Schimmelpfennig Et - Al.2023 SN Cognitive-Affective-disorders
Schimmelpfennig Et - Al.2023 SN Cognitive-Affective-disorders
Schimmelpfennig Et - Al.2023 SN Cognitive-Affective-disorders
SPECIALTY SECTION
This article was submitted to Analysis and interpretation of studies on cognitive and affective dysregulation
Interacting Minds and Brains,
a section of the journal often draw upon the network paradigm, especially the Triple Network Model,
Frontiers in Human Neuroscience which consists of the default mode network (DMN), the frontoparietal network
RECEIVED 28 December 2022 (FPN), and the salience network (SN). DMN activity is primarily dominant during
ACCEPTED 22 February 2023 cognitive leisure and self-monitoring processes. The FPN peaks during task
PUBLISHED 20 March 2023
involvement and cognitive exertion. Meanwhile, the SN serves as a dynamic
CITATION
Schimmelpfennig J, Topczewski J, Zajkowski W
“switch” between the DMN and FPN, in line with salience and cognitive demand.
and Jankowiak-Siuda K (2023) The role of the In the cognitive and affective domains, dysfunctions involving SN activity are
salience network in cognitive and affective connected to a broad spectrum of deficits and maladaptive behavioral patterns
deficits.
Front. Hum. Neurosci. 17:1133367. in a variety of clinical disorders, such as depression, insomnia, narcissism, PTSD
doi: 10.3389/fnhum.2023.1133367 (in the case of SN hyperactivity), chronic pain, and anxiety, high degrees of
COPYRIGHT neuroticism, schizophrenia, epilepsy, autism, and neurodegenerative illnesses,
© 2023 Schimmelpfennig, Topczewski, bipolar disorder (in the case of SN hypoactivity). We discuss behavioral and
Zajkowski and Jankowiak-Siuda. This is an
open-access article distributed under the terms neurological data from various research domains and present an integrated
of the Creative Commons Attribution License perspective indicating that these conditions can be associated with a widespread
(CC BY). The use, distribution or reproduction
in other forums is permitted, provided the
disruption in predictive coding at multiple hierarchical levels. We delineate the
original author(s) and the copyright owner(s) fundamental ideas of the brain network paradigm and contrast them with the
are credited and that the original publication in conventional modular method in the first section of this article. Following this, we
this journal is cited, in accordance with
accepted academic practice. No use, outline the interaction model of the key functional brain networks and highlight
distribution or reproduction is permitted which recent studies coupling SN-related dysfunctions with cognitive and affective
does not comply with these terms.
impairments.
KEYWORDS
triple network model, default mode network (DMN), the frontoparietal network (FPN),
salience network (SN), cognitive dysfunctions, affective dysfunctions
However, shortcomings of this paradigm have been noted personality factors (NEO-FFI; Li et al., 2022). FC is a powerful tool
(Fuster, 2000), and study results, like the discovery of cross- for exploring healthy brain organization as well as mental disorders
modal sensory processing modulations (Garner and Keller, 2022; and individual differences.
McClure et al., 2022), have begun to undermine even the most Uddin et al. (2019) identified six prevalent macro-scale brain
basic assumptions, such as monomodality of first-order sensory networks. Based on convergent evidence from many studies, three
poles (Cappe and Barone, 2005). The biggest questions being networks: Default Mode Network (DMN), Frontoparietal Network
raised regard the apparent independence and specialization of (FPN), and the Salience Network (SN), are often called canonical
structures. Studies making this assumption often give accurate but (Ciric et al., 2017; Uddin et al., 2022), as their interactions play a
inconclusive results in the broader context, and the lack of an role in almost all cognitive functions (see Figure 1). The abnormal
overarching model makes it difficult to draw unified conclusions. functional organization of these networks and dynamic cross-
The function of the anterior insula (AI) is an apt example network talk may underlie a wide range of psychiatric symptoms
(Wager and Barrett, 2017). Its activity is regularly attached to a in the “triple-network model of psychopathology” (Menon, 2018;
wide range of apparently unrelated processes from sensory and Menon et al., 2022).
