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This chapter focuses on impairments in inhibitory control and executive function in addiction. It reviews the role of prefrontal cortical circuits in regulating impulses, evaluating consequences, and guiding goal-directed behavior. Behavioral tasks and neuroimaging studies illustrate how weakened top-down control contributes to compulsive use and relapse. Importantly, the chapter also highlights evidence for neural plasticity and the recovery of control functions with sustained abstinence and intervention.
This chapter defines craving as a neurobiologically driven motivational state that persists beyond acute drug effects. It examines cue-, stress-, and drug-induced craving and the brain circuits that support these processes. Neuroimaging and behavioral evidence demonstrate how learned associations and emotional memory contribute to relapse vulnerability, even after prolonged abstinence. The chapter discusses methods for measuring craving and its relevance for predicting treatment outcomes.
Prenatal maternal stress is a known risk factor for later emotional problems, yet not all exposed offspring develop psychopathology. Executive functioning and prefrontal cortex structure and activity may buffer these effects, but it remains unclear whether genetic predispositions in these domains moderate associations with adolescent internalizing symptoms.
Methods
We examined 3,111 adolescents (1,881 females, 1,230 males). Prenatal stress was measured via a cumulative index across four domains. Internalizing symptoms were self-reported at ages 14 and 16. Genetic predisposition for executive functioning was indexed using a polygenic score (PGS) derived from adult samples, applied here to estimate genetic predisposition for executive functioning in adolescence. We also estimated a prefrontal cortex PGS based on cortical thickness and activation in six prefrontal regions, with a composite index derived from the first principal axis summarizing these measures.
Results
Higher prenatal stress was significantly associated with more internalizing symptoms in adolescence. Female sex and maternal genetic risk for internalizing symptoms were also associated with higher symptom levels. Neither genetic disposition for executive functioning nor prefrontal cortex moderated this association overall. However, a weak interaction emerged at age 16, indicating that a genetic disposition for higher executive functioning was associated with greater internalizing symptoms under high stress exposure.
Conclusions
Prenatal maternal stress predicted increased adolescent internalizing symptoms, with limited evidence for moderation by genetic predisposition for executive functioning. Higher genetic potential for executive functioning may confer increased sensitivity to early stress under certain developmental conditions.
Gaming disorder (GD) is increasingly recognized for its adverse impact on social functioning, yet the underlying neural mechanisms remain unclear, particularly during real-time social interactions. This study examined neural differences in the prefrontal cortex (PFC) and temporoparietal junction (TPJ) during cooperation and competition tasks in adolescents and young adults with GD.
Methods
Using functional near-infrared spectroscopy (fNIRS), we examined 175 male participants, classified into Gaming Disorder (n = 42), Hazardous Gaming (n = 69), and Healthy Control (n = 64) groups. Participants performed cooperation and competition tasks while activation, functional connectivity, and network topology were assessed within the PFC and TPJ.
Results
In the current study, GD participants exhibited significantly greater impairments in social and emotional functioning compared to the HG and HC groups. The GD group showed increased right TPJ activation during cooperation and decreased activation during competition. Both GD and HG groups demonstrated heightened medial PFC activation and functional connectivity, indicating compensatory engagement. Graph theory analysis revealed disrupted network topology in GD, including reduced nodal efficiency and centrality within the PFC and TPJ. Neural alterations were significantly correlated with clinical measures, including gaming duration and social-emotional deficits.
Conclusion
This study identifies critical neural disruptions underlying social dysfunction in GD, particularly within mentalizing and executive control networks. The neural markers observed in the GD group have important implications for clinical diagnosis and targeted intervention, whereas similar patterns in the HG group highlight opportunities for early detection and preventive strategies.
