Objective To determine whether memory tasks with demonstrated sensitivity to hippocampal function can detect variance related to preclinical Alzheimer disease (AD) biomarkers, we examined associations between performance in 3 memory tasks and CSF beta-amyloid (A beta)(42)/A beta(40) and phosopho-tau181 (p-tau181) in cognitively unimpaired older adults (CU). Methods CU enrolled in the Stanford Aging and Memory Study (n = 153; age 68.78 +/- 5.81 years; 94 female) completed a lumbar puncture and memory assessments. CSF A beta(42), A beta(40), and p-tau181 were measured with the automated Lumipulse G system in a single-batch analysis. Episodic memory was assayed using a standardized delayed recall composite, paired associate (wordpicture) cued recall, and a mnemonic discrimination task that involves discrimination between studied "target" objects, novel "foil" objects, and perceptually similar "lure" objects. Analyses examined cross-sectional relationships among memory performance, age, and CSF measures, controlling for sex and education. Results Age and lower A beta(42)/A beta(40) were independently associated with elevated p-tau181. Age, A beta 42/A beta 40, and p-tau181 were each associated with (1) poorer associative memory and (2) diminished improvement in mnemonic discrimination performance across levels of decreased task difficulty (i.e., target-lure similarity). P-tau mediated the effect of A beta(42)/A beta(40) on memory. Relationships between CSF proteins and delayed recall were similar but nonsignificant. CSF A beta(42) was not significantly associated with p-tau181 or memory. Conclusions Tests designed to tax hippocampal function are sensitive to subtle individual differences in memory among CU and correlate with early AD-associated biomarker changes in CSF. These tests may offer utility for identifying CU with preclinical AD pathology.

Age-related episodic memory decline is characterized by striking heterogeneity across individuals. Hippocampal pattern completion is a fundamental process supporting episodic memory. Yet, the degree to which this mechanism is impaired with age, and contributes to variability in episodic memory, remains unclear. We combine univariate and multivariate analyses of fMRI data from a large cohort of cognitively normal older adults (N=100) to measure hippocampal activity and cortical reinstatement during retrieval of trial-unique associations. Trial-wise analyses revealed that (a) hippocampal activity scaled with reinstatement strength, (b) cortical reinstatement partially mediated the relationship between hippocampal activity and associative retrieval, (c) older age weakened cortical reinstatement and its relationship to memory behaviour. Moreover, individual differences in the strength of hippocampal activity and cortical reinstatement explained unique variance in performance across multiple assays of episodic memory. These results indicate that fMRI indices of hippocampal pattern completion explain within- and across-individual memory variability in older adults.

Memory decline is a key feature of cognitive aging, even among putatively healthy individuals who do not meet clinical criteria for cognitive impairment. However, the magnitude of this decline varies considerably across individuals. Emerging evidence suggests that two hallmark AD pathologies, including the aberrant accumulation of the beta-amyloid (AB) and tau proteins, are present decades before clinical diagnosis of dementia. The Stanford Aging and Memory Study (SAMS) examines the contribution of abnormal AD biomarkers, together with changes in brain structure and function, to individual differences in episodic memory among healthy older adults. Cognitively normal older adults aged 60-88 years (CDR=0) provided molecular (CSF phospho-tau, AB42) biomarkers of Alzheimer's disease (AD) and underwent ultra-high resolution 7T structural MRI and whole-brain high-resolution functional MRI (fMRI). The structural metrics obtained here include CA1-SRLM thickness, ERC thickness, whole hippocampal volume, and DG/CA3 subfield volume. During high-resolution fMRI, participants engaged in encoding and retrieval phases of an associative memory task, yielding univariate measures of regional BOLD activity and multivariate measures of cortical reinstatement during memory retrieval. Behavioural measures of item memory and associative recollection werealso obtained. Functional measures of (a) univariate BOLD activity in the hippocampus and (b) hippocampal-mediated cortical reinstatement in ventral temporal and parietal cortex during memory retrieval explained significant variance in associative memory performance across participants. CSF AB42 exhibited a marginally significant positive relationship with associative memory and neuropsychological tests of delayed recall, and a significant positive relationship with CA1-SRLM thickness, DG/CA3 volume, and total hippocampal volume; by contrast, p-tau showed a significant negative relationship with reduced CA1-SRLM thickness. These initial results suggest that the presence of abnormal AD biomarkers exert early effects on both hippocampal microstructure and individual differences in memory among cognitively normal older adults. The results also reveal that fMRI assays of hippocampal-mediated retrieval processes partially explain individual differences in memory performance. Ongoing analyses will further examine the relationships between age-related changes in the functional and structural integrity of the hippocampus and MTL cortex, continuous levels of CSF AB42 and p-tau, and their unique or combined contributions to individual differences in episodic memory in cognitively normal older adults.

