When desire collides with reason: functional interactions between anteroventral prefrontal cortex and nucleus accumbens underlie the human ability to resist impulsive desires

Neural alterations of fronto-striatal circuitry during reward anticipation in euthymic bipolar disorder

BACKGROUND

Bipolar disorder (BD), with the hallmark symptoms of elevated and depressed mood, is thought to be characterized by underlying alterations in reward-processing networks. However, to date the neural circuitry underlying abnormal responses during reward processing in BD remains largely unexplored. The aim of this study was to investigate whether euthymic BD is characterized by aberrant ventral striatal (VS) activation patterns and altered connectivity with the prefrontal cortex in response to monetary gains and losses.

METHOD

During functional magnetic resonance imaging 20 euthymic BD patients and 20 age-, gender- and intelligence quotient-matched healthy controls completed a monetary incentive delay paradigm, to examine neural processing of reward and loss anticipation. A priori defined regions of interest (ROIs) included the VS and the anterior prefrontal cortex (aPFC). Psychophysiological interactions (PPIs) between these ROIs were estimated and tested for group differences for reward and loss anticipation separately.

RESULTS

BD participants, relative to healthy controls, displayed decreased activation selectively in the left and right VS during anticipation of reward, but not during loss anticipation. PPI analyses showed decreased functional connectivity between the left VS and aPFC in BD patients compared with healthy controls during reward anticipation.

CONCLUSIONS

This is the first study showing decreased VS activity and aberrant connectivity in the reward-processing circuitry in euthymic, medicated BD patients during reward anticipation. Our findings contrast with research supporting a reward hypersensitivity model of BD, and add to the body of literature suggesting that blunted activation of reward processing circuits may be a vulnerability factor for mood disorders.

Investigating the Impact of a Genome-Wide Supported Bipolar Risk Variant of MAD1L1 on the Human Reward System

Recent genome-wide association studies have identified MAD1L1 (mitotic arrest deficient-like 1) as a susceptibility gene for bipolar disorder and schizophrenia. The minor allele of the single-nucleotide polymorphism (SNP) rs11764590 in MAD1L1 was associated with bipolar disorder. Both diseases, bipolar disorder and schizophrenia, are linked to functional alterations in the reward system. We aimed at investigating possible effects of the MAD1L1 rs11764590 risk allele on reward systems functioning in healthy adults. A large homogenous sample of 224 young (aged 18-31 years) participants was genotyped and underwent functional magnetic resonance imaging (fMRI). All participants performed the 'Desire-Reason Dilemma' paradigm investigating the neural correlates that underlie reward processing and active reward dismissal in favor of a long-term goal. We found significant hypoactivations of the ventral tegmental area (VTA), the bilateral striatum and bilateral frontal and parietal cortices in response to conditioned reward stimuli in the risk allele carriers compared with major allele carriers. In the dilemma situation, functional connectivity between prefrontal brain regions and the ventral striatum was significantly diminished in the risk allele carriers. Healthy risk allele carriers showed a significant deficit of their bottom-up response to conditioned reward stimuli in the bilateral VTA and striatum. Furthermore, functional connectivity between the ventral striatum and prefrontal areas exerting top-down control on the mesolimbic reward system was reduced in this group. Similar alterations in reward processing and disturbances of prefrontal control mechanisms on mesolimbic brain circuits have also been reported in bipolar disorder and schizophrenia. Together, these findings suggest the existence of an intermediate phenotype associated with MAD1L1.

Role of Reward Sensitivity and Processing in Major Depressive and Bipolar Spectrum Disorders

Since Costello's (1972) seminal Behavior Therapy article on loss of reinforcers or reinforcer effectiveness in depression, the role of reward sensitivity and processing in both depression and bipolar disorder has become a central area of investigation. In this article, we review the evidence for a model of reward sensitivity in mood disorders, with unipolar depression characterized by reward hyposensitivity and bipolar disorders by reward hypersensitivity. We address whether aberrant reward sensitivity and processing are correlates of, mood-independent traits of, vulnerabilities for, and/or predictors of the course of depression and bipolar spectrum disorders, covering evidence from self-report, behavioral, neurophysiological, and neural levels of analysis. We conclude that substantial evidence documents that blunted reward sensitivity and processing are involved in unipolar depression and heightened reward sensitivity and processing are characteristic of hypomania/mania. We further conclude that aberrant reward sensitivity has a trait component, but more research is needed to clearly demonstrate that reward hyposensitivity and hypersensitivity are vulnerabilities for depression and bipolar disorder, respectively. Moreover, additional research is needed to determine whether bipolar depression is similar to unipolar depression and characterized by reward hyposensitivity, or whether like bipolar hypomania/mania, it involves reward hypersensitivity.

Better Working Memory and Motor Inhibition in Children Who Delayed Gratification

Background: Despite the extensive research on delayed gratification over the past few decades, the neurocognitive processes that subserve delayed gratification remains unclear. As an exploratory step in studying these processes, the present study aims to describe the executive function profiles of children who were successful at delaying gratification and those who were not.

Methods: A total of 138 kindergarten students (65 males, 73 females; M_age = 44 months, SD = 3.5; age range = 37–53 months) were administered a delayed gratification task, a 1-back test, a Day/night Stroop test and a Go/no-go test. The outcome measures of these tests were then analyzed between groups using a Multivariate Analysis of Variance, and subsequently a Multivariate Analysis of Covariance incorporating age as a covariate.

Results: Children who were successful in delaying gratification were significantly older and had significantly better outcomes in the 1-back test and go/no-go test. With the exception of the number of hits in the go/no-go test, all other group differences remained significant after controlling for age.

Conclusion: Children who were successful in delaying gratification showed better working memory and motor inhibition relative to those who failed the delayed gratification task. The implications of these findings are discussed.

Individual differences in self-reported self-control predict successful emotion regulation

Both self-control and emotion regulation enable individuals to adapt to external circumstances and social contexts, and both are assumed to rely on the overlapping neural resources. Here, we tested whether high self-reported self-control is related to successful emotion regulation on the behavioral and neural level. One hundred eight participants completed three self-control questionnaires and regulated their negative emotions during functional magnetic resonance imaging using reappraisal (distancing). Trait self-control correlated positively with successful emotion regulation both subjectively and neurally, as indicated by online ratings of negative emotions and functional connectivity strength between the amygdala and prefrontal areas, respectively. This stronger overall connectivity of the left amygdala was related to more successful subjective emotion regulation. Comparing amygdala activity over time showed that high self-controllers successfully maintained down-regulation of the left amygdala over time, while low self-controllers failed to down-regulate towards the end of the experiment. This indicates that high self-controllers are better at maintaining a motivated state supporting emotion regulation over time. Our results support assumptions concerning a close relation of self-control and emotion regulation as two domains of behavioral control. They further indicate that individual differences in functional connectivity between task-related brain areas directly relate to differences in trait self-control.

