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The Journal of Neuroscience, 2000, 20:RC65:1-6
RAPID COMMUNICATION
Methylphenidate Enhances Working Memory by Modulating Discrete
Frontal and Parietal Lobe Regions in the Human Brain
Mitul A.
Mehta1,
Adrian
M.
Owen3,
Barbara J.
Sahakian1,
Nahal
Mavaddat1,
John D.
Pickard2, and
Trevor W.
Robbins4
1 University of Cambridge, Department of Psychiatry,
and 2 Wolfson Brain Imaging Centre, Addenbrooke's
Hospital, Cambridge, CB2 2QQ, United Kingdom, 3 Medical
Research Council Cognition and Brain Sciences Unit, Cambridge, CB2 2EF,
United Kingdom, and 4 University of Cambridge, Department
of Experimental Psychology, Downing Site, Cambridge CB2 3EB, United
Kingdom
 |
ABSTRACT |
The indirect catecholamine agonist methylphenidate (Ritalin) is the
drug treatment of choice in attention deficit/hyperactivity disorder
(AD/HD), one of the most common behavioral disorders of childhood
(DSM-IV), although symptoms may persist into adulthood. Methylphenidate can enhance cognitive performance in adults and children diagnosed with AD/HD (Kempton et al., 1999 ;
Riordan et al., 1999 ) and also in normal human volunteers on
tasks sensitive to frontal lobe damage, including aspects of spatial
working memory (SWM) performance (Elliott et al., 1997 ). The present
study investigated changes in regional cerebral blood flow (rCBF)
induced by methylphenidate during performance of a self-ordered SWM
task to define the neuroanatomical loci of the beneficial effect of the
drug. The results show that the methylphenidate-induced improvements in
working memory performance occur with task-related reductions in rCBF
in the dorsolateral prefrontal cortex and posterior parietal
cortex. The beneficial effects of methylphenidate on working memory
were greatest in the subjects with lower baseline working memory
capacity. This is to our knowledge the first demonstration of a
localization of a drug-induced improvement in SWM performance in humans
and has relevance for understanding the treatment of AD/HD.
Key words:
cognition; dopamine; humans; methylphenidate; neuroimaging; Ritalin; stimulant; working memory
 |
INTRODUCTION |
Methylphenidate
is a stimulant drug related to amphetamine that acts to increase the
synaptic concentration of dopamine and noradrenaline (catecholamines)
by blocking their reuptake (Scheel-Kruger et al., 1977 ; Seeman
and Madras, 1998 ). Both of these neurotransmitters are known to affect
performance of spatial working memory (SWM) tasks in monkeys
(Arnsten, 1997 ) and humans (Coull et al., 1995 ; Elliott et al., 1997 ).
Local injection and iontophoretic application of specific dopaminergic
(Bernardi et al., 1982 ; Sawaguchi et al., 1988 ) and noradrenergic
agents (Arnsten and Goldman-Rakic, 1985 ) as well as
electrophysiological measures (Bernardi et al., 1982 ) in the monkey
have identified the lateral prefrontal cortex as a critical region by
which these monoamine systems influence SWM processes. In addition, in
humans, methylphenidate enhances performance of the SWM task used in
the present study (Elliott et al., 1997 ). However, the neural (cortical
or subcortical) localization of the effects of stimulant medications,
such as methylphenidate, on working memory performance has not been
determined in human subjects. The prefrontal and temporal cortices can
be hypothesized to be possible neuromodulatory sites of action because
damage to these cortical areas impairs self-ordered SWM performance
(Owen et al., 1996a ), and activations of the dorsolateral and
ventrolateral prefrontal cortex (in addition to PPC) are observed
during functional neuroimaging (Owen et al., 1996b ). In humans, direct
approaches aimed at defining the neuroanatomical site of performance
modulation by methylphenidate in vivo have only become
possible with the advent of functional neuroimaging techniques.
