The medial temporal lobe (MTL) is known to be critical for healthy memory function, but patients with MTL damage can, under certain circumstances, demonstrate successful learning of novel information encountered outside the laboratory. Here, we describe a patient, D.C., with extensive but focal bilateral MTL damage centering primarily on his hippocampus, whose memory for real-world experiences was assessed. Tests of remote memory indicated at least some capacity to retrieve specific details. To test his anterograde memory, he was taken on a tour of the NIH Clinical Center, with unique events occurring at each of ten specific locations. His memory for these events was tested after 1 h, and again after fifteen months. Initially, D.C. could not recall having participated in the tour, even when cued with photographs of specific places he had visited. However, he achieved 90% accuracy on a forced choice recognition test of old and new objects he encountered on the tour, and his recognition of these objects remained intact over a year later when he was tested once again. Subsequent recognition memory tests using novel picture stimuli in a standard laboratory-style computer task resulted in chance-level performance across multiple test formats and stimulus categories. These findings suggest a potentially privileged role for natural learning for long-term retention in a patient with severely damaged medial temporal lobes.
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