Scuola Universitaria Superiore IUSS, 27100, Pavia, Italy.
IRCCS Istituti Clinici Scientifici Maugeri, 27100, Pavia, Italy.
Neurol Sci. 2018 Mar;39(3):423-435. doi: 10.1007/s10072-017-3205-1. Epub 2017 Nov 29.
Neuroeconomics is providing insights into the neural bases of decision-making in normal and pathological conditions. In the neuropsychiatric domain, this discipline investigates how abnormal functioning of neural systems associated with reward processing and cognitive control promotes different disorders, and whether such evidence may inform treatments. This endeavor is crucial when studying different types of addiction, which share a core promoting mechanism in the imbalance between impulsive subcortical neural signals associated with immediate pleasurable outcomes and inhibitory signals mediated by a prefrontal reflective system. The resulting impairment in behavioral control represents a hallmark of alcohol use disorders (AUDs), a chronic relapsing disorder characterized by excessive alcohol consumption despite devastating consequences. This review aims to summarize available magnetic resonance imaging (MRI) evidence on reward-related decision-making alterations in AUDs, and to envision possible future research directions. We review functional MRI (fMRI) studies using tasks involving monetary rewards, as well as MRI studies relating decision-making parameters to neurostructural gray- or white-matter metrics. The available data suggest that excessive alcohol exposure affects neural signaling within brain networks underlying adaptive behavioral learning via the implementation of prediction errors. Namely, weaker ventromedial prefrontal cortex activity and altered connectivity between ventral striatum and dorsolateral prefrontal cortex likely underpin a shift from goal-directed to habitual actions which, in turn, might underpin compulsive alcohol consumption and relapsing episodes despite adverse consequences. Overall, these data highlight abnormal fronto-striatal connectivity as a candidate neurobiological marker of impaired choice in AUDs. Further studies are needed, however, to unveil its implications in the multiple facets of decision-making.
神经经济学为正常和病理条件下的决策神经基础提供了深入的见解。在神经精神领域，该学科研究与奖励处理和认知控制相关的神经系统的异常功能如何促进不同的障碍，以及这种证据是否可以为治疗提供信息。当研究不同类型的成瘾时，这项努力至关重要，因为这些成瘾的核心促进机制是与即时愉悦结果相关的冲动性皮质下神经信号与由前额叶反射系统介导的抑制信号之间的不平衡。由此导致的行为控制受损是酒精使用障碍（AUDs）的标志，AUDs 是一种慢性复发性疾病，其特征是尽管后果严重，但仍过度饮酒。本综述旨在总结 AUDs 中与奖励相关的决策改变的现有磁共振成像（MRI）证据，并设想可能的未来研究方向。我们综述了使用涉及金钱奖励的任务的功能磁共振成像（fMRI）研究，以及将决策参数与神经结构灰质或白质指标相关联的 MRI 研究。现有数据表明，过度的酒精暴露通过实施预测误差来影响适应性行为学习的大脑网络内的神经信号。具体来说，腹内侧前额叶皮层活动减弱和腹侧纹状体与背外侧前额叶皮层之间的连接改变可能是从目标导向行为向习惯行为转变的基础，而这反过来又可能是强迫性饮酒和复发的原因，尽管有不良后果。总体而言，这些数据突出了异常的额纹状体连接作为 AUDs 中选择受损的候选神经生物学标志物。然而，需要进一步的研究来揭示其在决策的多个方面的影响。
