Deficits in recent but not lifetime familiarity in amnestic mild cognitive impairment.

People with amnestic mild cognitive impairment (aMCI) repeat questions, seemingly without any sense of familiarity (i.e., recognition of prior occurrence without recollection of episodic context). Accumulation of neurofibrillary tau in preclinical Alzheimer's disease begins in perirhinal cortex, a medial temporal lobe region linked to familiarity. Both observations would predict impaired familiarity assessment in aMCI; however, the extant evidence is mixed. To reveal familiarity impairments, it may be necessary to minimize the influence of recollection. In the current study, older adults with aMCI and healthy controls were administered two tasks on which a well-characterized patient (NB) with selective familiarity impairments due to surgical left temporal lobe excision sparing the hippocampus showed abnormal performance: frequency judgments for words exposed to in a recent study phase and judgments of cumulative lifetime familiarity for object concepts denoted by words. We also administered a process dissociation procedure (PDP) task that previously revealed spared familiarity in aMCI. We predicted that familiarity would be spared in aMCI on the PDP task, but impaired when assessed by frequency judgments for recent laboratory exposures and lifetime familiarity judgments. Familiarity was spared on the PDP task, but was impaired when probed with frequency judgments for recently exposed words in aMCI. Lifetime familiarity was also not impaired in aMCI. These results highlight the benefits of studying familiarity under conditions that minimize recollection and the value of frequency judgments in revealing familiarity deficits, and suggest that perirhinal cortex may not be necessary for accessing familiarity accumulated over a lifetime of experience.