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1.
Proc Natl Acad Sci U S A ; 119(49): e2209078119, 2022 12 06.
Artigo em Inglês | MEDLINE | ID: mdl-36445964

RESUMO

In the history of humanity, most conflicts within and between societies have originated from perceived inequality in resource distribution. How humans achieve and maintain distributive justice has therefore been an intensely studied issue. However, most research on the corresponding psychological processes has focused on inequality aversion and has been largely agnostic of other motives that may either align or oppose this behavioral tendency. Here we provide behavioral, computational, and neuroimaging evidence that distribution decisions are guided by three distinct motives-inequality aversion, harm aversion, and rank reversal aversion-that interact with each other and can also deter individuals from pursuing equality. At the neural level, we show that these three motives are encoded by separate neural systems, compete for representation in various brain areas processing equality and harm signals, and are integrated in the striatum, which functions as a crucial hub for translating the motives to behavior. Our findings provide a comprehensive framework for understanding the cognitive and biological processes by which multiple prosocial motives are coordinated in the brain to guide redistribution behaviors. This framework enhances our understanding of the brain mechanisms underlying equality-related behavior, suggests possible neural origins of individual differences in social preferences, and provides a new pathway to understand the cognitive and neural basis of clinical disorders with impaired social functions.


Assuntos
Motivação , Justiça Social , Humanos , Encéfalo , Ciências Humanas , Afeto
2.
PLoS Biol ; 18(8): e3000800, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32776945

RESUMO

Studies of neural processes underlying delay of gratification usually focus on prefrontal networks related to curbing affective impulses. Here, we provide evidence for an alternative mechanism that facilitates delaying gratification by mental orientation towards the future. Combining continuous theta-burst stimulation (cTBS) with functional neuroimaging, we tested how the right temporoparietal junction (rTPJ) facilitates processing of future events and thereby promotes delay of gratification. Participants performed an intertemporal decision task and a mental time-travel task in the MRI scanner before and after receiving cTBS over the rTPJ or the vertex (control site). rTPJ cTBS led to both stronger temporal discounting for longer delays and reduced processing of future relative to past events in the mental time-travel task. This finding suggests that the rTPJ contributes to the ability to delay gratification by facilitating mental representation of outcomes in the future. On the neural level, rTPJ cTBS led to a reduction in the extent to which connectivity of rTPJ with striatum reflected the value of delayed rewards, indicating a role of rTPJ-striatum connectivity in constructing neural representations of future rewards. Together, our findings provide evidence that the rTPJ is an integral part of a brain network that promotes delay of gratification by facilitating mental orientation to future rewards.


Assuntos
Corpo Estriado/fisiologia , Tomada de Decisões/fisiologia , Desvalorização pelo Atraso/fisiologia , Rede Nervosa/fisiologia , Lobo Parietal/fisiologia , Lobo Temporal/fisiologia , Adulto , Mapeamento Encefálico , Corpo Estriado/anatomia & histologia , Corpo Estriado/diagnóstico por imagem , Feminino , Neuroimagem Funcional , Humanos , Comportamento Impulsivo/fisiologia , Masculino , Rede Nervosa/anatomia & histologia , Rede Nervosa/diagnóstico por imagem , Lobo Parietal/anatomia & histologia , Lobo Parietal/diagnóstico por imagem , Recompensa , Lobo Temporal/anatomia & histologia , Lobo Temporal/diagnóstico por imagem , Estimulação Magnética Transcraniana
3.
J Neurosci ; 2021 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-34103359

RESUMO

An organism's fitness is determined by how it chooses to adapt to effort in response to challenges. Exertion of effort correlates with activity in dorsomedial prefrontal cortex (dmPFC) and noradrenergic pupil dilation, but little is known about the role of these neurophysiological processes for decisions about future efforts - they may provide anticipatory energization to help us accept the challenge or a cost representation that is weighted against the expected rewards. Here we provide evidence for the former, by measuring pupil and fMRI brain responses while 52 human participants (29 females) chose whether to exert efforts to obtain rewards. Both pupil-dilation rate and dMPFC fMRI activity increased with anticipated effort level, and these increases differ depending on the choice outcome: They were stronger when participants chose to accept the challenge compared to when the challenge was declined. Crucially, the choice-dependent modulation of pupil and brain-activity effort representations were stronger in participants whose behavioral choices were more sensitive to effort. Our results identify a process involving the peripheral and central human nervous system that simulates the required energization prior to overt response, suggesting a role in guiding effort-based decisions.SIGNIFICANCE STATEMENT:The brain's arousal system tracks the effort we engage in during strenuous activity. But much less is known about what role this effort signaling may play when we decide whether to exert effort in the future. Here we characterize pupil-linked arousal and brain signals that guide decisions whether to engage in effort to gain money. During such choices, increases in brain activity and pupil dilation correlated with the effort involved in the chosen option, and these increases were stronger when people decided to accept the effort compared to when they rejected it. These results suggest that the brain arousal system guides decisions by energizing the organism for the prospective challenge.

