore, 2001; Piolino et al., 2004; Ries et al., 2006;
Svoboda, McKinnon, & Levine, 2006), which not only supports internally focused cognitive
processes, such as autobiographical memory, but also regulates arousal state, balance, and
breadth of attention (Buckner et al., 2008; Gusnard et al., 2001; Hahn et al., 2007; Hampson,
Driesen, Skudlarski, Gore, & Constable, 2006; Leech & Sharp, 2014; Raichle et al., 2001). An
fMRI study conducted by Maddock et al. (2001) found that the PCC is activated during
retrieval of autobiographical memories, especially when the retrieval process is successful.
In addition, research by Ries et al. (2006) has demonstrated that fMRI activation in the PCC
differs in older adults as a function of mild cognitive impairment. Namely, older adults with
mild cognitive impairment do not demonstrate activation of the PCC during episodic
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autobiographical memory retrieval, whereas healthy older adults do exhibit this activation.
Using the effect-location method, a meta-analysis of 24 functional neuroimaging studies of
autobiographical memory also found evidence for consistent activation of the PCC during
autobiographical memory retrieval (Svoboda et al. (2006). In addition to its involvement in
autobiographical memory, the PCC plays a key role in regulating attention, and failure to
deactivate the PCC at the right time is associated with poor attention, which leads to a
decrease in cognitive functioning (Bonnelle et al., 2012; Leech & Sharp, 2014; Mayer,
Mannell, Ling, Gasparovic, & Yeo, 2011; Sharp et al., 2011).
Another major brain region associated with autobiographical memory in the DMN is
the mPFC. For example, an fMRI study by Markowitsch, Vandekerckhove, Lanfermann,
and Russ (2003) found that retrieval of emotional autobiographical memories, involving
both happy and sad memories, activated medial prefrontal areas. In addition, a meta-
analysis conducted by Svoboda et al. (2006) has shown involvement of the mPFC during
retrieval of autobiographical memories. As for the involvement of the mPFC in auto-
biographical memory, Macrae, Moran, Heatherton, Banfield, and Kelley (2004) conducted
an experiment in which participants were asked to evaluate the personal relevance of a
series of personality trait adjectives and were subsequently tested on their memory of
these adjectives. The researchers found that activation of the mPFC was associated with
self-referential processing and, in addition, that failed versus successful retrievals were
associated with the mPFC and hippocampus, while self-descriptive versus nondescrip-
tive items were associated with only the mPFC. They suggested that the interaction
between retrieval and self-referencing is particularly important in the recollection of
autobiographical memories, thus explaining the important role that the mPFC plays in
autobiographical memory. In addition to autobiographical memory, the mPFC has been
known to play a crucial role in memory and decision-making. The mPFC forms and
stores schemas that lead to appropriate contextual and emotional responses through
memory consolidation (Alexander & Brown, 2011; Euston, Gruber, & McNaughton, 2012;
E. K. Miller & Cohen, 2001). These schemas compare past experiences with the current
set of events and facilitate the decision-making processes involved in choosing appro-
priate emotional or behavioral responses (Bechara & Damasio, 2005; Euston et al., 2012;
Fellows & Farah, 2007). The mPFC is also known to make key contributions to emotional
processes, such as reappraisal, expression, and regulation of emotions (Etkin, Egner, &
Kalisch, 2011; Papez, 1937; Quirk & Beer, 2006; Sheline et al., 2009). In particular, fMRI
studies have demonstrated that internally focused emotion regulation, especially as it
pertains to negative emotions, recruits regions associated with cognitive control,
AGING, NEUROPSYCHOLOGY, AND COGNITION 7

including the mPFC (Ochsner et al., 2004; Urry et al., 2006). In addition, research has
demonstrated that individuals with major depression fail to control activity in the mPFC
when actively reappraising negative pictures (Sheline et al. (2009).
To summarize, there is evidence that DMN regions have a strong association with
autobiographical memory, with the PCC and mPFC playing a particularly important role
in this relationship. Not only do these regions play a key role in autobiographical
memory retrieval, but also in cognition (e.g., attention regulation, memory consolida-
tion, and decision-making) and emotion (e.g., reappraisal, expression, and regulation).
These spatial overlaps are consistent with behavioral correlations between autobiogra-
phical memory, cognition, and emotion.
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Aging, autobiographical memory, and DMN


