Exploring the Neural Mechanisms of Mirrored-Self Misidentification in Alzheimer's Disease
Zhen Sun
Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Dementia Institute, Tianjin, China
Department of Neurology, Linfen Central Hospital, Linfen, China
Search for more papers by this authorGang Chen
Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
Department of Interventional Vascular Surgery, Binzhou Medical University Hospital, Binzhou, China
Search for more papers by this authorJinghuan Gan
Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
Search for more papers by this authorYuqiao Tang
College of Life Sciences, Wuhan University, Wuhan, China
Search for more papers by this authorHao Wu
Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Dementia Institute, Tianjin, China
Search for more papers by this authorZhihong Shi
Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Dementia Institute, Tianjin, China
Search for more papers by this authorTingting Yi
Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
Department of Neurology, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
Search for more papers by this authorYaqi Yang
Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
Search for more papers by this authorCorresponding Author
Shuai Liu
Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Dementia Institute, Tianjin, China
Correspondence: Yong Ji
Shuai Liu
Search for more papers by this authorCorresponding Author
Yong Ji
Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Dementia Institute, Tianjin, China
Correspondence: Yong Ji
Shuai Liu
Search for more papers by this authorZhen Sun
Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Dementia Institute, Tianjin, China
Department of Neurology, Linfen Central Hospital, Linfen, China
Search for more papers by this authorGang Chen
Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
Department of Interventional Vascular Surgery, Binzhou Medical University Hospital, Binzhou, China
Search for more papers by this authorJinghuan Gan
Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
Search for more papers by this authorYuqiao Tang
College of Life Sciences, Wuhan University, Wuhan, China
Search for more papers by this authorHao Wu
Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Dementia Institute, Tianjin, China
Search for more papers by this authorZhihong Shi
Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Dementia Institute, Tianjin, China
Search for more papers by this authorTingting Yi
Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
Department of Neurology, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
Search for more papers by this authorYaqi Yang
Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
Search for more papers by this authorCorresponding Author
Shuai Liu
Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Dementia Institute, Tianjin, China
Correspondence: Yong Ji
Shuai Liu
Search for more papers by this authorCorresponding Author
Yong Ji
Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Dementia Institute, Tianjin, China
Correspondence: Yong Ji
Shuai Liu
Search for more papers by this authorFunding: This work was supported by the Tianjin Municipal Education Commission Research Projects (grant number 2023KJ060); the Tianjin Science and Technology Plan Project (grant number 22ZYCGSY00840); the Tianjin Health Research Project (grant numbers TJWJ2023QN060 and TJWJ2022MS032); the Science and Technology Innovation Program for Higher Education Institutions in Shanxi Province (grant number 2022L250); the Tianjin Key Medical Discipline (Specialty) Construction Project (grant number TJYXZDXK-052B); and the National Natural Science Foundation (grant number 82171182).
ABSTRACT
Objective
Alzheimer's disease (AD) is a complex neurodegenerative condition that causes a range of cognitive disturbances, including mirror-self misidentification syndrome (MSM), in which patients cannot recognize themselves in a mirror. However, the mechanism of action of MSM is not precisely known. This study aimed to explore the possible neural mechanisms of action of MSM in AD using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI).
Methods
This study included 48 AD patients, 13 in the MSM group and 35 in the non-MSM group. The permeability of the blood–brain barrier (BBB) was quantitatively monitored by measuring the transfer rate (Ktrans) of the contrast agent from the vasculature to the surrounding tissue using DCE-MRI. The concentration of contrast agents in different brain regions was measured, and the Patlak model was used to calculate Ktrans. Ktrans values were compared between the left and right cerebral hemispheres in different brain areas between the MSM and non-MSM groups. Additionally, the difference in Ktrans values between mild and severe MSM was assessed. Logistic regression analysis was used to examine the risk factors for MSM.
Results
The Mann‒Whitney U test was used to compare two groups and revealed elevated Ktrans values in the left thalamus, left putamen, left globus pallidus, left corona radiata, and right caudate in the MSM group (p < 0.05). Logistic regression analysis revealed that increased Ktrans values in the left putamen (OR = 1.53, 95% CI = 1.04, 2.26) and left globus pallidus (OR = 1.54, 95% CI = 1.02, 2.31) may be risk factors for MSM. After dividing MSM patients into mild and moderate-severe groups, the Ktrans values of the thalamus in the moderate-severe group were greater than those in the mild group (p < 0.05).
Conclusion
Our study revealed the relationship between BBB permeability and MSM in AD. MSM is associated with BBB breakdown in the left putamen and globus pallidus. The left putamen and globus pallidus may function in mirror self-recognition. Higher BBB permeability in the thalamus may reflect the severity of AD in MSM.
Conflicts of Interest
The authors declare no conflicts of interest.
Open Research
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
Supporting Information
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