Altered Appetitive Conditioning and Neural Connectivity in Subjects With Compulsive Sexual Behavior

INTRODUCTION

There has been growing interest in a better understanding of the etiology of compulsive sexual behavior (CSB). It is assumed that facilitated appetitive conditioning might be an important mechanism for the development and maintenance of CSB, but no study thus far has investigated these processes.

AIM

To explore group differences in neural activity associated with appetitive conditioning and connectivity in subjects with CSB and a healthy control group.

METHODS

Two groups (20 subjects with CSB and 20 controls) were exposed to an appetitive conditioning paradigm during a functional magnetic resonance imaging experiment, in which a neutral stimulus (CS+) predicted visual sexual stimuli and a second stimulus (CS-) did not.

MAIN OUTCOME MEASURES

Blood oxygen level-dependent responses and psychophysiologic interaction.

RESULTS

As a main result, we found increased amygdala activity during appetitive conditioning for the CS+ vs the CS- and decreased coupling between the ventral striatum and prefrontal cortex in the CSB vs control group.

CONCLUSION

The findings show that neural correlates of appetitive conditioning and neural connectivity are altered in patients with CSB. The increased amygdala activation might reflect facilitated conditioning processes in patients with CSB. In addition, the observed decreased coupling could be interpreted as a marker for impaired emotion regulation success in this group.

Hyperresponsivity and impaired prefrontal control of the mesolimbic reward system in schizophrenia

Schizophrenia is characterized by substantial dysfunctions of reward processing, leading to detrimental consequences for decision-making. The neurotransmitter dopamine is responsible for the transmission of reward signals and also known to be involved in the mechanism of psychosis. Using functional magnetic resonance imaging (fMRI), sixteen medicated patients with schizophrenia and sixteen healthy controls performed the 'desire-reason dilemma' (DRD) paradigm. This paradigm allowed us to directly investigate reward-related brain activations depending on the interaction of bottom-up and top-down mechanisms, when a previously conditioned reward stimulus had to be rejected to achieve a superordinate long-term goal. Both patients and controls showed significant activations in the mesolimbic reward system. In patients with schizophrenia, however, we found a significant hyperactivation of the left ventral striatum (vStr) when they were allowed to accept the conditioned reward stimuli, and a reduced top-down regulation of activation in the ventral striatum (vStr) and ventral tegmental area (VTA) while having to reject the immediate reward to pursue the superordinate task-goal. Moreover, while healthy subjects exhibited a negative functional coupling of the vStr with both the anteroventral prefrontal cortex (avPFC) and the ventromedial prefrontal cortex (VMPFC) in the dilemma situation, this functional coupling was significantly impaired in the patient group. These findings provide evidence for an increased ventral striatal activation to reward stimuli and an impaired top-down control of reward signals by prefrontal brain regions in schizophrenia.

Reward Processing in Unipolar and Bipolar Depression: A Functional MRI Study

Differentiating bipolar disorders (BD) from unipolar depression (UD) remains a major clinical challenge. The identification of neurobiological markers may help to differentiate these disorders, particularly during depressive episodes. This cross-sectional study, including 33 patients with UD, 33 patients with BD, and 34 healthy controls, is one of the first to directly compare UD and BD with respect to reward processing. A card-guessing paradigm was employed and brain activity associated with reward processing was investigated by means of fMRI. A 3 (group) × 2 (condition: reward>control, loss>control) ANOVA was conducted using the nucleus accumbens (NAcc) as ROI. Furthermore, a whole-brain approach was applied. A functional connectivity analysis was performed to characterize diagnosis-related alterations in the functional coupling between the NAcc and other brain areas. The ANOVA revealed higher activity for healthy controls (HCs) than for BD and UD in the NAcc during reward processing. Moreover, UD showed a higher functional connectivity between the NAcc and the VTA than HC. The patients groups could be differentiated in that BD showed a decreased activation, in the reward condition, of the NAcc, caudate nucleus, thalamus, putamen, insula, and prefrontal areas compared with UD. These results may help to refine the understanding of neural correlates of reward processing in both disorders, and to understand the neural underpinnings of anhedonia, a core symptom of depressive episodes.

CREB1 Genotype Modulates Adaptive Reward-Based Decisions in Humans

Cyclic AMP response element-binding protein (CREB) contributes to adaptation of mesocorticolimbic networks by modulating activity-regulated transcription and plasticity in neurons. Activity or expression changes of CREB in the nucleus accumbens (NAc) and orbital frontal cortex (OFC) interact with behavioral changes during reward-motivated learning. However, these findings from animal models have not been evaluated in humans. We tested whether CREB1 genotypes affect reward-motivated decisions and related brain activation, using BOLD fMRI in 224 young and healthy participants. More specifically, participants needed to adapt their decision to either pursue or resist immediate rewards to optimize the reward outcome. We found significant CREB1 genotype effects on choices to pursue increases of the reward outcome and on BOLD signal in the NAc, OFC, insula cortex, cingulate gyrus, hippocampus, amygdala, and precuneus during these decisions in comparison with those decisions avoiding total reward loss. Our results suggest that CREB1 genotype effects in these regions could contribute to individual differences in reward- and associative memory-based decision-making.

Intergenerational transmission of self-regulation: A multidisciplinary review and integrative conceptual framework

This review examines mechanisms contributing to the intergenerational transmission of self-regulation. To provide an integrated account of how self-regulation is transmitted across generations, we draw from over 75 years of accumulated evidence, spanning case studies to experimental approaches, in literatures covering developmental, social, and clinical psychology, and criminology, physiology, genetics, and human and animal neuroscience (among others). First, we present a taxonomy of what self-regulation is and then examine how it develops--overviews that guide the main foci of the review. Next, studies supporting an association between parent and child self-regulation are reviewed. Subsequently, literature that considers potential social mechanisms of transmission, specifically parenting behavior, interparental (i.e., marital) relationship behaviors, and broader rearing influences (e.g., household chaos) is considered. Finally, evidence that prenatal programming may be the starting point of the intergenerational transmission of self-regulation is covered, along with key findings from the behavioral and molecular genetics literatures. To integrate these literatures, we introduce the self-regulation intergenerational transmission model, a framework that brings together prenatal, social/contextual, and neurobiological mechanisms (spanning endocrine, neural, and genetic levels, including gene-environment interplay and epigenetic processes) to explain the intergenerational transmission of self-regulation. This model also incorporates potential transactional processes between generations (e.g., children's self-regulation and parent-child interaction dynamics that may affect parents' self-regulation) that further influence intergenerational processes. In pointing the way forward, we note key future directions and ways to address limitations in existing work throughout the review and in closing. We also conclude by noting several implications for intervention work.

