Reward, attention, and HIV-related risk in HIV+ individuals

Relating distractor suppression to problematic drinking behavior

BACKGROUND

Impaired cognitive control has been linked to weakened self-regulatory processes underlying compulsive substance intake. Previous research has provided evidence for impaired task performance in substance-abusing groups during Stroop and Go/No-Go tasks. Mechanisms of distractor suppression in visual search might also involve overlapping regulatory components that support goal-directed behavior by resolving the attentional competition between distractors and the target of search. However, the efficiency of learning-dependent distractor suppression has not been examined in the context of drug abuse and a direct comparison between cognitive control and distractor suppression is lacking.

METHOD

A total of 84 participants were assigned either to the heavy drinking group (ALC, n = 42) or the control group (CTL, n = 42) based on self-reported substance use. Participants completed the Alcohol Use Disorders Identification Test (AUDIT) and Barratt Impulsiveness Scale (BIS). After that, participants completed a computerized version of the Stroop task, Go/No-go task, and a visual search task measuring learning-dependent distractor suppression.

RESULTS

The Stroop effect and the frequency of no-go errors did not differ between groups. However, learned distractor suppression was significantly blunted in the ALC group compared to the control group. Across participants, performance on the Stroop and Go/No-go task were correlated, while the magnitude of distractor suppression was related to neither.

CONCLUSIONS

Our findings support a divergence of mechanistic processes underlying cognitive control and attentional control, and demonstrate impaired learning-dependent distractor suppression in heavy drinkers relative to a control group. Impaired distractor suppression offers new insight into why drug cues can be difficult to ignore.

On the reliability of value-modulated attentional capture: An online replication and multiverse analysis

Stimuli predicting rewards are more likely to capture attention, even when they are not relevant to our current goals. Individual differences in value-modulated attentional capture (VMAC) have been associated with various psychopathological conditions in the scientific literature. However, the claim that this attentional bias can predict individual differences requires further exploration of the psychometric properties of the most common experimental paradigms. The current study replicated the VMAC effect in a large online sample (N = 182) and investigated the internal consistency, with a design that allowed us to measure the effect during learning (rewarded phase) and after acquisition, once feedback was omitted (unrewarded phase). Through the rewarded phase there was gradual increase of the VMAC effect, which did not decline significantly throughout the unrewarded phase. Furthermore, we conducted a reliability multiverse analysis for 288 different data preprocessing specifications across both phases. Specifications including more blocks in the analysis led to better reliability estimates in both phases, while specifications that removed more outliers also improved reliability, suggesting that specifications with more, but less noisy, trials led to better reliability estimates. Nevertheless, in most instances, especially those considering fewer blocks of trials, reliability estimates fell below the minimum recommended thresholds for research on individual differences. Given the present results, we encourage researchers working on VMAC to take into account reliability when designing studies aimed at capturing individual differences and provide recommendations to improve methodological practices.

Trichotomy revisited: A monolithic theory of attentional control

The control of attention was long held to reflect the influence of two competing mechanisms of assigning priority, one goal-directed and the other stimulus-driven. Learning-dependent influences on the control of attention that could not be attributed to either of those two established mechanisms of control gave rise to the concept of selection history and a corresponding third mechanism of attentional control. The trichotomy framework that ensued has come to dominate theories of attentional control over the past decade, replacing the historical dichotomy. In this theoretical review, I readily affirm that distinctions between the influence of goals, salience, and selection history are substantive and meaningful, and that abandoning the dichotomy between goal-directed and stimulus-driven mechanisms of control was appropriate. I do, however, question whether a theoretical trichotomy is the right answer to the problem posed by selection history. If we reframe the influence of goals and selection history as different flavors of memory-dependent modulations of attentional priority and if we characterize the influence of salience as a consequence of insufficient competition from such memory-dependent sources of priority, it is possible to account for a wide range of attention-related phenomena with only one mechanism of control. The monolithic framework for the control of attention that I propose offers several concrete advantages over a trichotomy framework, which I explore here.

