title: Feeling, learning from and being aware of inner states: interoceptive dimensions in neurodegeneration and stroke.
abstract: Interoception is a complex process encompassing multiple dimensions, such as accuracy, learning and awareness. Here, we examined whether each of those dimensions relies on specialized neural regions distributed throughout the vast interoceptive network. To this end, we obtained relevant measures of cardiac interoception in healthy subjects and patients offering contrastive lesion models of neurodegeneration and focal brain damage: behavioural variant fronto-temporal dementia (bvFTD), Alzheimer's disease (AD) and fronto-insular stroke. Neural correlates of the three dimensions were examined through structural and functional resting-state imaging, and online measurements of the heart-evoked potential (HEP). The three patient groups presented deficits in interoceptive accuracy, associated with insular damage, connectivity alterations and abnormal HEP modulations. Interoceptive learning was differentially impaired in AD patients, evidencing a key role of memory networks in this skill. Interoceptive awareness results showed that bvFTD and AD patients overestimated their performance; this pattern was related to abnormalities in anterior regions and associated networks sub-serving metacognitive processes, and probably linked to well-established insight deficits in dementia. Our findings indicate how damage to specific hubs in a broad fronto-temporo-insular network differentially compromises interoceptive dimensions, and how such disturbances affect widespread connections beyond those critical hubs. This is the first study in which a multiple lesion model reveals fine-grained alterations of body sensing, offering new theoretical insights into neuroanatomical foundations of interoceptive dimensions.This article is part of the themed issue 'Interoception beyond homeostasis: affect, cognition and mental health'.
authors.affiliation: Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Pacheco de Melo 1860, C1126AAB, Buenos Aires, Argentina.
authors.forename: Indira
authors.initials: I
authors.lastname: García-Cordero
authors.affiliation: Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Pacheco de Melo 1860, C1126AAB, Buenos Aires, Argentina.|National Scientific and Technical Research Council (CONICET), Avenida Rivadavia 1917, Buenos Aires, Argentina.
authors.forename: Lucas
authors.initials: L
authors.lastname: Sedeño
authors.affiliation: Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Pacheco de Melo 1860, C1126AAB, Buenos Aires, Argentina.|National Scientific and Technical Research Council (CONICET), Avenida Rivadavia 1917, Buenos Aires, Argentina.
authors.forename: Laura
authors.initials: L
authors.lastname: de la Fuente
authors.affiliation: Physiopathology Department, ICBM; East Neuroscience Department, Faculty of Medicine, University of Chile, Avenida Salvador 486, Providencia, Santiago, Chile.|Cognitive Neurology and Dementia, Neurology Department, Hospital del Salvador, Avenida Salvador 386, Providencia, Santiago, Chile.|Gerosciences Center for Brain Health and Metabolism, Avenida Salvador 486, Providencia, Santiago, Chile.|Centre for Advanced Research in Education, Periodista Jose Carrasco Tapia 75, Santiago, Chile.|Neurology Department, Clínica Alemana, Avenida Manquehue 1410, Santiago, Chile.
authors.forename: Andrea
authors.initials: A
authors.lastname: Slachevsky
authors.affiliation: Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Pacheco de Melo 1860, C1126AAB, Buenos Aires, Argentina.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Forno
authors.affiliation: Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Pacheco de Melo 1860, C1126AAB, Buenos Aires, Argentina.|Stroke Center, Favaloro Foundation University Hospital, Buenos Aires, Argentina.
authors.forename: Francisco
authors.initials: F
authors.lastname: Klein
authors.affiliation: Gerosciences Center for Brain Health and Metabolism, Avenida Salvador 486, Providencia, Santiago, Chile.|Departamento de Neurología Sur, Facultad de Medicina, Universidad de Chile Santiago, Chile.
authors.forename: Patricia
authors.initials: P
authors.lastname: Lillo
authors.affiliation: Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Pacheco de Melo 1860, C1126AAB, Buenos Aires, Argentina.
authors.forename: Jesica
authors.initials: J
authors.lastname: Ferrari
authors.affiliation: Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Pacheco de Melo 1860, C1126AAB, Buenos Aires, Argentina.
