Executive Functions, Memory, and Social Cognitive Deficits and Recovery in Chronic Alcoholism: A Critical Review to Inform Future Research

Neural correlates of reward magnitude and delay during a probabilistic delay discounting task in alcohol use disorder

RATIONALE

Alcohol-use disorder (AUD) is associated with the propensity to choose smaller sooner options on the delay discounting task. It is unclear, however, how inherent risk underlies delay discounting behavior. As impulsive choice is a hallmark feature in AUD, it is important to understand the neural response to reward and delay while accounting for risk in impulsive decision-making.

OBJECTIVE

This study examined activation associated with delay and reward magnitude, while controlling for risk in a probabilistic delay discounting task in AUD and examined if differences in activation were associated with treatment outcomes.

METHODS

Thirty-nine recently abstinent alcohol-dependent volunteers and 46 controls completed a probabilistic delay discounting task paired with functional magnetic resonance imaging. Alcohol use was collected using a self-report journal for 3 months following baseline scan.

RESULTS

During delay stimulus presentations, Controls exhibited greater activation compared to the Alcohol group notably in the anterior insula, middle/dorsal anterior cingulate cortex (ACC), dorsolateral prefrontal cortex (PFC), and inferior parietal lobule. For magnitude, the Alcohol group exhibited greater activation than Controls primarily in medial PFC, rostral ACC, left posterior parietal cortex, and right precuneus. Within the Alcohol group, alcohol craving severity negatively correlated with right lateral PFC activation during reward magnitude in individuals who completed the 3-month study without relapse, while non-completers showed the opposite relationship.

CONCLUSIONS

The results of this study extend previous findings that alcohol use disorder is associated with differences in activation during an immediate or delayed choice by delineating activation associated with the parameters of impulsive choice.

Alcohol Use Disorder Interventions Targeting Brain Sites for Both Conditioned Reward and Delayed Gratification

Alcohol use disorder is a destructive compulsion characterized by chronic relapse and poor recovery outcomes. Heightened reactivity to alcohol-associated stimuli and compromised executive function are hallmarks of alcohol use disorder. Interventions targeting these two interacting domains are thought to ameliorate these altered states, but the mutual brain sites of action are yet unknown. Although interventions on alcohol cue reactivity affect reward area responses, how treatments alter brain responses when subjects exert executive effort to delay gratification is not as well-characterized. Focusing on interventions that could be developed into effective clinical treatments, we review and identify brain sites of action for these two categories of potential therapies. Using activation likelihood estimation (ALE) meta-analysis, we find that interventions on alcohol cue reactivity localize to ventral prefrontal cortex, dorsal anterior cingulate, and temporal, striatal, and thalamic regions. Interventions for increasing delayed reward preference elicit changes mostly in midline default mode network regions, including posterior cingulate, precuneus, and ventromedial prefrontal cortex-in addition to temporal and parietal regions. Anatomical co-localization of effects appears in the ventromedial prefrontal cortex, whereas effects specific to delay-of-gratification appear in the posterior cingulate and precuneus. Thus, the current available literature suggests that interventions in the domains of cue reactivity and delay discounting alter brain activity along midline default mode regions, specifically in the ventromedial prefrontal cortex for both domains, and the posterior cingulate/precuneus for delay-of-gratification. We believe that these findings could facilitate targeting and development of new interventions, and ultimately treatments of this challenging disorder.

Effects of the monoamine stabilizer (-)OSU6162 on cognitive function in alcohol dependence

INTRODUCTION

Alcohol dependence (AD) is associated with a dysregulated mesolimbocortical dopamine system-a pathway which is also implicated in both reward and cognition. The monoamine stabilizer (-)-OSU6162 (OSU) is a novel pharmacological compound with the ability to reduce ethanol intake and ethanol seeking in long-term drinking rats as well as reducing alcohol craving in AD patients. Dopaminergic drugs can both impair and improve cognitive functions, and the aim of the current study was to investigate the effect of OSU treatment on cognitive functioning in AD patients.

METHOD

In a randomized double-blind placebo-controlled study, 56 individuals with AD received 14 days of OSU or placebo treatment. Neuropsychological tasks from the Cambridge Automated Neuropsychological Test Battery (CANTAB®) and other tasks were used to evaluate treatment effect on executive function/impulsivity, working memory, attention, emotional recognition, and divergent thinking.

RESULTS

Treatment with OSU did not impair neuropsychological function in any of the cognitive domains investigated (all p > 0.1). In fact, OSU treatment did, compared to placebo, improve future planning ability (F_(1,46) = 6.9; p = 0.012; Cohen's d = 0.54), verbal divergent thinking (F_(1,44) = 10.1; p = 0.003; d = 0.96), and response time for emotional recognition (F_(1,47) = 6.7; p = 0.013; d = 0.44).

CONCLUSION

OSU treatment did not cause short-term cognitive side effects, further supporting the potential of OSU as a clinically feasible pharmacological treatment in AD patients. OSU treatment might improve future planning, verbal divergent thinking, and emotional recognition latency, which in turn may have a beneficial impact on alcohol use outcomes. Future studies are needed to confirm these preliminary findings.

Microstructural damage of white-matter tracts connecting large-scale networks is related to impaired executive profile in alcohol use disorder

Alcohol Use Disorders (AUD) is associated with negative consequences on global functioning, likely reflecting chronic changes in brain morphology and connectivity. Previous attempts to characterize cognitive impairment in AUD addressed patients' performance in single domains, without considering their cognitive profile as a whole. While altered cognitive performance likely reflects abnormal white-matter microstructural properties, to date no study has directly addressed the relationship between a proxy of patients' cognitive profile and microstructural damage. To fill this gap we aimed to characterize the microstructural damage pattern, and its relationship with cognitive profile, in treatment-seeking AUD patients. Twenty-two AUD patients and 18 healthy controls underwent a multimodal MRI protocol including diffusion tensor imaging (DTI), alongside a comprehensive neurocognitive assessment. We used a principal component analysis (PCA) to identify superordinate components maximally explaining variability in cognitive performance, and whole-brain voxelwise analyses to unveil the neural correlates of AUD patients' cognitive impairment in terms of different white-matter microstructural features, i.e. fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD). PCA revealed a basic executive component, significantly impaired in AUD patients, associated with tasks tapping visuo-motor processing speed, attention and working-memory. Within a widespread pattern of white-matter damage in patients, we found diverse types of relationship linking WM microstructure and executive performance: (i) in the whole sample, we observed a linear relationship involving MD/RD metrics within both 'superficial' white-matter systems mediating connectivity within large-scale brain networks, and deeper systems modulating their reciprocal connections; (ii) in AUD patients vs. controls, a performance-by-group interaction highlighted a MD/AD pattern involving two frontal white-matter systems, including the genu of corpus callosum and cingulum bundle, mediating structural connectivity among central executive, salience and default mode networks. Alterations of prefrontal white-matter pathways are suggestive of abnormal structural connectivity in AUD, whereby a defective interplay among large-scale networks underpins patients' executive dysfunction. These findings highlight different directions for future basic and translational research aiming to tailor novel rehabilitation strategies and assess their functional outcomes.

Experimental Investigation Examining the Effects of Acute Exercise on Implicit Memory Function

Emerging work suggests that acute exercise can enhance explicit memory function. Minimal research, however, has examined whether acute exercise is associated with implicit memory, which was the purpose of this study. Three separate experimental studies were computed (N = 120; Mean age = 21). In Experiment 1, participants were randomly assigned to either a moderate-intensity bout of acute exercise (15-minute) or engaged in a seated control task (15-minute), followed by the completion of a word-fragmentation implicit memory task. Experiment 2 replicated Experiment 1, but instead employed a higher-intensity exercise protocol. For Experiment 3, participants were randomly assigned to either a moderate-intensity bout of acute exercise (15-minute) or engaged in a seated control task (15-minute), followed by the completion of a real world, 3-dimensional implicit memory task. For Experiment 1, the exercise and control groups, respectively, had an implicit memory score of 7.0 (0.5) and 7.5 (0.6) (t(38) = 0.67, p = .51). For Experiment 2, the exercise and control groups, respectively, had an implicit memory score of 6.9 (1.9) and 7.8 (2.4) (t(38) = 1.27, p = .21). These findings suggest that exercise, and the intensity of exercise, does not alter implicit memory from a word fragmentation task. For Experiment 3, the exercise and control groups, respectively, had a discrimination implicit memory index score of 0.48 (0.18) and 0.29 (0.32) (t(38) = 2.16, p = .03). In conclusion, acute exercise does not influence a commonly used laboratory-based assessment of implicit memory but may enhance real world-related implicit memory function.

Cognitive training as a component of treatment of alcohol use disorder: A review

OBJECTIVE

Cognitive training is an effective means of improving performance in a range of populations. Whether it may serve to facilitate cognitive recovery and longer-term outcomes in persons with alcohol use disorders (AUDs) is unclear. Here, we review historical and current literature and offer perspectives for model development and potential implementation.