Regional gray matter density associated with cognitive reflectivity-impulsivity: evidence from voxel-based morphometry

When faced with a problem or choice, humans can use two different strategies: “cognitive reflectivity,” which involves slow responses and fewer mistakes, or “cognitive impulsivity,” which comprises of quick responses and more mistakes. Different individuals use these two strategies differently. To our knowledge, no study has directly investigated the brain regions involved in reflectivity–impulsivity; therefore, this study focused on associations between these cognitive strategies and the gray matter structure of several brain regions. In order to accomplish this, we enrolled 776 healthy, right-handed individuals (432 men and 344 women; 20.7 ± 1.8 years) and used voxel-based morphometry with administration of a cognitive reflectivity–impulsivity questionnaire. We found that high cognitive reflectivity was associated with greater regional gray matter density in the ventral medial prefrontal cortex. Our finding suggests that this area plays an important role in defining an individual’s trait associated with reflectivity and impulsivity.

Dissociating pathomechanisms of depression with fMRI: bottom-up or top-down dysfunctions of the reward system

Depression is a debilitating psychiatric disorder characterized among other aspects by the inability to properly experience or respond to reward. However, it remains unclear whether patients with depression present impaired reward system due to abnormal modulatory mechanisms. We investigated the activation of the nucleus accumbens (NAcc), a crucial region involved in reward processing, with functional magnetic resonance imaging using the desire-reason-dilemma paradigm. This task allows tracking the activity of the NAcc during the acceptance or the rejection of previously conditioned reward stimuli. Patients were assigned into subgroups of lower (LA) or higher (HA) NAcc activation according to beta weights. LA patients presented significant hypoactivation in the ventral tegmental area in addition to bilateral ventral striatum, confirming impairments in the bottom-up input to the NAcc. Conversely, HA patients presented significant hyperactivation in prefrontal areas such as the rostral anterior cingulate cortex and the anterior ventral prefrontal cortex in addition to bilateral ventral striatum, suggesting disturbances in the top-down regulation of the NAcc. Demographic and clinical differences explaining the abnormal co-activations of midbrain and prefrontal regions were not identified. Therefore, we provide evidence for dysfunctional bottom-up processing in one potential neurobiological subtype of depression (LA) and dysfunctional top-down modulation in another subtype (HA). We suggest that the midbrain and prefrontal regions are more specific pathophysiological substrates for each depression subtype. Above all, our results encourage the segregation of patients by similar dysfunctional mechanisms of the dopaminergic system, which would finally contribute to disentangle more specific pathogeneses and guide the development of more personalized targets for future therapies.

Arbitration between controlled and impulsive choices

The impulse to act for immediate reward often conflicts with more deliberate evaluations that support long-term benefit. The neural architecture that negotiates this conflict remains unclear. One account proposes a single neural circuit that evaluates both immediate and delayed outcomes, while another outlines separate impulsive and patient systems that compete for behavioral control. Here we designed a task in which a complex payout structure divorces the immediate value of acting from the overall long-term value, within the same outcome modality. Using model-based fMRI in humans, we demonstrate separate neural representations of immediate and long-term values, with the former tracked in the anterior caudate (AC) and the latter in the ventromedial prefrontal cortex (vmPFC). Crucially, when subjects' choices were compatible with long-run consequences, value signals in AC were down-weighted and those in vmPFC were enhanced, while the opposite occurred when choice was impulsive. Thus, our data implicate a trade-off in value representation between AC and vmPFC as underlying controlled versus impulsive choice.

Common and disease-specific dysfunctions of brain systems underlying attentional and executive control in schizophrenia and bipolar disorder

Schizophrenia and bipolar disorder broadly overlap in multiple areas involving clinical phenomenology, genetics, and neurobiology. Still, the investigation into specific elementary (sub-)processes of executive functioning may help to define clear points of distinction between these categorical diagnoses to validate the nosological dichotomy and, indirectly, to further elucidate their pathophysiological underpinnings. In the present behavioral study, we sought to separate common from diagnosis-specific deficits in a series of specific elementary sub-functions of executive processing in patients with schizophrenia and bipolar disorder. For our purpose, we administered a modern and multi-purpose neuropsychological task paradigm to equal-sized and matched groups of schizophrenia patients, patients with bipolar disorder, and healthy control subjects. First, schizophrenia patients compared to the bipolar group exhibited a more pronounced deficit in general measures of task performance comprising both response speed and accuracy. Additionally, bipolar patients showed increased advance task preparation, i.e., were better able to compensate for response speed deficits when longer preparation intervals were provided. Set-shifting, on the other hand, was impaired to a similar degree in both patient groups. Finally, schizophrenia patients exhibited a specific deficit in conflict processing (inhibitory control) and the shielding of task-relevant processing from distraction (i.e., attentional maintenance). The present investigation suggests that specific neuropsychological measures of elementary executive functions may represent important points of dissociation between schizophrenia and bipolar disorder, which may help to differentiate the pathophysiological underpinnings of these major psychiatric disorders. In this context, the present findings highlight the measures of inhibitory control and attentional maintenance as promising candidates.

Right prefrontal and ventral striatum interactions underlying impulsive choice and impulsive responding

Although a multifaceted concept, many forms of impulsivity may originate from interactions between prefrontally-mediated cognitive control mechanisms and limbic, reward or incentive salience approach processes. We describe a novel task that combines reward and control processes to probe this putative interaction. The task involves elements of the monetary incentive delay task (Knutson et al., [2000]: Neuroimage 12:20-27) and the Go/No-Go task (Garavan et al., [1999]: Neuroimage 17:1820-1829) and requires human subjects to make fast responses to targets for financial reward but to occasionally inhibit responding when a NoGo signal rather than a target is presented. In elucidating the dynamic between reward anticipation and control we observed that successful inhibitions on monetary trials, relative to unsuccessful inhibitions, were associated, during the anticipation phase, with increased activation in the right inferior frontal gyrus (rIFG), decreased activity in the ventral striatum (VS), and altered functional connectivity between the two. Notably, this rIFG area had a small overlap but was largely distinct from an adjacent rIFG region that was active for the subsequent motor response inhibitions. Combined, the results suggest a role for adjacent regions of the rIFG in impulsive choice and in impulsive responding and identify a functional coupling between the rIFG and the VS.