Many studies have reported that the autobiographical memory retrieval process is
impaired in older adults (Craik & Park, 2000; Levine et al., 2002; Piolino et al., 2002).
Age-related deficits in autobiographical memory performance can be understood more
clearly by investigating the relationship between aging and the DMN, which comprises
the core brain regions involved in autobiographical memory. Several studies have
reported that aging reduces functional connectivity within the DMN (Damoiseaux
et al., 2008; Grady, Springer, Hongwanishkul, McIntosh, & Winocur, 2006). In particular,
the resting state activity of DMN regions, especially the PCC, decreases with age and
exhibits less deactivation during cognitive tasks involving external stimuli (Damoiseaux
et al., 2008; Grady et al., 2006; Koch, Gade, Schuch, & Philipp, 2010; Lustig et al., 2003; S.
L. Miller et al., 2008). For example, an fMRI study by Damoiseaux et al. (2008) found that
compared to younger adults, the resting state brain activity of older adults is reduced in
several DMN regions, such as the PCC, middle temporal gyrus, and superior parietal
region. In addition, they found that reductions in resting state brain activity among older
adults were associated with impairments in executive functioning and processing speed.
In addition, research has found that although young adults and older adults demon-
strate similar hippocampal activation during memory encoding, young adults demon-
strate greater deactivation of medial temporal regions, including the PCC, during
successful memory coding, whereas older adults do not (S. L. Miller et al. (2008). This
failure to deactivate medial temporal regions is especially noticeable in older adults who
exhibit poor memory task performance.
Similarly, an fMRI by Lustig et al. (2003) examined differences in brain regions
during resting state and a semantic classification task in young adults, older adults,
and older adults with early stage dementia of the Alzheimer type. They found that
young adults showed greater deactivation of the PCC during periods of active task
performance compared to older adults, irrespective of dementia diagnoses. In addi-
tion, individuals with dementia demonstrated even more pronounced positive activa-
tion of the PCC during periods of active task performance compared to older adults
without dementia. These results are consistent with another study that examined
correlations between age and brain activity during memory task performance at the
time of both encoding and recognition (Grady et al., 2006). Namely, this study found
evidence of gradual age-related reductions in brain activity and found that deactiva-
tion of the DMN regions during resting state gradually decreased with age (Grady
8 Y.-C. BAHK AND K.-H. CHOI

et al. (2006). To summarize, aging reduces connectivity between regions of the DMN,
with markedly less deactivation observed in areas such as the PCC during cognitive
tasks. Age-related decreases in DMN connectivity are consistent with the degradation
of autobiographical memory that occurs with aging. This phenomenon impacts
various cognitive domains and is not limited to older adults, but to adults across
the lifespan.
Recently, Mevel et al. (2013) examined the relationship between DMN connectivity
disturbances in normal aging and autobiographical memory. In their study, they mea-
sured the resting state brain activity, cognitive functions, and autobiographical memory
of 70 participants (aged 19–80), and found that episodic autobiographical memory was
positively correlated with DMN connectivity (i.e., right PCC connectivity with the left
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middle and right inferior temporal cortices, the right amygdala/anterior hippocampus,
and the right middle temporal cortex), whereas other cognitive functions were not.
Mevel et al. (2013) noted that both cognitive functions and autobiographical memory
decreased with aging, but only autobiographical memory was significantly correlated
with DMN connectivity and this relationship was still significant after controlling for the
effect of age.
Several studies have reported age-related increases in the activity of anterior brain
areas (e.g., anterior cingulate, mPFC, bilateral prefrontal cortex, and superior frontal
cortices), which comprise a compensatory process due to reduced connectivity of the
DMN (Davis, Dennis, Daselaar, Fleck, & Cabeza, 2008; Grady et al., 2006; Van Den Heuvel,
Mandl, Luigjes, & Pol, 2008). Decreased connectivity of DMN regions and concomitant
compensatory responses involving increased anterior brain activity reduce attentional
efficiency by making it difficult to concentrate fully on external stimuli. This “Posterior-
Anterior Shift in Aging” model explains the decline of cognitive functions that occur with
aging (Davis et al., 2008). This decrease in cognitive functioning influences the reduction
in autobiographical memory specificity of older adults.
To summarize, the DMN connectivity decreases with aging. This disturbance is
prominent in individuals with memory problems and the decrease in DMN connectivity
(especially PCC) is inextricably linked to the declines in autobiographical memory and
cognitive functioning in older adults.

