This is a habilitation thesis submitted to and accepted by the council of the faculty of life sciences at the Humboldt-Universität zu Berlin, Berlin, Germany. The thesis is written in English, but some formal parts (e.g., on the title page) and acknowledgements are written in German language. / Die Research-Domain-Criteria-Initiative und andere haben vorgeschlagen, zur Konzeption psychischer Störungen dimensionale psychologische Konstrukte zu verwenden. Die vorliegende Arbeit beschreibt mehrere Experimente, in denen mit Augenbewegungsaufgaben das Konstrukt der kognitiven Kontrolle evaluiert wurde. Die Studien sollten klären, welche kognitiven und neuronalen Mechanismen zu den bei Menschen mit Schizophrenie oder Zwangsstörung erhöhten Latenzen volitionaler Sakkaden beitragen. In drei Studien wurden Anforderungen der Antisakkadenaufgabe isoliert und funktionelle Magnetresonanztomographie angewendet. Die Ergebnisse legen nahe, dass die verlangsamte volitionale Sakkadengenerierung bei Schizophrenie durch eine dysfunktionale Aktivierung des lateralen präfrontalen Cortex und der supplementären Augenfelder vermittelt wird, was mit Defiziten in der proaktiven Handlungskontrolle verbunden sein könnte. Fünf weitere Experimente sollten Teilprozesse aufklären und haben gezeigt, dass die Defizite möglicherweise aus einer Beeinträchtigung der volitionalen Loslösung der Fixation und der motorischen Vorbereitung resultieren. Zwei weitere Studien legen nahe, dass auch die Zwangsstörung mit erhöhten Latenzen volitionaler Sakkaden assoziiert ist. Effekte experimenteller Variation haben jedoch gezeigt, dass diesen Defiziten wahrscheinlich eine Verlangsamung der Reaktionsauswahl zugrundeliegt. Die bei beiden Patientengruppen vermutlich betroffenen Mechanismen dienen zielgerichteten Verhaltensweisen. Man kann vermuten, dass die Defizite eine Störung auf der Ebene eines allgemeinen Faktors exekutiver Funktionen widerspiegeln. Die experimentellen Ergebnisse weisen jedoch auch auf störungsspezifische Funktionsbeeinträchtigungen hin. Zukünftige Forschung muss den Zusammenhang zwischen diesen Beeinträchtigungen und Symptomen besser aufzuklären, wenn Konzepte psychischer Störungen, die auf experimentell definierten psychologischen Konstrukten basieren, am Ende erfolgreich sein sollen. / The research domain criteria initiative and others have suggested to conzeptualize mental disorders on the basis of dimensional psychological constructs. The present work describes several experiments using eye movement tasks to evaluate the construct of cognitive control. The studies aimed at uncovering cognitive and neural mechanisms involved in increased latencies of volitional saccades as found in individuals with schizophrenia or obsessive-compulsive disorder. Three studies used functional magnetic resonance imaging and isolated different demands of the antisaccade task. The results suggest that slowed volitional saccade generation in schizophrenia is mediated by dysfunctional activation of the lateral prefrontal cortex and the supplementary eye fields, which may relate to deficits in proactive control of action. Five additional behavioral experiments aimed at specifying sub-processes and showed that the deficits might result from impairments in volitional fixation disengagement and motor preparation. Two studies in individuals with obsessive-compulsive disorder suggest that this disorder is also associated with increased latencies of volitional saccades. However, experimental variation revealed that these deficits may reflect a slowing in response selection. The mechanisms affected in both groups are serving goal-directed behaviors and may reflect a disturbance on the level of a common executive functions factor. However, the experimental results also suggest disorder specific functional impairment. Future research will have to improve our understanding of the relationship between these impairments and symptoms if concepts based on experimentally defined psychological constructs shall be successful in the end.

