Predictive factors for postoperative delirium in thoracic surgery.

OBJECTIVE: We examined cases in which delirium developed after thoracic surgery under general anesthesia at our hospital to determine the predictive factors for postoperative delirium, as well as the perioperative findings in cases showing postoperative delirium. METHODS: This retrospective study included 1674 patients who underwent surgery under general anesthesia at our hospital between 2012 and 2022, A psychiatrist diagnosed postoperative delirium using the Confusion Assessment Method. RESULTS: There were 99 (5.9%) patients with postoperative delirium in our study, including 85 (86%) men, of whom 31 (31%) had a history of cerebrovascular disease. The incidence of postoperative delirium in patients aged > 80 years was 20% (36/182). The postoperative delirium group showed significantly longer hospital stays and more frequent postoperative complications than the group without postoperative delirium. In univariate analysis, age ≥ 80 years, male sex, history of cerebrovascular disease, hypertension, history of atrial fibrillation, and history of smoking were identified as significant factors, while multivariate analysis identified age ≥ 80 years, male sex, history of cerebrovascular disease, hypertension, and history of smoking as significant factors (odds ratios = 5.15, 2.04, 3.10, 1.67, and 2.36, respectively). In the 169 cases with none of these five factors, the postoperative delirium risk was 0% (0/169). CONCLUSIONS: In patients undergoing thoracic surgery, predictive factors for postoperative delirium include age ≥ 80 years, male sex, history of cerebrovascular disease, hypertension, and smoking history. The findings also indicate that patients with these risk factors may require psychiatric consultation before surgery.

Diurnal Variation of Brain Activity in the Human Suprachiasmatic Nucleus.

The suprachiasmatic nucleus (SCN) is the central clock for circadian rhythms. Animal studies have revealed daily rhythms in the neuronal activity in the SCN. However, the circadian activity of the human SCN has remained elusive. In this study, to reveal the diurnal variation of the SCN activity in humans, we localized the SCN by employing an areal boundary mapping technique to resting-state functional images and investigated the SCN activity using perfusion imaging. In the first experiment (n = 27, including both sexes), we scanned each participant four times a day, every 6 h. Higher activity was observed at noon, while lower activity was recorded in the early morning. In the second experiment (n = 20, including both sexes), the SCN activity was measured every 30 min for 6 h from midnight to dawn. The results showed that the SCN activity gradually decreased and was not associated with the electroencephalography. Furthermore, the SCN activity was compatible with the rodent SCN activity after switching off the lights. These results suggest that the diurnal variation of the human SCN follows the zeitgeber cycles of nocturnal and diurnal mammals and is modulated by physical lights rather than the local time.

Functional connectivity in autism spectrum disorder evaluated using rs-fMRI and DKI.

We evaluated functional connectivity (FC) in patients with adult autism spectrum disorder (ASD) using resting-state functional MRI (rs-fMRI) and diffusion kurtosis imaging (DKI). We acquired rs-fMRI data from 33 individuals with ASD and 33 healthy controls (HC) and DKI data from 18 individuals with ASD and 17 HC. ASD showed attenuated FC between the right frontal pole (FP) and the bilateral temporal fusiform cortex (TFusC) and enhanced FC between the right thalamus and the bilateral inferior division of lateral occipital cortex, and between the cerebellar vermis and the right occipital fusiform gyrus (OFusG) and the right lingual gyrus, compared with HC. ASD demonstrated increased axial kurtosis (AK) and mean kurtosis (MK) in white matter (WM) tracts, including the right anterior corona radiata (ACR), forceps minor (FM), and right superior longitudinal fasciculus (SLF). In ASD, there was also a significant negative correlation between MK and FC between the cerebellar vermis and the right OFusG in the corpus callosum, FM, right SLF and right ACR. Increased DKI metrics might represent neuroinflammation, increased complexity, or disrupted WM tissue integrity that alters long-distance connectivity. Nonetheless, protective or compensating adaptations of inflammation might lead to more abundant glial cells and cytokine activation effectively alleviating the degeneration of neurons, resulting in increased complexity. FC abnormality in ASD observed in rs-fMRI may be attributed to microstructural alterations of the commissural and long-range association tracts in WM as indicated by DKI.

Reduced neurite density index in the prefrontal cortex of adults with autism assessed using neurite orientation dispersion and density imaging.

