Mentalizing the body: spatial and social cognition in anosognosia for hemiplegia

Besharati, Sahba; Forkel, Stephanie J.; Kopelman, Michael; Solms, Mark; Jenkinson, Paul M.; Fotopoulou, Aikaterini

doi:10.1093/brain/awv390

Cited by 59 publications

(75 citation statements)

References 80 publications

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“…Specifically, the cingulum connects limbic system structures that have been previously associated with emotional and memory processing, and is part of the default mode network (23)–a pattern of intrinsic connectivity observed during self-referential, introspective states, including autobiographical retrieval, future imaging and mentalisation. These abilities relate to well-documented deficits in AHP patients’ general awareness (“why are you in hospital?”), anticipatory awareness (“are you able to reach the table with your left hand?”, 24) and mentalisation (25; “the doctors think there is some paralysis, do you agree?”, 26).…”

Section: Discussionmentioning

confidence: 99%

Anosognosia for Hemiplegia as a tripartite disconnection syndrome

Pacella

Foulon

Jenkinson³

et al. 2019

Preprint

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1The rare syndrome of Anosognosia for Hemiplegia (AHP) can provide unique insights into 2 the neurocognitive processes of motor awareness. Yet, prior studies have only explored 3 predominately discreet lesions. Using advanced structural neuroimaging methods in 174 patients with 4 a right-hemisphere stroke, we were able to identify three neural networks that contribute to AHP, 5 when disconnected: the (1) premotor loop (2) limbic system, and (3) ventral attention network. Our 6 results suggest that human motor awareness is contingent on the joint contribution of these three 7 systems. 83 Motor awareness allows individuals to have insight into their motor performance, a 9 fundamental aspect of self-awareness. However, following damage to the right hemisphere, patients 10 with left paralysis may show delusions of intact motor ability, or anosognosia for hemiplegia (AHP, 11 1). Hence, studying AHP offers unique opportunities to explore the neurocognitive mechanisms of 12 motor awareness. 13While early studies regarded AHP as secondary to concomitant spatial deficits such as hemineglect 14 2 caused by parietal lesions, more recent experimental and voxel-based, lesion-symptom mapping 15 (VLSM) results suggest that AHP is an independent syndrome. These earlier studies address AHP as 16 an impairment of action and body monitoring, with lesions to the lateral premotor cortex and the 17 anterior insula (3,4), affecting patients' ability to detect discrepancies between feed-forward motor 18 predictions and sensorimotor feedback. However, these hypotheses are insufficient to explain all the 19 AHP symptoms, such as patients' inability to update their beliefs based on social feedback or more 20 general difficulties experienced in their daily living (5,6). Indeed, others have suggested that AHP 21 can be caused by a functional disconnection between regions processing top-down beliefs about the 22

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Section: Discussionmentioning

confidence: 99%

Anosognosia for Hemiplegia as a tripartite disconnection syndrome

Pacella

Foulon

Jenkinson³

et al. 2019

Preprint

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“…The PIP connections may therefore allow for an enrichment of these visual experiences with somatosensory information whenever visual stimuli are consciously perceived within the frontal-parietal network (Engelen, de Graaf, Sack, & de Gelder, 2015). Parietal lesions to the PIP may disconnect the somatosensory areas from the inferior parietal lobule and prevent a mutual exchange of information between these two regions that may underlie conditions such as anosognosia (Besharati et al, 2016). One can argue that in these patients, the disconnection of the PIP may prevent tactile and proprioceptive stimuli relayed in the postcentral gyrus from reaching the inferior parietal lobule for a conscious perception of the contralateral hemibody.…”

