Marcus J. Naumer

Factors modulating neural reactivity to drug cues in addiction: A survey of human neuroimaging studies

Human neuroimaging studies suggest that neural cue reactivity is strongly associated with indices of drug use, including addiction severity and treatment success. However, little is known about factors that modulate cue reactivity. The goal of this review, in which we survey published fMRI and PET studies on drug cue reactivity in cocaine, alcohol, and tobacco cigarette users, is to highlight major factors that modulate brain reactivity to drug cues. First, we describe cue reactivity paradigms used in neuroimaging research and outline the brain circuits that underlie cue reactivity. We then discuss major factors that have been shown to modulate cue reactivity and review specific evidence as well as outstanding questions related to each factor. Building on previous model-building reviews on the topic, we then outline a simplified model that includes the key modulatory factors and a tentative ranking of their relative impact. We conclude with a discussion of outstanding challenges and future research directions, which can inform future neuroimaging studies as well as the design of treatment and prevention programs.

Object Familiarity and Semantic Congruency Modulate Responses in Cortical Audiovisual Integration Areas

The cortical integration of auditory and visual features is crucial for efficient object recognition. Previous studies have shown that audiovisual (AV) integration is affected by where and when auditory and visual features occur. However, because relatively little is known about the impact of what is integrated, we here investigated the impact of semantic congruency and object familiarity on the neural correlates of AV integration. We used functional magnetic resonance imaging to identify regions involved in the integration of both (congruent and incongruent) familiar animal sounds and images and of arbitrary combinations of unfamiliar artificial sounds and object images. Unfamiliar object images and sounds were integrated in the inferior frontal cortex (IFC), possibly reflecting learning of novel AV associations. Integration of familiar, but semantically incongruent combinations also correlated with IFC activation and additionally involved the posterior superior temporal sulcus (pSTS). For highly familiar semantically congruent AV pairings, we again found AV integration effects in pSTS and additionally in superior temporal gyrus. These findings demonstrate that the neural correlates of object-related AV integration reflect both semantic congruency and familiarity of the integrated sounds and images.

Brain Regions Related to Tool Use and Action Knowledge Reflect Nicotine Dependence

In addition to reward- and craving-related processes, habitual mechanisms play an important role in addiction. While the dorsal striatum has been proposed to code for the motivational state of habitual drug-seeking actions, the neural underpinnings of the corresponding drug-taking skills and action knowledge remain poorly understood. We used functional magnetic resonance imaging (fMRI) and a behavioral orientation affordance paradigm to investigate the neural and behavioral correlates of automatized drug-taking actions in nicotine dependence. Smokers exhibited higher fMRI activations than nonsmokers when viewing smoking-related but not when viewing control images. These group differences in fMRI activations were located not only in brain regions associated with craving and habitual learning (left ventral and dorsal striatum, dorsolateral prefrontal cortex, insula, uncus, medial frontal gyrus, right subcallosal gyrus, and bilateral parahippocampal gyrus), but also in a network of brain regions which has been strongly implicated in the encoding of action knowledge and tool use skills (bilateral premotor cortex, left superior parietal lobule, and right lateral cerebellum). A behavioral affordance reaction-time task indicated that smokers, but not nonsmokers, showed an automatized responsiveness to smoking paraphernalia similar to everyday objects. Moreover, smokers showed strong intercorrelations between fMRI activations in tool use-related brain regions, behavioral responsiveness to smoking-related cues, and severity of nicotine dependence. Apparently smoking-related action representations in smokers are stored in brain regions typically representing tool use skills and action knowledge. Most importantly, cortical and behavioral correlates of the respective drug-taking skills vary with the individual degree of nicotine dependence.

