Review ArticleThe Insular Cortex, Alzheimer Disease Pathology, and Their Effects on Blood Pressure VariabilityKitamura, Juri MD*; Nagai, Michiaki MD†; Ueno, Hiroki MD*; Ohshita, Tomohiko MD‡; Kikumoto, Mai MD‡; Toko, Megumi MD‡; Kato, Masaya MD†; Dote, Keigo MD‡; Yamashita, Hiroshi MD‡; Kario, Kazuomi MD§Author Information *Department of Clinical Neuroscience and Therapeutics, Applied Life Science, Institute of Biomedical and Health Sciences, Hiroshima University Departments of †Cardiology ‡Neurology, Hiroshima City Asa Hospital, Hiroshima §Department of Medicine, Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan The authors declare no conflicts of interest. Reprints: Michiaki Nagai, MD, Department of Cardiology, Hiroshima City Asa Hospital, 2-1-1 Kabeminami, Asakita-ku, Hiroshima 731-0293, Japan (e-mail: email@example.com). Alzheimer Disease & Associated Disorders: July-September 2020 - Volume 34 - Issue 3 - p 282-291 doi: 10.1097/WAD.0000000000000340 Buy Metrics Abstract Recent findings indicate that the human cardiovascular system is regulated by a cortical network comprised of the insular cortex (Ic), anterior cingulate gyrus, and amygdala which is necessary for the regulation of the central autonomic network system. Alzheimer disease (AD) affects the Ic at a preclinical stage. The pathology of AD at the Ic is suggested to predispose the cardiovascular system to detrimental changes such as increased blood pressure variability (BPV). In this review article, we focus on the physiology of the Ic in the relationship between the central autonomic network and BPV. We provide a summary of the published evidence regarding the relationship between Ic damage and exaggerated BPV in the context of AD pathology. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.