New Long-Term Encoding in Severely Amnesic Alzheimer's Disease Patients Revealed Through Repeated Exposure to Artistic Items

Background: Encoding of new information is considered to be impossible in people with Alzheimer's disease (PWAD) at a moderate to severe stage. However, a few case studies reported new learning under special circumstances, especially with music. Objective: This article aims at clarifying PWAD's learning capacities toward unknown material under more ecological settings, which is repeated exposure without encoding instruction. Methods: Twenty-three PWAD (Age: m= 84.6(5.2), 5 <= MMSE <= 19) underwent presentations of unknown artistic pieces (targets) through 8 daily individual sessions. These sessions were followed by a test session, during which their knowledge of the targets was assessed through a verbal and behavioral scale (the sense of familiarity scale) against a series of unknown items (distractors). Results: Through this design, we were able to objectify encoding of three types of targets (verses, paintings, and music) against distractors the day after exposure sessions, and 2 months after the last presentation (study 1). Music and paintings were eventually well-encoded by most participants, whereas poems encoding was poorer. When compared to distractors, target items were significantly better recognized. We then compared the recognition of target paintings against two types of painting distractors, either perceptually or semantically related (study 2). The targets were better recognized than all three painting distractors, even when they were very close to the targets. Conclusion: Despite massive anterograde amnesia, our results clearly showed that recognition-based learning without conscious memory of the encoding context is preserved in PWAD at a severe stage, revealed through an increasing sense of familiarity following repeated exposure. These findings could open new perspective both for researchers and clinicians and improve the way we understand and care for PWAD living in healthcare facilities.