Rewarding outcomes enhance attentional capture and delay attentional disengagement

Attentional capture and disengagement are distinct process involved in attentional orienting. Most current studies have examined either the process of attentional capture or disengagement by manipulating stimuli associated with either positive (gains) or negative outcomes (losses). However, few studies have investigated whether attentional capture and disengagement are modulated by reward and loss outcomes. In the current study, we want to examine whether positive or negative outcomes could modulate distinguishing process of attentional capture and disengagement. Here, we manipulated different colored singleton stimuli associated with reward or loss outcomes; these stimuli were either presented at the center of screen or at the peripheral location. The participants' task was to search the target and identify the orientation of line segment in target as quickly as possible. The results showed that people had difficulty disengaging from a central reward-distractor, in comparison to loss- and neutral-distractor when target was presented at peripheral location. Similarly, peripheral reward-distractor captured more attention than loss- and neutral-distractor when target was presented at the center of screen after central fixation disappeared. Through our discoveries, we can conclude that positive rewards can increase attentional capture and delay attentional disengagement in healthy people.

An fMRI analysis of verbal and non-verbal working memory in people with a past history of opioid dependence

Introduction

Working memory describes the ability to maintain and manipulate information held in mind, and it is a fundamental aspect of executive function. Within drug addiction, impairments of executive control over behavior are thought to lead to poor decision making and risky behaviors. Previous research has demonstrated working memory (WM) and executive function difficulties in opioid-dependent individuals, but the neural underpinnings of such impairments in this population are not well understood.

Methods

This study used functional magnetic resonance imaging to examine the neural mechanisms involved in WM in 13 opioid-dependent, methadone-maintained participants (OP) and 13 matched, healthy controls (HC). A Sternberg item-recognition task was administered with three conditions: (1) a "verbal" condition in which participants determined whether any six visually presented target letters matched a probe item that was presented 4-6 s later, (2) a "non-verbal" condition in which participants were presented with a Chinese character and, following a 4-6 s delay, determined whether the character matched the probe item, and (3) a "control" condition in which participants were presented with three horizontal lines and following the same delay, determined whether the lines matched a probe item (always the same three lines). Functional magnetic resonance imaging (fMRI) contrasts focused on the delay (or "maintenance") phase for verbal and non-verbal conditions relative to the control condition.

Results

Accuracy on the WM task did not differ between groups, but the OP group was significantly slower to respond. The fMRI imaging results indicated differences in brain activity between the OP and HC groups. fMRI-guided regions of interest correlated with age of first alcohol and THC use, suggesting that early substance use, in addition to years of opioid-abuse, may have played a role in the OP group's WM performance.

Discussion

A deeper understanding of these neural differences between opioid-dependent individuals and their healthy control counterparts helps shed light on fundamental ways in which substance use impacts the brain and cognition, potentially opening up novel avenues for therapeutic targets to treat substance use disorder.

Sign-tracking modulates reward-related neural activation to reward cues, but not reward feedback

Research shows cognitive and neurobiological overlap between sign-tracking [value-modulated attentional capture (VMAC) by response-irrelevant, discrete cues] and maladaptive behaviour (e.g. substance abuse). We investigated the neural correlates of sign-tracking in 20 adults using an additional singleton task (AST) and functional magnetic resonance imaging (fMRI). Participants responded to a target to win monetary reward, the amount of which was signalled by singleton type (reward cue: high value vs. low value). Singleton responses resulted in monetary deductions. Sign-tracking-greater distraction by high-value vs. low-value singletons (H > L)-was observed, with high-value singletons producing slower responses to the target than low-value singletons. Controlling for age and sex, analyses revealed no differential brain activity across H > L singletons. Including sign-tracking as a regressor of interest revealed increased activity (H > L singletons) in cortico-subcortical loops, regions associated with Pavlovian conditioning, reward processing, attention shifts and relative value coding. Further analyses investigated responses to reward feedback (H > L). Controlling for age and sex, increased activity (H > L reward feedback) was found in regions associated with reward anticipation, attentional control, success monitoring and emotion regulation. Including sign-tracking as a regressor of interest revealed increased activity in the temporal pole, a region related to value discrimination. Results suggest sign-tracking is associated with activation of the 'attention and salience network' in response to reward cues but not reward feedback, suggesting parcellation between the two at the level of the brain. Results add to the literature showing considerable overlap in neural systems implicated in reward processing, learning, habit formation, emotion regulation and substance craving.

