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Michel M, Gao Y, Mazor M, Kletenik I, Rahnev D. When visual metacognition fails: widespread anosognosia for visual deficits. Trends Cogn Sci 2024:S1364-6613(24)00226-2. [PMID: 39353838 DOI: 10.1016/j.tics.2024.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 09/07/2024] [Accepted: 09/09/2024] [Indexed: 10/04/2024]
Abstract
Anosognosia for visual deficits - cases where significant visual deficits go unnoticed - challenges the view that our own conscious experiences are what we know best. We review these widespread and striking failures of awareness. Anosognosia can occur with total blindness, visual abnormalities induced by brain lesions, and eye diseases. We show that anosognosia for visual deficits is surprisingly widespread. Building on previous accounts, we introduce a framework showing how apparently disparate forms of anosognosia fit together. The central idea is that, to notice a deficit, individuals need to form expectations about normal vision, compare expectations and visual input, and judge any mismatch at the metacognitive level. A failure in any of these three steps may lead to unawareness of visual deficits.
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Affiliation(s)
| | - Yi Gao
- Georgia Institute of Technology, Atlanta, GA, USA
| | | | - Isaiah Kletenik
- Division of Cognitive and Behavioral Neurology, Department of Neurology and Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA 02115, USA
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Tisserand A, Blanc F, Muller C, Durand H, Demuynck C, Ravier A, Sanna L, de Sousa PL, Botzung A, Mondino M, Philippi N. Neuroimaging of autobiographical memory in dementia with Lewy bodies: a story of insula. Brain Commun 2024; 6:fcae272. [PMID: 39210911 PMCID: PMC11358644 DOI: 10.1093/braincomms/fcae272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 06/17/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024] Open
Abstract
Although deficits in learning and retrieving new information are well characterized in dementia with Lewy bodies, autobiographical memory has never been explored in this disease. Yet, autobiographical memory impairments are a pervasive feature of dementia, well characterized in other neurodegenerative diseases. Moreover, autobiographical memory corresponds to an extension over time of the self, which we hypothesize is altered in dementia with Lewy bodies and impairment of which could be linked to the insular atrophy occurring from an early stage of the disease. In this study, we sought to characterize autobiographical memory impairments and explore their neural correlates in dementia with Lewy bodies, on the assumption that insular damage could impact the self, including its most elaborate components, such as autobiographical memory. Twenty patients with prodromal to mild dementia with Lewy bodies were selected to participate in this exploratory study along with 20 healthy control subjects. The Autobiographical Interview was used to assess autobiographical memory. Performances were compared between patients and control subjects, and an analysis across life periods and recall conditions was performed. 3D magnetic resonance images were acquired for all participants, and correlational analyses were performed in the patient group using voxel-based morphometry. The behavioural results of the Autobiographical Interview showed that autobiographical memory performances were significantly impaired in dementia with Lewy body patients compared to control subjects in a temporally ungraded manner, for both the free recall and the specific probe conditions (P < 0.0001), though with greater improvement after probing in the patient group. Furthermore, autobiographical memory impairments were correlated with grey matter volume within right insular cortex, temporoparietal junction, precuneus, putamen, left temporal cortex, bilateral parahippocampus and cerebellum, using a threshold of P = 0.005 uncorrected. The behavioural results confirm the existence of temporally ungraded autobiographical memory impairments in dementia with Lewy bodies, from the early stage of the disease. As we expected, neuroimaging analysis revealed a role for the insula and the precuneus in autobiographical memory retrieval, two regions associated with elementary aspects of the self, among other brain regions classically associated with autobiographical memory, such as medial temporal lobe and temporoparietal junction. Our findings provide important insights regarding the involvement of the insula in the self and suggest that insular damage could lead to a global collapse of the self, including its more elaborated components, such as autobiographical memory.