Thus, we conducted the present study to examine the
effects of methylphenidate on regional cerebral blood flow (rCBF) in
normal volunteers using positron emission tomography (PET). Based on the results of previous studies (Mattay et al., 1996 ; Owen et al.,
1996b ; Elliott et al., 1997 ), we predicted that methylphenidate would
enhance spatial working memory performance and that this would be
accompanied by changes in rCBF in regions of the frontal and parietal
lobes known to be activated by the task (Owen et al., 1996b ).
 |
MATERIALS AND METHODS |
Procedure. The study protocol for this investigation
was approved by the Cambridge Local Research Ethics Committee and the Administration of Radioactive Substances Advisory Council.
Written informed consent was obtained for all subjects. For the study, 10 healthy right-handed male volunteers (mean age, 34.8 years; SD,
3.40) were seen on two occasions separated by 2 weeks. On each session
volunteers were given either 40 mg of methylphenidate or placebo
(lactose) presented in identical capsules. Imaging commenced ~90 min
after ingestion of the capsule to maximize the levels of drug during
the scans (Gualtieri et al., 1982 ). Before scans or tablet ingestion on
session 1, subjects were given a brief baseline assessment with the
digit span test from the Weschler Adult Intelligence Scale-Revised,
the National Adult Reading Test, and the spatial span test from the
CANTAB battery (Owen et al., 1996b ). In addition, subjects were
trained on a simple version (four and six boxes) of the SWM task used
during the activation scans. On each test session, cardiovascular
measures and a set of 16 visual analog scale ratings (Bond and Lader,
1974 ) were taken before tablet ingestion, after scan 3 or 4, and after
scan 6. For each session, six PET scans (each of 90 sec data
acquisition) were obtained for each subject, two for each of three task
conditions (see below). The order of administration of the tasks was
randomized across the six scans for each subject. The General Electric
Advance system was used to measure rCBF. For each scan subjects
received a 20 sec intravenous bolus of
H215O through a cannula
in the left arm at a concentration of 300 Mbq/ml and flow rate of 10 ml/min before data acquisition.
Cognitive task. The two task conditions and control
condition used were identical to those described by Owen et al.
(1996b) . For the task conditions, subjects were presented either six
("easy") or twelve ("difficult") red circles on a
touch-sensitive computer screen suspended above the scanner. For each
problem, subjects were required to search through the array of red
circles for blue tokens by touching each one to reveal its contents.
The goal was to find all of the blue tokens, which were hidden behind
the red circles. The key instruction was that, once a blue token had
been found behind a particular red circle, that circle would not be used again to hide a token. Each circle was only used once to hide a
token, and therefore two types of error were possible. A between-search
error occurred when a subject returned to a circle in which they had
previously found a blue token, and a within-search error occurred when
a subject returned to a circle within the same search. The performance
measure of errors described in Results refers to between-search
errors. Subjects performed the task continually for 30 sec before, and
for the 90 sec duration of, scan acquisition. Over this period of
time, subjects performed between three and five task problems. The
control condition was designed to have similar visual, spatial, and
motor requirements as both of the task conditions. Eight circles were,
therefore, presented on the computer screen, and the central one
changed color at a rate of approximately once per second. On the color
change, subjects were required to touch the central circle with the
same finger used for the memory tasks.
Data analysis. Initially, individual three-dimensional (3-D)
magnetic resonance imaging (MRI) was obtained (whole brain, 256 × 256 × 128 pixels) using a 0.5 T system. MRI images were resliced to be co-registered with the PET data to allow for anatomical localization of regions with statistically significant changes in rCBF
between conditions. PET data were realigned (to individual MRI scans
and to a standard brain), normalized (for global CBF), smoothed (using
an isotropic Gaussian kernel of 16 mm), and analyzed using the
Statistical Parametric Mapping 96 (SPM96) (Friston et al., 1995 ) package.
