Can LLMs Reason Over Long Horizons? An Empirical Evaluation of Context Strategies for Longitudinal Clinical Reasoning

Understanding and reasoning over long contexts has become a key requirement for deploying large language models (LLMs) in realistic applications. Although recent LLMs support increasingly long context windows, they often fail to use relevant evidence that is already present in the input, revealing a gap between context access and effective context utilization. In this work, we propose Recursive Evidence Replay as LLM Harness for Long-Context Reasoning (RECONTEXT), a training-free inference method for improving long-context reasoning. RECONTEXT uses model-internal relevance signals to construct a query-conditioned evidence pool and replays it before final generation while preserving the full original context. This recursive selection process separates evidence organization from answer generation without training, external memory, or context pruning. We also provide a theoretical analysis based on associative memory, which characterizes the context as a memory store, the question as a retrieval cue, attention as cue-trace association, and replay as trace reactivation. Experiments on eight long-context datasets with 128K context length show that RECONTEXT consistently improves evidence utilization across Qwen3-4B, Qwen3-8B, and Llama3-8B, achieving the best average rank on all three backbones. Code is available at https://github.com/Yanjun-Zhao/ReContext.

Long-context reasoning is essential for complex and long-horizon tasks, yet the performance of large language models (LLMs) degrades as context length increases. Recent approaches address this by processing input chunk by chunk while maintaining a bounded textual memory in model context. However, premature information compression can discard critical details essential for subsequent reasoning. In this paper, we introduce Commit-on-Evidence Memory (CoEM), which learns when to convert source evidence into compact memory facts. Specifically, under a fixed context-memory budget, CoEM preserves potentially useful source excerpts verbatim in a pending set, allowing subsequent context to clarify their relevance before irreversible compression. As new context arrives, a learned policy revisits each pending excerpt and decides whether to promote it to the committed memory, retain it for further consideration, or discard it. A frozen verifier ensures proposed facts are accepted only if supported by retained excerpts and current context. To further guide effective memory management, we train this policy using reinforcement learning by combining fine-grained, step-level evidence rewards with final answer rewards. Extensive experiments demonstrate that CoEM consistently improves long-context reasoning. When evaluated on 6,400 documents long-context input, CoEM outperforms the strongest memory baseline by 10.4-11.4 F1 points on Qwen3.5-9B. Code repository: https://github.com/benmagnifico/CoEM.

Clinical LLM assistants must reason over multi-visit patient trajectories, yet whether the compact history representations used to scale them---retrieval, structured timelines, LLM summaries, agentic memory---preserve the longitudinal signal clinical reasoning needs has not been measured. We introduce ClinTraceBench: 385 MIMIC-IV-derived verified dialogues with event-ID provenance, a nine-task taxonomy (T1--T9), and L0--L4 deterministic + L5 human-audit validation (98.92% agreement). We evaluate eight history representation strategies---a no-context floor, \textit{last-visit-only}, \textit{full-context}, BGE-M3 \textit{dense-retrieval}, two compression schemes, and two agentic-memory systems (\textit{Mem0}, \textit{A-Mem})---across four backbones (DeepSeek-V3, GPT-4o-mini, Haiku4.5, Sonnet4.6) on 6{,}271 questions: 32 cells, 200{,}672 predictions. Four findings: (SP4) a controlled T3 injection probe isolates compression-induced \textit{relation} loss---with the attribution sentence present \textit{before} construction, \textit{Mem0}, \textit{A-Mem} and \textit{llm-summary} still recover only 0--5.3% of the injected positives; (SP1) compressed strategies pay an aggregation tax on multi-visit trends and cross-patient comparisons; (SP2) the blind-to-full gap spans $+29.8$~pp (GPT-4o-mini) to $+62.7$~pp (Haiku); (SP3) abstention scales non-monotonically with context length. On the Pareto frontier Haiku dominates Sonnet under \textit{full-context} ($25.76 vs.\ $106.21), inverting the ``biggest backbone wins'' heuristic.