Editing Anterior cingulate cortex (section)

==Pathology==
Studying the effects of damage to the ACC provides insights into the type of functions it serves in the intact brain. Behavior that is associated with lesions in the ACC includes: inability to detect errors, severe difficulty with resolving stimulus conflict in a [[Stroop task]], emotional instability, inattention, and [[akinetic mutism]].<ref>{{cite journal | vauthors = Janer KW, Pardo JV | title = Deficits in selective attention following bilateral anterior cingulotomy | journal = Journal of Cognitive Neuroscience | volume = 3 | issue = 3 | pages = 231–41 | date = 1991 | pmid = 23964838 | doi = 10.1162/jocn.1991.3.3.231 | s2cid = 39599951 }}</ref><ref name=Bush00/><ref name=Posner98/> There is evidence that damage to ACC is present in patients with [[schizophrenia]], where studies have shown patients have difficulty in dealing with conflicting spatial locations in a Stroop-like task and having abnormal ERNs.<ref name=Posner98/><ref name=Holroyd04/> Participants with [[ADHD]] were found to have reduced activation in the dorsal area of the ACC when performing the [[Stroop task]].<ref>{{cite journal | vauthors = Bush G, Frazier JA, Rauch SL, Seidman LJ, Whalen PJ, Jenike MA, Rosen BR, Biederman J | title = Anterior cingulate cortex dysfunction in attention-deficit/hyperactivity disorder revealed by fMRI and the Counting Stroop | journal = Biological Psychiatry | volume = 45 | issue = 12 | pages = 1542–52 | date = June 1999 | pmid = 10376114 | doi = 10.1016/S0006-3223(99)00083-9 | s2cid = 205870638 }}</ref> Together, these findings corroborate results from imaging and electrical studies about the variety of functions attributed to the ACC.

===OCD===
There is strong evidence that this area may have a role in [[obsessive–compulsive disorder]]. A recent study from the University of Cambridge showed that participants with OCD had higher levels of [[Glutamate (neurotransmitter)|glutamate]] and lower levels of [[Γ-Aminobutyric acid|GABA]] in the anterior cingulate cortex, compared to participants without OCD. They used magnetic resonance spectroscopy to assess the balance of excitatory and inhibitory neurotransmission by measuring glutamate and GABA levels in anterior cingulate cortex and supplementary motor area of healthy volunteers and participants with OCD. Participants with OCD had significantly higher levels of glutamate and lower levels of GABA in the ACC and a higher Glu:GABA ratio in that region.<ref>{{Cite journal |last1=Biria |first1=Marjan |last2=Banca |first2=Paula |last3=Healy |first3=Máiréad P. |last4=Keser |first4=Engin |last5=Sawiak |first5=Stephen J. |last6=Rodgers |first6=Christopher T. |last7=Rua |first7=Catarina |last8=de Souza |first8=Ana Maria Frota Lisbôa Pereira |last9=Marzuki |first9=Aleya A. |last10=Sule |first10=Akeem |last11=Ersche |first11=Karen D. |last12=Robbins |first12=Trevor W. |date=2023-06-27 |title=Cortical glutamate and GABA are related to compulsive behaviour in individuals with obsessive compulsive disorder and healthy controls |journal=Nature Communications |language=en |volume=14 |issue=1 |page=3324 |doi=10.1038/s41467-023-38695-z |pmid=37369695 |issn=2041-1723|pmc=10300066 |bibcode=2023NatCo..14.3324B }}</ref>