affective processing to higher-order cognition (Uddin et al., 2017), The DMN was the first large-scale network identified in human
such as body and emotional awareness, pain (Liu et al., 2021), subjects and, later, across all mammalian species studied to date
self-recognition and motivation (Craig, 2009), singing and music (Garin et al., 2022). Its central nodes consist of the posterior
recognition (Zamorano et al., 2019), uncertainty, empathy, and cingulate cortex (PCC), precuneus, and ventromedial prefrontal
risky decisions (Singer et al., 2009), visual consciousness (Salomon cortex (VMPFC; Bressler and Menon, 2010). The DMN is often
et al., 2018), time perception (Vicario et al., 2020), attention span referred to as a task-negative network, characterized by a stable
(Nelson et al., 2010) and integration of internal interoceptive and and replicable deactivation of its core nodes during tasks requiring
external sensory signals (Chen et al., 2021), as well as homeostasis cognitive effort in PET and fMRI studies (e.g., Raichle et al.,
(Flynn, 1999). 2001). Nonetheless, some nodes are active throughout cognitive
The systemic perspective describes psychological functions processing, implying that DMN plays a more complex and dynamic
as the result of interdependent processes driven by domain- role in cognition (Weber et al., 2022). It was shown that the DMN is
general functional brain networks, which do not have strict spatial active during tasks requiring autobiographical memory, prospective
boundaries (Park and Friston, 2013; Uddin et al., 2019; Luo, 2021). thinking, ego/allocentric spatial reference, and understanding of
Moreover, the decoupling of structural and functional networks is others’ intentions (Buckner et al., 2008; Spreng et al., 2009).
required to achieve the advanced context-sensitive integration that Additionally, the DMN is crucial for high-level social cognitive
is typical for humans (Griffa et al., 2022). processes, mediating individual variability in cognitive empathy
response (Oliveira-Silva et al., 2023).
FPN activity is significantly negatively correlated with DMN
2. Brain functional networks (Uddin and Menon, 2009), and its activation is relatively strongest
during cognitive effort. Its function is primarily related to task
The perspective that the human brain is organized into selection and executive function, using input from other brain
hierarchically modularized networks is now widely accepted networks to actively process information, and supporting higher-
(Wang et al., 2015). In contrast to the assumption of independent order cognitive functions, such as attentional control and working
and functionally rigid modules similar to a set of specialized memory. The FPN is also essential for decision-making in the
tools (Gigerenzer and Todd, 1999), functional neural networks context of goal-directed behavior in rule-based problem-solving
are assessed as dynamic, elastic, and hierarchical (Gilmore (Lindquist and Barrett, 2012). It connects the lateral posterior
et al., 2018). This is necessary in order to confront changing parietal cortex (PPC) and the dorsolateral prefrontal cortex
environmental factors and develop a wide range of context- (DLPFC; Seeley et al., 2007).
dependent behaviors (Bressler and McIntosh, 2007; Bressler The SN includes the AI and dorsolateral cingulate cortex
and Menon, 2010). Transitions between functional networks (dACC; Sridharan et al., 2008). It is distinguished by a unique
are a response to environmental changes (Sadaghiani and cellular component, the von Economo neurons in the AI/dACC
Kleinschmidt, 2013). Zerbi et al. (2019) showed that a rapid (Banovac et al., 2021), characterized by a large spindle-shaped body.
reconfiguration of the functional connectome occurred in The SN functions as a dynamic switch between concentration on
response to a threat by the release of norepinephrine, which self and the inner world, mediated by the DMN, and task-related
drastically increases global brain connectivity, primarily within the and directed attention on outside stimuli maintained by the
salience network. FPN. Additionally, the amygdala and other SN subcortical nodes
Functional neural networks have emerged from the temporally co-activate in response to various experimental tasks, indicating
organized coupling of activity across vastly dispersed brain regions. a more domain-general role in identifying homeostatically most
They are characterized by the functional interdependence of brain relevant competing internal and external stimuli (Chong et al.,
structures within their frameworks (Bressler and Menon, 2010). 2017; Seeley, 2019). Its function has been shown to be relevant for
Functional networks are bounded by the anatomical structure of processing reward, motivation, emotion, and pain (Menon, 2015).
neural connections (Xie et al., 2021). The topology of functional Allocation of attentional resources to the most salient stimuli
networks is dependent on individual development (Shanmugan requires top-down sensitivity control and a bottom-up mechanism
et al., 2022). Furthermore, Functional connectivity (FC) can be for filtering stimuli (Parr and Friston, 2017). A central role of the
used to predict behavioral traits such as fluid intelligence or even SN is filled by the insula, acting as a gatekeeper of executive control.