Population Health ManagementVol. 21, No. 1 Point of ViewOpen AccessAdvancing Health Systems and Pharmaceutical Relations: Best Practices for Population HealthRichard G. Stefanacci and Scott GuerinRichard G. StefanacciGovernment Policy Systems and Analytics, The Access Group, Berkeley Heights, New Jersey.College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania.Search for more papers by this author and Scott GuerinGovernment Policy Systems and Analytics, The Access Group, Berkeley Heights, New Jersey.Search for more papers by this authorPublished Online:1 Feb 2018https://doi.org/10.1089/pop.2017.0022AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Health systems continue to become bigger, gaining market clout as evidenced by PricewaterhouseCooper proclaiming 2016 “the year of merger mania.”1 As health systems expand, a corresponding trend has emerged to increase the level of risk and clinical integration, with a shift in focus to efficient and effective population health management.This shift in focus was demonstrated in a national survey we conducted with 27 executives from a wide range of health systems in terms of location, size, and level of integration. Perhaps the most telling response was related to the level of clinical integration in their organizations now versus 3, 5, and 10 years in the future on a scale of 0 (no integration/risk) to 5 (full risk integrated). On average, the health systems indicated they were currently at a level of 2.5, but would steadily increase to a full risk integrated model similar to Kaiser Health System over the next decade (unpublished data; The Access Group Integrated Health System Survey; September 26, 2016).Success for full-risk integrated health systems relies on thoughtful management of all aspects of care including pharmaceutical treatments, and on this point, health system respondents expressed a strong interest in controlling outpatient treatment selections across several patient populations over the next several years (Fig. 1). Importantly, a follow-up question indicated that the organizations are very confident that they will gain this control. Most likely, the driver of this change is the anticipation of accepting a higher level of risk, with outcomes tied to improving clinical and financial outcomes.FIG. 1. Desire to control outpatient treatment selections. ACO, accountable care organization. Source: Data on file. Integrated Health System Survey. September 26, 2016. The Access Group.Part of health systems' management of pharmaceuticals can come from their development and enforcement of preferred outpatient drug lists. The executives participating in this survey agreed that this will be a strong trend over the next 3 to 5 years and project that the use of outpatient drug lists will almost double during this time frame. Leading factors in determining an outpatient preferred drug list center on delivery of accountable outcomes, overall reduction in total cost of care, and improved efficacy over competitor treatments. The impact on patient quality of life was rated last on the list of factors.Health System Management of PharmaceuticalsHealth systems evaluate and manage pharmaceuticals differently than traditional managed care organizations (MCO). MCOs are focused on contracting for price, whereas health systems can create contracts based on unique service offerings, especially given that many are not yet payers so contracting for price would not be possible. In addition, treatment decisions in MCOs are typically made by pharmacy directors with annual contracts compared with the multiyear contracts made by chief medical officers in health systems. The 2 models also differ in their ability to influence provider and patient behavior. MCOs can set formularies and treatment protocols offering financial incentives for provider compliance. Patients can be encouraged by their physicians to adhere to their treatment plan by engaging them in the decision-making process. But health systems have more control levers at their disposal. For example, health systems formularies and treatment guidelines can be embedded in a system's electronic medical records that are set to guide clinical decisions to specific protocols and treatment options. Also, health system patient portals can be used to direct patients to the clinical options the health system has adopted in addition to offering patient education, adherence programs, and communication options; these portals tend to be more trusted than those of MCOs.Model for Successful Health System Pharmaceutical PartnershipTraditionally, pharmaceutical manufacturers have concentrated on gaining access through payers via their marketing and educational efforts focused solely on their product. In contrast, the health system has a much broader view than a single treatment, which places emphasis on prevention and addressing changes in lifestyle that help limit diseases from progressing to the point that requires clinical intervention. This focus comes from the health system's greater emphasis on population health management and provider integration than a traditional payer. The population health perspective emphasizes the idea that if more resources are deployed “upstream” to increase disease awareness, modify lifestyle behavior, and increase preventive action, the cost savings will be substantial because the “downstream” medical costs will be minimized or avoided.Pharmaceutical manufacturers that understand this broader perspective and the specific needs of health systems can be viewed as a true partner providing a service solution, rather than simply a drug sales organization selling a product. A few manufacturers are seeing this trend and responding by establishing field teams and internal departments that specifically target health systems with tools and resources to support population health. These resources include disease-specific patient education, screening and prevention materials, decision-support tools, and field training to educate the account teams on how to speak to health systems in terms that are important to them. This approach of engaging a health system begins with the manufacturer first articulating value by demonstrating how its treatment aligns with the goals of the health system. This would include the clinical background information typically found in product background presentations, in addition to any health economic and outcomes research data. The population health materials and resources can then be introduced to support the health system's broader focus in managing the disease. One difficulty for manufacturers when approaching health systems about population health resources is that initial materials should be above brand, avoiding branded product information. Specific product mentions can raise issues around the legitimacy of the tools and materials, possibly skewing the information and steering people to a specific product, rather than providing population health solutions.An additional manufacturer's approach to health systems can come from providing tools to help change the behavior of both providers and patients. The product value story is an essential first step to provide a reason to make a change; however, as already mentioned, health systems have the advantage of being able to format their electronic medical record systems and patient portals. For providers, these systems can contain features to enforce adherence to a preferred formulary, flag missed appointments or refills, and present clinical data that indicate clinical action. Patient portals can serve as appointment reminders and contain adherence tools, along with disease- and treatment-specific information.As health systems continue to expand and evolve to address the health of populations, the way pharmaceutical manufacturers interact with them is changing as well, with both groups moving from transactional fee for service to value-based offerings. Manufacturers are beginning to adapt to this new environment by becoming a true partner to health systems through providing resources that align with the system's clinical and business priorities. Most importantly, manufacturers are providing effective services to help change provider and patient behavior to ultimately improve the health of populations.Author Disclosure StatementThe authors are employees of The Access Group that funded the survey.Reference1 PwC. Merger Mania, Drug Pricing and New Tech: PwC's Health Research Institute List of Top Health Industry Trends for 2016 (News Release). December 9, 2015. www.pwc.com/us/en/press-releases/2015/pwc-top-health-issues-2016-press-release.html Accessed January 25, 2017. Google ScholarFiguresReferencesRelatedDetails Volume 21Issue 1Feb 2018 InformationCopyright 2018, Mary Ann Liebert, Inc.To cite this article:Richard G. Stefanacci and Scott Guerin.Advancing Health Systems and Pharmaceutical Relations: Best Practices for Population Health.Population Health Management.Feb 2018.4-5.http://doi.org/10.1089/pop.2017.0022creative commons licensePublished in Volume: 21 Issue 1: February 1, 2018Online Ahead of Print:March 15, 2017PDF download