Functional neuroimaging studies in addiction: Multisensory drug stimuli and neural cue reactivity

Neuroimaging studies on cue reactivity have substantially contributed to the understanding of addiction. In the majority of studies drug cues were presented in the visual modality. However, exposure to conditioned cues in real life occurs often simultaneously in more than one sensory modality. Therefore, multisensory cues should elicit cue reactivity more consistently than unisensory stimuli and increase the ecological validity and the reliability of brain activation measurements. This review includes the data from 44 whole-brain functional neuroimaging studies with a total of 1168 subjects (812 patients and 356 controls). Correlations between neural cue reactivity and clinical covariates such as craving have been reported significantly more often for multisensory than unisensory cues in the motor cortex, insula and posterior cingulate cortex. Thus, multisensory drug cues are particularly effective in revealing brain-behavior relationships in neurocircuits of addiction responsible for motivation, craving awareness and self-related processing.

Cortical Plasticity of Audio–Visual Object Representations

Several regions in human temporal and frontal cortex are known to integrate visual and auditory object features. The processing of audio–visual (AV) associations in these regions has been found to be modulated by object familiarity. The aim of the present study was to explore training-induced plasticity in human cortical AV integration. We used functional magnetic resonance imaging to analyze the neural correlates of AV integration for unfamiliar artificial object sounds and images in naïve subjects (PRE training) and after a behavioral training session in which subjects acquired associations between some of these sounds and images (POST-training). In the PRE-training session, unfamiliar artificial object sounds and images were mainly integrated in right inferior frontal cortex (IFC). The POST-training results showed extended integration-related IFC activations bilaterally, and a recruitment of additional regions in bilateral superior temporal gyrus/sulcus and intraparietal sulcus. Furthermore, training-induced differential response patterns to mismatching compared with matching (i.e., associated) artificial AV stimuli were most pronounced in left IFC. These effects were accompanied by complementary training-induced congruency effects in right posterior middle temporal gyrus and fusiform gyrus. Together, these findings demonstrate that short-term cross-modal association learning was sufficient to induce plastic changes of both AV integration of object stimuli and mechanisms of AV congruency processing.

Bilateral visual field maps in a patient with only one hemisphere

In mammals smooth retinotopic maps of the visual field are formed along the visual processing pathway whereby the left visual field is represented in the right hemisphere and vice versa. The reorganization of retinotopic maps in the lateral geniculate nucleus (LGN) of the thalamus and early visual areas (V1–V3) is studied in a patient who was born with only one cerebral hemisphere. Before the seventh week of embryonic gestation, the development of the patients right cerebral hemisphere terminated. Despite the complete loss of her right hemisphere (di- and telencephalon) at birth, the patients remaining hemisphere has not only developed maps of the contralateral (right) visual hemifield but, surprisingly, also maps of the ipsilateral (left) visual hemifield. Retinal ganglion-cells changed their predetermined crossing pattern in the optic chiasm and grew to the ipsilateral LGN. In the visual cortex, islands of ipsilateral visual field representations were located along the representations of the vertical meridian. In V1, smooth and continuous maps from contra- and ipsilateral hemifield overlap each other, whereas in ventral V2 and V3 ipsilateral quarter field representations invaded small distinct cortical patches. This reveals a surprising flexibility of the self-organizing developmental mechanisms responsible for map formation.

Sensory and motor aspects of addiction

Research on the psychological and neuronal underpinnings of addiction has concentrated mostly on affective, motivational, learning, and executive processes and the brain regions subserving these functions. In contrast, sensory and motor aspects of addiction have largely been neglected even though they may be highly relevant for the development and preservation of addiction. The aim of the present review is to emphasize the significance of sensory and motor processes for the better understanding and treatment of addiction. We focus on research investigating substance-related addictions and on brain imaging studies in humans that have assessed the contribution of cortical and cerebellar systems to sensory and motor mechanisms of addiction. Activations of sensory and motor brain regions in response to drug-associated cues can predict relapse and correlate with craving, severity of dependence and automatized behavioral reactions towards drug-related stimuli. We propose a model of how sensory and motor processes might be involved in the different stages of addiction.

