Cholinergic blockade reveals a role for human hippocampal theta in memory encoding but not retrieval

Reviewer #1 (Public review):

Summary:

The authors report intracranial EEG findings from 12 epilepsy patients performing an associative recognition memory task under the influence of scopolamine. They show that scopolamine administered before encoding disrupts hippocampal theta phenomena and reduces memory performance, and that scopolamine administered after encoding but before retrieval impairs hippocampal theta phenomena (theta power, theta phase reset) and neural reinstatement but does not impair memory performance. This is an important study with exciting, novel results and translational implications. The manuscript is well-written, the analyses are thorough and comprehensive, and the results seem robust.

Strengths:

(1) Very rare experimental design (intracranial neural recordings in humans coupled with pharmacological intervention).

(2) Extensive analysis of different theta phenomena.

(3) Well-established task with different conditions for familiarity versus recollection.

(4) Clear presentation of findings and excellent figures.

(5) Translational implications for diseases with cholinergic dysfunction (e.g., AD).

(6) Findings challenge existing memory models, and the discussion presents interesting novel ideas.

Weaknesses:

(1) One of the most important results is the lack of memory impairment when scopolamine is administered after encoding but before retrieval (scopolamine block 2). The effect goes in the same direction as for scopolamine during encoding (p = 0.15). Could it be that this null effect is simply due to reduced statistical power (12 subjects with only one block per subject, while there are two blocks per subject for the condition with scopolamine during encoding), which may become significant with more patients? Is there actually an interaction effect indicating that memory impairment is significantly stronger when scopolamine is applied before encoding (Figure 1d)? Similar questions apply to familiarity versus recollection (lines 78-80). This is a very critical point that could alter major conclusions from this study, so more discussion/analysis of these aspects is needed. If there are no interaction effects, then the statements in lines 84-86 (and elsewhere) should be toned down.

(2) Further, could it simply be that scopolamine hadn't reached its major impact during retrieval after administration in block 2? Figure 2e speaks in favor of this possibility. I believe this is a critical limitation of the experimental design that should be discussed.

(3) It is not totally clear to me why slow theta was excluded from the reinstatement analysis. For example, despite an overall reduction in theta power, relative patterns may have been retained between encoding and recall. What are the results when using 1-128 Hz as input frequencies?

(4) In what way are the results affected by epileptic artifacts occurring during the task (in particular, IEDs)?

Reviewer #2 (Public review):

Summary:

In this study, performed in human patients, the authors aimed at dissecting out the role of cholinergic modulation in different types of memory (recollection-based vs familiarity and novelty-based) and during different memory phases (encoding and retrieval). Moreover, their goal was to obtain the electrophysiological signature of cholinergic modulation on network activity of the hippocampus and the entorhinal cortex.

Strengths:

The authors combined cognitive tasks and intracranial EEG recordings in neurosurgical epilepsy patients. The study confirms previous evidence regarding the deleterious effects of scopolamine, a muscarinic acetylcholine receptor antagonist, on memory performance when administered prior to the encoding phase of the task. During both encoding and retrieval phases, scopolamine disrupts the power of theta oscillations in terms of amplitude and phase synchronization. These results raise the question of the role of theta oscillations during retrieval and the meaning of scopolamine's effect on retrieval-associated theta rhythm without cognitive changes. The authors clearly discussed this issue in the discussion session.
A major point is the finding that the scopolamine-mediated effect is selective for recollection-based memory and not for familiarity- and novelty-based memory.

The methodology used is powerful, and the data underwent a detailed and rigorous analysis.

Weaknesses:

A limited cohort of patients; the age of the patients is not specified in the table.

Author response:

Reviewer #1 (Public review):

Summary:

The authors report intracranial EEG findings from 12 epilepsy patients performing an associative recognition memory task under the influence of scopolamine. They show that scopolamine administered before encoding disrupts hippocampal theta phenomena and reduces memory performance, and that scopolamine administered after encoding but before retrieval impairs hippocampal theta phenomena (theta power, theta phase reset) and neural reinstatement but does not impair memory performance. This is an important study with exciting, novel results and translational implications. The manuscript is well-written, the analyses are thorough and comprehensive, and the results seem robust.

Strengths:

(1) Very rare experimental design (intracranial neural recordings in humans coupled with pharmacological intervention).

(2) Extensive analysis of different theta phenomena.

(3) Well-established task with different conditions for familiarity versus recollection.

