Anterior insular network disconnection and cognitive impairment in Parkinson's disease

Graphical abstract
Highlights • Cognitive dysfunction in PD is related to FC of the dorsal anterior insula (dAI) • In PD only, FC between the dAI and DMN was most strongly related to cognition. • FC of dAI with anterior cingulate was reduced and related to cognition in PD. • Increased DMN and FPN centrality is related to dAI-ACC disconnection in PD. • Altered interplay between dAI, DMN, and FPN underlies poor cognition in PD.
Background The insula is a central brain hub involved in cognition and affected in Parkinson’s disease (PD). The aim of this study was to assess functional connectivity (FC) and betweenness centrality (BC) of insular sub-regions and their relationship with cognitive impairment in PD. Methods Whole-brain 3D-T1, resting-state functional MRI and a battery of cognitive tests (CAMCOG) were included for 53 PD patients and 15 controls. The insular cortex was segmented into ventral (vAI) and dorsal (dAI) anterior and posterior sub-regions. Connectivity between insular sub-regions and resting-state networks was assessed and related to cognition; BC was used to further explore nodes associated with cognition. Results Cognitive performance was significantly lower in PD patients compared to controls (p