An analysis of the neural mechanisms underlying cognitive impairment in depersonalization-derealization disorder based on low-frequency fluctuation

doi:10.3969/j.issn.1006-7795.2026.03.020

Abstract

Abstract: Objective To investigate the characteristics of spontaneous brain activity in patients with depersonalization-derealization disorder (DPRD) and explore their correlation with cognitive impairment.Methods Forty-eight patients from Beijing Anding Hospital, Capital Medical University, with DPRD and thirty-two healthy controls were included in the study. Clinical symptoms were assessed, and cognitive functions were evaluated by using the Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery (MCCB) and the Stroop Color-Word Test. Resting-state functional magnetic resonance imaging (rs-fMRI) data were acquired. Amplitude of low-frequency fluctuation (ALFF) analysis was performed, followed by correlation analyses between ALFF values and clinical characteristics.Results Compared to healthy controls, DPRD patients exhibited significantly reduced ALFF values in the bilateral thalamus, left insula, left lingual gyrus, left cerebellum, bilateral fusiform gyrus, left superior temporal gyrus, and right medial and paracingulate gyri. Conversely, ALFF values were increased in the right insula and the right inferior frontal gyrus (pars triangularis). Correlation analyses revealed that ALFF values in the right insula were negatively correlated with scores on verbal learning and visual memory tests. ALFF values in the left cerebellum and the right medial and paracingulate gyri were negatively correlated with self-unreality scores. ALFF values in the right inferior frontal gyrus (pars triangularis) and the right insula were positively correlated with temporal disintegration scores.Conclusion Brain functional abnormalities in DPRD primarily involve regions associated with self-processing, emotion regulation, sensory integration, and cognitive control. It may collectively underlies the cognitive impairment and core clinical symptoms observed in these patients.

Key words: depersonalization-derealization disorder, low-frequency fluctuation, rest-state functional magnetic resonance imaging, cognition function, insula, sensory integration, self-referential processing

CLC Number:

Song Nan, Zheng Sisi, Jia Hongxiao. An analysis of the neural mechanisms underlying cognitive impairment in depersonalization-derealization disorder based on low-frequency fluctuation[J]. Journal of Capital Medical University, 2026, 47(3): 569-578.