Characterization of basal ganglia volume changes in the context of HIV and polysubstance use

HIV and psychoactive substances can impact the integrity of the basal ganglia (BG), a neural substrate of cognition, motor control, and reward-seeking behaviors. This study assessed BG gray matter (GM) volume as a function of polysubstance (stimulant and opioid) use and HIV status. We hypothesized that comorbid polysubstance use and HIV seropositivity would alter BG GM volume differently than would polysubstance use or HIV status alone. We collected structural MRI scans, substance use history, and HIV diagnoses. Participants who had HIV (HIV +), a history of polysubstance dependence (POLY +), both, or neither completed assessments for cognition, motor function, and risk-taking behaviors (N = 93). All three clinical groups showed a left-lateralized pattern of GM reduction in the BG relative to controls. However, in the HIV + /POLY + group, stimulant use was associated with increased GM volume within the globus pallidus and putamen. This surpassed the effects from opioid use, as indicated by decreased GM volume throughout the BG in the HIV-/POLY + group. Motor learning was impaired in all three clinical groups, and in the HIV + /POLY + group, motor learning was associated with increased caudate and putamen GM volume. We also observed associations between BG GM volume and risk-taking behaviors in the HIV + /POLY- and HIV-/POLY + groups. The effects of substance use on the BG differed as a function of substance type used, HIV seropositivity, and BG subregion. Although BG volume decreased in association with HIV and opioid use, stimulants can, inversely, lead to BG volume increases within the context of HIV.

The past, present, and future of selection history

The last ten years of attention research have witnessed a revolution, replacing a theoretical dichotomy (top-down vs. bottom-up control) with a trichotomy (biased by current goals, physical salience, and selection history). This third new mechanism of attentional control, selection history, is multifaceted. Some aspects of selection history must be learned over time whereas others reflect much more transient influences. A variety of different learning experiences can shape the attention system, including reward, aversive outcomes, past experience searching for a target, target‒non-target relations, and more. In this review, we provide an overview of the historical forces that led to the proposal of selection history as a distinct mechanism of attentional control. We then propose a formal definition of selection history, with concrete criteria, and identify different components of experience-driven attention that fit within this definition. The bulk of the review is devoted to exploring how these different components relate to one another. We conclude by proposing an integrative account of selection history centered on underlying themes that emerge from our review.

Restoration of KCC2 Membrane Localization in Striatal Dopamine D2 Receptor-Expressing Medium Spiny Neurons Rescues Locomotor Deficits in HIV Tat-Transgenic Mice

People infected with HIV (PWH) are highly susceptible to striatal and hippocampal damage. Motor and memory impairments are common among these patients, likely as behavioral manifestations of damage to these brain regions. GABAergic dysfunction from HIV infection and viral proteins such as transactivator of transcription (Tat) have been well documented. We recently demonstrated that the neuron specific Cl- extruder, K+ Cl- cotransporter 2 (KCC2), is diminished after exposure to HIV proteins, including Tat, resulting in disrupted GABAAR-mediated hyperpolarization and inhibition. Here, we utilized doxycycline (DOX)-inducible, GFAP-driven HIV-1 Tat transgenic mice to further explore this phenomenon. After two weeks of Tat expression, we found no changes in hippocampal KCC2 levels, but a significant decrease in the striatum that was associated with hyperlocomotion in the open field assay. We were able to restore KCC2 activity and baseline locomotion with the KCC2 enhancer, CLP290. Additionally, we found that CLP290, whose mechanism of action has yet to be described, acts to restore phosphorylation of serine 940 resulting in increased KCC2 membrane localization. We also examined neuronal subpopulation contributions to the noted effects and found significant differences. Dopamine D2 receptor-expressing medium spiny neurons (MSNs) were selectively vulnerable to Tat-induced KCC2 loss, with no changes observed in dopamine D1 receptor-expressing MSNs. These results suggest that disinhibition/diminished hyperpolarization of dopamine D2 receptor-expressing MSNs can manifest as increased locomotion in this context. They further suggest that KCC2 activity might be a therapeutic target to alleviate motor disturbances related to HIV.

Reward history impacts attentional orienting and inhibitory control on untrained tasks

It has been robustly shown that stimuli with reward history receive attentional priority. However, the majority of this research tests reward history effects on attentional bias using similar tasks for both the reward learning phase and the unrewarded testing phase, which limits our understanding of how the effects of reward history generalize beyond the trained tasks and mental sets. Across two new experiments, the current study addresses these issues by first associating reward with a stimulus in a visual search paradigm, and then testing value-driven effects of that stimulus in untrained and unrewarded tasks, including a cueing paradigm, a go/no-go task, and a delay discounting task. Results of Experiment 1 demonstrate that history of reward association in a visual search task generalizes to value-driven attentional bias in a different attention paradigm (i.e., cueing), indicating these effects are indeed attributable to imbued value that can transfer to other tasks beyond that in which the reward was trained. The results of Experiment 2 demonstrate that in addition to eliciting attentional orienting on untrained tasks, reward history can lead to better inhibitory control in the go/no-go task. We find no evidence for reward history effects in the delay discounting task. Together, these experiments demonstrate that when the reward association task is in the attention domain, reward history modulates attentional priority, and this effect generalizes to untrained and unrewarded tasks that utilize both spatial and nonspatial attention.

