Research report Henry, where have you lost your Self ? Nathalie Philippi a,b,c,d,* , Daniel Roquet c ,H  edi Ben Malek a,b,d , Vincent Noblet c , Anne Botzung a,b , Benjamin Cretin a,b and Fr  ed  eric Blanc b,c,e a Neurology Service, Neuropsychology Unit, University Hospital of Strasbourg, Strasbourg, France b CMRR (Memory Resources and Research Centre), University Hospital of Strasbourg, Strasbourg, France c ICube Laboratory (UMR 7357) and FMTS, University of Strasbourg and CNRS, Strasbourg, France d Neuropsychology and Pathophysiology of Schizophrenia (U1114), University of Strasbourg and INSERM, Strasbourg, France e Geriatrics Department, University Hospital of Strasbourg, Strasbourg, France article info Article history: Received 18 December 2016 Reviewed 12 May 2017 Revised 16 June 2017 Accepted 26 June 2017 Action editor Michael Kopelman Published online 14 July 2017 Keywords: Alzheimer's disease Case-report Self Autobiographical memory Medial prefrontal cortex Insula abstract The Self is a complex construct encompassing distinct components, including episodic and semantic autobiographical memory, the Self-concept, and the subjective sense of Self, which highest level consists of Self-awareness. The neuro-anatomical correlates are complex, and it is debated as to whether a common region could support these different components of the Self, with a particular interest for the cortical midline structures and the medial prefrontal cortex (MPFC). Alzheimer's disease (AD) constitutes an interesting model for the study of Self as autobiographical memory typically deteriorates as the disease progresses. Here, we report the unexpected case of Henry, a patient with MCI due to AD who was unable to produce any personal autobiographical memories, nor describe his Self- concept, had a poor personal semantic memory, and disclosed unusual anosognosia for this stage of the disease. His cognitive performance was compared to a group of matched AD patients and a group of healthy controls confirming that the main components of his Self were degraded. We hypothesized that it was due to a marked atrophy within the cortical midline, as visually assessed on his MRI. We further elucidated these findings through Voxel-based morphometry analysis, which confirmed a significant atrophy of the MPFC that was specific to this patient. Moreover, this revealed significant atrophy within the bilateral insular cortex. Given the stage of the disease, the degradation of the Self is unlikely to be accounted for by deficient mnemonic processes, especially as the presence of discrete temporal atrophy was noted. We suggest that this specific pattern of MPFC and insular atrophy is responsible for the systematic collapse of the patient's Self, through the breakdown of the subjective sense of Self, which is proposed as a prerequisite to all other components, according to the model proposed by Prebble, Addis, and Tippett (2013). © 2017 Elsevier Ltd. All rights reserved. * Corresponding author. University Hospital of Strasbourg, Unit e de Neuropsychologie, Service de Neurologie, H^ opital de Hautepierre, 1, avenue Moli ere, 67000 Strasbourg, France. E-mail address: Nathalie.philippi@chru-strasbourg.fr (N. Philippi). Available online at www.sciencedirect.com ScienceDirect Journal homepage: www.elsevier.com/locate/cortex cortex 95 (2017) 37 e50 http://dx.doi.org/10.1016/j.cortex.2017.06.019 0010-9452/© 2017 Elsevier Ltd. All rights reserved.