METHOD

We considered a large literature regarding the nature of alcohol-related compromise, early efforts to clarify the nature of recovery and current models and methods underlying cognitive training paradigms. We then constructed a narrative review demonstrating evolving frameworks and empirical data informing the critical review of cognitive training methods as a means of mitigating compromise and facilitating functional outcomes.

RESULTS

Cognitive improvement with abstinence is generally noted, but training protocols may enhance performance and generalize benefit to untrained, but highly similar, tasks. Transfer of training to dissimilar tasks and functional outcomes is uncommonly reported. It is noteworthy that some work suggests that clinician ratings for participants are improved. Inconsistency in sample characteristics, training protocols, and outcome measures constrain general conclusions while suggesting opportunities for study and development.

CONCLUSIONS

Cognitive training protocols have shown benefit in a variety of populations but have been examined infrequently in persons with AUDs. This overview indicates significant opportunity for cognitive improvement and recovery and thus a strong potential role for training protocols. However, supportive data are not robustly obtained. We suggest that one step in bridging this gap is the implementation of a conceptual framework incorporating contextual, behavioral, and neurobiological variables. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Executive Impairment in Alcohol Use Disorder Reflects Structural Changes in Large-Scale Brain Networks: A Joint Independent Component Analysis on Gray-Matter and White-Matter Features

Alcohol Use Disorder (AUD) entails chronic effects on brain structure. Neurodegeneration due to alcohol toxicity is a neural signature of executive impairment typically observed in AUD, previously related to both gray-matter volume/density and white-matter abnormalities. Recent studies highlighted the role of meso-cortico-limbic structures supporting the salience and executive networks, in which the extent of neurostructural damage is significantly related to patients’ executive performance. Here we aim to integrate multimodal information on gray-matter and white-matter features with a multivariate data-driven approach (joint Independent Component Analysis, jICA), and to assess the relationship between the extent of damage in the resulting neurostructural superordinate components and executive profile in AUD. Twenty-two AUD patients and 18 matched healthy controls (HC) underwent a Magnetic Resonance Imaging (MRI) protocol, alongside clinical and neuropsychological examinations. We ran jICA on five neurostructural features, including gray-matter density and different diffusion tensor imaging metrics. We extracted 12 Independent Components (ICs) and compared the resulting mixing coefficients in patients vs. HC. Finally, we correlated significant ICs with executive and clinical variables. One out of 12 ICs (IC11) discriminated patients from healthy controls and correlated positively both with executive performance in all subjects, and with lifetime duration of alcohol abuse in patients. In line with previous related evidence, this component involved widespread gray-matter and white-matter patterns including key nodes and fiber tracts of salience, default-mode and central executive networks. These findings highlighted the role of multivariate data integration as a valuable approach revealing superordinate hallmarks of neural changes related to cognition in neurological and psychiatric populations.

Acute exercise and mindfulness meditation on learning and memory: randomized controlled intervention

Background: The purpose of this experiment was to evaluate the potential combined effects of acute exercise and mindfulness mediation on episodic memory.

Methods: All data collection occurred in the authors’ laboratory (January to May of 2019). In this three-arm, within-subject design, participants (N=20; M_age=21.6 years) completed three counterbalanced laboratory visits, including Exercise Only, Exercise + Meditation and Control. Learning and memory were assessed from a word-list task. A one-factor repeated-measures ANOVA was computed for two memory outcomes, including the learning outcome (average performance across the 6 trials) and the long-term memory recall (10-minute delay).

Results: The exercise conditions had a greater learning effect when compared to the Control visit, M_diff = 0.68 (95% CI: 0.10, 1.25), P = 0.02. The Exercise + Memory visit had better longterm memory when compared to Exercise Only, M_diff = 0.95 (95% CI: 0.07, 1.83), P = 0.03.

Conclusion: The present experiment provides suggestive evidence that acute exercise may enhance learning and, when coupling acute exercise prior to encoding with meditation during early consolidation, long-term memory may be enhanced.

Selank, Peptide Analogue of Tuftsin, Protects Against Ethanol-Induced Memory Impairment by Regulating of BDNF Content in the Hippocampus and Prefrontal Cortex in Rats

The effects of a peptide anxiolytic Selank synthesized on the basis of the endogenous peptide tuftsin on memory impairment and content of brain-derived neurotrophic factor (BDNF) in brain structures were analyzed in outbred rats receiving 10% ethanol as the only source of fluid for 30 weeks. In the object recognition test, Selank (0.3 mg/kg a day, 7 days, intraperitoneally) produced a cognitive-stimulating effect in 9 months rats not exposed to ethanol (p<0.05) and prevented the formation of ethanol-induced memory and attention disturbances (p<0.01) developing during alcohol withdrawal. In ex vivo experiments, Selank prevented ethanol-induced increase in BDNF content in the hippocampus and frontal cortex (p<0.05). These results indicate positive effects of the tuftsin analogue on age-related memory disturbances associated with chronic alcohol intoxication and confirm the involvement of the neurotrophin mechanism related to BDNF production into the effect of Selank.

Impaired Recent Verbal Memory in Pornography-Addicted Juvenile Subjects

We aimed to find the differences in memory capabilities between pornography-addicted and nonaddicted juveniles. We enrolled 30 juveniles (12-16 y) consisting of 15 pornography addiction and 15 nonaddiction subjects. We used Rey Auditory Verbal Learning Test (RAVLT) to measure verbal memory, Rey-Osterrieth Complex Figure Test (ROCFT) for visual memory, along with Trail Making Test A and B (TMT-A and TMT-B) for attention. We found a significant reduction in the RAVLT A6 result of the addiction group (nonaddiction vs addiction: 13.47 ± 2.00 vs 11.67 ± 2.44, MD = -1.80, p=0.04), but not in ROCFT or attention tests. Analysis in sex subgroups yielded no sex-specific difference. We concluded that pornography addiction may be associated with impaired recent verbal memory in juveniles, regardless of sex and without association to attention.

Mental Imagery and Acute Exercise on Episodic Memory Function

Mental imagery is used extensively in the sporting domain. It is used for performance-enhancement purposes, arousal regulation, affective and cognitive modification, and rehabilitation purposes. The purpose of this experiment was to evaluate whether acute exercise and mental imagery of acute exercise have similar effects on cognitive performance, specifically memory function. A within-subject randomized controlled experiment was employed. Participants (N = 24; M_age = 21.5 years) completed two exercise-related visits (i.e., actual exercise and mental imagery of exercise), in a counterbalanced order. The acute-exercise session involved 10 min of intermittent sprints. The mental-imagery session involved a time-matched period of mental imagery. After each manipulation (i.e., acute exercise or mental imagery of acute exercise), memory was evaluated from a paired-associative learning task and a comprehensive evaluation of memory, involving spatial–temporal integration (i.e., what, where, and when aspects of memory). Bayesian analyses were computed to evaluate the effects of actual exercise and mental imagery of exercise on memory function. For the paired-associative learning task, there was moderate evidence in favor of the null hypothesis for a main effect for condition (BF₀₁ = 2.85) and time by condition interaction (BF₀₁ = 3.30). Similarly, there was moderate evidence in favor of the null hypothesis for overall (what-where-when) memory integration (BF₀₁ = 3.37), what-loop (BF₀₁ = 2.34), where-loop (BF₀₁ = 3.45), and when-loop (BF₀₁ = 3.46). This experiment provides moderate evidence in support of the null hypothesis. That is, there was moderate evidence to support a non-differential effect of acute exercise and mental imagery of acute exercise on memory function.

Gambling and Social Cognition: a Systematic Review

Purpose of Review

The aim of this article was to review current research regarding social cognition (SC) in gambling disorder (GD), to (i) compile and synthetize the current state of existing literature on this topic, and (ii) propose cognitive remediation therapy approaches focused on SC for clinicians.

Recent Findings

It is well known that disordered gamblers show impairment regarding non-social cognitive functions such as inhibition, attention, and decision-making. Furthermore, patients with substance use disorders also present certain deficits regarding social information processing which are difficult to differentiate from the intrinsic toxic effects linked to drugs or alcohol consumption.

Summary

To date, relatively little research has been undertaken to explore SC in gambling disorder (GD) with neuropsychological tasks. Preliminary results suggest impaired non-verbal emotion processing, but only one study has directly measured SC in GD. As a consequence, future research on this framework should propose diverse measures of SC, while controlling for other factors such as personality traits and subtypes of disordered gamblers.