Rationale Although there is evidence that impaired executive functioning plays a role in addictive behavior, the longitudinal relationship between the two remains relatively unknown. Objectives In a prospective-longitudinal community study, we tested the hypothesis that lower executive functioning is associated with more addictive behavior at one point in time and over time. Methods Three hundred and thirty-eight individuals (19–27 years, 59% female) from a random community sample were recruited into three groups: addictive disorders related to substances (n = 100) or to behaviors (n = 118), or healthy controls (n = 120). At baseline, participants completed nine executive function tasks from which a latent variable of general executive functioning (GEF) was derived. Addictive behavior (i.e., quantity and frequency of use, and number of DSM-5 criteria met) were assessed using standardized clinical interviews at baseline and three annual follow-ups. The trajectories of addictive behaviors were examined using latent growth curve modeling. Results At baseline, we found weak to no evidence of an associations between GEF and addictive behavior. We found evidence for an association between a lower GEF at baseline and a higher increase in the quantity of use and a smaller decrease in frequency of use over time, but no evidence for an association with an increase in the number of DSM-5 criteria met. Conclusions Lower EFs appear to lead to a continuing loss of control over use, whereas addictive disorders may develop secondarily after a long period of risky use. Previous etiological models assuming lower EF as a direct vulnerability factor for addictive disorders need to be refined.

Konvergierende neurobiologische Studien zeigen, dass Negative Kindheitserfahrungen (Adverse Childhood Experiences, ACEs) mehrere dicht miteinander verknüpfte Hirnsysteme beeinflussen und die Entwicklung von Exekutivfunktionen stören, insbesondere die Fähigkeit, unangemessene Affekte und Handlungen zu unterdrücken. In der vorliegenden Arbeit wurde zunächst untersucht, wie Exekutivfunktionen in nicht-emotionalen (kühlen) und emotionalen (heißen) Situationen (d. h. Emotionsregulation) mit einer hohen Exposition gegenüber ACEs zusammenhängen und ob solche Beziehungen durch akuten Stress verstärkt werden. Unsere Ergebnisse zeigen, dass gewalttätiges Verhalten bei Opfern von Kindheitstraumata eher mit Defiziten in heißen Exekutivfunktionen als mit Defiziten in kühlen Exekutivfunktionen verbunden sein könnte, insbesondere unter Stressbedingungen. Insgesamt zeigt diese Studie erstens die Nützlichkeit von OpenFace, einem kostengünstigen und dennoch effektiven Instrument zur Untersuchung des mimischen Verhaltens bei der Emotionsregulation. Zweitens eröffnet sie Perspektiven für eine gezieltere Erforschung von und Interventionen bei ACEs. Drittens bezieht sie Jugendliche ein, eine wenig erforschte Altersgruppe, die sich in einer sensiblen Phase der Entwicklung von Exekutivfunktionen befinden. / Converging neurobiological studies show that Adverse Childhood Experiences (ACEs) affect multiple densely interconnected neurobiological systems and disrupt the development of executive functions (EFs), especially the ability to inhibit inappropriate affects and actions, potentially modulating factors in the relationship between ACEs and violent behaviour. This study first sought to assess how EFs under non-emotional (cool) and emotional (hot) situations (i.e. emotion regulation) are related with high-exposure to ACEs, and whether any such relationships would be aggravated by acute stress. Our findings show that violent behavior among victims of childhood trauma might be associated more with deficits in hot EFs than it is with deficits in cool EFs, especially more so under conditions of stress. Altogether, this study first shows the usefulness of OpenFace, a low cost yet effective tool to study facial behaviour in emotion regulation. Second, it opens perspectives towards more targeted research on, and interventions for ACEs, and third, it involves adolescents, a little researched age group, yet a sensitive period of EFs development.

