The Subjective Value of Cognitive Effort is Encoded by a Domain-General Valuation Network.

Cognitive control is necessary for goal-directed behavior, yet people treat cognitive control demand as a cost, which discounts the value of rewards in a similar manner as other costs, such as delay or risk. It is unclear, however, whether the subjective value (SV) of cognitive effort is encoded in the same putatively domain-general brain valuation network implicated in other cost domains, or instead engages a distinct frontoparietal network, as implied by recent studies. Here, we provide rigorous evidence that the valuation network, with core foci in the ventromedial prefrontal cortex and ventral striatum, also encodes SV during cognitive effort-based decision-making in healthy, male and female adult humans. We doubly dissociate this network from frontoparietal regions that are instead recruited as a function of decision difficulty. We show that the domain-general valuation network jointly and independently encodes both reward benefits and cognitive effort costs. We also demonstrate that cognitive effort SV signals predict choice and are influenced by state and trait motivation, including sensitivity to reward and anticipated task performance. These findings unify cognitive effort with other cost domains, and suggest candidate neural mechanisms underlying state and trait variation in willingness to expend cognitive effort.SIGNIFICANCE STATEMENT Subjective effort costs are increasingly understood to diminish cognitive control over task performance and can thus undermine functioning across health and disease. Yet, we are only beginning to understand how decisions about cognitive effort are made. A key question is how subjective values are computed. Recent work suggests that the value of cognitive effort might be computed by networks that are distinct from those involved in other domains like intertemporal and risky decision-making, implying distinct mechanisms. Here we demonstrate that the domain-general network also encodes effort-discounted value, linking cognitive effort closely with other domains. Our results thus elucidate key mechanisms supporting decisions about cognitive effort, and point to candidate neural targets for intervention in disorders involving impaired cognitive motivation.

Exploring brain-behavior relationships in the N-back task.

Working memory (WM) function has traditionally been investigated in terms of two dimensions: within-individual effects of WM load, and between-individual differences in task performance. In human neuroimaging studies, the N-back task has frequently been used to study both. A reliable finding is that activation in frontoparietal regions exhibits an inverted-U pattern, such that activity tends to decrease at high load levels. Yet it is not known whether such U-shaped patterns are a key individual differences factor that can predict load-related changes in task performance. The current study investigated this question by manipulating load levels across a much wider range than explored previously (N â€‹= â€‹1-6), and providing a more comprehensive examination of brain-behavior relationships. In a sample of healthy young adults (n â€‹= â€‹57), the analysis focused on a distinct region of left lateral prefrontal cortex (LPFC) identified in prior work to show a unique relationship with task performance and WM function. In this region it was the linear slope of load-related activity, rather than the U-shaped pattern, that was positively associated with individual differences in target accuracy. Comprehensive supplemental analyses revealed the brain-wide selectivity of this pattern. Target accuracy was also independently predicted by the global resting-state connectivity of this LPFC region. These effects were robust, as demonstrated by cross-validation analyses and out-of-sample prediction, and also critically, were primarily driven by the high-load conditions. Together, the results highlight the utility of high-load conditions for investigating individual differences in WM function.

Intertemporal Decision-Making Involves Prefrontal Control Mechanisms Associated with Working Memory.

Intertemporal decision-making involves simultaneous evaluation of both the magnitude and delay to reward, which may require the integrated representation and comparison of these dimensions within working memory (WM). In the current study, neural activation associated with intertemporal decision-making was directly compared with WM load-related activation. During functional magnetic resonance imaging, participants performed an intermixed series of WM trials and intertemporal decision-making trials both varying in load, with the latter in terms of choice difficulty, via options tailored to each participant's subjective value function for delayed rewards. The right anterior prefrontal cortex (aPFC) and dorsolateral prefrontal cortex (dlPFC) showed activity modulation by choice difficulty within WM-related brain regions. In aPFC, these 2 effects (WM, choice difficulty) correlated across individuals. In dlPFC, activation increased with choice difficulty primarily in patient (self-controlled) individuals, and moreover was strongest when the delayed reward was chosen on the most difficult trials. Finally, the choice-difficulty effects in dlPFC and aPFC were correlated across individuals, suggesting a functional relationship between the 2 regions. Together, these results suggest a more precise account of the relationship between WM and intertemporal decision-making that is specifically tied to choice difficulty, and involves the coordinated activation of a lateral PFC circuit supporting successful self-control.

Cognitive effort: A neuroeconomic approach.