Effects of Acute Exercise and Learning Strategy Implementation on Memory Function

Background and Objectives: Long-term potentiation (LTP), the functional connectivity among neurons, is considered a mechanism of episodic memory. Both acute exercise and learning are thought to influence memory via an LTP-related mechanism. Limited research has evaluated the individual and combined effects of acute exercise and learning strategy implementation (e.g., 3-R technique, cue-integration) on memory, which was the purpose of this study. Materials and Methods: For Experiment 1, participants (n = 80; M_age = 20.9 years) were randomized into one of four experimental groups, including Exercise + Learning (E + L), Learning Only (L), Exercise Only (E), and Control Group (C; no exercise and no learning strategy implementation). The exercise stimulus involved an acute 15-min bout of lower-intensity (60% of heart rate max) walking exercise and the learning strategy involved the implementation of the 3-R technique. Experiment 2 (n = 77; M_age = 21.1 years) replicated Experiment 1 but addressed limitations (e.g., exposure level of the memory task) from Experiment 1 and employed a higher-intensity bout of exercise (77% of heart rate max). Experiment 3 (n = 80; M_age = 21.0 years) evaluated these same four experimental conditions but employed a cue-integration learning strategy and a moderate-intensity bout of acute exercise (64% of heart rate max). Results: These three experiments demonstrate that both learning techniques were effective in enhancing memory and we also provided evidence of a main effect for acute exercise (Experiment 3). However, we did not observe consistent evidence of a learning by exercise interaction effect. Conclusions: We demonstrate that both acute exercise and different learning techniques are effective in enhancing long-term memory function.

Emotional processing and social cognition in alcohol use disorder

OBJECTIVE

To review deficits in emotional processing and social cognition potentially contributing to the dysfunctional emotion regulation and difficulties with interpersonal relationships observed in individuals with alcohol use disorder (AUD) and to provide directions for future research.

METHOD

First is presented a review of emotional and social-cognitive impairments in recently detoxified AUD individuals that include alexithymia, difficulties in decoding others' emotions, and reduced theory of mind and empathy skills. Social cognition disorders in AUD pose different issues discussed, such as whether (1) these deficits are consequences of excessive alcohol consumption or premorbid risk factors for addiction, (2) emotional and social impairments impede positive treatment outcome, (3) recovery of social abilities is possible with sustained abstinence, and (4) AUD patients are unaware of their emotional and social dysfunctions. Finally, current knowledge on structural and functional brain correlates of these deficits in AUD are reviewed.

RESULTS

Emotional and social-cognitive functions affected in AUD can potentially compromise efforts to initiate and maintain abstinence by hampering efficacy of clinical treatment. Such dysfunction can obstruct efforts to enable or reinstate higher-order abilities such as emotional self-regulation, motivation to change, success in interpersonal/social interactions, and emotional insight and awareness of social dysfunctions (i.e., accurate metacognition).

CONCLUSIONS

The present review highlights the need to account for emotional processing and social cognition in the evaluation and rehabilitation of alcohol-related neurocognitive disorders and to consider psychotherapeutic treatment involving remediation of emotional and social skills as implemented in psychiatric and neurological disorders. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Acute Exercise on Memory Reconsolidation

Background and Objective: Once a memory is reactivated, it enters a labile state and, thus, is vulnerable to memory decay and/or distortion. Recent research demonstrates that acute, high-intensity exercise is associated with enhanced episodic memory function. Very limited research, however, has evaluated whether acute exercise can attenuate memory distortion from memory reactivation, which was the purpose of this study. Methods: A between-subject randomized controlled intervention was employed. Participants (N = 80) were randomly assigned to one of four groups, including (1) reminder with exercise, (2) reminder, (3) no reminder, and (4) interference control. For the groups, participants completed three visits (Visit 1, 2, and 3), which all occurred 48 hours apart. An exception to this was the interference control group, which did not complete Visit 2. On Visit 2, the reminder with exercise group engaged in a 15 min bout of high-intensity exercise (80% of heart rate reserve) immediately after memory reactivation. On Visit 3, participants engaged in a free recall (4 trials) of the memory task encoded on Visit 1. Results: In a 4 (groups) × 4 (learning trials) mixed-measures ANOVA, with the group as the between-subjects variable and the learning trials (1–4) as the within-subject variable, there was a significant main effect group, F(3, 76) = 4.18, p = 0.008, η²_p = 0.14, and a significant main effect for the learning trials, F(2.40, 182.59) = 49.25, p < 0.001, η²_p = 0.39, but there was no group by learning trials interaction, F(7.20, 182.59) = 1.07, p = 0.38, η²_p = 0.04. Conclusion: Our findings suggest that exercise may, potentially, attenuate memory distortion from memory reactivation. However, future work is needed to confirm these findings before any strong conclusions can be reached.

Acute Exercise Intensity and Memory Function: Evaluation of the Transient Hypofrontality Hypothesis

Background and Objective: The transient hypofrontality hypothesis predicts that memory function will be impaired during high-intensity exercise, as a result of a need for metabolic and cognitive resources to be allocated toward sustaining movement, as opposed to performing a cognitive task. The purpose of these experiments was to evaluate this transient hypofrontality hypothesis. Materials and Methods: Experiment 1 involved participants (n = 24; M_age = 21.9 years) completing four counterbalanced visits. Two visits evaluated working memory function, either at rest or during a high-intensity bout of acute exercise. The other two visits evaluated episodic memory function, either at rest or during a high-intensity bout of acute exercise. Experiment 2 (n = 24; M_age = 20.9 years) extended Experiment 1 by evaluating memory function (working memory) across 4 counterbalanced conditions, including at rest and during light (30% of heart rate reserve; HRR), moderate (50% HRR) and high-intensity (80% HRR) acute exercise. Results: Experiment 1 demonstrated that, when compared to rest, both working memory and episodic memory were impaired during high-intensity acute exercise. Experiment 2 replicated this effect, but then also showed that, unlike high-intensity acute exercise, memory function was not impaired during low- and moderate-intensity acute exercise. Conclusions: Our experiments provide support for the transient hypofrontality hypothesis. Both working memory and episodic memory are impaired during high-intensity acute exercise. Working memory does not appear to be impaired during lower exercise intensities.

High-Intensity Acute Exercise and Directed Forgetting on Memory Function

Background and Objectives: Despite accumulating research demonstrating that acute exercise may enhance memory function, very little research has evaluated whether acute exercise can effectuate intentional directed forgetting (DF), an adaptative strategy to facilitate subsequent memory performance. Materials and Methods: A three-arm parallel-group randomized controlled intervention was employed. Participants were randomized into one of three groups, including: (1) exercise plus DF (Ex + DF), (2) DF (directed forgetting) only (DF) and (3) R (remember) only (R). The acute bout of exercise included 15 min of high-intensity treadmill exercise. The memory assessment involved the presentation of two-word lists. After encoding the first word list, participants were either instructed to forget all of those words (DF) or to remember them. Following this, participants encoded the second word list. Results: We observed a statistically significant main effect for list F(1, 57) = 12.27, p < 0.001, η²_p = 0.18, but no main effect for group F(2, 57) = 1.32, p = 0.27, η²_p = 0.04, or list by group interaction, F(2, 57) = 2.89, p = 0.06, η²_p = 0.09. Conclusions: This study demonstrates a directed forgetting effect in that cueing an individual to forget a previously encoded list of items facilitates memory performance on a subsequent list of items. However, we failed to demonstrate any beneficial effect of acute exercise in facilitating directed forgetting. These findings are discussed in the context of directed forgetting theories, particularly the attention inhibition mechanism, as well as the timing of the acute bout of exercise.

Handedness, Grip Strength, and Memory Function: Considerations by Biological Sex

Background and Objective: The objective of this study was to evaluate the potential independent and interactive effects of handedness and grip strength on episodic memory function, and whether biological sex moderated these relationships. Materials and Methods: 162 young adults (Mage = 20.7 years) completed a series of memory assessments including a subjective memory complaint evaluation and several objective measures of memory. Handedness (i.e., left-hand dominant, inconsistent handedness (ICH), and right-hand dominant) was evaluated using the Edinburgh Handedness Inventory. Handgrip strength was determined from a handgrip dynamometer. Results: When compared to ICH individuals, retrospective memory scores were statistically significantly worse for left-handed (p = 0.02) and right-handed (p = 0.03) individuals. Higher grip strength was statistically significantly associated with fewer retrospective memory complaints (b = 0.10, 95% CI: 0.01, 0.19, p = 0.04). Conclusions: The present study provides some suggestive evidence that ICH (inconsistent handedness) and greater grip strength are associated with fewer retrospective memory complaints. However, we did not observe any evidence of an interaction effect of handedness and grip strength on memory, and similarly, biological sex did not interact with these parameters to influence memory.

Exercise and Episodic Specificity Induction on Episodic Memory Function

Background and objectives: Episodic specific induction (ESI) is a manipulation shown to enhance episodic memory function. Episodic specificity induction involves thoroughly unpacking a recently encoded memory, with this enhanced retrieval-induced process helping to facilitate subsequent cognitions. In addition to ESI, emerging work suggests that acute exercise may also help to facilitate episodic memory function. The purpose of this study was to evaluate the potential individual and combined effects of acute exercise and ESI on subsequent episodic memory performance. Materials and Methods: Participants (n = 120) were randomly assigned into one of four groups, (1) ESI and exercise (ESI + E), (2) ESI only (ESI), (3) exercise only (E), and (4) no ESI and no exercise (Control; C). The ESI protocol involved watching a short video and then recalling details about the setting, people, and actions in the video. The exercise protocol involved an acute bout (15 min) of treadmill exercise. After these tasks, episodic memory function was evaluated with an autobiographical interview assessment and a computerized episodic memory task involving what–where–when integration. Results: We did not observe significant main effects for exercise or ESI on memory function but did observe some suggestive evidence of an interaction effect of these two parameters on episodic memory. That is, for the exercise group, memory performance was higher when combined with ESI as opposed to without ESI. Conclusions: Acute exercise and ESI may interact to influence episodic memory function.

