Hippocampal-occipital connectivity reflects autobiographical memory deficits in aphantasia

Reviewer #1 (Public Review):

Summary:
In this article, the authors investigate whether the connectivity of the hippocampus is altered in individuals with aphantasia ¬- people who have reduced mental imagery abilities and where some describe having no imagery, and others describe having vague and dim imagery. The study investigated this question using a fMRI paradigm, where 14 people with aphantasia and 14 controls were tested, and the researchers were particularly interested in the key regions of the hippocampus and the visual-perceptual cortices. Participants were interviewed using the Autobiographical Interview regarding their autobiographical memories (AMs), and internal and external details were scored. In addition, participants were queried on their perceived difficulty in recalling memories, imagining, and spatial navigation, and their confidence regarding autobiographical memories was also measured. Results showed that participants with aphantasia reported significantly fewer internal details (but not external details) compared to controls; that they had lower confidence in their AMs; and that they reported finding remembering and imagining in general more difficult than controls. Results from the fMRI section showed that people with aphantasia displayed decreased hippocampal and increased visual-perceptual cortex activation during AM retrieval compared to controls. In contrast, controls showed strong negative functional connectivity between the hippocampus and the visual cortex. Moreover, resting state connectivity between the hippocampus and visual cortex predicted better visualisation skills. The authors conclude that their study provides evidence for the important role of visual imagery in detail-rich vivid AM, and that this function is supported by the connectivity between the hippocampus and visual cortex. This study extends previous findings of reduced episodic memory details in people with aphantasia, and enables us to start theorising about the neural underpinnings of this finding.

The data provided good support for the conclusion that the authors draw, namely that there is a 'tight link between visual imagery and our ability to retrieve vivid and detail-rich personal past events'. However, as the authors also point out, the exact nature of this relationship is difficult to infer from this study alone, as the slow temporal resolution of fMRI cannot establish the directionality between the hippocampus and the visual-perceptual cortex. This is an exciting future avenue to explore.

Weaknesses:
A weakness of the study is that some of the questions used are a bit vague, and no objective measure is used, which could have been more informative. For example, the spatial navigation question (reported as 'How difficult is it typically for you to orient you spatially?' - a question which is ungrammatical, but potentially reflects a typo in the manuscript) could have been more nuanced to tap into whether participants relied mostly on cognitive maps (likely supported by the hippocampus) or landmarks. It would also have been interesting to conduct a spatial navigation task, as participants do not necessarily have insight into their spatial navigation abilities (they could have been overconfident or underconfident in their abilities). Secondly, the question 'how difficult is it typically for you to use your imagination?' could also be more nuanced, as imagination is used in a variety of ways, and we only have reason to hypothesise that people with aphantasia might have difficulties in some cases (i.e. sensory imagination involving perceptual details). It is unlikely that people with aphantasia would have more difficulty than controls in using their imagination to imagine counterfactual situations and engage in counterfactual thought (de Brigard et al., 2013, https://doi.org/10.1016%2Fj.neuropsychologia.2013.01.015) due to its non-sensory nature, but the question used does not distinguish between these types of imagination. Again, this is a ripe area for future research. The general phrasing of 'how difficult is [x]' could also potentially bias participants towards more negative answers, something which ought to be controlled for in future research.

Strengths:
A great strength of this study is that it introduces a fMRI paradigm in addition to the autobiographical interview, paralleling work done on episodic memory in cognitive science (e.g. Addis and Schacter, 2007, https://doi.org/10.1016%2Fj.neuropsychologia.2006.10.016 ), which has examined episodic and semantic memory in relation to imagination (future simulation) in non-aphantasic participants as well as clinical populations. Future work could build on this study, and for example use the recombination paradigm (Addis et al. 2009, 10.1016/j.neuropsychologia.2008.10.026 ), which would shed further light on the ability of people with aphantasia to both remember and imagine events. Future work could also build on the interesting findings regarding spatial navigation, which together with previous findings in aphantasia (e.g. Bainbridge et al., 2021, https://doi.org/10.1016/j.cortex.2020.11.014 ) strongly suggests that spatial abilities in people with aphantasia are unaffected. This can shed further light on the different neural pathways of spatial and object memory in general. In general, this study opens up a multitude of new avenues to explore and is likely to have a great impact on the field of aphantasia research.

Reviewer #2 (Public Review):

Summary:
This study investigates to what extent neural processing of autobiographical memory retrieval is altered in people who are unable to generate mental images ('aphantasia'). Self-report as well as objective measures were used to establish that the aphantasia group indeed had lower imagery vividness than the control group. The aphantasia group also reported fewer sensory and emotional details of autobiographical memories. In terms of brain activity, compared to controls, aphantasics had a reduction in activity in the hippocampus and an increase in activity in the visual cortex during autobiographical memory retrieval. For controls, these two regions were also functionally connected during autobiographical memory retrieval, which did not seem to be the case for aphantasics. Finally, resting-state connectivity between the visual cortex and hippocampus was positively related to autobiographical vividness in the control group but negatively in the aphantasia group. The results are in line with the idea that aphantasia is caused by an increase in noise within the visual system combined with a decrease in top-down communication from the hippocampus.

Recent years have seen a lot of interest in the influence of aphantasia on other cognitive functions and one of the most consistent findings is deficits in autobiographical memory. This is one of the first studies to investigate the neural correlates underlying this difference, thereby substantially increasing our understanding of aphantasia and the relationship between mental imagery and autobiographical memory.

Strengths:
One of the major strengths of this study is the use of both self-report as well as objective measures to quantify imagery ability. Furthermore, the fMRI analyses are hypothesis-driven and reveal unambiguous results, with alterations in hippocampal and visual cortex processing seeming to underlie the deficits in autobiographical memory.

Weaknesses:
In terms of weaknesses, the control task, doing mathematical sums, also differs from the autobiographical memory task in aspects that are unrelated to imagery or memory, such as self-relevance and emotional salience, which makes it hard to conclude that the differences in activity are reflecting only the cognitive processes under investigation.

Overall, I believe that this is a timely and important contribution to the field and will inspire novel avenues for further investigation.