authors.forename: Clara
authors.initials: C
authors.lastname: Rodriguez
authors.affiliation: Geriatric psychiatry and Memory Clinic; Institute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Pacheco de Melo 1860, C1126AAB Buenos Aires, Argentina.
authors.forename: Julian
authors.initials: J
authors.lastname: Bustin
authors.affiliation: Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Pacheco de Melo 1860, C1126AAB, Buenos Aires, Argentina.
authors.forename: Teresa
authors.initials: T
authors.lastname: Torralva
authors.affiliation: Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Pacheco de Melo 1860, C1126AAB, Buenos Aires, Argentina.|National Scientific and Technical Research Council (CONICET), Avenida Rivadavia 1917, Buenos Aires, Argentina.
authors.forename: Sandra
authors.initials: S
authors.lastname: Baez
authors.affiliation: Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Pacheco de Melo 1860, C1126AAB, Buenos Aires, Argentina.|National Scientific and Technical Research Council (CONICET), Avenida Rivadavia 1917, Buenos Aires, Argentina.
authors.forename: Adrian
authors.initials: A
authors.lastname: Yoris
authors.affiliation: Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Pacheco de Melo 1860, C1126AAB, Buenos Aires, Argentina.
authors.forename: Sol
authors.initials: S
authors.lastname: Esteves
authors.affiliation: Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Pacheco de Melo 1860, C1126AAB, Buenos Aires, Argentina.|National Scientific and Technical Research Council (CONICET), Avenida Rivadavia 1917, Buenos Aires, Argentina.
authors.forename: Margherita
authors.initials: M
authors.lastname: Melloni
authors.affiliation: Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Pacheco de Melo 1860, C1126AAB, Buenos Aires, Argentina.|National Scientific and Technical Research Council (CONICET), Avenida Rivadavia 1917, Buenos Aires, Argentina.
authors.forename: Paula
authors.initials: P
authors.lastname: Salamone
authors.affiliation: Centro de Neurociencia Social y Cognitiva (CSCN), Escuela de Psicología-Universidad Adolfo Ibáñez, Diagonal Las Torres 2640, Santiago, Chile.
authors.forename: David
authors.initials: D
authors.lastname: Huepe
authors.affiliation: Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Pacheco de Melo 1860, C1126AAB, Buenos Aires, Argentina.|National Scientific and Technical Research Council (CONICET), Avenida Rivadavia 1917, Buenos Aires, Argentina.|Centre of Excellence in Cognition and its Disorders, Australian Research Council (ACR), Macquarie University, 16 University Avenue, NSW 2109, Sydney, New South Wales, Australia.
authors.forename: Facundo
authors.initials: F
authors.lastname: Manes
authors.affiliation: Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Pacheco de Melo 1860, C1126AAB, Buenos Aires, Argentina.|National Scientific and Technical Research Council (CONICET), Avenida Rivadavia 1917, Buenos Aires, Argentina.|Faculty of Elementary and Special Education (FEEyE), National University of Cuyo (UNCuyo), Sobremonte 74, C5500 Mendoza, Argentina.
authors.forename: Adolfo M
authors.initials: AM
authors.lastname: García
authors.affiliation: Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Pacheco de Melo 1860, C1126AAB, Buenos Aires, Argentina aibanez@ineco.org.ar.|National Scientific and Technical Research Council (CONICET), Avenida Rivadavia 1917, Buenos Aires, Argentina.|Centro de Neurociencia Social y Cognitiva (CSCN), Escuela de Psicología-Universidad Adolfo Ibáñez, Diagonal Las Torres 2640, Santiago, Chile.|Centre of Excellence in Cognition and its Disorders, Australian Research Council (ACR), Macquarie University, 16 University Avenue, NSW 2109, Sydney, New South Wales, Australia.|Universidad Autónoma del Caribe, Calle 90, N° 46-112, C2754 Barranquilla, Colombia.
authors.forename: Agustín
authors.initials: A
authors.lastname: Ibañez
mesh_terms: D000368:Aged; D001364:Awareness; D005260:Female; D006801:Humans; D065812:Interoception; D007858:Learning; D008297:Male; D008875:Middle Aged; D019636:Neurodegenerative Diseases / Q000503:physiopathology*; D020521:Stroke / Q000503:physiopathology*
keywords: awareness; interoception; learning; neurodegenerative diseases; stroke