Brain Advance Access originally published online on December 24, 2007
Brain 2008 131(4):971-986; doi:10.1093/brain/awm307
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Reduced error-related activation in two anterior cingulate circuits is related to impaired performance in schizophrenia
1Department of Psychiatry and 2Department of Radiology, Massachusetts General Hospital Harvard Medical School, Boston, MA 02215, 3Department of Psychology, Suffolk University, Boston, MA 02114, USA, 4Department of Neurology, Department of Ophthalmology and Department of Visual Sciences, University of British Columbia, Vancouver, BC, Canada and 5Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA 02129 and Harvard Medical School, Boston, MA 02215, USA
Correspondence to: Dara S. Manoach, 149 13th St, Room 2608, Charlestown, MA 02129, USA E-mail: dara{at}nmr.mgh.harvard.edu
To perform well on any challenging task, it is necessary to evaluate your performance so that you can learn from errors. Recent theoretical and experimental work suggests that the neural sequellae of error commission in a dorsal anterior cingulate circuit index a type of contingency- or reinforcement-based learning, while activation in a rostral anterior cingulate circuit reflects appraisal of the affective or motivational significance of errors. Patients with schizophrenia show rigid, perseverative behaviour that is not optimally responsive to outcome. Findings of reduced anterior cingulate cortex (ACC) activity during error commission in schizophrenia suggest that difficulties in evaluating and modifying behaviour in response to errors may contribute to behavioural rigidity. Using event-related functional MRI and an antisaccade paradigm with concurrent monitoring of eye position, the present study examined error-related activation and its relation to task performance in the anatomic components of two ACC circuits that are theorized to make distinct contributions to error processing. Eighteen chronic-medicated schizophrenia patients and 15 healthy controls participated. Compared to controls, patients showed increased antisaccade error rates and decreased error-related activation in the reinforcement learning network—dorsal ACC, striatum and brainstem (possibly substantia nigra)—and also in the affective appraisal network—rostral ACC, insula and amygdala. These reductions remained when the effects of antipsychotic medication dose and error rate were statistically controlled. Activation in these networks was inversely related to error rate in both patient and control groups, but the slope of this relation was shallower in patients (i.e. across participants with schizophrenia, decrements in error rate were associated with smaller decrements in activation). This indicates that the blunted neural response to errors in schizophrenia was not simply a reflection of more frequent errors. Our findings demonstrate a blunted response to error commission that is associated with worse performance in two ACC circuits in schizophrenia. In the dACC circuit, the blunted response may reflect deficient modification of prepotent stimulus-response mappings in response to errors, and in the rACC network it may reflect diminished concern regarding behavioural outcomes. However, despite these deficits and in the absence of external feedback regarding errors, patients corrected their errors as frequently as controls suggesting intact error recognition and ability to institute corrective action. Impairments in evaluating and learning from errors in schizophrenia may contribute to behaviour that is rigid and perseverative rather than optimally guided by outcomes, and may compromise performance across a wide range of tasks.
Key Words: schizophrenia; anterior cingulate cortex; response monitoring; functional MRI; error processing
Abbreviations: ACC, anterior cingulate cortex; BPRS, Brief Psychiatric Rating Scale; CPZ, chlorpromazine; ERN, error-related negativity; ERP, event-related potentials; FIR, finite impulse response; HDR, haemodynamic responses; PANSS, Positive and Negative Syndrome Scale
Received August 10, 2007. Revised November 19, 2007. Accepted November 26, 2007.
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