Autobiographical memory training


In addition to aging, reductions in autobiographical memory can occur as a result of
depression, schizophrenia, mild cognitive impairment, and dementia (Brittlebank et al.,
1993; Mackinger et al., 2000; Williams et al., 2007). With regard to depression, there have
been several studies aimed at training autobiographical memory (see Table 2), including
a study by Raes, Williams, and Hermans (2009) examining the efficacy of a 4-week group
training program. The program, which was administered to 10 patients with depression,
was focused on increasing the specificity of autobiographical memory retrieval.
Importantly, the researchers found that individuals who participated in the training
program showed significant improvements in autobiographical memory specificity and
depressive symptoms. Another study by Serrano, Latorre, Gatz, and Montanes (2004)
provided autobiographical memory training to 20 older adults with clinically significant
depressive symptoms, which was provided in the form of once weekly individual
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Table 2. Studies of autobiographical memory training.


Studies (year) Program Type Subjects Changes
Raes et al. (2009) Memory Specificity Training (MEST) Group 10 in-patients with depressive symptomatology Autobiographical memory specificity
4 sessions (mean age = 47.40) (F = 27.82, p < .001);
Rumination (F = 8.71, p < .05);
feelings of hopelessness (F = 8.71, p < .05);
problem-solving skills (F = 4.00, p = .08)
Serrano et al. (2004) Life review therapy using autobiographical Individual 20 older adults with depressive symptomatology Autobiographical memory specificity
retrieval practice 4 sessions (mean age = 75.8) (F = 5.22, p < .05);
23 control group CES-D (F = 38.99, p < .0001);
(mean age = 78.4) beck hopelessness scale (F = 33.66,
p < .0001);
life satisfaction index (F = 28.78, p < .0001)
Ricarte et al. (2012) Event-specific memory training on Group 24 schizophrenia patients with depressive symptoms Autobiographical memory specificity
autobiographical memory 10 (mean age = 35.21) (F = 42.23, p < .001);
sessions 26 control group BDI (F = 16.12, p = .001)
(mean age = 38.34)
Ricarte et al. (2014) Specific positive event training on Individual 16 patients with schizophrenia Autobiographical memory specificity
autobiographical memory 4 sessions (mean age = 38.93) (F = 14.56, p = .002)
16 control group
(mean age = 38.37)
Lalanne et al. (2015) Cognitive training program for Group 16 patients with early to moderate dementia of the Autobiographical memory specificity
autobiographical memory 6 sessions Alzheimer type (p < .001, d = .066);
(mean age = 71.44) GDS
17 control group (p < .001, d = .065)
(mean age = 73.06)
Lopes et al. (2016) Reminiscence program focused on Individual 20 older adults with cognitive impairment Autobiographical memory specificity
autobiographical memory 5 sessions (mean age = 83.85) (Z = 4.310, p = .000);
21 control group Montreal Cognitive Assessment
(mean age = 83.62) (Z = 2.305, p = .021);
GDS
(Z = 3.730, p = .000)
BDI: beck depression inventory; CES-D: center for epidemiologic studies depression scale; GDS: geriatric depression scale.
AGING, NEUROPSYCHOLOGY, AND COGNITION
9
10 Y.-C. BAHK AND K.-H. CHOI

therapy across a period of 4 weeks. With the exception of negative memories, the focus
of treatment was on increasing the specificity of positive autobiographical memories.
Compared to the control group, the treatment group showed more specificity in positive
and neutral autobiographical memories, less depressive symptoms, less ambiguity, and
increased satisfaction after 2 weeks of treatment. With regard to schizophrenia, J. Ricarte,
Hernández-Viadel, Latorre, and Ros (2012) conducted group-based autobiographical
memory training on 24 patients with schizophrenia and depressive symptoms, which
was aimed at increasing the specificity of memory and decreasing depressive symptoms.
After receiving once weekly treatment for 10 weeks, the treatment group demonstrated
significant improvements in both of these areas. Importantly, the improvements in
autobiographical memory specificity were maintained even after controlling for changes
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in depressive symptoms. However, a similar study by J. Ricarte, Hernández-Viadel,


