Cools Roshan, Froböse Monja, Aarts Esther, Hofmans Lieke
Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands.
Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands.
Handb Clin Neurol. 2019;163:123-143. doi: 10.1016/B978-0-12-804281-6.00007-0.
The major ascending neuromodulator dopamine has long been implicated in cognitive control. Effects of dopamine-related disorders and the treatment of the cognitive control deficits associated with these disorders are commonly attributed to modulation of the prefrontal cortex. However, many disorders that are accompanied by cognitive control deficits also implicate abnormal dopamine transmission in the striatum, which has been associated more readily with value-based learning, choice, and motivation. We put forward the hypothesis that effects of dopamine on cognitive control reflect, in part, indirect modulation of value-based learning and choice computations that alter the motivation to exert control. This hypothesis is grounded in accumulating evidence from work with experimental animals as well as neurochemical PET, pharmacologic fMRI, and computational modeling work with healthy volunteers and patients with addictive disorders, ADHD, and Parkinson's disease. Consistent with an "inverted-U"-shaped relationship between dopamine and value-based learning, this evidence suggests that dopaminergic drugs might paradoxically increase our drive away from cognitive control in individuals with high baseline levels of dopamine, perhaps by "overdosing" dopamine levels, and thus reducing the value of cognitive control. The hypothesis has implications for the many dopamine-related disorders, which are often accompanied by either apathy or problems with impulse control, and their pharmacotreatment with dopaminergic drugs. For example, the cognitive deficits that are commonly associated with prefrontal cortex dysfunctioning might instead reflect modulation of striatal dopamine and its role in the willingness rather than the ability to exert control.
主要的上行神经调质多巴胺长期以来一直被认为与认知控制有关。多巴胺相关疾病的影响以及与这些疾病相关的认知控制缺陷的治疗通常归因于前额叶皮层的调节。然而,许多伴有认知控制缺陷的疾病也涉及纹状体中多巴胺传递异常,而纹状体更容易与基于价值的学习、选择和动机相关联。我们提出一个假设,即多巴胺对认知控制的影响部分反映了对基于价值的学习和选择计算的间接调节,这些计算改变了施加控制的动机。这一假设基于来自实验动物研究以及神经化学正电子发射断层扫描(PET)、药物功能磁共振成像(fMRI)以及对健康志愿者、成瘾性疾病患者、注意力缺陷多动障碍(ADHD)患者和帕金森病患者的计算建模工作所积累的证据。与多巴胺和基于价值的学习之间的“倒U形”关系一致,这一证据表明,多巴胺能药物可能会自相矛盾地增加多巴胺基线水平较高的个体远离认知控制的驱动力,可能是通过使多巴胺水平“过量”,从而降低认知控制的价值。该假设对许多与多巴胺相关的疾病具有启示意义,这些疾病通常伴有冷漠或冲动控制问题,以及它们使用多巴胺能药物的药物治疗。例如,通常与前额叶皮层功能障碍相关的认知缺陷可能反而反映了纹状体多巴胺的调节及其在施加控制的意愿而非能力方面的作用。