The Effects of Acute Exercise on Retroactive Memory Interference

PURPOSE

Retroactive interference involves the disruption of previously encoded information from newly learned information and thus may impair the consolidation of long-term memory. The objective of this study was to evaluate whether acute exercise can attenuate retroactive memory interference.

DESIGN

Three experimental studies were employed. Experiment 1 employed a between-subject randomized control trial (RCT) involving moderate-intensity walking (15 minutes). Experiment 2 employed a between-subject RCT involving high-intensity jogging (15 minutes). Experiment 3 employed a within-subject RCT involving moderate-intensity walking (15 minutes).

SETTING

University setting.

PARTICIPANTS

One hundred twelve young adults.

MEASURES

After exercise, memory interference was evaluated from an episodic word-list memory task, involving the recall of 2 word lists.

RESULTS

The pooled effect size (standard difference in means: -0.35; 95% confidence interval: -0.64 to -0.06) across the 3 experiments was statistically significant (P = .01).

CONCLUSION

We provide suggestive evidence that acute, short-duration exercise may help attenuate a retroactive memory interference effect. Implications of these findings for exercise to improve memory and attenuate memory decay are discussed.

Aerobic Physical Exercise as a Neuroprotector Strategy for Ethanol Binge-Drinking Effects in the Hippocampus and Systemic Redox Status in Rats

The heavy and episodic EtOH drinking pattern, equivalent to weekend consumption, characterizes the binge-drinking pattern and promotes a misbalance of encephalic metabolic functions, concurring to neurodegeneration and cerebral dysfunction. And for being a legal drug, it has global public health and social relevance. In this way, we aimed to investigate the effects of physical training, in a treadmill, on the deleterious effects of EtOH on hippocampal functions, related to memory and learning. For this, we used 40 Wistar rats, divided into four groups: Control group, Trained group (trained animals with doses of distilled water), EtOH group (nontrained animals with doses of 3 g/kg/day of EtOH, 20% w/v), and Trained+EtOH group (trained animals exposed to EtOH). The physical exercise was performed by running on a treadmill for 5 days a week for 4 weeks, and all doses of EtOH were administered through intragastric gavage in four repeated cycles of EtOH in binge. After the experimental period, the animals were submitted to the object recognition task and Morris water maze test, and after being euthanized, the blood and hippocampus were collected for Trolox Equivalent Antioxidant Capacity (TEAC), Reduced Glutathione Content (GSH), and Nitrite and Lipid Peroxidation (LPO) level measurements. Our results showed that EtOH caused marked oxidative stress and mnemonic damage, and the physical exercise promoted neuroprotective effects, among them, the modulation of oxidative biochemistry in plasma (by restoring GSH levels) and in the hippocampus (by reducing LPO levels and increasing antioxidant parameters) and cognitive function improvement. Therefore, physical exercise can be an important prophylactic and therapeutic tool in order to ameliorate and even prevent the deleterious effects of EtOH on cognitive functions.

Neural oscillatory dynamics of inhibitory control in young adult binge drinkers

Alcohol consumption is often characterized by heavy episodic, or binge drinking, which has been on the rise. The aim of this study was to examine the neural dynamics of inhibitory control in demographically matched groups of young, healthy adults (N = 61) who reported engaging in binge (BD) or light drinking patterns (LD). Electroencephalography signal was recorded during a fast-paced visual Go/NoGo paradigm probing the ability to inhibit prepotent responses. No group differences were found in task performance. BDs showed attenuated event-related theta (4-7 Hz) on inhibition trials compared to LDs, which correlated with binge episodes and alcohol consumption but not with measures of mood or disposition including impulsivity. A greater overall decrease of early beta power (15-25 Hz) in BDs may indicate deficient preparatory "inhibitory brake" before deliberate responding. The results are consistent with deficits in the inhibitory control circuitry and are suggestive of allostatic neuroadaptive changes associated with binge drinking.

Exercise and Retrieval-Induced Forgetting

Retrieving a subset of items from memory can cause forgetting of other related items in memory, referred to as retrieval-induced forgetting (RIF). This type of forgetting (RIF) is thought to be related to working memory and executive control processes, of which are known to be influenced by acute exercise. The objective of this study was to evaluate whether acute exercise could accentuate RIF. A two-arm, parallel-group randomized controlled intervention was employed. Participants (N = 40) were randomized into one of two groups, including an experimental group (15-min of moderate-intensity exercise) and a control group (time-matched seated task). Retrieval-induced forgetting (RIF) and retrieval practice (RP) were assessed from a category-exemplar memory task. There was no significant main effect for RIF and no group by RIF interaction, suggesting that acute exercise did not alter RIF more than the control group. There was a significant main effect for RP, but there was no group by RP interaction. These RP findings align with the RIF findings, indicating that acute exercise did not alter RP more so than the control group. In conclusion, our experimental results do not provide support for an association of acute exercise on retrieval-induced forgetting or retrieval practice.

Experimental Effects of Acute Exercise in Attenuating Memory Interference: Considerations by Biological Sex

Background and Objectives: The objective of this experiment was to evaluate the effects of acute exercise on memory interference and determine if this potential relationship is moderated by sex. Materials and Methods: A randomized controlled experiment was conducted (N = 40), involving young adult males (n = 20) and females (n = 20) completing two counterbalanced visits (exercise and no exercise). The exercise visit involved an acute (15 min), moderate-intensity bout of treadmill exercise, while the control visit involved a time-matched seated task. Memory interference, including both proactive interference and retroactive interference, involved the completion of a multi-trial memory task. Results: In a factorial ANOVA with the outcome being List B, there was a main effect for condition (F(1,38) = 5.75, P = 0.02, n²_p = 0.13), but there was no main effect for sex (F(1,38) = 1.39, P = 0.24, n²_p = 0.04) or sex by condition interaction (F(1,38) = 1.44, P = 0.23, n²_p = 0.04). Conclusion: In conclusion, acute moderate-intensity exercise was effective in attenuating a proactive memory interference effect. This effect was not moderated by biological sex.

A comparison of implicit and explicit reward learning in low risk alcohol users versus people who binge drink and people with alcohol dependence

Chronic alcohol use leads to specific neurobiological alterations in the dopaminergic brain reward system, which probably are leading to a reward deficiency syndrome in alcohol dependence. The purpose of our study was to examine the effects of such hypothesized neurobiological alterations on the behavioral level, and more precisely on the implicit and explicit reward learning. Alcohol users were classified as dependent drinkers (using the DSM-IV criteria), binge drinkers (using criteria of the USA National Institute on Alcohol Abuse and Alcoholism) or low-risk drinkers (following recommendations of the Scientific board of trustees of the German Health Ministry). The final sample (n = 94) consisted of 36 low-risk alcohol users, 37 binge drinkers and 21 abstinent alcohol dependent patients. Participants were administered a probabilistic implicit reward learning task and an explicit reward- and punishment-based trial-and-error-learning task. Alcohol dependent patients showed a lower performance in implicit and explicit reward learning than low risk drinkers. Binge drinkers learned less than low-risk drinkers in the implicit learning task. The results support the assumption that binge drinking and alcohol dependence are related to a chronic reward deficit. Binge drinking accompanied by implicit reward learning deficits could increase the risk for the development of an alcohol dependence.

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Alcohol dependent patients were impaired in implicit and explicit reward learning.

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Alcohol dependence may lead to implicit and explicit reward learning deficits.

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Binge drinkers learned less than low-risk drinkers in the implicit learning task.

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Binge drinking is related to implicit reward learning deficits.

Combining approach bias modification with working memory training during inpatient alcohol withdrawal: an open-label pilot trial of feasibility and acceptability

Background

According to contemporary neurocognitive models, addiction is maintained by the biasing of information-processing and decision-making systems towards relatively automatic, impulsive, reward-seeking responses to drug-related stimuli, and away from more controlled, deliberative, “reflective” states of processing that could result in decisions to delay or avoid drug use. Cognitive training programs aimed at either countering “impulsive” processing or enhancing “reflective” processing alone have shown promise. However, there has been no attempt to simultaneously target both aspects of processing with a combined training program. We aimed to test the feasibility and acceptability of a novel ‘dual-training’ program targeting both processes during residential alcohol withdrawal, and to measure abstinence rates following discharge.

Methods

Thirty-seven patients undergoing alcohol withdrawal at a residential unit participated in this open-label pilot feasibility study. We tested a 4-session program of dual cognitive training targeting both impulsive (approach bias) and reflective (working memory) aspects of processing. Descriptive statistics were used to examine feasibility (training uptake and completion rates) and acceptability (withdrawal from the study; participants’ ratings of the tasks). Alcohol abstinence rates were examined 2-weeks post-discharge.

