Department of Psychiatry and Behavioral Health, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York.
Department of Psychiatry and Behavioral Health, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York.
Biol Psychiatry Cogn Neurosci Neuroimaging. 2024 Nov;9(11):1211-1221. doi: 10.1016/j.bpsc.2024.07.014. Epub 2024 Jul 25.
Individuals with substance use disorder show impaired self-awareness of ongoing behavior. This deficit suggests problems with metacognition, which has been operationalized in the cognitive neuroscience literature as the ability to monitor and evaluate the success of one's own cognition and behavior. However, the neural mechanisms of metacognition have not been characterized in a population with drug addiction.
Community samples of participants with opioid use disorder (OUD) (n = 27) and healthy control participants (n = 29) performed a previously validated functional magnetic resonance imaging metacognition task (perceptual decision-making task along with confidence ratings of performance). Measures of recent drug use and addiction severity were also acquired.
Individuals with OUD had lower metacognitive sensitivity (i.e., disconnection between task performance and task-related confidence) than control individuals. Trial-by-trial analyses showed that this overall group difference was driven by (suboptimally) low confidence in participants with OUD during correct trials. In functional magnetic resonance imaging analyses, the task engaged an expected network of brain regions (e.g., rostrolateral prefrontal cortex and dorsal anterior cingulate/supplementary motor area, both previously linked to metacognition); group differences emerged in a large ventral anterior cluster that included the medial and lateral orbitofrontal cortex and striatum (higher activation in OUD). Trial-by-trial functional magnetic resonance imaging analyses showed group differences in rostrolateral prefrontal cortex activation, which further correlated with metacognitive behavior across all participants. Exploratory analyses suggested that the behavioral and neural group differences were exacerbated by recent illicit opioid use and unexplained by general cognition.
With confirmation and extension of these findings, metacognition and its associated neural circuits could become new, promising therapeutic targets in addiction.
物质使用障碍个体表现出对正在进行的行为的自我意识受损。这种缺陷表明存在元认知问题，元认知在认知神经科学文献中被定义为监测和评估自身认知和行为成功的能力。然而，在吸毒人群中，元认知的神经机制尚未得到描述。
社区样本中的阿片类药物使用障碍（OUD）患者（n=27）和健康对照参与者（n=29）完成了以前验证过的功能磁共振成像元认知任务（感知决策任务以及对表现的信心评分）。还获得了最近药物使用和成瘾严重程度的测量。
OUD 个体的元认知敏感性（即任务表现与任务相关信心之间的脱节）低于对照个体。逐案分析表明，这种总体组间差异是由 OUD 参与者在正确试验中（不恰当地）低信心驱动的。在功能磁共振成像分析中，任务涉及到一个预期的大脑区域网络（例如，额外侧前额叶皮层和背侧前扣带/辅助运动区，两者以前都与元认知有关）；在一个包括内侧和外侧眶额皮层和纹状体的大腹侧前簇中出现了组间差异（OUD 中激活度更高）。逐案功能磁共振成像分析显示，在额外侧前额叶皮层的激活中存在组间差异，这进一步与所有参与者的元认知行为相关。探索性分析表明，最近非法阿片类药物使用加剧了行为和神经组间差异，并且无法用一般认知来解释。
随着这些发现的确认和扩展，元认知及其相关的神经回路可能成为成瘾治疗的新的、有前途的靶点。