4.
Neuromodulation ; 24(5): 890-898, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33078518

RESUMO

BACKGROUND: Migraine is a multifactorial neurovascular disorder, which affects about 12% of the general population. In episodic migraine, the visual cortex revealed abnormal processing, most likely due to decreased preactivation level. Transcranial direct current stimulation (tDCS) is able to modify cortical excitability and might result in an alleviation of migraine occurrence if used repetitively. OBJECTIVE: To test the hypothesis that self-administered anodal tDCS over the visual cortex significantly decreases the number of monthly migraine days in episodic migraine. MATERIALS AND METHODS: The study was single-blind, randomized, and sham-controlled. Inclusion criteria were age 18-80 years and an ICHD-3 diagnosis of episodic migraine. Exclusion criteria were pregnancy, presence of a neurodegenerative disorder, a contraindication against MRI examinations, and less than two migraine days during the 28-day baseline period. Patients in whom the baseline period suggested chronic migraine were excluded. After baseline, participants applied daily either verum (anodal-1 mA to 20 min) or sham tDCS (anodal-1 mA to 30 sec) at Oz (reference Cz electrode) for 28 days. Headache diaries were used to record the number of migraine days at baseline, during the stimulation period, and during four subsequent 28-day periods. RESULTS: Twenty-eight patients were included; two were excluded after the baseline period because less than two migraine days occurred; three were excluded because their headache diaries suggested the diagnosis of chronic migraine. Twenty-three datasets were taken for further analysis. Compared to sham tDCS (n = 12), verum tDCS (n = 11) resulted in a lower number of migraine days (p = 0.010) across all follow-up periods. We found no significant change in total headache days (p = 0.165), anxiety (p = 0.884), or depression scores (p = 0.535). No serious adverse events occurred; minor side effects were similar in both groups. CONCLUSIONS: This study provides Class II evidence that self-administered anodal tDCS over the visual cortex in episodic migraine results in a significantly lower number of monthly migraine days. However, it has neither an immediate nor a long-term effect.


Assuntos
Transtornos de Enxaqueca , Estimulação Transcraniana por Corrente Contínua , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Eletrodos , Humanos , Pessoa de Meia-Idade , Transtornos de Enxaqueca/terapia , Método Simples-Cego , Adulto Jovem
5.
Cereb Cortex ; 29(11): 4850-4862, 2019 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-30888032

RESUMO

While it is established that humans use model-based (MB) and model-free (MF) reinforcement learning in a complementary fashion, much less is known about how the brain determines which of these systems should control behavior at any given moment. Here we provide causal evidence for a neural mechanism that acts as a context-dependent arbitrator between both systems. We applied excitatory and inhibitory transcranial direct current stimulation over a region of the left ventrolateral prefrontal cortex previously found to encode the reliability of both learning systems. The opposing neural interventions resulted in a bidirectional shift of control between MB and MF learning. Stimulation also affected the sensitivity of the arbitration mechanism itself, as it changed how often subjects switched between the dominant system over time. Both of these effects depended on varying task contexts that either favored MB or MF control, indicating that this arbitration mechanism is not context-invariant but flexibly incorporates information about current environmental demands.