Results

Seven participants withdrew after commencing training. Twenty-six (70%) completed the 4-session training protocol, and four completed 3 sessions before discharging. Among participants who provided ratings, nearly all (93%) rated the training as interesting. Most (87%) indicated that they felt it had improved their attention. However, most did not feel it had decreased their craving for alcohol. At 2-weeks post-discharge, 16 (53%) participants reported abstaining from alcohol. For comparison, an earlier pilot trial in the same setting found a 68% abstinence rate with approach bias training alone, and 47% abstinence in a non-training control group.

Conclusions

Dual training during residential alcohol detoxification appears to be both acceptable and feasible, suggesting that future research is warranted to test its effectiveness at reducing likelihood of relapse.

Role of Patient Sex in Early Recovery from Alcohol-Related Cognitive Impairment: Women Penalized

BACKGROUND

The objective was to explore the role of patient sex in cognitive recovery and to identify predictive factors for non-recovery in alcohol use disorder (AUD).

METHODS

All patients with AUD admitted to a residential addictions treatment center were systematically assessed at admission and after 6 weeks of abstinence in a controlled environment. The inclusion criteria were that patients were admitted for AUD with baseline alcohol-related cognitive impairment (baseline total Montreal Cognitive Assessment (MoCA) score < 26) and reassessed at 6 weeks (n = 395). A logistic regression model was built to determine the influence of sex on recovery status (MoCA < or ≥ 26) taking into account the interaction effect of sex with alcohol consumption on cognitive function.

RESULTS

The mean age was 50.10 years (SD = 9.79), and 27.41% were women. At baseline, the mean MoCA scores were 21.36 (SD = 3.04). Participants who did not achieve recovery (59.3% of women vs 53.8% of men) had lower total MoCA scores at baseline. The 2 factors that was significantly and independently associated with non-recovery and with a non-zero coefficient was being a woman and initial MoCA score (respective adjusted odds ratios (AOR) = 1.5 and 0.96, p-values < 0.05).

CONCLUSIONS

These results could influence the time required in a controlled environment to maintain abstinence and the duration of in-care for women.

Effectiveness of a Health Behavioural Intervention Aimed at Reduction of Risky Sexual Behaviours among Young Men in the KwaZulu-Natal Province, South Africa

Two studies evaluating the same behavioural intervention were conducted in two areas in the KwaZulu-Natal province of South Africa using a randomized pre-test post-test control group design for study 1 (peri-urban) and a pre-test post-test design without a control group for study 2 (rural). The intervention included discussions and skills training on: (1) notions of masculinity, manhood, and responsibility, (2) personal and sexual relationships, (3) general communication skills, and (4) alcohol and other substance use. The intervention was aimed at men between 18 and 35 years of age. Measures of attitude, subjective norms, perceived behavioural control and intention for condom use, human immunodeficiency virus (HIV) testing, reduction of alcohol and drug use, avoiding sex while intoxicated, and avoiding sex with intoxicated people were assessed using a facilitator-administered questionnaire. The results for study 1 showed that 4 of the 19 variables scored significantly different at baseline and that all 19 variables showed no significant changes between pre-test and post-test. For study 2, one significant difference was found for attitude towards avoiding sex when one is intoxicated. Overall, the intervention had minimal success with just one area of positive effect. Further development and testing of this programme is recommended before it can be considered for broader scale implementation.

Experimental Manipulation of Psychological Control Scenarios: Implications for Exercise and Memory Research

The purpose of this experiment was to evaluate the extent to which variations in control activities influence memory function, as well as to investigate the participants’ memory expectations for the various conditions. A within-subject, counterbalanced experimental design was employed. Across four visits, participants engaged in four tasks, including an acute exercise session, and three cognitive-engagement control tasks of varying degrees of cognitive engagement and valence, namely reading neutral text, looking at a video, and puzzle completion. Participants’ perceived expectations for how each condition would improve their memory performance was also assessed. We observed no differences in objective cognitive performance or outcome expectations across the three evaluated control tasks, and thus, future studies may wish to employ either of these control tasks, which should not compromise making comparisons across studies.

The effects of acute exercise on episodic memory function among young university students: moderation considerations by biological sex

Background: The objective of this study was to evaluate potential sex-specific differences on episodic memory function and determine whether sex moderates the effects of acute exercise on episodic memory.

Methods: A randomized controlled intervention was employed. This experiment was conducted among young University students (mean age = 21 years). Both males (n=20) and females (n=20)completed two counterbalanced laboratory visits, with one visit involving a 15-minute bout of moderate-intensity exercise prior to the memory task. The control visit engaged in a time matched seated task. Memory function (including short-term memory, learning, and long-term memory) was assessed from the RAVLT (Rey Auditory Verbal Learning Test).

Results: We observed a significant main effect for time (P<0.001, ƞ²_p= 0.77) and a marginally significant main effect for sex (P=0.06, ƞ²_p= 0.09), but no time by sex by condition interaction(P=0.91, ƞ²_p= 0.01). We also observed some suggestive evidence of a more beneficial effect of acute exercise on memory for females.

Conclusion: In conclusion, females outperformed males in verbal memory function. Additional research is needed to further evaluate whether sex moderates the effects of acute exercise on memory function.

Effects of Intensity-Specific Acute Exercise on Paired-Associative Memory and Memory Interference

The improvement of memory performance is an ever-growing interest in research, with implications in many fields. Thus, identifying strategies to enhance memory and attenuate memory interference is of great public health and personal interest. The objective of this paper was to evaluate the role of intensity-specific acute exercise on improving paired-associative memory function and attenuating memory interference. A counterbalanced, randomized controlled, within-subject experimental design was employed. The three counterbalanced visits included a control visit, moderate-intensity exercise (50% of HRR; heart rate reserve) and vigorous-intensity exercise (80% of HRR), all of which occurred prior to the memory assessment. To evaluate memory interference, an AB/AC paired-associative task was implemented for each laboratory visit. The number of correctly recalled words from List 1 (AB–DE) was statistically significantly (F = 4.63, p = 0.01, η2p = 0.205) higher for the vigorous-intensity condition (M = 6.53, SD = 1.54) as compared to moderate-intensity (M = 6.11, SD = 1.59) and control (M = 5.00, SD = 2.56) conditions. No statistical significance was found between proactive interference or retroactive interference across the experimental conditions. This experiment provides evidence for an intensity-specific effect of acute exercise on short-term, paired-associative memory, but not memory interference.

The effects of acute exercise intensity on episodic and false memory among young adult college students

Background: Previous experimental work demonstrates that acute exercise may enhance episodic memory performance. However, limited research has examined the extent to which acute exercise influences false episodic memory production, and no studies, to date, have examined whether there is an intensity-specific effect of acute exercise on both true episodic and false episodic memories. Thus, the present experiment evaluated the effects of intensity-specific acute exercise on episodic memory and false episodic memory. Methods: A three-arm, parallel, between-group randomized controlled trial was employed in the University setting, with participants (N=60; M_age= 20.8 years) randomized into a moderate intensity exercise group (15-minute bout of treadmill exercise at 50% heart rate reserve), a high intensity exercise group (15-minute bout of treadmill exercise at 80% heart rate reserve), or a control group (time-matched period of sitting). True episodic and false episodic memory were both assessed using 6 word-lists from the Deese-Roediger-McDermott (DRM) paradigm, including both a short-term recall and a delayed memory recognition assessment. Results: For the number of words recalled across each of the 6 lists, there was a significant main effect for list (P<0.001, η² _p=0.15), marginally significant main effect for group (P=0.07, η² _p=0.09), but no list by group interaction effect (P=0.44, η² _p=0.03). Those in the high-intensity exercise group recalled significantly (P<0.05) more words than the control group. For the false episodic word recall, across various lists, high-intensity acute exercise was associated with a greater rate of false episodic memories. For the memory recognition task, there was no main effect for word type (P=0.46, η² _p=0.01), group (P=0.4443, η² _p=.03), word type by group interaction (P=0.44,η² _p=0.03), recall by group interaction (P=0.4441, η² _p=0.04), or word type by recall by group interaction (P=0.32, η² _p=0.04). However, there was a main effect for recall (P<0.001, η² _p=.54)and a word type by recall interaction (P<0.001, η² _p=0.77). Conclusion: These findings suggest that acute high-intensity exercise may enhance true episodic memories, and, possibly, also increase the rate of false episodic memories. We discuss these findings in the context of how different acute exercise intensities may have unique and differential effects on underlying mechanistic processes related to true and false episodic memory.