The possible neural and neurochemical bases of the hubris syndrome are reviewed by considering relevant evidence from behavioural and cognitive neuroscience in relation to biological psychiatry. This multidisciplinary evidence includes studies of brain-damaged patients and functional neuroimaging and identifies the prefrontal cortex as a crucial region of a brain network undertaking decision-making. The prefrontal cortex is also identified as important for the subjective and behavioural expression of relevant personality traits such as narcissism and impulsivity. Factors that adversely affect so-called executive functions of the prefrontal cortex, such as stress, drug abuse and illness, are also taken into account to highlight possible neurochemical and endocrine influences. A novel hypothesis is presented which postulates a key role for the chronic stress of leadership status depleting monoamine neurotransmitters such as serotonin, dopamine and noradrenaline, which interact with pre-existing temperamental traits, to produce dysfunctional modulation of decision-making circuits controlled by the ventromedial prefrontal cortex
Long assumed to have no real function, we now understand the importance of the prefrontal cortex for a wide range of cognitive functions, including decision-making. Some of the earliest understanding of the role of the prefrontal cortex came from the famous case study of Phineas Gage. Through a mining accident, Gage’s prefrontal cortex was extensively damaged. He showed no observable impairments in motor, sensory or memory skills. He however did show marked differences in personality and planning. Over the following decades, research built upon understanding of the role of the prefrontal cortex. Today, the prefrontal cortex as a region is recognised across many species and is considered the most evolutionarily advanced in humans. The current consensus is that prefrontal cortex is an integration area, integrating information from all over the brain.
Moral feelings (e.g., guilt, pity) and values (e.g., honesty, generosity) motivate humans to act on other people’s needs. Research over the last two decades has suggested that these complex constructs can be decomposed into specific cognitive-affective and neuroanatomical components. This chapter gives operational definitions of what distinguishes moral from other forms of social and emotional functions. The cognitive components that distinguish different moral feelings (e.g., guilt being related to self-agency and indignation to another person being the agent) are elucidated. An overview of evidence from brain lesion and functional imaging studies on moral judgement and feeling in general is presented, with a focus more specifically on recent evidence that links particular brain networks to specific moral feelings (in particular, guilt and sympathy). The implications of this evidence for understanding psychopathology are addressed. The chapter also discusses the implications of opposing models of frontal cortical function for the understanding of moral cognition. Suggestions for future avenues of research in this area are provided. The cognitive neuroscience of moral emotions and motivations may provide novel and powerful ways to gauge complex aspects of adaptive and maladaptive human social behaviour.
Fully updated for the second edition, this text remains a comprehensive and current treatment of the cognitive neuroscience of memory. Featuring a new chapter on group differences in long-term memory, areas covered also include cognitive neuroscience methods, human brain mechanisms underlying long-term memory success, long-term memory failure, implicit memory, working memory, memory and disease, memory in animals, and recent developments in the field. Both spatial and temporal aspects of brain processing during different types of memory are emphasized. Each chapter includes numerous pedagogical tools, including learning objectives, background information, further reading, review questions, and figures. Slotnick also explores current debates in the field and critiques of popular views, portraying the scientific process as a constantly changing, iterative, and collaborative endeavor.
Although the neural basis of TOT states is not yet fully understood, we do know that (1) TOTs may involve competition among candidate word representations and the involvement of the anterior cingulate cortex in conflict detection; (2) TOTs may involve recruitment of the prefrontal cortex, possibly to exert top-down control over memory-retrieval efforts such as by priming situationally relevant memory representations or otherwise initiating goal-oriented behavior that is aimed at resolving the TOT state; (3) left hemisphere temporal regions known to be involved in language are likely involved, both in the stalling of retrieval mechanisms that is taking place to prevent successful retrieval of the target word, and also possibly in where the presumed competition among candidate word representations is taking place; and (4) future research is clearly needed in order to determine the extent to which people undergoing left hemisphere sourced anomia experience increases in subjective sensations of TOT states compared to other populations and how separable these TOT states may be from access to partial target attributes.
Offspring of parents with bipolar disorder (BD offspring) face elevated risks for emotional dysregulation and cognitive deficits, particularly in working memory. This study investigates working memory deficits and their neural correlates in BD offspring.
Methods
We assessed 41 BD offspring and 25 age-matched healthy controls (HCs) using a spatial N-back task and task-related functional magnetic resonance imaging (fMRI).
