Impaired updating of working memory representations in individuals with high BMI: evidence for dopaminergic mechanisms

Reviewer #1 (Public Review):

Herzog and colleagues investigated the interactions between working memory (WM) task condition (updating, maintenance) and BMI (body-mass-index), while considering selected dopaminergic genes (COMT, Taq1A, C957T, DARPP-32). Emerging evidence suggests that there might be a specific negative association with BMI in the updating but not maintenance condition, with potential bearings to reversal reward learning in obesity. The inclusion of multiple dopaminergic genes is a strength in the present study, considering the complexity of the interactions between tonic and phasic dopamine across the brain that may distinctly associate with the component processes of WM. Here, the finding was that BMI was negatively associated with WM performance regardless of the condition (updating, maintenance), but in models including moderation by either Taq1A or DARPP-32 (but not by COMT and C957T) an interaction by task condition was observed. Furthermore, a two-way interaction effect between BMI and genotype was observed exclusively in the updating condition. These findings are in line with the accounts by which striatal dopamine as reflected by Taq1A and DARPP-32 play an important role in working memory updating, while cortical dopamine as reflected by COMT is mainly associated with maintenance. The authors conclude that the genetic moderation reflects a compound negative effect of having high BMI and a risk allele in Taq1A or DARPP-32 to working memory updating specifically.

These data increment the accumulating evidence that the dopamine system may play an important role in obesity, but some of the claims in the present work are not entirely supported by the data and analysis presented. In particular, theoretical analysis of the extant evidence and formulation of the hypothesis remains elusive in terms of the potential mechanisms of updating/maintaining balance in obesity, and as such the interpretation of the present findings in the light of dopaminergic moderation warrants some caution. The result that Taq1A and DARPP-32 moderated the interaction between WM condition and BMI requires intricate post hoc analysis to understand the bearings to update. The authors found that Taq1A or DARPP-32 genotype moderated the negative association between BMI and WM exclusively in the update condition (significant two-way interaction effect), suggesting that the BMI-WM associations in other conditions were similar across genotypes. Importantly, visual inspection of the relationship between WM and BMI (Fig 4 & 5) suggests more prevalent positive effects of the putatively advantageous Taq1A-A1 and DARPP-32-AA genotypes to the overall negative relationship between WM and BMI in updating, but not in the other conditions. Given that an overall negative relationship was statistically supported across all conditions (model 1), a plausible interpretation would be that the updating condition stands out in terms of a positive moderation by putative advantageous genotypes, rather than compound negative consequences of BMI and genotype in updating. Critically, this interpretation stands in stark contrast with the interpretation put forth by the authors suggesting a specifically negative association between BMI and WM updating.

In conclusion, in its current form the title of the present work is ambivalent in terms of 1) the use of the term "impaired" in the context of cognitively normal individuals, 2) a BMI group difference specifically in the updating condition, and 3) the dopaminergic mechanisms based on observational data.

Reviewer #2 (Public Review):

Summary:
The authors investigated if obesity is associated with elevated working memory deficits. Prior theorizing would suggest that individuals with a higher BMI would be worse at working memory updating, potentially due to impaired dopaminergic signaling in the striatum. However, the authors find that higher BMI was associated with worse working memory performance, irrespective of having to ignore or update new information. To further explore the putative dopaminergic mechanisms, participants are stratified according to genetic polymorphisms in COMT, Taq1A, DARPP, and C957T and the ratio of the amino acids phenylalanine and tyrosine, all implicated in dopamine-signaling. They find that especially for working memory updating, carriers of a risk allele of Taq1A and DARPP, but not of COMT and C957T, performed worse with increasing BMI. The detrimental effects of these polymorphisms on updating only surfaced for individuals with high but not low BMI.

Although the authors allude to potential imbalances in the striatal go/no-go dopamine pathways to explain these findings, the dopaminergic mechanisms of the effects remain speculative.

Strengths:
Differentiating between working memory maintenance (ignoring) and updating is a powerful way to get a deeper insight into specific working memory deficits in individuals with obesity. This way of assessing working memory could potentially be applied to various populations at risk for cognitive or working memory deficits.

By pooling data from three studies, the authors reached a relatively large sample of 320 participants, which enables the assessment of more subtle effects on working memory, including the differentiation between updating and ignoring.

Working memory gating has long implicated striatal dopamine signaling. This paper shows that specific combinations of risk factors, a high BMI and carrying a risk allele, can contribute to very selective working memory impairments. More insight into how these risk factors interact can ultimately lead to more tailor-made treatments.

Weaknesses:
The majority of participants seem to fall within the normal BMI range, whereas the interaction between BMI and genetic variations or amino acid ratio particularly surfaces at higher BMI. As genetic variations are usually associated with small effect sizes, the effective sample size, although large for a behavioral analysis only, might have been too small to detect meaningful effects of risk alleles of COMT and C957T.

The relationships between genetic variations, BMI, and specific disturbances in dopamine signaling are complex, as compensating mechanisms might be at play to mitigate any detrimental effects. The results would therefore benefit from more direct measures or manipulations of dopaminergic processes.

The introduction could benefit from a more elaborate description of the predicted effects: into which direction (better or worse updating) would the authors predict each effect to go and why? This is clearly explained for COMT, but not for e.g. DARPP-32.