Relating value-driven attention to psychopathology

Reward-associated objects receive preferential attention, reflecting a bias in information processing that develops automatically following associative learning. Mounting evidence suggests that such value-driven attention operates abnormally in certain psychopathologies, with attentional biases for reward-associated objects being either exaggerated or blunted compared to healthy controls. Here, I review the evidence linking value-driven attention to psychopathology, including drug addiction, depression, attention-deficit hyperactivity disorder (ADHD), compulsivity, and impulsive and risky decision-making. I conclude by offering an integrative framework for conceptualizing the link between value-driven attention and psychopathology, along with suggestions for future research into this burgeoning area of investigation, including research on object attachment.

From sign-tracking to attentional bias: Implications for gambling and substance use disorders

Sign-tracking behavior in Pavlovian autoshaping is known to be a relevant index of the incentive salience attributed to reward-related cues. Evidence has accumulated to suggest that animals that exhibit a sign-tracker phenotype are especially vulnerable to addiction and relapse due to their proneness to attribute incentive salience to drug cues, and their relatively weak cognitive and attentional control over their behavior. Interestingly, sign-tracking is also influenced by reward uncertainty in a way that may promote gambling disorder. Research indicates that reward uncertainty sensitizes sign-tracking responses and favors the development of a sign-tracker phenotype, compatible with the conditioned attractiveness of lights and sounds in casinos for problem gamblers. The study of attentional biases in humans (an effect akin to sign-tracking in animals) leads to similar observations, notably that the propensity to develop attraction for conditioned stimuli (CSs) is predictive of addictive behavior. Here we review the literature on drug addiction and gambling disorder, highlighting the similarities between studies of sign-tracking and attentional biases.

Dopaminergic impact of cART and anti-depressants on HIV neuropathogenesis in older adults

The success of combination antiretroviral therapy (cART) has transformed HIV infection into a chronic condition, resulting in an increase in the number of older, cART-treated adults living with HIV. This has increased the incidence of age-related, non-AIDS comorbidities in this population. One of the most common comorbidities is depression, which is also associated with cognitive impairment and a number of neuropathologies. In older people living with HIV, treating these overlapping disorders is complex, often creating pill burden or adverse drug-drug interactions that can exacerbate these neurologic disorders. Depression, NeuroHIV and many of the neuropsychiatric therapeutics used to treat them impact the dopaminergic system, suggesting that dopaminergic dysfunction may be a common factor in the development of these disorders. Further, changes in dopamine can influence the development of inflammation and the regulation of immune function, which are also implicated in the progression of NeuroHIV and depression. Little is known about the optimal clinical management of drug-drug interactions between cART drugs and antidepressants, particularly in regard to dopamine in older people living with HIV. This review will discuss those interactions, first examining the etiology of NeuroHIV and depression in older adults, then discussing the interrelated effects of dopamine and inflammation on these disorders, and finally reviewing the activity and interactions of cART drugs and antidepressants on each of these factors. Developing better strategies to manage these comorbidities is critical to the health of the aging, HIV-infected population, as the older population may be particularly vulnerable to drug-drug interactions affecting dopamine.

Measuring attention to reward as an individual trait: the value-driven attention questionnaire (VDAQ)

Reward history is a powerful determinant of what we pay attention to. This influence of reward on attention varies substantially across individuals, being related to a variety of personality variables and clinical conditions. Currently, the ability to measure and quantify attention-to-reward is restricted to the use of psychophysical laboratory tasks, which limits research into the construct in a variety of ways. In the present study, we introduce a questionnaire designed to provide a brief and accessible means of assessing attention-to-reward. Scores on the questionnaire correlate with other measures known to be related to attention-to-reward and predict performance on multiple laboratory tasks measuring the construct. In demonstrating this relationship, we also provide evidence that attention-to-reward as measured in the lab, an automatic and implicit bias in information processing, is related to overt behaviors and motivations in everyday life as assessed via the questionnaire. Variation in scores on the questionnaire is additionally associated with a distinct biomarker in brain connectivity, and the questionnaire exhibits acceptable test-retest reliability. Overall, the Value-Driven Attention Questionnaire (VDAQ) provides a useful proxy-measure of attention-to-reward that is much more accessible than typical laboratory assessments.

