Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Excellence Cluster NeuroCure; 10117 Berlin, Germany / Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Berlin Center for Advanced Neuroimaging, Department of Neurology; 10117 Berlin, Germany / Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Bernstein Center for Computational Neuroscience; 10117 Berlin, Germany.
Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Excellence Cluster NeuroCure; 10117 Berlin, Germany.
Mult Scler. 2018 Aug;24(9):1163-1173. doi: 10.1177/1352458517717089. Epub 2017 Jun 28.
Decision-making (DM) abilities deteriorate with multiple sclerosis (MS) disease progression which impairs everyday life and is thus clinically important.
To investigate the underlying neurocognitive processes and their relation to regional gray matter (GM) loss induced by MS.
We used a functional magnetic resonance imaging (fMRI) Iowa Gambling Task to measure DM-related brain activity in 36 MS patients and 21 healthy controls (HC). From this activity, we determined neural parameters of two cognitive stages, a deliberation ("choice") period preceding a choice and a post-choice ("feedback") stage reporting decision outcomes. These measures were related to DM separately in intact and damaged GM areas as determined by a voxel-based morphometry analysis.
Severely affected patients (with high lesion burden) showed worse DM-learning than HC ( t = -1.75, p = 0.045), moderately affected (low lesion burden) did not. Activity in the choice stage in intact insular ( t = 4.60, p = 0.034), anterior cingulate ( t = 4.50, p = 0.044), and dorsolateral prefrontal areas ( t = 4.43, p = 0.049) and in insular areas with GM loss ( t = 3.78, p = 0.011) was positively linked to DM performance across patients with severe tissue damage and HC. Furthermore, activity in intact orbitofrontal areas was positively linked to DM-learning during the feedback stage across these participants ( t = 4.49, p = 0.032). During none of the stages, moderately affected patients showed higher activity than HC, which might have indicated preserved DM due to compensatory activity.
We identified dysregulated activity linked to impairment in specific cognitive stages of reward-related DM. The link of brain activity and impaired DM in areas with MS-induced GM loss suggests that this deficit might be tightly coupled to MS neuropathology.
多发性硬化症（MS）疾病的进展会导致决策能力下降，从而影响日常生活，这在临床上很重要。
探讨与 MS 引起的区域性灰质（GM）损失相关的潜在神经认知过程及其关系。
我们使用功能磁共振成像（fMRI）爱荷华赌博任务来测量 36 名 MS 患者和 21 名健康对照者（HC）的与决策相关的大脑活动。从这些活动中，我们确定了两个认知阶段的神经参数，即选择前的深思（“选择”）期和报告决策结果的选择后（“反馈”）期。这些措施分别与完整和受损 GM 区域的 DM 相关，由基于体素的形态测量分析确定。
严重受影响的患者（具有高病变负担）的 DM 学习能力比 HC 差（t=-1.75，p=0.045），中度受影响的患者（低病变负担）则没有。在完整的岛叶（t=4.60，p=0.034）、前扣带回（t=4.50，p=0.044）和背外侧前额叶区域（t=4.43，p=0.049）以及 GM 损失的岛叶区域（t=3.78，p=0.011）的选择阶段的活动与严重组织损伤的患者和 HC 之间的 DM 表现呈正相关。此外，在这些参与者中，完整的眶额区域的活动在反馈阶段与 DM 学习呈正相关（t=4.49，p=0.032）。在没有一个阶段，中度受影响的患者的活动比 HC 高，这可能表明由于代偿性活动，DM 得到了保留。
我们确定了与奖赏相关的 DM 特定认知阶段受损相关的失调活动。大脑活动与 MS 引起的 GM 损失导致的 DM 受损之间的联系表明，这种缺陷可能与 MS 神经病理学密切相关。