Results
Compared to HCs, BD offspring exhibit reduced accuracy and lower signal-detection sensitivity (d′) on the 1-back task. fMRI reveals hyperactivation in the right intracalcarine cortex/lingual gyrus (ICC/LG) in BD offspring, particularly during the 1-back condition. Psychophysiological interaction (PPI) analyses show reduced connectivity between the right ICC/LG and the left postcentral gyrus in BD offspring as task load increases from 0-back to 1-back. This connectivity positively correlates with 1-back task performance in HCs but not in BD offspring. Additionally, using bilateral dorsolateral prefrontal cortex (DLPFC) as regions of interest, PPI analyses show diminished condition-dependent connectivity between the left DLPFC and the left superior frontal gyrus/paracingulate cortex, and between the right DLPFC and the left postcentral gyrus/precentral gyrus in BD offspring as the task load increases.
Conclusions
These findings suggest that BD offspring exhibit working memory deficits and impaired neural connectivity involving both sensory processing and higher-order cognitive systems. Such deficits may emerge at a genetically predisposed stage of bipolar disorder, underscoring the significance of early identification and intervention strategies.
Section 9.1 reviews the brain regions that have been associated with attention, which include sensory processing regions in addition to lateral prefrontal cortex and parietal cortex control regions. These regions are similar to the regions that have been associated with working memory and long-term memory. In Section 9.2, the brain regions associated with imagery are reviewed, which also include sensory processing regions, the lateral prefrontal cortex, and the parietal cortex, similarly to working memory. Section 9.3 details the regions of the brain associated with language processing, which include the left inferior lateral prefrontal cortex and the left posterior lateral temporal cortex; these regions are of relevance to multiple types of memory. Section 9.4 considers brain regions associated with emotion and their role in memory. Section 9.5 touches on a relatively new line of research that considers the role of memory in decision-making.
Alzheimer’s dementia (AD) is a progressive, neurodegenerative disease often accompanied by neuropsychiatric symptoms that profoundly impact both patients and caregivers. Agitation is among the most prevalent and distressing of these symptoms and often requires treatment. Appropriate therapeutic interventions depend on understanding the biological basis of agitation and how it may be affected by treatment. This narrative review discusses a proposed pathophysiology of agitation in Alzheimer’s dementia based on convergent evidence across research approaches. Available data indicate that agitation in Alzheimer’s dementia is associated with an imbalance of activity between key prefrontal and subcortical brain regions. The monoamine neurotransmitter systems serve as key modulators of activity within these brain regions and circuits and are rendered abnormal in AD. Patients with AD who exhibited agitation symptoms during life have alterations in neurotransmitter nuclei and related systems when the brain is examined at autopsy. The authors present a model of agitation in Alzheimer’s dementia in which noradrenergic hyperactivity along with serotonergic deficits and dysregulated striatal dopamine release contribute to agitated and aggressive behaviors.
Much research has focused on executive function (EF) impairments in psychopathy, a severe personality disorder characterized by a lack of empathy, antisocial behavior, and a disregard for social norms and moral values. However, it is still unclear to what extent EF deficits are present across psychopathy factors and, more importantly, which EF domains are impaired. The current meta-analysis answers these questions by synthesizing the results of 50 studies involving 5,694 participants from 12 different countries. Using multilevel random-effects models, we pooled effect sizes (Cohen's d) for five different EF domains: overall EF, inhibition, planning, shifting, and working memory. Moreover, differences between psychopathy factors were evaluated. Our analyses revealed small deficits in overall EF, inhibition, and planning performance. However, a closer inspection of psychopathy factors indicated that EF deficits were specific to lifestyle/antisocial traits, such as disinhibition. Conversely, interpersonal/affective traits, such as boldness, showed no deficits and in some cases even improved EF performance. These findings suggest that EF deficits are not a key feature of psychopathy per se, but rather are related to antisociality and disinhibitory traits. Potential brain correlates of these findings as well as implications for future research and treatment are discussed.