Cognitive effort has been implicated in numerous theories regarding normal and aberrant behavior and the physiological response to engagement with demanding tasks. Yet, despite broad interest, no unifying, operational definition of cognitive effort itself has been proposed. Here, we argue that the most intuitive and epistemologically valuable treatment is in terms of effort-based decision-making, and advocate a neuroeconomics-focused research strategy. We first outline psychological and neuroscientific theories of cognitive effort. Then we describe the benefits of a neuroeconomic research strategy, highlighting how it affords greater inferential traction than do traditional markers of cognitive effort, including self-reports and physiologic markers of autonomic arousal. Finally, we sketch a future series of studies that can leverage the full potential of the neuroeconomic approach toward understanding the cognitive and neural mechanisms that give rise to phenomenal, subjective cognitive effort.

An experimental manipulation of the value of effort.

People who take on challenges and persevere longer are more likely to succeed in life. But individuals often avoid exerting effort, and there is limited experimental research investigating whether we can learn to value effort. We developed a paradigm to test the hypothesis that people can learn to value effort and will seek effortful challenges if directly incentivized to do so. We also dissociate the effects of rewarding people for choosing effortful challenges and performing well. The results provide limited evidence that rewarding effort increased people's willingness to choose harder tasks when rewards were no longer offered (near transfer). There was also mixed evidence that rewarding effort increased willingness to choose harder tasks in another unrelated and unrewarded task (far transfer). These heterogeneous results highlight the need for further research to understand when this paradigm may be the most effective for increasing and generalizing the value of effort.

Effects of current and past depressive episodes on behavioral performance and subjective experience during an N-back task.

BACKGROUND AND OBJECTIVES: Depression impairs working memory (WM). And, while many studies have documented impairment in WM during depression remission, those using the N-back task did not find differences between individuals with remitted depression and healthy controls. One reason for these findings may be that certain depression phenotypes, such as the childhood-onset form, which is likely to be associated with persistent WM problems, are underrepresented or unevenly represented in the studies. Because childhood-onset depression (COD) affects individuals while cognitive development is still ongoing, it is more likely to have lasting detrimental effects, as evidenced in residual memory impairment, than depression that onsets later in life. Further, it is unclear if depression episodes have cumulative effects on WM when measured via the N-back. METHODS: We examined the effects of depression on WM performance (response time, accuracy, signal detection d') and subjective experience (difficulty, mental effort required) during a four-level N-back task among 112 adults with COD (42 currently depressed; 70 remitted depressed) and 80 never-depressed controls. RESULTS: Compared to never-depressed controls, there was minimal evidence of impaired WM performance among participants with remitted or current depression; the groups also reported overall similar subjective experiences during the N-back. Notably, number of lifetime depressive episodes had a detrimental cumulative effect on response accuracy and d'. LIMITATIONS: WM was assessed only in regard to verbal memory. The sample size of currently depressed cases was smaller than that of the other groups. CONCLUSIONS: WM remains largely intact among adults with remitted COD, but increased number of depression episodes worsens WM performance.

Is it cognitive effort you measure? Comparing three task paradigms to the Need for Cognition scale.

Measuring individual differences in cognitive effort can be elusive as effort is a function of motivation and ability. We report six studies (N = 663) investigating the relationship of Need for Cognition and working memory capacity with three cognitive effort measures: demand avoidance in the Demand Selection Task, effort discounting measured as the indifference point in the Cognitive Effort Discounting paradigm, and rational reasoning score with items from the heuristic and bias literature. We measured perceived mental effort with the NASA task load index. The three tasks were not correlated with each other (all r's < .1, all p's > .1). Need for Cognition was positively associated with effort discounting (r = .168, p < .001) and rational reasoning (r = .176, p < .001), but not demand avoidance (r = .085, p = .186). Working memory capacity was related to effort discounting (r = .185, p = .004). Higher perceived effort was related to poorer rational reasoning. Our data indicate that two of the tasks are related to Need for Cognition but are also influenced by a participant's working memory capacity. We discuss whether any of the tasks measure cognitive effort.

Economic Choice and Heart Rate Fractal Scaling Indicate That Cognitive Effort Is Reduced by Depression and Boosted by Sad Mood.

