Slowly Forgetting: ALF

Illustration by Shaumya Sankar

If you’re a student of psychology, then you’ve probably heard of HM, or Henry Molaison. He’s the person behind one of the most famous case studies in cognitive psychology, who lost his ability to form new memories after brain surgery. Memory research is one of the areas of psychology where case studies continue to offer significant opportunities for advancing the field. A contemporary example is the phenomenon known as accelerated long-term forgetting (ALF), which was first discussed in the form of a case report. A patient had suffered brain hypoxia, meaning that he had been depleted of oxygen for a period of time, causing brain damage. After this episode, his anterograde memory, that is his ability to create new memories and then recall them,  was deeply changed. 

Initial testing revealed an almost perfect retention of information at short delay intervals. However, when the time between learning and recalling grew larger, it was clear he was forgetting things at a pathological rate (De Renzi & Lucchelli, 1993). In short, ALF Patients show fast decay of recently learned information, but only after a long period of time. In clinical practice, most standardized memory tests focus on episodic memory. They measure performance using verbal and figural recall or recognition tasks. Recall is usually tested after a delay of approximately 20-30 minutes. This is not long enough to detect ALF. The pathological forgetting usually does not become apparent until approximately 24 hours (Savage et al., 2019). 

Most cases of ALF are reported in relation with different forms of epilepsy, but ALF has also been associated with other diseases. For example, in a study by Weston and colleagues (2018), it is suggested that ALF may be an early, presymptomatic feature of Alzheimer’s disease. It also occurs in individuals with transient ischemic attacks (a sort of ministroke), or after severe traumatic brain injury. 

Studies suggest that ALF is most likely an impairment of memory consolidation, rather than memory encoding (Hoefeijzers et al., 2013). Memory consolidation, or the stabilization of a memory after its encoding,  occurs over days and weeks (Chambers, 2017). The standard model of consolidation (Squire & Alvarez, 1995) assumes two phases of consolidation, which Mayes and colleagues (2003) also refer to as “fast” and “slow” consolidation. In the first, early phase of consolidation, the medial temporal lobe (MTL) with structures such as the hippocampus is considered central. As you might remember, HM had large parts of both his hippocampus removed. Within this model, we can assume that he was not able to start the early phase of consolidation.  

In the second, later phase of consolidation, memories are reorganized to be supported by the neocortex and eventually become independent of the MTL.
For this reason, research on ALF examining prolonged retrieval delays may be useful in gaining insight into the processes that are important for successful maintenance of information in long-term memory (Butler et al., 2019). 

In terms of the structures involved the hippocampus has a central role in both encoding and retrieval of information (Atherton et al., 2019). Some studies have found an association between ALF and hippocampal abnormalities. That being said, the picture is more complicated than trouble in the hippocampus = ALF. While hippocampal volume correlates with forgetting over short periods of time, meaning that smaller hippocampuses are associated with more forgetting, there is no such relationship in the brains of ALF in patients with memory loss brought on by epilepsy. Thus, it  seems that hippocampal dysfunction alone is not sufficient to explain ALF (Helmstaedter et al., 2019). Indeed., ALF has been found predominantly in tasks involving word lists and visual designs. Both types of stimuli affect item memory, which is supported by extra-hippocampal regions (Ranganath & Ritchey, 2012), underlining how this problem stretches beyond the hippocampus. This has stimulated research into the relevance of extrahippocampal regions (Mameniškienė et al., 2020). 

ALF continues to be an elusive diagnosis, but as research continues, we get a better understanding of how our brain shapes the inner workings of our memory. In the same vein, it’s important not to forget the patients. By continuing research, we can hope to one day be able to provide a better diagnosis, and who knows, maybe even treatment? A first step would be to implement more sophisticated tests for memory, going beyond the current 20-30 minutes recall delay. 


Atherton, K. E., Filippini, N., Zeman, A., Nobre, A. C., & Butler, C. R. (2019). Encoding-related brain activity and accelerated forgetting in transient epileptic amnesia. Cortex; a journal devoted to the study of the nervous system and behavior, 110, 127–140.

Butler, C., Gilboa, A., & Miller, L. (2019). Accelerated long-term forgetting. Cortex; a journal devoted to the study of the nervous system and behavior, 110, 1–4.

Chambers A. M. (2017). The role of sleep in cognitive processing: focusing on memory consolidation. Wiley interdisciplinary reviews. Cognitive science, 8(3), 10.1002/wcs.1433.

De Renzi, E., & Lucchelli, F. (1993). Dense retrograde amnesia, intact learning capability and abnormal forgetting rate: A consolidation deficit? Cortex: A Journal Devoted to the Study of the Nervous System and Behavior, 29(3), 449–466.

Helmstaedter, C., Winter, B., Melzer, N., Lohmann, H., & Witt, J. A. (2019). Accelerated long-term forgetting in focal epilepsies with special consideration given to patients with diagnosed and suspected limbic encephalitis. Cortex; a journal devoted to the study of the nervous system and behavior, 110, 58–68.