Section: Tracts Between the Inferior Parietal Lobule And The Postcentmentioning

confidence: 99%

Short parietal lobe connections of the human and monkey brain

Catani

Naianna

Beyh

et al. 2017

Cortex

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The parietal lobe has a unique place in the human brain. Anatomically, it is at the crossroad between the frontal, occipital, and temporal lobes, thus providing a middle ground for multimodal sensory integration. Functionally, it supports higher cognitive functions that are characteristic of the human species, such as mathematical cognition, semantic and pragmatic aspects of language, and abstract thinking. Despite its importance, a comprehensive comparison of human and simian intraparietal networks is missing. In this study, we used diffusion imaging tractography to reconstruct the major intralobar parietal tracts in twenty-one datasets acquired in vivo from healthy human subjects and eleven ex vivo datasets from five vervet and six macaque monkeys. Three regions of interest (postcentral gyrus, superior parietal lobule and inferior parietal lobule) were used to identify the tracts. Surface projections were reconstructed for both species and results compared to identify similarities or differences in tract anatomy (i.e., trajectories and cortical projections). In addition, post-mortem dissections were performed in a human brain. The largest tract identified in both human and monkey brains is a vertical pathway between the superior and inferior parietal lobules. This tract can be divided into an anterior (supramarginal gyrus) and a posterior (angular gyrus) component in both humans and monkey brains. The second prominent intraparietal tract connects the postcentral gyrus to both supramarginal and angular gyri of the inferior parietal lobule in humans but only to the supramarginal gyrus in the monkey brain. The third tract connects the postcentral gyrus to the anterior region of the superior parietal lobule and is more prominent in monkeys compared to humans. Finally, short U-shaped fibres in the medial and lateral aspects of the parietal lobe were identified in both species. A tract connecting the medial parietal cortex to the lateral inferior parietal cortex was observed in the monkey brain only. Our findings suggest a consistent pattern of intralobar parietal connections between humans and monkeys with some differences for those areas that have cytoarchitectonically distinct features in humans. The overall pattern of intraparietal connectivity supports the special role of the inferior parietal lobule in cognitive functions characteristic of humans.

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“…Furthermore, a larger sample size would have allowed for comparisons according to the particular location of the insular-cortex lesions (anterior vs. posterior insular cortex), which could be of special interest given the functional segregation within the insular cortex revealed by functional imaging and intracerebral electrical stimulation studies (Kurth, Zilles, Fox, Laird, & Eickhoff, 2010). Another limitation is that lesion patients would be likely to have known insight problems, particularly in the righthemisphere-lesioned patients (Besharati et al, 2016;Heilman, 2014). The patients who were enrolled in our research performed a physical examination strictly, including speaking, movement, anosognosia, and so on.…”

Section: Limitationmentioning

confidence: 99%

Multidimensional assessment of empathic abilities in patients with insular glioma

Chen

Wang

et al. 2016

Cogn Affect Behav Neurosci

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Recent studies have provided evidence that there are two possible systems for empathy: affective empathy (AE) and cognitive empathy (CE). Neuroimaging paradigms have proven that the insular cortex is involved in empathy processing, particularly in AE. However, these observations do not provide causal evidence for the role of the insula in empathy. Although impairments in empathy have been described following insular damage in a few case studies, it is not clear whether insular cortex is involved in CE and whether these two systems are impaired independently or laterally in patients with insular gliomas. In this study, we assessed 17 patients with an insular glioma, 17 patients with a noninsular glioma, and 30 healthy controls using a method that combined a self-report empathy questionnaire with the emotion recognition task, assessment of empathy for others' pain, and the emotional perspective-taking paradigm. We found that patients with an insular glioma had lower scores for empathic concern and perspective taking than did either healthy controls or lesion controls. The patients' abilities to recognize facial emotions, perceive others' pain, and understand the emotional perspectives of others were also significantly impaired. Furthermore, we did not observe a laterality effect on either AE or CE among those with insular lesions. These findings revealed that both AE and CE are impaired in patients with an insular glioma and that the insular cortex may be a central neuroanatomical structure in both the AE and CE systems.

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Mentalizing the body: spatial and social cognition in anosognosia for hemiplegia

Cited by 59 publications

References 80 publications

Anosognosia for Hemiplegia as a tripartite disconnection syndrome

Anosognosia for Hemiplegia as a tripartite disconnection syndrome

Short parietal lobe connections of the human and monkey brain

Multidimensional assessment of empathic abilities in patients with insular glioma

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