FIGURE 1
Three canonical networks.
Thanks to a widespread connectivity fingerprint, its posterior part decisions and predicted the likelihood of choosing the safe option
integrates signals from within the body with external stimuli. Then, in the next choice. This suggests that people with elevated levels of
the interaction of the anterior and posterior parts of the insula neuroticism may interpret relatively safe situations as threatening
moderates autonomic reactions and generates a signal sent to the (Feinstein et al., 2006). Hamilton et al. (2013), in a review article,
anterior cingulate cortex (ACC), selectively intensifying salient presented findings showing the activity of key SN structures (AI
stimuli that require further cortical analysis. The right dAIC is and ACC) and the amygdala, in response to negative stimuli in
considered to be a unique brain region, functioning as a hub depressed individuals. They also observed elevated AI activity in
that influences both the FPN and DMN (Uddin, 2015). A strong insomniacs when trying to fall asleep (Chen et al., 2014) and in the
negative correlation between the DMN and FPN relates to the right AI among narcissistic individuals (Fan et al., 2011).
higher efficiency of executive functions (Posner et al., 2016; see In addition, resting-state studies also contribute to our
Figure 2). understanding of SN function and dysfunction. Seeley et al. (2007)
noted a positive correlation between reported levels of pre-test
anxiety and a measure of the strength of functional connections
3. Network dysfunction. The impact of between AI and dACC. Markett et al. (2013), on the other hand,
showed a correlation between Cloninger’s temperamental harm
network materiality on dysfunction avoidance scale and the strength of connections between AI and
ACC and AI and DLPFC. Stronger functional connectivity between
The correct SN response determines the appropriateness of
dorsal ACC and new cortex regions has been reported in patients
behavior, and the AI plays a key role in the proper functioning of the
diagnosed with panic anxiety (Pannekoek et al., 2013).
entire network. Disorders within this structure are correlated with
It is noteworthy that SN hyperactivity is linked not only to
many cognitive-affective dysfunctions—including those associated
psychological but also physical vulnerability. For example, the
with both psychiatric disorders and neurodegenerative diseases.
volume of gray matter within the insula and ACC, among others,
is characteristically high in patients suffering from chronic pain
(Borsook et al., 2013; Cauda et al., 2014), and the subjectively
3.1. Deficits associated with an overactive perceived level of pain is correlated with the strength of AI and ACC
salience network activations (Legrain et al., 2011).
All of the above results seem consistent with the SN model
Overactivity in the AI-dACC pathway is mainly associated and suggest that AI overactivation leads to excessive sensitivity and
with affective disorders (high anxiety) and neuroticism (Massullo anxiety arousal, and maybe a joint transdiagnostic characteristic in
et al., 2020). Findings indicate elevated AI activity in response to numerous conditions. This is likely related to the low excitability
facial emotional expressions (Paulus and Stein, 2006), particularly threshold of the structures that make up the SN (particularly the
in individuals with high levels of anxiety (Stein et al., 2007). right AI) and the classification of excessive stimuli as important.
Paulus et al. (2003) showed an association of AI with questionnaire This leads to the generalization and over-mobilization of stress
measures—neuroticism and risk avoidance, as well as behavioral reactions in non-threatening situations (Menon and Uddin, 2010;
measures in making risky decisions in a gambling game. Higher Hermans et al., 2014). In the case of narcissism, on the other
activation within this structure was characteristic of riskier hand, a proposed model of SN dysfunction relies on the inability
FIGURE 2
A basic interaction model of the three canonical networks.
of a dysregulated right AI to turn off the DMN, leading to an stronger connections in the dorsal stream performed faster and
excessive concentration of thoughts on one’s self (Jankowiak-Siuda more effectively on a cognitive task requiring the activity of
and Zajkowski, 2013). attentional processes.
