The Relationship Between Autobiographical Memory, Cognition, and Emotion in Older Adults: A Review
The Relationship Between Autobiographical Memory, Cognition, and Emotion in Older Adults: A Review
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
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AGING, NEUROPSYCHOLOGY, AND COGNITION, 2017
https://doi.org/10.1080/13825585.2017.1377681
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.
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
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.
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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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.
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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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
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).
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
Conclusion
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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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