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Right anterior insula: core region of hallucinations in cognitive neurodegenerative diseases.

Blanc F, Noblet V, Philippi N, Cretin B, Foucher J, Armspach JP, Rousseau F, Alzheimer's Disease Neuroimaging Initiati - PLoS ONE (2014)

Bottom Line: Focal brain volume on MRI was analyzed and compared between the two groups according to the VBM method.Correlations between intensity of hallucinations and brain volume were found in the right anterior insula, precentral gyrus, superior temporal gyrus, and left precuneus.We checked the neuropathological status and we found that the 4 patients autopsied in the AD-hallu group had the mixed pathology AD and Dementia with Lewy bodies (DLB).

View Article: PubMed Central - PubMed

Affiliation: University Hospital of Strasbourg, Neuropsychology Unit, Neurology Service, Strasbourg, France; University of Strasbourg and CNRS, ICube laboratory UMR 7357, FMTS (Fédération de Médecine Translationnelle de Strasbourg), Strasbourg, France; University Hospital of Strasbourg, CMRR (Memory Resources and Research Centre), Strasbourg, France; University Hospital of Strasbourg, Day Hospital of Geriatrics, Geriatrics Service, Strasbourg, France.

ABSTRACT

Objectives: We investigated the neural basis of hallucinations Alzheimer's disease (AD) by applying voxel-based morphometry (VBM) to anatomical and functional data from the AD Neuroimaging Initiative.

Methods: AD patients with hallucinations, based on the Neuropsychiatric Inventory (NPI-Q) (AD-hallu group; n = 39), were compared to AD patients without hallucinations matched for age, sex, educational level, handedness and MMSE (AD-c group; n = 39). Focal brain volume on MRI was analyzed and compared between the two groups according to the VBM method. We also performed voxel-level correlations between brain volume and hallucinations intensity. A similar paradigm was used for the PET analysis. "Core regions" (i.e. regions identified in both MRI and PET analyses, simply done by retaining the clusters obtained from the two analyses that are overlapping) were then determined.

Results: Regions with relative atrophy in association with hallucinations were: anterior part of the right insula, left superior frontal gyrus and lingual gyri. Regions with relative hypometabolism in association with hallucinations were a large right ventral and dorsolateral prefrontal area. "Core region" in association with hallucinations was the right anterior part of the insula. Correlations between intensity of hallucinations and brain volume were found in the right anterior insula, precentral gyrus, superior temporal gyrus, and left precuneus. Correlations between intensity of hallucinations and brain hypometabolism were found in the left midcingulate gyrus. We checked the neuropathological status and we found that the 4 patients autopsied in the AD-hallu group had the mixed pathology AD and Dementia with Lewy bodies (DLB).

Conclusion: Neural basis of hallucinations in cognitive neurodegenerative diseases (AD or AD and DLB) include a right predominant anterior-posterior network, and the anterior insula as the core region. This study is coherent with the top-down/bottom-up hypotheses on hallucinations but also hypotheses of the key involvement of the anterior insula in hallucinations in cognitive neurodegenerative diseases.

No MeSH data available.


Related in: MedlinePlus

Brain regions of relative atrophy of AD patients with hallucinations compared to healthy controls (A and B left) and AD patients without hallucinations compared to healthy controls (A and B right).Brain regions of relative hypometabolism of AD patients compared to healthy controls (C). (A: for gray matter only: T = p<0.05, correction FWE, minimum cluster size = 25 voxels; B: T = p<0.001, without correction, minimum cluster size = 25 voxels; C. T = p<0.001, without correction, minimum cluster size = 25 voxels) A. The relative atrophy involves hippocampi and amygdalas for the two AD groups, for the analysis with correction. B. The relative atrophy of gray matter (red) and white matter (yellow) involves also input and output pathways of the hippocampi including amygdalas, entorhinal cortex, fornix, thalami and cingulate gyrus. C: Relative hypometabolism (FDG PET) of AD-hallu (left) and AD-c (right) compared to healthy controls. Right is right.
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pone-0114774-g001: Brain regions of relative atrophy of AD patients with hallucinations compared to healthy controls (A and B left) and AD patients without hallucinations compared to healthy controls (A and B right).Brain regions of relative hypometabolism of AD patients compared to healthy controls (C). (A: for gray matter only: T = p<0.05, correction FWE, minimum cluster size = 25 voxels; B: T = p<0.001, without correction, minimum cluster size = 25 voxels; C. T = p<0.001, without correction, minimum cluster size = 25 voxels) A. The relative atrophy involves hippocampi and amygdalas for the two AD groups, for the analysis with correction. B. The relative atrophy of gray matter (red) and white matter (yellow) involves also input and output pathways of the hippocampi including amygdalas, entorhinal cortex, fornix, thalami and cingulate gyrus. C: Relative hypometabolism (FDG PET) of AD-hallu (left) and AD-c (right) compared to healthy controls. Right is right.

Mentions: Comparison with FWE correction (P<0.05) of GM of AD-hallu patients with healthy controls showed significant relative atrophy in hippocampi and amygdalas (Figure 1A left). The same regions were found for the comparison of AD-c patients and healthy controls (Figure 1A right). The whole cluster size of voxels is of 5554 when comparing AD-c to healthy controls, and of 1389 when comparing AD-hallu to healthy controls.