Assuntos
Tomada de Decisões/fisiologia , Córtex Pré-Frontal/fisiologia , Reforço Psicológico , Adulto , Feminino , Humanos , Masculino , Modelos Neurológicos , Modelos Psicológicos , Estimulação Transcraniana por Corrente Contínua , Estimulação Magnética Transcraniana , Adulto Jovem
6.
Proc Natl Acad Sci U S A ; 114(17): 4360-4364, 2017 04 25.
Artigo em Inglês | MEDLINE | ID: mdl-28396395

RESUMO

Honesty plays a key role in social and economic interactions and is crucial for societal functioning. However, breaches of honesty are pervasive and cause significant societal and economic problems that can affect entire nations. Despite its importance, remarkably little is known about the neurobiological mechanisms supporting honest behavior. We demonstrate that honesty can be increased in humans with transcranial direct current stimulation (tDCS) over the right dorsolateral prefrontal cortex. Participants (n = 145) completed a die-rolling task where they could misreport their outcomes to increase their earnings, thereby pitting honest behavior against personal financial gain. Cheating was substantial in a control condition but decreased dramatically when neural excitability was enhanced with tDCS. This increase in honesty could not be explained by changes in material self-interest or moral beliefs and was dissociated from participants' impulsivity, willingness to take risks, and mood. A follow-up experiment (n = 156) showed that tDCS only reduced cheating when dishonest behavior benefited the participants themselves rather than another person, suggesting that the stimulated neural process specifically resolves conflicts between honesty and material self-interest. Our results demonstrate that honesty can be strengthened by noninvasive interventions and concur with theories proposing that the human brain has evolved mechanisms dedicated to control complex social behaviors.


Assuntos
Córtex Pré-Frontal/fisiologia , Enganação , Tomada de Decisões , Feminino , Humanos , Masculino , Princípios Morais , Estimulação Transcraniana por Corrente Contínua
7.
Eur J Neurosci ; 49(5): 687-700, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30307650

RESUMO

The basal ganglia (BG) are involved in motivation and goal-directed behavior. Recent studies suggest that limbic territories of BG not only support reward seeking (appetitive approach) but also the encoding of aversive conditioned stimuli (CS) and the production of aversive-related behaviors (avoidance or escape). This study aimed to identify inside two BG nuclei, the striatum and pallidum, the territories involved in aversive behaviors and to compare the effects of stimulating these territories to those resulting from stimulation of the anterior Insula (aIns), a region that is well-known to be involved in aversive encoding and associated behaviors. Two monkeys performed an approach/avoidance task in which they had to choose a behavior (approach or avoidance) in an appetitive (reward) or aversive (air-puff) context. During this task, either one (single-cue) or two (dual-cue) CS provided essential information about which context-adapted behavior should be selected. Microstimulation was applied during the CS presentation. Stimulation generally reduced approaches in the appetitive contexts and increased escape behaviors (premature responses) and/or passive avoidance (noninitiated action) in aversive context. These effects were more pronounced in ventral parts of all examined structures, with significant differences observed between stimulated structures. Thresholds to induce effects were lowest in the pallidum. Striatal stimulation led to the largest diversity of effects, with a subregion even leading to enhanced active avoidance. Finally, aIns stimulations produced stronger effects in the dual-cue context. These results provide causal evidence that limbic territories of BG, like aIns, play crucial roles in the selection of context-motivated behaviors.


Assuntos
Aprendizagem da Esquiva/fisiologia , Comportamento Animal/fisiologia , Córtex Cerebral/fisiologia , Comportamento de Escolha/fisiologia , Corpo Estriado/fisiologia , Sistema Límbico/fisiologia , Animais , Comportamento Apetitivo/fisiologia , Condicionamento Clássico/fisiologia , Estimulação Elétrica , Feminino , Globo Pálido/fisiologia , Macaca fascicularis , Macaca mulatta , Masculino , Recompensa
8.
Nat Rev Neurosci ; 15(8): 549-62, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24986556

RESUMO

How does our brain choose the best course of action? Choices between material goods are thought to be steered by neural value signals that encode the rewarding properties of the choice options. Social decisions, by contrast, are traditionally thought to rely on neural representations of the self and others. However, recent studies show that many types of social decisions may also involve neural value computations. This suggests a unified mechanism for motivational control of behaviour that may incorporate both social and non-social factors. In this Review, we outline a theoretical framework that may help to identify possible overlaps and differences between the neural processes that guide social and non-social decision making.