Background: Core symptoms of autism-spectrum disorder (ASD) have been associated with prefrontal cortex abnormalities. However, the mechanisms behind the observation remain incomplete, partially due to the challenges of modeling complex gray matter (GM) structures. This study aimed to identify GM microstructural alterations in adults with ASD using neurite orientation dispersion and density imaging (NODDI) and voxel-wise GM-based spatial statistics (GBSS) to reduce the partial volume effects from the white matter and cerebrospinal fluid. Materials and methods: A total of 48 right-handed participants were included, of which 22 had ASD (17 men; mean age, 34.42 ± 8.27 years) and 26 were typically developing (TD) individuals (14 men; mean age, 32.57 ± 9.62 years). The metrics of NODDI (neurite density index [NDI], orientation dispersion index [ODI], and isotropic volume fraction [ISOVF]) were compared between groups using GBSS. Diffusion tensor imaging (DTI) metrics and surface-based cortical thickness were also compared. The associations between magnetic resonance imaging-based measures and ASD-related scores, including ASD-spectrum quotient, empathizing quotient, and systemizing quotient were also assessed in the region of interest (ROI) analysis. Results: After controlling for age, sex, and intracranial volume, GBSS demonstrated significantly lower NDI in the ASD group than in the TD group in the left prefrontal cortex (caudal middle frontal, lateral orbitofrontal, pars orbitalis, pars triangularis, rostral middle frontal, and superior frontal region). In the ROI analysis of individuals with ASD, a significantly positive correlation was observed between the NDI in the left rostral middle frontal, superior frontal, and left frontal pole and empathizing quotient score. No significant between-group differences were observed in all DTI metrics, other NODDI (i.e., ODI and ISOVF) metrics, and cortical thickness. Conclusion: GBSS analysis was used to demonstrate the ability of NODDI metrics to detect GM microstructural alterations in adults with ASD, while no changes were detected using DTI and cortical thickness evaluation. Specifically, we observed a reduced neurite density index in the left prefrontal cortices associated with reduced empathic abilities.

Right-Lateralized Enhancement of the Auditory Cortical Network During Imagined Music Performance.

Although the primary role of the auditory cortical areas is to process actual sounds, these areas are also activated by tasks that process imagined music, suggesting that the auditory cortical areas are involved in the processes underlying musical imagery. However, the mechanism by which these areas are involved in such processes is unknown. To elucidate this feature of the auditory cortical areas, we analyzed their functional networks during imagined music performance in comparison with those in the resting condition. While imagined music performance does not produce any musical sounds, the participants heard the same actual sounds from the MRI equipment in both experimental conditions. Therefore, if the functional connectivity between these conditions differs significantly, one can infer that the auditory cortical areas are actively involved in imagined music performance. Our functional connectivity analysis revealed a significant enhancement in the auditory network during imagined music performance relative to the resting condition. The reconfiguration profile of the auditory network showed a clear right-lateralized increase in the connectivity of the auditory cortical areas with brain regions associated with cognitive, memory, and emotional information processing. On the basis of these results, we hypothesize that auditory cortical areas and their networks are actively involved in imagined music performance through the integration of auditory imagery into mental imagery associated with music performance.

The Precuneus Contributes to Embodied Scene Construction for Singing in an Opera.

Performing an opera requires singers on stage to process mental imagery and theory of mind tasks in conjunction with singing and action control. Although it is conceivable that the precuneus, as a posterior hub of the default mode network, plays an important role in opera performance, how the precuneus contributes to opera performance has not been elucidated yet. In this study, we aimed to investigate the contribution of the precuneus to singing in an opera. Since the precuneus processes mental scenes, which are multimodal and integrative, we hypothesized that it is involved in opera performance by integrating multimodal information required for performing a character in an opera. We tested this hypothesis by analyzing the functional connectivity of the precuneus during imagined singing and rest. This study included 42 opera singers who underwent functional magnetic resonance imaging when performing "imagined operatic singing" with their eyes closed. During imagined singing, the precuneus showed increased functional connectivity with brain regions related to language, mirror neuron, socio-cognitive/emotional, and reward processing. Our findings suggest that, with the aid of its widespread connectivity, the precuneus and its network allow embodiment and multimodal integration of mental scenes. This information processing is necessary for imagined singing as well as performing an opera. We propose a novel role of the precuneus in opera performance.

Corrigendum: Increased Functional Connectivity of the Angular Gyrus During Imagined Music Performance.

[This corrects the article DOI: 10.3389/fnhum.2019.00092.].

Neurite orientation dispersion and density imaging reveals white matter microstructural alterations in adults with autism.