Voluntary alcohol access during adolescence/early adulthood, but not during adulthood, causes faster omission contingency learning

In omission contingency training, rodents learn to suppress their natural tendency to approach or touch a reward-predictive cue (termed "autoshaping" or "sign-tracking" responses) if the approach/touching responses lead to the omission of the reward. Previous research has shown that high levels of alcohol exposure (through alcohol vapor exposure) or adolescent alcohol consumption (with some versions of the omission contingency task) can lead to faster omission contingency learning. However, the alcohol exposure procedures and/or omission contingency task parameters differed between these different demonstrations. It was unclear whether the same voluntary alcohol consumption procedures during adolescence/early adulthood and/or adulthood would lead to faster omission contingency learning in one or both age groups. Here, rats received 6 weeks of chronic intermittent access to 20% alcohol or water from PND 26-66 (adolescence/early adulthood in Exp. 1) or PND 68-108 (adulthood in Exp. 2) and began behavioral training (autoshaping training followed by omission contingency training) several days later. We found no evidence that alcohol access at either age altered the number of trials with a sign-tracking response on the levers during autoshaping training. However, alcohol access during adolescence/early adulthood, but not during adulthood, led to faster learning to withhold responding on the lever under omission contingencies during the subsequent phase. We also found no evidence that the level of alcohol consumption was correlated with sign-tracking behavior in the autoshaping phase or with the suppression of lever-pressing during the omission contingency phase. Our results suggest that adolescent/early adult rats have increased vulnerability, compared with adults, to some long-term behavioral effects of voluntary alcohol consumption.

Alterations in White Matter Microstructure and Connectivity in Young Adults with Alcohol Use Disorder

BACKGROUND

Magnetic resonance imaging (MRI) studies have shown differences in volume and structure in the brains of individuals with alcohol use disorder (AUD). Most research has focused on neuropathological effects of alcohol that appear after years of chronic alcohol misuse. However, few studies have investigated white matter (WM) microstructure and diffusion MRI-based (DWI) connectivity during early stages of AUD. Therefore, the goal of this work was to investigate WM integrity and structural connectivity in emerging adulthood AUD subjects using both conventional DWI metrics and a novel connectomics approach.

METHODS

Twenty-two AUD and 18 controls (CON) underwent anatomic and diffusion MRI. Outcome measures were scalar diffusion metrics and structural network connectomes. Tract-Based Spatial Statistics was used to investigate group differences in diffusion measures. Structural connectomes were used as input into a community structure procedure to obtain a coclassification index matrix (an indicator of community association strength) for each subject. Differences in coclassification and structural connectivity (indexed by streamline density) were assessed via the Network Based Statistics Toolbox.

RESULTS

AUD had higher fractional anisotropy (FA) values throughout the major WM tracts, but also had lower FA values in WM tracts in the cerebellum and right insula (p_TFCE  < 0.05). Mean diffusivity was generally lower in the AUD group (p_TFCE  < 0.05). AUD had lower coclassification of nodes between ventral attention and default mode networks and higher coclassification between nodes of visual, default mode, and somatomotor networks. Additionally, AUD had higher fiber density between an adjacent pair of nodes within the default mode network.

CONCLUSIONS

Our results indicate that emerging adulthood AUD subjects may have differential patterns of FA and distinct differences in structural connectomes compared with CON. These data suggest that such alterations in microstructure and structural connectivity may uniquely characterize early stages of AUD and/or a predisposition for development of AUD.

Compulsivity in Alcohol Use Disorder and Obsessive Compulsive Disorder: Implications for Neuromodulation

Alcohol use Disorder (AUD) is one of the leading causes of morbidity and mortality worldwide. The progression of the disorder is associated with the development of compulsive alcohol use, which in turn contributes to the high relapse rate and poor longer term functioning reported in most patients, even with treatment. While the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines AUD by a cluster of symptoms, parsing its heterogeneous phenotype by domains of behavior such as compulsivity may be a critical step to improve outcomes of this condition. Still, neurobiological underpinnings of compulsivity need to be fully elucidated in AUD in order to better design targeted treatment strategies. In this manuscript, we review and discuss findings supporting common mechanisms between AUD and OCD, dissecting the construct of compulsivity and focusing specifically on characteristic disruptions in habit learning and cognitive control in the two disorders. Finally, neuromodulatory interventions are proposed as a probe to test compulsivity as key pathophysiologic feature of AUD, and as a potential therapy for the subgroup of individuals with compulsive alcohol use, i.e., the more resistant stage of the disorder. This transdiagnostic approach may help to destigmatize the disorder, and suggest potential treatment targets across different conditions.

Selective micro-structural integrity impairment of the isthmus subregion of the corpus callosum in alcohol-dependent males

BACKGROUND

Previous studies have provided evidence that alcohol-dependent patients have abnormality in corpus callosum (CC); however, it is unclear whether micro-structural integrity of the CC subregions is differentially affected in this disorder.

METHODS

In this study, a total of 39 male individuals, including 19 alcohol-dependent patients and 20 age-matched healthy controls, underwent diffusion tensor imaging (DTI). CC was reconstructed by DTI tractography and was divided into seven subregions. Multiple diffusion metrics of each subregion were compared between two groups.

RESULTS

Compared to healthy controls, patients exhibited increased axial diffusivity (P = 0.007), radial diffusivity (P = 0.009) and mean diffusivity (P = 0.005) in the isthmus. In addition, we observed that daily alcohol intake was correlated positively with radial diffusivity and mean diffusivity and negatively with fractional anisotropy, while abstinence time of hospitalization was negatively correlated with mean diffusivity in the patients.

CONCLUSION

These findings suggest a selective micro-structural integrity impairment of the corpus callosum subregions in alcohol dependence, characterized by axon and myelin alterations in the isthmus.

Neurological, nutritional and alcohol consumption factors underlie cognitive and motor deficits in chronic alcoholism

Variations in pattern and extent of cognitive and motor impairment occur in alcoholism (ALC). Causes of such heterogeneity are elusive and inconsistently accounted for by demographic or alcohol consumption differences. We examined neurological and nutritional factors as possible contributors to heterogeneity in impairment. Participants with ALC (n = 96) and a normal comparison group (n = 41) were examined on six cognitive and motor domains. Signs of historically determined subclinical Wernicke's encephalopathy were detected using the Caine et al. criteria, which were based on postmortem examination and chart review of antemortem data of alcoholic cases with postmortem evidence for Wernicke's encephalopathy. Herein, four Caine criteria provided quantification of dietary deficiency, cerebellar dysfunction, low general cognitive functioning and oculomotor abnormalities in 86 of the 96 ALC participants. Subgroups based on Caine criteria yielded a graded effect, where those meeting more criteria exhibited greater impairment than those meeting no to fewer criteria. These results could not be accounted for by history of drug dependence. Multiple regression indicated that compromised performance on ataxia, indicative of cerebellar dysfunction, predicted non-mnemonic and upper motor deficits, whereas low whole blood thiamine level, consistent with limbic circuit dysfunction, predicted mnemonic deficits. This double dissociation indicates biological markers that contribute to heterogeneity in expression of functional impairment in ALC. That non-mnemonic and mnemonic deficits are subserved by the dissociable neural systems of frontocerebellar and limbic circuitry, both commonly disrupted in ALC, suggests neural mechanisms that can differentially affect selective functions, thereby contributing to heterogeneity in pattern and extent of dysfunction in ALC.

Impaired Specificity of Future Thinking in Alcohol Use Disorders

BACKGROUND

While there has been a body of work that has investigated past thinking in individuals with alcohol use disorders (AUD), little is known about future thinking in these individuals.

METHODS

We invited participants with AUD and control participants to construct past and future events. We have also investigated the relationship between constructing past and future events and depression.

RESULTS

By analyzing the specificity (i.e., the ability in constructing specific events situated in time and space) of these events, results demonstrated lower specificity of past and future thinking in AUD participants compared to control participants. No significant differences were observed between the specificity of past and future thinking in AUD or in control participants. Further, significant negative correlations were observed between depression and past/future thinking in AUD participants but not in controls.

CONCLUSIONS

Difficulties in constructing specific future scenarios, as observed in AUD participants compared with controls, are presumably related to ruminative thinking and emotional avoidance aspects of depression, which should be investigated in future studies. More specifically, individuals with AUD may tend to construct general future scenarios to dwell on negative past events and/or to avoid coping with hopelessness and processing of upsetting or distressful future scenarios.

Rich club and reward network connectivity as endophenotypes for alcohol dependence: a diffusion tensor imaging study

We aimed to examine the whole-brain white matter connectivity and local topology of reward system nodes in patients with alcohol use disorder (AUD) and unaffected siblings, relative to healthy comparison individuals. Diffusion-weighted magnetic resonance imaging scans were acquired from 18 patients with AUD, 15 unaffected siblings of AUD patients and 15 healthy controls. Structural networks were examined using network-based statistic and connectomic analysis. Connectomic analysis showed a significant ordered difference in normalized rich club organization (AUD < Siblings < Controls). We also found rank ordered differences (Control > Sibling > AUD) for both nodal clustering coefficient and nodal local efficiency in reward system nodes, particularly left caudate, right putamen and left hippocampus. Network-based statistic analyses showed that AUD group had significantly weaker connectivity than controls in the right hemisphere, mostly in the edges connecting putamen and hippocampus with other brain regions. Our results suggest that reward system network abnormalities, especially in subcortical structures, and impairments in rich-club organization might be related to the familial predisposition for AUD.