Threat reduces value-driven but not salience-driven attentional capture

What we direct our attention to is strongly influenced by both bottom-up and top-down processes. Moreover, the control of attention is biased by prior learning, such that attention is automatically captured by stimuli previously associated with either reward or threat. It is unknown whether value-oriented and threat-oriented mechanisms of selective information processing function independently of one another, or whether they interact with each other in the selection process. Here, we introduced the threat of electric shock into the value-driven attentional capture paradigm to examine whether the experience of threat influences the attention capturing quality of previously reward-associated stimuli. The results showed that value-driven attentional capture was blunted by the experience of threat. This contrasts with previous reports of threat potentiating attentional capture by physically salient stimuli, which we replicate here. Our findings demonstrate that threat selectively interferes with value-based but not salience-based attentional priority, consistent with a competitive relationship between value-based and threat-based information processing. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Reduced Value-Driven Attentional Capture Among Children with ADHD Compared to Typically Developing Controls

The current study examined whether children with ADHD were more distracted by a stimulus previously associated with reward, but currently goal-irrelevant, than their typically-developing peers. In addition, we also probed the associated cognitive and motivational mechanisms by examining correlations with other behavioral tasks. Participants included 8-12 year-old children with ADHD (n = 30) and typically developing controls (n = 26). Children were instructed to visually search for color-defined targets and received monetary rewards for accurate responses. In a subsequent search task in which color was explicitly irrelevant, we manipulated whether a distractor item appeared in a previously reward-associated color. We examined whether children responded more slowly on trials with the previously-rewarded distractor present compared to trials without this distractor, a phenomenon referred to as value-driven attentional capture (VDAC), and whether children with and without ADHD differed in the extent to which they displayed VDAC. Correlations among working memory performance, immediate reward preference (delay discounting) and attentional capture were also examined. Children with ADHD were significantly less affected by the presence of the previously rewarded distractor than were control participants. Within the ADHD group, greater value-driven attentional capture was associated with poorer working memory. Although both ADHD and control participants were initially distracted by previously reward-associated stimuli, the magnitude of distraction was larger and persisted longer among control participants.

Test-retest reliability of value-driven attentional capture

Attention is biased toward learned predictors of reward. The degree to which attention is automatically drawn to arbitrary reward cues has been linked to a variety of psychopathologies, including drug dependence, HIV-risk behaviors, depressive symptoms, and attention deficit/hyperactivity disorder. In the context of addiction specifically, attentional biases toward drug cues have been related to drug craving and treatment outcomes. Given the potential role of value-based attention in psychopathology, the ability to quantify the magnitude of such bias before and after a treatment intervention in order to assess treatment-related changes in attention allocation would be desirable. However, the test-retest reliability of value-driven attentional capture by arbitrary reward cues has not been established. In the present study, we show that an oculomotor measure of value-driven attentional capture produces highly robust test-retest reliability for a behavioral assessment, whereas the response time (RT) measure more commonly used in the attentional bias literature does not. Our findings provide methodological support for the ability to obtain a reliable measure of susceptibility to value-driven attentional capture at multiple points in time, and they highlight a limitation of RT-based measures that should inform the use of attentional-bias tasks as an assessment tool.

Effects of HIV-1 TAT protein and methamphetamine exposure on visual discrimination and executive function in mice

Mild neurocognitive impairments are common in people with human immunodeficiency virus (HIV) infection. HIV-encoded proteins, such as trans-activator of transcription (TAT), contribute to neuropathology and cognitive function in medicated subjects. The combination of TAT and comorbid methamphetamine use may further impair neurocognitive function in HIV-positive individuals by affecting dopaminergic systems in the brain. The current study examined the effects of TAT protein expression and methamphetamine exposure on cognitive function and dopamine systems in mice. Transgenic mice with inducible brain expression of the TAT protein were exposed to a binge methamphetamine regimen. TAT expression was induced via a doxycycline-containing diet during the final stage of the regimen and maintained throughout cognitive testing. Learning and executive function were assessed using an operant visual discrimination protocol, with a strategy switch and reversal. TAT expression and methamphetamine exposure improved visual discrimination learning. Combined TAT expression and methamphetamine exposure increased perseverative errors during reversal learning. TAT expression altered reversal learning by improving early stage, but impairing late stage, learning. TAT expression was also associated with an increase in dopamine transporter expression in the caudate putamen. These results highlight that TAT expression and methamphetamine exposure likely affect a range of selective cognitive processes, with some potentially improving function under certain conditions.