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Affiliation(s)
- Alice Tisserand
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), IMIS Team and IRIS Platform, University of Strasbourg and CNRS, 67000 Strasbourg, France
- CM2R (Research and Resources Memory Centre), Geriatric Day Hospital and Neuropsychology Unit, Geriatrics Department and Neurology Service, University Hospitals of Strasbourg, 67000 Strasbourg, France
| | - Frédéric Blanc
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), IMIS Team and IRIS Platform, University of Strasbourg and CNRS, 67000 Strasbourg, France
- CM2R (Research and Resources Memory Centre), Geriatric Day Hospital and Neuropsychology Unit, Geriatrics Department and Neurology Service, University Hospitals of Strasbourg, 67000 Strasbourg, France
| | - Candice Muller
- CM2R (Research and Resources Memory Centre), Geriatric Day Hospital and Neuropsychology Unit, Geriatrics Department and Neurology Service, University Hospitals of Strasbourg, 67000 Strasbourg, France
| | - Hélène Durand
- CM2R (Research and Resources Memory Centre), Geriatric Day Hospital and Neuropsychology Unit, Geriatrics Department and Neurology Service, University Hospitals of Strasbourg, 67000 Strasbourg, France
| | - Catherine Demuynck
- CM2R (Research and Resources Memory Centre), Geriatric Day Hospital and Neuropsychology Unit, Geriatrics Department and Neurology Service, University Hospitals of Strasbourg, 67000 Strasbourg, France
| | - Alix Ravier
- CM2R (Research and Resources Memory Centre), Geriatric Day Hospital and Neuropsychology Unit, Geriatrics Department and Neurology Service, University Hospitals of Strasbourg, 67000 Strasbourg, France
| | - Léa Sanna
- CM2R (Research and Resources Memory Centre), Geriatric Day Hospital and Neuropsychology Unit, Geriatrics Department and Neurology Service, University Hospitals of Strasbourg, 67000 Strasbourg, France
| | - Paulo Loureiro de Sousa
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), IMIS Team and IRIS Platform, University of Strasbourg and CNRS, 67000 Strasbourg, France
| | - Anne Botzung
- CM2R (Research and Resources Memory Centre), Geriatric Day Hospital and Neuropsychology Unit, Geriatrics Department and Neurology Service, University Hospitals of Strasbourg, 67000 Strasbourg, France
| | - Mary Mondino
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), IMIS Team and IRIS Platform, University of Strasbourg and CNRS, 67000 Strasbourg, France
| | - Nathalie Philippi
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), IMIS Team and IRIS Platform, University of Strasbourg and CNRS, 67000 Strasbourg, France
- CM2R (Research and Resources Memory Centre), Geriatric Day Hospital and Neuropsychology Unit, Geriatrics Department and Neurology Service, University Hospitals of Strasbourg, 67000 Strasbourg, France
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Klingbeil J, Mühlig M, Bahr E, Welle F, Ritter T, Stockert A, Wawrzyniak M, Saur D. Undoubtedly unaware of homonymous hemianopia: The contribution of overconfidence to anosognosia of hemianopia. Cortex 2024; 177:224-234. [PMID: 38875736 DOI: 10.1016/j.cortex.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/31/2024] [Accepted: 03/11/2024] [Indexed: 06/16/2024]
Abstract
A new functional deficit caused by a stroke can be understood as a situation of uncertainty that has to prompt deficit discovery and subsequent incorporation into an altered self-perception. Anosognosia for visual field deficits is frequent after stroke. For hemiplegia, patients' performance in a riddle test provided evidence that the inability to generate and adjust beliefs in face of uncertainty contributes to anosognosia for hemiplegia. In this prospective study, the same riddles are used in patients with homonymous hemianopia due to a first-ever stroke in the posterior cerebral artery territory and in an age-matched control cohort. The riddles create a situation of uncertainty that is resolved with five successive clues which progressively delimit the target word. After each clue, patients have to guess the target word and rate their confidence in the answer's correctness. Patients were tested once during the hospital stay. According to the Bisiach score for anosognosia, 12 out of 29 patients were unaware of their visual field deficits. All patients with anosognosia for hemianopia had right hemisphere lesions. Patients with and without anosognosia did not differ significantly in global cognitive impairment, mental flexibility or memory function. Importantly, patients with anosognosia showed higher confidence ratings than patients without anosognosia and controls in the first two clues (situations of uncertainty). This was demonstrated by a significant interaction effect in a mixed ANOVA with the factors group (anosognosia, nosognosia, controls) and riddle clues. An exploratory lesion subtraction analysis showed a high proportion of deficit unawareness in patients with lesions in the right fusiform and (para)hippocampal gyri. Our findings suggest that overconfidence in situations of uncertainty might contribute to the appearance of anosognosia for hemianopia. Because this has been demonstrated before in anosognosia for hemiplegia, we suggest that overconfidence is a supra-modal contributor to deficit unawareness.