Recent [[Seed-based d mapping|SDM meta-analyses]] of [[voxel-based morphometry]] studies comparing people with OCD and healthy controls has found people with OCD to have increased [[grey matter]] volumes in bilateral [[lenticular nucleus|lenticular nuclei]], extending to the [[caudate nucleus|caudate nuclei]], while decreased grey matter volumes in bilateral dorsal [[medial frontal gyrus|medial frontal]]/anterior cingulate cortex.<ref name="Radua and Mataix-Cols, 2009">{{cite journal | vauthors = Radua J, Mataix-Cols D | title = Voxel-wise meta-analysis of grey matter changes in obsessive-compulsive disorder | journal = The British Journal of Psychiatry | volume = 195 | issue = 5 | pages = 393–402 | date = November 2009 | pmid = 19880927 | doi = 10.1192/bjp.bp.108.055046 | doi-access = free }}</ref><ref name="radua2010">{{cite journal | vauthors = Radua J, van den Heuvel OA, Surguladze S, Mataix-Cols D | title = Meta-analytical comparison of voxel-based morphometry studies in obsessive-compulsive disorder vs other anxiety disorders | journal = Archives of General Psychiatry | volume = 67 | issue = 7 | pages = 701–11 | date = July 2010 | pmid = 20603451 | doi = 10.1001/archgenpsychiatry.2010.70 | doi-access = free }}
</ref> These findings contrast with those in people with other anxiety disorders, who evince decreased (rather than increased) [[grey matter]] volumes in bilateral [[lenticular nucleus|lenticular]] / [[caudate nucleus|caudate nuclei]], while also decreased grey matter volumes in bilateral dorsal [[medial frontal gyrus|medial frontal]] / anterior cingulate gyri.<ref name="radua2010" />

===Schizophrenia spectrum disorders===
In individuals with [[schizophrenia]] spectrum disorders, the anterior cingulate cortex has been found to be smaller compared to that of control subjects.<ref name="Haznedar 2004">{{Cite journal | last1 = Haznedar | first1 = M. M. | last2 = Buchsbaum | first2 = M. S. | last3 = Hazlett | first3 = E. A. | last4 = Shihabuddin | first4 = L. | last5 = New | first5 = A. | last6 = Siever | first6 = L. J. | doi = 10.1016/j.schres.2004.02.025 | title = Cingulate gyrus volume and metabolism in the schizophrenia spectrum | journal = Schizophrenia Research | volume = 71 | issue = 2–3 | pages = 249–262 | year = 2004 | pmid =  15474896| s2cid = 28889346 }}</ref><ref name="Fujiwara 2007">{{Cite journal | last1 = Fujiwara | first1 = H. | last2 = Hirao | first2 = K. | last3 = Namiki | first3 = C. | last4 = Yamada | first4 = M. | last5 = Shimizu | first5 = M. | last6 = Fukuyama | first6 = H. | last7 = Hayashi | first7 = T. | last8 = Murai | first8 = T. | doi = 10.1016/j.neuroimage.2007.03.068 | title = Anterior cingulate pathology and social cognition in schizophrenia: A study of gray matter, white matter and sulcal morphometry | journal = NeuroImage | volume = 36 | issue = 4 | pages = 1236–1245 | year = 2007 | pmid =  17524666| url = https://repository.kulib.kyoto-u.ac.jp/dspace/bitstream/2433/124279/3/yigak03320.pdf | hdl = 2433/124279 | s2cid = 25750603 | hdl-access = free }}</ref> 
[[Meta-analyses]] have shown that its activity is reduced during emotion processing,<ref>{{cite journal |last1= Taylor |first1=S-F |last2= Kang |first2=J |last3= Brege |first3=I-S |last4= Tso |first4=I-F | last5= Hosanagar |first5=A | last6= Johnson |first6=T | title= Meta-analysis of functional neuroimaging studies of emotion perception and experience in schizophrenia |journal=Biological Psychiatry |date=15 Jan 2012 |volume=71| issue=2| pages=136-145| doi=10.1016/j.biopsych.2011.09.007|pmid= 21993193}}</ref> and its [[functional connectivity]] with the [[striatum]] is diminished at rest, which has been linked to cognitive rigidity.<ref>{{cite journal |last1= Grimaldi |first1=D-A |last2= Patane' |first2=A |last3= Cattarinussi |first3=G |last4= Sambataro |first4=F |title= Functional connectivity of the striatum in psychosis: Meta-analysis of functional magnetic resonance imaging studies and replication on an independent sample |journal=Neuroscience & Biobehavioral Reviews |date=2 May 2025 |volume=174 |doi=10.1016/j.neubiorev.2025.106179 |pmid= 40288705}}</ref>

