Transdiagnostic impairment of cognitive control in mental illness

Abstract

Intact cognitive control or executive function has characteristic patterns in both behavior and functional neurocircuitry. Functional neuroimaging studies have shown that a frontal-cingulate-parietal-insular (i.e., "multiple demand") network forms a common functional substrate undergirding successful adaptation to diverse cognitive processing demands. Separate work on intact neurocognitive performance implicates a higher order factor that largely explains performance across domains and may reflect trait cognitive control capacity. In the current review we highlight findings from respective psychiatric disorders (i.e., psychotic, bipolar and unipolar depressive, anxiety, and substance use disorders) suggesting that cognitive control perturbations amidst psychopathology are most pronounced within these common brain and behavioral indices of adaptive cognitive functioning and moreover, are evident across disorders (i.e., transdiagnostically). Specifically, within each of the disorder classes impairments are consistent in the multiple demand network across a wide range of cognitive tasks. While severity varies between disorders, broad as opposed to domain-specific impairments consistently emerge in neurocognitive performance. Accumulating findings have revealed that phenotypically diverse psychiatric disorders share a common factor or vulnerability to dysfunction that is in turn related to broad neurocognitive deficits. Furthermore, we have observed that regions of the multiple demand network, which overlap with the salience network (dorsal anterior cingulate and bilateral anterior insula) are characterized by reduced gray matter transdiagnostically and predict weaker neurocognitive performance. In summary, transdiagnostic (as opposed to disorder-specific) patterns of symptomatic distress and neurocognitive performance deficits, concurrent with parallel anomalies of brain structure and function may largely contribute to the real-world socio-occupational impairment common across disorders.

Keywords: Cognitive control; Multiple demand network; Neurocognition; RDoC; Transdiagnostic; fMRI.

Figure 1

Shared patterns of decreased gray matter from the voxel-based morphometry (VBM) meta-analysis. Patient versus healthy participant comparisons (a) for studies pooled across all diagnoses, (b) separately by psychotic or non-psychotic diagnosis studies, and (c) from a conjunction across the psychotic and non-psychotic diagnostic groups. Common gray matter loss is evident across diagnoses in the anterior insula and dorsal anterior cingulate (dACC). Adapted from Goodkind et al. (2015).

Figure 2

Extracted per voxel probabilities of decreased gray matter in the VBM meta-analysis, separated by diagnosis and common gray matter loss region (left and right anterior insula, dACC). Values represent the probability of identifying a gray matter abnormality for an average voxel within the region of interest, derived from the modeled activation maps. SCZ=schizophrenia, BPD=bipolar disorder, MDD=major depressive disorder/dysthymia, SUD=substance use disorder, OCD=obsessive-compulsive disorder, ANX=anxiety disorders. Adapted from Goodkind et al. (2015).

Figure 3

Among 163 healthy participants from the BRAINnet Foundation Database database who had completed a computerized neurocognitive assessment battery covering a broad range of basic and higher-level cognitive functions, lower gray matter across the three common gray matter loss regions (left and right anterior insula, dACC) predicted worse performance in terms of general executive function, with a similar trend for sustained attention, but no effect on general cognitive and performance speed.

Figure 4

The multiple demand network as empirically derived by Müller & colleagues (2015) from conjunction of results across three large-scale meta-analyses of diverse cognitive tasks in healthy participants (retrieved through ANIMA (http://anima.fz-juelich.de)). aMCC/pre-SMA=anterior mid-cingulate cortex/ pre-supplementary motor area; IPC/IPS=intraparietal cortex/sulcus; MFG=middle frontal gyrus; IFJ/IFG=inferior frontal junction gyrus; vlPFC=ventrolateral prefrontal cortex.