BACKGROUND: Evidences suggesting the association between behavioral anomalies in autism and white matter (WM) microstructural alterations are increasing. Diffusion tensor imaging (DTI) is widely used to infer tissue microstructure. However, due to its lack of specificity, the underlying pathology of reported differences in DTI measures in autism remains poorly understood. Herein, we applied neurite orientation dispersion and density imaging (NODDI) to quantify and define more specific causes of WM microstructural changes associated with autism in adults. METHODS: NODDI (neurite density index [NDI], orientation dispersion index, and isotropic volume fraction [ISOVF]) and DTI (fractional anisotropy [FA], mean diffusivity [MD], axial diffusivity, and radial diffusivity [RD]) measures were compared between autism (N = 26; 19 males and 7 females; 32.93 ± 9.24 years old) and age- and sex-matched typically developing (TD; N = 25; 17 males and 8 females; 34.43 ± 9.02 years old) groups using tract-based spatial statistics and region-of-interest analyses. Linear discriminant analysis using leave-one-out cross-validation (LDA-LOOCV) was also performed to assess the discriminative power of diffusion measures in autism and TD. RESULTS: Significantly lower NDI and higher ISOVF, suggestive of decreased neurite density and increased extracellular free-water, respectively, were demonstrated in the autism group compared with the TD group, mainly in commissural and long-range association tracts, but with distinct predominant sides. Consistent with previous reports, the autism group showed lower FA and higher MD and RD when compared with TD group. Notably, LDA-LOOCV suggests that NDI and ISOVF have relatively higher accuracy (82%) and specificity (NDI, 84%; ISOVF, 88%) compared with that of FA, MD, and RD (accuracy, 67-73%; specificity, 68-80%). LIMITATIONS: The absence of histopathological confirmation limit the interpretation of our findings. CONCLUSIONS: Our results suggest that NODDI measures might be useful as imaging biomarkers to diagnose autism in adults and assess its behavioral characteristics. Furthermore, NODDI allows interpretation of previous findings on changes in WM diffusion tensor metrics in individuals with autism.

Music Intervention Reduces Persistent Fibromyalgia Pain and Alters Functional Connectivity Between the Insula and Default Mode Network.

OBJECTIVE: The aims of the present study were to examine the effects of short-term music interventions among patients with fibromyalgia (FM) and to clarify the alterations in functional connectivity and persistent pain. DESIGN: Pilot study. SETTING: All participants were evaluated at Juntendo University from November 2017 to January 2019. SUBJECTS: We enrolled female patients who had been clinically diagnosed with FM (N = 23). METHODS: All participants listened to Mozart's Duo for Violin and Viola No. 1, K. 423, in a quiet room for 17 minutes. We compared the degree of pain using resting-state functional magnetic resonance imaging and the numeric rating scale before and after listening to music. RESULTS: Pain scores were significantly reduced after listening to music. Further, we observed there was a significant difference in connectivity between the right insular cortex (IC) and posterior cingulate cortex (PCC)/precuneus (PCu) before and after listening to music. We also found that the difference between the right IC-PCu connectivity and the difference in pain scores were significantly correlated. CONCLUSIONS: We found that a short period of music intervention reduced chronic pain and altered functional IC-default mode network connectivity. Furthermore, music potentially normalized the neural network via IC-default mode network connectivity, yielding temporary pain relief in patients with FM. Further longitudinal studies with larger sample sizes are required to confirm these results.

Difficulty differentiating a case of posterior cortical atrophy from a psychogenic disturbance of vision.

Differentiating posterior cortical atrophy (PCA) from other diseases can be difficult and time-consuming, and there is a particularly high possibility of misdiagnosis when psychiatrists diagnose complaints related to visual perception. Here, a case of PCA involving prominent visual perceptual disorders is reported; PCA was difficult to distinguish from psychogenic disturbance of vision in this case. For a year, a 59-year-old woman had had visual perceptual disorders, including a distorted view and prosopagnosia. She underwent examinations at multiple clinical departments at several medical institutions before receiving a definitive diagnosis of PCA. This PCA diagnosis was based on clinical symptoms, including Gerstmann syndrome, Bálint's syndrome, and transcortical sensory aphasia, and hypoperfusion in the occipital lobe observed on single-photon emission computed tomography. This case was initially misdiagnosed as a psychogenic disease partly because characteristic clinical manifestations of PCA include visual agnosia with a disjunctive component. This patient displayed a disordered perception of stationary objects but an intact perception of moving objects. For example, she had to grope her way through a room at home, but she could visit a familiar hair salon on foot without hindrance. Behaviours like claiming to be blind while inexplicably moving without colliding with surrounding objects may lead to the misdiagnosis of PCA as a psychogenic or dissociative disorder involving histrionic or neurologically irrational symptoms with an expectation of sympathy or personal gain. It is critical to make every effort to exclude organic diseases, even in cases provisionally diagnosed as psychogenic disease. Despite its low prevalence, PCA should be considered a syndrome caused by Alzheimer's disease, dementia with Lewy bodies, or other dementias.