Latorre, Ros, and Serrano (2014), which also provided autobiographical memory training
based on positive events to patients with schizophrenia, only found evidence of
improvements in autobiographical memory specificity, but not depressive symptoms,
in the treatment group. With regard to cognitive impairment, Lalanne, Gallarda, and
Piolino (2015) provided a cognitive training program focused on autobiographical
memory to 16 patients with early to moderate dementia of the Alzheimer type and
found significant improvements in autobiographical memory performance and mood.
Similarly, Lopes, Afonso, and Ribeiro (2016) conducted an individual reminiscence
program focused on autobiographical memory for 20 older adults with cognitive impair-
ment, which was provided once weekly across a 5-week period. They found that the
treatment group showed better outcomes in autobiographical memory performance,
cognitive functioning (as measured by the Montreal Cognitive Assessment), anxiety, and
depression. To summarize, there have been several studies examining autobiographical
memory training programs, which are aimed at increasing autobiographical memory
specificity. These programs are not only for older adults, but also for other populations,
and in most studies, autobiographical memories have been improved through training
(Lalanne et al., 2015; Lopes et al., 2016; J. Ricarte et al., 2012; J., 2014; Serrano et al.,
2004). In addition, these trainings have not only improved autobiographical memory,
but also cognitive function, anxiety, and depressive symptoms (Lalanne et al., 2015;
Lopes et al., 2016; J. Ricarte et al., 2012; Serrano et al., 2004).
There are a few possible explanations as to why enhancement to autobiographical
memory affects not only autobiographical memory specificity, but also results in corre-
sponding improvements in depressive symptoms and cognition: (a) reductions in auto-
biographical memory specificity reduce one’s ability to imagine the future, which leads
to an increase in hopelessness and depression (Williams et al., 1996). This explanation is
consistent with the current understanding regarding the functional aspects of the DMN,
which closely relate to both autobiographical memory and imagining the future
(Andreasen et al., 1995; Schacter et al., 2007; Spreng et al., 2009); (b) reductions in
autobiographical memory specificity play a role in strengthening negative ruminative
thoughts (e.g., “Why am I such a loser”, “I’m in such a bad mood”, “I just don’t feel like
doing anything”; (Nolen-Hoeksema, 1991)), and, as a result, it exacerbates depressed
mood (Raes et al., 2006, 2005); (c) decreases in autobiographical memory specificity limit
one’s exposure to negative memories and emotions, which although pleasant in the
short term, negatively impacts psychological health in the long term. In particular,
AGING, NEUROPSYCHOLOGY, AND COGNITION 11

reductions in memory specificity represent an avoidant-coping strategy, which contri-


butes to long-term depression (Hermans et al., 2005); (d) decreased autobiographical
memory specificity leads to impairments in problem-solving in social or interpersonal
situations. This explanation is consistent with studies that have reported that reductions
autobiographical memory specificity are related to impairments in executive function
(Piolino et al., 2010). Deficits in problem-solving increase the likelihood that one will
encounter negative situations in social or interpersonal relationships, thereby reducing
opportunities for positive reinforcement and increasing the risk for depression (Evans,
Williams, O’loughlin, & Howells, 1992; Goddard, Dritschel, & Burton, 1996).
Maintaining or improving cognitive functioning in older adults has been a major
topic in recent clinical research, and numerous studies have examined the impact of
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training on the cognitive functions of older adults. In most studies, significant improve-
ments have been observed for the specific tasks used in training or for similar tasks.
However, the impact of training on other cognitive domains or on everyday functioning
is modest at best, sometimes with no effect at all (Ball et al., 2002; Rebok, Carlson, &
Langbaum, 2007). This failure to generalize training outcomes indicates that alternative
cognitive training programs are needed for older adults. In this regard, the processing
training approach is an alternative cognitive training paradigm that should be consid-
ered. This approach uses a set of cognitive tasks that requires heavy cognitive load for
specific cognitive processes and measures improvements in other tasks that are con-
sidered to share the same cognitive process (Ball et al., 1998; Kramer, Larish, & Strayer,
1995; Silsupadol et al., 2009).
The underlying assumption of this approach is that if two different tasks require
strong participation of a particular brain area, then the two tasks are more likely to
reflect the same cognitive process that is dependent on that brain region. In other
words, enhancing performance on one task can improve performance on other tasks
that recruit similar brain regions. These findings have several clinical implications for the
use of autobiographical memory training among older adults (see Figure 1).
Autobiographical memory is associated with activation of the same brain regions
involved in other cognitive functions (e.g., attention, memory, executive function), and
a few studies have shown that autobiographical memory training leads to accompany-
ing improvements in these cognitive functions as well (Lopes et al., 2016; Raes et al.,
2009). Thus, autobiographical memory training may also serve as an effective form of
cognitive training. Although research in this area is still lacking, autobiographical

Figure 1. Treatment model.


