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Sayalı C, van den Bosch R, Määttä JI, Hofmans L, Papadopetraki D, Booij J, Verkes RJ, Baas M, Cools R. Methylphenidate undermines or enhances divergent creativity depending on baseline dopamine synthesis capacity. Neuropsychopharmacology 2023; 48:1849-1858. [PMID: 37270619 PMCID: PMC10584959 DOI: 10.1038/s41386-023-01615-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/10/2023] [Accepted: 05/17/2023] [Indexed: 06/05/2023]
Abstract
Catecholamine-enhancing psychostimulants, such as methylphenidate have long been argued to undermine creative thinking. However, prior evidence for this is weak or contradictory, stemming from studies with small sample sizes that do not consider the well-established large variability in psychostimulant effects across different individuals and task demands. We aimed to definitively establish the link between psychostimulants and creative thinking by measuring effects of methylphenidate in 90 healthy participants on distinct creative tasks that measure convergent and divergent thinking, as a function of individuals' baseline dopamine synthesis capacity, indexed with 18F-FDOPA PET imaging. In a double-blind, within-subject design, participants were administered methylphenidate, placebo or selective D2 receptor antagonist sulpiride. The results showed that striatal dopamine synthesis capacity and/or methylphenidate administration did not affect divergent and convergent thinking. However, exploratory analysis demonstrated a baseline dopamine-dependent effect of methylphenidate on a measure of response divergence, a creativity measure that measures response variability. Response divergence was reduced by methylphenidate in participants with low dopamine synthesis capacity but enhanced in those with high dopamine synthesis capacity. No evidence of any effect of sulpiride was found. These results show that methylphenidate can undermine certain forms of divergent creativity but only in individuals with low baseline dopamine levels.
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Affiliation(s)
- Ceyda Sayalı
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Ruben van den Bosch
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Jessica I Määttä
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Lieke Hofmans
- Department of Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Danae Papadopetraki
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jan Booij
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, The Netherlands
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robbert-Jan Verkes
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Matthijs Baas
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Roshan Cools
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
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van den Bosch R, Hezemans FH, Määttä JI, Hofmans L, Papadopetraki D, Verkes RJ, Marquand AF, Booij J, Cools R. Evidence for absence of links between striatal dopamine synthesis capacity and working memory capacity, spontaneous eye-blink rate, and trait impulsivity. eLife 2023; 12:83161. [PMID: 37083626 PMCID: PMC10162803 DOI: 10.7554/elife.83161] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 04/19/2023] [Indexed: 04/22/2023] Open
Abstract
Individual differences in striatal dopamine synthesis capacity have been associated with working memory capacity, trait impulsivity and spontaneous eye-blink rate (sEBR), as measured with readily available and easily administered, 'off-the-shelf' tests. Such findings have raised the suggestion that individual variation in dopamine synthesis capacity, estimated with expensive and invasive brain positron emission tomography (PET) scans, can be approximated with simple, more pragmatic tests. However, direct evidence for the relationship between these simple trait measures and striatal dopamine synthesis capacity has been limited and inconclusive. We measured striatal dopamine synthesis capacity using [18F]-FDOPA PET in a large sample of healthy volunteers (N=94) and assessed the correlation with simple, short tests of working memory capacity, trait impulsivity, and sEBR. We additionally explored the relationship with an index of subjective reward sensitivity. None of these trait measures correlated significantly with striatal dopamine synthesis capacity, nor did they have out-of-sample predictive power. Bayes Factor analyses indicated the evidence was in favour of absence of correlations for all but subjective reward sensitivity. These results warrant caution for using these off-the-shelf trait measures as proxies of striatal dopamine synthesis capacity.