Relating Attentional Biases for Stimuli Associated with Social Reward and Punishment to Autistic Traits

Evidence for impaired attention to social stimuli in autism has been mixed. The role of social feedback in shaping attention to other, non-social stimuli that are predictive of such feedback has not been examined in the context of autism. In the present study, participants searched for a color-defined target during a training phase, with the color of the target predicting the emotional reaction of a face that appeared after each trial. Then, participants performed visual search for a shape-defined target while trying to ignore the color of stimuli. On a subset of trials, one of the non-targets was rendered in the color of a former target from training. Autistic traits were measured for each participant using the Autism Quotient (AQ). Our findings replicate robust attentional capture by stimuli learned to predict valenced social feedback. There was no evidence that autistic traits are associated with blunted attention to predictors of social outcomes. Consistent with an emerging body of literature, our findings cast doubt on strong versions of the claim that autistic traits can be explained by a blunted influence of social information on the attention system. We extend these findings to non-social stimuli that predict socially relevant information.

Selection history: How reward modulates selectivity of visual attention

Visual attention enables us to selectively prioritize or suppress information in the environment. Prominent models concerned with the control of visual attention differentiate between goal-directed, top-down and stimulus-driven, bottom-up control, with the former determined by current selection goals and the latter determined by physical salience. In the current review, we discuss recent studies that demonstrate that attentional selection does not need to be the result of top-down or bottom-up processing but, instead, is often driven by lingering biases due to the "history" of former attention deployments. This review mainly focuses on reward-based history effects; yet other types of history effects such as (intertrial) priming, statistical learning and affective conditioning are also discussed. We argue that evidence from behavioral, eye-movement and neuroimaging studies supports the idea that selection history modulates the topographical landscape of spatial "priority" maps, such that attention is biased toward locations having the highest activation on this map.

HIV, Tat and dopamine transmission

Human Immunodeficiency Virus (HIV) is a progressive infection that targets the immune system, affecting more than 37 million people around the world. While combinatorial antiretroviral therapy (cART) has lowered mortality rates and improved quality of life in infected individuals, the prevalence of HIV associated neurocognitive disorders is increasing and HIV associated cognitive decline remains prevalent. Recent research has suggested that HIV accessory proteins may be involved in this decline, and several studies have indicated that the HIV protein transactivator of transcription (Tat) can disrupt normal neuronal and glial function. Specifically, data indicate that Tat may directly impact dopaminergic neurotransmission, by modulating the function of the dopamine transporter and specifically damaging dopamine-rich regions of the CNS. HIV infection of the CNS has long been associated with dopaminergic dysfunction, but the mechanisms remain undefined. The specific effect(s) of Tat on dopaminergic neurotransmission may be, at least partially, a mechanism by which HIV infection directly or indirectly induces dopaminergic dysfunction. Therefore, precisely defining the specific effects of Tat on the dopaminergic system will help to elucidate the mechanisms by which HIV infection of the CNS induces neuropsychiatric, neurocognitive and neurological disorders that involve dopaminergic neurotransmission. Further, this will provide a discussion of the experiments needed to further these investigations, and may help to identify or develop new therapeutic approaches for the prevention or treatment of these disorders in HIV-infected individuals.

Mechanisms of Cognitive Aging in the HIV-Positive Adult

PURPOSE OF REVIEW

As of the year 2016, an estimated 50% of the United States' HIV-Positive population is aged 50 years or older. Due to a combination of increased rates of infection in older adults, and successful anti-retroviral (ART) regimens allowing HIV-positive adults to survive for decades with the disease, we are now faced with a steadily graying HIV-positive population, with only limited knowledge of how the cognitive and physiological effects of aging intersect with those of chronic HIV-infection.

RECENT FINDINGS

Age-related changes to mood, cognition, and neurological health may be experienced differently in those living with HIV, and research concerning quality of life, mental health, and cognitive aging needs to account for and explore these factors more carefully in the coming years.

SUMMARY

This review will explore the topic of cognitive aging with HIV: 1. Central nervous system (CNS) infection of HIV and how the virus affects brain integrity and function; 2. Cognitive and behavioral symptoms of HIV-Associated Neurocognitive Disorders (HAND); 3. Neurobiological theories of Cognitive Aging and how these processes may be exacerbated by HIV-infection; 4: Clinical implications and complications of aging with HIV and factors that may result in poorer cognitive outcomes.