(4) Clear presentation of findings and excellent figures.

(5) Translational implications for diseases with cholinergic dysfunction (e.g., AD).

(6) Findings challenge existing memory models, and the discussion presents interesting novel ideas.

Weaknesses:

(1) One of the most important results is the lack of memory impairment when scopolamine is administered after encoding but before retrieval (scopolamine block 2). The effect goes in the same direction as for scopolamine during encoding (p = 0.15). Could it be that this null effect is simply due to reduced statistical power (12 subjects with only one block per subject, while there are two blocks per subject for the condition with scopolamine during encoding), which may become significant with more patients? Is there actually an interaction effect indicating that memory impairment is significantly stronger when scopolamine is applied before encoding (Figure 1d)? Similar questions apply to familiarity versus recollection (lines 78-80). This is a very critical point that could alter major conclusions from this study, so more discussion/analysis of these aspects is needed. If there are no interaction effects, then the statements in lines 84-86 (and elsewhere) should be toned down.

The reviewer highlights important concerns regarding the statistical power of the behavioral effects. We address these concerns in the revised manuscript in two ways: (1) we provide a supplemental analysis using a matched number of blocks between the placebo and scopolamine conditions to avoid statistical bias related to differing trial counts, and (2) we include a supplemental figure illustrating paired comparisons between blocks.

(2) Further, could it simply be that scopolamine hadn't reached its major impact during retrieval after administration in block 2? Figure 2e speaks in favor of this possibility. I believe this is a critical limitation of the experimental design that should be discussed.

The reviewer raises an important methodological concern regarding the time required for scopolamine's effect to manifest and the subsequent impact on the study outcomes. Previous studies report that the average time to maximum serum concentration after intravenous (IV) scopolamine administration is approximately 5 minutes (Renner et al., 2005), with the corresponding clinical onset estimated at 10 minutes. In our study, the retrieval period in Block 2 commenced at 15 ± 0.2 post-injection across all subjects. Given this timing, there is sufficient reason to conclude that scopolamine had reached its major impact during the Block 2 retrieval phase. Furthermore, the observation of significant disruptions to theta oscillations during this same retrieval phase provides strong evidence that the drug was in full effect at that time.

(3) It is not totally clear to me why slow theta was excluded from the reinstatement analysis. For example, despite an overall reduction in theta power, relative patterns may have been retained between encoding and recall. What are the results when using 1-128 Hz as input frequencies?

Slow theta (2–4 Hz) was excluded from the reinstatement analysis to avoid potential confounding effects. Given the observed disruption to slow theta power following scopolamine administration, any subsequent changes in slow theta reinstatement would be causally ambiguous, potentially arising directly from the power effects. Therefore, we would be unable to determine whether changes in slow theta reinstatement were genuinely independent of changes in power.

(4) In what way are the results affected by epileptic artifacts occurring during the task (in particular, IEDs)?

To exclude abnormal events and interictal activity, a kurtosis threshold of 4 was applied to each trial, effectively filtering out segments exhibiting significant epileptic artifacts.

Reviewer #2 (Public review):

Summary:

In this study, performed in human patients, the authors aimed at dissecting out the role of cholinergic modulation in different types of memory (recollection-based vs familiarity and novelty-based) and during different memory phases (encoding and retrieval). Moreover, their goal was to obtain the electrophysiological signature of cholinergic modulation on network activity of the hippocampus and the entorhinal cortex.

Strengths:

The authors combined cognitive tasks and intracranial EEG recordings in neurosurgical epilepsy patients. The study confirms previous evidence regarding the deleterious effects of scopolamine, a muscarinic acetylcholine receptor antagonist, on memory performance when administered prior to the encoding phase of the task. During both encoding and retrieval phases, scopolamine disrupts the power of theta oscillations in terms of amplitude and phase synchronization. These results raise the question of the role of theta oscillations during retrieval and the meaning of scopolamine's effect on retrieval-associated theta rhythm without cognitive changes. The authors clearly discussed this issue in the discussion session. A major point is the finding that the scopolamine-mediated effect is selective for recollection-based memory and not for familiarity- and novelty-based memory.

The methodology used is powerful, and the data underwent a detailed and rigorous analysis.

Weaknesses:

A limited cohort of patients; the age of the patients is not specified in the table.

To comply with human subject privacy protection policies, age was not reported; however, we did not find any significant effects of age on the behavioral or neural measures.