Acquired alexithymia following damage to the anterior insula.
Acquired alexithymia following damage to the anterior insula.
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DOI：
10.1016/j.neuropsychologia.2016.01.021
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发表时间：
2016-02
期刊：
影响因子：
2.6
通讯作者：
Grafman J
中科院分区：
文献类型：
--
作者：
Hogeveen J;Bird G;Chau A;Krueger F;Grafman J
述情障碍是一种亚临床状态，其特征是对一个人的情绪状态的意识受损，这对心理健康和社会交往有深远的影响。尽管这种情况的临床意义，导致述情障碍的神经认知障碍仍不清楚。最近的理论模型表明，受损的前额叶（AI）功能可能参与述情障碍，但这一假设缺乏确凿的证据。我们测量了大样本脑损伤患者（N=129）和非脑损伤对照组（N=33）的述情障碍水平，以确定AI明显受损后是否可以获得述情障碍。首先分析述情障碍水平作为组的函数，基于AI损伤将患者分为四组：AI损伤>15%的患者，AI损伤<15%的患者，AI无损伤的患者和健康对照。方差分析显示，述情障碍水平在各组之间存在差异（p=0.009），相对于所有其他组，>15% AI损伤导致更高的述情障碍（所有p<0.01）。接下来，以AI的损伤程度、相关区域（前扣带回皮质，ACC）的损伤程度和全脑的损伤程度为预测变量，以述情障碍为因变量，拟合多元线性回归模型。重要的是，在控制了其他两个回归因素（ACC损伤;总损伤体积）后，AI损伤的增加预测了述情障碍的增加。总的来说，我们的研究结果表明，明显的AI损伤会导致述情障碍水平的增加，这为该区域支持情绪意识提供了关键证据。
Alexithymia is a subclinical condition characterized by impaired awareness of one’s emotional states, which has profound effects on mental health and social interaction. Despite the clinical significance of this condition, the neurocognitive impairment(s) that lead to alexithymia remain unclear. Recent theoretical models suggest that impaired anterior insula (AI) functioning might be involved in alexithymia, but conclusive evidence for this hypothesis is lacking. We measured alexithymia levels in a large sample of brain-injured patients (N=129) and non-brain-injured control participants (N=33), to determine whether alexithymia can be acquired after pronounced damage to the AI. Alexithymia levels were first analyzed as a function of group, with patients separated into four groups based on AI damage: patients with >15% damage to AI, patients with <15% damage to AI, patients with no damage to AI, and healthy controls. An ANOVA revealed that alexithymia levels varied across groups (p=0.009), with >15% AI damage causing higher alexithymia relative to all other groups (all p<0.01). Next, a multiple linear regression model was fit with the degree of damage to AI, the degree of damage to a related region (the anterior cingulate cortex, ACC), and the degree of damage to the whole brain as predictor variables, and alexithymia as the dependent variable. Critically, increased AI damage predicted increased alexithymia after controlling for the other two regressors (ACC damage; total lesion volume). Collectively, our results suggest that pronounced AI damage causes increased levels of alexithymia, providing critical evidence that this region supports emotional awareness.