Disruption of Frontal Lobe Neural Synchrony During Cognitive Control by Alcohol Intoxication

Decision making relies on dynamic interactions of distributed, primarily frontal brain regions. Extensive evidence from functional magnetic resonance imaging (fMRI) studies indicates that the anterior cingulate (ACC) and the lateral prefrontal cortices (latPFC) are essential nodes subserving cognitive control. However, because of its limited temporal resolution, fMRI cannot accurately reflect the timing and nature of their presumed interplay. The present study combines distributed source modeling of the temporally precise magnetoencephalography (MEG) signal with structural MRI in the form of "brain movies" to: (1) estimate the cortical areas involved in cognitive control ("where"), (2) characterize their temporal sequence ("when"), and (3) quantify the oscillatory dynamics of their neural interactions in real time. Stroop interference was associated with greater event-related theta (4 - 7 Hz) power in the ACC during conflict detection followed by sustained sensitivity to cognitive demands in the ACC and latPFC during integration and response preparation. A phase-locking analysis revealed co-oscillatory interactions between these areas indicating their increased neural synchrony in theta band during conflict-inducing incongruous trials. These results confirm that theta oscillations are fundamental to long-range synchronization needed for integrating top-down influences during cognitive control. MEG reflects neural activity directly, which makes it suitable for pharmacological manipulations in contrast to fMRI that is sensitive to vasoactive confounds. In the present study, healthy social drinkers were given a moderate alcohol dose and placebo in a within-subject design. Acute intoxication attenuated theta power to Stroop conflict and dysregulated co-oscillations between the ACC and latPFC, confirming that alcohol is detrimental to neural synchrony subserving cognitive control. It interferes with goal-directed behavior that may result in deficient self-control, contributing to compulsive drinking. In sum, this method can provide insight into real-time interactions during cognitive processing and can characterize the selective sensitivity to pharmacological challenge across relevant neural networks.

Abnormal fronto-striatal intrinsic connectivity reflects executive dysfunction in alcohol use disorders

The neural bases of cognitive impairment(s) in alcohol use disorders (AUDs) have been explained either with the specific involvement of frontal regions mostly affected by alcohol neurotoxic effects, or with a global brain damage underlying different neuro-cognitive alterations. Novel insights into this issue might come from the analysis of resting-state brain activity, representing a baseline level of intrinsic connectivity within and between the networks underlying cognitive performance. We thus addressed the neural bases of cognitive impairment(s) in 22 AUD patients, compared with 18 healthy controls, by coupling resting-state fMRI with an in-depth neuropsychological assessment of the main cognitive domains. We assessed a relationship between AUD patients' cognitive impairment and two complementary facets of intrinsic brain functioning, i.e., intensity of activation and functional network connectivity, related to the strength of connectivity within and between resting-state networks, respectively. Alcoholic patients' decreased cognitive performance involved specifically an executive domain associated with attentional and working-memory tasks. This impairment reflected an abnormal relationship, in patients versus controls, between cognitive performance and the intensity of intrinsic activity in the dorsolateral prefrontal and striatal nodes of the executive control network. Functional connectivity between the same structures was positively correlated with executive performance in the whole sample, but significantly reduced in patients. The present data suggest that AUD patients' executive impairment reflects dysfunctional connectivity between the cortical and subcortical nodes of the networks underlying cognitive control on goal-directed behavior. This evidence provides a baseline for future studies addressing the abnormal neural architecture underlying cognitive impairment in AUDs and the outcome of rehabilitative treatment.

Widespread Cognitive Deficits in Alcoholism Persistent Following Prolonged Abstinence: An Updated Meta-analysis of Studies That Used Standardised Neuropsychological Assessment Tools

Objective

This study presents an updated meta-analysis replicating the study of (Stavro, K., Pelletier, J., & Potvin, S. (2013). Widespread and sustained cognitive deficits in alcoholism: A meta-analysis. Addiction Biology, 18, 203–213. doi:10.1111/j.1369-1600.2011.00418.x) regarding the cognitive functioning of alcoholics as a function of time abstinent.

Methods

A total of 34 studies (including a total of 2,786 participants) that met pre-determined inclusion and exclusion criteria were included in the analyses. The alcoholics were categorised into recently detoxified alcoholics (0–31 days sober), alcoholics 32–365 days sober and alcoholics &gt;365 days sober consistent with the previous study. The current study employed more stringent control on the tests included in the analysis to include only those tasks described in contemporary neuropsychological test compendia. Forty-seven percent of the papers surveyed were not include in the previous meta-analysis.

Results

The results indicated that there was a diffuse and pervasive pattern of cognitive deficit among recently detoxified alcoholics and that these deficits, particularly with regard to memory functioning, persisted even in longer term abstinent alcoholics. This was inconsistent with the prior meta-analysis which contended that significant cognitive recovery was possible after as little as 1 year.

Conclusion

The persisting cognitive deficits were noted across a wide range of cognitive functions, supporting the notion of a diffuse rather than a specific compromise of cognition in alcoholism following discontinuation, as measured using standardised neuropsychological tests. Limitations on the finding included the fact that it was a cross-sectional rather than a longitudinal analysis, was subject to heterogeneity of method, had low representation of females in the samples, and had fewer studies of long-term sober samples.

Mental disorders and the risk of adult violent and psychological victimisation: a prospective, population-based study

AIMS

Psychiatric patients are at increased risk to become victim of violence. It remains unknown whether subjects of the general population with mental disorders are at risk of victimisation as well. In addition, it remains unclear whether the risk of victimisation differs across specific disorders. This study aimed to determine whether a broad range of mood, anxiety and substance use disorders at baseline predict adult violent (physical and/or sexual) and psychological victimisation at 3-year follow-up, also after adjustment for childhood trauma. Furthermore, this study aimed to examine whether specific types of childhood trauma predict violent and psychological victimisation at follow-up, after adjustment for mental disorder. Finally, this study aimed to examine whether the co-occurrence of childhood trauma and any baseline mental disorder leads to an incrementally increased risk of future victimisation.

METHODS

Data were derived from the first two waves of the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2): a psychiatric epidemiological cohort study among a nationally representative adult population. Mental disorders were assessed using the Composite International Diagnostic Interview version 3.0. Longitudinal associations between 12 mental disorders at baseline and violent and psychological victimisation at 3-year follow-up (n = 5303) were studied using logistic regression analyses, with adjustment for sociodemographic characteristics and childhood trauma. Furthermore, the moderating effect of childhood trauma on these associations was examined.

RESULTS

Associations with victimisation varied considerably across specific mental disorders. Only alcohol dependence predicted both violent and psychological victimisation after adjustment for sociodemographic characteristics and childhood trauma. Depression, panic disorder, social phobia, generalised anxiety disorder and alcohol dependence predicted subsequent psychological victimisation in the fully adjusted models. All types of childhood trauma independently predicted violent and psychological victimisation after adjustment for any mental disorder. The presence of any childhood trauma moderated the association between any anxiety disorder and psychological victimisation, whereas no interaction between mental disorder and childhood trauma on violent victimisation existed.

CONCLUSIONS

The current study shows that members of the general population with mental disorders are at increased risk of future victimisation. However, the associations with violent and psychological victimisation vary considerably across specific disorders. Clinicians should be aware of the increased risk of violent and psychological victimisation in individuals with these mental disorders - especially those with alcohol dependence - and individuals with a history of childhood trauma. Violence prevention programmes should be developed for people at risk. These programmes should not only address violent victimisation, but also psychological victimisation.

A Patient-Tailored Evidence-Based Approach for Developing Early Neuropsychological Training Programs in Addiction Settings

Substance use disorders (SUDs) are associated with impairments of cognitive functions, and cognitive training programs are thus rapidly developing in SUD treatment. However, neuropsychological impairments observed early after withdrawal (i.e., early impairments), that is, approximately in the first six months, may be widespread. Consequently, it might not be possible to train all the identified early impairments. In these situations, we propose that the priority of cognitive training should be given to the early impairments found to be associated with early dropout or relapse (i.e., relapse-related impairments). However, substance-specific relapse-related impairments have not been singled out among all early impairments so far. Using a systematic literature search, we identified the types of established early impairments for all SUDs, and we assessed the extent to which these early impairments were found to be associated with relapse-related impairments. All cognitive functions were investigated according to a classification based on current neuropsychological models, distinguishing classical cognitive, substance-bias, and social cognition systems. According to the current evidence, demonstrated relapse-related impairments in alcohol use disorder comprised impulsivity, long-term memory, and higher-order executive functions. For cannabis use disorder, the identified relapse-related impairments were impulsivity and working memory. For stimulant use disorder, the identified relapse-related impairments were attentional abilities and higher-order executive functions. For opioid use disorder, the only identified relapse-related impairments were higher executive functions. However, many early impairments were not explored with respect to dropout/relapse, particularly for stimulant and opioid use disorders. The current literature reveals substance-specific relapse-related impairments, which supports a pragmatic patient-tailored approach for defining which early impairments should be prioritized in terms of training among patients with SUDs.

