Neurofunctional Differences in Cognitive and Behavioral Impulsivity in Veterans with PTSD

与创伤后应激相关的不良后果，如攻击性行为、冒险和自杀 创伤后应激障碍（PTSD）是退伍军人群体中持续存在的公共卫生问题。然而，PTSD相关的冲动 行为只是最近才成为一个主要的临床研究兴趣。理论模型表明， 创伤后应激障碍和冲动。认知神经科学的研究表明，冲动可以用两个 子领域：认知冲动（也称为选择冲动）或对直接 满足和行为冲动（也称为快速反应冲动）或行为困难 抑制作用认知冲动与不良后果有关，如危险的性行为， 药物滥用、行为冲动与暴力爆发和亲密伴侣暴力有关。 研究表明，认知冲动和行为冲动可能有不同的神经病理学根源。为 例如，认知冲动似乎与两种神经功能异常有关：1）表现不佳 从背外侧前额叶皮层（dlPFC）延伸到背侧纹状体的自我控制网络，以及2） 过度敏感的奖励网络，从腹内侧前额叶皮层（vmPFC）延伸到腹侧 纹状体另一方面，行为冲动似乎与内部连接减少有关。 从右额叶区域（右下额叶）延伸的右侧抑制性控制通路 皮质，右侧dlPFC）并穿过右侧颞顶区域。 了解认知和行为冲动如何与PTSD联系在一起，可能会为揭示创伤后应激障碍提供一条途径。 冲动性及其子领域与退伍军人PTSD相关不良后果相互作用的不同方式。 经过充分验证，功能磁共振成像顺从的任务允许单独的认知和行为冲动的审讯 神经回路系统，可用于进一步了解PTSD神经病理学。比如说， 时间折扣（TD）任务，检查较大的后来者之间的跨期选择， 更小的更快的提供了一个简单但可量化的认知冲动指数。类似地，go-no-go（GNG） 任务已被证明是有效的评估行为冲动，通过检查的频率， 委托错误（即当参与者对禁止刺激做出反应时）。然而，调查表明， 研究了作为PTSD相关冲动性基础的神经激活和功能连接， 退伍军人群体中的子域很少。因此，我们的目标是1）使用fMRI TD任务来检查 创伤后应激障碍退伍军人认知冲动的功能神经解剖学基础; 2）使用功能磁共振成像 GNG任务检查退伍军人行为冲动的功能神经解剖学基础， 创伤后应激障碍水平升高在更广泛的神经网络背景下检查PTSD相关的冲动性 功能障碍可能导致开发新的，基于神经回路的，以患者为中心的治疗方法， 针对与不良健康相关的可塑性认知和行为冲动相关目标定制 创伤后应激障碍退伍军人的结果。

Adverse outcomes, such as aggressive behavior, risk-taking, and suicide, associated with Posttraumatic Stress Disorder (PTSD) are an ongoing public health concern in Veteran populations. However, PTSD-related impulsive behavior has only recently become a major clinical research interest. Theoretical models suggest a link between PTSD and impulsivity. Cognitive neuroscience research indicates that impulsivity can be represented by two subdomains: cognitive impulsivity (also called choice impulsivity) or elevated sensitivity to immediate gratification and behavioral impulsivity (also called rapid response impulsivity) or difficulties with behavioral inhibition. Where cognitive impulsivity is associated with adverse outcomes such as risky sexual behavior and substance abuse, behavioral impulsivity is associated with violent outbursts and intimate partner violence. Research suggests that cognitive and behavioral impulsivity may have separate neuropathological origins. For example, cognitive impulsivity appears to be linked to two neurofunctional abnormalities: 1) an underperforming self-control network that extends from the dorsolateral prefrontal cortex (dlPFC) to the dorsal striatum and 2) an oversensitive reward network, which extends from ventromedial prefrontal cortex (vmPFC) to ventral striatum. On the other hand, behavioral impulsivity appears to be associated with a reduced connectivity within a right-lateralized inhibitory control pathway that extends from the right frontal region (right inferior frontal cortex, right dlPFC) and passes through the right temporoparietal region. Understanding how cognitive and behavioral impulsivity are linked to PTSD may provide a path for uncovering the different ways impulsivity and its subdomains interact with PTSD-related adverse outcomes in Veterans. Well validated, fMRI amenable tasks allow for the interrogation of separate cognitive and behavioral impulsivity neurocircuit systems, which could be utilized to further understand PTSD neuropathology. For example, temporal discounting (TD) tasks, which examine intertemporal choice between larger later reinforcers and smaller sooner ones provide a simple yet quantifiable index of cognitive impulsivity. Similarly, go-no-go (GNG) tasks have been shown to be effective in assessing behavioral impulsivity by examining the frequency of commission errors (i.e. when a participant responds to no-go stimuli). However, investigations that have examined the neuroactivation and functional connectivity that underlie PTSD – related impulsivity and its subdomains in Veteran populations are sparse. Therefore, we aim to 1) use an fMRI TD task to examine the functional neuroanatomical underpinnings of cognitive impulsivity in Veterans with PTSD and 2) use an fMRI GNG task to examine the functional neuroanatomical underpinnings of behavioral impulsivity in Veterans with elevated PTSD levels. Examining PTSD-related impulsivity within the context of broader neural network dysfunction may lead to the development of novel, neurocircuit based, patient-centered treatments that are tailored toward malleable cognitive and behavioral impulsivity-related targets linked to adverse health outcomes for Veterans with PTSD.