Whole-brain functional neuroimaging correlates of cognitive flexibility impairments in people with mental disorders: A transdiagnostic coordinate-based meta-analysis

Introduction: Set-shifting skills allow individuals to flexibly adapt their behavior against environmental feedback. Impairments of this cognitive control process represent the core features of heterogeneous mental disorders. However, it is unclear whether the neural mechanisms of set-shifting impairments are shared across different mental disorders. Materials and methods: We systematically screened the neuroimaging literature and conducted a coordinate-based meta-analysis. Of 1930 publications, 22 functional neuroimaging studies investigating neural response differences during the performance of set-shifting paradigm on the scanner in individuals with a mental disorder, including schizophrenia, depression, anxiety disorder, neurodevelopmental disorders, eating disorders, obsessive-compulsive disorder, behavioral addiction were selected. Results: We found significant hyperactivation responses during set-shifting in the right medial frontal/anterior cingulate gyrus, the right superior parietal lobule, and the left superior temporal gyrus in patients with schizophrenia, autism spectrum disorders, or generalized anxiety disorder. Conclusions: Our findings suggest a common substrate of increased activity in the frontoparietal network (FPN) across mental disorders during set-shifting. FPN activation responses may represent a biomarker of altered cognition across traditional nosographic categories.