Assuntos
Tomada de Decisões , Recompensa , Comportamento Social , Valores Sociais , Humanos , Percepção Social
9.
Ann Neurol ; 82(3): 409-418, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28833531

RESUMO

OBJECTIVES: Chronic sleep restriction is highly prevalent in modern society and is, in its clinical form, insufficient sleep syndrome, one of the most prevalent diagnoses in clinical sleep laboratories, with substantial negative impact on health and community burden. It reflects every-day sleep loss better than acute sleep deprivation, but its effects and particularly the underlying mechanisms remain largely unknown for a variety of critical cognitive domains, as, for example, risky decision making. METHODS: We assessed financial risk-taking behavior after 7 consecutive nights of sleep restriction and after 1 night of acute sleep deprivation compared to a regular sleep condition in a within-subject design. We further investigated potential underlying mechanisms of sleep-loss-induced changes in behavior by high-density electroencephalography recordings during restricted sleep. RESULTS: We show that chronic sleep restriction increases risk-seeking, whereas this was not observed after acute sleep deprivation. This increase was subjectively not noticed and was related to locally lower values of slow-wave energy during preceding sleep, an electrophysiological marker of sleep intensity and restoration, in electrodes over the right prefrontal cortex. INTERPRETATION: This study provides, for the first time, evidence that insufficient sleep restoration over circumscribed cortical areas leads to aberrant behavior. In chronically sleep restricted subjects, low slow-wave sleep intensity over the right prefrontal cortex-which has been shown to be linked to risk behavior-may lead to increased and subjectively unnoticed risk-seeking. Ann Neurol 2017;82:409-418.


Assuntos
Encéfalo/fisiopatologia , Assunção de Riscos , Privação do Sono/psicologia , Adolescente , Adulto , Comportamento de Escolha/fisiologia , Eletroencefalografia , Humanos , Masculino , Testes Neuropsicológicos , Polissonografia , Desempenho Psicomotor/fisiologia , Tempo de Reação/fisiologia , Sono/fisiologia , Privação do Sono/fisiopatologia , Adulto Jovem
10.
Cereb Cortex ; 27(2): 1094-1102, 2017 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-26656728

RESUMO

Goal-directed choices should be guided by the expected value of the available options. However, people are often influenced by past costs in their decisions, thus succumbing to a bias known as the "sunk-cost effect." Recent functional magnetic resonance imaging data show that the sunk-cost effect is associated with increased activity in dorsolateral prefrontal cortex (dlPFC) and altered crosstalk of the dlPFC with other prefrontal areas. Are these correlated neural processes causally involved in the sunk-cost effect? Here, we employed transcranial direct current stimulation (tDCS) to examine the role of the dlPFC for biasing choices in line with the cost of past expenses. Specifically, we applied different types of tDCS over the right dlPFC while participants performed an investment task designed to assess the impact of past investments on current choices. Our results show a pronounced sunk-cost effect that was significantly increased by anodal tDCS, but left unaltered by cathodal or sham stimulation. Importantly, choices were not affected by stimulation when no prior investments had been made, underlining the specificity of the obtained effect. Our findings suggest a critical role of the dlPFC in the sunk-cost effect and thus elucidate neural mechanisms by which past investments may influence current decision-making.


Assuntos
Tomada de Decisões/fisiologia , Córtex Pré-Frontal/fisiologia , Estimulação Transcraniana por Corrente Contínua , Adolescente , Adulto , Comportamento de Escolha , Método Duplo-Cego , Economia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Desempenho Psicomotor , Assunção de Riscos , Adulto Jovem
11.
Psychopathology ; 51(2): 105-109, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29642073

RESUMO

Several personality disorders involve pathological behaviors that violate social norms, commonly held expectations about what ought to be done in specific situations. These symptoms usually emerge early in development, are persistent and hard to treat, and are often ego-syntonic. Here I present some recent brain stimulation studies suggesting that pathological changes in different aspects of norm-compliant behavior reflect dysfunctions of brain circuits involving distinct prefrontal brain areas. One set of studies shows that transcranial direct current stimulation of the right lateral prefrontal cortex changes the behavioral sensitivity to social incentives for norm-compliant behavior. Crucially, social norm compliance in response to such incentives could even be increased during excitatory stimulation, demonstrating that the affected neural process is a biological prerequisite for appropriate reaction to social signals that trigger norm compliance. In another set of studies, we show that stimulation of a different (more dorsal) part of the right prefrontal cortex enhances honesty in a realistic setting where participants had the opportunity to cheat for real monetary gains. Interestingly, these stimulation-induced increases in both socially cued or purely voluntary norm compliance were not linked to changes in other aspects of decision- making (such as risk or impatience), and they did not reflect changes in beliefs about what is appropriate behavior. These results suggest that disorders of distinct brain circuits may causally underlie egosyntotic changes in norm-compliant behavior. This raises the tantalizing possibility that pathologies of norm-compliant behavior may be ameliorated by interventions targeting the function of these brain circuits.


