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  <head>
    <title>099-01 Learning, memory, and their biological foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Learning, memory, and biology">
      <outline text="Learning and memory are not one faculty">
        <outline text="Learning: durable change produced by experience"/>
        <outline text="Memory: encode, store, stabilise, retrieve"/>
        <outline text="Skill acquired without recalling the practice"/>
        <outline text="Separate attention, encoding, retention, retrieval">
          <outline text="Not every failure is loss of memory"/>
        </outline>
      </outline>
      <outline text="Non-associative learning">
        <outline text="Habituation to repeated inconsequential stimuli">
          <outline text="Not sensory fatigue: recovers with time or novelty"/>
        </outline>
        <outline text="Sensitisation after strong or important stimuli">
          <outline text="Generalises: pain, vigilance, startle"/>
        </outline>
        <outline text="Short term: transmitter release and excitability"/>
        <outline text="Long term: gene expression, structural remodelling"/>
      </outline>
      <outline text="Classical and fear conditioning">
        <outline text="Neutral cue predicts a meaningful event">
          <outline text="Contingency, not mere temporal pairing"/>
        </outline>
        <outline text="Extinction is new inhibitory learning">
          <outline text="Spontaneous recovery, renewal, reinstatement"/>
        </outline>
        <outline text="Amygdala assigns threat value"/>
        <outline text="Hippocampus represents context and relationships"/>
        <outline text="Prefrontal regulates by safety and goals"/>
        <outline text="Exposure uses prediction error">
          <outline text="Tolerable engagement, varied safe contexts"/>
        </outline>
      </outline>
      <outline text="Operant and observational learning">
        <outline text="Reinforcement increases, punishment decreases">
          <outline text="Positive adds, negative removes"/>
        </outline>
        <outline text="Negative reinforcement maintains avoidance">
          <outline text="Blocks corrective learning, long-term disability"/>
        </outline>
        <outline text="Immediate, reliable, valued consequences dominate"/>
        <outline text="Continuous reinforcement: fast acquisition and extinction"/>
        <outline text="Intermittent reinforcement makes behaviour persist">
          <outline text="Checking, gambling, digital rewards"/>
        </outline>
        <outline text="Shaping reinforces successive approximations">
          <outline text="Small steps build self-efficacy"/>
        </outline>
        <outline text="Modelling: attention, retention, reproduction, motivation">
          <outline text="Feasible demonstration, corrective feedback"/>
        </outline>
      </outline>
      <outline text="Working memory and memory systems">
        <outline text="Working memory holds and manipulates limited information"/>
        <outline text="Executive control protects goals, updates, switches"/>
        <outline text="Capacity falls with distraction, sleep loss, pain, anxiety">
          <outline text="Nonadherence may be cognitive overload"/>
        </outline>
        <outline text="Chunking reduces burden, does not transfer to novices"/>
        <outline text="Declarative: episodic and semantic"/>
        <outline text="Nondeclarative: skills, habits, priming, conditioning"/>
        <outline text="Hippocampal networks form new declarative memories">
          <outline text="Not the permanent repository"/>
        </outline>
        <outline text="Basal ganglia and cerebellum: habits, skills, timing"/>
      </outline>
      <outline text="Encoding and consolidation">
        <outline text="Active attention, elaboration, organisation, generation"/>
        <outline text="Retrieval practice beats passive rereading"/>
        <outline text="Spacing beats massed repetition"/>
        <outline text="Interleaving improves discrimination but feels harder"/>
        <outline text="Fluency of rereading is a poor measure"/>
        <outline text="Synaptic consolidation over minutes to hours">
          <outline text="Receptor trafficking, kinases, protein synthesis"/>
        </outline>
        <outline text="Systems consolidation reorganises networks over time"/>
        <outline text="Sleep coordinates hippocampal and cortical activity">
          <outline text="Also restores attention and emotion regulation"/>
        </outline>
      </outline>
      <outline text="Synaptic plasticity and neuromodulation">
        <outline text="Long-term potentiation raises synaptic effectiveness">
          <outline text="Coincident depolarisation and glutamate"/>
          <outline text="Calcium entry through NMDA receptors"/>
          <outline text="AMPA receptor insertion or modification"/>
        </outline>
        <outline text="Long-term depression weakens synapses, prevents saturation"/>
        <outline text="Dopamine: prediction error, motivational significance"/>
        <outline text="Acetylcholine: attention and cortical learning"/>
        <outline text="Noradrenaline: arousal and uncertainty"/>
        <outline text="Stress hormones strengthen central emotional features">
          <outline text="But impair flexible contextual recall"/>
        </outline>
        <outline text="Pain, addiction, fear, habits are also learned change"/>
      </outline>
      <outline text="Retrieval and forgetting">
        <outline text="Retrieval is reconstructive">
          <outline text="Context, expectation, emotion fill the gaps"/>
        </outline>
        <outline text="Confidence and accuracy imperfectly related"/>
        <outline text="Suggestive questions and imagination alter recall"/>
        <outline text="Reconsolidation has boundary conditions"/>
        <outline text="Forgetting: decay, interference, retrieval failure"/>
        <outline text="Proactive and retroactive interference"/>
        <outline text="Vary examples, recall as in future use"/>
      </outline>
      <outline text="Disorders, transfer, and feedback">
        <outline text="Medial temporal damage impairs new episodic learning">
          <outline text="Span, remote knowledge, skill may be spared"/>
        </outline>
        <outline text="Frontal dysfunction impairs strategy, source monitoring"/>
        <outline text="Delirium makes memory testing unreliable"/>
        <outline text="Memory complaint needs history, function, course"/>
        <outline text="Expertise needs structure, retrieval, varied use"/>
        <outline text="Feedback: timely, specific, controllable process"/>
        <outline text="Excess threat narrows attention, invites concealment"/>
        <outline text="Biological and behavioural levels are complementary"/>
      </outline>
    </outline>
  </body>
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