Being in two minds: the neural basis of experiencing action crises in personal long-term goals

Although the successful pursuit of long-term goals constitutes an essential prerequisite to personal development, health, and well-being, little research has been devoted to the understanding of its underlying neural processes. A critical phase in the pursuit of long-term goals is defined as an action crisis, conceptualized as the intra-psychic conflict between further goal pursuit and disengagement from the goal. In the present research, we applied an interdisciplinary (cognitive and neural) approach to the analysis of processes underlying the experience of an action crisis. In Study 1, a longitudinal field study, action crises in personal goals gave rise to an increased and unbiased (re)evaluation of the costs and benefits (i.e., rewards) of the goal. Study 2 was a magnetic resonance imaging study examining resting-state functional connectivity. The extent of experienced action crises was associated with enhanced fronto-accumbal connectivity signifying increased reward-related impact on prefrontal action control. Action crises, furthermore, mediated the relationship between a dispositional measure of effective goal pursuit (action orientation) and fronto-accumbal connectivity. The converging and complementary results from two methodologically different approaches advance the understanding of the neurobiology of personal long-term goals, especially with respect to the role of rewards in the context of goal-related conflicts.

Disturbed anterior prefrontal control of the mesolimbic reward system and increased impulsivity in bipolar disorder

Bipolar disorder (BD) is characterized by recurrent mood episodes ranging from severe depression to acute full-blown mania. Both states of this severe psychiatric disorder have been associated with alterations of reward processing in the brain. Here, we present results of a functional magnetic resonance imaging (fMRI) study on the neural correlates and functional interactions underlying reward gain processing and reward dismissal in favor of a long-term goal in bipolar patients. Sixteen medicated patients diagnosed with bipolar I disorder, euthymic to mildly depressed, and sixteen matched healthy controls performed the 'desire-reason dilemma' (DRD) paradigm demanding rejection of priorly conditioned reward stimuli to successfully pursue a superordinate goal. Both groups exhibited significant activations in reward-related brain regions, particularly in the mesolimbic reward system. However, bipolar patients showed reduced neural responses of the ventral striatum (vStr) when exploiting a reward stimulus, and exhibited a decreased suppression of the reward-related activation of the mesolimbic reward system while having to reject immediate reward in favor of the long-term goal. Further, functional interaction between the anteroventral prefrontal cortex and the vStr in the 'DRD' was significantly impaired in the bipolar group. These findings provide evidence for a reduced responsivity of the vStr to reward stimuli in BD, possibly related to clinical features like anhedonia. The disturbed top-down control of mesolimbic reward signals by prefrontal brain regions in BD can be interpreted in terms of a disease-related enhanced impulsivity, a trait marker of BD.

The lateral prefrontal cortex and complex value-based learning and decision making

Tremendous progress has been made in discerning the neurocognitive basis of value-based decision making and learning. Although the majority of studies to date have employed simple task paradigms, recent work has started to examine more complex aspects of value processing including: the value of engaging rule-based cognitive control; the integration of multiple pieces of information (e.g., reward magnitude and delay) to discern the best course of action; pursuing future rewards; valuation of abstract concepts (e.g., fairness); and comparing the value of executed versus imagined alternative actions. We provide a comprehensive review of functional neuroimaging, electrophysiological, and lesion evidence suggesting that the lateral prefrontal cortex (LPFC) plays a critical role in these complex aspects of value processing. In particular, we focus on the specific information that the LPFC represents, and argue that it includes both cognitive and value-based information. We also discuss how the role of the LPFC is distinct from other value-related regions. Finally, we articulate a framework for understanding the contribution of subregions along the rostro-caudal axis of the LPFC, and thereby bridge the cognitive control and decision making literatures.

Anterior cingulate cortex instigates adaptive switches in choice by integrating immediate and delayed components of value in ventromedial prefrontal cortex

Actions can lead to an immediate reward or punishment and a complex set of delayed outcomes. Adaptive choice necessitates the brain track and integrate both of these potential consequences. Here, we designed a sequential task whereby the decision to exploit or forego an available offer was contingent on comparing immediate value and a state-dependent future cost of expending a limited resource. Crucially, the dynamics of the task demanded frequent switches in policy based on an online computation of changing delayed consequences. We found that human subjects choose on the basis of a near-optimal integration of immediate reward and delayed consequences, with the latter computed in a prefrontal network. Within this network, anterior cingulate cortex (ACC) was dynamically coupled to ventromedial prefrontal cortex (vmPFC) when adaptive switches in choice were required. Our results suggest a choice architecture whereby interactions between ACC and vmPFC underpin an integration of immediate and delayed components of value to support flexible policy switching that accommodates the potential delayed consequences of an action.

Trait impulsivity is related to ventral ACC and amygdala activity during primary reward anticipation

Trait impulsivity is characterized by behavioral disinhibition and rash decision-making that contribute to many maladaptive behaviors. Previous research demonstrates that trait impulsivity is related to the activity of brain regions underlying reward sensitivity and emotion regulation, but little is known about this relationship in the context of immediately available primary reward. This is unfortunate, as impulsivity in these contexts can lead to unhealthy behaviors, including poor food choices, dangerous drug use and risky sexual practices. In addition, little is known about the relationship between integration of reward and affective neurocircuitry, as measured by resting-state functional connectivity, and trait impulsivity in everyday life, as measured with a commonly used personality inventory. We therefore asked healthy adults to undergo a functional magnetic resonance imaging task in which they saw cues indicating the imminent oral administration of rewarding taste, as well as a resting-state scan. Trait impulsivity was associated with increased activation during anticipation of primary reward in the anterior cingulate cortex (ACC) and amygdala. Additionally, resting-state functional connectivity between the ACC and the right amygdala was negatively correlated with trait impulsivity. These findings demonstrate that trait impulsivity is related not only to ACC-amygdala activation but also to how tightly coupled these regions are to one another.