===Anxiety===
The ACC has been suggested to have possible links with [[Social Anxiety|social anxiety]], along with the amygdala part of the brain, but this research is still in its early stages.<ref>{{cite journal | vauthors = Lieberman MD, Eisenberger NI | title = Neuroscience. Pains and pleasures of social life | journal = Science | volume = 323 | issue = 5916 | pages = 890–1 | date = February 2009 | pmid = 19213907 | doi = 10.1126/science.1170008 | s2cid = 206518219 }}</ref> A more recent study, by the Wake Forest Baptist Medical Centre, confirms the relationship between the ACC and anxiety regulation, by revealing mindfulness practice as a meditator for anxiety precisely through the ACC.<ref>{{cite journal | vauthors = Zeidan F, Martucci KT, Kraft RA, McHaffie JG, Coghill RC | title = Neural correlates of mindfulness meditation-related anxiety relief | journal = Social Cognitive and Affective Neuroscience | volume = 9 | issue = 6 | pages = 751–9 | date = June 2014 | pmid = 23615765 | pmc = 4040088 | doi = 10.1093/scan/nst041 }}</ref>

===Depression===
The adjacent [[subgenual area|subcallosal cingulate gyrus]] has been implicated in [[major depression]] and research indicates that [[deep-brain stimulation]] of the region could act to alleviate depressive symptoms.<ref>{{cite journal | vauthors = Hamani C, Mayberg H, Stone S, Laxton A, Haber S, Lozano AM | title = The subcallosal cingulate gyrus in the context of major depression | journal = Biological Psychiatry | volume = 69 | issue = 4 | pages = 301–8 | date = February 2011 | pmid = 21145043 | doi = 10.1016/j.biopsych.2010.09.034 | s2cid = 35458273 | doi-access = free }}</ref> Although people with depression had smaller subgenual ACCs,<ref>{{cite journal | vauthors = Ongür D, Ferry AT, Price JL | title = Architectonic subdivision of the human orbital and medial prefrontal cortex | journal = The Journal of Comparative Neurology | volume = 460 | issue = 3 | pages = 425–49 | date = June 2003 | pmid = 12692859 | doi = 10.1002/cne.10609 | s2cid = 9798173 }}</ref> their ACCs were more active when adjusted for size.  This correlates well with increased subgenual ACC activity during sadness in healthy people,<ref>{{cite journal | vauthors = George MS, Ketter TA, Parekh PI, Horwitz B, Herscovitch P, Post RM | title = Brain activity during transient sadness and happiness in healthy women | journal = The American Journal of Psychiatry | volume = 152 | issue = 3 | pages = 341–51 | date = March 1995 | pmid = 7864258 | doi = 10.1176/ajp.152.3.341 }}</ref> and normalization of activity after successful treatment.<ref>{{cite book|last1=Licinio |first1=Julio|last2=Wong|first2=Ma-Li | name-list-style = vanc |title=Biology of Depression: From Novel Insights to Therapeutic Strategies|url=https://archive.org/details/biologydepressio00lici |url-access=limited |date=29 January 2008|publisher=Wiley-VCH Verlag GmbH & Co. KGaA|isbn=9783527307852|pages=[https://archive.org/details/biologydepressio00lici/page/n455 425]–466}}</ref> Of note, the activity of the subgenual cingulate cortex correlates with individual differences in negative affect during the baseline resting state; in other words, the greater the subgenual activity, the greater the negative affectivity in temperament.<ref>{{cite journal | vauthors = Zald DH, Mattson DL, Pardo JV | title = Brain activity in ventromedial prefrontal cortex correlates with individual differences in negative affect | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 99 | issue = 4 | pages = 2450–4 | date = February 2002 | pmid = 11842195 | pmc = 122385 | doi = 10.1073/pnas.042457199 | bibcode = 2002PNAS...99.2450Z | doi-access = free }}</ref>

===Lead exposure===
A study of brain MRIs taken on adults that had previously participated in the [[Cincinnati Lead Study]] found that people that had higher levels of [[lead]] exposure as children had decreased brain size as adults. This effect was most pronounced in the ACC (Cecil et al., 2008)<ref>{{cite journal | vauthors = Cecil KM, Brubaker CJ, Adler CM, Dietrich KN, Altaye M, Egelhoff JC, Wessel S, Elangovan I, Hornung R, Jarvis K, Lanphear BP | title = Decreased brain volume in adults with childhood lead exposure | journal = PLOS Medicine | volume = 5 | issue = 5 | pages = e112 | date = May 2008 | pmid = 18507499 | pmc = 2689675 | doi = 10.1371/journal.pmed.0050112 | doi-access = free }}</ref> and is thought to relate to the cognitive and behavioral deficits of affected individuals.