Punishments can help inform us to make adaptive changes in behavior. However, previous research suggested that only low punishment-sensitive individuals “learn” from punishment, whereas high punishment-sensitive individuals do not. Here we used a flanker interference task with performance-contingent punishment signals to test the hypothesis that a clinical group characterized by heightened punishment sensitivity (i.e., patients with anorexia nervosa [AN]) would fail to adapt to conflict following punishment. To distinguish between state and trait factors, we tested for between-group differences in separate cohorts of acutely underweight patients (acAN; n = 40) and weight-recovered former patients (recAN; n = 25) relative to age-matched healthy controls (n = 48). The acAN patients showed an abnormally reversed congruency-sequence effect in error rates following punishment, despite generally superior accuracy, suggesting that punishment distracted acAN patients and interfered with interference control. The influence of punishment was more subtle in recAN and did not reach statistical significance, but both reaction time and error rate data hinted that elevated sensitivity to punishment negatively affects cognitive control even after long-term weight normalization. Together, these findings emphasize that punishment sensitivity may be a clinically relevant trait marker in AN and provide novel experimental evidence that punishment may have a detrimental impact on adaptive behavior in the disorder. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Rationale The cognitive control dilemma describes the necessity to balance two antagonistic modes of attention: stability and flexibility. Stability refers to goal-directed thought, feeling, or action and flexibility refers to the complementary ability to adapt to an ever-changing environment. Their balance is thought to be maintained by neurotransmitters such as dopamine, most likely in a U-shaped rather than linear manner. However, in humans, studies on the stability-flexibility balance using a dopaminergic agent and/or measurement of brain dopamine are scarce. Objective The study aimed to investigate the causal involvement of dopamine in the stability-flexibility balance and the nature of this relationship in humans. Methods Distractibility was assessed as the difference in reaction time (RT) between distractor and non-distractor trials in a visual search task. In a randomized, placebo-controlled, double-blind, crossover study, 65 healthy participants performed the task under placebo and a dopamine precursor (L-DOPA). Using 18F-DOPA-PET, dopamine availability in the striatum was examined at baseline to investigate its relationship to the RT distractor effect and to the L-DOPA-induced change of the RT distractor effect. Results There was a pronounced RT distractor effect in the placebo session that increased under L-DOPA. Neither the RT distractor effect in the placebo session nor the magnitude of its L-DOPA-induced increase were related to baseline striatal dopamine. Conclusions L-DOPA administration shifted the stability-flexibility balance towards attentional capture by distractors, suggesting causal involvement of dopamine. This finding is consistent with current theories of prefrontal cortex dopamine function. Current data can neither confirm nor falsify the inverted U-shaped function hypothesis with regard to cognitive control.

A number of studies have concluded that cognitive control is not fully established until late adolescence. The precise differences in brain function between adults and adolescents with respect to cognitive control, however, remain unclear. To address this issue, we conducted a study in which 185 adolescents (mean age (SD) 14.6 (0.3) years) and 28 adults (mean age (SD) 25.2 (6.3) years) performed a single task that included both a stimulus-response (S-R) interference component and a task-switching component. Behavioural responses (i.e. reaction time, RT; error rate, ER) and brain activity during correct, error and post-error trials, detected by functional magnetic resonance imaging (fMRI), were measured. Behaviourally, RT and ER were significantly higher in incongruent than in congruent trials and in switch than in repeat trials. The two groups did not differ in RT during correct trials, but adolescents had a significantly higher ER than adults. In line with similar RTs, brain responses during correct trials did not differ between groups, indicating that adolescents and adults engage the same cognitive control network to successfully overcome S-R interference or task switches. Interestingly, adolescents with stronger brain activation in the bilateral insulae during error trials and in fronto-parietal regions of the cognitive control network during post-error trials did have lower ERs. This indicates that those mid-adolescents who commit fewer errors are better at monitoring their performance, and after detecting errors are more capable of flexibly allocating further cognitive control resources. Although we did not detect a convincing neural correlate of the observed behavioural differences between adolescents and adults, the revealed interindividual differences in adolescents might at least in part be due to brain development.

