title: Neural substrates of socioemotional self-awareness in neurodegenerative disease.
abstract: BACKGROUND
  Neuroimaging studies examining neural substrates of impaired self-awareness in patients with neurodegenerative diseases have shown divergent results depending on the modality (cognitive, emotional, behavioral) of awareness. Evidence is accumulating to suggest that self-awareness arises from a combination of modality-specific and large-scale supramodal neural networks.
  
  
  METHODS
  We investigated the structural substrates of patients' tendency to overestimate or underestimate their own capacity to demonstrate empathic concern for others. Subjects' level of empathic concern was measured using the Interpersonal Reactivity Index, and subject-informant discrepancy scores were used to predict regional atrophy pattern, using voxel-based morphometry analysis. Of the 102 subjects, 83 were patients with neurodegenerative diseases such as behavioral variant frontotemporal dementia (bvFTD) or semantic variant primary progressive aphasia (svPPA); the other 19 were healthy older adults.
  
  
  RESULTS
  bvFTD and svPPA patients typically overestimated their level of empathic concern compared to controls, and overestimating one's empathic concern predicted damage to predominantly right-hemispheric anterior infero-lateral temporal regions, whereas underestimating one's empathic concern showed no neuroanatomical basis.
  
  
  CONCLUSIONS
  These findings suggest that overestimation and underestimation of one's capacity for empathic concern cannot be interpreted as varying degrees of the same phenomenon, but may arise from different pathophysiological processes. Damage to anterior infero-lateral temporal regions has been associated with semantic self-knowledge, emotion processing, and social perspective taking; neuropsychological functions partly associated with empathic concern itself. These findings support the hypothesis that-at least in the socioemotional domain-neural substrates of self-awareness are partly modality-specific.
authors.affiliation: Memory and Aging Center, University of California San Francisco, California ; Department of Neurology, University of California San Francisco, California ; Department of Neurology, University Hospital Basel, Switzerland ; Memory Clinic, University Center for Medicine of Aging, Felix-Platter Hospital Basel, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Sollberger
authors.affiliation: Memory and Aging Center, University of California San Francisco, California ; Department of Neurology, University of California San Francisco, California.
authors.forename: Howard J
authors.initials: HJ
authors.lastname: Rosen
authors.affiliation: Memory and Aging Center, University of California San Francisco, California ; Department of Neurology, University of California San Francisco, California.
authors.forename: Tal
authors.initials: T
authors.lastname: Shany-Ur
authors.affiliation: Memory and Aging Center, University of California San Francisco, California ; Department of Neurology, University of California San Francisco, California.
authors.forename: Jerin
authors.initials: J
authors.lastname: Ullah
authors.affiliation: Memory and Aging Center, University of California San Francisco, California ; Department of Neurology, University of California San Francisco, California.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Stanley
authors.affiliation: Memory and Aging Center, University of California San Francisco, California ; Department of Neurology, University of California San Francisco, California.
authors.forename: Victor
authors.initials: V
authors.lastname: Laluz
authors.affiliation: Department of Radiology, University of California San Francisco, California ; Magnetic Resonance Imaging Unit, San Francisco Veterans Affairs Hospital San Francisco, California.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Weiner
authors.affiliation: Department of Speech, Language and Hearing Sciences Tucson, Arizona.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Wilson
authors.affiliation: Memory and Aging Center, University of California San Francisco, California ; Department of Neurology, University of California San Francisco, California.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Miller
authors.affiliation: Memory and Aging Center, University of California San Francisco, California ; Department of Neurology, University of California San Francisco, California.
authors.forename: Katherine P
authors.initials: KP
authors.lastname: Rankin
mesh_terms: D000368:Aged; D001364:Awareness / Q000502:physiology*; D004645:Empathy / Q000502:physiology*; D005260:Female; D057174:Frontotemporal Lobar Degeneration / Q000473:pathology* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012647:Self-Assessment; D013702:Temporal Lobe / Q000473:pathology*
keywords: Affective perspective taking; dementia; empathy; infero-lateral temporal cortex; neurodegeneration; semantic self-knowledge; unawareness; voxel-based morphometry