Functional MRI data suggests that at least three subdivisions Alterations within all brain networks activity and connectivity
can be recognized within the insula on the basis of differential FC in the Triple Network Model (TNM) may underlie Post Traumatic
patterns: a dorsal anterior (dAI) involved in high-level cognitive Stress Disorder (PTSD; Lebois et al., 2022). It is proposed that
control processes (activated by tasks requiring attention and overactive and hyperconnected SN destabilizes intrinsically weakly
redirecting information to the DLPFC-PPC loop), a ventral anterior connected and hypoactive DMN and FPN. In pursuance of
(vAI) involved in affective processes (responsible for the flow of this model, alternations in networks e.g., increased posterior SN
affective stimuli to specialized areas within the limbic cortex and connectivity to the PI may result in raised sensitivity to stimuli and
medial prefrontal cortex), and a posterior insula (PI) involved in potential threats, that contribute to avoidance and hypervigilance
sensorimotor processing (Deen et al., 2011; Chang et al., 2013). which characterize PTSD patients. Hyperactivation in the AI is
Subjects with stronger connections in the ventral stream were linked with re-experiencing traumatic memories (Nicholson et al.,
characterized by stronger affective feelings, and subjects with 2020).
The SN with a low threshold for perceived saliency is not able disrupting the stimulus relevance selection taking place in the SN
to efficiently regulate the DMN and FPN switching (Weng et al., (Menon et al., 2022; Pugliese et al., 2022). On the other hand,
2019). The impairment of cognitive control over salience processing Palaniyappan et al. (2013) highlighted the disruption between the
in PTSD may be reflected in the reduced insular functional SN and FPN. Granger causality analysis indicated a significantly
connectivity in the ACC and the supplementary motor region (Lee reduced effect of SN on FPN activity, manifested by the inability to
et al., 2022). The FPN and the DMN are weakly interconnected strongly engage executive structures and “mute” the DMN during
and hypoactive, which causes narrowed cognition and incapacity cognitive effort.
for top-down SN regulation in the FPN as well as dissociation and The theory of predictive coding (PC) and Bayesian inference
fear generalization in the DMN. offers a comprehensive principle of brain function with the
As shown by Fenster et al. (2018), low involvement in potential to link various levels of observation into a more
AI is linked to depersonalization and emotional detachment unified model of schizophrenia (e.g., Adams et al., 2022 or
symptoms in PTSD. However, Akiki et al. (2017) suggest that Limongi et al., 2018). PC defines a biological scheme, where
alterations within the DMN may also underlie impairments the brain can be seen as a computational organ generating
in the processing of self-referential information. In addition, predictions to infer the probable causes of the sensory signals,
hyperconnectivity of the DMN with prefrontal FPN areas may which can be compared with actual sensory samples (Friston,
limit the capacity of the FPN to engage in other cognitively 2010). Bottom-up sensory evidence (information from the sensory
demanding tasks, thus underpinning symptoms of reduced milieu) ascends brain hierarchical architecture, where the lower
cognitive efficacy in the PTSD group. Charquero-Ballester levels of the brain receive predictive signals from higher
et al. (2022) demonstrated positive correlations between levels of the brain, which encode prior beliefs. The accuracy
activity of SN and severity of PTSD symptoms and showed of prediction is cyclically tested—when the incoming sensory
that successful Cognitive Therapy for PTSD can normalize input violates predictions, a prediction error (PE) is created
the dynamics of brain networks. The Triple Network Model and sent forward to update higher-level expectations (Bayesian
offers a valuable way of comprehending the underlying neural belief updating; Friston, 2019). Agents weigh new evidence and
mechanisms of PTSD, but it is unlikely to account for all PTSD prior knowledge according to the level of confidence placed
