The dual-path hypothesis for the emergence of anosognosia in Alzheimer's disease.
The dual-path hypothesis for the emergence of anosognosia in Alzheimer's disease.
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DOI：
10.3389/fneur.2023.1239057
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发表时间：
2023
影响因子：
3.4
通讯作者：
中科院分区：
文献类型：
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虽然神经认知模型已经被提出来解释阿尔茨海默病（AD）的病感失认症，但负责其在人脑中起源的神经级联仍然未知。在这里，我们建立在一个机械的双路径假设，使错误监测和情绪处理系统的自我意识的关键要素，在AD病感失认症的出现具有明显的影响。从疾病感失认症作为一种维度综合征的概念出发，疾病感失认症在缺乏对自身缺陷的关注（即，我们的假设指出，（i）对缺陷的无意识可能是由于对错误监控系统的主要损害，而（ii）对缺陷的无意识更可能是由于情绪处理和错误监控之间的不平衡。在第一种情况下，前扣带皮层和后扣带皮层发挥主要作用的错误监控系统中的突触故障将对错误（或缺陷）意识产生负面影响，阻止患者意识到他们的状况。在第二种情况下，杏仁核和眶额皮层在情绪处理系统中起着重要作用，如果患者的情绪处理系统受损，患者就无法监测内部环境中的相关错误（或缺陷），也无法为这些错误（或缺陷）赋予适当的价值，从而使它们对错误监测系统的影响产生偏差。我们的假设基于两个科学前提。一个来自AD患者的初步结果，显示错误监测系统中的突触故障沿着诊断时认知困难的意识下降。另一种观点来自躯体标记假说，该假说认为情绪信号对适应行为至关重要。这些前提的进一步探索将是非常有趣的照亮自我意识的基础，并提高我们的知识的基础路径的病感失认症在AD和其他大脑疾病。
Although neurocognitive models have been proposed to explain anosognosia in Alzheimer’s disease (AD), the neural cascade responsible for its origin in the human brain remains unknown. Here, we build on a mechanistic dual-path hypothesis that brings error-monitoring and emotional processing systems as key elements for self-awareness, with distinct impacts on the emergence of anosognosia in AD. Proceeding from the notion of anosognosia as a dimensional syndrome, varying between a lack of concern about one’s own deficits (i.e., anosodiaphoria) and a complete lack of awareness of deficits, our hypothesis states that (i) unawareness of deficits would result from primary damage to the error-monitoring system, whereas (ii) anosodiaphoria would more likely result from an imbalance between emotional processing and error-monitoring. In the first case, a synaptic failure in the error-monitoring system, in which the anterior and posterior cingulate cortices play a major role, would have a negative impact on error (or deficits) awareness, preventing patients from becoming aware of their condition. In the second case, an impairment in the emotional processing system, in which the amygdala and the orbitofrontal cortex play a major role, would prevent patients from monitoring the internal milieu for relevant errors (or deficits) and assigning appropriate value to them, thus biasing their impact on the error-monitoring system. Our hypothesis stems on two scientific premises. One comes from preliminary results in AD patients showing a synaptic failure in the error-monitoring system along with a decline of awareness for cognitive difficulties at the time of diagnosis. Another comes from the somatic marker hypothesis, which proposes that emotional signals are critical to adaptive behavior. Further exploration of these premises will be of great interest to illuminate the foundations of self-awareness and improve our knowledge of the underlying paths of anosognosia in AD and other brain disorders.
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影响因子：
4
作者：
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通讯作者：
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影响因子：
4.7
作者：
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通讯作者：
Huntley J
影响因子：
3.7
作者：
Chu, CC;Tranel, D;VanHoesen, GW
通讯作者：
VanHoesen, GW
影响因子：
3.7
作者：
Daselaar, Sander M.;Iyengar, Vijeth;Cabeza, Roberto E.
通讯作者：
Cabeza, Roberto E.
DOI：
10.1111/j.1749-6632.2003.tb07094.x
发表时间：
2003-01-01
期刊：
AMYGDALA IN BRAIN FUNCTION: BASIC AND CLINICAL APPROACHES
影响因子：
--
作者：
Bechara, A;Damasio, H;Damasio, AR
通讯作者：
Damasio, AR