Contents lists available at ScienceDirect Neuropsychologia journal homepage: www.elsevier.com/locate/neuropsychologia Musical anhedonia after focal brain damage Amy M. Belfi a,b, ⁎ , Erin Evans b , Jonah Heskje b , Joel Bruss b , Daniel Tranel a,b,c a Interdisciplinary Graduate Program in Neuroscience, University of Iowa Carver College of Medicine, 356 MRC, Iowa City, IA, USA b Department of Neurology, University of Iowa Carver College of Medicine, 2155 RCP, Iowa City, IA, USA c Department of Psychological and Brain Sciences, University of Iowa, E11 Seashore Hall, Iowa City, IA, USA ARTICLE INFO Keywords: Music Pleasure Reward Emotion Lesion ABSTRACT People listen to music because it is pleasurable. However, there are individual differences in the reward value of music. At the extreme low end of this continuum, individuals who derive no pleasure from music are said to have ‘musical anhedonia.’ Cases of acquired musical anhedonia following focal brain damage are rare, with only a handful having been reported in the scientific literature. Here, we surveyed a large sample of patients with focal brain damage to identify the frequency, specificity, and neural correlates of acquired musical anhedonia. Participants completed the Musical anhedonia Questionnaire and the Barcelona Music Reward Questionnaire (Mas-Herrero et al., 2013) to assess changes in musical enjoyment and reward following brain injury. Neuroanatomical data were analyzed with a proportional MAP-3 method to create voxelwise lesion proportion difference maps. No clear or consistent neuroanatomical correlates of musical anhedonia were identified. One patient with damage to the right-hemisphere putamen and internal capsule displayed specific and severe acquired musical anhedonia. These findings indicate that acquired musical anhedonia is very uncommon, a result which is consistent with the fact that only a small number of such cases have been reported in the literature. This rarity could have positive implications for the therapeutic potentialities of music in patients with severe neurological disorders. 1. Introduction Many people listen to music because it is pleasurable. However, there are significant individual differences in the reward value of music; some individuals find music more pleasing than others (Mas- Herrero et al., 2013). These individual differences extend to both ends of the spectrum, where on one end are individuals who find abnormal pleasure in music (“musicophilia”), and on the other are individuals who derive no pleasure from music (“musical anhedonia”). The latter comes in two basic forms: ‘congenital’ musical anhedonia, which refers to a subset of the general population who displays a lifelong pattern of no pleasure from music; and ‘acquired’ musical anhedonia, which refers to individuals who previously enjoyed music but developed anhedonia for music after focal brain damage. Congenital musical anhedonia has been shown to occur in approxi- mately 5% of healthy adults (Mas-Herrero et al., 2013, 2014). These individuals show a lack of pleasure from music, both in self-reported ratings and physiological responses (Mas-Herrero et al., 2014). Individuals classified as musically anhedonic (using the Barcelona Music Reward Questionnaire; Mas-Herrero et al., 2013) show impaired physiological responses, and differences in neural activity, when listening to music, as compared to individuals with average and high musical hedonism (Martínez-Molina et al., 2016; Mas-Herrero et al., 2014). However, individuals with musical anhedonia display normal physiological responsiveness to monetary rewards, illustrating that their anhedonia for music does not necessarily generalize to other rewarding stimuli. Acquired anhedonia for specific behaviors has been reported in rare patients with neurological damage (for example, anhedonia for smok- ing: Naqvi et al., 2007). Music-specific anhedonia appears to be especially rare, though, and only three published case-study reports have described individuals with a specific anhedonia for music (Griffiths et al., 2004; Mazzoni et al., 1993; Satoh et al., 2011). These case reports depict patients with similar behavioral phenotypes, all exhibiting a marked loss in emotional response and desire to listen to music following acquired brain damage. The earliest case (Mazzoni et al., 1993) was a patient with a lesion to the right temporo-parietal area. Prior to his brain injury, this patient was an amateur guitar player. After his brain injury he showed no cognitive deficits, but complained of a lack of appreciation of music, saying that it sounded unemotional and detached. However, he performed normally on tasks that assessed perception of musical http://dx.doi.org/10.1016/j.neuropsychologia.2017.01.030 Received 30 March 2016; Received in revised form 12 December 2016; Accepted 27 January 2017 ⁎ Correspondence to: NYU Department of Psychology, 6 Washington Place, Room 275, New York, NY 10003. E-mail address: amy.belfi@nyu.edu (A.M. Belfi). Neuropsychologia 97 (2017) 29–37 Available online 31 January 2017 0028-3932/ © 2017 Elsevier Ltd. All rights reserved. MARK