For the statistical analyses of the neuroimaging data, the general
linear model, as implemented by SPM96 (Friston et al., 1995 ), was used
to estimate the blood flow changes between each condition for each
voxel. Scan order was covaried using ANCOVA. For activations occurring
in areas of the brain previously shown to be involved in performance of
the working memory task (ventrolateral and dorsolateral prefrontal,
premotor, and posterior parietal cortices), an intensity threshold
(uncorrected for multiple comparisons) of p 0.001 was applied. For other areas of the brain a corrected intensity
threshold of p 0.05 was applied. These thresholds, based on 3-D Gaussian random field theory, predict the likelihood of
obtaining a false positive in an extended 3-D field.
Behavioral data for the cognitive tasks, cardiovascular measures, and
subjective ratings on the visual analog scales were analyzed (using
SPSS for the Apple Macintosh) using repeated-measures ANOVAs
with session order as a between-subjects factor and drug and, where
appropriate, time as within-subjects factors.
 |
RESULTS |
Effects of Ritalin of self-ordered spatial working
memory performance
Analysis of the behavioral performance of subjects
confirmed previous findings (Elliott et al., 1997 ) with subjects on
methylphenidate making fewer between-search errors on the SWM task than
when on placebo [mean and SEs of search errors per 12 circle problem
on drug: 11.5 (3.32) and placebo: 16.1 (4.48);
F(1,8) = 5.57; p = 0.046].
The drug had no effect on within-search errors [drug: 3.24 (1.19) and
placebo: 4.95 (2.25); F(1,8) = 1.55;
p = 0.25].
Effects of Ritalin on task-dependent and task-independent
changes in rCBF
The effects of methylphenidate on rCBF, independent of
task conditions, were analyzed using specific contrasts. Consistent with the effects of methylphenidate on glucose metabolism (Volkow et
al., 1997 ), the drug only produced increases in blood flow in the right
cerebellum, but led to decreases in blood flow in regions within the
frontal and temporal lobes (Table 1). The loci of task-related effects of methylphenidate on rCBF, as revealed by
the significant drug × task interaction, were clearly defined, with changes in rCBF in the dorsolateral prefrontal cortex (DLPFC), supplementary motor cortex, and posterior parietal cortex (PPC)-all in
the left hemisphere (Fig. 1). The
adjusted blood flow values for the three regions showing the peak
statistical interaction effect between task and drug are displayed in
Figure 2a-c, exhibited by
methylphenidate-induced reductions in rCBF for the task conditions with
no effect of methylphenidate on rCBF for the control condition. There
were no significant interactions of task difficulty with drug
(drug-placebo), and so the easy and difficult conditions were combined
for the purpose of illustration (Fig. 2). The attenuation of activity
in the supplementary motor cortex (Fig. 2b) was not predicted on the basis of previous findings (Owen et al., 1996b ), and
because the peak interaction effect Z-value (corrected for multiple comparisons) was not significant, it was not analyzed further.
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Table 1.
Stereotaxic coordinates of significant changes in rCBF in
the drug condition compared with the placebo conditions
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Figure 1.
a, Schematic image showing the
regions of significant rCBF change for the interaction effect of the
SWM task and methylphenidate (task-control × drug-placebo)
superimposed on an average 3-D Montreal Neurological Institute glass
brain using a height threshold of Z = 3.09, p = 0.001. Stereotaxic coordinates [x, y,
z] (Table 1, legend), cortical region (Brodmann area), and
Z scores for the significant activations (see Materials
and Methods) are: [ 40, 26, 24], left dorsolateral prefrontal cortex
(9), Z = 3.40; [ 18, 16, 40], left supplementary
motor area (6), Z = 3.69, and [ 12, 64, 48],
left PPC (7), Z = 3.91. b and
c are merged PET-MRI sections illustrating the
significant rCBF interaction between drug and task shown in
a. The interaction effect in the left DLPFC is
illustrated in b and c; in
addition, the interaction in the inferior left PPC is clearly visible
in c. The front of the brain is to the
right in all three images.