Targeting the Glucocorticoid Receptors During Alcohol Withdrawal to Reduce Protracted Neurocognitive Disorders

Persistent regional glucocorticoid (GC) dysregulation in alcohol-withdrawn subjects emerges as a key factor responsible for protracted molecular and neural alterations associated with long-term cognitive dysfunction. Regional brain concentrations of corticosterone vary independently from plasma concentrations in alcohol-withdrawn subjects, which may account for the treatment of alcohol withdrawal-induced persistent pathology. Thus, from a pharmacological point of view, a main issue remains to determine the relative efficacy of compounds targeting the GC receptors to attenuate or suppress the long-lasting persistence of brain regional GC dysfunctions in abstinent alcoholics, as well as persistent changes of neural plasticity. Data from animal research show that acting directly on GC receptors during the withdrawal period, via selective antagonists, can significantly counteract the development and persistence of cognitive and neural plasticity disorders during protracted abstinence. A critical remaining issue is to better assess the relative long-term efficacy of GC antagonists and other compounds targeting the corticotropic axis activity such as gamma-aminobutyric acid A (GABA_A) and GABA_B agonists. Indeed, benzodiazepines (acting indirectly on GABA_A receptors) and baclofen (agonist of the GABA_B receptor) are the compounds most widely used to reduce alcohol dependence. Clinical and preclinical data suggest that baclofen exerts an effective and more powerful counteracting action on such persistent cognitive and endocrine dysfunctions as compared to diazepam, even though its potential negative effects on memory processes, particularly at high doses, should be better taken into account.

The role of the orbitofrontal cortex in alcohol use, abuse, and dependence

One of the major functions of the orbitofrontal cortex (OFC) is to promote flexible motivated behavior. It is no surprise, therefore, that recent work has demonstrated a prominent impact of chronic drug use on the OFC and a potential role for OFC disruption in drug abuse and addiction. Among drugs of abuse, the use of alcohol is particularly salient with respect to OFC function. Although a number of studies in humans have implicated OFC dysregulation in alcohol use disorders, animal models investigating the association between OFC and alcohol use are only beginning to be developed, and there is still a great deal to be revealed. The goal of this review is to consider what is currently known regarding the role of the OFC in alcohol use and dependence. I will first provide a brief, general overview of current views of OFC function and its contributions to drug seeking and addiction. I will then discuss research to date related to the OFC and alcohol use, both in human clinical populations and in non-human models. Finally I will consider issues and strategies to guide future study that may identify this brain region as a key player in the transition from moderated to problematic alcohol use and dependence.

A novel multichoice touchscreen paradigm for assessing cognitive flexibility in mice

Cognitive flexibility refers to various processes which enable behaviors to be modified on the basis of a change in the contingencies between stimuli or responses and their associated outcomes. Reversal learning is a form of cognitive flexibility which measures the ability to adjust responding based on a switch in the stimulus–outcome contingencies of, typically two, perceptually distinct stimuli. Reversal tasks have provided valuable insight into the neural basis of cognitive flexibility, implicating brain regions including the lateral orbitofrontal cortex (lOFC) and dorsomedial prefrontal cortex (dmPFC). However, with two-stimulus reversal, it is difficult to determine whether response errors are due excessive perseveration, deficient learning, or other problems with updating. To address this limitation, we developed a mouse three-choice touchscreen-based visual reversal task, in which the contingencies of two stimuli were switched on reversal but a third, simultaneously presented, stimulus was never reinforced. We found that, in male C57BL/6J mice, responding at the previously rewarded stimulus predominated over the newly and never-reinforced stimuli during early reversal. Next, we showed that acute pharmacological inhibition of lOFC, but not dmPFC, impaired early reversal performance, relative to noninactivated controls. Interestingly, however, lOFC inactivation deficits were characterized by increased choice of the never-reinforced stimulus and a decrease in (perseverative-like) responding at the previously rewarded stimulus. These effects are inconsistent with the historical notion of lOFC mediating response inhibition and closer to recent views of the lOFC's role in response/outcome tracking. Overall, these findings provide initial support the utility of this novel paradigm for studying cognitive flexibility and its underlying neural substrates.

Working Memory Training in Alcohol Use Disorder: A Randomized Controlled Trial

Background

Alcohol use disorder (AUD) is associated with cognitive deficits such as impaired executive functions, which are hypothesized to contribute to the progression of the disease and worsen treatment outcome. Training of working memory (WM) to improve cognitive functions and thereby reduce alcohol use has been proposed as a novel treatment strategy.

Methods

Patients with AUD (n = 50) who were recruited to an outpatient addiction clinic were randomized to receive 5 weeks of active WM training or control training. Participants had weekly follow‐up visits, and all cognitive training sessions were done online at home. Primary outcomes were WM function and change in self‐reported heavy drinking. Secondary outcomes were craving, other drinking outcomes, and performance on a range of neuropsychological tasks from the Cambridge Neuropsychological Test Automated Battery.

Results

The active training group demonstrated a significantly greater improvement in verbal WM compared with the control group. No statistically significant effect of training was found on the primary drinking outcome, but a trend was observed indicating that WM training reduces the number of drinks per drinking occasion. WM training had no statistically significant effect on any of the other neuropsychological tasks.

Conclusions

Cognitive training can improve WM function in individuals with AUD, suggesting that such interventions are feasible to administer in this patient population. The results do not support an effect of WM training on heavy drinking or transfer effects to other cognitive domains. Future studies should evaluate WM training as an adjunct to evidence‐based treatments for AUD to assess potential synergistic effects.

Salience network structural integrity predicts executive impairment in alcohol use disorders

The neural bases of cognitive impairment(s) in alcohol use disorders (AUDs) might reflect either a global brain damage underlying different neuro-cognitive alterations, or the involvement of specific regions mostly affected by alcohol neuro-toxic effects. While voxel-based-morphometry (VBM) studies have shown a distributed atrophic pattern in fronto-limbic and cerebellar structures, the lack of comprehensive neuro-cognitive assessments prevents previous studies from drawing robust inferences on the specificity of the association between neuro-structural and cognitive impairments in AUDs. To fill this gap, we addressed the neuro-structural bases of cognitive impairment in AUDs, by coupling VBM with an in-depth neuropsychological assessment. VBM results highlighted a diffuse pattern of grey matter reduction in patients, involving the key-nodes of the meso-cortico-limbic (striatum, hippocampus, medial prefrontal cortex), salience (insular and dorsal anterior cingulate cortex) and executive (inferior frontal cortex) networks. Grey matter density in the insular and anterior cingulate sectors of the salience network, significantly decreased in patients, explained almost half of variability in their defective attentional and working-memory performance. The multiple cognitive and neurological impairments observed in AUDs might thus reflect a specific executive deficit associated with the selective damage of a salience-based neural mechanism enhancing access to cognitive resources required for controlled cognition and behaviour.

Lower Prefrontal and Hippocampal Volume and Diffusion Tensor Imaging Differences Reflect Structural and Functional Abnormalities in Abstinent Individuals with Alcohol Use Disorder

BACKGROUND

Alcohol use disorder (AUD) is known to have adverse effects on brain structure and function. Multimodal assessments investigating volumetric, diffusion, and cognitive characteristics may facilitate understanding of the consequences of long-term alcohol use on brain circuitry, their structural impairment patterns, and their impact on cognitive function in AUD.

METHODS

Voxel- and surface-based volumetric estimations, diffusion tensor imaging (DTI), and neuropsychological tests were performed on 60 individuals: 30 abstinent individuals with AUD (DSM-IV) and 30 healthy controls. Group differences in the volumes of cortical and subcortical regions, fractional anisotropy (FA), axial and radial diffusivities (AD and RD, respectively), and performance on neuropsychological tests were analyzed, and the relationship among significantly different measures was assessed using canonical correlation.

RESULTS

AUD participants had significantly smaller volumes in left pars orbitalis, right medial orbitofrontal, right caudal middle frontal, and bilateral hippocampal regions, lower FA in 9 white matter (WM) regions, and higher FA in left thalamus, compared to controls. In AUD, lower FA in 6 of 9 WM regions was due to higher RD and due to lower AD in the left external capsule. AUD participants scored lower on problem-solving ability, visuospatial memory span, and working memory. Positive correlations of prefrontal cortical, left hippocampal volumes, and FA in 4 WM regions with visuospatial memory performance and negative correlation with lower problem-solving ability were observed. Significant positive correlation between age and FA was observed in bilateral putamen.

CONCLUSIONS

Findings showed specific structural brain abnormalities to be associated with visuospatial memory and problem-solving ability-related impairments observed in AUD. Higher RD in 6 WM regions suggests demyelination, and lower AD in left external capsule suggests axonal loss in AUD. The positive correlation between FA and age in bilateral putamen may reflect accumulation of iron depositions with increasing age.