BACKGROUND: People with depression typically exhibit diminished cognitive control. Control is subjectively costly, prompting speculation that control deficits reflect reduced cognitive effort. Evidence that people with depression exert less cognitive effort is mixed, however, and motivation may depend on state affect. METHODS: We used a cognitive effort discounting task to measure propensity to expend cognitive effort and fractal structure in the temporal dynamics of interbeat intervals to assess on-task effort exertion for 49 healthy control subjects, 36 people with current depression, and 67 people with remitted depression. RESULTS: People with depression discounted more steeply, indicating that they were less willing to exert cognitive effort than people with remitted depression and never-depressed control subjects. Also, steeper discounting predicted worse functioning in daily life. Surprisingly, a sad mood induction selectively boosted motivation among participants with depression, erasing differences between them and control subjects. During task performance, depressed participants with the lowest cognitive motivation showed blunted autonomic reactivity as a function of load. CONCLUSIONS: Discounting patterns supported the hypothesis that people with current depression would be less willing to exert cognitive effort, and steeper discounting predicted lower global functioning in daily life. Heart rate fractal scaling proved to be a highly sensitive index of cognitive load, and data implied that people with lower motivation for cognitive effort had a diminished physiological capacity to respond to rising cognitive demands. State affect appeared to influence motivation among people with current depression given that they were more willing to exert cognitive effort following a sad mood induction.

The role of defeatist performance beliefs on cognitive effort-cost decision-making in schizophrenia.

Impairments in effort-cost decision-making have been consistently observed in people with schizophrenia (SZ) and may be an important mechanism of negative symptoms. However, the processes that give rise to impairments in effort-cost decision-making are unclear, leading to limited progress in identifying the most relevant treatment targets. Drawing from cognitive models of negative symptoms and goal-directed behavior, this study aimed to examine how and under what type of task conditions defeatist performance beliefs contribute to these decision-making processes. Outpatients with SZ (n = 30) and healthy controls (CN; n = 28) completed a cognitive effort allocation task, the Cognitive Effort-Discounting (COGED) task, which assesses participants' willingness to exert cognitive effort for monetary rewards based on parametrically varied working memory demands (completing N-back levels). Results showed that although participants with SZ demonstrated reduced willingness to work for rewards across N-back levels compared to CN participants, they showed less choice modulation across different N-back conditions. However, among SZ participants with greater defeatist performance beliefs, there was a reduced willingness to choose the high effort option at higher N-back levels (N-back levels 3, 4, and 5 versus 2-back). Results suggest that compared to CN, the SZ group's subjective willingness to expend effort largely did not dynamically adjust as cognitive load increased. However, defeatist beliefs may undermine willingness to expend cognitive effort, especially when cognitive task demands are high. These beliefs may be a viable treatment target to improve effort-cost decision-making impairments in people with SZ.

Cognitive effort avoidance in veterans with suicide attempt histories.

Suicide attempts (SA) are increasing in the United States, especially in veterans. Discovering individual cognitive features of the subset of suicide ideators who attempt suicide is critical. Cognitive theories attribute SA to facile schema-based negative interpretations of environmental events. Over-general autobiographical memory and facile solutions in problem solving tasks in SA survivors suggest that aversion to expending cognitive effort may be a neurobehavioral marker of SA risk. In veterans receiving care for mood disorder, we compared cognitive effort discounting and evidence-gathering in a beads task between veterans with (SAHx+; n = 26) versus without (SAHx-; n = 22) a history of SA. Groups did not differ in depressed mood or in a proxy metric of premorbid intelligence. Compared to SAHx- participants, SAHx+ participants self-reported significantly more severe cognitive problems in most domains, and also eschewed choice to earn higher monetary reward if earning it required a slightly increased working memory (WM) demand relative to an easy WM task. There was no group difference, however, in extent of evidence-gathering before declaring a conclusion in a beads task. These preliminary data suggest that aversion to expenditure of cognitive effort, potentially as a component of cognitive difficulties, may be a marker for SA risk.

Effects of average reward rate on vigor as a function of individual variation in striatal dopamine.

RATIONALE: We constantly need to decide not only which actions to perform, but also how vigorously to perform them. In agreement with an earlier theoretical model, it has been shown that a significant portion of the variance in our action vigor can be explained by the average rate of rewards received for that action. Moreover, this invigorating effect of average reward rate was shown to vary with within-subject changes in dopamine, both in human individuals and experimental rodents. OBJECTIVES: Here, we assessed whether individual differences in the effect of average reward rate on vigor are related to individual variation in a stable measure of striatal dopamine function in healthy, unmedicated participants. METHODS: Forty-four participants performed a discrimination task to test the effect of average reward rate on response times to index vigor and completed an [18F]-DOPA PET scan to index striatal dopamine synthesis capacity. RESULTS: We did not find an interaction between dopamine synthesis capacity and average reward rate across the entire group. However, a post hoc analysis revealed that participants with higher striatal dopamine synthesis capacity, particularly in the nucleus accumbens, exhibited a stronger invigorating effect of average reward rate among the 30 slowest participants. CONCLUSIONS: Our findings provide converging evidence for a role of striatal dopamine in average reward rate signaling, thereby extending the current literature on the mechanistic link between average reward rate, vigor, and dopamine.