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Affiliation(s)
- Julian Klingbeil
- Neuroimaging Laboratory, Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany.
| | - Martin Mühlig
- Neuroimaging Laboratory, Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Emma Bahr
- Neuroimaging Laboratory, Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Florian Welle
- Neuroimaging Laboratory, Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Tim Ritter
- Neuroimaging Laboratory, Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Anika Stockert
- Neuroimaging Laboratory, Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Max Wawrzyniak
- Neuroimaging Laboratory, Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Dorothee Saur
- Neuroimaging Laboratory, Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
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Besharati S, Jenkinson PM, Kopelman M, Solms M, Bulgarelli C, Pacella V, Moro V, Fotopoulou A. What I think she thinks about my paralysed body: Social inferences about disability-related content in anosognosia for hemiplegia. J Neuropsychol 2024. [PMID: 38899773 DOI: 10.1111/jnp.12378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/06/2024] [Accepted: 06/03/2024] [Indexed: 06/21/2024]
Abstract
The neuropsychological disorder of anosognosia for hemiplegia (AHP) can offer unique insights into the neurocognitive processes of body consciousness and representation. Previous studies have found associations between selective social cognition deficits and anosognosia. In this study, we examined how such social cognition deficits may directly interact with representations of one's body as disabled in AHP. We used a modified set of previously validated Theory of Mind (ToM) stories to create disability-related content that was related to post-stroke paralysis and to investigate differences between right hemisphere damage patients with (n = 19) and without (n = 19) AHP. We expected AHP patients to perform worse than controls when trying to infer paralysis-related mental states in the paralysis-related ToM stories and explored whether such differences depended on the inference patients were asked to perform (e.g. self or other referent perspective-taking). Using an advanced structural neuroimaging technique, we expected selective social cognitive deficits to be associated with posterior parietal cortex lesions and deficits in self-referent perspective-taking in paralysis-related mentalising to be associated with frontoparietal disconnections. Group- and individual-level results revealed that AHP patients performed worse than HP controls when trying to infer paralysis-related mental states. Exploratory lesion analysis results revealed some of the hypothesised lesions, but also unexpected white matter disconnections in the posterior body and splenium of the corpus collosum associated with a self-referent perspective-taking in paralysis-related ToM stories. The study has implications for the multi-layered nature of body awareness, including abstract, social perspectives and beliefs about the body.
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Affiliation(s)
- Sahba Besharati
- Department of Psychology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Paul M Jenkinson
- Faculty of Psychology, Counselling and Psychotherapy, The Cairnmillar Institute, Melbourne, Australia
- Research Department of Clinical, Educational and Heath Psychology, University College London, London, UK
| | - Michael Kopelman
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mark Solms
- Neuroscience Institute, University of Cape Town, Rondebosch, South Africa
| | | | | | - Valentina Moro
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Verona, Italy
| | - Aikaterini Fotopoulou
- Research Department of Clinical, Educational and Heath Psychology, University College London, London, UK
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Gettens Bourgea KM, Erkkinen M, Gale SA, McGinnis SM, Daffner KR, Silbersweig D, Schildkrout B. Case Studies 7A and 7B: Two Physician-Patients With Early Alzheimer's Disease and Differing Levels of Insight. J Neuropsychiatry Clin Neurosci 2024; 36:220-227. [PMID: 38835225 DOI: 10.1176/appi.neuropsych.20230217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Affiliation(s)
- Katelyn M Gettens Bourgea
- Departments of Neurology (Gettens Bourgea, Erkkinen, Gale, McGinnis, Daffner) and Psychiatry (Silbersweig, Schildkrout), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Michael Erkkinen
- Departments of Neurology (Gettens Bourgea, Erkkinen, Gale, McGinnis, Daffner) and Psychiatry (Silbersweig, Schildkrout), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Seth A Gale
- Departments of Neurology (Gettens Bourgea, Erkkinen, Gale, McGinnis, Daffner) and Psychiatry (Silbersweig, Schildkrout), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Scott M McGinnis