Increased functional connectivity between prefrontal cortex and reward system in pathological gambling

Pathological gambling (PG) shares clinical characteristics with substance-use disorders and is thus discussed as a behavioral addiction. Recent neuroimaging studies on PG report functional changes in prefrontal structures and the mesolimbic reward system. While an imbalance between these structures has been related to addictive behavior, whether their dysfunction in PG is reflected in the interaction between them remains unclear. We addressed this question using functional connectivity resting-state fMRI in male subjects with PG and controls. Seed-based functional connectivity was computed using two regions-of-interest, based on the results of a previous voxel-based morphometry study, located in the prefrontal cortex and the mesolimbic reward system (right middle frontal gyrus and right ventral striatum). PG patients demonstrated increased connectivity from the right middle frontal gyrus to the right striatum as compared to controls, which was also positively correlated with nonplanning aspect of impulsiveness, smoking and craving scores in the PG group. Moreover, PG patients demonstrated decreased connectivity from the right middle frontal gyrus to other prefrontal areas as compared to controls. The right ventral striatum demonstrated increased connectivity to the right superior and middle frontal gyrus and left cerebellum in PG patients as compared to controls. The increased connectivity to the cerebellum was positively correlated with smoking in the PG group. Our results provide further evidence for alterations in functional connectivity in PG with increased connectivity between prefrontal regions and the reward system, similar to connectivity changes reported in substance use disorder.

Inhibitory Control Contributes to “Motor”- but not “Cognitive”- Impulsivity

Literature on impulsivity regularly claims inhibitory control deficits underlie impulsive behavior. The current study investigated whether taxing inhibitory control will increase reflection (decision making under conditions of uncertainty), temporal (delay of gratification), and motor impulsivity (behavioral disinhibition). Inhibitory control was challenged, via a random letter generation task presented during responding to three impulsivity measures: the Information Sampling Task (IST), Single Key Impulsivity Paradigm, and the Stop Signal Task (SST). Participants (n = 33) were assigned to the inhibitory control challenging (experimental) condition, or to a control condition in which inhibitory control was not challenged. The SST was affected by the inhibitory control challenge: participants in the experimental condition displayed increased motor impulsivity, evidenced in longer stop signal reaction times (SSRTs) compared to the control group. The manipulation did not affect reflection- or temporal- impulsivity measures. These data support the suggestion that the mechanisms underlying the motor subtype of impulsivity are dissociable from the temporal and reflection subtypes, and that engagement of inhibitory control is not necessary to prevent impulsive decision making.

A further evaluation of decision-making under risk and under ambiguity in schizophrenia

Abnormal decision-making has been described as a key-concept to understand some behavioral disturbances in schizophrenia. However, whether schizophrenia patients display impairments in profitable decision-making on experimental designs is still controversial (1) to assess performance on decision-making paradigms under ambiguity and under risk conditions in a large sample of schizophrenia patients and (2) to study the impact of clinical variables on decision-making performance in schizophrenia. The Iowa gambling task (IGT) and the game of dice task (GDT) were administered to assess, respectively, decision-making under ambiguity and under risk in 63 schizophrenia patients and 67 healthy controls. In addition, clinical variables (e.g., schizophrenic symptoms, self-reported depression, and impulsivity) were evaluated using appropriate questionnaires the same day. Pharmacological treatments were reported. Schizophrenia patients had impaired performances on both IGT and GDT tasks. No correlation between the decision-making tasks performance and clinical variables was found. Lower gains on the GDT were associated with executive dysfunctioning in schizophrenia. These findings give evidence that schizophrenia patients display impairments in both decision-making under ambiguity and under risk.

Impulsivity and self-control during intertemporal decision making linked to the neural dynamics of reward value representation

A characteristic marker of impulsive decision making is the discounting of delayed rewards, demonstrated via choice preferences and choice-related brain activity. However, delay discounting may also arise from how subjective reward value is dynamically represented in the brain when anticipating an upcoming chosen reward. In the current study, brain activity was continuously monitored as human participants freely selected an immediate or delayed primary liquid reward and then waited for the specified delay before consuming it. The ventromedial prefrontal cortex (vmPFC) exhibited a characteristic pattern of activity dynamics during the delay period, as well as modulation during choice, that is consistent with the time-discounted coding of subjective value. The ventral striatum (VS) exhibited a similar activity pattern, but preferentially in impulsive individuals. A contrasting profile of delay-related and choice activation was observed in the anterior PFC (aPFC), but selectively in patient individuals. Functional connectivity analyses indicated that both vmPFC and aPFC exerted modulatory, but opposite, influences on VS activation. These results link behavioral impulsivity and self-control to dynamically evolving neural representations of future reward value, not just during choice, but also during postchoice delay periods.

Discriminative inhibitory control of cocaine seeking involves the prelimbic prefrontal cortex

BACKGROUND

Recent neuroimaging studies have shown that people with cocaine addiction retain some degree of control over drug craving that correlates with neural activity in the lateral prefrontal cortex (PFC). Here, we report similar findings in a rat model of inhibitory control of cocaine seeking.

METHODS

Rats actively responding for cocaine were trained to stop responding when presented with a discriminative stimulus that signaled lack of reinforcement. Rats were then tested for inhibitory control of cocaine seeking in novel behavioral contexts and in circumstances when cocaine seeking is particularly intense (e.g., following drug priming). The role of neuronal activity in different subregions of the PFC was assessed using local pharmacologic inactivation and c-Fos immunohistochemistry.

RESULTS

Rats progressively acquired the ability to stop cocaine seeking, even during drug intoxication and after a long history of cocaine self-administration. Inhibitory control of cocaine seeking was flexible, sufficiently strong to block cocaine-primed reinstatement, and selectively depended on increased neuronal activity within the prelimbic PFC, which is considered the rodent functional homolog of the human lateral PFC.

CONCLUSIONS

Parallel evidence in both animal models and humans indicate that recruitment of prefrontal inhibitory control of drug seeking is still functional after prolonged cocaine use. Preclinical investigation of the mechanisms underlying this capacity may contribute to designing new behavioral and/or pharmacologic strategies to promote its use for the prevention of relapse in addiction.

