Visual working memory impairments for single items following medial temporal lobe damage.

A growing body of research indicates that the medial temporal lobe (MTL) is essential not only for long-term episodic memory but also for visual working memory (VWM). In particular, recent work has shown that the MTL is especially important for VWM when complex, high-resolution binding is required. However, all of these studies tested VWM for multiple items which invites the possibility that working memory capacity was exceeded and patient impairments instead reflected deficits in long-term memory. Thus, the precise conditions under which the MTL is critical for VWM and the type of working memory processes that are affected by MTL damage are not yet clear. To address these issues, we examined the effects of MTL damage on VWM for a single item (i.e., a square that contained color, location, and orientation information) using confidence-based receiver operating characteristic methods to assess VWM discriminability and to separate perceiving- and sensing-based memory judgments. This approach was motivated by dual-process theories of cognition that posit distinct subprocesses underlie performance across perception, working memory, and long-term memory. The results indicated that MTL patients were significantly impaired in VWM for a single item. Interestingly, the patients were not impaired at making accurate high-confidence judgments that a change had occurred (i.e., perceiving), rather they were impaired at making low-confidence judgments that they sensed whether or not there had been a change in the absence of identifying the exact change. These results demonstrate that the MTL is critical in supporting working memory even for a single item, and that it contributes selectively to sensing-based discriminations.