We studied item and source memory with fMRI in healthy volunteers and carried out a parallel study in memory-impaired patients. In experiment 1, volunteers studied a list of words in the scanner and later took an item memory test and a source memory test. Brain activity in the hippocampal region, perirhinal cortex, and parahippocampal cortex was associated with words that would later be remembered (item memory). The activity in these regions that predicted subsequent success at item memory predicted subsequent source memory to a similar degree. In experiment 2, memory-impaired patients with damage thought to be limited to the hippocampal region were given an item memory test and a source memory test, as in experiment 1. The patients were similarly impaired on the item memory test and the source memory test. Together, the findings suggest that medial temporal lobe structures broadly support recognition memory function and that item memory and source memory similarly depend on these structures. amnesia ͉ hippocampus ͉ recognition memory O ne of the most widely studied examples of declarative memory is recognition memory, the ability to judge an item as having been encountered previously. Recognition memory depends on the integrity of the medial temporal lobe (MTL), which includes the hippocampal region (subicular complex, CA fields, and dentate gyrus) and the entorhinal, perirhinal, and parahippocampal cortices (1). Much of what is known about the anatomy and organization of human recognition memory has come from the systematic study of patients with circumscribed damage to MTL structures. More recently, recognition memory has been studied in the healthy brain by using functional magnetic resonance imaging (fMRI).A useful technique in many of these fMRI studies is the subsequent memory paradigm (2). In this paradigm, brain activity is measured with fMRI while volunteers study a list of items (e.g., words or pictures). Later, participants take a recognition memory test outside of the scanner. Brain activity associated with items that will later be remembered can then be compared to brain activity associated with items that will later be forgotten. Typically, structures within the MTL are identified by such a contrast (3).A fundamental but controversial issue concerns the possible division of labor for recognition memory function within the MTL. Some studies using the subsequent memory paradigm reported that memory for the context in which an item is learned (source memory) is predicted especially by activity during study in the hippocampal region (and possibly parahippocampal cortex) and that memory for the item itself (item memory) is predicted especially by activity during study in the adjacent cortex (4-6). Others have found that item memory is predicted by widespread activity in the MTL during study, including in the hippocampus (7-9). Furthermore, it has been suggested that recognition memory judgments lie along a continuum of memory strength, and that in some respects categories like item memory and source me...