Institute for Systems Medicine, Department of Human Medicine, MSH Medical School Hamburg, Hamburg, Germany.
Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Addict Biol. 2023 Oct;28(10):e13331. doi: 10.1111/adb.13331.
Recent studies increasingly highlight involvement of the cerebellum in drug craving and addiction. However, its exact role, that is, whether the cerebellum is a critical component of a brain network underlying addictive behaviour, or whether it rather is a facilitator or mediator, is still unclear. Findings concerning the newly recognized internet gaming disorder (IGD) suggest that changes in cerebellar connectivity and functioning are associated with behavioural/non-substance addiction. Here, we systematically review the literature on IGD and cerebellar involvement following the PRISMA guidelines. A total of 13 neuroimaging studies met the inclusion criteria. Studies utilized a broad range of diagnostic instruments and resulting cut-off criteria, rendering it difficult to compare findings. Results on altered cerebro-cerebellar connectivity in patients with IGD are mixed; most studies report altered or increased functional connectivity. Moreover, decreased cerebellar grey matter volume is reported. Studies have further indicated that differential activation patterns in the cerebellum may enable discrimination between healthy subjects and subjects with IGD, even allowing for prediction of treatment outcomes. Given the strong connectivity between the cerebellum and cerebral regions, the cerebellum may act as an intermediary between regions involved in craving and addiction and consequently affect symptoms of IGD. Results suggest differential involvement of the cerebellar lobes, emphasizing a need for high-resolution parcellation of the cerebellum in future studies. However, the studies included in the present review have small sample sizes and include mostly male participants. Thus, results may have limited generalizability yet highlight a crucial role of the cerebellum in IGD that needs further investigation.
最近的研究越来越强调小脑在药物成瘾和成瘾中的作用。然而，其确切作用，即小脑是否是成瘾行为相关脑网络的关键组成部分，或者它是否是促进因素或中介因素，仍不清楚。关于新认识的网络成瘾障碍（IGD）的研究结果表明，小脑连接和功能的变化与行为/非物质成瘾有关。在这里，我们按照 PRISMA 指南系统地综述了关于 IGD 和小脑参与的文献。共有 13 项神经影像学研究符合纳入标准。研究采用了广泛的诊断工具和由此产生的截止标准，使得很难比较研究结果。IGD 患者小脑连接改变的研究结果不一致；大多数研究报告小脑功能连接改变或增加。此外，小脑灰质体积减少。研究还表明，小脑的差异激活模式可能能够区分健康受试者和 IGD 受试者，甚至可以预测治疗结果。鉴于小脑与大脑区域之间的强连接，小脑可能作为涉及成瘾的区域与成瘾之间的中介，从而影响 IGD 的症状。结果表明小脑小叶的差异参与，强调在未来的研究中需要对小脑进行高分辨率分割。然而，本综述中包含的研究样本量较小，且主要包括男性参与者。因此，结果可能具有有限的普遍性，但突出了小脑在 IGD 中的关键作用，需要进一步研究。