The decision to engage cognitive control is driven by expected reward-value: neural and behavioral evidence

Cognitive control is a fundamental skill reflecting the active use of task-rules to guide behavior and suppress inappropriate automatic responses. Prior work has traditionally used paradigms in which subjects are told when to engage cognitive control. Thus, surprisingly little is known about the factors that influence individuals' initial decision of whether or not to act in a reflective, rule-based manner. To examine this, we took three classic cognitive control tasks (Stroop, Wisconsin Card Sorting Task, Go/No-Go task) and created novel ‘free-choice’ versions in which human subjects were free to select an automatic, pre-potent action, or an action requiring rule-based cognitive control, and earned varying amounts of money based on their choices. Our findings demonstrated that subjects' decision to engage cognitive control was driven by an explicit representation of monetary rewards expected to be obtained from rule-use. Subjects rarely engaged cognitive control when the expected outcome was of equal or lesser value as compared to the value of the automatic response, but frequently engaged cognitive control when it was expected to yield a larger monetary outcome. Additionally, we exploited fMRI-adaptation to show that the lateral prefrontal cortex (LPFC) represents associations between rules and expected reward outcomes. Together, these findings suggest that individuals are more likely to act in a reflective, rule-based manner when they expect that it will result in a desired outcome. Thus, choosing to exert cognitive control is not simply a matter of reason and willpower, but rather, conforms to standard mechanisms of value-based decision making. Finally, in contrast to current models of LPFC function, our results suggest that the LPFC plays a direct role in representing motivational incentives.

The neurobiology of reward and cognitive control systems and their role in incentivizing health behavior

OBJECTIVE

This article reviews the neurobiology of cognitive control and reward processes and addresses their role in the treatment of addiction. We propose that the neurobiological mechanisms involved in treatment may differ from those involved in the etiology of addiction and consequently are worthy of increased investigation.

METHOD

We review the literature on reward and control processes and evidence of differences in these systems in drug addicted individuals. We also review the relatively small literature on neurobiological predictors of abstinence.

RESULTS

We conclude that prefrontal control systems may be central to a successful recovery from addiction. The frontal lobes have been shown to regulate striatal reward-related processes, to be among the regions that predict treatment outcome, and to show elevated functioning in those who have succeeded in maintaining abstinence.

CONCLUSION

The evidence of the involvement of the frontal lobes in recovery is consistent with the hypothesis that recovery is a distinct process that is more than the undoing of those processes involved in becoming addicted and a return to the pre-addiction state of the individual. The extent to which these frontal systems are engaged by treatment interventions may contribute to their efficacy.

The association between cingulate cortex glutamate concentration and delay discounting is mediated by resting state functional connectivity

Humans vary in their ability to delay gratification and impulsive decision making is a common feature in various psychiatric disorders. The level of delay discounting is a relatively stable psychological trait, and therefore neural processes implicated in delay discounting are likely to be based on the overall functional organization of the brain (under task-free conditions) in which state-dependent shifts from baseline levels occur. The current study investigated whether delay discounting can be predicted by intrinsic properties of brain functioning. Fourteen healthy male subjects performed a delay discounting task. In addition, resting state functional magnetic resonance imaging (fMRI) and magnetic resonance spectroscopy (¹H MRS) were used to investigate the relationship between individual differences in delay discounting and molecular and regional measures of resting state (baseline) activity of dorsal anterior cingulate cortex (dACC). Results showed that delay discounting was associated with both dACC glutamate concentrations and resting state functional connectivity of the dACC with a midbrain region including ventral tegmental area and substantia nigra. In addition, a neural pathway was established, showing that the effect of glutamate concentrations in the dACC on delay discounting is mediated by functional connectivity of the dACC with the midbrain. The current findings are important to acknowledge because spontaneous intrinsic brain processes have been proposed to be a potential promising biomarker of disease and impulsive decision making is associated with several psychiatric disorders.

A functional neuroimaging study assessing gender differences in the neural mechanisms underlying the ability to resist impulsive desires

There is ample evidence of gender differences in neural processes and behavior. Differences in reward-related behaviors have been linked to either temporary or permanent organizational influences of gonadal hormones on the mesolimbic dopamine system and reward-related activation. Still, little is known about the association between biological gender and the neural underpinnings of the ability to resist reward-related impulses. Here we assessed with functional magnetic resonance imaging which neural processes enable men and women to successfully control their desire for immediate reward when this is required by a higher-order goal (i.e., during a 'desire-reason dilemma'; Diekhof and Gruber, 2010). Thirty-two participants (16 females) were closely matched for age, personality characteristics (e.g., novelty seeking) and behavioral performance in the 'desire-reason task'. On the neural level, men and women showed similarities in the general response of the nucleus accumbens and of the ventral tegmental area to predictors of immediate reward, but they differed in additional brain mechanisms that enabled self-controlled decisions against the preference for immediate reward. Firstly, men exhibited a stronger reduction of activation in the ventral pallidum, putamen, temporal pole and pregenual anterior cingulate cortex during the 'desire-reason dilemma'. Secondly, connectivity analyses revealed a significant change in the direction of the connectivity between anteroventral prefrontal cortex and nucleus accumbens during decisions counteracting the reward-related impulse when comparing men and women. Together, these findings support the view of a sexual dimorphism that manifested in the recruitment of gender-specific neural resources during the successful deployment of self-control.

Nucleus accumbens response to food cues predicts subsequent snack consumption in women and increased body mass index in those with reduced self-control

Individuals have difficulty controlling their food consumption, which is due in part to the ubiquity of tempting food cues in the environment. Individual differences in the propensity to attribute incentive (motivational) salience to and act on these cues may explain why some individuals eat more than others. Using fMRI in healthy women, we found that food cue related activity in the nucleus accumbens, a key brain region for food motivation and reward, was related to subsequent snack food consumption. However, both nucleus accumbens activation and snack food consumption were unrelated to self-reported hunger, or explicit wanting and liking for the snack. In contrast, food cue reactivity in the ventromedial prefrontal cortex was associated with subjective hunger/appetite, but not with consumption. Whilst the food cue reactivity in the nucleus accumbens that predicted snack consumption was not directly related to body mass index (BMI), it was associated with increased BMI in individuals reporting low self-control. Our findings reveal a neural substrate underpinning automatic environmental influences on consumption in humans and demonstrate how self-control interacts with this response to predict BMI. Our data provide support for theoretical models that advocate a 'dual hit' of increased incentive salience attribution to food cues and poor self-control in determining vulnerability to overeating and overweight.

Are executive function and impulsivity antipodes? A conceptual reconstruction with special reference to addiction

RATIONALE

Although there is considerable interest in how either executive function (EF) or impulsivity relate to addiction, there is little apparent overlap between these research areas.

