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Clinical Manifestations.

Katia Andrade1, Patrick Maloyan2, Dimitrios Pantazis3

  • 1Institute of Memory and Alzheimer's Disease (IM2A), Salpêtrière University Hospital, Paris, Paris, France.

Alzheimer'S & Dementia : the Journal of the Alzheimer'S Association
|December 25, 2025
PubMed
Summary
This summary is machine-generated.

Anosognosia, or lack of insight in Alzheimer's disease (AD), is linked to changes in the orbitofrontal cortex (OFC) and anterior cingulate cortex (ACC). These brain regions are crucial for self-awareness and emotional processing in AD patients.

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Area of Science:

  • Neuroscience
  • Neurology
  • Cognitive Science

Background:

  • Anosognosia, a deficit in self-awareness, is a significant neuropsychiatric symptom in Alzheimer's disease (AD).
  • This symptom typically emerges early in AD progression and tends to worsen over time.

Purpose of the Study:

  • To investigate the specific brain structures and areas contributing to the development of anosognosia in individuals with Alzheimer's disease.
  • To test a dual-path hypothesis regarding the neural underpinnings of anosognosia in AD.

Main Methods:

  • The study analyzed a subgroup of 125 participants from the Alzheimer's Disease Neuroimaging Initiative (ADNI) cohort who progressed from mild cognitive impairment (MCI) to AD.
  • Cortical thickness was assessed in specific brain regions implicated in error monitoring and emotional processing.

Main Results:

  • Deterioration in self-awareness correlated significantly with cortical thinning in the orbitofrontal cortex (OFC) and anterior cingulate cortex (ACC).
  • Specific areas within the OFC (right hemisphere p32, left hemisphere a25) and ACC (left hemisphere a24) showed significant associations with anosognosia.

Conclusions:

  • The findings support a dual-path model for anosognosia in AD, highlighting the importance of the indirect pathway involving emotional processing and error-monitoring.
  • The indirect pathway, particularly involving the OFC, plays a critical role in the self-awareness loop within the context of Alzheimer's disease.