Tondelli Manuela, Manigrasso Miriana, Zamboni Giovanna
Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, 41121 Modena, Italy.
Brain Sci. 2024 Feb 23;14(3):204. doi: 10.3390/brainsci14030204.
Little is known about the brain correlates of anosognosia or unawareness of disease in Parkinson's Disease (PD) and Huntington's Disease (HD). The presence of unawareness or impaired self-awareness (ISA) of illness has profound implications for patients and their caregivers; therefore, studying awareness and its brain correlates should be considered a key step towards developing effective recognition and management of this symptom as it offers a window into the mechanism of self-awareness and consciousness as critical components of the human cognition. We reviewed research studies adopting MRI or other in vivo neuroimaging technique to assess brain structural and/or functional correlates of unawareness in PD and HD across different cognitive and motor domains. Studies adopting task or resting-state functional magnetic resonance imaging, and/or 18-F fluorodeoxyglucose positron emission tomography brain imaging and/or magnetic resonance imaging structural measures were considered. Only six studies investigating neuroimaging features of unawareness in PD and two in HD were identified; there was great heterogeneity in the clinical characteristics of the study participants, domain of unawareness investigated, method of unawareness assessment, and neuroimaging technique used. Nevertheless, some data converge in identifying regions of the salience and frontoparietal networks to be associated with unawareness in PD patients. In HD, the few data are affected by the variability in the severity of motor symptoms. Further studies are needed to better understand the mechanisms and brain correlates of unawareness in PD and HD; in addition, the use of dopaminergic medications should be carefully considered.
关于帕金森病（PD）和亨廷顿舞蹈病（HD）中失认症或疾病不自知的大脑关联，人们了解甚少。疾病不自知或自我意识受损（ISA）的存在对患者及其照料者有着深远影响；因此，研究意识及其大脑关联应被视为朝着有效识别和管理这一症状迈出的关键一步，因为它为作为人类认知关键组成部分的自我意识和意识机制提供了一个窗口。我们回顾了采用磁共振成像（MRI）或其他活体神经成像技术来评估PD和HD在不同认知和运动领域中不自知的大脑结构和/或功能关联的研究。考虑采用任务态或静息态功能磁共振成像、和/或18氟脱氧葡萄糖正电子发射断层扫描脑成像和/或磁共振成像结构测量的研究。仅确定了六项调查PD中不自知神经成像特征的研究和两项调查HD中不自知神经成像特征的研究；研究参与者的临床特征、所调查的不自知领域、不自知评估方法以及所使用的神经成像技术存在很大异质性。尽管如此，一些数据在确定与PD患者不自知相关的突显网络和额顶叶网络区域方面趋于一致。在HD中，少数数据受到运动症状严重程度变异性的影响。需要进一步研究以更好地理解PD和HD中不自知的机制和大脑关联；此外，应谨慎考虑多巴胺能药物的使用。
