Patterns of anterior cingulate activation in schizophrenia: a selective review

Rick Adams¹, Anthony S David²

¹University College London Medical School, London, UK ²Department of Psychological Medicine, Institute of Psychiatry, King’s College London, London, UK

Background: Anterior cingulate cortex (ACC) dysfunction is implicated in schizophrenia by numerous strands of scientific investigation. Functional neuroimaging studies of the ACC in schizophrenia have shown task-related hypo-activation, hyper-activation, and normal activation relative to comparison subjects. Interpreting these results and explaining their inconsistencies has been hindered by our ignorance of the healthy ACC’s function. This review aims to clarify the site and magnitude of ACC activations in schizophrenia, and sources of their variation.

Method: 48 studies of mnemonic and executive task-related activations in schizophrenia using both positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) were analyzed.

Results: Abnormal activations in schizophrenia were not restricted to the “cognitive” part of the ACC. Hypoactivations were most common, and were found in all types of tasks. Hyperactivations when found, were largely in n-back tasks.

Conclusions: Hypoactivations cannot be explained by poor performance, more demanding control conditions or chronicity of illness alone. Patients on anti-psychotic medication tended to show both greater ACC activation and better performance, although whether this is directly due to their medication or the resultant reduction in symptoms is unclear. The relationship between ACC rCBF and task performance is not straightforward. Future research should better control confounding factors and incorporate different levels of difficulty.

Keywords: functional magnetic resonance imaging, positron emission tomography, schizophrenia, anterior cingulate cortex