OBJECTIVES

The present paper aims to determine if components of these two constructs are conceptual antipodes--widely separated on a shared continuum.

METHODS

EFs and impulsivities were compared and contrasted. Specifically, the definitions of the components of EF and impulsivity, the methods used to measure the various components, the populations of drug users that show deficits in these components, and the neural substrates of these components were compared and contrasted.

RESULTS

Each component of impulsivity had an antipode in EF. EF, however, covered a wider range of phenomena, including compulsivity.

CONCLUSIONS

Impulsivity functions as an antipode of certain components of EF. Recognition of the relationship between EF and impulsivity may inform the scientific inquiry of behavioral problems such as addiction. Other theoretical implications are discussed.

[Neuroimaging markers: their role for differential diagnosis and therapeutic decisions in personalized psychiatry]

In the context of personalized psychiatry there is growing interest in the development of neuroimaging markers for differential diagnosis and individualized therapy of mental disorders. This article reports on new neuroimaging markers for the diagnosis of Alzheimer's disease and particularly recent multi-functional magnetic resonance imaging (m-fMRI) studies in patients with schizophrenic and affective psychoses. Using experimental key paradigms for targeted assessment of pathophysiologically relevant neurofunctional systems, these studies reveal both differences and commonalities between the diagnostic categories. In addition, the article outlines research strategies for further development of the classification of major psychoses on the basis of a more precise characterization of the neurofunctional and pathophysiological phenotype. Multivariate approaches may help to identify more complex neuroimaging markers relevant for diagnosis and/or prognosis. Finally, some examples will be presented for the use of neuroimaging markers in the individualized choice of therapy.

Modulation of frontostriatal interaction aligns with reduced primary reward processing under serotonergic drugs

Recently, functional interactions between anteroventral prefrontal cortex and nucleus accumbens (NAcc) have been shown to relate to behavior counteracting reward-desiring (Diekhof and Gruber, 2010). Downregulation of the reward system by serotonin has also been suggested as the mode of action accounting for unsatisfactory effects of serotonin reuptake inhibitors (SSRIs) such as insufficient alleviation or even increase of anhedonia, and loss of interest. However, understanding of the in vivo mechanisms of SSRI-related alteration of the human reward system is still incomplete. Using functional magnetic resonance imaging (fMRI) within a double-blind cross-over within-subjects study design and administering the SSRI paroxetine, the dopamine/norepinephrine reuptake inhibitor bupropione, and placebo for 7 d each, we investigated a group of 18 healthy male subjects. Under paroxetine, subjects showed significantly decreased activation of the bilateral NAcc during processing of primary rewards (erotic videos), but not under bupropion. Similar to the previous study, analysis of psychophysiological interactions revealed that this downregulation relied on negative interactions between left and right NAcc fMRI signals and the bilateral anteroventral prefrontal cortex that now were significantly enhanced under paroxetine and reduced under bupropion. Individual drug-dependent modulations of interacting brain regions were significantly associated with individual expressions of impulsivity as a personality trait. Our results corroborate and extend previous insights on interregional crosstalk from secondary to primary rewards and demonstrate parallels between active inhibitory control of and serotonergic effects on the dopaminergic reward system's activity.

Preliminary evidence for an impulsivity-based thrifty eating phenotype

INTRODUCTION

Low birth weight is associated with obesity and an increased risk for metabolic/cardiovascular diseases in later life.

RESULTS

The results of the snack delay test, which encompassed four distinct trials, indicated that the gender × intrauterine growth restriction (IUGR) × trial interaction was a predictor of the ability to delay the food reward (P = 0.002). Among children with normal birth weights, girls showed a greater ability to delay food rewards than did boys (P = 0.014).In contrast, among children with IUGR, there was no such differential ability between girls and boys. Furthermore, in girls, impulsive responding predicted both increased consumption of palatable fat (P = 0.007) and higher BMIs (P = 0.020) at 48 mo of age, although there was no such association with BMI at 36 mo.

DISCUSSION

In girls, the quality of fetal growth may contribute to impulsive eating, which may promote an increased intake of fats and consequently higher BMIs. As with the original thrifty phenotype, such a mechanism would be adaptive when food supplies are sparse, but would be problematic in societies with ample access to calorically rich foods.

METHODS

We examined whether the quality of intrauterine growth programs obesogenic eating behaviors, by investigating (i) the relationship between birth weight and impulsive eating in 3-year-old children (using the snack delay test), and (ii) whether impulsive eating predicts fat intake and/or BMI at 4 years of age (using a laboratory-based test meal).

The functional neuroanatomy of decision making: prefrontal control of thought and action

Humans exhibit a remarkable capacity for flexible thought and action. Despite changing internal needs and external context, individuals maintain stable goals and pursue purposeful action. Functional neuroimaging research examining the neural underpinnings of such behavioral flexibility has progressed within several distinct traditions, as evident in the largely separate literatures on "cognitive control" and on "decision making." Both topics investigate the formulation of desires and intentions, the integration of knowledge and context, and the resolution of conflict and uncertainty. Additionally, each recognizes the fundamental role of the prefrontal cortex in supporting flexible selection of behavior. But despite this notable overlap, neuroimaging studies in cognitive control and decision making have exerted only limited influence on each other, in part due to differences in their theoretical and experimental groundings. Additionally, the precise organization of control processing within prefrontal cortex has remained unclear, fostering an acceptance of vague descriptions of decision making in terms of canonical cognitive control functions such as "inhibition" or "self-control." We suggest a unifying role for models of the hierarchical organization of action selection within prefrontal cortex. These models provide an important conceptual link between decision-making phenomena and cognitive-control processes, potentially facilitating cross-fertilization between these topics.