Assuntos
Encéfalo/diagnóstico por imagem , Transtornos da Personalidade/diagnóstico , Normas Sociais , Estimulação Transcraniana por Corrente Contínua/métodos , Adulto , Feminino , Humanos , Masculino , Adulto Jovem
12.
J Neurosci ; 36(47): 12053-12065, 2016 11 23.
Artigo em Inglês | MEDLINE | ID: mdl-27881788

RESUMO

Gamma and beta oscillations are routinely observed in motor-related brain circuits during movement preparation and execution. Entrainment of gamma or beta oscillations via transcranial alternating current stimulation (tACS) over primary motor cortex (M1) has opposite effects on motor performance, suggesting a causal role of these brain rhythms for motor control. However, it is largely unknown which brain mechanisms characterize these changes in motor performance brought about by tACS. In particular, it is unclear whether these effects result from brain activity changes only in the targeted areas or within functionally connected brain circuits. Here we investigated this issue by applying gamma-band and beta-band tACS over M1 in healthy humans during a visuomotor task and concurrent functional magnetic resonance imaging (fMRI). Gamma tACS indeed improved both the velocity and acceleration of visually triggered movements, compared with both beta tACS and sham stimulation. Beta tACS induced a numerical decrease in velocity compared with sham stimulation, but this was not statistically significant. Crucially, gamma tACS induced motor performance enhancements correlated with changed BOLD activity in the stimulated M1. Moreover, we found frequency- and task-specific neural compensatory activity modulations in the dorsomedial prefrontal cortex (dmPFC), suggesting a key regulatory role of this region in motor performance. Connectivity analyses revealed that the dmPFC interacted functionally with M1 and with regions within the executive motor system. These results suggest a role of the dmPFC for motor control and show that tACS-induced behavioral changes not only result from activity modulations underneath the stimulation electrode but also reflect compensatory modulation within connected and functionally related brain networks. More generally, our results illustrate how combined tACS-fMRI can be used to resolve the causal link between cortical rhythms, brain systems, and behavior. SIGNIFICANCE STATEMENT: Recent research has suggested a causal role for gamma oscillations during movement preparation and execution. Here we combine transcranial alternating current stimulation (tACS) with functional magnetic resonance imaging (fMRI) to identify the neural mechanisms that accompany motor performance enhancements triggered by gamma tACS over the primary motor cortex. We show that the tACS-induced motor performance enhancements correlate with changed neural activity in the stimulated area and modulate, in a frequency- and task-specific manner, the neural activity in the dorsomedial prefrontal cortex. This suggests a regulatory role of this region for motor control. More generally, we show that combined tACS-fMRI can elucidate the causal link between brain oscillations, neural systems, and behavior.


Assuntos
Relógios Biológicos/fisiologia , Córtex Cerebral/fisiologia , Ritmo Gama/fisiologia , Movimento/fisiologia , Rede Nervosa/fisiologia , Desempenho Psicomotor/fisiologia , Sincronização Cortical/fisiologia , Feminino , Humanos , Masculino , Adulto Jovem
13.
J Neurosci ; 35(7): 3085-99, 2015 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-25698745

RESUMO

Incidental negative emotions unrelated to the current task, such as background anxiety, can strongly influence decisions. This is most evident in psychiatric disorders associated with generalized emotional disturbances. However, the neural mechanisms by which incidental emotions may affect choices remain poorly understood. Here we study the effects of incidental anxiety on human risky decision making, focusing on both behavioral preferences and their underlying neural processes. Although observable choices remained stable across affective contexts with high and low incidental anxiety, we found a clear change in neural valuation signals: during high incidental anxiety, activity in ventromedial prefrontal cortex and ventral striatum showed a marked reduction in (1) neural coding of the expected subjective value (ESV) of risky options, (2) prediction of observed choices, (3) functional coupling with other areas of the valuation system, and (4) baseline activity. At the same time, activity in the anterior insula showed an increase in coding the negative ESV of risky lotteries, and this neural activity predicted whether the risky lotteries would be rejected. This pattern of results suggests that incidental anxiety can shift the focus of neural valuation from possible positive consequences to anticipated negative consequences of choice options. Moreover, our findings show that these changes in neural value coding can occur in the absence of changes in overt behavior. This suggest a possible pathway by which background anxiety may lead to the development of chronic reward desensitization and a maladaptive focus on negative cognitions, as prevalent in affective and anxiety disorders.