Right anterior insula: core region of hallucinations in cognitive neurodegenerative diseases.

Blanc F, Noblet V, Philippi N, Cretin B, Foucher J, Armspach JP, Rousseau F, Alzheimer's Disease Neuroimaging Initiati - PLoS ONE (2014)

Brain regions of relative atrophy of AD patients with hallucinations compared to healthy controls (A and B left) and AD patients without hallucinations compared to healthy controls (A and B right).Brain regions of relative hypometabolism of AD patients compared to healthy controls (C). (A: for gray matter only: T = p<0.05, correction FWE, minimum cluster size = 25 voxels; B: T = p<0.001, without correction, minimum cluster size = 25 voxels; C. T = p<0.001, without correction, minimum cluster size = 25 voxels) A. The relative atrophy involves hippocampi and amygdalas for the two AD groups, for the analysis with correction. B. The relative atrophy of gray matter (red) and white matter (yellow) involves also input and output pathways of the hippocampi including amygdalas, entorhinal cortex, fornix, thalami and cingulate gyrus. C: Relative hypometabolism (FDG PET) of AD-hallu (left) and AD-c (right) compared to healthy controls. Right is right.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4257732&req=5

pone-0114774-g001: Brain regions of relative atrophy of AD patients with hallucinations compared to healthy controls (A and B left) and AD patients without hallucinations compared to healthy controls (A and B right).Brain regions of relative hypometabolism of AD patients compared to healthy controls (C). (A: for gray matter only: T = p<0.05, correction FWE, minimum cluster size = 25 voxels; B: T = p<0.001, without correction, minimum cluster size = 25 voxels; C. T = p<0.001, without correction, minimum cluster size = 25 voxels) A. The relative atrophy involves hippocampi and amygdalas for the two AD groups, for the analysis with correction. B. The relative atrophy of gray matter (red) and white matter (yellow) involves also input and output pathways of the hippocampi including amygdalas, entorhinal cortex, fornix, thalami and cingulate gyrus. C: Relative hypometabolism (FDG PET) of AD-hallu (left) and AD-c (right) compared to healthy controls. Right is right.
Mentions: Comparison with FWE correction (P<0.05) of GM of AD-hallu patients with healthy controls showed significant relative atrophy in hippocampi and amygdalas (Figure 1A left). The same regions were found for the comparison of AD-c patients and healthy controls (Figure 1A right). The whole cluster size of voxels is of 5554 when comparing AD-c to healthy controls, and of 1389 when comparing AD-hallu to healthy controls.

Bottom Line: Focal brain volume on MRI was analyzed and compared between the two groups according to the VBM method.Correlations between intensity of hallucinations and brain volume were found in the right anterior insula, precentral gyrus, superior temporal gyrus, and left precuneus.We checked the neuropathological status and we found that the 4 patients autopsied in the AD-hallu group had the mixed pathology AD and Dementia with Lewy bodies (DLB).

View Article: PubMed Central - PubMed

Affiliation: University Hospital of Strasbourg, Neuropsychology Unit, Neurology Service, Strasbourg, France; University of Strasbourg and CNRS, ICube laboratory UMR 7357, FMTS (Fédération de Médecine Translationnelle de Strasbourg), Strasbourg, France; University Hospital of Strasbourg, CMRR (Memory Resources and Research Centre), Strasbourg, France; University Hospital of Strasbourg, Day Hospital of Geriatrics, Geriatrics Service, Strasbourg, France.

ABSTRACT

Objectives: We investigated the neural basis of hallucinations Alzheimer's disease (AD) by applying voxel-based morphometry (VBM) to anatomical and functional data from the AD Neuroimaging Initiative.

Methods: AD patients with hallucinations, based on the Neuropsychiatric Inventory (NPI-Q) (AD-hallu group; n = 39), were compared to AD patients without hallucinations matched for age, sex, educational level, handedness and MMSE (AD-c group; n = 39). Focal brain volume on MRI was analyzed and compared between the two groups according to the VBM method. We also performed voxel-level correlations between brain volume and hallucinations intensity. A similar paradigm was used for the PET analysis. "Core regions" (i.e. regions identified in both MRI and PET analyses, simply done by retaining the clusters obtained from the two analyses that are overlapping) were then determined.

Results: Regions with relative atrophy in association with hallucinations were: anterior part of the right insula, left superior frontal gyrus and lingual gyri. Regions with relative hypometabolism in association with hallucinations were a large right ventral and dorsolateral prefrontal area. "Core region" in association with hallucinations was the right anterior part of the insula. Correlations between intensity of hallucinations and brain volume were found in the right anterior insula, precentral gyrus, superior temporal gyrus, and left precuneus. Correlations between intensity of hallucinations and brain hypometabolism were found in the left midcingulate gyrus. We checked the neuropathological status and we found that the 4 patients autopsied in the AD-hallu group had the mixed pathology AD and Dementia with Lewy bodies (DLB).

Conclusion: Neural basis of hallucinations in cognitive neurodegenerative diseases (AD or AD and DLB) include a right predominant anterior-posterior network, and the anterior insula as the core region. This study is coherent with the top-down/bottom-up hypotheses on hallucinations but also hypotheses of the key involvement of the anterior insula in hallucinations in cognitive neurodegenerative diseases.

No MeSH data available.


Related in: MedlinePlus