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Affiliation(s)
- Ruben van den Bosch
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Frank H Hezemans
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Jessica I Määttä
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Lieke Hofmans
- Department of Developmental Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Danae Papadopetraki
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Robbert-Jan Verkes
- Department of Psychiatry, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Andre F Marquand
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Jan Booij
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Roshan Cools
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, Netherlands
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Chen P, Geurts DEM, Määttä JI, van den Bosch R, Hofmans L, Papadopetraki D, den Ouden H, Cools R. Effect of striatal dopamine on Pavlovian bias. A large [¹⁸F]-DOPA PET study. Behav Neurosci 2023; 137:184-195. [PMID: 36633988 DOI: 10.1037/bne0000547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Interaction between Pavlovian and instrumental control systems is key for adaptive motivated behavior, but also plays an important role in various neuropsychiatric disorders, including depression, addiction, and anxiety. Here, we employed the flouorodopa positron emission tomography ([¹⁸F]-DOPA PET) in healthy participants (N = 100) to assess whether dopamine synthesis capacity (Ki), specifically in the ventral striatum, accounts for individual variation in Pavlovian-to-instrumental transfer (PIT). Surprisingly, this was not the case. Rather, the relationship of ventral striatal Ki with PIT depended on working memory (WM) capacity. Ventral striatal dopamine boosted the effects of Pavlovian cues on instrumental responding to a greater degree in participants with higher WM capacity. Caution is warranted to interpret this post hoc four-way interaction given the modest sample size. Nonetheless, these results chime with prior findings demonstrating that dopaminergic drugs boost Pavlovian biases to a greater degree in participants with greater WM capacity and highlight the importance of interactions between striatal dopamine and WM capacity. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Ping Chen
- Donders Institute for Brain, Cognition and Behaviour
| | | | | | | | - Lieke Hofmans
- Donders Institute for Brain, Cognition and Behaviour
| | | | | | - Roshan Cools
- Donders Institute for Brain, Cognition and Behaviour
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van den Bosch R, Lambregts B, Määttä J, Hofmans L, Papadopetraki D, Westbrook A, Verkes RJ, Booij J, Cools R. Striatal dopamine dissociates methylphenidate effects on value-based versus surprise-based reversal learning. Nat Commun 2022; 13:4962. [PMID: 36002446 PMCID: PMC9402573 DOI: 10.1038/s41467-022-32679-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
Psychostimulants such as methylphenidate are widely used for their cognitive enhancing effects, but there is large variability in the direction and extent of these effects. We tested the hypothesis that methylphenidate enhances or impairs reward/punishment-based reversal learning depending on baseline striatal dopamine levels and corticostriatal gating of reward/punishment-related representations in stimulus-specific sensory cortex. Young healthy adults (N = 100) were scanned with functional magnetic resonance imaging during a reward/punishment reversal learning task, after intake of methylphenidate or the selective D2/3-receptor antagonist sulpiride. Striatal dopamine synthesis capacity was indexed with [18F]DOPA positron emission tomography. Methylphenidate improved and sulpiride decreased overall accuracy and response speed. Both drugs boosted reward versus punishment learning signals to a greater degree in participants with higher dopamine synthesis capacity. By contrast, striatal and stimulus-specific sensory surprise signals were boosted in participants with lower dopamine synthesis. These results unravel the mechanisms by which methylphenidate gates both attention and reward learning. The mechanisms underpinning the variability in methylphenidate’s effects on cognition remain unclear. Here, the authors show that such effects reflect changes in striatal dopamine-related output gating of task-relevant cortical signals, and that these changes depend on baseline dopamine synthesis capacity.