Population Health ManagementVol. 21, No. 5 CommentariesThe Psychology Behind Population Health ManagementScott Guerin and Richard G. StefanacciScott GuerinAddress correspondence to:Scott Guerin, PhDThe Access Group400 Connell Drive, 2nd FloorBerkeley Heights, NJ 07922E-mail Address: sguerin@theaccessgp.comFaculty in the Psychology Department, Kean University, Union, New Jersey.The Access Group, Berkeley Heights, New Jersey.Search for more papers by this author and Richard G. StefanacciThe Access Group, Berkeley Heights, New Jersey.Faculty in the College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania.Search for more papers by this authorPublished Online:26 Sep 2018https://doi.org/10.1089/pop.2017.0147AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"The Psychology Behind Population Health Management." Population Health Management, 21(5), pp. 344–345FiguresReferencesRelatedDetailsCited byThe Role of Prevention in Healthy AgingClinics in Geriatric Medicine, Vol. 36, No. 4 Volume 21Issue 5Oct 2018 InformationCopyright 2018, Mary Ann Liebert, Inc., publishersTo cite this article:Scott Guerin and Richard G. Stefanacci.The Psychology Behind Population Health Management.Population Health Management.Oct 2018.344-345.http://doi.org/10.1089/pop.2017.0147Published in Volume: 21 Issue 5: September 26, 2018Online Ahead of Print:November 30, 2017Keywordshealth psychologycare continuumpopulation health managementpatient engagementPDF download