abnormalities. in a prediction or PE, which determines the impact on belief
updates. The insular cortex in this framework is seen as an
integrator of low-level sensory PEs with interoceptive expectations,
regulating emotion and affective salience (Barrett and Simmons,
3.2. Deficits associated with 2015).
underperformance of the salience network In addition, the SN plays an essential role in the bidirectional
circulation of prior beliefs, in order to execute functional
Reduced strength of causal influence from the AI to the FPN integration and activation of task stimuli (Limongi et al.,
and DMN has been linked to cognitive and affective deficits. 2020). Royer et al. (2020) showed an insula microstructural
Up until now, the best-documented links relate to schizophrenia, gradient transition with changes in local affiliation: from the
autism, and bipolar disorder. granular posterior, through ventral, up to agranular dorsal
Schizophrenia is characterized by impaired thinking and anterior subregions. The shift in gradient corresponded with
perception as well as shallow, maladaptive affect, which can be an FC transition from primarily sensorimotor (unimodal) to
considered a defect of executive control. As shown by Limongi modulatory and association (transmodal) networks, analogous
et al. (2020), the key SN nodes’ excitation-inhibition balance is to the hierarchical organization of other subcortical systems
impacted by the pathophysiology of glutamate neurotransmission. responsible for perceptual, control, and higher-level cognitive
Reduced FC has been demonstrated between the SN and DMN functions. Therefore, the multidimensional cytoarchitecture
(Buckner et al., 2009; Orliac et al., 2013) and between the SN of the insular cortex (and the whole SN) is well suited for
and FPN (Moran et al., 2013), as well as within SN—between computing and transmitting the accuracy of ascending sensory
the AI and dACC (White et al., 2010). Structural MRI studies in PEs. The FC hierarchical gradient is considered to be a large-
people with schizophrenia have revealed a smaller volume of gray scale neural architecture for the PC and allostasis—predictive
matter, encompassing all three networks (Palaniyappan et al., 2011; regulation of the body’s energy resources, which is vital
Krishnadas et al., 2014). The most recent research on individuals for every aspect of a living organism (Katsumi et al.,
with schizophrenia revealed a general decrease in insula FC, as well 2022).
as a reduction in the differentiation of connectivity profiles between The view that brain inference systems are changed in
insular subregions, which was associated with clinical symptom schizophrenia is supported by well-documented deficits in
variability (Tian et al., 2019). cognitive decision-making in numerous studies (e.g., Schmack
Orliac et al. (2013) noted negative moderate correlations et al., 2015; Kirihara et al., 2020). Failures of inference can
between left striatum connectivity (included in the SN) and levels explain a wide range of psychotic symptoms and traits (Friston
of hallucinations and depression. The researchers interpret this as et al., 2016). Neurotransmitter alterations underlie imprecision in
a potential confirmation of the “relevance dysfunction” (aberrant the PC hierarchical mechanism, particularly in the post-synaptic
salience) hypothesis in schizophrenia, proposed by Kapur (2003). gain of cortical NMDA receptors and GABAergic neurons with
It assumes that dysfunctional connections of the corticothalamic- elevated dopaminergic neuromodulation. Disturbed neural PE
parietal loop lead to chaotic discharges of dopaminergic neurons, signals induce misattribution of the salience of stimuli. The
participation of the insula in monitoring the disruption of of their preexisting beliefs and that these deficits primarily
predictions is compatible with its function in processing salient manifest in situations of uncertainty (Gomot and Wicker,
stimuli and neuropathology in the assignment of behavioral 2012).
salience to non-target stimuli in schizophrenia (Sridharan et al., Meta-analysis of bipolar disorder (BD) patients focused on
2008). rs-fMRI and analysis of effective connectivity have shown that
Furthermore, Luo et al. (2020) showed that control signals functional integration within and among three core brain networks
from rAI are improperly elevated and directed towards both (SN, DMN, and FPN) is abnormal (Sha et al., 2019; Yoon
the FPN and DMN, disrupting the contextually congruent et al., 2021; Zhang et al., 2022). Altered connectivity patterns
assignment of brain resources in patients with schizophrenia. were dependent on mood, as well as the type of BD (Zhang
Liddle et al. (2016) used magnetoencephalography (MEG) to et al., 2022). BD patients expressed altered connectivity both
measure beta oscillations in the insula during a saliency modulation within networks (FPN, SN) and between (DMN-SN, DMN-
task to compare activity during task-relevant and task-irrelevant FPN). There were also differences between stages of the disorder:
stimulus processing. Beta oscillations were chosen as they mediate compared to the depression stage, patients with euthymic stage
endogenous long-range integrative signals or prior expectations expressed a hyperconnectivity among the FPN and reduced
to recurring environmental stimuli. When compared to healthy connectivity between SN and FPN and SN and DMN (Zhang
controls, schizophrenia patients had more beta synchronization et al., 2022). Martino and Magioncalda (2022) and Magioncalda
in the insula when processing irrelevant stimuli over relevant and Martino (2022) suggested that the lack of integration between
ones (stronger reaction to disruption of prediction; Fries, SN, DMN, and FPN may be due to changes in neurotransmitter
2015). signaling which can be observed during the manic and depressive
Empirical studies also link schizophrenia symptoms to phases of BD.
