Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière (DMU 6), Paris, France.
National Reference Center for Tourette syndrome, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, F-75013, Paris, France.
Transl Psychiatry. 2021 Nov 3;11(1):560. doi: 10.1038/s41398-021-01691-2.
Reward sensitivity has been suggested as one of the central pathophysiological mechanisms in Tourette disorder. However, the subjective valuation of a reward by introduction of delay has received little attention in Tourette disorder, even though it has been suggested as a trans-diagnostic feature of numerous neuropsychiatric disorders. We aimed to assess delay discounting in Tourette disorder and to identify its brain functional correlates. We evaluated delayed discounting and its brain functional correlates in a large group of 54 Tourette disorder patients and 31 healthy controls using a data-driven approach. We identified a subgroup of 29 patients with steeper reward discounting, characterised by a higher burden of impulse-control disorders and a higher level of general impulsivity compared to patients with normal behavioural performance or to controls. Reward discounting was underpinned by resting-state activity of a network comprising the orbito-frontal, cingulate, pre-supplementary motor area, temporal and insular cortices, as well as ventral striatum and hippocampus. Within this network, (i) lower connectivity of pre-supplementary motor area with ventral striatum predicted a higher impulsivity and a steeper reward discounting and (ii) a greater connectivity of pre-supplementary motor area with anterior insular cortex predicted steeper reward discounting and more severe tics. Overall, our results highlight the heterogeneity of the delayed reward processing in Tourette disorder, with steeper reward discounting being a marker of burden in impulsivity and impulse control disorders, and the pre-supplementary motor area being a hub region for the delay discounting, impulsivity and tic severity.
奖励敏感性被认为是抽动障碍的核心病理生理机制之一。然而，在抽动障碍中，通过引入延迟来对奖励进行主观评估的研究很少，尽管它被认为是许多神经精神障碍的跨诊断特征。我们旨在评估抽动障碍中的延迟折扣，并确定其大脑功能相关性。我们使用数据驱动的方法评估了 54 名抽动障碍患者和 31 名健康对照者的延迟折扣及其大脑功能相关性。我们确定了一个由 29 名患者组成的亚组，这些患者的奖励折扣更陡峭，其冲动控制障碍负担更重，一般冲动水平高于行为表现正常的患者或对照组。奖励折扣由包括眶额皮质、扣带回、辅助运动前区、颞叶和脑岛皮质以及腹侧纹状体和海马体在内的网络的静息状态活动支持。在这个网络中，（i）辅助运动前区与腹侧纹状体的连接降低预测了更高的冲动性和更陡峭的奖励折扣，（ii）辅助运动前区与前脑岛皮层的连接增加预测了更陡峭的奖励折扣和更严重的抽动。总体而言，我们的结果强调了抽动障碍中延迟奖励处理的异质性，更陡峭的奖励折扣是冲动和冲动控制障碍负担的标志物，辅助运动前区是延迟折扣、冲动和抽动严重程度的枢纽区域。
