Abstract
Outcome processing, the ability to learn from feedback, is an important component of adaptive behavior and rehabilitation. Evidence from healthy adults implicates the striatum and dopamine in outcome processing. Animal research shows that damage to dopaminergic pathways in the brain can lead to a disruption of dopamine tone and transmission. Such evidence thus suggests that persons with TBI experience deficits in outcome processing. However, no research has directly investigated outcome processing and associated neural mechanisms in TBI. Here, we examine outcome processing in individuals with TBI during learning. Given that TBI negatively impacts striatal and dopaminergic systems, we hypothesize that individuals with TBI exhibit deficits in learning from outcomes. To test this hypothesis, individuals with moderate-to-severe TBI and healthy adults were presented with a declarative paired-associate word learning task. Outcomes indicating performance accuracy were presented immediately during task performance and in the form of either monetary or performance-based feedback. Two types of feedback provided the opportunity to test whether extrinsic and intrinsic motivational aspects of outcome presentation play a role during learning and outcome processing. Our results show that individuals with TBI exhibited impaired learning from feedback compared to healthy participants. Additionally, individuals with TBI exhibited increased activation in the striatum during outcome processing. The results of this study suggest that outcome processing and learning from immediate outcomes is impaired in individuals with TBI and might be related to inefficient use of neural resources during task performance as reflected by increased activation of the striatum.
Highlights
69 million people sustain a traumatic brain injury (TBI) each year worldwide (Dewan et al, 2019) with cognitive difficulties being extremely common (Jourdan et al, 2018)
Our results show that individuals with TBI exhibited impaired learning from feedback compared to healthy participants
The results of this study suggest that outcome processing and learning from immediate outcomes is impaired in individuals with TBI and might be related to inefficient use of neural resources during task performance as reflected by increased activation of the striatum
Summary
69 million people sustain a traumatic brain injury (TBI) each year worldwide (Dewan et al, 2019) with cognitive difficulties being extremely common (Jourdan et al, 2018). Difficulty learning from action outcomes (performance feedback) mediated by the fronto-striatal network is one underexplored and potentially critical area for understanding the underlying causes of memory problems in TBI. Feedback-based learning largely relies on the fronto-striatal network, with the ventral striatum and the ventromedial prefrontal cortex (VMPFC) playing critical roles (Tricomi & Depasque, 2017). Neuroimaging studies have shown that activity in the striatum increases during positive feedback presentation and decreases during negative feedback presentation. Such similar activation patterns are observed during both non-declarative and declarative learning tasks (Tricomi & Fiez, 2008). This activation pattern has been detected regardless of whether feedback is extrinsic (such as a monetary gain/loss) (e.g. Delgado, Nystrom, Fissell, Noll, & Fiez, 2000) or intrinsic (such as positive/negative performance related feedback) (Tricomi, Delgado, McCandliss, McClelland, & Fiez, 2006)
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