Hoefeijzers, S., Dewar, M., Della Sala, S., Zeman, A., & Butler, C. (2013). Accelerated long- term forgetting in transient epileptic amnesia: an acquisition or consolidation deficit?. Neuropsychologia, 51(8), 1549–1555.

Mameniškienė, R., Puteikis, K., Jasionis, A., & Jatužis, D. (2020). A Review of Accelerated Long-Term Forgetting in Epilepsy. Brain sciences, 10(12), 945.

Mayes, A. R., Isaac, C. L., Holdstock, J. S., Cariga, P., Gummer, A., & Roberts, N. (2003). Long-term amnesia: A review and detailed illustrative case study. Cortex: A Journal Devoted to the Study of the Nervous System and Behavior, 39(4-5), 567–603. 9452(08)70855-4

Ricci, M., Mohamed, A., Savage, G., & Miller, L. A. (2015). Disruption of learning and long-term retention of prose passages in patients with focal epilepsy. Epilepsy & behavior : E&B, 51, 104– 111.

Ranganath, C., & Ritchey, M. (2012). Two cortical systems for memory-guided behaviour. Nature reviews. Neuroscience, 13(10), 713–726.

Squire, L. R., & Alvarez, P. (1995). Retrograde amnesia and memory consolidation: a neurobiological perspective. Current opinion in neurobiology, 5(2), 169–177.


Choosing a master’s : a few tips

Illustration by Shaumy Sankar

As a student in the sixth semester of my bachelors the decision for a master’s major is getting more and more important. And I know from many of my fellow students that most uf us have not yet made a decision about our future master’s degree program. In the following blog post I would like to share some inspirations on how to choose the right master’s degree program. 

Make some general considerations first

Take time for reflection and thoughts about the future. For example: Was there a course during the bachelor’s program that gained your interest in particular, and that you want to deepen? Or maybe you’re looking to try something new? Career considerations are also part of the picture: are you more interested in theory and research or in practice? Where do you want to work later? 

To get an overview, it might be helpful for you to think about what you definitely don’t want to do. If you feel overwhelmed, starting with what you definitely don’t want to do is sometimes easier. Important is: try not to limit yourself to something. If for some reason you’re unsatisfied with your choice, it will be easier for you to reorient yourself if you at least have a Plan B.

The key is to get an idea about what your future job might look like.

Your university’s master’s information day is a good place to start to learn about the different programs available.
Browse through the different departments on the university’s website and gather information based on their study programs. Which study program arouses your interest the most?

Gaining insight into a certain field or profession requires some personal initiative. Different universities offer opportunities for career insights on a regular basis. How these are done differs from university to university. Every year, the University of Bern invites psychologists to talk about their jobs and career paths, offering students a unique inside view of their field of choice. Both the University of Geneva and the University of Fribourg offer courses essentially providing the same service. Chances are, your university offers something similar. Even if you’re not in the related programs, you’re almost certain to be welcomed by the course instructor if you ask to audit the sessions that you’re interested in! 

Once you have an idea about what field you want to know more about, I would suggest trying to organize a trial day. A good place to start is to ask one of your lecturers if they know of any institutions or companies working in the area you want to learn more about. Another possibility is to directly contact a place you would be interested in working, for example a private practice, a clinic or a rehabilitation center. When contacting them, spend some time finding the right person. Don’t email the head of the hospital, but maybe the head of the department you want to visit, preferably a psychologist, or someone with an academic background similar to yours. Send them an email, and don’t forget to call them if you don’t have an answer within a week or two! Emails are easily ignored or forgotten, but if you get to talk to them, they will have to give you some thought. The worst thing that happens is that they tell you no. Don’t take it personally, and try again somewhere else. If it was easy, it wouldn’t be worth doing!   

Ask for a mini-internship, for example one day of observing their daily work, and attach your CV. Speaking from personal experience, I was able to visit various neuropsychological institutions for a few days and observe the daily work of interns as well as trained psychologists. Not only did I get a clearer idea about the field, but I was also able to make some contacts that might come in handy later. If you are interested in research, your best bet is to contact the head of the lab directly. Depending on the size of the research team, they might have someone designated as intern responsable. You will be able to tell from their website. Lab’s work closely with the rest of the university, and can certainly be expected to accommodate you for a day or two.  

Finally, psyCH offers several opportunities to get in touch with people from all areas of psychology. Our official internship platform, psyPra is a good place to look for internship opportunities. Click here to have a look!

That being said, personal contact is always the best way to go! Show up to the next psyKo, and speak to professionals in the field! Countless internships started out as casual conversations between conference attendees.  Click here to read more about this year’s conference!

Don’t be afraid to take your time! 

If you are unsure between two fields then use your time to gain some experience! You can do internships in both fields during a gap year and make your decision based on your experiences.  

Inform yourself through people in the field 

Read job ads in psychology, for example on FSP’s website, and see what appeals to you the most. You could also view career biographies of role models, for example via Linkedin. Psychoscope is published by the FSP every month, and gives insight into the workday of psychologist’s from all over Switzerland!  

Finally and most important, talk to the right people. Exchange ideas with fellow students and with master’s students. And especially talk to people in the field for example during trial days or internships.

