Incentive processing in Congenital Adrenal Hyperplasia (CAH): a reward-based antisaccade study

Abstract

Little is known about how steroid hormones contribute to the beneficial effect of incentives on cognitive control during adolescent development. In this study, 27 adolescents with Congenital Adrenal Hyperplasia (CAH, mean age 15.6 years, 12 female), a disorder of cortisol deficiency and androgen excess, and 36 healthy participants (mean age 16.3 years, 18 female) completed a reward-based antisaccade task. In this mixed-saccade task, participants performed eye movements towards (prosaccades) or away (antisaccades) from a peripherally occuring stimulus. On incentive trials, monetary reward was provided for correct performance, while no such reward was provided on no-incentive trials. Consistent with the hypothesis, the results showed that healthy, but not CAH adolescents, significantly improved their inhibitory control (antisaccade accuracy) during incentive trials relative to no-incentive trials. These findings were not driven by severity of CAH (salt wasters vs. simple virilizers), individual hormone levels, sex, age-at-diagnosis, or medication type (dexamethasone vs. hydrocortisone). In addition, no significant differences between groups were found on orienting responses (prosaccades). Additional analyses revealed an impact of glucocorticoid (GC) dosage, such that higher GC dose predicted better antisaccade performance. However, this effect did not impact incentive processing. The data are discussed within the context of steroid hormone mediated effects on cognitive control and reward processing.

Figure 1

Stimuli were presented on a black background (for clarity of presentation, colour schemes are reversed in the figure). Each trial started with the cue, which was presented for 1250 – 1750 ms and which indicated the type of incentive and the type of saccade, both of which were randomized. Once the cue disappeared, the white target asterisk was displayed for 1850 ms on either the left hand or right hand side approximately 6.15 deg to the centrally presented cue. Then, the feedback display (subtending ~1.8 deg in visual angle) was presented for 1000 ms on the side where the correct eye movement should have occurred. This sample trial shows a rewarded antisaccade, where the cue (“+”) indicated the reward and an antisaccade was correctly executed to the left.