Dorsomedial prefrontal metabolism and unawareness of current characteristics of personality traits in Alzheimer's disease.

ABSTRACT

Anosognosia is a complex symptom corresponding to a lack of awareness of one's current clinical status. Anosognosia for cognitive deficits has frequently been described in Alzheimer's disease (AD), while unawareness of current characteristics of personality traits has rarely been considered. We used a well-established questionnaire-based method in a group of 37 AD patients and in healthy controls to probe self- and hetero-evaluation of patients' personality and we calculated differential scores between each participant's and his/her relative's judgments. A brain-behavior correlation was performed using 18-fluorodeoxyglucose positron emission tomography (FDG-PET) images. The behavioral data showed that AD patients presented with anosognosia for current characteristics of their personality and their anosognosia was primarily explained by impaired third perspective taking. The brain-behavior correlation analysis revealed a negative relationship between anosognosia for current characteristics of personality and dorsomedial prefrontal cortex (dMPFC) activity. Behavioral and neuroimaging data are consistent with the view that impairment of different functions subserved by the dMPFC (self-evaluation, inferences regarding complex enduring dispositions of self and others, confrontation of perspectives in interpersonal scripts) plays a role in anosognosia for current characteristics of personality in AD patients.