2012). To further explore potential modality-specific Belnacasan molecular weight neural substrates of self-awareness, future studies should not only examine the neural basis of the respective self-awareness measure but also the neural basis of the modality to which it relates. Hemispheric lateralization of self-awareness Similar to the majority of neuroimaging studies examining neural substrates of impaired self-awareness in various types of brain pathologies, such as neurodegeneration, stroke, schizophrenia, or traumatic brain

injury (Orfei et al. 2008; Zamboni and Wilcock 2011), we found right lateralization of the neural substrates of overestimation Inhibitors,research,lifescience,medical of one’s empathic concern. The variable lateralization patterns across studies might be partially due to the diversity of modalities of self-awareness Inhibitors,research,lifescience,medical studied, and also to the type of measures applied. For example, verbally demanding questions, likely engaging left hemispheric brain regions more than right-hemispheric brain regions (Knecht et al. 2000), might critically influence the lateralization of the neural substrates of the respective self-awareness measure. For instance, one’s socioemotional self-awareness as measured by semantically demanding questions has previously been related to

predominantly Inhibitors,research,lifescience,medical left-sided temporal pole activation in healthy controls (Ruby and Decety 2004). Notably, in this study neural substrates of empathic concern itself were right-lateralized, whereas substrates of one’s overestimation of empathic

concern were found bilaterally with right-hemispheric predominance. Interestingly, Inhibitors,research,lifescience,medical bilateral involvement has been found in most neuroimaging studies of impaired self-awareness (Orfei et al. 2008; Zamboni and Wilcock 2011), pointing to a potentially critical link between self-awareness and parallel processing in bilaterally connected neural circuits. “Tarnishing” may be multifactorial No brain region significantly predicted underestimation of one’s empathic concern, which supported our hypothesis. As pointed out by others (Tranel et al. 2010), our data suggest that relationships Inhibitors,research,lifescience,medical between measures of self-awareness and other measures such as brain atrophy can be obscured by examining self-awareness measures independent of their directionality. Awareness of this issue is critical not only for interpreting previous neuroimaging studies of impaired self-awareness no in neurodegenerative disease in which patients were not separated into those who polish (overestimate) and tarnish (underestimate) their functioning but also for designing and analyzing future studies. One potential reason we did not find a structural brain basis for underestimation of one’s empathic concern is reflected by the fact that tarnishers showed little change in their empathic concern relative to their premorbid level, likely resulting in restricted range of brain-behavioral relationships.