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Figure 2.
Graphical depiction of the task × drug
interaction for mean adjusted rCBF (to the mean global cerebral blood
flow) from the peak of statistically significant changes in the left
dorsolateral prefrontal cortex (a), left
supplementary motor area (b), and left PPC
(c). In all three areas there is a
methylphenidate-induced reduction in rCBF for the working memory task
condition with no corresponding reduction for the control condition.
d, Mean adjusted rCBF for the area of greatest
task-independent, drug-induced reduction in blood flow, the left
temporal pole. Values on ordinate are arbitrary numbers of relative
adjusted blood flow. Error bars represent SDs.
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|
Hemispheric effects of Ritalin on task-dependent changes
in rCBF
Previous research has defined regions within the DLPFC and
PPC in the right hemisphere as involved in performance of the
self-ordered SWM task. The significant interaction between drug and
task in the left hemisphere in the present study was, therefore,
surprising, although it is consistent with other cognitive
psychopharmacological studies using catecholamine agents (Daniel et
al., 1991 ; Grasby et al., 1992 ; Mattay et al., 1996 ). Consequently,
supplementary analyses were performed to directly compare the left and
right hemisphere drug-induced, task-related changes in rCBF within the DLFPC and the PPC. Repeated-measures ANOVAs showed no interaction of
the drug and task with laterality for either the DLPFC
(F(1,9) = 2.58; p = 0.14) or the PPC (F(1,9) = 2.76;
p = 0.13). Therefore, it appears that the interaction
between methylphenidate and the working memory task, although
only reaching significance in the left hemisphere according to our
statistical criterion, should not be thought of as being unequivocally
unilateral. Indeed, closer inspection of these interactions in the
equivalent right hemisphere regions revealed decreases in rCBF of
Z = 1.61 (DLPFC) and 1.63 (PPC).
Cardiovascular and subjective effects of Ritalin
Subsequent analyses attempted to specify the underlying
cognitive, subjective, or cardiovascular processes that might be
associated with the enhancement of SWM performance seen after
methylphenidate administration. It was predicted that the cognitive
effects of methylphenidate would not be related to drug-induced effects
on subjective or cardiovascular measures. To assess the influence of
methylphenidate on changes in subjective mood ratings, responses on a
set of 16 visual analog scales (Bond and Lader, 1974 ) were analyzed
using repeated-measures ANOVAs. Because of the number of
comparisons being made, a restricted significance threshold of
p = 0.01 was used. No significant main effects of drug
condition or interactions with drug condition were found.
Repeated-measures ANOVA was also used to assess the influence of
methylphenidate on the cardiovascular measures of heart rate and blood
pressure. A significant effect of drug administration was found for the systolic blood pressure measurements (Table
2), but this was not related to the
improved performance on the working memory task (Pearson's product
moment correlation coefficient, r = 0.15; p = 0.68).
Relationship of drug-induced enhanced performance to
baseline memory span
Prompted by the results of a previous study using a
dopamine D2 receptor agonist (bromocriptine) (Kimberg et al., 1997 ),
the possible relationship between the baseline memory span scores and
the drug-induced improvement in SWM performance was investigated. The
drug-induced reduction in SWM errors correlated negatively with verbal
(r = 0.78; p = 0.007), as well as
spatial (r = 0.67; p = 0.033)
baseline memory span. Thus, subjects with lower baseline memory
capacity demonstrated greater improvement in SWM in terms of error
reduction after treatment with methylphenidate. In addition, both the
digit and spatial memory span scores were highly, positively, correlated (r = 0.78; p = 0.008),
suggesting that the drug-induced improvement may be related to general
baseline working memory capacity rather than specifically spatial or
verbal components.
