Who am I with my Lewy bodies? A self‐concept study

Abstract

AbstractBackgroundNeurodegenerative diseases are marked by changes in personal identity, including the self‐concept (SC), which refers to a collection of knowledge about oneself, made up of personal semantic information. Modifications of the Self have been extensively investigated in Alzheimer's disease (AD), whereas it has never been studied in dementia with Lewy bodies (DLB). Yet, key regions for Self‐processing such as the medial prefrontal, the anterior cingulate and the insular cortices, are damaged early in the course of DLB. Thus, the purpose of this study was to investigate the SC integrity and to explore its neuroanatomical correlates in early DLB as compared to AD and normal ageing.MethodTwenty prodromal to mild DLB patients were compared to twenty‐one prodromal to mild AD patients, and to twenty‐one healthy control subjects, matched in terms of age and educational level. For all participants, SC was assessed using the Twenty Statements Test (TST) during which the subjects were asked to produce up to twenty affirmations answering the question: who am I? Behavioral performance was compared between the groups. 3D MRI images were acquired for DLB patients and correlational analyses were performed using voxel‐based morphometry (VBM).ResultBehavioral results obtained in the TST showed significantly decreased performances in both DLB and AD groups compared to healthy control subjects (p<0.001). Moreover, DLB patients tended to produce less Self‐affirmations than AD patients. Additionally, correlational analyses between behavioral scores and neuroimaging data in the DLB group revealed positive correlations between the number of produced Self‐affirmations and grey matter volume in the medial and orbitofrontal prefrontal cortices and in the lateral temporal cortex, among other regions (central sulcus, hippocampus, cerebellum).ConclusionOur behavioral results confirmed that SC is affected from the early stage in both DLB and AD, and tends to be even more deteriorated in DLB. Interestingly, VBM analyses revealed that decreased performance in DLB patients was related to focal atrophy in regions such as medial prefrontal and lateral temporal cortices, which are central in the networks of Self‐processing and semantic memory, respectively.