PIDFIF, Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT)/Instituto de Ciências Nucleares Aplicadas à Saúde (ICNAS), University of Coimbra, Coimbra, Portugal.
CIBIT/ICNAS, University of Coimbra, Coimbra, Portugal.
Diabetes Metab J. 2022 Nov;46(6):866-878. doi: 10.4093/dmj.2021.0307. Epub 2022 Mar 22.
Risky health decisions and impulse control profiles may impact on metabolic control in type 1 diabetes mellitus (T1DM). We hypothesize that the neural correlates of cognitive impulsivity and decision-making in T1DM relate to metabolic control trajectories.
We combined functional magnetic resonance imaging (fMRI), measures of metabolic trajectories (glycosylated hemoglobin [HbA1c] over multiple time points) and behavioral assessment using a cognitive impulsivity paradigm, the Balloon Analogue Risk Task (BART), in 50 participants (25 T1DM and 25 controls).
Behavioral results showed that T1DM participants followed a rigid conservative risk strategy along the iterative game. Imaging group comparisons showed that patients showed larger activation of reward related, limbic regions (nucleus accumbens, amygdala) and insula (interoceptive saliency network) in initial game stages. Upon game completion differences emerged in relation to error monitoring (anterior cingulate cortex [ACC]) and inhibitory control (inferior frontal gyrus). Importantly, activity in the saliency network (ACC and insula), which monitors interoceptive states, was related with metabolic trajectories, which was also found for limbic/reward networks. Parietal and posterior cingulate regions activated both in controls and patients with adaptive decision-making, and positively associated with metabolic trajectories.
We found triple converging evidence when comparing metabolic trajectories, patients versus controls or risk averse (non-learners) versus patients who learned by trial and error. Dopaminergic reward and saliency (interoceptive and error monitoring) circuits show a tight link with impaired metabolic trajectories and cognitive impulsivity in T1DM. Activity in parietal and posterior cingulate are associated with adaptive trajectories. This link between reward-saliency-inhibition circuits suggests novel strategies for patient management.
冒险的健康决策和冲动控制特征可能会影响 1 型糖尿病（T1DM）的代谢控制。我们假设 T1DM 患者的认知冲动性和决策的神经相关性与代谢控制轨迹有关。
我们结合了功能磁共振成像（fMRI）、代谢轨迹（多个时间点的糖化血红蛋白[HbA1c]）和使用认知冲动性范式（气球模拟风险任务[BART]）的行为评估，共纳入 50 名参与者（25 名 T1DM 和 25 名对照组）。
行为结果表明，T1DM 参与者在迭代游戏中遵循严格保守的风险策略。成像组比较显示，患者在初始游戏阶段表现出更大的与奖励相关的、边缘区域（伏隔核、杏仁核）和脑岛（内脏突显网络）的激活。在游戏结束时，与错误监测（前扣带皮层[ACC]）和抑制控制（额下回）有关的差异出现。重要的是，突显网络（ACC 和脑岛）的活动与代谢轨迹有关，这也与边缘/奖励网络有关。顶叶和后扣带皮层在控制组和适应性决策的患者中均被激活，与代谢轨迹呈正相关。
当比较代谢轨迹、患者与对照组或风险厌恶（非学习者）与通过试错学习的患者时，我们发现了三重证据。多巴胺能奖励和突显（内脏和错误监测）回路与 T1DM 中受损的代谢轨迹和认知冲动性密切相关。顶叶和后扣带皮层的活动与适应性轨迹有关。奖励-突显-抑制回路之间的这种联系为患者管理提供了新的策略。