Assuntos
Ansiedade/patologia , Ansiedade/psicologia , Mapeamento Encefálico , Encéfalo/fisiopatologia , Tomada de Decisões/fisiologia , Motivação/fisiologia , Assunção de Riscos , Análise de Variância , Encéfalo/irrigação sanguínea , Humanos , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Masculino , Oxigênio/sangue , Psicofísica , Tempo de Reação/fisiologia , Análise de Regressão , Reforço Psicológico , Adulto Jovem
14.
J Neurosci ; 35(43): 14544-56, 2015 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-26511245

RESUMO

Optimal behavior requires striking a balance between exploiting tried-and-true options or exploring new possibilities. Neuroimaging studies have identified different brain regions in humans where neural activity is correlated with exploratory or exploitative behavior, but it is unclear whether this activity directly implements these choices or simply reflects a byproduct of the behavior. Moreover, it remains unknown whether arbitrating between exploration and exploitation can be influenced with exogenous methods, such as brain stimulation. In our study, we addressed these questions by selectively upregulating and downregulating neuronal excitability with anodal or cathodal transcranial direct current stimulation over right frontopolar cortex during a reward-learning task. This caused participants to make slower, more exploratory or faster, more exploitative decisions, respectively. Bayesian computational modeling revealed that stimulation affected how much participants took both expected and obtained rewards into account when choosing to exploit or explore: Cathodal stimulation resulted in an increased focus on the option expected to yield the highest payout, whereas anodal stimulation led to choices that were less influenced by anticipated payoff magnitudes and were more driven by recent negative reward prediction errors. These findings suggest that exploration is triggered by a neural mechanism that is sensitive to prior less-than-expected choice outcomes and thus pushes people to seek out alternative courses of action. Together, our findings establish a parsimonious neurobiological mechanism that causes exploration and exploitation, and they provide new insights into the choice features used by this mechanism to direct decision-making.


Assuntos
Comportamento de Escolha/fisiologia , Comportamento Exploratório/fisiologia , Lobo Frontal/fisiologia , Estimulação Transcraniana por Corrente Contínua , Adulto , Teorema de Bayes , Tomada de Decisões/fisiologia , Eletrodos , Feminino , Humanos , Aprendizagem/fisiologia , Masculino , Modelos Psicológicos , Neuroimagem , Personalidade/fisiologia , Recompensa , Fatores Socioeconômicos , Adulto Jovem
15.
BMC Med Inform Decis Mak ; 16(1): 138, 2016 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-27809908

RESUMO

BACKGROUND: Cognitive biases and personality traits (aversion to risk or ambiguity) may lead to diagnostic inaccuracies and medical errors resulting in mismanagement or inadequate utilization of resources. We conducted a systematic review with four objectives: 1) to identify the most common cognitive biases, 2) to evaluate the influence of cognitive biases on diagnostic accuracy or management errors, 3) to determine their impact on patient outcomes, and 4) to identify literature gaps. METHODS: We searched MEDLINE and the Cochrane Library databases for relevant articles on cognitive biases from 1980 to May 2015. We included studies conducted in physicians that evaluated at least one cognitive factor using case-vignettes or real scenarios and reported an associated outcome written in English. Data quality was assessed by the Newcastle-Ottawa scale. Among 114 publications, 20 studies comprising 6810 physicians met the inclusion criteria. Nineteen cognitive biases were identified. RESULTS: All studies found at least one cognitive bias or personality trait to affect physicians. Overconfidence, lower tolerance to risk, the anchoring effect, and information and availability biases were associated with diagnostic inaccuracies in 36.5 to 77 % of case-scenarios. Five out of seven (71.4 %) studies showed an association between cognitive biases and therapeutic or management errors. Of two (10 %) studies evaluating the impact of cognitive biases or personality traits on patient outcomes, only one showed that higher tolerance to ambiguity was associated with increased medical complications (9.7 % vs 6.5 %; p = .004). Most studies (60 %) targeted cognitive biases in diagnostic tasks, fewer focused on treatment or management (35 %) and on prognosis (10 %). Literature gaps include potentially relevant biases (e.g. aggregate bias, feedback sanction, hindsight bias) not investigated in the included studies. Moreover, only five (25 %) studies used clinical guidelines as the framework to determine diagnostic or treatment errors. Most studies (n = 12, 60 %) were classified as low quality. CONCLUSIONS: Overconfidence, the anchoring effect, information and availability bias, and tolerance to risk may be associated with diagnostic inaccuracies or suboptimal management. More comprehensive studies are needed to determine the prevalence of cognitive biases and personality traits and their potential impact on physicians' decisions, medical errors, and patient outcomes.


