Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, MRI Research Centre - Hermitage Capodimonte, Università degli Studi della Campania "Luigi Vanvitelli", 80138 Naples, Italy.
Department of Psychology, Università degli Studi della Campania "Luigi Vanvitelli", Caserta, Italy.
Cortex. 2017 Dec;97:1-16. doi: 10.1016/j.cortex.2017.09.016. Epub 2017 Oct 3.
Theory of Mind (ToM), the ability to recognize thoughts and emotions of another, may be one of the cognitive domains affected in amyotrophic lateral sclerosis (ALS), a neurodegenerative disease now recognized as a multi-system disorder. The present study aimed to identify early dysfunctions of brain resting state functional magnetic resonance imaging (RS-fMRI) networks in a group of ALS patients longitudinally explored for impairment of "cognitive" and "affective" ToM subcomponents. RS-fMRI connectivity was investigated in a group of 21 patients with ALS (i.e., 9 with bulbar-onset or ALS-B and 12 with limb-onset or ALS-L) in early stages of disease and 15 healthy controls (HCs). The same subjects were assessed, at baseline and after six months, for neuropsychological performances, including cognitive and affective ToM and multi-domain cognitive functions. The RS-fMRI study showed a decreased connectivity in frontotemporal areas within the main cognitive resting state networks, including the default mode (DMN), the right and left fronto-parietal (R-, L-FPN), and the salience (SLN) networks, in the entire ALS group. As exploratory results, comparing the ALS-B subgroup to the ALS-L one, we revealed a widespread decrease of RS-fMRI signals in the left middle frontal gyrus for L-FPN and SLN and in the left superior frontal gyrus for SLN. At baseline, no ToM or other cognitive abnormalities were reported in the entire group of ALS patients compared to HCs, although, after six months, the ALS-B subset exhibited a significant impairment of both affective and cognitive ToM subcomponents, whereas the ALS-L group showed significant impairment of the cognitive subcomponent alone. Our findings provide original evidence of the deficit of both ToM subcomponents during the ALS course, supporting the hypothesis of a biologically more aggressive character of ALS-B. Moreover, early RS-fMRI abnormalities in cognitive networks may underlie and precede the clinical appearance of ToM alterations in ALS.
心理理论（Theory of Mind，ToM），即识别他人思想和情感的能力，可能是肌萎缩侧索硬化症（amyotrophic lateral sclerosis，ALS）影响的认知领域之一，这种神经退行性疾病现在被认为是一种多系统障碍。本研究旨在确定一组 ALS 患者脑静息态功能磁共振成像（RS-fMRI）网络的早期功能障碍，这些患者在疾病的早期阶段进行了纵向探索，以评估“认知”和“情感”ToM 亚成分的损伤。我们对 21 名 ALS 患者（即 9 名球部起病或 ALS-B 和 12 名肢体起病或 ALS-L）和 15 名健康对照者（HCs）进行了 RS-fMRI 连接研究。同一组受试者在基线和 6 个月时进行了神经心理学评估，包括认知和情感 ToM 以及多领域认知功能。RS-fMRI 研究显示，在整个 ALS 组中，主要认知静息态网络内的额颞区连接减少，包括默认模式网络（DMN）、右侧和左侧额顶叶网络（R-FPN、L-FPN）和突显网络（SLN）。作为探索性结果，我们将 ALS-B 亚组与 ALS-L 亚组进行比较，发现 L-FPN 和 SLN 的左侧中额回和 SLN 的左侧额上回的 RS-fMRI 信号广泛减少。在基线时，与 HCs 相比，整个 ALS 患者组均未报告 ToM 或其他认知异常，尽管在 6 个月后，ALS-B 亚组表现出情感和认知 ToM 亚成分的显著损伤，而 ALS-L 组仅表现出认知亚成分的显著损伤。我们的研究结果为 ALS 病程中存在两个 ToM 亚成分缺陷提供了原始证据，支持 ALS-B 生物学侵袭性更强的假说。此外，认知网络中早期 RS-fMRI 异常可能是 ALS 患者出现 ToM 改变的临床症状之前的基础和前提。
