title: The right insula contributes to memory awareness in cognitively diverse older adults.
abstract: Unawareness of memory loss is a challenging characteristic of Alzheimer's disease (AD) and other age-related neurodegenerative conditions at their earliest stages, adversely affecting important outcomes such as patient decision making and safety. The basis of this metacognitive disturbance has been elusive; however it is almost certainly determined in part by compromise to brain regions critical for self-assessment. The subjectivity of traditional measurements of self-awareness in dementia has likely limited the rigor with which its neuroanatomic correlates can be established. Here we objectively measure memory awareness (metamemory) using a Feeling of Knowing (FOK) task in a group of cognitively diverse older adults, including 14 with mild AD and 20 cognitively healthy older adults. Performance on the metamemory task was examined in relation to the structural integrity of 14 bilateral neuroanatomic regions hypothesized to support self-awareness. Less accurate metamemory was associated only with reduced right insular volume (r=.41, p=.019). Implications of the current findings for models of metacognitive aging are discussed, with attention to the role of the insula in the conscious detection of errors.
authors.affiliation: Cognitive Neuroscience Division of the Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY, United States; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States; Department of Neurology, Columbia University Medical Center, New York, NY, United States. Electronic address: sc2460@cumc.columbia.edu.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Cosentino
authors.affiliation: Cognitive Neuroscience Division of the Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY, United States; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States; Department of Neurology, Columbia University Medical Center, New York, NY, United States.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Brickman
authors.affiliation: Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States.
authors.forename: Erica
authors.initials: E
authors.lastname: Griffith
authors.affiliation: Cognitive Neuroscience Division of the Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY, United States; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States; Department of Neurology, Columbia University Medical Center, New York, NY, United States.
authors.forename: Christian
authors.initials: C
authors.lastname: Habeck
authors.affiliation: Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States.
authors.forename: Sarah
authors.initials: S
authors.lastname: Cines
authors.affiliation: Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States.
authors.forename: Meagan
authors.initials: M
authors.lastname: Farrell
authors.affiliation: Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States.
authors.forename: Danielle
authors.initials: D
authors.lastname: Shaked
authors.affiliation: Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States; Department of Neurology, Columbia University Medical Center, New York, NY, United States; Department of Psychiatry, Columbia University Medical Center, New York, NY, United States.
authors.forename: Edward D
authors.initials: ED
authors.lastname: Huey
authors.affiliation: Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States.
authors.forename: Tamara
authors.initials: T
authors.lastname: Briner
authors.affiliation: Cognitive Neuroscience Division of the Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY, United States; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States; Department of Neurology, Columbia University Medical Center, New York, NY, United States.
authors.forename: Yaakov
authors.initials: Y
authors.lastname: Stern
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000473:pathology / Q000523:psychology*; D001364:Awareness; D001921:Brain / Q000473:pathology; D002540:Cerebral Cortex / Q000473:pathology*; D004292:Dominance, Cerebral; D006801:Humans; D008279:Magnetic Resonance Imaging; D008568:Memory; D008875:Middle Aged; D012647:Self-Assessment
keywords: Alzheimer's disease; Anosognosia; Awareness; Insula; Metacognition