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Differential insular cortex sub-regional atrophy in neurodegenerative diseases: a systematic review and meta-analysis
Fathy YY, Hoogers SE, Berendse HW, van der Werf YD, Visser PJ, de Jong FJ, van de Berg WDJ.. Brain imaging and behavior, 2020-12-01
Topic: Brain proteins, microglia and lab models
The insular cortex is proposed to function as a central brain hub characterized by wide-spread connections and diverse functional roles. As a result, its centrality in the brain confers high metabolic demands predisposing it to dysfunction in disease. However, the functional profile and vulnerability to degeneration varies across the insular sub-regions. The aim of this systematic review and meta-analysis is to summarize and quantitatively analyze the relationship between insular cortex sub-regional atrophy, studied by voxel based morphometry, with cognitive and neuropsychiatric deficits in frontotemporal dementia (FTD), Alzheimer's disease (AD), Parkinson's disease (PD), and dementia with Lewy bodies (DLB). We systematically searched through Pubmed and Embase and identified 519 studies that fit our criteria. A total of 41 studies (n = 2261 subjects) fulfilled the inclusion criteria for the meta-analysis. The peak insular coordinates were pooled and analyzed using Anatomic Likelihood Estimation. Our results showed greater left anterior insular cortex atrophy in FTD whereas the right anterior dorsal insular cortex showed larger clusters of atrophy in AD and PD/DLB. Yet contrast analyses did not reveal significant differences between disease groups. Functional analysis showed that left anterior insular cortex atrophy is associated with speech, emotion, and affective-cognitive deficits, and right dorsal atrophy with perception and cognitive deficits. In conclusion, insular sub-regional atrophy, particularly the anterior dorsal region, may contribute to cognitive and neuropsychiatric deficits in neurodegeneration. Our results support anterior insular cortex vulnerability and convey the differential involvement of the insular sub-regions in functional deficits in neurodegenerative diseases.
Key findings
- As a result, its centrality in the brain confers high metabolic demands predisposing it to dysfunction in disease.
- Our results showed greater left anterior insular cortex atrophy in FTD whereas the right anterior dorsal insular cortex showed larger clusters of atrophy in AD and PD/DLB.
- Yet contrast analyses did not reveal significant differences between disease groups.
- Functional analysis showed that left anterior insular cortex atrophy is associated with speech, emotion, and affective-cognitive deficits, and right dorsal atrophy with perception and cognitive deficits.
- In conclusion, insular sub-regional atrophy, particularly the anterior dorsal region, may contribute to cognitive and neuropsychiatric deficits in neurodegeneration.
Why it matters
This systematic review and meta-analysis examined insular cortex atrophy patterns across frontotemporal dementia, Alzheimer's disease, Parkinson's disease and dementia with Lewy bodies, and contrast analyses did not reveal significant differences between disease groups. It describes brain changes associated with these diseases and does not test any treatment, cure or prevention.
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Study details
- Study designsystematic review
- Participants2,261
- Evidence strengthHigh
How this study scored 65/100
Published in a peer-reviewed journal, and it is a systematic review of all the studies on the question. Scored zero for effect reported because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Brain imaging and behavior) |
| Journal's citation record | 1 / 4 | Brain Imaging and Behavior: journal h-index 89 (OpenAlex, 2026-10-29) |
| Study design | 12 / 12 | A systematic review of all the studies on the question |
| Strength of evidence | 5 / 5 | Rated “high” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 2 / 5 | 2020 — within 10 year(s) of the newest study here |
| Sample size | 3 / 4 | 2,261 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | A review of other studies — randomisation is not credited here |
| Times cited | 4 / 7 | Cited 81 times (OpenAlex, 2026-10-10) |
| Citations per year | 3 / 5 | 10.1 citations a year over 8 year(s) since 2020 |
| Impact for its field and year | 2 / 6 | Cited 1.1× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 1 / 6 | Cited by 1 other studies in this library |
| Still being cited | 2 / 4 | Cited 32 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Wilma D. J. van de Berg: h-index 50 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | Erasmus MC: institution h-index 1,321 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 5 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 31011951) |
| Free to read | 2 / 2 | Free to read |
| Total | 65 / 100 | — |
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Read the original
- DOI: 10.1007/s11682-019-00099-3
- PubMed: 31011951
- Original source →
- Free full text: Brain Imaging and Behavior →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record names 7 authors; APA and Vancouver show the first six, BibTeX and the downloads carry all of them. Check the citation against the original before you use it.
APA 7th
Fathy, Y. Y., Hoogers, S. E., Berendse, H. W., van der Werf, Y. D., Visser, P. J., de Jong, F. J., et al. (2020). Differential insular cortex sub-regional atrophy in neurodegenerative diseases: a systematic review and meta-analysis. Brain imaging and behavior. https://doi.org/10.1007/s11682-019-00099-3
Vancouver
Fathy YY, Hoogers SE, Berendse HW, van der Werf YD, Visser PJ, de Jong FJ, et al. Differential insular cortex sub-regional atrophy in neurodegenerative diseases: a systematic review and meta-analysis. Brain imaging and behavior. 2020. doi:10.1007/s11682-019-00099-3. PMID: 31011951.
BibTeX
@article{fathy2020-31011951,
author = {Fathy, Y. Y. and Hoogers, S. E. and Berendse, H. W. and van der Werf, Y. D. and Visser, P. J. and de Jong, F. J. and van de Berg, W. D. J.},
title = {{Differential insular cortex sub-regional atrophy in neurodegenerative diseases: a systematic review and meta-analysis}},
journal = {Brain imaging and behavior},
year = {2020},
doi = {10.1007/s11682-019-00099-3},
pmid = {31011951},
url = {https://doi.org/10.1007/s11682-019-00099-3}
}
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