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Affiliation(s)
- Ruben van den Bosch
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.
| | - Britt Lambregts
- Radboud University Medical Center, Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Jessica Määttä
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Lieke Hofmans
- Department of Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Danae Papadopetraki
- Radboud University Medical Center, Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Andrew Westbrook
- Cognitive, Linguistic & Psychological Sciences Department, Brown University, Providence, RI, USA
| | - Robbert-Jan Verkes
- Radboud University Medical Center, Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Jan Booij
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands.,Radboud University Medical Center, Department of Medical Imaging, Nijmegen, The Netherlands
| | - Roshan Cools
- Radboud University Medical Center, Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
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Hofmans L, Westbrook A, van den Bosch R, Booij J, Verkes RJ, Cools R. Effects of average reward rate on vigor as a function of individual variation in striatal dopamine. Psychopharmacology (Berl) 2022; 239:465-478. [PMID: 34735591 DOI: 10.1007/s00213-021-06017-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 10/15/2021] [Indexed: 11/24/2022]
Abstract
RATIONALE We constantly need to decide not only which actions to perform, but also how vigorously to perform them. In agreement with an earlier theoretical model, it has been shown that a significant portion of the variance in our action vigor can be explained by the average rate of rewards received for that action. Moreover, this invigorating effect of average reward rate was shown to vary with within-subject changes in dopamine, both in human individuals and experimental rodents. OBJECTIVES Here, we assessed whether individual differences in the effect of average reward rate on vigor are related to individual variation in a stable measure of striatal dopamine function in healthy, unmedicated participants. METHODS Forty-four participants performed a discrimination task to test the effect of average reward rate on response times to index vigor and completed an [18F]-DOPA PET scan to index striatal dopamine synthesis capacity. RESULTS We did not find an interaction between dopamine synthesis capacity and average reward rate across the entire group. However, a post hoc analysis revealed that participants with higher striatal dopamine synthesis capacity, particularly in the nucleus accumbens, exhibited a stronger invigorating effect of average reward rate among the 30 slowest participants. CONCLUSIONS Our findings provide converging evidence for a role of striatal dopamine in average reward rate signaling, thereby extending the current literature on the mechanistic link between average reward rate, vigor, and dopamine.
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Affiliation(s)
- Lieke Hofmans
- Donders Institute for Brain, Cognition & Behaviour, Radboud University, Nijmegen, The Netherlands. .,Department of Psychiatry, Radboudumc, Nijmegen, The Netherlands. .,Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.
| | - Andrew Westbrook
- Donders Institute for Brain, Cognition & Behaviour, Radboud University, Nijmegen, The Netherlands.,Department of Psychiatry, Radboudumc, Nijmegen, The Netherlands.,Department of Cognitive, Linguistics and Psychological Sciences, Brown University, Providence, USA
| | - Ruben van den Bosch
- Donders Institute for Brain, Cognition & Behaviour, Radboud University, Nijmegen, The Netherlands.,Department of Psychiatry, Radboudumc, Nijmegen, The Netherlands
| | - Jan Booij
- Department of Medical Imaging, Radboudumc, Nijmegen, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Robbert-Jan Verkes
- Department of Psychiatry, Radboudumc, Nijmegen, The Netherlands.,Forensic Psychiatric Centre Nijmegen, Pompestichting, Nijmegen, The Netherlands.,Department of Criminal Law, Law School, Radboud Universiteit, Nijmegen, The Netherlands
| | - Roshan Cools
- Donders Institute for Brain, Cognition & Behaviour, Radboud University, Nijmegen, The Netherlands.,Department of Psychiatry, Radboudumc, Nijmegen, The Netherlands
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Westbrook A, Ghosh A, van den Bosch R, Määttä JI, Hofmans L, Cools R. Striatal dopamine synthesis capacity reflects smartphone social activity. iScience 2021; 24:102497. [PMID: 34113831 PMCID: PMC8170001 DOI: 10.1016/j.isci.2021.102497] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/01/2021] [Accepted: 04/28/2021] [Indexed: 01/15/2023] Open
Abstract
Striatal dopamine and smartphone behavior have both been linked with behavioral variability. Here, we leverage day-to-day logs of natural, unconstrained smartphone behavior and establish a correlation between a measure of smartphone social activity previously linked with behavioral variability and a measure of striatal dopamine synthesis capacity using [18F]-DOPA PET in (N = 22) healthy adult humans. Specifically, we find that a higher proportion of social app interactions correlates with lower dopamine synthesis capacity in the bilateral putamen. Permutation tests and penalized regressions provide evidence that this link between dopamine synthesis capacity and social versus non-social smartphone interactions is specific. These observations provide a key empirical grounding for current speculations about dopamine's role in digital social behavior. Putamen dopamine synthesis capacity correlates with smartphone social app use. The correlation parallels a prior link between social app use and motor variability. It is selective to social app use, controlling for multiple smartphone use factors.