Temporal Characteristics of Audiovisual Information Processing

In complex natural environments, auditory and visual information often have to be processed simultaneously. Previous functional magnetic resonance imaging (fMRI) studies focused on the spatial localization of brain areas involved in audiovisual (AV) information processing, but the temporal characteristics of AV information flow in these regions remained unclear. In this study, we used fMRI and a novel information–theoretic approach to study the flow of AV sensory information. Subjects passively perceived sounds and images of objects presented either alone or simultaneously. Applying the measure of mutual information, we computed for each voxel the latency in which the blood oxygenation level-dependent signal had the highest information content about the preceding stimulus. The results indicate that, after AV stimulation, the earliest informative activity occurs in right Heschls gyrus, left primary visual cortex, and the posterior portion of the superior temporal gyrus, which is known as a region involved in object-related AV integration. Informative activity in the anterior portion of superior temporal gyrus, middle temporal gyrus, right occipital cortex, and inferior frontal cortex was found at a later latency. Moreover, AV presentation resulted in shorter latencies in multiple cortical areas compared with isolated auditory or visual presentation. The results provide evidence for bottom-up processing from primary sensory areas into higher association areas during AV integration in humans and suggest that AV presentation shortens processing time in early sensory cortices.

Audiovisual Functional Magnetic Resonance Imaging Adaptation Reveals Multisensory Integration Effects in Object-Related Sensory Cortices

Information integration across different sensory modalities contributes to object recognition, the generation of associations and long-term memory representations. Here, we used functional magnetic resonance imaging adaptation to investigate the presence of sensory integrative effects at cortical levels as early as nonprimary auditory and extrastriate visual cortices, which are implicated in intermediate stages of object processing. Stimulation consisted of an adapting audiovisual stimulus S1 and a subsequent stimulus S2 from the same basic-level category (e.g., cat). The stimuli were carefully balanced with respect to stimulus complexity and semantic congruency and presented in four experimental conditions: (1) the same image and vocalization for S1 and S2, (2) the same image and a different vocalization, (3) different images and the same vocalization, or (4) different images and vocalizations. This two-by-two factorial design allowed us to assess the contributions of auditory and visual stimulus repetitions and changes in a statistically orthogonal manner. Responses in visual regions of right fusiform gyrus and right lateral occipital cortex were reduced for repeated visual stimuli (repetition suppression). Surprisingly, left lateral occipital cortex showed stronger responses to repeated auditory stimuli (repetition enhancement). Similarly, auditory regions of interest of the right middle superior temporal gyrus and sulcus exhibited repetition suppression to auditory repetitions and repetition enhancement to visual repetitions. Our findings of crossmodal repetition-related effects in cortices of the respective other sensory modality add to the emerging view that in human subjects sensory integrative mechanisms operate on earlier cortical processing levels than previously assumed.

Sensory modality of smoking cues modulates neural cue reactivity

RationaleBehavioral experiments have demonstrated that the sensory modality of presentation modulates drug cue reactivity.ObjectivesThe present study on nicotine addiction tested whether neural responses to smoking cues are modulated by the sensory modality of stimulus presentation.MethodsWe measured brain activation using functional magnetic resonance imaging (fMRI) in 15 smokers and 15 nonsmokers while they viewed images of smoking paraphernalia and control objects and while they touched the same objects without seeing them.ResultsHaptically presented, smoking-related stimuli induced more pronounced neural cue reactivity than visual cues in the left dorsal striatum in smokers compared to nonsmokers. The severity of nicotine dependence correlated positively with the preference for haptically explored smoking cues in the left inferior parietal lobule/somatosensory cortex, right fusiform gyrus/inferior temporal cortex/cerebellum, hippocampus/parahippocampal gyrus, posterior cingulate cortex, and supplementary motor area.ConclusionsThese observations are in line with the hypothesized role of the dorsal striatum for the expression of drug habits and the well-established concept of drug-related automatized schemata, since haptic perception is more closely linked to the corresponding object-specific action pattern than visual perception. Moreover, our findings demonstrate that with the growing severity of nicotine dependence, brain regions involved in object perception, memory, self-processing, and motor control exhibit an increasing preference for haptic over visual smoking cues. This difference was not found for control stimuli. Considering the sensory modality of the presented cues could serve to develop more reliable fMRI-specific biomarkers, more ecologically valid experimental designs, and more effective cue-exposure therapies of addiction.