Elsevier

Journal of Psychiatric Research

Volume 83, December 2016, Pages 37-46
Journal of Psychiatric Research

Review article
Transdiagnostic impairment of cognitive control in mental illness

https://doi.org/10.1016/j.jpsychires.2016.08.001Get rights and content

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.

Section snippets

A common underlying cognitive control factor: behavior

Latent variable analysis of performance on a wide array of neuropsychological tasks has shown that intact cognition has a characteristic pattern of interrelated executive functions throughout the lifespan from childhood (Lehto et al., 2003) through middle (Miyake et al., 2000) and older adulthood (Adrover-Roig et al., 2012). For example, Miyake et al., 2000, Miyake and Friedman, 2012) have demonstrated that updating (i.e., monitoring and refreshing working memory store), inhibition (resisting

Summary, limitations, & future directions

Accumulating findings have revealed that psychiatric disorders share a common factor or vulnerability to dysfunction. Similarly, historic conceptualizations of distinct cognitive domains have been superseded by models that include a higher order common cognitive control/executive function factor. Separate studies suggest this common cognitive control factor may be related to deficits in a frontal-cingulate-parietal-insular network recruited for a wide diversity of cognitive demands.

Conclusions

Consistent with principles of the Research Domain Criteria (RDoC) project (Kozak and Cuthbert, 2016), the current review implicates disruption of a cognitive control network across disorders. Importantly, this network parallels the multiple demand network intrinsic to adaptive, flexible cognition. Given our prior findings of transdiagnostic gray matter loss in overlapping regions of this network, a parallel is suggested across structural and functional measures of brain dysfunction. Also

Conflict of interest

The authors declare no competing financial interests relevant to this research.

Acknowledgements

LM was supported by National Institute of Mental Health K23 MH104849. AE was supported by the Sierra-Pacific Mental Illness Research, Education and Clinical Center (MIRECC) at the Palo Alto VA.

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