Population Health ManagementVol. 21, No. 3 CommentaryThe Electronic Health Record Foundation for Pharmaceutical ManagementRichard G. Stefanacci, Scott Guerin, and Tim Van AkenRichard G. StefanacciFaculty in the College of Population Health at Thomas Jefferson University, The Access Group, Berkeley Heights, New Jersey.Search for more papers by this author, Scott GuerinGovernment Policy Systems & Analytics, The Access Group, Berkeley Heights, New Jersey.Search for more papers by this author, and Tim Van AkenHealth IT Lead, Kameleon Partners, Solon, Ohio.Search for more papers by this authorPublished Online:1 Jun 2018https://doi.org/10.1089/pop.2017.0103AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"The Electronic Health Record Foundation for Pharmaceutical Management." Population Health Management, 21(3), pp. 170–171FiguresReferencesRelatedDetails Volume 21Issue 3Jun 2018 InformationCopyright 2018, Mary Ann Liebert, Inc.To cite this article:Richard G. Stefanacci, Scott Guerin, and Tim Van Aken.The Electronic Health Record Foundation for Pharmaceutical Management.Population Health Management.Jun 2018.170-171.http://doi.org/10.1089/pop.2017.0103Published in Volume: 21 Issue 3: June 1, 2018Online Ahead of Print:August 22, 2017PDF download

Even though physicians make the correct diagnoses and prescribe the right treatments, it doesn’t mean patients will fill their prescriptions and take every pill. There are several points along the patient journey where people get sidetracked and stop taking their medications. Making matters worse, as managed care plans increase the out-ofpocket expenses for patients in efforts to reduce their pharmaceutical expenditures, optimum treatment outcomes are increasingly being lost. In the short run, shifting costs to patients may result in lower pharmaceutical costs for a health plan, but it may actually mean higher overall medical expenditures. Direct costs related to people not taking their medication as prescribed have been estimated at over $100 billion dollars annually. Lack of adherence is associated with a 30% to 50% increase in treatment failures. Here are some common factors that can affect treatment adherence: Understanding the importance of treatment. Physicians often don’t get a chance to fully explain the importance of taking medications as prescribed because of the limited time they have with patients. A patient’s perception of the value of a drug and her beliefs about whether it can improve her health make up a major factor affecting adherence. Some basic motivational interviewing skills and tools can help clinicians engage patients in their treatment, which has been shown to have a strong influence on adherence. Ability to pay. The cost of prescription drugs represents a significant barrier to adherence. Unfortunately, out-of-pocket (OOP) costs have been increasing for some time, growing by nearly 40% from 1996 to 2005, and data show that they continued to climb after that. The ACA slowed the trend, but it is expected to pick up again in the next decade. Medicare Part D protects low-income enrollees from high OOP costs. But for the other beneficiaries in traditional Medicare with Part D coverage, it’s a different story. For them, the OOP costs are 100% of the cost of medications until they meet their deductible, 25% during the initial benefit, 45% in the “donut hole” coverage gap, and then 5% when their spending reaches the catastrophic phase of their coverage. Helping people take their meds. Of course, there’s still an enormous gap between having medications and actually taking them and even a wider gap between taking them as directed. This is fertile territory for innovation and for integration of digital technology into the health care system. A number of smartphone-based apps prompt people to take their pills. Some work wirelessly with specially designed pill bottles. A company called AiCure has developed a facial recognition app that works by people taking pictures of themselves as they take their medication. Automated medication dispensing machines used in hospitals have been adapted for home use. In some cases, adherence technologies go beyond simple reminders, reinforcing messages about the value of the medication or addressing psychological adherence barriers.