White matter alterations in adult with autism spectrum disorder evaluated using diffusion kurtosis imaging.

PURPOSE: Autism spectrum disorder (ASD) is related to impairment in various white matter (WM) pathways. Utility of the recently developed two-compartment model of diffusion kurtosis imaging (DKI) to analyse axial diffusivity of WM is restricted by several limitations. The present study aims to validate the utility of model-free DKI in the evaluation of WM alterations in ASD and analyse the potential relationship between DKI-evident WM alterations and personality scales. METHODS: Overall, 15 participants with ASD and 15 neurotypical (NT) controls were scanned on a 3 T magnetic resonance (MR) scanner, and scores for autism quotient (AQ), systemising quotient (SQ) and empathising quotient (EQ) were obtained for both groups. Multishell diffusion-weighted MR data were acquired using two b-values (1000 and 2000 s/mm2). Differences in mean kurtosis (MK), radial kurtosis (RK) and axial kurtosis (AK) between the groups were evaluated using tract-based spatial statistics (TBSS). Finally, the relationships between the kurtosis indices and personality quotients were examined. RESULTS: The ASD group demonstrated significantly lower AK in the body and splenium of corpus callosum than the NT group; however, no other significant differences were identified. Negative correlations were found between AK and AQ or SQ, predominantly in WM areas related to social-emotional processing such as uncinate fasciculus, inferior fronto-occipital fasciculus, and inferior and superior longitudinal fasciculi. CONCLUSIONS: Model-free DKI and its indices may represent a novel, objective method for detecting the disease severity and WM alterations in patients with ASD.

Simultaneous fMRI-EEG-DTI recording of MMN in patients with schizophrenia.

Functional magnetic resonance imaging (fMRI), electroencephalogram (EEG), and diffusion tensor imaging (DTI) recording have complementary spatiotemporal resolution limitations but can be powerful methods when used together to enable both functional and anatomical modeling, with each neuroimaging procedure used to maximum advantage. We recorded EEGs during event-related fMRI followed by DTI in 15 healthy volunteers and 12 patients with schizophrenia using an omission mismatch negativity (MMN) paradigm. Blood oxygenation level-dependent (BOLD) signal changes were calculated in a region of interest (ROI) analysis, and fractional anisotropy (FA) in the white matter fibers related to each area was compared between groups using tract-specific analysis. Patients with schizophrenia had reduced BOLD activity in the left middle temporal gyrus, and BOLD activity in the right insula and right parahippocampal gyrus significantly correlated with positive symptoms on the Positive and Negative Syndrome Scale (PANSS) and hostility subscores. BOLD activation of Heschl's gyri also correlated with the limbic system, including the insula. FA values in the left anterior cingulate cortex (ACC) significantly correlated with changes in the BOLD signal in the right superior temporal gyrus (STG), and FA values in the right ACC significantly correlated with PANSS scores. This is the first study to examine MMN using simultaneous fMRI, EEG, and DTI recording in patients with schizophrenia to investigate the potential implications of abnormalities in the ACC and limbic system, including the insula and parahippocampal gyrus, as well as the STG. Structural changes in the ACC during schizophrenia may represent part of the neural basis for the observed MMN deficits. The deficits seen in the feedback/feedforward connections between the prefrontal cortex and STG modulated by the ACC and insula may specifically contribute to impaired MMN generation and clinical manifestations.

Increased Functional Connectivity of the Angular Gyrus During Imagined Music Performance.