Assuntos
Tomada de Decisão Clínica , Personalidade , Médicos/psicologia , Pensamento , Humanos
16.
Eur J Neurosci ; 42(1): 1667-74, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25970697

RESUMO

The successful acquisition of arithmetic skills is an essential step in the development of mathematical competencies and has been associated with neural activity in the left posterior parietal cortex (PPC). It is unclear, however, whether this brain region plays a causal role in arithmetic skill acquisition and whether arithmetic learning can be modulated by means of non-invasive brain stimulation of this key region. In the present study we addressed these questions by applying transcranial direct current stimulation (tDCS) over the left PPC during a short-term training that simulates the typical path of arithmetic skill acquisition (specifically the transition from effortful procedural to memory-based problem-solving strategies). Sixty participants received either anodal, cathodal or sham tDCS while practising complex multiplication and subtraction problems. The stability of the stimulation-induced learning effects was assessed in a follow-up test 24 h after the training. Learning progress was modulated by tDCS. Cathodal tDCS (compared with sham) decreased learning rates during training and resulted in poorer performance which lasted over 24 h after stimulation. Anodal tDCS showed an operation-specific improvement for subtraction learning. Our findings extend previous studies by demonstrating that the left PPC is causally involved in arithmetic learning (and not only in arithmetic performance) and that even a short-term tDCS application can modulate the success of arithmetic knowledge acquisition. Moreover, our finding of operation-specific anodal stimulation effects suggests that the enhancing effects of tDCS on learning can selectively affect just one of several cognitive processes mediated by the stimulated area.


Assuntos
Aprendizagem/fisiologia , Conceitos Matemáticos , Lobo Parietal/fisiologia , Resolução de Problemas/fisiologia , Estimulação Transcraniana por Corrente Contínua , Adulto , Feminino , Lateralidade Funcional , Humanos , Masculino , Adulto Jovem
17.
Cereb Cortex ; 24(11): 2815-21, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23794715

RESUMO

Voluntary selective attention can prioritize different features in a visual scene. The frontal eye-fields (FEF) are one potential source of such feature-specific top-down signals, but causal evidence for influences on visual cortex (as was shown for "spatial" attention) has remained elusive. Here, we show that transcranial magnetic stimulation (TMS) applied to right FEF increased the blood oxygen level-dependent (BOLD) signals in visual areas processing "target feature" but not in "distracter feature"-processing regions. TMS-induced BOLD signals increase in motion-responsive visual cortex (MT+) when motion was attended in a display with moving dots superimposed on face stimuli, but in face-responsive fusiform area (FFA) when faces were attended to. These TMS effects on BOLD signal in both regions were negatively related to performance (on the motion task), supporting the behavioral relevance of this pathway. Our findings provide new causal evidence for the human FEF in the control of nonspatial "feature"-based attention, mediated by dynamic influences on feature-specific visual cortex that vary with the currently attended property.


Assuntos
Atenção/fisiologia , Mapeamento Encefálico , Córtex Visual/fisiologia , Campos Visuais/fisiologia , Percepção Visual/fisiologia , Adulto , Feminino , Lateralidade Funcional , Humanos , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Masculino , Oxigênio/sangue , Estimulação Luminosa , Tempo de Reação/fisiologia , Estimulação Magnética Transcraniana , Córtex Visual/irrigação sanguínea , Adulto Jovem
18.
Cereb Cortex ; 24(5): 1152-64, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-23236204