Neuroimaging studies suggest alterations in prefrontal cortex (PFC) activity in healthy adults under stress. Adolescents with non-suicidal self-injury (NSSI) report difficulties in stress and emotion regulation, which may be dependent on their level of borderline personality disorder (BPD).
Aims
The aim was to examine alterations in the PFC in adolescents with NSSI during stress.
Method
Adolescents (13–17 years) engaging in non-suicidal self-injury (n = 30) and matched healthy controls (n = 29) performed a task with low cognitive demand and the Trier Social Stress Test (TSST). Mean PFC oxygenation across the PFC was measured with an eight-channel near-infrared spectroscopy system. Alongside self-reports on affect, dissociation and stress, BPD pathology was assessed via clinical interviews.
Results
Mixed linear-effect models revealed a significant effect of time on PFC oxygenation and a significant time×group interaction, indicating increased PFC activity in patients engaging in NSSI at the beginning of the TSST compared with healthy controls. Greater BPD symptoms overall were associated with an increase in PFC oxygenation during stress. In exploratory analyses, mixed models addressing changes in PFC connectivity over time as a function of BPD symptoms were significant only for the left PFC.
Conclusions
Results indicate differences in the neural stress response in adolescents with NSSI in line with classic neuroimaging findings in adults with BPD. The link between PFC oxygenation and measures of BPD symptoms emphasises the need to further investigate adolescent risk-taking and self-harm across the spectrum of BPD, and maybe overall personality pathology, and could aid in the development of tailored therapeutic interventions.
Major depressive disorder (MDD) is characterized by deficient reward functions in the brain. However, existing findings on functional alterations during reward anticipation, reward processing, and learning among MDD patients are inconsistent, and it was unclear whether a common reward system implicated in multiple reward functions is altered in MDD. Here we meta-analyzed 18 past studies that compared brain reward functions between adult MDD patients (N = 477, mean age = 26.50 years, female = 59.40%) and healthy controls (N = 506, mean age = 28.11 years, females = 55.58%), and particularly examined group differences across multiple reward functions. Jack-knife sensitivity and subgroup meta-analyses were conducted to test robustness of findings across patient comorbidity, task paradigm, and reward nature. Meta-regression analyses assessed the moderating effect of patient symptom severity and anhedonia scores. We found during reward anticipation, MDD patients showed lower activities in the lateral prefrontal-thalamus circuitry. During reward processing, patients displayed reduced activities in the right striatum and prefrontal cortex, but increased activities in the left temporal cortex. During reward learning, patients showed reduced activity in the lateral prefrontal–thalamic–striatal circuitry and the right parahippocampal–occipital circuitry but higher activities in bilateral cerebellum and the left visual cortex. MDD patients showed decreased activity in the right thalamus during both reward anticipation and learning, and in the right caudate during both reward processing and learning. Larger functional changes in MDD were observed among patients with more severe symptoms and higher anhedonia levels. The thalamic-striatal circuitry functional alterations could be the key neural mechanism underlying MDD patients overarching reward function deficiencies.
Divergent thinking is a critical creative cognitive process. Its neural mechanisms have been well-studied through structural and functional imaging in healthy individuals but are less explored in patients with bipolar disorder (BD). Because of the traditional link between creativity and BD, this study investigated the structural correlates of divergent thinking in patients with BD through surface-based morphometry.
Methods:
Fifty-nine patients diagnosed with BD I or BD II (35.3 ± 8.5 years) and 56 age- and sex-matched controls (33.9 ± 7.4 years) were recruited. The participants underwent structural magnetic resonance imaging and an evaluation of divergent thinking by using the Chinese version of the Abbreviated Torrance Test for Adults (ATTA). FreeSurfer 7.0 was used to generate thickness and surface area maps for each participant. Brainwise regression of the association between cortical thickness or surface area and ATTA performance was conducted using general linear models.
Results:
Divergent thinking performance did not differ significantly between the patients with BD and the healthy controls. In these patients, total ATTA score was negatively correlated with cortical thickness in the right middle frontal gyrus, right occipital, and left precuneus but positively correlated with the surface area of the right superior frontal gyrus. By contrast, total ATTA scores and cortical thickness or surface area were not significantly correlated among the controls.