- Departments of Neurology (Gettens Bourgea, Erkkinen, Gale, McGinnis, Daffner) and Psychiatry (Silbersweig, Schildkrout), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Kirk R Daffner
- Departments of Neurology (Gettens Bourgea, Erkkinen, Gale, McGinnis, Daffner) and Psychiatry (Silbersweig, Schildkrout), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - David Silbersweig
- Departments of Neurology (Gettens Bourgea, Erkkinen, Gale, McGinnis, Daffner) and Psychiatry (Silbersweig, Schildkrout), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Barbara Schildkrout
- Departments of Neurology (Gettens Bourgea, Erkkinen, Gale, McGinnis, Daffner) and Psychiatry (Silbersweig, Schildkrout), Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston
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Roseman M, Elias U, Kletenik I, Ferguson MA, Fox MD, Horowitz Z, Marshall GA, Spiers HJ, Arzy S. A neural circuit for spatial orientation derived from brain lesions. Cereb Cortex 2024; 34:bhad486. [PMID: 38100330 PMCID: PMC10793567 DOI: 10.1093/cercor/bhad486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 11/27/2023] [Accepted: 11/27/2023] [Indexed: 12/17/2023] Open
Abstract
There is disagreement regarding the major components of the brain network supporting spatial cognition. To address this issue, we applied a lesion mapping approach to the clinical phenomenon of topographical disorientation. Topographical disorientation is the inability to maintain accurate knowledge about the physical environment and use it for navigation. A review of published topographical disorientation cases identified 65 different lesion sites. Our lesion mapping analysis yielded a topographical disorientation brain map encompassing the classic regions of the navigation network: medial parietal, medial temporal, and temporo-parietal cortices. We also identified a ventromedial region of the prefrontal cortex, which has been absent from prior descriptions of this network. Moreover, we revealed that the regions mapped are correlated with the Default Mode Network sub-network C. Taken together, this study provides causal evidence for the distribution of the spatial cognitive system, demarking the major components and identifying novel regions.
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Affiliation(s)
- Moshe Roseman
- Neuropsychiatry Lab, Department of Medical Neurosciences, Faculty of Medicine, Hadassah Ein Kerem Campus, Hebrew University of Jerusalem, Jerusalem 9112001, Israel
| | - Uri Elias
- Neuropsychiatry Lab, Department of Medical Neurosciences, Faculty of Medicine, Hadassah Ein Kerem Campus, Hebrew University of Jerusalem, Jerusalem 9112001, Israel
| | - Isaiah Kletenik
- Center for Brain Circuit Therapeutics, Departments of Neurology, Psychiatry, and Radiology, Brigham & Women’s Hospital, Boston, MA 02115, United States
- Harvard Medical School, Boston, MA 02115, United States
- Division of Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women’s Hospital, Boston, MA 02115, United States
| | - Michael A Ferguson
- Center for Brain Circuit Therapeutics, Departments of Neurology, Psychiatry, and Radiology, Brigham & Women’s Hospital, Boston, MA 02115, United States
- Harvard Medical School, Boston, MA 02115, United States
| | - Michael D Fox
- Center for Brain Circuit Therapeutics, Departments of Neurology, Psychiatry, and Radiology, Brigham & Women’s Hospital, Boston, MA 02115, United States
- Harvard Medical School, Boston, MA 02115, United States
| | - Zalman Horowitz
- Neuropsychiatry Lab, Department of Medical Neurosciences, Faculty of Medicine, Hadassah Ein Kerem Campus, Hebrew University of Jerusalem, Jerusalem 9112001, Israel
| | - Gad A Marshall
- Harvard Medical School, Boston, MA 02115, United States
- Division of Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women’s Hospital, Boston, MA 02115, United States
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women’s Hospital, Boston, MA 02115, United States
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Hugo J Spiers
- Institute of Behavioural Neuroscience, Department of Experimental Psychology, University College London, London WC1H 0AP, United Kingdom
| | - Shahar Arzy
- Neuropsychiatry Lab, Department of Medical Neurosciences, Faculty of Medicine, Hadassah Ein Kerem Campus, Hebrew University of Jerusalem, Jerusalem 9112001, Israel
- Department of Neurology, Hadassah Hebrew University Medical School, Jerusalem 9112001, Israel
- Department of Brain and Cognitive Sciences, Hebrew University of Jerusalem, Jerusalem 9190501, Israel
