Dementia with Lewy bodies (DLB) is characterized by insular atrophy, which occurs at the early stage of the disease. Damage to the insula has been associated with disorders reflecting impairments of the most fundamental components of the self, such as anosognosia, which is a frequently reported symptom in patients with Lewy bodies (LB). The purpose of this study was to investigate modifications of the self-concept (SC), another component of the self, and to identify neuroanatomical correlates, in prodromal to mild DLB. Twenty patients with prodromal to mild DLB were selected to participate in this exploratory study along with 20 healthy control subjects matched in terms of age, gender, and level of education. The Twenty Statements Test (TST) was used to assess the SC. Behavioral performances were compared between LB patients and control subjects. Three-dimensional magnetic resonance images (MRI) were acquired for all participants and correlational analyses were performed using voxel-based morphometry (VBM) in whole brain and using a mask for the insula. The behavioral results on the TST showed significantly impaired performances in LB patients in comparison with control subjects (p < .0001). Correlational analyses using VBM revealed positive correlations between the TST and grey matter volume within insular cortex, right supplementary motor area, bilateral inferior temporal gyri, right inferior frontal gyrus, and left lingual gyrus, using a threshold of p = .001 uncorrected, including total intracranial volume (TIV), age, and MMSE as nuisance covariates. Additionally, correlational analysis using a mask for the insula revealed positive correlation with grey matter volume within bilateral insular cortex, using a threshold of p = .005. The behavioral results confirm the existence of SC impairments in LB patients from the prodromal stage of the disease, compared to matched healthy controls. As we expected, VBM analyses revealed involvement of the insula, among that of other brain regions, already known to be involved in other self-components. While this study is exploratory, our findings provide important insights regarding the involvement of the insula within the self, confirming the insula as a core region of the self-networks, including for high-order self-representations such as the SC.

中文翻译：

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拥有路易体的我是谁？岛叶作为自我概念网络的核心区域

路易体痴呆（DLB）的特点是岛叶萎缩，发生在疾病的早期阶段。岛叶损伤与反映自我最基本组成部分受损的疾病有关，例如失认症，这是路易体 (LB) 患者经常报告的症状。本研究的目的是调查自我概念（SC）（自我的另一个组成部分）的改变，并确定前驱期至轻度 DLB 的神经解剖学相关性。选择 20 名患有前驱期至轻度 DLB 的患者以及 20 名年龄、性别和教育水平相匹配的健康对照受试者参加这项探索性研究。二十个陈述测试（TST）用于评估 SC。比较 LB 患者和对照组受试者的行为表现。采集所有参与者的三维磁共振图像（MRI），并使用基于体素的形态测量（VBM）对整个大脑进行相关分析，并使用脑岛掩模。 TST 的行为结果显示，与对照受试者相比，LB 患者的表现明显受损 (p < .0001)。使用 VBM 进行的相关分析显示，TST 与岛叶皮质、右侧辅助运动区、双侧颞下回、右侧额下回和左侧舌回内的灰质体积呈正相关，阈值 p = 0.001 未校正，包括总灰质体积颅内容积 (TIV)、年龄和 MMSE 作为令人讨厌的协变量。此外，使用岛叶掩模进行的相关分析显示，其与双侧岛叶皮层内的灰质体积呈正相关，阈值 p = 0.005。行为结果证实，与匹配的健康对照相比，LB 患者在疾病前驱阶段就存在 SC 损伤。正如我们所预期的，VBM 分析揭示了岛叶的参与，以及其他大脑区域的参与，已知这些区域参与了其他自身成分。虽然这项研究是探索性的，但我们的研究结果提供了有关岛叶参与自我的重要见解，证实岛叶是自我网络的核心区域，包括 SC 等高阶自我表征。