12 Y.-C. BAHK AND K.-H. CHOI

memory training has the potential to be useful in improving the cognitive functioning of
older adults and may contribute to overall improvements in their quality of life.
These findings and explanations highlight the importance of autobiographical mem-
ory and the usefulness of autobiographical memory training. However, despite these
advancements, there is still no clear model as to how autobiographical memory training
affects the brain, cognitive functioning, and depression. It is thus necessary to study how
autobiographical memory training affects the brain regions involved (e.g., PCC and
mPFC).

Assessments of autobiographical memory


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Just as there are various cognitive functions, there are many ways to measure autobio-
graphical memory. In this review, we try to summarize the assessments of autobiogra-
phical memory used across autobiographical memory studies.
The autobiographical memory test (AMT; (J. M. Williams & Broadbent, 1986)) has been
used in various autobiographical memory studies. The AMT presents five positive words
and five negative words, and asks the examinee to report specific autobiographical
memories verbally or in writing. Specific personal memories are defined as involving a
clear time or place, having occurred within a day, and occurring at least a week ago.
Positive and negative words are presented alternately by the examiner. Raes, Hermans,
Williams, and Eelen (2007) have classified autobiographical memory as assessed via the
AMT in greater detail: (a) specific memory, (b) categorical memory, (c) extended mem-
ory, (d) no memory, (e) no response, and (f) duplicate reactions. Only the number of
specific memories is counted toward the score.
The autobiographical interview (AI; (Levine et al., 2002)) is an interview measure of
autobiographical memory, which assesses autobiographical memory divided into five
lifetime periods: under 11 years, 11–17 years, 18–35 years, 35–55 years, and the last year.
The examiner provides a list of about 100 typical life events to help participants’ recall. In
the subsequent recall phase, participants describe any incidents in an impromptu
manner without any interference from the examiner. After recall of all events is com-
plete, participants are encouraged to give more specific detail through clear instructions
(e.g., “Is that all you can tell? I wish you could give me a little more detail”), which occurs
at the general probe stage. Scoring is based on the contents that are recorded. To do
this, each memory is divided into detailed information units.
The autobiographical memory interview (Kopelman et al., 1989) is also an interview
measure of autobiographical memory. In this interview, autobiographical memory is
divided into personal episodic memory and personal semantic memory, which are
quantified in different ways. In the case of episodic memory, the same method as the
AI is used. In the case of semantic memory, a structured interview method is used.
The Sentence Completion for Events from the Past Test is an autobiographical
memory measure developed by Raes et al. (2007). The test comprises 11 unfinished
sentence stems, which examinees are asked to complete, after which the examiner
codes the completed sentence into five categories: (a) specific memory, (b) extended
memory, (c) categorical memory (repeated events), (d) semantic memory, or (e)
missing.
AGING, NEUROPSYCHOLOGY, AND COGNITION 13

There are limitations to the currently available autobiographical memory measure-


ment tools. To begin, most of the autobiographical memory measurement tools use an
interview format. In addition, there are no standardized procedures or manuals that
explain the methods for measurement or grading. Yanes, Roberts, and Carlos (2008)
have suggested that reductions in autobiographical memory specificity sometimes occur
as a result of difficulties in keeping the task instructions in working memory. Thus, there
is a need to develop standardized and validated autobiographical measurement tools
that can be used across all populations.

Conclusion
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In conclusion, autobiographical memory specificity decreases with age because of


reduced connectivity of the DMN. Furthermore, the DMN regions involved in autobio-
graphical memory are also involved in cognition and emotion, and, accordingly, aging
not only causes decreases in autobiographical memory performance, but also in cogni-
tive functions, such as attention, memory, and executive function. Lastly, there have
been several studies demonstrating the positive effect that autobiographical memory
training has on autobiographical memory, depression, and cognitive functions, even
though there is less neuroimaging evidence in this area. Further research is needed:
First, there is no research that provides a clear model of the relationship between
autobiographical memory and various cognitive functions. Second, there exists no
large-scale autobiographical memory training study that has used a neurocognitive
battery as an outcome measure. Third, there is no neuroimaging data regarding the
impact of autobiographical memory training on various brain regions.

Disclosure statement
No potential conflict of interest was reported by the authors.

Funding
This research was supported by National Research Foundation of Korea Grant [NRF-
2016R1C1B1015930] to Kee-Hong Choi.

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