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Henry, where have you lost your Self?

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Cortex; a Journal Devoted to the Study of the Nervous System and Behavior
|August 27, 2017
PubMed
Summary

This study details a unique Alzheimer's patient with severe Self-concept loss due to specific medial prefrontal cortex (MPFC) and insular cortex atrophy. This suggests the subjective sense of Self is crucial for maintaining Self-awareness in Alzheimer's disease (AD).

Keywords:
Alzheimer's diseaseAutobiographical memoryCase-reportInsulaMedial prefrontal cortexSelf

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Area of Science:

  • Neuroscience
  • Cognitive Psychology
  • Neurology

Background:

  • The Self is a multifaceted construct involving autobiographical memory, self-concept, and self-awareness.
  • Alzheimer's disease (AD) offers a model to study Self-degradation due to its impact on memory.
  • The medial prefrontal cortex (MPFC) and cortical midline structures are implicated in Self-related processing.

Observation:

  • A patient with mild cognitive impairment (MCI) due to AD, named Henry, exhibited profound loss of autobiographical memory, self-concept, and personal semantic memory.
  • Henry also displayed unusual anosognosia (lack of insight) regarding his cognitive deficits.
  • Neuroimaging revealed significant atrophy in Henry's MPFC and bilateral insular cortex, distinct from typical AD patterns.

Findings:

  • Voxel-based morphometry confirmed specific MPFC atrophy in Henry, correlating with his degraded Self components.
  • Significant atrophy in the bilateral insular cortex was also observed.
  • The pattern of atrophy suggests the collapse of the Self is linked to the breakdown of the subjective sense of Self, rather than solely mnemonic decline.

Implications:

  • The subjective sense of Self may be a foundational component necessary for other Self-related processes.
  • This case highlights the critical role of the MPFC and insular cortex in maintaining Self-awareness and identity in AD.
  • Understanding these neuro-anatomical underpinnings can inform future therapeutic strategies for cognitive and Self-related deficits in neurodegenerative diseases.