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Feelings Without Memory in Alzheimer Disease

Guzmán-Vélez, Edmarie MA*,†; Feinstein, Justin S. PhD†,‡,§; Tranel, Daniel PhD*,†

Cognitive and Behavioral Neurology: September 2014 - Volume 27 - Issue 3 - p 117–129
doi: 10.1097/WNN.0000000000000020
Original Studies

Background: Patients with Alzheimer disease (AD) typically have impaired declarative memory as a result of hippocampal damage early in the disease. Far less is understood about AD’s effect on emotion.

Objective: We investigated whether feelings of emotion can persist in patients with AD, even after their declarative memory for what caused the feelings has faded.

Methods: A sample of 17 patients with probable AD and 17 healthy comparison participants (case-matched for age, sex, and education) underwent 2 separate emotion induction procedures in which they watched film clips intended to induce feelings of sadness or happiness. We collected real-time emotion ratings at baseline and at 3 post-induction time points, and we administered a test of declarative memory shortly after each induction.

Results: As expected, the patients with AD had severely impaired declarative memory for both the sad and happy films. Despite their memory impairment, the patients continued to report elevated levels of sadness and happiness that persisted well beyond their memory for the films. This outcome was especially prominent after the sadness induction, with sustained elevations in sadness lasting for more than 30 minutes, even in patients with no conscious recollection for the films.

Conclusions: These findings indicate that patients with AD can experience prolonged states of emotion that persist well beyond the patients’ memory for the events that originally caused the emotion. The preserved emotional life evident in patients with AD has important implications for their management and care, and highlights the need for caretakers to foster positive emotional experiences.

*Department of Psychology, University of Iowa, Iowa City, Iowa

Department of Neurology, Division of Behavioral Neurology and Cognitive Neuroscience, University of Iowa College of Medicine, Iowa City, Iowa

Department of Psychology, University of Tulsa, Tulsa, Oklahoma

§Laureate Institute for Brain Research, Tulsa, Oklahoma

The sadness and happiness inductions can be obtained for research purposes from coauthor Justin S. Feinstein at

Supported by National Institute of Neurological Disorders and Stroke Grant P01 NS19632 (D.T.), the National Science Foundation Graduate Research Fellowship Program under Grant 1048957 (E.G.-V.), Kiwanis International, the Fraternal Order of Eagles, an American Psychological Association of Graduate Students Basic Psychological Research Grant, and the William K. Warren Foundation.

The authors declare no conflicts of interest.

Reprints: Daniel Tranel, PhD, Department of Neurology, Division of Behavioral Neurology and Cognitive Neuroscience, University of Iowa College of Medicine, 200 Hawkins Drive, Iowa City, Iowa 52242 (e-mail:

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received October 29, 2013

Accepted December 26, 2013

© 2014 by Lippincott Williams & Wilkins.