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Kletenik I, Cohen AL, Glanz BI, Ferguson MA, Tauhid S, Li J, Drew W, Polgar-Turcsanyi M, Palotai M, Siddiqi SH, Marshall GA, Chitnis T, Guttmann CRG, Bakshi R, Fox MD. Multiple sclerosis lesions that impair memory map to a connected memory circuit. J Neurol 2023; 270:5211-5222. [PMID: 37532802 PMCID: PMC10592111 DOI: 10.1007/s00415-023-11907-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Nearly 1 million Americans are living with multiple sclerosis (MS) and 30-50% will experience memory dysfunction. It remains unclear whether this memory dysfunction is due to overall white matter lesion burden or damage to specific neuroanatomical structures. Here we test if MS memory dysfunction is associated with white matter lesions to a specific brain circuit. METHODS We performed a cross-sectional analysis of standard structural images and verbal memory scores as assessed by immediate recall trials from 431 patients with MS (mean age 49.2 years, 71.9% female) enrolled at a large, academic referral center. White matter lesion locations from each patient were mapped using a validated algorithm. First, we tested for associations between memory dysfunction and total MS lesion volume. Second, we tested for associations between memory dysfunction and lesion intersection with an a priori memory circuit derived from stroke lesions. Third, we performed mediation analyses to determine which variable was most associated with memory dysfunction. Finally, we performed a data-driven analysis to derive de-novo brain circuits for MS memory dysfunction using both functional (n = 1000) and structural (n = 178) connectomes. RESULTS Both total lesion volume (r = 0.31, p < 0.001) and lesion damage to our a priori memory circuit (r = 0.34, p < 0.001) were associated with memory dysfunction. However, lesion damage to the memory circuit fully mediated the association of lesion volume with memory performance. Our data-driven analysis identified multiple connections associated with memory dysfunction, including peaks in the hippocampus (T = 6.05, family-wise error p = 0.000008), parahippocampus, fornix and cingulate. Finally, the overall topography of our data-driven MS memory circuit matched our a priori stroke-derived memory circuit. CONCLUSIONS Lesion locations associated with memory dysfunction in MS map onto a specific brain circuit centered on the hippocampus. Lesion damage to this circuit fully mediated associations between lesion volume and memory. A circuit-based approach to mapping MS symptoms based on lesions visible on standard structural imaging may prove useful for localization and prognosis of higher order deficits in MS.
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Affiliation(s)
- Isaiah Kletenik
- Division of Cognitive and Behavioral Neurology, Brigham and Women's Hospital, 60 Fenwood Road, 9016H, Boston, MA, 02115, USA.
- Department of Neurology, Brigham and Women's Hospital, Boston, USA.
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Alexander L Cohen
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
- Computational Radiology Laboratory, Department of Radiology, Boston Children's Hospital, Boston, MA, USA
| | - Bonnie I Glanz
- Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School Boston, Boston, MA, USA
| | - Michael A Ferguson
- Department of Neurology, Brigham and Women's Hospital, Boston, USA
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | - Shahamat Tauhid
- Department of Neurology, Brigham and Women's Hospital, Boston, USA
| | - Jing Li
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, USA
| | - William Drew
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, USA
| | - Mariann Polgar-Turcsanyi
- Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School Boston, Boston, MA, USA
| | - Miklos Palotai
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Shan H Siddiqi
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| | - Gad A Marshall
- Division of Cognitive and Behavioral Neurology, Brigham and Women's Hospital, 60 Fenwood Road, 9016H, Boston, MA, 02115, USA
- Department of Neurology, Brigham and Women's Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
- Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Tanuja Chitnis
- Department of Neurology, Brigham and Women's Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
- Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School Boston, Boston, MA, USA
| | - Charles R G Guttmann
- Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
- Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rohit Bakshi
- Department of Neurology, Brigham and Women's Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
- Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School Boston, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael D Fox
- Division of Cognitive and Behavioral Neurology, Brigham and Women's Hospital, 60 Fenwood Road, 9016H, Boston, MA, 02115, USA
- Department of Neurology, Brigham and Women's Hospital, Boston, USA
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
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