title: Mechanism of disorientation: reality filtering versus content monitoring.
abstract: Disorientation is frequent after brain damage. It is a constituent component of post-traumatic amnesia and was part of the original definition of the Korsakoff syndrome, together with amnesia and confabulations. Orbitofrontal reality filtering is a pre-conscious memory control process that has been held accountable for disorientation and a specific type of confabulations that patients act upon. A recent study questioned the specificity of this process and suggested that confabulating patients who failed in orbitofrontal reality filtering similarly failed to monitor the precise content of memories, a critical step within the strategic retrieval account, which describes a series of processes leading up to the recollection of memories. In the present study we combined the proposed experimental requirements of both processes in a single continuous recognition task and tested a group of 21 patients with a matched deficit of delayed free recall. We found that only deficient reality filtering, but not content monitoring, significantly correlated with disorientation and distinguished between confabulators and non-confabulators. Thus, reality confusion, as evident in disorientation and behaviourally spontaneous confabulation, primarily reflects an inability to monitor memories' relation with ongoing reality rather than to monitor their precise content.
authors.affiliation: Laboratory of Cognitive Neurorehabilitation, Department of Clinical Neurosciences, Medical School, University of Geneva, Geneva, Switzerland.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Bouzerda-Wahlen
authors.forename: Louis
authors.initials: L
authors.lastname: Nahum
authors.forename: Radek
authors.initials: R
authors.lastname: Ptak
authors.forename: Armin
authors.initials: A
authors.lastname: Schnider
mesh_terms: D000328:Adult; D000368:Aged; D000647:Amnesia / Q000523:psychology; D003221:Confusion / Q000523:psychology*; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D007858:Learning; D008297:Male; D008568:Memory / Q000502:physiology; D011939:Mental Recall / Q000502:physiology; D008875:Middle Aged; D009483:Neuropsychological Tests; D009949:Orientation / Q000502:physiology; D010465:Perception / Q000502:physiology; D011597:Psychomotor Performance / Q000502:physiology; D014145:Trail Making Test; D014705:Verbal Behavior
keywords: Disorientation; Extinction; False memory; Orbitofrontal cortex; Post-traumatic amnesia; Strategic retrieval account