Making decisions is a dynamic process. Especially when we face a decision between conflicting options, different forces seem to drag our mind from one option to the other one (James, 1890), again and again. This process may last for a long time, sometimes only coming to a decision when we are finally forced to choose, e.g. by an important deadline. Psychology and many other disciplines were interested in how humans make decisions from their beginnings on. Many different influences on decisions were discovered (e.g. Kahneman & Tversky, 1979; Todd & Gigerenzer, 2000). In the face of these advances, it seems odd, that knowledge about the ongoing process of reaching a decision is rare and much of the investigation has focused on the final outcome of choice situations (Townsend & Busemeyer, 1995). A very recent approach, called neuroeconomics, started out to investigate what happens behind the scenes of a final decision. Using modern neuroimaging methods, many neuroeconomists explain decision making in the brain in terms of a hierarchy of different neural modules that work together like a big corporation to finally make the best possible decision (Sanfey, Loewenstein, McClure, & Cohen, 2006). However, the focus on neural modules also limits this approach to a quite static view of decision making and many questions, related to the dynamic aspects of decision making, still remain open: How do we continuously control impulsive or habitual tendencies in our decisions when we pursue long-term goals? How do we shift attention back and forth between (goal) relevant properties of choice options? How do we adjust and readjust our focus of attention to relevant information in order to avoid distraction by irrelevant or misleading information? And how are we influenced by the environmental context when we make decisions? The present work aims to show how an approach based on the concepts of dynamic systems theory could complement the module oriented approach and enhance our knowledge of the processes of decision making. Chapter 2 elaborates the limits of the module oriented approach, with a special focus on decisions under conflict, when we are faced with conflicting information, and introduces the principles of a complementary dynamic approach. Chapter 3 deduces the dynamic hypothesis of this work: ongoing processes interactions at different time scales can explain specific cognitive functions without postulating specialized modules for this function. To approach this hypothesis, chapter 4 will develop a theoretical and empirical framework to study decision making dynamically. The empirical part, building on the empirical framework, starts with chapter 5 presenting an EEG experiment. Chapter 6 presents two mouse tracking experiments, and chapter 7 presents a modelling study, reproducing the empirical data of chapters 5 and 6. The general discussion in chapter 8 summarizes the theoretical and empirical results and discusses possible limitations. Finally, chapter 9 discusses the implications of the dynamic approach to decision making, presents an outlook on future research projects, and closes the work by offering a dynamic picture of the processes behind the stage of a final decision. / „Man kann nicht beides haben: Den Rahm und die Butter.“ - „Wer die Wahl hat, hat die Qual.“ Mit diesen Sprichwörtern beklagt der Volksmund, womit das Leben uns immer wieder konfrontiert: wir müssen entscheiden, und oftmals führt uns das in Entscheidungskonflikte. Im Dilemma solcher Konflikte mag es begründet sein, dass das Thema der vorliegenden Arbeit, die Entscheidungsforschung, nicht nur in der Psychologie schon immer eine wichtige Rolle spielte, sondern auch in anderen Disziplinen, wie der Ökonomie, der angewandten Mathematik und der Philosophie. Die langjährigen Bestrebungen, diese unterschiedlichen Fachbereiche zu integrieren (z.B. Kahneman & Tversky, 1979; von Neumann & Morgenstern, 1944; Savage, 1972), münden aktuell in das Forschungsgebiet der Neuroökonomie (Camerer, Loewenstein, & Prelec, 2005; Loewenstein, Rick, & Cohen, 2008; Sanfey, Loewenstein, McClure, & Cohen, 2006). Neuroökonomen nutzen vielfach die Methoden der bildgebenden Hirnforschung, um durch die Lokalisierung der neuronalen Basis hierarchisch gegliederter Module Entscheidungsprozesse zu erklären (z.B. Sanfey et al., 2006; Fellows, 2004). Während die Anwendung bildgebender Methoden Potential birgt (z.B. Harrison, 2008), ist es vor allem der modulorientierte Ansatz, der das Risiko einer zu eingeschränkten Sichtweise auf Entscheidungsprozesse trägt (z.B. Ortmann, 2008; Oullier & Kelso, 2006). Dies zeigt sich zum Beispiel im von der kognitiven Psychologie intensiv erforschten Bereich von Entscheidungen unter Konflikt. Eine zentrale Rolle bei dieser Art von Entscheidungen spielen kognitive Kontrollprozesse, die der Umsetzung zielorientierten Verhaltens (Norman & Shallice, 2000) durch Konfliktlösung und -anpassung dienen. Als Bindeglied dieser beiden Prozesse gilt die Detektion von Entscheidungskonflikten, welche die vorherrschende Conflict Monitoring Theory (Botvinick, Braver, Barch, Carter, & Cohen, 2001) entsprechend dem modulorientiertem Ansatz einem speziellen neuronalen Modul zuordnet, das im anterioren cingulären Cortex lokalisiert ist (Botvinick, Cohen, & Carter, 2004). Die Probleme eines einseitigen modulorientierten Ansatzes verdeutlichen hier unter anderem die widersprüchliche Befundlage (z.B. Mansouri, Tanaka, & Buckley, 2009) und die letztlich weiterhin ungeklärte Frage nach den zugrundeliegenden Prozessen. Die Arbeit hat deshalb zum Ziel, den modulorientierten Ansatz um einen komplementären Ansatz auf Basis der Theorie dynamischer Systeme (Dynamical Systems Theory, DST) zu ergänzen. Aus dem grundlegenden DST-Prinzip der kontinuierlichen (z.B. Spivey, 2007) Interaktion rückgekoppelter Komponenten (z.B. Kelso, 1995; Van Orden, Holden, & Turvey, 2003) wird zunächst die dynamische Hypothese abgeleitet, dass sich Effekte auf verschiedenen Zeitskalen gegenseitig bedingen und einander hervorbringen. Für Entscheidungen unter Konflikt bedeutet dies, dass sich die Prozesse der Konfliktlösung und anpassung durch ihre direkte Interaktion im kognitiven System gegenseitig erzeugen. Zur Überprüfung dieser Hypothese werden innerhalb der Arbeit generelle empirische Strategien entwickelt, welche die Untersuchung von Entscheidungsprozessen auf verschiedenen Zeitskalen ermöglichen. Im empirischen Teil der Arbeit werden sodann zwei dieser Strategien zur Anwendung gebracht, um den Erkenntnisgewinn des dynamischen Ansatzes zu illustrieren. Zunächst wird in einer EEG-Studie eine Frequency-Tagging-Methode (z.B. Müller & Hübner, 2002; Müller, Andersen, & Keil, 2007) auf die Untersuchung der kognitiven Kontrollprozesse in einer Flanker-Aufgabe (Eriksen & Eriksen, 1974) adaptiert. Die neue Kombination einer kontinuierlichen neurophysiologischen Methode und eines klassischen Konflikt-Paradigmas ermöglicht die gleichzeitige Untersuchung kontinuierlicher Veränderungen der Aufmerksamkeit auf relevante und irrelevante Information. Die Ergebnisse der Studie stützen die Hypothese einer direkten Interaktion von Prozessen der Konfliktlösung und -anpassung und stellen bereits einen Widerspruch zur Conflict Monitoring Theory dar. Als weitere empirische Strategie wird in zwei Experimenten die Methode des Maus-Tracking (z.B. Buetti & Kerzel, 2009; Song & Nakayama, 2009; Spivey, Grosjean, & Knoblich, 2005) im Rahmen einer Simon-Aufgabe (Simon, 1969) eingesetzt. Die erneute Kombination einer kontinuierlichen Methode, diesmal auf Reaktionsebene, mit einem klassischen Konflikt-Paradigma erlaubt die Messung von Verhaltenstendenzen im Verlauf des gesamten Entscheidungsprozesses. Mit Hilfe einer neu entwickelten regressionsbasierten Analysemethode werden die Subprozesse einzelner Entscheidungen separiert und Einblicke in die Dynamik von Konfliktlösung und -anpassung gewonnen. Die Ergebnisse zeigen ein komplexes Muster zeitlicher Interaktion zwischen den beiden kognitiven Kontrollprozessen, wobei die Konfliktanpassung zeitlich unabhängig von der Verarbeitung irrelevanter Information ist. Dies steht erneut im Widerspruch zu Annahmen der Conflict Monitoring Theory. Zusammenfassend stützen die empirischen Ergebnisse die dynamische Hypothese der kontinuierlichen Interaktion rückgekoppelter Komponenten und werden im nächsten Schritt in einem dynamisch-konnektionistischen Netzwerkmodell integriert. Als Alternative zum Modell der Conflict Monitoring Theory verzichtet es entsprechend dem dynamischen Ansatz auf ein Conflict Monitoring Modul (Botvinick et al., 2001). Es verfügt stattdessen über Verarbeitungs-Prozesse auf verschiedenen Zeitskalen (Kiebel, Daunizeau, & Friston, 2008) und eine Rückkopplung zwischen der Netzwerkschicht, die der Informationsverarbeitung dient, und jener, die der Zielrepräsentation dient (Gilbert & Shallice, 2002; Cohen & Huston, 1994). Die Ergebnisse der Simulation zeigen, dass das Modell sowohl die klassischen Befunde zur Konfliktlösung und anpassung (z.B. Gratton, Coles, & Donchin, 1992), als auch das in den empirischen Studien gefundene kontinuierliche Datenmuster von Entscheidungsprozessen reproduziert. Die empirischen Befunde und die Ergebnisse der Modellierung bestätigen somit die postulierte dynamische Hypothese, dass sich Effekte auf verschiedenen Zeitskalen gegenseitig bedingen und einander hervorbringen. Dies verdeutlicht den komplementären Wert des dynamischen Ansatzes zum modulorientierten Ansatz, welcher vielfach in der Neuroökonomie verfolgt wird. Der hier entwickelte DST-basierte Ansatz bietet somit sowohl ein komplementäres Denkmodell, welches wie der modulorientierte Ansatz eine Verbindung zwischen den Phänomenen auf neuronaler und Verhaltensebene herstellt, als auch neue empirische Methoden zur dynamischen Erforschung von Entscheidungen. Daraus wird abschließend eine Fokuserweiterung für die zukünftige Forschung abgeleitet: zum einen auf die kontinuierlichen Prozesse, welche zu einer Entscheidung führen, und zum anderen auf die Interaktionsdynamik dieser Prozesse. Die Arbeit schließt mit dem Bild eines Entscheidungsprozesses als einer selbstorganisierten, metastabilen Balance (z.B. Kelso, 1995) bei der Lösung verschiedener Entscheidungsdilemmata (Goschke, 2003).

