Cardiac interoception in neurological conditions and its relevance for dimensional approaches

YORIS ADRIAN; SEDEÑO LUCAS; SALAMONE PAULA; IBAÑEZ AGUSTIN; GARCIA ADOLFO; GARCIA CORDERO, INDIRA

The Interoceptive Basis of the Mind

Oxford University Press

Año: 2018; p. 187 - 211

Dimensional and transdiagnostic approaches have revealed multiple alterations shared by several neuropsychiatric conditions. While this has been copiously shown for externally triggered neurocognitive processes (such as perception, recognition, or classification of outer stimuli), the disruption of inner signal monitoring across brain disorders remains poorly understood. This chapter aims to bridge this gap while proposing cardiac interoception as a potential common biomarker in neurological diseases (including stroke, Alzheimer?s disease, behavioral variant frontotemporal dementia, multiple sclerosis, Parkinson?s disease, functional motor disorders, and chronic pain). We focus on key aspects of cardiac interoception, such as (i) the mechanisms underlying different interoceptive dimensions (accuracy, awareness and metacognition, learning); (ii) the relationship among interoception, emotion, and social cognition; and (iii) the roles of different interoceptive (mainly vagal and sensorimotor) pathways. We consider behavioral, neuroanatomical, and brain functional evidence, and discuss available findings in the context of an experimental and clinical agenda. We also evaluate the potential role of interoception as (a) a predictor of clinical outcomes, (b) a marker of neurocognitive deficits in neurological diseases, and (c) a general source of insights for breakthroughs in the treatment and prevention of multiple disorders. We emphasize the relevance of this domain to promote a hitherto missing synthesis of simultaneous autonomic, emotional, and social cognition deficits in brain-damaged patients. Finally, we outline future directions to improve the dimensional and transdiagnostic assessment of interoception in multiple pathologies.