Reduced Brain Volume May Diminish Self-Monitoring Skills in Dementia

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Patients with dementia had decreased ability for self-monitoring, probably as a result of impairments of the insula and orbitofrontal cortex.

The findings of a brain imaging study suggested that poor self-monitoring skills in people with dementia may be connected to reduced gray matter volume in certain areas of the brain. The study results were published in the Journal of Neuropsychiatry and Clinical Neurosciences.

Self-monitoring is the ability to adjust oneself to social situations, taking into consideration cues from others as well as one’s own presentation. Neuroimaging studies have complemented the theoretic concept of self-monitoring, pointing to several brain structures involved in the ability to self-monitor. This study investigated self-monitoring in the context of dementia.

The investigators identified 77 patients with various types of dementia plus 31 healthy controls, all native Greek speakers. Among the total patients, 39 met the core criteria for Alzheimer disease, and 38 were diagnosed with a frontotemporal dementia syndrome. After neurocognitive and neuropsychiatric assessment, diagnoses were confirmed through magnetic resonance imaging. Volume reduction of brain structures was assessed with voxel-based morphometry.

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Researchers found associations between reduced gray matter volume in certain brain structures and 2 subscales of the Revised Self-Monitoring Scale, the Expressive Behavior subscale and the Self-Presentation subscale, which rate ability to monitor others’ and one’s own behavior, respectively.

Decreased expressive scores were linked with reduced volume in such areas as the right olfactory cortex, inferior frontal gyrus, superior temporal pole, parahippocampal gyrus, insula, and medial temporal gyrus.

Decreased self-presentation scores were also linked with decreased volume in the bilateral olfactory cortex rectus gyrus and inferior frontal gyrus, as well as insula bilateral, right superior temporal pole, and left medial temporal gyrus. Additionally, reduced volume was found in the parahippocampal gyrus and anterior superior frontal gyrus.

Taken together, these findings suggest that certain brain structures are important for self-monitoring and reductions in their volume may lead to impaired self-monitoring in patients with dementia.

A limitation of the study was the use of caregiver-reported measures of patients’ self-monitoring.


Parthimos T, Karavasilis E, Rankin K, et al. The neural correlates of impaired self-monitoring among individuals with neurodegenerative dementias [published online January 3, 2019]. J Neuropsychiatry Clin Neurosci. doi: 10.1176/appi.neuropsych.17120349