Multilevel convergence of interoceptive impairments in hypertension: New evidence of disrupted body-brain interactions

• Published in: Human brain mapping Vol. 39; no. 4; pp. 1563 - 1581
• Main Authors: Yoris, Adrián, Abrevaya, Sofía, Esteves, Sol, Salamone, Paula, Lori, Nicolas Francisco, Martorell, Miguel, Legaz, Agustina, Alifano, Florencia, Petroni, Agustín, Sánchez, Ramiro, Sedeño, Lucas, García, Adolfo M., Ibáñez, Agustín
• Format: Journal Article
• Language: English
• Published: United States Wiley 01.04.2018; John Wiley & Sons, Inc; John Wiley and Sons Inc
• Subjects: Abnormalities; Aged; Atrophy; Autonomic nervous system; Brain; Brain - diagnostic imaging; Brain - pathology; Brain - physiopathology; Brain damage; Brain injury; Brain mapping; Ciências Médicas; Cognition; Cognitive ability; Cortex (cingulate); Diffusion Tensor Imaging; Disease control; Electroencephalography; embodied cognition; Evoked Potentials; Female; Functional magnetic resonance imaging; Gray Matter; Gray Matter - diagnostic imaging; Gray Matter - pathology; Gray Matter - physiopathology; Heart; Heart - physiopathology; Heart diseases; heart evoked potential; Humans; Hypertension; Hypertension - diagnostic imaging; Hypertension - physiopathology; Interoception; Interoception - physiology; Magnetic Resonance Imaging; Male; Markers; Medical imaging; Medicina Básica; Mental disorders; Morphometry; Multilevel Analysis; Neural networks; Neural Pathways; Neural Pathways - diagnostic imaging; Neural Pathways - pathology; Neural Pathways - physiopathology; Neuroimaging; Neurological diseases; Neurology; Organ Size; Patients; Science & Technology; Substantia alba; interoception; heart evoked potential; hypertension; embodied cognition; neuroimaging
• ISSN: 1065-9471; 1097-0193; 1097-0193
• DOI: 10.1002/hbm.23933

Interoception, the sensing of visceral body signals, involves an interplay between neural and autonomic mechanisms. Clinical studies into this domain have focused on patients with neurological and psychiatric disorders, showing that damage to relevant brain mechanisms can variously alter interoceptive functions. However, the association between peripheral cardiac-system alterations and neurocognitive markers of interoception remains poorly understood. To bridge this gap, we examined multidimensional neural markers of interoception in patients with early stage of hypertensive disease (HTD) and healthy controls. Strategically, we recruited only HTD patients without cognitive impairment (as shown by neuropsychological tests), brain atrophy (as assessed with voxel-based morphometry), or white matter abnormalities (as evidenced by diffusion tensor imaging analysis). Interoceptive domains were assessed through (a) a behavioral heartbeat detection task; (b) measures of the heart-evoked potential (HEP), an electrophysiological cortical signature of attention to cardiac signals; and (c) neuroimaging recordings (MRI and fMRI) to evaluate anatomical and functional connectivity properties of key interoceptive regions (namely, the insula and the anterior cingulate cortex). Relative to controls, patients exhibited poorer interoceptive performance and reduced HEP modulations, alongside an abnormal association between interoceptive performance and both the volume and functional connectivity of the above regions. Such results suggest that peripheral cardiac-system impairments can be associated with abnormal behavioral and neurocognitive signatures of interoception. More generally, our findings indicate that interoceptive processes entail bidirectional influences between the cardiovascular and the central nervous systems. Work has been partially supported by the CONICET, the INECO Foundation and regular projects of CONICYT/FONDECYT (1170010); FONCyT‐PICT (2012‐0412 and 2012‐1309), and FONDAP (15150012)