The drug × task interaction effect on rCBF was not
attributable to generalized changes in blood flow
The interaction effects evidenced in this study between
methylphenidate administration and SWM task performance were not
attributable to generalized effects of methylphenidate on attenuating
blood flow (Krimer et al., 1998 ), because they occurred in different loci than the drug-induced changes in rCBF (Table 1). It is also unlikely that the significant interactions of methylphenidate and the
cognitive task on rCBF were artifacts of the overall drug-induced attenuation of rCBF. This is illustrated by the comparison of Figure
2d to Figure 2a-c. Figure 2d shows
the adjusted blood flow values for the region of the brain showing
the most significant generalized reduction of rCBF in response to
methylphenidate administration the left temporal pole. In Figure
2d methylphenidate administration led to reduced blood flow
in both the working memory and the control tasks. This contrasts with
the effects for the left DLPFC, left supplementary motor area, and left
PPC (Fig. 2a-c), where reductions in rCBF after
methylphenidate were specific to the working memory task conditions.
Nor was it the case that all areas of the brain activated by the task
were attenuated by methylphenidate. For example, the right
ventrolateral prefrontal cortex, which has been shown to be activated
by the task (Owen et al., 1996b ), shows no significant drug-induced
attenuation in rCBF after drug [mean adjusted blood flow values (with
SDs in parentheses) for the stereotaxic coordinates 36, 50, and
20 for control condition and task conditions: on drug, 56.0 (1.47),
56.5 (0.90); on placebo, 56.5 (1.35), 57.7 (1.36)].
 |
DISCUSSION |
The results of this study have demonstrated, we think for
the first time, that methylphenidate-induced enhancement of
self-ordered SWM performance is accompanied by discrete changes in rCBF
within the DLPFC and PPC. These changes were not caused by generalized effects of methylphenidate on rCBF or artifacts of rCBF changes restricted to cortical regions activated by the task.
The locus of the interaction effect in the left prefrontal cortex is
entirely consistent with other neuroimaging studies investigating the
neural correlates of monoaminergic modulation of cognitive functions
(Daniel et al., 1991 ; Grasby et al., 1992 ; Mattay et al., 1996 ). For
example, Grasby et al. (1992) showed that the dopamine agonist
apomorphine attenuated increased rCBF during a verbal memory task in
the left DLPFC which, unlike our study, was accompanied by impaired
performance in those on drug. In the present study, the significant
methylphenidate-induced reduction of blood flow in the left DLFPC (and
the trend in the right DLPFC) therefore appears important for an
understanding of the clear enhancement of performance accuracy on the
SWM task. Furey et al. (1997) were able to demonstrate a drug-induced
speeding of reaction time (but with no effect on performance accuracy)
on a facial recognition task after the anticholinesterase
physostigmine. This shortening of response latencies was
associated with decreased rCBF in the right DLPFC (Furey et al., 1997 ).
In contrast, studies with catecholaminergic agents, including the
present one, have observed task-related modulation of rCBF in the left
DLPFC. Moreover, the present enhancement in performance, induced by
methylphenidate, was on choice accuracy, whereas physostigmine
shortened response latencies (performance accuracy was at ceiling) in a
rather different facial recognition paradigm. There are theoretical
grounds for concluding that measures of accuracy and latency reflect
different aspects of memory retrieval processes (Baddeley, 1986 ).
Consequently, it would appear that cholinergic and catecholaminergic
systems may modulate different aspects of retrieval in the frontal
lobes, although further research using a common test procedure would be
required to empirically demonstrate such a dissociation.
Because the present task has been shown to preferentially activate the
right DLPFC (Owen et al., 1996b ), it is possible that the drug-induced
improvement in SWM is mediated by effects on other cognitive processes
that modulate performance on this task. One possible mechanism may
involve a change in task-related rCBF in the left DLPFC associated with
a facilitation of verbal rehearsal via the articulatory loop (Baddeley,
1986 ), given that activation in this area has been observed
during some verbal working memory tasks (Smith and Jonides, 1998 ).