abnormal signaling of PEs (particularly in the brain areas of
reward, value-based decision-making), lack of long-term stability
of internal models and priors (Sterzer et al., 2019). A DCM study of
the PC provided further evidence of abnormal connectivity in the 4. Discussion, limitations, and
neuropathology and pathophysiology of schizophrenia (Fogelson directions for further research
et al., 2014). The long-standing unpredictability about upcoming
sensory inputs finally leads to stimulus avoidance and psychomotor This mini-review segregates SN dysfunctions into hyperactivity
poverty, which is observed in clinical conditions (Corlett et al., and hypoactivity, which can lead to a simplistic perception of the
2016). In conclusion, the symptoms of schizophrenia are consistent mechanisms of the described deficits. However, it should be noted
with a decrease in high-level precision or a failure of sensory that the actual role of the SN in the presented disorders is more
attenuation (an overestimate of the trustworthiness of the PEs), elusive. First, SN dysfunctions are a unifying feature of a whole
leading to false inferences and failure in cognitive control as well range of deficits, but this does not mean that they are the only
as the possibility of hallucinations and delusions (Sterzer et al., or even the main cause. Second, the relationships between and
2018). within SN structures themselves are complex and varied, which is
Autism spectrum disorder (ASD) belongs to a group of one reason why the dysfunctions themselves are different. Third,
developmental disorders characterized by qualitative abnormalities atypical connections or activations within SNs are not sufficient
in social interactions and behavioral patterns, as well as a limited conditions for cognitive-affective dysfunction to occur.
and repetitive repertoire of interests and activities (ICD-10). The second point, which entails exploring the more intricate
A meta-analysis of fMRI studies found that AI and ACC are interactions and conditional dependencies that distinguish
regularly less active in people with autism, compared to a control the mechanisms underlying various disorders, seems most
group, during social tasks (Di Martino et al., 2009). Uddin intriguing from the standpoint of future research. Attempts
and Menon’s (2009) model of dysfunction in autism posits that have been made to specify these mechanisms, such as the
the disorder is caused by deficits in communication between briefly described neural models of dysfunction in autism
sensory and limbic structures and the insula. This leads to (Uddin and Menon, 2009), narcissism (Jankowiak-Siuda and
the SN’s “underestimation” of the importance of social stimuli, Zajkowski, 2013) or schizophrenia (Kapur, 2003; Palaniyappan
which explains the phenotype of characteristic dysfunctions in and Liddle, 2012). However, most of them are not yet
responding to social stimuli. Moreover, changes in the FC pattern supported by enough empirical evidence to fully validate all
among the dAIC, DMN, and FPN correlate with the severity the hypotheses they pose; for now, they mainly serve to steer
of ASD symptoms (Uddin et al., 2015). Gonzalez-Gadea et al. further research.
(2015), using the PC framework, implied that persons with It must also be taken into account that the functional
ASD may have reduced precision adjustment when confronted connectivity data derived from imaging studies suffer from
with uncertainty because of rigid expectations (Van de Cruys limited spatial and temporal resolution, limiting the inference
et al., 2014). The predisposition to suppress bottom-up inputs to sufficiently large brain areas and sufficiently slow dynamical
and the attentional bias toward anticipated stimuli may hinder processes. Coupling these findings with methods capturing
the ability to adjust precision in dynamic real-world contexts. millisecond dynamics (such as single or multi-electrode
This result is consistent with previous research on predictive arrays; Spira and Hai, 2013) could lead to new insights
coding in ASD (Lawson et al., 2014), which indicates that and fuller understanding of the processes governing the
autistic persons struggle to contextualize sensory input in light network dynamics.
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