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Unravelling the neural basis of spatial delusions after stroke

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dc.contributor.authorAlves, Pedro Nascimento
dc.contributor.authorFonseca, Ana Catarina
dc.contributor.authorSilva, Daniela
dc.contributor.authorAndrade, Matilde R
dc.contributor.authorMelo, Teresa Pinho e
dc.contributor.authorThiebaut de Schotten, Michel
dc.contributor.authorMartins, Isabel Pavão
dc.date.accessioned2021-04-13T16:56:12Z
dc.date.available2021-04-13T16:56:12Z
dc.date.issued2021
dc.description© 2021 American Neurological Associationpt_PT
dc.description.abstractObjective: Knowing explicitly where we are is an interpretation of our spatial representations. Reduplicative paramnesia is a disrupting syndrome in which patients present a firm belief of spatial mislocation. Here, we studied the largest sample of patients with delusional misidentifications of space (i.e. reduplicative paramnesia) after stroke to shed light on their neurobiology. Methods: In a prospective, cumulative, case-control study, we screened 400 patients with acute right-hemispheric stroke. We included 64 cases and 233 controls. First, lesions were delimited and normalized. Then, we computed structural and functional disconnection maps using methods of lesion-track and network-mapping. The maps were compared, controlling for confounders. Second, we built a multivariate logistic model including clinical, behavioural and neuroimaging data. Finally, we performed a nested cross-validation of the model with a support-vector machine analysis. Results: The most frequent misidentification subtype was confabulatory mislocation (56%), followed by place reduplication (19%) and chimeric assimilation (13%). Our results indicate that structural disconnection is the strongest predictor of the syndrome and included two distinct streams, connecting right fronto-thalamic and right occipito-temporal structures. In the multivariate model, the independent predictors of reduplicative paramnesia were the structural disconnection map, lesion sparing of right dorsal fronto-parietal regions, age and anosognosia. Good discrimination accuracy was demonstrated (area under the curve = 0.80[0.75-0.85]). Interpretation: Our results localize the anatomical circuits that may have a role in the abnormal spatial-emotional binding and in the defective updating of spatial representations underlying reduplicative paramnesia. This novel data may contribute to better understand the pathophysiology of delusional syndromes after stroke.pt_PT
dc.description.sponsorshipThe authors acknowledge our colleagues from the Department of Neurology and from the Language Research Laboratory for their contribution to patient screening. This work received funding from “PRÉMIO JOÃO LOBO ANTUNES” – SCML (grant to P.N.A.), from “Bolsa de Investigação em Doenças Vasculares Cerebrais 2017”–SPAVC (grant to P.N.A.) and from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation program (grant agreement No. 818521 to M.T.S.).“Data were provided in part bythe Human Connectome Project, WU-Minn Consortium(Principal Investigators: David Van Essen and KamilUgurbil; 1U54 MH091657) funded by the 16 NIH Institutes and Centers that support the NIH Blueprint for Neuroscience Research; and by the McDonnell Center for Systems Neuroscience at Washington University.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationAnn Neurol. 2021 Apr 2. doi: 10.1002/ana.26079pt_PT
dc.identifier.doi10.1002/ana.26079pt_PT
dc.identifier.eissn1531-8249
dc.identifier.issn0364-5134
dc.identifier.urihttp://hdl.handle.net/10451/47397
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherJohn Wiley & Sons, Inc.pt_PT
dc.relationBrain connections, Stroke, Symptoms Predictions and Brain Repair
dc.relation.publisherversionhttps://onlinelibrary.wiley.com/journal/15318249pt_PT
dc.titleUnravelling the neural basis of spatial delusions after strokept_PT
dc.typejournal article
dspace.entity.typePublication
oaire.awardNumber818521
oaire.awardTitleBrain connections, Stroke, Symptoms Predictions and Brain Repair
oaire.awardURIinfo:eu-repo/grantAgreement/EC/H2020/818521/EU
oaire.citation.titleAnnals of Neurologypt_PT
oaire.fundingStreamH2020
person.familyNameNascimento Alves
person.familyNameFonseca
person.familyNameSilva
person.familyNamePinho e Melo
person.familyNamePavão Martins
person.givenNamePedro
person.givenNameAna Catarina
person.givenNameDaniela
person.givenNameTeresa
person.givenNameIsabel
person.identifier18561
person.identifier.ciencia-id561D-EA98-5D64
person.identifier.ciencia-idD515-BC34-ED65
person.identifier.ciencia-id4D1D-4040-BE76
person.identifier.orcid0000-0001-5740-5904
person.identifier.orcid0000-0001-6913-5526
person.identifier.orcid0000-0003-2329-9132
person.identifier.orcid0000-0002-0375-0101
person.identifier.orcid0000-0002-9611-7400
person.identifier.scopus-author-id16452610900
person.identifier.scopus-author-id7103152782
project.funder.identifierhttp://doi.org/10.13039/501100008530
project.funder.nameEuropean Commission
rcaap.rightsrestrictedAccesspt_PT
rcaap.typearticlept_PT
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