Indeed, articulatory suppression is known to impair performance in
a spatial reasoning task requiring working memory (Vandierdonck and De
Vooght, 1997 ) and in the task used here (T. W. Robbins, A. M. Owen, V. Foot, and J. Newton, unpublished observations), suggesting
some verbal mediation of accurate performance.
Alternatively, the drug could be acting to suppress distracting verbal
mediation. The lack of evidence for a lateralized effect on rCBF when
the two sides are directly compared, together with the finding of a
specific relationship of the drug effect to verbal and visual working
memory measures, suggest that the drug may be acting on more general
working memory processes. The reduction in activation in the DLPFC on
drug during the task performance may be related to methylphenidate
treatment resulting in an increased efficiency with which the working
memory task is completed by a neural network including the DLPFC. The
neuronal nature of this increased efficiency may be manifested as an
increased response to signals with concomitant suppression of
background noise, a well-documented effect of catecholamines (Foote and
Morrison, 1975 ). Because there were up to 11 distractors present at any stage during the task when the subject was searching for one token, the
overall detectable effect of this increase in signal-to-noise ratio may
be a reduction in neuronal activity, and hence, a reduction in blood
flow in certain regions within the task-specific neural network
(Raichle, 1987 ). The fact that the subjects with the least effective
baseline working memory capacity (tested outside the scanner) exhibited
the greatest degree of improvement after methylphenidate is consistent
with this account (as can be described by sigmoidal functions of signal
discriminability) (Kimberg et al., 1997 ).
A number of psychological processes are thought to be involved in the
SWM task (Petrides et al., 1993 ; see also Goldman-Rakic, 1995 ) and
include (1) online storage and active response organization based on
the retrieval of information from posterior cortical association
systems (involving the mid-ventrolateral prefrontal cortex), and (2)
the active manipulation and monitoring of information within working
memory (involving the mid-DLPFC). By analogy, the results of the
present study can be taken as reflecting selective modulation of (1)
the former processes, mediated by drug-induced changes in rCBF in
the PPC, and (2) the latter processes mediated by drug-induced changes
in rCBF in the left DLPFC. Thus, the findings provide valuable insights
into the mechanism of enhancement of SWM performance by
the catecholaminergic stimulant drug methylphenidate. These results have important consequences for understanding
the methylphenidate-induced improvements seen in children with
AD/HD on working memory tasks (Tannock et al., 1995 ; Kempton et al., 1999 ) and in comparison with other paradigms (e.g.,
response inhibition) (Vaidya et al., 1998 ). More generally, the results
are important for understanding the possible beneficial effects of
catecholaminergic drugs in a range of cognitive disorders,
including acute brain injury (McDowell et al., 1998 ) and schizophrenia
(Mortimer, 1997 ).
 |
FOOTNOTES |
Received Oct. 26, 1999; revised Jan. 7, 2000; accepted Jan. 19, 2000.
This work was supported by a Wellcome Trust Programme Grant to T.W.R.,
B. J. Everitt, A. C. Roberts, and B.J.S. M.A.M. was supported by a Medical Research Council (MRC) Studentship. We thank Dr.
David A. Menon for clinical advice, Dr. Wim Reidel for assistance, and
Dr. Matthew Brett for discussion. This research was completed within
the MRC Cooperative group in Brain, Behavior, and Neuropsychiatry.
Correspondence should be addressed to Dr. Barbara Sahakian at
University of Cambridge, Department of Psychiatry, Level E4, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK. E-mail:
jenny.hall{at}msexc.addenbrookes.anglox.nhs.uk.
This article is published in
The Journal of Neuroscience, Rapid Communications Section,
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JNeurosci, 2000, 20:RC65 (1-6). The
publication date is the date of posting online at
www.jneurosci.org.
 |
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