Perception has a clear temporal structure: each stimulus is preceded and followed by other stimuli. However, we may think about recently encountered stimuli in a temporal order that deviates from the perceptual input. How does the brain generate and maintain distinct representations of temporal structure associated with perception and reflection? In this experiment, we constructed a task that dissociates the temporal structure of perception and reflection. Participants viewed one face and one scene (2 s each) in one of two sequences: Face-Scene or Scene-Face. Following perception, participants were cued to direct their internal attention towards one then the other of the just-seen stimuli (refreshing, Johnson et al., 2005). Participants were instructed to imagine the picture as vividly as possible and answer a question about it (Male/Female or Indoor/Outdoor). Each refresh period lasted 2 s. On half the trials, participants refreshed the pictures in the same order they were perceived. On the other half of trials, participants refreshed the pictures in the reverse order. We applied multi-voxel pattern analysis to decode the temporal structure of perception and reflection. Based on an initial analysis of 12 participants, and consistent with our previous findings, we were able to decode the temporal structure of perception above chance in occipital, ventral temporal, and parietal cortices (all p < .001), with a trend in prefrontal cortex (p = .06). Critically, we were also able to decode the temporal structure of reflection in occipital, ventral temporal, parietal (all p < .01), and prefrontal cortices (p < .05). Consistent with previous studies indicating that perception and reflection share overlapping visual representations, our results indicate that perception and reflection share common neural machinery for the representation of temporal structure. Meeting abstract presented at VSS 2015.

The load theory of visual attention proposes that efficient selective perceptual processing of task-relevant information during search is determined automatically by the perceptual demands of the display. If the perceptual demands required to process task-relevant information are not enough to consume all available capacity, then the remaining capacity automatically and exhaustively “spills-over” to task-irrelevant information. The spill-over of perceptual processing capacity increases the likelihood that task-irrelevant information will impair performance. In two visual search experiments, we tested the automaticity of the allocation of perceptual processing resources by measuring the extent to which the processing of task-irrelevant distracting stimuli was modulated by both perceptual load and top-down expectations using behavior, functional magnetic resonance imaging, and electrophysiology. Expectations were generated using a trial-by-trial cue that provided information about the likely load of the upcoming visual search task. When the cues were valid, behavioral interference was eliminated and the influence of load on frontoparietal and visual cortical responses was attenuated relative to when the cues were invalid. In conditions in which task-irrelevant information interfered with performance and modulated visual activity, individual differences in mean blood oxygenation level dependent responses measured from the left intraparietal sulcus were negatively correlated with individual differences in the severity of distraction. These results are consistent with the interpretation that a top-down biasing mechanism interacts with perceptual load to support filtering of task-irrelevant information.

Environmental context learned without awareness can facilitate visual processing of goal-relevant information. According to one view, the benefit of implicitly learned context relies on the neural systems involved in spatial attention and hippocampus-mediated memory. While this view has received empirical support, it contradicts traditional models of hippocampal function. The purpose of the present work was to clarify the influence of spatial context on visual search performance and on brain structures involved memory and attention. Event-related functional magnetic resonance imaging revealed that activity in the hippocampus as well as in visual and parietal cortex was modulated by learned visual context even though participants' subjective reports and performance on a post-experiment recognition task indicated no explicit knowledge of the learned context. Moreover, the magnitude of the initial selective hippocampus response predicted the magnitude of the behavioral benefit due to context observed at the end of the experiment. The results suggest that implicit contextual learning is mediated by attention and memory and that these systems interact to support search of our environment.

