a Department of Psychiatry and Psychotherapy, Medical Faculty , University of Cologne , Cologne , Germany.
b Department of Psychiatry, Psychotherapy and Psychosomatic , Johanniter Hospital Oberhausen , Oberhausen , Germany.
Am J Drug Alcohol Abuse. 2019;45(1):51-66. doi: 10.1080/00952990.2018.1557675. Epub 2019 Jan 11.
Delay discounting (DD) describes the phenomenon of devaluing future rewards in favor of immediate rewards. Increased DD is a key behavioral marker of addiction, and has been suggested as a target for interventions to alleviate addiction symptoms (e.g., preference for immediate drug use over larger-and-later rewards, and relapses) in patients with substance use disorders (SUD).
Performed a meta-analysis on neuroimaging results of DD regarding specific contrasts in healthy participants. Reviewed the results of existing patient studies in light of the meta-analyses results.
We conducted activation likelihood estimation meta-analyses on DD neuroimaging studies (25 studies, n = 583; 354 males and 229 females) regarding six analytic strategies.
The meta-analyses revealed various subdivisions of the cortical-basal ganglia circuits that are associated with different aspects of DD in healthy subjects. By comparing the meta-analyses results and patients' studies regarding each contrast, we highlighted three brain regions that may underlie excessive DD in patients. Decreased left inferior frontal gyrus (IFG) activity was related to less preference for delayed choices; reduced ventral striatum (VS) activity was associated with impaired valuation processes; and declined anterior cingulate cortex (ACC)/medial prefrontal cortex (mPFC) activity was associated with alterations in processing difficult choices.
We propose that neuromodulation (e.g. deep brain simulation) or behavioral interventions (e.g. episodic future imagination) targeting these key brain regions (IFG, VS, ACC/mPFC) may be effective for improving DD function in patients with SUD, enhancing valuations of future rewards and helping to resist the temptation of immediate drug use.
延迟折扣（DD）描述了一种偏好即时奖励而轻视未来奖励的现象。DD 增加是成瘾的关键行为标志物，并且已经被提出作为减轻成瘾症状（例如，对即时药物使用的偏好超过更大和更晚的奖励，以及复发）的干预靶点，用于患有物质使用障碍（SUD）的患者。
对健康参与者的 DD 神经影像学结果进行元分析。根据元分析结果审查现有患者研究的结果。
我们对 DD 神经影像学研究（25 项研究，n = 583；354 名男性和 229 名女性）进行了激活似然估计元分析，采用了六种分析策略。
元分析显示，与健康受试者的 DD 不同方面相关的皮质基底节回路的各个细分。通过比较每个对比的元分析结果和患者研究，我们突出了三个可能导致患者过度 DD 的大脑区域。左额下回（IFG）活动减少与对延迟选择的偏好减少有关；腹侧纹状体（VS）活动减少与估值过程受损有关；前扣带皮层（ACC）/内侧前额叶皮层（mPFC）活动减少与处理困难选择有关。
我们提出，针对这些关键大脑区域（IFG、VS、ACC/mPFC）的神经调节（例如，深部脑刺激）或行为干预（例如，情节性未来想象）可能对改善 SUD 患者的 DD 功能有效，增强对未来奖励的评估，并有助于抵抗即时药物使用的诱惑。
