Ventromedial-frontopolar prefrontal cortex atrophy correlates with insight loss in frontotemporal dementia and Alzheimer's disease

Michael Hornberger, Belinda Yew, Silvia Gilardoni, Eneida Mioshi, Ezequiel Gleichgerrcht, Facundo Manes, John R. Hodges

Research output: Contribution to journalArticlepeer-review

60 Citations (Scopus)


Loss in insight is a major feature of frontotemporal dementia (FTD) but has been investigated relatively little. More importantly, the neural basis of insight loss is still poorly understood. The current study investigated insight deficit profiles across a large cohort of neurodegenerative patients (n = 81), including FTD and Alzheimer's disease (AD) patients. We employed a novel insight questionnaire, which tapped into changes across different domains: social interaction, emotion, diagnosis/treatment, language, and motivation. FTD subtypes varied considerably for insight loss, with the behavioral variant worst and the progressive non-fluent variant least affected. All other subtypes and AD showed milder but consistent insight loss. Voxel-based morphometry analysis revealed that overall insight loss correlated with ventromedial and frontopolar prefrontal atrophy, with exception of social interaction and emotion insight loss, which additionally correlated with lateral temporal and amygdala atrophy, respectively. Our results show that patients with neurodegenerative conditions show variable loss of insight, with ventromedial and frontopolar cortex regions appearing to be particularly important for insight. Hum Brain Mapp 35:616-626, 2014.

Original languageEnglish
Pages (from-to)616-626
Number of pages11
JournalHuman Brain Mapping
Issue number2
Early online date5 Nov 2012
Publication statusPublished - Feb 2014


  • Alzheimer's disease
  • Frontopolar cortex
  • Frontotemporal dementia
  • Insight
  • Self-evaluation
  • Ventromedial frontal cortex
  • Voxel-based morphometry

Cite this