The angular gyrus (AG) is a hub of several networks that are involved in various functions, including attention, self-processing, semantic information processing, emotion regulation, and mentalizing. Since these functions are required in music performance, it is likely that the AG plays a role in music performance. Considering that these functions emerge as network properties, this study analyzed the functional connectivity of the AG during the imagined music performance task and the resting condition. Our hypothesis was that the functional connectivity of the AG is modulated by imagined music performance. In the resting condition, the AG had connections with the medial prefrontal cortex (mPFC), posterior cingulate cortex (PCC), and precuneus as well as the superior and inferior frontal gyri and with the temporal cortex. Compared with the resting condition, imagined music performance increased the functional connectivity of the AG with the superior frontal gyrus (SFG), mPFC, precuneus, PCC, hippocampal/parahippocampal gyrus (H/PHG), and amygdala. The anterior cingulate cortex (ACC) and superior temporal gyrus (STG) were newly engaged or added to the AG network during the task. In contrast, the supplementary motor area (SMA), sensorimotor areas, and occipital regions, which were anti-correlated with the AG in the resting condition, were disengaged during the task. These results lead to the conclusion that the functional connectivity of the AG is modulated by imagined music performance, which suggests that the AG plays a role in imagined music performance.

Functional Connectivity of the Caudate in Schizophrenia Evaluated with Simultaneous Resting-State Functional MRI and Electroencephalography Recordings.

BACKGROUND: Aberrant functional connectivity (FC) is increasingly implicated in the clinical phenomenology of schizophrenia. This study focused on the FC of the cortico-striatal network, which is thought to be disrupted in schizophrenia and to contribute to its clinical manifestations. METHODS: We used simultaneous resting-state functional magnetic resonance imaging (rsfMRI) and electroencephalography (EEG) recordings to investigate FC in patients with schizophrenia. The study included 20 patients with schizophrenia and 20 healthy controls (HCs). Simultaneously recorded rsfMRI and EEG data were collected with an MR-compatible amplifier, and rsfMRI data were analyzed with the CONN toolbox to calculate FC. The study focused on the caudate, which was defined as the seed. We also performed between-group comparisons of standardized low-resolution electromagnetic tomography intracortical lagged coherence for each EEG frequency band. RESULTS: Compared to HCs, patients with schizophrenia showed enhanced FC between the caudate nucleus and the posterior cingulate cortex, temporal, and occipital regions on rsfMRI. It is thus possible that HCs have negative FC between these regions, whereas patients with schizophrenia have non-negative FC. The EEG results showed no significant differences in oscillations or in FC between the groups in any frequency band in any region. CONCLUSIONS: Increased FC in the caudate may represent aberrant between-network FC resulting from the disruption of segregation between networks.

The parietal opercular auditory-sensorimotor network in musicians: A resting-state fMRI study.

Auditory-sensorimotor coupling is critical for musical performance, during which auditory and somatosensory feedback signals are used to ensure desired outputs. Previous studies reported opercular activation in subjects performing or listening to music. A functional connectivity analysis suggested the parietal operculum (PO) as a connector hub that links auditory, somatosensory, and motor cortical areas. We therefore examined whether this PO network differs between musicians and non-musicians. We analyzed resting-state PO functional connectivity with Heschl's gyrus (HG), the planum temporale (PT), the precentral gyrus (preCG), and the postcentral gyrus (postCG) in 35 musicians and 35 non-musicians. In musicians, the left PO exhibited increased functional connectivity with the ipsilateral HG, PT, preCG, and postCG, whereas the right PO exhibited enhanced functional connectivity with the contralateral HG, preCG, and postCG and the ipsilateral postCG. Direct functional connectivity between an auditory area (the HG or PT) and a sensorimotor area (the preCG or postCG) did not significantly differ between the groups. The PO's functional connectivity with auditory and sensorimotor areas is enhanced in musicians relative to non-musicians. We propose that the PO network facilitates musical performance by mediating multimodal integration for modulating auditory-sensorimotor control.

Serum prolactin levels and sexual dysfunction in patients with schizophrenia treated with antipsychotics: comparison between aripiprazole and other atypical antipsychotics.

OBJECTIVES: Antipsychotics, even atypical ones, can induce hyperprolactinemia. Aripiprazole (APZ), a dopamine D2 partial agonist, has a unique pharmacological profile and few side effects. We investigated the incidence of hyperprolactinemia in patients with schizophrenia treated with APZ and other antipsychotics. METHODS: Serum prolactin levels were measured by ELISA (enzyme-linked immunosorbent assay). A questionnaire survey was used to evaluate subjective sexual dysfunction. RESULTS: Based on the results of the questionnaire, approximately half (48.1%) of the patients complained of sexual dysfunction. The serum prolactin levels were significantly higher in patients with sexual dysfunction than in those without. In patients treated with antipsychotic monotherapy, the serum prolactin levels were significantly lower in patients treated with APZ than with other antipsychotics. In patients receiving 2 or more antipsychotics, the serum prolactin levels were significantly lower in patients treated with APZ-containing regimens than in patients treated with APZ-free regimens. CONCLUSIONS: Treatment with APZ did not influence the serum prolactin level, and adjunctive treatment with APZ may ameliorate the hyperprolactinemia that occurs during monotherapy with other antipsychotics.