People often falsely recognize items that are similar to previously encountered items. This robust memory error is referred to as gist-based false recognition. A widely held view is that this error occurs because the details fade rapidly from our memory. Contrary to this view, an initial experiment revealed that, following the same encoding conditions that produce high rates of gist-based false recognition, participants overwhelmingly chose the correct target rather than its related foil when given the option to do so. A second experiment showed that this result is due to increased access to stored details provided by reinstatement of the originally encoded photograph, rather than to increased attention to the details. Collectively, these results suggest that details needed for accurate recognition are, to a large extent, still stored in memory and that a critical factor determining whether false recognition will occur is whether these details can be accessed during retrieval. False
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 INTRODUCTION Human memory is not a literal reproduction of the past, like a photograph or film, but rather a constructed representation of past experience that is influenced by a variety of factors related to the originally encoded event, including general knowledge, personal biases, information from other events, and inferences (Bartlett, 1932; Johnson, 1997; Johnson, Hashtroudi, & Lindsay, 1993; Loftus, 1979, 2003; Roediger, 1996; Schacter, Norman, & Koutstaal, 1998). These constructive processes presumably lead to functionally beneficial representations of the past, but they also cause memory to be prone to error (Schacter, 1999, 2001) The mistaken recognition of an item that is similar, but not identical, to a previously encountered item is a ubiquitous and robust memory error referred to as gist-based false recognition (Koutstaal & Schacter, 1997; cf., Reyna & Brainerd, 1995). For instance, people tend to mistakenly recognize a word that is a synonym of a studied word (Anisfeld & Knapp, 1968), an abstract shape that is structurally similar to studied shapes (Koutstaal, Schacter, Verfaellie, Brenner, & Jackson, 1999; Slotnick & Schacter, 2004), or a pictured object that has the same verbal label as a studied item (Koutstaal, 2006). In these cases, people fail to remember the specific details of an event but can remember more abstracted information — the “gist” — such as the superordinate category of an encountered object. One possibility is that these errors occur because the original details have been lost from memory, either because they were not encoded originally or because the memory trace has degraded over time. Then, at retrieval, the system relies on more abstract information to reconstruct the lost details. This line of thinking has been implicit in much of the literature. For instance, in the Constructive Memory Framework put False
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 forward by Schacter et al. (1998), it was proposed that gist-based false recognition results primarily from a failure of pattern separation, a process that occurs during encoding. Thus, according to this proposal, gist-based false recognition occurs in large part because the details were not adequately encoded in the first place. Brainerd and Reyna’s (2002) Fuzzy Trace Theory proposed that verbatim details are forgotten more rapidly than gist information, a combination that contributes to gist-based false recognition (see also Reyna & Brainerd, 1995). However, it is also known that people can store an impressive amount of information, particularly about recently encountered pictures or objects. For example, Standing (1973) demonstrated that people could recognize thousands of experimentally presented pictures. More recently, Brady et al. (2008) had participants study 2,896 pictures of objects shown for 3 s each. In a forced-choice test, participants were asked to make subtle distinctions based on memory: the foil was the same object as the studied item, but in a slightly different state (e.g., a bread box with the loaf of bread inside the box or outside the box). Participants scored 87% correct in this condition, suggesting that people can store a large amount of detailed information about recently encountered objects (see also Konkle, Brady, Alvarez, & Oliva, 2010). These findings present a puzzle. On the one hand, a large body of data on false recognition suggests that the detail stored in episodic memory is limited and that memory relies heavily on constructive processes to compensate for this limitation. On the other hand, the findings concerning highly specific recognition of visual objects suggest that the level of detail stored in episodic memory is far greater than what would have been False
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 expected on the basis of the false recognition findings. Here we attempt to reconcile these seemingly contradictory results. We suggest that, even when rates of false recognition are high, people do retain many details, but do not adequately utilize them at retrieval. In two experiments, we explored the hypothesis that high rates of false recognition occur when people do not attend to or do not retrieve the relevant perceptual details. To this end, we developed an experimental paradigm that encouraged participants to focus on the relevant perceptual details. EXPERIMENT 1 Method Rationale and Design The conditions of the memory test are depicted in Figure
1. On each trial, the participant was presented with three pictures. Two of the pictures were related to one another because they were both exemplars of the same category and shared a common verbal label. It is important to note that the conditions did not differ systematically in terms of their perceptual presentation; they differed only in terms of the content of the participant’s memory. The participant’s task was to select one of the items as studied or reject all three items as new (“all new”). In the baseline target condition, one of the pictures was a target (studied item) and the other two items were not systematically related to any of the studied items. In the baseline lure condition, all three items were not systematically related to any of the studied items and the correct response was “all new”. In the single related item condition, one of the pictures was related to a studied item. The other two items were not systematically related to any of the studied items. The correct False
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 response was “all new”, but we anticipated that participants would falsely recognize the related item with high frequency, reflecting a standard gist-based false recognition effect. In the target and related item condition, the target was presented adjacent to the related item. The third item was not systematically related to any of the studied items. In this condition, the nature of the discrimination required was made explicit to the participant. Both the target and the related lure were likely to seem familiar, thus requiring that the participant systematically compared the target and related lure and identified features that distinguished them. If gist-based false recognition occurs because people fail to attend to or retrieve relevant perceptual details still stored in memory, then false recognition rates should be substantially reduced in this condition. Participants 32 college students (15 male, ages 18-29, mean 22) from the Boston metropolitan area served as participants and were paid $70 (participants were scanned with functional MRI during the experiment; the imaging data will be presented in a separate report). Candidates were excluded for participation that did not meet standard MRI safety criteria, required glasses to see normally, had strabismus or a history of eye surgery, or that were left handed. All participants provided informed consent as approved by the Institutional Review Board at Harvard University. Nine participants were replaced: 4 for poor performance (hits minus false alarms less than .30); 3 for eye tracking problems; 2 for anatomical abnormalities. Stimulus Materials 384 pairs of object photographs or detailed, colored drawings served as stimuli (Koutstaal, 2006; Koutstaal, et al., 2001). The items within a pair were related to each False
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 other because they were both exemplars of the same category and shared a common verbal label (e.g., wrench, dog, tree). However, the two pictures were perceptually distinct exemplars of the category and, at a minimum, differed in terms of color or orientation. Stimuli were fully counterbalanced (Supplementary Methods). Procedure Participants were told that their memory would be tested later and were presented with 144 objects (500 ms duration, 1500 ms ISI) and indicated whether the pictured object could fit into a 13 inch box in the real world by a button press. A box measuring approximately 13 inches was presented. The participant was given a self-paced break halfway through the study session. Then the participant was placed in an MRI scanner. The occurrence of similar foils was clearly explained to the participant. The test was divided into four blocks; each began with 15 s of fixation and ended with 10 s of fixation and contained 12 trials of each condition. Each trial lasted 5 s. With the constraint that the two related items were next to each other, there were four possible arrangements of the pictures; each occurred equally often within each block. 24 fixation trials, also lasting 5 s, were randomly intermixed within each block. Results Accuracy The accuracy data are shown in Figure
2 (reaction times are reported in Supplementary
Table
1). Within the baseline target condition, the hit rate was reasonably high (.76, SEM = .02, green bar). Within the baseline foil condition, the correct rejection rate was reasonably high (.69, SEM = .03, blue bar). Therefore, participants performed the task well. False
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People often falsely recognize items that are similar to previously encountered items. This robust memory error is referred to as gist-based false recognition. A widely held view is that this error occurs because the details fade rapidly from our memory. Contrary to this view, an initial experiment revealed that, following the same encoding conditions that produce high rates of gist-based false recognition, participants overwhelmingly chose the correct target rather than its related foil when given the option to do so. A second experiment showed that this result is due to increased access to stored details provided by reinstatement of the originally encoded photograph, rather than to increased attention to the details. Collectively, these results suggest that details needed for accurate recognition are, to a large extent, still stored in memory and that a critical factor determining whether false recognition will occur is whether these details can be accessed during retrieval.