===Autism===
Impairments in the development of the anterior cingulate, together with impairments in the dorsal medial-frontal cortex, may constitute a neural substrate for socio-cognitive deficits in [[autism spectrum disorders|autism]], such as social orienting and [[joint attention]].<ref>{{cite journal|url=http://infantlab.fiu.edu/articles/Mundy,%202003%20JCPP.pdf |title=Annotation: The neural basis of social impairments in autism: the role of the dorsal medial-frontal cortex and anterior cingulate system |author=Peter Mundy |journal=Journal of Child Psychology and Psychiatry |year=2003 |volume=44 |issue=6 |pages=793–809 |doi=10.1111/1469-7610.00165 |pmid=12959489 |url-status=dead |archive-url=https://web.archive.org/web/20120307115650/http://infantlab.fiu.edu/articles/Mundy%2C%202003%20JCPP.pdf |archive-date=7 March 2012 }}</ref>

===PTSD===
An increasing number of studies are investigating the role of the ACC in [[post-traumatic stress disorder]]. PTSD diagnosis and related symptoms such as skin conductance response (SCR) to "potentially startling sounds" were found to be correlated with reduced ACC volume.<ref>{{cite journal | vauthors = Young DA, Chao L, Neylan TC, O'Donovan A, Metzler TJ, Inslicht SS | title = Association among anterior cingulate cortex volume, psychophysiological response, and PTSD diagnosis in a Veteran sample | journal = Neurobiology of Learning and Memory | volume = 155 | pages = 189–196 | date = November 2018 | pmid = 30086395 | pmc = 6361720 | doi = 10.1016/j.nlm.2018.08.006 }}</ref> Further, childhood trauma and executive dysfunction seem to correlate with reduced ACC connectivity to surrounding neural regions.<ref name="Silveira 499–509">{{cite journal | vauthors = Silveira S, Shah R, Nooner KB, Nagel BJ, Tapert SF, de Bellis MD, Mishra J | title = Impact of Childhood Trauma on Executive Function in Adolescence-Mediating Functional Brain Networks and Prediction of High-Risk Drinking | journal = Biological Psychiatry. Cognitive Neuroscience and Neuroimaging | volume = 5 | issue = 5 | pages = 499–509 | date = May 2020 | pmid = 32299789 | doi = 10.1016/j.bpsc.2020.01.011 | pmc = 8366521 }}</ref> In a longitudinal study, this reduced connectivity was able to predict high-risk drinking (binge drinking at least once per week for the past 12 months) up to four years later.<ref name="Silveira 499–509"/>

===General risk of psychopathology===
A study on differences in brain structure of adults with high and low levels of [[Metacognitive therapy#Self-Regulatory Executive Function model|cognitive-attentional syndrome]] demonstrated diminished volume of the dorsal part of the ACC in the former group, indicating relationship between cortical thickness of ACC and general risk of [[psychopathology]].<ref>{{Cite journal |last1=Kowalski |first1=Joachim |last2=Wypych |first2=Marek |last3=Marchewka |first3=Artur |last4=Dragan |first4=Małgorzata |date=2022-03-10 |title=Brain structural correlates of cognitive-attentional syndrome – a Voxel-Based Morphometry Study |url=https://doi.org/10.1007/s11682-022-00649-2 |journal=Brain Imaging and Behavior |volume=16 |issue=4 |pages=1914–1918 |language=en |doi=10.1007/s11682-022-00649-2 |pmid=35266100 |s2cid=247360689 |issn=1931-7565|url-access=subscription }}</ref>