Linking dopaminergic reward signals to the development of attentional bias: A positron emission tomographic study

The attention system is shaped by reward history, such that learned reward cues involuntarily draw attention. Recent research has begun to uncover the neural mechanisms by which learned reward cues compete for attention, implicating dopamine (DA) signaling within the dorsal striatum. How these elevated priority signals develop in the brain during the course of learning is less well understood, as is the relationship between value-based attention and the experience of reward during learning. We hypothesized that the magnitude of the striatal DA response to reward during learning contributes to the development of a learned attentional bias towards the cue that predicted it, and examined this hypothesis using positron emission tomography with [¹¹C]raclopride. We measured changes in dopamine release for rewarded versus unrewarded visual search for color-defined targets as indicated by the density and distribution of the available D₂/D₃ receptors. We then tested for correlations of individual differences in this measure of reward-related DA release to individual differences in the degree to which previously reward-associated but currently task-irrelevant stimuli impair performance in an attention task (i.e., value-driven attentional bias), revealing a significant relationship in the right anterior caudate. The degree to which reward-related DA release was right hemisphere lateralized was also predictive of later attentional bias. Our findings provide support for the hypothesis that value-driven attentional bias can be predicted from reward-related DA release during learning.

On the value-dependence of value-driven attentional capture

Findings from an increasingly large number of studies have been used to argue that attentional capture can be dependent on the learned value of a stimulus, or value-driven. However, under certain circumstances attention can be biased to select stimuli that previously served as targets, independent of reward history. Value-driven attentional capture, as studied using the training phase-test phase design introduced by Anderson and colleagues, is widely presumed to reflect the combined influence of learned value and selection history. However, the degree to which attentional capture is at all dependent on value learning in this paradigm has recently been questioned. Support for value-dependence can be provided through one of two means: (1) greater attentional capture by prior targets following rewarded training than following unrewarded training, and (2) greater attentional capture by prior targets previously associated with high compared to low value. Using a variant of the original value-driven attentional capture paradigm, Sha and Jiang (Attention, Perception, and Psychophysics, 78, 403-414, 2016) failed to find evidence of either, and raised criticisms regarding the adequacy of evidence provided by prior studies using this particular paradigm. To address this disparity, here we provided a stringent test of the value-dependence hypothesis using the traditional value-driven attentional capture paradigm. With a sufficiently large sample size, value-dependence was observed based on both criteria, with no evidence of attentional capture without rewards during training. Our findings support the validity of the traditional value-driven attentional capture paradigm in measuring what its name purports to measure.

Impairments of Motor Function While Multitasking in HIV

Human immunodeficiency virus (HIV) became a treatable illness with the introduction of combination antiretroviral therapy (CART). As a result, patients with regular access to CART are expected to live decades with HIV. Long-term HIV infection presents unique challenges, including neurocognitive impairments defined by three major stages of HIV-associated neurocognitive disorders (HAND). The current investigation aimed to study cognitive and motor impairments in HIV using a novel multitasking paradigm. Unlike current standard measures of cognitive and motor performance in HIV, multitasking increases real-world validity by mimicking the dual motor and cognitive demands that are part of daily professional and personal settings (e.g., driving, typing and writing). Moreover, multitask assessments can unmask compensatory mechanisms, normally used under single task conditions, to maintain performance. This investigation revealed that HIV+ participants were impaired on the motor component of the multitask, while cognitive performance was spared. A patient-specific positive interaction between motor performance and working memory recall was driven by poor HIV+ multitaskers. Surprisingly, HAND stage did not correspond with multitask performance and a variety of commonly used assessments indicated normal motor function among HIV+ participants with poor motor performance during the experimental task. These results support the use of multitasks to reveal otherwise hidden impairment in chronic HIV by expanding the sensitivity of clinical assessments used to determine HAND stage. Future studies should examine the capability of multitasks to predict performance in personal, professional and health-related behaviors and prognosis of patients living with chronic HIV.

Going for It

What we pay attention to is influenced by reward learning. Previously reward-associated stimuli are difficult to ignore, automatically drawing our attention even when we know they are no longer beneficial to us. Recent research has suggested that these value-dependent attentional biases affect more than just perception, biasing an individual to act in such a way as to pursue the attended stimulus. Here, I review this evidence and argue for a direct link between attentional biases and shifts in action-related priorities. Given this link, abnormal or otherwise inappropriate reward-related attentional biases are hypothesized to contribute to undesired habits and poor economic choices.