Last but not least: Don’t worry. You can always change location, reallocate your credits, or completely change your master’s degree program. Sometimes, despite careful research, a study program just isn’t what you thought it would be. The worst thing that could happen is that you end up trying something else, and that not really so bad is it?


What does a neuropsychologist do? – Interview with Martina Studer

How would you explain your job to someone who has no clue about neuropsychology?

I see patients who have just suffered a brain injury, for example strokes, traumatic brain injuries or after brain tumor operations. Most of them show various cognitive deficits, e.g. problems with attention, memory or executive functions. We apply neuropsychological tests and compare the performance of the patient to a matched healthy control group (same age, gender and education level) to diagnose possible acquired cognitive impairments. With this information and with our clinical impression determine the focus of the therapy. 

Regarding therapy, we have two approaches: First, restoration which means to exercise a function, and second, compensation which means helping yourself with compensating strategies. For certain functions like attentional impairments or executive dysfunctions, we do exercises to train and to improve them. For example, if a patient has a reduced alertness (basic reaction time), we do exercises where the patient has to react as quickly as possible. Research results imply to train at the custom-fitted performance level of the patient, to challenge the patient at his level. For certain areas, however, restoration approaches are less suitable and compensation strategies must be learned instead. Memory impairments are treated by compenstaion strategies like mnemonic bridges, diaries, smartphone reminders or lists. 

Could you tell me a bit about your educational background? How did you end up studying psychology?

I had finished teacher trainings college in Lucerne to become a primary school teacher, and I started teaching. The school where I worked motivated me to go further, and I decided to become a school psychologist. This brought me to study psychology in Bern. At the beginning of university, I hardly ever thought that I will become a neuropsychologist or to do a PhD.

During my master’s, I attended a lecture on neuropsychology. That was definitely a key moment. Besides, developmental psychology was also one of my favorite subjects. I specialized in Neuro- and Developmental Psychology which aroused my interest in pediatric neuropsychology. So I did an internship as pediatric neuropsychologist at the Children’s University Hospital of the Inselspital. 

After completing my master degree, I got a fabulous job offer from the Children’s Hospital as pediatric neuropsychologist. Because I also got a lot of interest in doing science, I decided to start a PhD at the same time. That was really a dream and very busy time! After my PhD, I did a Post-doc at the University of Berkeley in California and returned to Bern to complete my clinical education as clinical neuropsychologist in the University Hospital of Neurology. Today, I still combine clinical work and research – I think that’s a great privilege – although, this sometimes involves night shifts (laughs).

So you didn’t set out with the goal of getting a PhD in neuropsychology? 

No, not at all. My parents are not academics and a lot of things were foreign to me – if you have family members who work in a certain field, you probably have earlier opportunities for insights or more precise ideas of how a job would look like. Internships have proven to be particularly helpful to me. They allowed me to make new contacts and to gain insights into various fields. 

Do you remember a particularly interesting or impressive experience during your studies, an internship or at work?

Yes, certainly! Especially people who fully stand up for what they do and really have a lot of expertise in it. 

What do you like the most about your work? Is there anything you wish you knew before you got into the field?

I really enjoy working with patients. Some of them are people I would never meet in my private life. Furthermore, I see patients directly after a brain injury. Many of them stay with us for several weeks why I get to know them and see their progress. I find it very nice to accompany these people. There are many different patients – sometimes also very severely impaired people and it is amazing to observe how they improve, from a severely disoriented status at the beginning to average cognitive profiles.  

And it’s an interesting field especially because many questions are still unanswered, there is a lot of therapy options that could still be tried. 

What rather…not negative… but what you should know is that there are fewer positions and that you are quite specialized. You can’t change jobs that easily. I like to compare that with medical doctors who have better possibilities to change their workplace. 

But it is for example possible to change from children to adults neuropsychology. I started in the children’s area and then changed to adults. The clinical images are different. For instance I have never seen pediatric patients with a visual hemispatial neglect or a severe amnesia – impairments I see now quite regularly in my everyday life as adult neuropsychologist.

It would also be possible to do an additional title in psychotherapy. In our ward we do diagnostics and therapy. However, if you want to do outpatient neuropsychological therapy, you need this specialisation as well. And of course, this increases the range of patients you can work with. 

What opportunities are there for someone with a fresh master’s in neuropsychology?

Unfortunately, the possibilities are quite limited. But more and more clinical neuropsychological residency positions are being created for students with a fresh Masters’ Degree. Besides that, there is to possibility to start in a normal neuropsychology position. Furthermore, you can start a  PhD which is often very theoretical and different from what you do as a clinical neuropsychologist.  There are also very few clinical PhD Positions. In general, I recommend to think it through whether you will start doing a PhD – you have to enjoy scientific work and be able to accept setbacks.

 Do you have any advice for someone who is interested in becoming a neuropsychologist?

Do an internship as early as possible! Internships are usually offered at larger institutions. Don’t get discouraged if you get a no at first. Keep going! Just trust that you will eventually make it. 

Other possibilities would be to write a bachelor’s thesis or master’s thesis on neuropsychology, and to attend neuropsychology seminars. Also build up a network with people in the field. Once you have your foot in the door – you are more or less inside.