Striatal dopamine dissociates methylphenidate effects on value-based versus surprise-based reversal learning.

Psychostimulants such as methylphenidate are widely used for their cognitive enhancing effects, but there is large variability in the direction and extent of these effects. We tested the hypothesis that methylphenidate enhances or impairs reward/punishment-based reversal learning depending on baseline striatal dopamine levels and corticostriatal gating of reward/punishment-related representations in stimulus-specific sensory cortex. Young healthy adults (N = 100) were scanned with functional magnetic resonance imaging during a reward/punishment reversal learning task, after intake of methylphenidate or the selective D2/3-receptor antagonist sulpiride. Striatal dopamine synthesis capacity was indexed with [18F]DOPA positron emission tomography. Methylphenidate improved and sulpiride decreased overall accuracy and response speed. Both drugs boosted reward versus punishment learning signals to a greater degree in participants with higher dopamine synthesis capacity. By contrast, striatal and stimulus-specific sensory surprise signals were boosted in participants with lower dopamine synthesis. These results unravel the mechanisms by which methylphenidate gates both attention and reward learning.

A randomised controlled trial of an open lung strategy with staircase recruitment, titrated PEEP and targeted low airway pressures in patients with acute respiratory distress syndrome.

INTRODUCTION: Tidal volume and plateau pressure minimisation are the standard components of a protective lung ventilation strategy for patients with acute respiratory distress syndrome (ARDS). Open lung strategies, including higher positive end-expiratory pressure (PEEP) and recruitment manoeuvres to date have not proven efficacious. This study examines the effectiveness and safety of a novel open lung strategy, which includes permissive hypercapnia, staircase recruitment manoeuvres (SRM) and low airway pressure with PEEP titration. METHOD: Twenty ARDS patients were randomised to treatment or ARDSnet control ventilation strategies. The treatment group received SRM with decremental PEEP titration and targeted plateau pressure < 30 cm H2O. Gas exchange and lung compliance were measured daily for 7 days and plasma cytokines in the first 24 hours and on days 1, 3, 5 and 7 (mean ± SE). Duration of ventilation, ICU stay and hospital stay (median and interquartile range) and hospital survival were determined. RESULTS: There were significant overall differences between groups when considering plasma IL-8 and TNF-α. For plasma IL-8, the control group was 41% higher than the treatment group over the seven-day period (ratio 1.41 (1.11 to 1.79), P = 0.01), while for TNF-α the control group was 20% higher over the seven-day period (ratio 1.20 (1.01 to 1.42) P = 0.05). PaO2/FIO2 (204 ± 9 versus 165 ± 9 mmHg, P = 0.005) and static lung compliance (49.1 ± 2.9 versus 33.7 ± 2.7 mls/cm H2O, P < 0.001) were higher in the treatment group than the control group over seven days. There was no difference in duration of ventilation (180 (87 to 298) versus 341 (131 to 351) hrs, P = 0.13), duration of ICU stay (9.9 (5.6 to 14.8) versus 16.0 (8.1 to 19.3) days, P = 0.19) and duration of hospital stay (17.9 (13.7 to 34.5) versus 24.7 (20.5 to 39.8) days, P = 0.16) between the treatment and control groups. CONCLUSIONS: This open lung strategy was associated with greater amelioration in some systemic cytokines, improved oxygenation and lung compliance over seven days. A larger trial powered to examine clinically-meaningful outcomes is warranted. TRIAL REGISTRATION: ACTRN12607000465459.

Age of red blood cells and mortality in the critically ill.