References

［1］American Psychiatric Association, DSM-5 Task Force. Diagnostic and statistical manual of mental disorders: DSM-5TM［M］. 5th ed. Arlington: American Psychiatric Publishing, Inc., 2013.
［2］Song M K, Zheng S S, Song N, et al. Clinical characteristics of 217 Chinese cases with depersonalization/derealization disorder［J］. BMC Psychiatry, 2024, 24(1): 597.
［3］世界卫生组织. ICD-10精神与行为障碍分类临床描述与诊断要点［M］. 范肖冬,汪向东,于欣,等译, 北京：人民卫生出版社, 1993.
［4］Yang J Y, Millman L S M, David A S, et al. The prevalence of depersonalization-derealization disorder: a systematic review［J］. J Trauma Dissociation, 2023, 24(1): 8-41.
［5］Simeon D, Knutelska M, Putnam F W, et al. Attention and memory in depersonalization-spectrum dissociative disorders: impact of selective-divided attentional condition, stimulus emotionality, and stress［J］. J Trauma Dissociation, 2023, 24(1): 42-62.
［6］Guralnik O, Giesbrecht T, Knutelska M, et al. Cognitive functioning in depersonalization disorder［J］. J Nerv Ment Dis, 2007, 195(12): 983-988.
［7］Guralnik O, Schmeidler J, Simeon D. Feeling unreal: cognitive processes in depersonalization［J］. Am J Psychiatry, 2000, 157(1): 103-109.
［8］宋楠, 贾竑晓. 人格解体患者认知功能及与临床症状和社会功能的相关性［J］. 首都医科大学学报, 2020, 41(1): 59-63.
［9］Zheng S S, Song M K, Song N, et al. Dysfunctional large-scale brain networks in drug-nave depersonalization-derealization disorder patients［J］. BMC Psychiatry, 2025, 25(1): 59.
［10］Murphy R J. Depersonalization/derealization disorder and neural correlates of trauma-related pathology: a critical review［J］. Innov Clin Neurosci, 2023, 20(1/3): 53-59.
［11］Modesti M N, Rapisarda L, Capriotti G, et al. Functional neuroimaging in dissociative disorders: a systematic review［J］. J Pers Med, 2022, 12(9): 1405.
［12］Simeon D, Knutelska M. Depersonalization disorder: directed forgetting as a function of emotionality［J］. J Trauma Dissociation, 2023, 24(2): 241-251.
［13］Jia Y, Song N, Ning Y Z, et al. Altered self-referential-related brain regions in depersonalization-derealization disorder［J］. Brain Behav, 2025, 15(2): e70314.
［14］Zheng S S, Zhang F X, Shum H P H, et al. Unraveling the brain dynamics of depersonalization-derealization disorder: a dynamic functional network connectivity analysis［J］. BMC Psychiatry, 2024, 24(1): 685.
［15］Sierra M, Berrios G E. The Cambridge depersonalisation scale: a new instrument for the measurement of depersonalisation［J］. Psychiatry Res, 2000, 93(2): 153-164.
［16］Fagioli F, Telesforo L, DellErba A, et al. Depersonalization: an exploratory factor analysis of the Italian version of the Cambridge depersonalization scale［J］. Compr Psychiatry, 2015, 60: 161-167.
［17］Sierra M, Baker D, Medford N, et al. Unpacking the depersonalization syndrome: an exploratory factor analysis on the Cambridge depersonalization scale［J］. Psychol Med, 2005, 35(10): 1523-1532.
［18］汪春运. 人格解体的检出和评价——介绍剑桥人格解体量表［J］. 四川精神卫生, 2011, 24(3): 186-187.
［19］贾晓菊, 刘恩益, 王哲. 中文版剑桥人格解体量表的信度和效度检验［J］. 神经疾病与精神卫生, 2010, 10(6): 551-553.
［20］Nuechterlein K H, Green M F, Kern R S, et al. The MATRICS Consensus Cognitive Battery, part 1: test selection, reliability, and validity［J］. Am J Psychiatry, 2008,165(2):203-213.
［21］邹义壮, 崔界峰, 王健, 等. 精神分裂症认知功能成套测验中文版临床信度及效度的研究［J］. 中华精神科杂志, 2009, 42(1): 29-33.
［22］Shi C, Kang L, Yao S Q, et al. The MATRICS consensus cognitive battery (MCCB): co-norming and standardization in China［J］. Schizophr Res, 2015, 169(1/3): 109-115.［23］Mancano M, Papagno C. Emotional and social dimension of abstract concepts meet with interoception in right anterior insula［J］. J Neurosci, 2026, 46(2): e0238252025.
［24］Medford N, Brierley B, Brammer M, et al. Emotional memory in depersonalization disorder: a functional MRI study［J］. Psychiatry Res, 2006, 148(2/3): 93-102.
［25］Maister L, Ciaunica A. Self-portrait of a stranger: self-face representation and interoception in depersonalization experiences［J］. Cognition, 2025, 265: 106261.
［26］Wang Y, Zhou Y X, Liu A H, et al. Abnormal resting-state functional connectivity between the dorsal anterior cingulate cortex and the limbic system contributes to pain and emotion regulation impairment in fibromyalgia patients［J］. Int J Rheum Dis, 2026, 29(1): e70531.
［27］Liu J X, Wang X Y, Zhang H Q, et al. Functional differentiation and interactions among inferior, medial frontal and posterior temporal cortex in semantic control［J］. Commun Biol, 2025, 9(1): 41.
［28］Geier K T, Vidal J P, Barbeau E J, et al. Examination of the role of the mediodorsal thalamus in supporting frontal cortical processes［J］. Cortex, 2026, 197: 139-160.
［29］Tenório R B, Vieira A A, Franklin G L, et al. The cognitive cerebellum: a hub for motor, emotional, and executive control［J］. Arq Neuropsiquiatr, 2025, 83(12): 1-12.
［30］Kumral E, Ece Çetin F, Deniz Çetin Z, et al. Visual and cognitive disorders associated with isolated lingual gyrus infarctions［J］. J Neuropsychiatry Clin Neurosci, 2025, 38(2):128-133.
［31］Quinn B P A, Andrews T J. The perceptual and neural processing of familiar faces is shaped by the statistical regularities of real-world viewing［J］. Cerebral Cortex, 2025, 35(12): bhaf328.
［32］Themistocleous C. Linguistic and emotional prosody: a systematic review and ALE meta-analysis［J］. Neurosci Biobehav Rev, 2025, 175: 106210.

[1]	Wu Ziyao, Feng Sitong, Dong Linrui, Zheng Sisi, Ning Yanzhe, Jia Hongxiao. Study of cognitive function and social function in the subhealthy people with spleen qi deficiency syndrome [J]. Journal of Capital Medical University, 2024, 45(3): 453-457.
[2]	Zheng Sisi, Song Mingkang, Song Nan, Zhu Hong, Jia Hongxiao. A preliminary study on the therapeutic efficacy of Duloxetine in the treatment of depersonalization-derealization disorder [J]. Journal of Capital Medical University, 2023, 44(4): 578-582.