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A number of studies have concluded that cognitive control is not fully established until late adolescence. The precise differences in brain function between adults and adolescents with respect to cognitive control, however, remain unclear. To address this issue, we conducted a study in which 185 adolescents (mean age (SD) 14.6 (0.3) years) and 28 adults (mean age (SD) 25.2 (6.3) years) performed a single task that included both a stimulus-response (S-R) interference component and a task-switching component. Behavioural responses (i.e. reaction time, RT; error rate, ER) and brain activity during correct, error and post-error trials, detected by functional magnetic resonance imaging (fMRI), were measured. Behaviourally, RT and ER were significantly higher in incongruent than in congruent trials and in switch than in repeat trials. The two groups did not differ in RT during correct trials, but adolescents had a significantly higher ER than adults. In line with similar RTs, brain responses during correct trials did not differ between groups, indicating that adolescents and adults engage the same cognitive control network to successfully overcome S-R interference or task switches. Interestingly, adolescents with stronger brain activation in the bilateral insulae during error trials and in fronto-parietal regions of the cognitive control network during post-error trials did have lower ERs. This indicates that those mid-adolescents who commit fewer errors are better at monitoring their performance, and after detecting errors are more capable of flexibly allocating further cognitive control resources. Although we did not detect a convincing neural correlate of the observed behavioural differences between adolescents and adults, the revealed interindividual differences in adolescents might at least in part be due to brain development.

Restless legs syndrome (RLS) is a sensory-motor disorder characterized by abnormal circadian rhythm with an increase in the severity of sensory and motor symptoms at night. Even though many neurological diseases have shown a strong nexus between motor and cognitive symptoms, to date, cognitive functions especially cognitive control in RLS has been poorly understood. Given that cognitive control is a key to leading a self-serving and successful life, including many aspects of employment, social life, and attaining long-term goals, this thesis aimed to examine cognitive control and the underlying mechanisms in RLS. Thalamic gamma aminobutyric acid (GABA), which has been linked to RLS sensory-motor symptoms, also plays an important role in cognitive control. Therefore, the potential relationship between thalamic GABA level and cognitive control in RLS was examined (Study I). RLS patients displayed reduced working memory-based control performances as compared to healthy controls. Elevated thalamic GABA was found to attenuate the observed control deficits in RLS, even though changes in thalamic GABA levels might not be the ultimate causes of these deficits. According to the modulatory effect of thalamic GABA on thalamic activity and thalamo-cortical connectivity, relatively higher GABA levels may have helped RLS patients compensate for their pathological changes such as thalamic hyperactivity and hypoconnectivity, which may underpin the observed control deficits. The critical feature of RLS, abnormal circadian rhythm is thought to be related to nocturnal striatal dopamine deficiency. Concerning the dopaminergic modulation of cognitive control, the circadian variation of cognitive control processes has been investigated (Study II & III). RLS patients displayed reduced attentional control (Study II) and automatic response activation (Study III) at night, which resulted from decreased activation within the extra-striate visual cortex, the superior parietal cortex, and the premotor cortex. As there were no activity changes within the prefrontal cortex, it is likely that cortico-basal ganglia cognitive loops were less prone to RLS. Instead, striatal dopamine deficiency at night may have influenced the cortico-cortical functional connectivity and cortico-basal ganglia motor loops in RLS. These findings not only shed light on the underlying mechanisms of cognitive control, but also advance early clinical treatment possibilities for cognitive changes in RLS patients. Furthermore, recent insights into daytime-related cognition may help patients develop a suitable daytime schedule to minimize the detrimental effects induced by cognitive deficits.