Peters Sarah K, Dunlop Katharine, Downar Jonathan
Institute of Medical Science, University of Toronto Toronto, ON, Canada.
Institute of Medical Science, University of TorontoToronto, ON, Canada; Krembil Research Institute, University Health NetworkToronto, ON, Canada; Department of Psychiatry, University of TorontoToronto, ON, Canada; MRI-Guided rTMS Clinic, University Health NetworkToronto, ON, Canada.
Front Syst Neurosci. 2016 Dec 27;10:104. doi: 10.3389/fnsys.2016.00104. eCollection 2016.
The salience network (SN) plays a central role in cognitive control by integrating sensory input to guide attention, attend to motivationally salient stimuli and recruit appropriate functional brain-behavior networks to modulate behavior. Mounting evidence suggests that disturbances in SN function underlie abnormalities in cognitive control and may be a common etiology underlying many psychiatric disorders. Such functional and anatomical abnormalities have been recently apparent in studies and meta-analyses of psychiatric illness using functional magnetic resonance imaging (fMRI) and voxel-based morphometry (VBM). Of particular importance, abnormal structure and function in major cortical nodes of the SN, the dorsal anterior cingulate cortex (dACC) and anterior insula (AI), have been observed as a common neurobiological substrate across a broad spectrum of psychiatric disorders. In addition to cortical nodes of the SN, the network's associated subcortical structures, including the dorsal striatum, mediodorsal thalamus and dopaminergic brainstem nuclei, comprise a discrete regulatory loop circuit. The SN's cortico-striato-thalamo-cortical loop increasingly appears to be central to mechanisms of cognitive control, as well as to a broad spectrum of psychiatric illnesses and their available treatments. Functional imbalances within the SN loop appear to impair cognitive control, and specifically may impair self-regulation of cognition, behavior and emotion, thereby leading to symptoms of psychiatric illness. Furthermore, treating such psychiatric illnesses using invasive or non-invasive brain stimulation techniques appears to modulate SN cortical-subcortical loop integrity, and these effects may be central to the therapeutic mechanisms of brain stimulation treatments in many psychiatric illnesses. Here, we review clinical and experimental evidence for abnormalities in SN cortico-striatal-thalamic loop circuits in major depression, substance use disorders (SUD), anxiety disorders, schizophrenia and eating disorders (ED). We also review emergent therapeutic evidence that novel invasive and non-invasive brain stimulation treatments may exert therapeutic effects by normalizing abnormalities in the SN loop, thereby restoring the capacity for cognitive control. Finally, we consider a series of promising directions for future investigations on the role of SN cortico-striatal-thalamic loop circuits in the pathophysiology and treatment of psychiatric disorders.
突显网络（SN）通过整合感觉输入来引导注意力、关注动机性突显刺激并募集适当的功能性脑-行为网络以调节行为，从而在认知控制中发挥核心作用。越来越多的证据表明，SN功能紊乱是认知控制异常的基础，可能是许多精神疾病的常见病因。最近，在使用功能磁共振成像（fMRI）和基于体素的形态测量学（VBM）对精神疾病进行的研究和荟萃分析中，这种功能和解剖学异常已很明显。特别重要的是，在广泛的精神疾病中，已观察到SN的主要皮质节点，即背侧前扣带回皮质（dACC）和前岛叶（AI）的结构和功能异常，这是一种常见的神经生物学基础。除了SN的皮质节点外，该网络相关的皮质下结构，包括背侧纹状体、内侧背侧丘脑和多巴胺能脑干核，构成了一个离散的调节环路。SN的皮质-纹状体-丘脑-皮质环路似乎越来越成为认知控制机制以及广泛的精神疾病及其现有治疗方法的核心。SN环路内的功能失衡似乎会损害认知控制，特别是可能会损害认知、行为和情绪的自我调节，从而导致精神疾病症状。此外，使用侵入性或非侵入性脑刺激技术治疗此类精神疾病似乎可以调节SN皮质-皮质下环路的完整性，这些效应可能是许多精神疾病脑刺激治疗机制的核心。在这里，我们综述了重度抑郁症、物质使用障碍（SUD）、焦虑症、精神分裂症和饮食失调（ED）中SN皮质-纹状体-丘脑环路异常的临床和实验证据。我们还综述了新出现的治疗证据，即新型侵入性和非侵入性脑刺激治疗可能通过使SN环路异常正常化来发挥治疗作用，从而恢复认知控制能力。最后，我们考虑了一系列关于SN皮质-纹状体-丘脑环路在精神疾病病理生理学和治疗中的作用的未来研究的有前景的方向。