INTRODUCTION: In critically ill patients, it is uncertain whether exposure to older red blood cells (RBCs) may contribute to mortality. We therefore aimed to evaluate the association between the age of RBCs and outcome in a large unselected cohort of critically ill patients in Australia and New Zealand. We hypothesized that exposure to even a single unit of older RBCs may be associated with an increased risk of death. METHODS: We conducted a prospective, multicenter observational study in 47 ICUs during a 5-week period between August 2008 and September 2008. We included 757 critically ill adult patients receiving at least one unit of RBCs. To test our hypothesis we compared hospital mortality according to quartiles of exposure to maximum age of RBCs without and with adjustment for possible confounding factors. RESULTS: Compared with other quartiles (mean maximum red cell age 22.7 days; mortality 121/568 (21.3%)), patients treated with exposure to the lowest quartile of oldest RBCs (mean maximum red cell age 7.7 days; hospital mortality 25/189 (13.2%)) had an unadjusted absolute risk reduction in hospital mortality of 8.1% (95% confidence interval = 2.2 to 14.0%). After adjustment for Acute Physiology and Chronic Health Evaluation III score, other blood component transfusions, number of RBC transfusions, pretransfusion hemoglobin concentration, and cardiac surgery, the odds ratio for hospital mortality for patients exposed to the older three quartiles compared with the lowest quartile was 2.01 (95% confidence interval = 1.07 to 3.77). CONCLUSIONS: In critically ill patients, in Australia and New Zealand, exposure to older RBCs is independently associated with an increased risk of death.

Use of extracorporeal membrane lung assist device (Novalung) in H1N1 patients.

We present three patients with severe respiratory failure secondary to H1N1 influenza type A pneumonitis, in whom hypercapnia and respiratory acidosis were not controlled by the conventional mechanical lung ventilation or high-frequency oscillatory ventilation. Use of a pumpless arteriovenous extracorporeal carbon dioxide removal device (Novalung™, Inspiration Healthcare Ltd, Leicester, UK) resulted in reduced carbon dioxide levels, improved pH, and a reduction in inspiratory pressures, allowing for a less-harmful ventilator strategy. These cases demonstrate that the Novalung is a safe and effective device to use in patients with H1N1 pneumonitis refractory to the conventional therapy and may be an alternative to extracorporeal membrane oxygenation (ECMO) in selected cases.

A mosaic of cost-benefit control over cortico-striatal circuitry.

Dopamine contributes to cognitive control through well-established effects in both the striatum and cortex. Although earlier work suggests that dopamine affects cognitive control capacity, more recent work suggests that striatal dopamine may also impact on cognitive motivation. We consider the emerging perspective that striatal dopamine boosts control by making people more sensitive to the benefits versus the costs of cognitive effort, and we discuss how this sensitivity shapes competition between controlled and prepotent actions. We propose that dopamine signaling in distinct cortico-striatal subregions mediates different types of cost-benefit tradeoffs, and also discuss mechanisms for the local control of dopamine release, enabling selectivity among cortico-striatal circuits. In so doing, we show how this cost-benefit mosaic can reconcile seemingly conflicting findings about the impact of dopamine signaling on cognitive control.

Striatal dopamine synthesis capacity reflects smartphone social activity.

Striatal dopamine and smartphone behavior have both been linked with behavioral variability. Here, we leverage day-to-day logs of natural, unconstrained smartphone behavior and establish a correlation between a measure of smartphone social activity previously linked with behavioral variability and a measure of striatal dopamine synthesis capacity using [18F]-DOPA PET in (N = 22) healthy adult humans. Specifically, we find that a higher proportion of social app interactions correlates with lower dopamine synthesis capacity in the bilateral putamen. Permutation tests and penalized regressions provide evidence that this link between dopamine synthesis capacity and social versus non-social smartphone interactions is specific. These observations provide a key empirical grounding for current speculations about dopamine's role in digital social behavior.

Effort, avolition and motivational experience in schizophrenia: Analysis of behavioral and neuroimaging data with relationships to daily motivational experience.

Recent research suggests that schizophrenia is associated with reduced effort allocation. We examined willingness to expend effort, neural correlates of effort allocation, and the relationship of effort to daily motivational experience in schizophrenia. We recruited 28 individuals with schizophrenia and 30 controls to perform an effort task during fMRI. Individuals with schizophrenia also completed an ecological momentary assessment (EMA) protocol. Individuals with schizophrenia with high negative symptoms were less willing to expend effort for rewards. Daily EMA assessments of motivation were positively associated with effort allocation at a trend-level. Individuals with schizophrenia and controls displayed similar increases in BOLD activation in frontal, cingulate, parietal, and insular regions during effort-based decision-making. However, negative symptoms were associated with reduced BOLD activation in bilateral ventral striatum. These results replicate previous reports of reduced effort allocation in schizophrenia patients with severe negative symptoms, and provide evidence for the role of ventral striatum in effort impairments.