McTeague Lisa M, Goodkind Madeleine S, Etkin Amit
Department of Psychiatry & Behavioral Sciences for McTeague, Medical University of South Carolina, Charleston, SC, USA.
New Mexico VA Healthcare System, Albuquerque, NM, USA; University of New Mexico, Department of Psychiatry & Behavioral Sciences, Albuquerque, NM, USA.
J Psychiatr Res. 2016 Dec;83:37-46. doi: 10.1016/j.jpsychires.2016.08.001. Epub 2016 Aug 5.
Intact cognitive control or executive function has characteristic patterns in both behavior and functional neurocircuitry. Functional neuroimaging studies have shown that a frontal-cingulate-parietal-insular (i.e., "multiple demand") network forms a common functional substrate undergirding successful adaptation to diverse cognitive processing demands. Separate work on intact neurocognitive performance implicates a higher order factor that largely explains performance across domains and may reflect trait cognitive control capacity. In the current review we highlight findings from respective psychiatric disorders (i.e., psychotic, bipolar and unipolar depressive, anxiety, and substance use disorders) suggesting that cognitive control perturbations amidst psychopathology are most pronounced within these common brain and behavioral indices of adaptive cognitive functioning and moreover, are evident across disorders (i.e., transdiagnostically). Specifically, within each of the disorder classes impairments are consistent in the multiple demand network across a wide range of cognitive tasks. While severity varies between disorders, broad as opposed to domain-specific impairments consistently emerge in neurocognitive performance. Accumulating findings have revealed that phenotypically diverse psychiatric disorders share a common factor or vulnerability to dysfunction that is in turn related to broad neurocognitive deficits. Furthermore, we have observed that regions of the multiple demand network, which overlap with the salience network (dorsal anterior cingulate and bilateral anterior insula) are characterized by reduced gray matter transdiagnostically and predict weaker neurocognitive performance. In summary, transdiagnostic (as opposed to disorder-specific) patterns of symptomatic distress and neurocognitive performance deficits, concurrent with parallel anomalies of brain structure and function may largely contribute to the real-world socio-occupational impairment common across disorders.
完整的认知控制或执行功能在行为和功能性神经回路中都有其特征模式。功能性神经影像学研究表明,额叶 - 扣带回 - 顶叶 - 脑岛(即“多重需求”)网络构成了一个共同的功能性基础,支撑着对各种认知加工需求的成功适应。关于完整神经认知表现的单独研究表明,一个高阶因素在很大程度上解释了跨领域的表现,并且可能反映特质认知控制能力。在当前的综述中,我们强调了来自各种精神疾病(即精神病性、双相和单相抑郁、焦虑和物质使用障碍)的研究结果,这些结果表明,精神病理学中的认知控制扰动在这些适应性认知功能的常见脑和行为指标中最为明显,而且在各种疾病中(即跨诊断地)都很明显。具体而言,在每一类疾病中,多重需求网络在广泛的认知任务中的损伤都是一致的。虽然不同疾病之间严重程度有所不同,但在神经认知表现中始终出现的是广泛而非特定领域的损伤。越来越多的研究结果表明,表型多样的精神疾病共享一个共同因素或功能障碍易感性,而这又与广泛的神经认知缺陷相关。此外,我们观察到,多重需求网络中与显著性网络(背侧前扣带回和双侧前脑岛)重叠的区域,其灰质在跨诊断上减少,并预示着较弱的神经认知表现。总之,症状困扰和神经认知表现缺陷的跨诊断(而非特定疾病)模式,以及同时出现的脑结构和功能异常,可能在很大程度上导致了各种疾病中常见的现实社会职业损害。