Conclusion:
The findings indicate that divergent thinking involves cerebral structures for executive control, mental imagery, and visual processing in patients with BD, and the right prefrontal cortex might be the most crucial of these structures.
Borderline personality disorder (BPD) is a severe psychiatric disorder conceptualised as a disorder of emotion regulation. Emotion regulation has been linked to a frontolimbic network comprising the dorsolateral prefrontal cortex and the amygdala, which apparently synchronises its activity via oscillatory coupling in the theta frequency range.
Aims
To analyse whether there are distinct differences in theta oscillatory coupling in frontal brain regions between individuals with BPD and matched controls during emotion regulation by cognitive reappraisal.
Method
Electroencephalogram (EEG) recordings were performed in 25 women diagnosed with BPD and 25 matched controls during a cognitive reappraisal task in which participants were instructed to downregulate negative emotions evoked by aversive visual stimuli. Between- and within-group time–frequency analyses were conducted to analyse regulation-associated theta activity (3.5–8.5 Hz).
Results
Oscillatory theta activity differed between the participants with BPD and matched controls during cognitive reappraisal. Regulation-associated theta increases were lower in frontal regions in the BPD cohort compared with matched controls. Functional connectivity analysis for regulation-associated changes in the theta frequency band revealed a lower multivariate interaction measure (MIM) increase in frontal brain regions in persons with BPD compared with matched controls.
Conclusions
Our findings support the notion of alterations in a frontal theta network in BPD, which may be underlying core symptoms of the disorder such as deficits in emotion regulation. The results add to the growing body of evidence for altered oscillatory brain dynamics in psychiatric populations, which might be investigated as individualised treatment targets using non-invasive stimulation methods.
Depression and loneliness are common among people with dementia, including Alzheimer’s disease, and a recent paper in Neurology suggests that loneliness may actually increase the chance of getting dementia.
In this chapter, we delve into the intricate domains of working memory (WM) and executive functions (EFs), two pivotal cognitive processes. We elucidate WM, delineate its subcomponents, and elucidate the tasks employed to evaluate them. The chapter explores the neural foundations of WM and EFs, spotlighting the key brain regions and networks implicated in these cognitive operations. We unravel the developmental trajectory of WM throughout childhood and adolescence, emphasizing the underlying brain changes fueling this progression. A distinction is made between cool EFs, which function in emotionally neutral contexts, and hot EFs, which govern behavior in high-stakes scenarios. We underscore the influence of WM and EFs on academic achievement, especially in educational and problem-solving contexts. The chapter also provides insights into strategies for enhancing academic performance by either minimizing WM and EF demands or refining these cognitive faculties.
Catatonia is a psychomotor syndrome frequently observed in disorders with neurodevelopmental impairments, including psychiatric disorders such as schizophrenia. The orbitofrontal cortex (OFC) has been repeatedly associated with catatonia. It presents with an important interindividual morphological variability, with three distinct H-shaped sulcal patterns, types I, II, and III, based on the continuity of the medial and lateral orbital sulci. Types II and III have been identified as neurodevelopmental risk factors for schizophrenia. The sulcal pattern of the OFC has never been investigated in catatonia despite the role of the OFC in the pathophysiology and the neurodevelopmental component of catatonia.
Methods
In this context, we performed a retrospective analysis of the OFC sulcal pattern in carefully selected homogeneous and matched subgroups of schizophrenia patients with catatonia (N = 58) or without catatonia (N = 65), and healthy controls (N = 82).
Results
Logistic regression analyses revealed a group effect on OFC sulcal pattern in the left (χ2 = 18.1; p < .001) and right (χ2 = 28.3; p < .001) hemispheres. Catatonia patients were found to have more type III and less type I in both hemispheres compared to healthy controls and more type III on the left hemisphere compared to schizophrenia patients without catatonia.
Conclusion
Because the sulcal patterns are indirect markers of early brain development, our findings support a neurodevelopmental origin of catatonia and may shed light on the pathophysiology of this syndrome.