Three-dimensional stereotactic surface projection in the statistical analysis of single photon emission computed tomography data for distinguishing between Alzheimer's disease and depression.

AIM: To evaluate usefulness of single photon emission computed tomography (SPECT) with three-dimensional stereotactic surface projection (3D-SSP) in distinguishing between Alzheimer's disease (AD) and depression. METHODS: We studied 43 patients who presented with both depressive symptoms and memory disturbance. Each subject was evaluated using the following: (1) the Minimal Mental State Examination; (2) the Hamilton Rating Scale for Depression; (3) Clinical Global Impression-Severity scale (CGI-S); and (4) SPECT imaging with 3D-SSP. RESULTS: The MMSE scores correlated significantly with the maximum Z-scores of AD-associated regions. CGI-S scores correlated significantly with the maximum Z-scores of depression-associated regions. Factor analysis identified three significant factors. Of these, Factor 1 could be interpreted as favouring a tendency for AD, Factor 2 as favouring a tendency for pseudo-dementia, and Factor 3 as favouring a depressive tendency. CONCLUSION: We investigated whether these patients could be categorized as types: Type A (true AD), Type B (pseudo-dementia), Type C (occult AD), and Type D (true depression). The factor scores in factor analysis supported the validity of this classification. Our results suggest that SPECT with 3D-SSP is highly useful for distinguishing between depression and depressed mood in the early stage of AD.

Reorganization of the thalamocortical network in musicians.

The cortico-thalamocortical network is relevant to music performance in that the network can regulate sensitivity to afferent input or sound, mediate the integration of multimodal information required for the performance, and play a role in skilled performance control. We, therefore, predicted that this network would be reorganized via musical training-induced neuroplasticity. To test this hypothesis, we analyzed resting-state functional connectivity of the thalamocortical network in musicians (n=35) and nonmusicians (n=35). The seed-to-voxel functional connectivity analysis of the left thalamus seed showed enhanced connectivity voxels in the precuneus/posterior cingulate cortex (PCC) in musicians compared with nonmusicians. Region of interest (ROI)-to-ROI functional connectivity analysis showed that the auditory areas were also more strongly connected with the left thalamus in musicians. Discriminant analysis using the ROI-to-ROI functional connectivity data of the precuneus/PCC and auditory areas as predictors yielded an 87% correct discrimination of musicians from nonmusicians. Therefore, we can conclude that, as a consequence of long-term musical training, musicians have a characteristically organized thalamocortical network. The precuneus and PCC are principal nodes of the default mode network and play a pivotal role in the manipulation of mental imagery. We propose that the reorganized thalamocortical network in musicians contributes not only to higher sensitivity to sound but also to the integration of mental imagery with sound, which are both presumed to be important for better music performance.

Dynamic Reconfiguration of the Supplementary Motor Area Network during Imagined Music Performance.

The supplementary motor area (SMA) has been shown to be the center for motor planning and is active during music listening and performance. However, limited data exist on the role of the SMA in music. Music performance requires complex information processing in auditory, visual, spatial, emotional, and motor domains, and this information is integrated for the performance. We hypothesized that the SMA is engaged in multimodal integration of information, distributed across several regions of the brain to prepare for ongoing music performance. To test this hypothesis, functional networks involving the SMA were extracted from functional magnetic resonance imaging (fMRI) data that were acquired from musicians during imagined music performance and during the resting state. Compared with the resting condition, imagined music performance increased connectivity of the SMA with widespread regions in the brain including the sensorimotor cortices, parietal cortex, posterior temporal cortex, occipital cortex, and inferior and dorsolateral prefrontal cortex. Increased connectivity of the SMA with the dorsolateral prefrontal cortex suggests that the SMA is under cognitive control, while increased connectivity with the inferior prefrontal cortex suggests the involvement of syntax processing. Increased connectivity with the parietal cortex, posterior temporal cortex, and occipital cortex is likely for the integration of spatial, emotional, and visual information. Finally, increased connectivity with the sensorimotor cortices was potentially involved with the translation of thought planning into motor programs. Therefore, the reconfiguration of the SMA network observed in this study is considered to reflect the multimodal integration required for imagined and actual music performance. We propose that the SMA network construct "the internal representation of music performance" by integrating multimodal information required for the performance.