Impulsive personality and the ability to resist immediate reward: an fMRI study examining interindividual differences in the neural mechanisms underlying self-control

The ability to resist immediate rewards is crucial for lifetime success and individual well-being. Using functional magnetic resonance imaging, we assessed the association between trait impulsivity and the neural underpinnings of the ability to control immediate reward desiring. Low and high extreme impulsivity groups were compared with regard to their behavioral performance and brain activation in situations, in which they had to forego immediate rewards with varying value to achieve a superordinate long-term goal. We found that highly impulsive (HI) individuals, who successfully compensated for their lack in behavioral self-control, engaged two complementary brain mechanisms when choosing actions in favor of a long-term goal, but at the expense of an immediate reward. First, self-controlled decisions led to a general attenuation of reward-related activation in the nucleus accumbens, which was accompanied by an increased inverse connectivity with the anteroventral prefrontal cortex. Second, HI subjects controlled their desire for increasingly valuable, but suboptimal rewards through a linear reduction of activation in the ventromedial prefrontal cortex (VMPFC). This was achieved by an increased inverse coupling between the VMPFC and the ventral striatum. Importantly, the neural mechanisms observed in the HI group differed from those in extremely controlled individuals, despite similar behavioral performance. Collectively, these results suggest trait-specific neural mechanisms that allow HI individuals to control their desire for immediate reward.

Differential effects of dopaminergic therapies on dorsal and ventral striatum in Parkinson's disease: implications for cognitive function

Cognitive abnormalities are a feature of Parkinson's disease (PD). Unlike motor symptoms that are clearly improved by dopaminergic therapy, the effect of dopamine replacement on cognition seems paradoxical. Some cognitive functions are improved whereas others are unaltered or even hindered. Our aim was to understand the effect of dopamine replacement therapy on various aspects of cognition. Whereas dorsal striatum receives dopamine input from the substantia nigra (SN), ventral striatum is innervated by dopamine-producing cells in the ventral tegmental area (VTA). In PD, degeneration of SN is substantially greater than cell loss in VTA and hence dopamine-deficiency is significantly greater in dorsal compared to ventral striatum. We suggest that dopamine supplementation improves functions mediated by dorsal striatum and impairs, or heightens to a pathological degree, operations ascribed to ventral striatum. We consider the extant literature in light of this principle. We also survey the effect of dopamine replacement on functional neuroimaging in PD relating the findings to this framework. This paper highlights the fact that currently, titration of therapy in PD is geared to optimizing dorsal striatum-mediated motor symptoms, at the expense of ventral striatum operations. Increased awareness of contrasting effects of dopamine replacement on dorsal versus ventral striatum functions will lead clinicians to survey a broader range of symptoms in determining optimal therapy, taking into account both those aspects of cognition that will be helped versus those that will be hindered by dopaminergic treatment.

Cognitive neuroscience of self-regulation failure

Self-regulatory failure is a core feature of many social and mental health problems. Self-regulation can be undermined by failures to transcend overwhelming temptations, negative moods and resource depletion, and when minor lapses in self-control snowball into self-regulatory collapse. Cognitive neuroscience research suggests that successful self-regulation is dependent on top-down control from the prefrontal cortex over subcortical regions involved in reward and emotion. We highlight recent neuroimaging research on self-regulatory failure, the findings of which support a balance model of self-regulation whereby self-regulatory failure occurs whenever the balance is tipped in favor of subcortical areas, either due to particularly strong impulses or when prefrontal function itself is impaired. Such a model is consistent with recent findings in the cognitive neuroscience of addictive behavior, emotion regulation and decision-making.

Cognitive neuroscience of self-regulation failure

Self-regulatory failure is a core feature of many social and mental health problems. Self-regulation can be undermined by failures to transcend overwhelming temptations, negative moods and resource depletion, and when minor lapses in self-control snowball into self-regulatory collapse. Cognitive neuroscience research suggests that successful self-regulation is dependent on top-down control from the prefrontal cortex over subcortical regions involved in reward and emotion. We highlight recent neuroimaging research on self-regulatory failure, the findings of which support a balance model of self-regulation whereby self-regulatory failure occurs whenever the balance is tipped in favor of subcortical areas, either due to particularly strong impulses or when prefrontal function itself is impaired. Such a model is consistent with recent findings in the cognitive neuroscience of addictive behavior, emotion regulation and decision-making.

Endogenous testosterone modulates prefrontal-amygdala connectivity during social emotional behavior

It is clear that the steroid hormone testosterone plays an important role in the regulation of social emotional behavior, but it remains unknown which neural circuits mediate these hormonal influences in humans. We investigated the modulatory effects of endogenous testosterone on the control of social emotional behavior by applying functional magnetic resonance imaging while healthy male participants performed a social approach-avoidance task. This task operationalized social emotional behavior by having participants approach and avoid emotional faces by pulling and pushing a joystick, respectively. Affect-congruent trials mapped the automatic tendency to approach happy faces and avoid angry faces. Affect-incongruent trials required participants to override those automatic action tendencies and select the opposite response (approach-angry, avoid-happy). The social emotional control required by affect-incongruent responses resulted in longer reaction times (RTs) and increased activity at the border of the ventrolateral prefrontal cortex and frontal pole (VLPFC/FP). We show that endogenous testosterone modulates these cerebral congruency effects through 2 mechanisms. First, participants with lower testosterone levels generate larger VLPFC/FP responses during affect-incongruent trials. Second, during the same trials, endogenous testosterone modulates the effective connectivity between the VLPFC/FP and the amygdala. These results indicate that endogenous testosterone influences local prefrontal activity and interregional connectivity supporting the control of social emotional behavior.

The neural correlates of intertemporal decision-making: contributions of subjective value, stimulus type, and trait impulsivity

Making choices between payoffs available at different points in time reliably engages a decision-making brain circuit that includes medial prefrontal cortex (mPFC), posterior cingulate cortex (PCC), and ventral striatum (VS). Previous neuroimaging studies produced differing accounts of the functions of these regions, including that these regions: (1) are sensitive to the value of rewards discounted by a function of delay ('subjective value'); (2) are differentially sensitive to the availability of an immediate reward; and (3) are implicated in impulsive decision-making. In this event-related fMRI study of 20 volunteers, these hypotheses were investigated simultaneously using a delay discounting task in which magnitude of rewards and stimulus type, i.e., the presence or absence of an immediate option, were independently varied, and in which participants' trait impulsivity was assessed with the Barratt Impulsiveness Scale. Results showed that mPFC, PCC, and VS are sensitive to the subjective value of rewards, whereas mPFC and PCC, but not VS, are sensitive to the presence of an immediate reward in the choice option. Moderation by individual differences in trait impulsivity was specific to the mPFC. Conjunction analysis showed significant overlap in mPFC and PCC for the main effects of subjective value and stimulus type, indicating these regions may serve multiple distinct roles during intertemporal decision-making. These findings significantly advance our understanding of the specificity and overlap of functions subserved by different regions involved in intertemporal decision-making, and help to reconcile conflicting accounts in the literature.