What is abnormal about addiction-related attentional biases?

BACKGROUND

The phenotype of addiction includes prominent attentional biases for drug cues, which play a role in motivating drug-seeking behavior and contribute to relapse. In a separate line of research, arbitrary stimuli have been shown to automatically capture attention when previously associated with reward in non-clinical samples.

METHODS AND RESULTS

Here, I argue that these two attentional biases reflect the same cognitive process. I outline five characteristics that exemplify attentional biases for drug cues: resistant to conflicting goals, robust to extinction, linked to dorsal striatal dopamine and to biases in approach behavior, and can distinguish between individuals with and without a history of drug dependence. I then go on to describe how attentional biases for arbitrary reward-associated stimuli share all of these features, and conclude by arguing that the attentional components of addiction reflect a normal cognitive process that promotes reward-seeking behavior.

Mechanisms of habitual approach: Failure to suppress irrelevant responses evoked by previously reward-associated stimuli

Reward learning has a powerful influence on the attention system, causing previously reward-associated stimuli to automatically capture attention. Difficulty ignoring stimuli associated with drug reward has been linked to addiction relapse, and the attention system of drug-dependent patients seems especially influenced by reward history. This and other evidence suggests that value-driven attention has consequences for behavior and decision-making, facilitating a bias to approach and consume the previously reward-associated stimulus even when doing so runs counter to current goals and priorities. Yet, a mechanism linking value-driven attention to behavioral responding and a general approach bias is lacking. Here we show that previously reward-associated stimuli escape inhibitory processing in a go/no-go task. Control experiments confirmed that this value-dependent failure of goal-directed inhibition could not be explained by search history or residual motivation, but depended specifically on the learned association between particular stimuli and reward outcome. When a previously high-value stimulus is encountered, the response codes generated by that stimulus are automatically afforded high priority, bypassing goal-directed cognitive processes involved in suppressing task-irrelevant behavior. (PsycINFO Database Record

Information processing biases in the brain: Implications for decision-making and self-governance

To make behavioral choices that are in line with our goals and our moral beliefs, we need to gather and consider information about our current situation. Most information present in our environment is not relevant to the choices we need or would want to make and thus could interfere with our ability to behave in ways that reflect our underlying values. Certain sources of information could even lead us to make choices we later regret, and thus it would be beneficial to be able to ignore that information. Our ability to exert successful self-governance depends on our ability to attend to sources of information that we deem important to our decision-making processes. We generally assume that, at any moment, we have the ability to choose what we pay attention to. However, recent research indicates that what we pay attention to is influenced by our prior experiences, including reward history and past successes and failures, even when we are not aware of this history. Even momentary distractions can cause us to miss or discount information that should have a greater influence on our decisions given our values. Such biases in attention thus raise questions about the degree to which the choices that we make may be poorly informed and not truly reflect our ability to otherwise exert self-governance.

The Role of Dopamine in Value-Based Attentional Orienting

Reward learning gives rise to strong attentional biases. Stimuli previously associated with reward automatically capture visual attention regardless of intention. Dopamine signaling within the ventral striatum plays an important role in reward learning, representing the expected reward initiated by a cue. How dopamine and the striatum may be involved in maintaining behaviors that have been shaped by reward learning, even after reward expectancies have changed, is less well understood. Nonspecific measures of brain activity have implicated the striatum in value-based attention. However, the neurochemical mechanisms underlying the attentional priority of learned reward cues remain unexplored. Here, we investigated the contribution of dopamine to value-based attention using positron emission tomography (PET) with [(11)C]raclopride. We show that, in the explicit absence of reward, the magnitude of attentional capture by previously reward-associated but currently task-irrelevant distractors is correlated across individuals with changes in available D2/D3 dopamine receptors (presumably due to intrasynaptic dopamine) linked to distractor processing within the right caudate and posterior putamen. Our findings provide direct evidence linking dopamine signaling within the striatum to the involuntary orienting of attention, and specifically to the attention-grabbing quality of learned reward cues. These findings also shed light on the neurochemical basis of individual susceptibility to value-driven attentional capture, which is known to play a role in addiction. More broadly, the present study highlights the value and feasibility of using PET to relate changes in the release of a neurotransmitter to learning-dependent changes in healthy adults.