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Affiliation(s)
- Andrew Westbrook
- Radboud University Medical Centre, Department of Psychiatry, Nijmegen 6525 GA, The Netherlands.,Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen 6525 EN, The Netherlands.,Department of Cognitive, Linguistic & Psychological Sciences, Brown University, Providence, RI 02912, USA
| | - Arko Ghosh
- Institute of Psychology, Cognitive Psychology Unit, Leiden University, Leiden 2333 AK, The Netherlands
| | - Ruben van den Bosch
- Radboud University Medical Centre, Department of Psychiatry, Nijmegen 6525 GA, The Netherlands.,Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen 6525 EN, The Netherlands
| | - Jessica I Määttä
- Radboud University Medical Centre, Department of Psychiatry, Nijmegen 6525 GA, The Netherlands.,Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen 6525 EN, The Netherlands
| | - Lieke Hofmans
- Radboud University Medical Centre, Department of Psychiatry, Nijmegen 6525 GA, The Netherlands.,Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen 6525 EN, The Netherlands
| | - Roshan Cools
- Radboud University Medical Centre, Department of Psychiatry, Nijmegen 6525 GA, The Netherlands.,Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen 6525 EN, The Netherlands
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Hofmans L, Papadopetraki D, van den Bosch R, Määttä JI, Froböse MI, Zandbelt BB, Westbrook A, Verkes RJ, Cools R. Methylphenidate boosts choices of mental labor over leisure depending on striatal dopamine synthesis capacity. Neuropsychopharmacology 2020; 45:2170-2179. [PMID: 32919405 PMCID: PMC7784967 DOI: 10.1038/s41386-020-00834-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/19/2020] [Accepted: 08/21/2020] [Indexed: 11/09/2022]
Abstract
The cognitive enhancing effects of methylphenidate are well established, but the mechanisms remain unclear. We recently demonstrated that methylphenidate boosts cognitive motivation by enhancing the weight on the benefits of a cognitive task in a manner that depended on striatal dopamine. Here, we considered the complementary hypothesis that methylphenidate might also act by changing the weight on the opportunity cost of a cognitive task, that is, the cost of foregoing alternative opportunity. To this end, 50 healthy participants (25 women) completed a novel cognitive effort-discounting task that required choices between task and leisure. They were tested on methylphenidate, placebo, as well as the selective D2-receptor agent sulpiride, the latter to strengthen inference about dopamine receptor selectivity of methylphenidate's effects. Furthermore, they also underwent an [18F]DOPA PET scan to quantify striatal dopamine synthesis capacity. Methylphenidate boosted choices of cognitive effort over leisure across the group, and this effect was greatest in participants with more striatal dopamine synthesis capacity. The effects of sulpiride did not reach significance. This study strengthens the motivational account of methylphenidate's effects on cognition, and suggests that methylphenidate reduces the cost of mental labor by increasing striatal dopamine.
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Affiliation(s)
- Lieke Hofmans
- Donders Institute for Brain, Cognition & Behaviour, Radboud University, Nijmegen, The Netherlands.