RESUMO

Perception is an active inferential process in which prior knowledge is combined with sensory input, the result of which determines the contents of awareness. Accordingly, previous experience is known to help the brain "decide" what to perceive. However, a critical aspect that has not been addressed is that previous experience can exert 2 opposing effects on perception: An attractive effect, sensitizing the brain to perceive the same again (hysteresis), or a repulsive effect, making it more likely to perceive something else (adaptation). We used functional magnetic resonance imaging and modeling to elucidate how the brain entertains these 2 opposing processes, and what determines the direction of such experience-dependent perceptual effects. We found that although affecting our perception concurrently, hysteresis and adaptation map into distinct cortical networks: a widespread network of higher-order visual and fronto-parietal areas was involved in perceptual stabilization, while adaptation was confined to early visual areas. This areal and hierarchical segregation may explain how the brain maintains the balance between exploiting redundancies and staying sensitive to new information. We provide a Bayesian model that accounts for the coexistence of hysteresis and adaptation by separating their causes into 2 distinct terms: Hysteresis alters the prior, whereas adaptation changes the sensory evidence (the likelihood function).


Assuntos
Adaptação Fisiológica/fisiologia , Mapeamento Encefálico , Córtex Cerebral/fisiologia , Memória/fisiologia , Rede Nervosa/fisiologia , Percepção Visual/fisiologia , Adulto , Córtex Cerebral/irrigação sanguínea , Movimentos Oculares , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Modelos Logísticos , Imageamento por Ressonância Magnética , Masculino , Oxigênio/sangue , Estimulação Luminosa , Psicofísica , Adulto Jovem
19.
J Neurosci ; 33(39): 15466-76, 2013 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-24068815

RESUMO

Humans tend to use the self as a reference point to perceive the world and gain information about other people's mental states. However, applying such a self-referential projection mechanism in situations where it is inappropriate can result in egocentrically biased judgments. To assess egocentricity bias in the emotional domain (EEB), we developed a novel visuo-tactile paradigm assessing the degree to which empathic judgments are biased by one's own emotions if they are incongruent to those of the person we empathize with. A first behavioral experiment confirmed the existence of such EEB, and two independent fMRI experiments revealed that overcoming biased empathic judgments is associated with increased activation in the right supramarginal gyrus (rSMG), in a location distinct from activations in right temporoparietal junction reported in previous social cognition studies. Using temporary disruption of rSMG with repetitive transcranial magnetic stimulation resulted in a substantial increase of EEB, and so did reducing visuo-tactile stimulation time as shown in an additional behavioral experiment. Our findings provide converging evidence from multiple methods and experiments that rSMG is crucial for overcoming emotional egocentricity. Effective connectivity analyses suggest that this may be achieved by early perceptual regulation processes disambiguating proprioceptive first-person information (touch) from exteroceptive third-person information (vision) during incongruency between self- and other-related affective states. Our study extends previous models of social cognition. It shows that although shared neural networks may underlie emotional understanding in some situations, an additional mechanism subserved by rSMG is needed to avoid biased social judgments in other situations.


Assuntos
Encéfalo/fisiologia , Emoções/fisiologia , Empatia/fisiologia , Percepção Social , Mapeamento Encefálico , Humanos , Estimulação Luminosa , Psicologia Social , Tato
20.
Neuroimage ; 100: 145-60, 2014 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-24844745

RESUMO

We introduce matched-filter fMRI, which improves BOLD (blood oxygen level dependent) sensitivity by variable-density image acquisition tailored to subsequent image smoothing. Image smoothing is an established post-processing technique used in the vast majority of fMRI studies. Here we show that the signal-to-noise ratio of the resulting smoothed data can be substantially increased by acquisition weighting with a weighting function that matches the k-space filter imposed by the smoothing operation. We derive the theoretical SNR advantage of this strategy and propose a practical implementation of 2D echo-planar acquisition matched to common Gaussian smoothing. To reliably perform the involved variable-speed trajectories, concurrent magnetic field monitoring with NMR probes is used. Using this technique, phantom and in vivo measurements confirm reliable SNR improvement in the order of 30% in a "resting-state" condition and prove robust in different regimes of physiological noise. Furthermore, a preliminary task-based visual fMRI experiment equally suggests a consistent BOLD sensitivity increase in terms of statistical sensitivity (average t-value increase of about 35%). In summary, our study suggests that matched-filter acquisition is an effective means of improving BOLD SNR in studies that rely on image smoothing at the post-processing level.


Assuntos
Interpretação Estatística de Dados , Processamento de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética/métodos , Adulto , Sensibilidades de Contraste/fisiologia , Humanos , Razão Sinal-Ruído , Córtex Visual/fisiologia
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