The interaction between episodic retrieval and visual attention is relatively unexplored. Given that systems mediating attention and episodic memory appear to be segregated, and perhaps even in competition, it is unclear how visual attention is recruited during episodic retrieval. We investigated the recruitment of visual attention during the suppression of gist-based false recognition, the tendency to falsely recognize items that are similar to previously encountered items. Recruitment of visual attention was associated with activity in the dorsal attention network. The inferior parietal lobule, often implicated in episodic retrieval, tracked veridical retrieval of perceptual detail and showed reduced activity during the engagement of visual attention, consistent with a competitive relationship with the dorsal attention network. These findings suggest that the contribution of the parietal cortex to interactions between visual attention and episodic retrieval entails distinct systems that contribute to different components of the task while also suppressing each other.

The false memory effect produced by the Deese/Roediger & McDermott (DRM) paradigm is reportedly impervious to warnings to avoid false alarming to the critical lures (D. A. Gallo, H. L. Roediger III, & K. B. McDermott, 2001). This finding has been used as strong evidence against models that attribute the false alarms to a decision process (e.g., M. B. Miller & G. L. Wolford, 1999). In this report, the authors clarify their earlier article and suggest that subjects establish only 2 underlying criteria for a recognition judgment, a liberal criterion for items that seem to be related to 1 of the study list themes and a conservative criterion for items that do not seem to be related. They demonstrate that warnings designed on the basis of these underlying criteria are effective in significantly suppressing the false recognition effect, suggesting that strategic control of the retrieval response does play a role in the DRM paradigm.

Memory is prone to distortions that can have serious consequences in everyday life. Here we integrate emerging evidence that several types of memory distortions imagination inflation, gist-based and associative memory errors, and post-event misinformation - reflect adaptive cognitive processes that contribute to the efficient functioning of memory, but produce distortions as a consequence of doing so. We consider recent cognitive and neuroimaging studies that link these distortions with adaptive processes, including simulation of future events, semantic and contextual encoding, creativity, and memory updating. We also discuss new evidence concerning factors that can influence the occurrence of memory distortions, such as sleep and retrieval conditions, as well as conceptual issues related to the development of an adaptive perspective.