- Department of Psychiatry, Radboudumc, Nijmegen, The Netherlands.
| | - Danae Papadopetraki
- Donders Institute for Brain, Cognition & Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Psychiatry, Radboudumc, Nijmegen, The Netherlands
| | - Ruben van den Bosch
- Donders Institute for Brain, Cognition & Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Psychiatry, Radboudumc, Nijmegen, The Netherlands
| | - Jessica I Määttä
- Donders Institute for Brain, Cognition & Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Psychiatry, Radboudumc, Nijmegen, The Netherlands
| | - Monja I Froböse
- Donders Institute for Brain, Cognition & Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Bram B Zandbelt
- Donders Institute for Brain, Cognition & Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Psychiatry, Radboudumc, Nijmegen, The Netherlands
| | - Andrew Westbrook
- Donders Institute for Brain, Cognition & Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Psychiatry, Radboudumc, Nijmegen, The Netherlands
- Department of Cognitive, Linguistics and Psychological Sciences, Brown University, Providence, RI, USA
| | - Robbert-Jan Verkes
- Department of Psychiatry, Radboudumc, Nijmegen, The Netherlands
- Forensic Psychiatric Centre Nijmegen, Pompestichting, Nijmegen, The Netherlands
- Department of Criminal Law, Law School, Radboud Universiteit, Nijmegen, The Netherlands
| | - Roshan Cools
- Donders Institute for Brain, Cognition & Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Psychiatry, Radboudumc, Nijmegen, The Netherlands
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Hofmans L, van den Bosch R, Määttä JI, Verkes RJ, Aarts E, Cools R. The cognitive effects of a promised bonus do not depend on dopamine synthesis capacity. Sci Rep 2020; 10:16473. [PMID: 33020514 PMCID: PMC7536197 DOI: 10.1038/s41598-020-72329-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 08/27/2020] [Indexed: 11/28/2022] Open
Abstract
Reward motivation is known to enhance cognitive control. However, detrimental effects have also been observed, which have been attributed to overdosing of already high baseline dopamine levels by further dopamine increases elicited by reward cues. Aarts et al. (2014) indeed demonstrated, in 14 individuals, that reward effects depended on striatal dopamine synthesis capacity, measured with [18F]FMT-PET: promised reward improved Stroop control in low-dopamine individuals, while impairing it in high-dopamine individuals. Here, we aimed to assess this same effect in 44 new participants, who had previously undergone an [18F]DOPA-PET scan to quantify dopamine synthesis capacity. This sample performed the exact same rewarded Stroop paradigm as in the prior study. However, we did not find any correlation between reward effects on cognitive control and striatal dopamine synthesis capacity. Critical differences between the radiotracers [18F]DOPA and [18F]FMT are discussed, as the discrepancy between the current and our previous findings might reflect the use of the potentially less sensitive [18F]DOPA radiotracer in the current study.
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Affiliation(s)
- Lieke Hofmans
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Kapittelweg 29 r.2.269, 6525 EN, Nijmegen, The Netherlands. .,Department of Psychiatry, Radboudumc, Nijmegen, The Netherlands.
| | - Ruben van den Bosch
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Kapittelweg 29 r.2.269, 6525 EN, Nijmegen, The Netherlands.,Department of Psychiatry, Radboudumc, Nijmegen, The Netherlands
| | - Jessica I Määttä
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Kapittelweg 29 r.2.269, 6525 EN, Nijmegen, The Netherlands.,Department of Psychiatry, Radboudumc, Nijmegen, The Netherlands
| | - Robbert-Jan Verkes
- Department of Psychiatry, Radboudumc, Nijmegen, The Netherlands.,Forensic Psychiatric Centre Nijmegen, Pompestichting, Nijmegen, The Netherlands.,Department of Criminal Law, Law School, Radboud Universiteit, Nijmegen, The Netherlands
| | - Esther Aarts
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Kapittelweg 29 r.2.269, 6525 EN, Nijmegen, The Netherlands
| | - Roshan Cools
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Kapittelweg 29 r.2.269, 6525 EN, Nijmegen, The Netherlands.,Department of Psychiatry, Radboudumc, Nijmegen, The Netherlands
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