Table 1.
Study characteristics of structural imaging studies included in systematic review
| Author (y) | N of patients | MMSE (SD) | Anosognosia measure | Metacognitive stimuli | Type of scan | Threshold | Analysis | Peak coordinate (MNI/T88) |
Region [Brodmann area] | Correlation | ||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| x | y | z | ||||||||||
| Anosognosia | ||||||||||||
| De Castro et al. (2007) | 21 AD | 18.2 (5.0) | Self-Consciousness Questionnaire Denial of illness scale |
N/A | CT MRI |
ROI | N/A | N/A | N/A | N/A | No significant regions | |
| Fujimoto et al. (2017) | 49 AD | 21.6 (2.9) | Anosognosia score | N/A | MRI | Whole brain | Gray matter density | 15 | 18 | 56 | L superior frontal gyrus [6, 8] | ↓ |
| Guerrier et al. (2018) | 30 AD | 24.0 (3.8) | Cognitive Difficulties Scale | N/A | MRI | Whole brain | Gray matter density | −11 0 −53 33 |
−2 −68 −2 0 |
42 −27 39 −36 |
L dorsal anterior cingulate [24] Posterior vermis L postcentral gyrus [6] R fusiform gyrus [20] |
↓ ↓ ↓ ↓ |
| Hornberger et al. (2014) | 15 AD 24 bvFTD 18 semantic dementia 13 PNFA 11 LPA |
22.1 (7.6) | Insight questionnaire | N/A | MRI | ROI | Gray matter density | N/A✝ | N/A✝ | N/A✝ | No significant regions for AD only analysis | |
| Ruby et al. (2009) | 14 AD 17 HC 17 YC |
N/A | Judgment of personality | N/A | MRI | Whole brain | N/A | N/A | N/A | N/A | No MRI results reported | |
| Senturk et al. (2017) | 21 AD 26 aMCI |
Un-aware 24.1 (2.6) Aware 25.3 (3.1) |
Anosognosia Questionnaire Dementia Clinical Insight Rating Scale |
N/A | MRI | ROI | N/A | N/A | N/A | N/A | No significant regions found | |
| Metacognition | ||||||||||||
| Bertrand et al. (2018) | 14 AD 20 HC |
23.3 (2.3) 29.3 (1.5) |
N/A | Feeling of Knowing (FoK): Episodic retrieval task |
MRI | ROI | Cortical thickness | N/A | N/A | N/A | R posterior cingulate cortex R medial prefrontal cortex |
↓ ↓ |
| Cosentino et al. (2015) | 14 AD 20 HC |
23.3 (2.3) 29.3 (1.5) |
N/A | Feeling of knowing (FoK): Episodic retrieval task |
MRI | ROI | Volumetric ROI | N/A | N/A | N/A | R insula | ↓ |
| Genon et al. (2014) | 21 AD | 23.6 (2.0) | N/A | Adapted Remember/Know paradigm: Word recall Self-recognition task Self-recollection task |
MRI | Whole brain | Gray matter density | 30 N/A |
45 N/A |
6 N/A |
Lateral prefrontal cortex R/M superior frontal gyrus |
↓ ↓ |
| Genon et al. (2016) | 23 AD | N/A | N/A | Feeling of Knowing (FoK): Face-name association Episodic and Semantic memory |
MRI | Whole brain | Gray matter volume | 45 −27 27 −41 N/A 52 31 −33 34 24 46 46 46 |
27 45 −9 2 N/A −54 −20 −61 −75 −50 28 37 24 |
13 11 55 39 N/A −14 −22 −44 −44 −49 14 16 31 |
R inferior/middle frontal L middle orbital gyrus R posterior frontal L precentral gyrus M posterior cingulate cortex R inferior temporal gyrus R medial temporal lobe L cerebellum R cerebellum R cerebellum R inferior frontal gyrus M frontal gyrus M frontal gyrus |
↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ |
| Massimo et al. (2013) | 17 AD | 20.6 (0.7) | N/A | Judgment of Learning (JOL): Rey Complex Figure Immediate Free Recall |
MRI | Whole brain | Gray matter density | 34 13 23 −15 |
49 47 22 37 |
10 7 40 −30 |
R frontal pole [10] R Anterior cingulate cortex [32] R Anterior cingulate cortex [32] R Orbitofrontal cortex [11] |
↓ ↓ ↓ ↓ |
| Both Anosognosia and Metacognition measures | ||||||||||||
| Perrotin et al. (2015) | 23 AD | 21.5 (4.6) | Cognitive Difficulties Scale | Judgment of Learning (JOL): RL/RI-16 |
MRI | ROI | N/A | N/A | N/A | N/A | No MRI results reported | |
| Philippi et al. (2017) | 1 AD 7 AD 12 HC |
25 24.6 (1.0) 28.8 (1.0) |
Study specific anosognosia questionnaire | Remember/Know paradigm: Word recognition memory test |
MRI | ROI | Gray matter volume | N/A 5✝ −5✝ 22✝ −39✝ 40✝ −13✝ −9✝ |
N/A 59✝ 51✝ 51✝ −12✝ −7✝ 4✝ −101✝ |
N/A −3✝ −24✝ 12✝ −3✝ −4✝ 19✝ 1✝ |
Medial prefrontal cortex R medial frontal gyrus [10] L inferior frontal gyrus (rectus)/orbital [11] R superior frontal gyrus L insula [13] R insula [13] L Caudate L Cuneus [18] |
↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ |
| Tondelli et al. (2018) | 12 AD 15 aMCI |
23.4 (1.0) 27.3 (0.4) |
Anosognosia Questionnaire Dementia Clinical Insight Rating Scale |
Judgment of Learning (JOL): Functional Assessment Battery Rey Auditory Verbal Learning Babcock Story Recall Test Rey Figure Recall Stroop |
MRI | ROI | Gray matter volume | 30✝ 26✝ −24✝ 30✝ −34✝ N/A N/A |
−20✝ 62✝ −8✝ −14✝ 20✝ N/A N/A |
−18✝ 20✝ −14✝ −16✝ −26✝ N/A N/A |
Hippocampus (MTL) Superior frontal gyrus Amygdala (MTL) Hippocampus (MTL) Frontal orbital cortex Anterior cingulate cortex Middle cingulate cortex |
↓ ↓ ↓ ↓ ↓ ↓ ↓ |
All significant regions in studies reached threshold of FWE 0.05.
Key: AD, Alzheimer’s disease; aMCI, amnesic mild cognitive impairment; bvFTD, behavioral frontotemporal dementia; CT, computed tomography; HC, healthy older controls; YC, healthy young controls; L, left hemisphere; LPA, progressive aphasia; M, middle; MMSE = Mini-Mental State Examination; MNI, Montreal Neurological Institute; MRI, magnetic resonance imaging; MTL, medial temporal lobe; PNFA, primary nonfluent aphasia; R, right hemisphere; ROI, region of interest; T88, Talairach; SD = standard deviation.
✝ = coordinates published but not AD only.
↓ = negative correlation—as anosognosia score increases, gray matter volume/density decreases.