Alcohol use and cerebral white matter compromise in adolescence

Differential effects of moderate chronic ethanol consumption on neurobehavior, white matter glial protein expression, and mTOR pathway signaling with adolescent brain maturation

Background: Adolescent brains are highly vulnerable to heavy alcohol exposure. Increased understanding of how alcohol adversely impacts brain maturation may improve treatment outcomes.Objectives: This study characterizes short-term versus long-term effects of ethanol feeding on behavior, frontal lobe glial proteins, and mTOR signaling.Methods: Adolescent rats (8/group) were fed liquid diets containing 26% or 0% ethanol for 2 or 9 weeks, then subjected to novel object recognition (NOR) and open field (OF) tests. Frontal lobes were used for molecular assays.Results: Significant ethanol effects on OF performance occurred in the 2-week model (p < .0001). Further shifts in OF and NOR performance were unrelated to ethanol exposure in the 9-week models (p < .05 to p < .0001). Ethanol inhibited MAG1 (p < .01) and MBP (p < .0001) after 2 but not 9 weeks. However, both control and ethanol 9-week models had significantly reduced MAG1 (p < .001-0.0001), MBP (p < .0001), PDGFRA (p < .05-0.01), and PLP (p < .001-0.0001) relative to the 2-week models. GFAP was the only glial protein significantly inhibited by ethanol in both 2- (p < .01) and 9-week (p < .05) models. Concerning the mTOR pathway, ethanol reduced IRS-1 (p < .05) and globally inhibited mTOR (p < .01 or p < .001) in the 9- but not the 2-week model.Conclusions: Short-term versus long-term ethanol exposures differentially alter neurobehavioral function, glial protein expression, and signaling through IRS-1 and mTOR, which have known roles in myelination during adolescence. These findings suggest that strategies to prevent chronic alcohol-related brain pathology should consider the increased maturation-related vulnerability of adolescent brains.

Adolescent binge ethanol impacts H3K9me3-occupancy at synaptic genes and the regulation of oligodendrocyte development

Introduction

Binge drinking in adolescence can disrupt myelination and cause brain structural changes that persist into adulthood. Alcohol consumption at a younger age increases the susceptibility of these changes. Animal models to understand ethanol's actions on myelin and white matter show that adolescent binge ethanol can alter the developmental trajectory of oligodendrocytes, myelin structure, and myelin fiber density. Oligodendrocyte differentiation is epigenetically regulated by H3K9 trimethylation (H3K9me3). Prior studies have shown that adolescent binge ethanol dysregulates H3K9 methylation and decreases H3K9-related gene expression in the PFC.

Methods

Here, we assessed ethanol-induced changes to H3K9me3 occupancy at genomic loci in the developing adolescent PFC. We further assessed ethanol-induced changes at the transcription level with qPCR time course approaches in oligodendrocyte-enriched cells to assess changes in oligodendrocyte progenitor and oligodendrocytes specifically.

Results

Adolescent binge ethanol altered H3K9me3 regulation of synaptic-related genes and genes specific for glutamate and potassium channels in a sex-specific manner. In PFC tissue, we found an early change in gene expression in transcription factors associated with oligodendrocyte differentiation that may lead to the later significant decrease in myelin-related gene expression. This effect appeared stronger in males.

Conclusion

Further exploration in oligodendrocyte cell enrichment time course and dose response studies could suggest lasting dysregulation of oligodendrocyte maturation at the transcriptional level. Overall, these studies suggest that binge ethanol may impede oligodendrocyte differentiation required for ongoing myelin development in the PFC by altering H3K9me3 occupancy at synaptic-related genes. We identify potential genes that may be contributing to adolescent binge ethanol-related myelin loss.

Sniffing out meaning: Chemosensory and semantic neural network changes in sommeliers

Wine tasting is a very complex process that integrates a combination of sensation, language, and memory. Taste and smell provide perceptual information that, together with the semantic narrative that converts flavor into words, seem to be processed differently between sommeliers and naïve wine consumers. We investigate whether sommeliers' wine experience shapes only chemosensory processing, as has been previously demonstrated, or if it also modulates the way in which the taste and olfactory circuits interact with the semantic network. Combining diffusion-weighted images and fMRI (activation and connectivity) we investigated whether brain response to tasting wine differs between sommeliers and nonexperts (1) in the sensory neural circuits representing flavor and/or (2) in the neural circuits for language and memory. We demonstrate that training in wine tasting shapes the microstructure of the left and right superior longitudinal fasciculus. Using mediation analysis, we showed that the experience modulates the relationship between fractional anisotropy and behavior: the higher the fractional anisotropy the higher the capacity to recognize wine complexity. In addition, we found functional differences between sommeliers and naïve consumers affecting the flavor sensory circuit, but also regions involved in semantic operations. The former reflects a capacity for differential sensory processing, while the latter reflects sommeliers' ability to attend to relevant sensory inputs and translate them into complex verbal descriptions. The enhanced synchronization between these apparently independent circuits suggests that sommeliers integrated these descriptions with previous semantic knowledge to optimize their capacity to distinguish between subtle differences in the qualitative character of the wine.

Tissue Microarray Lipidomic Imaging Mass Spectrometry Method: Application to the Study of Alcohol-Related White Matter Neurodegeneration

Central nervous system (CNS) white matter pathologies accompany many diseases across the lifespan, yet their biochemical bases, mechanisms, and consequences have remained poorly understood due to the complexity of myelin lipid-based research. However, recent advances in matrix-assisted laser desorption/ionization-imaging mass spectrometry (MALDI-IMS) have minimized or eliminated many technical challenges that previously limited progress in CNS disease-based lipidomic research. MALDI-IMS can be used for lipid identification, semi-quantification, and the refined interpretation of histopathology. The present work illustrates the use of tissue micro-arrays (TMAs) for MALDI-IMS analysis of frontal lobe white matter biochemical lipidomic pathology in an experimental rat model of chronic ethanol feeding. The use of TMAs combines workload efficiency with the robustness and uniformity of data acquisition. The methods described for generating TMAs enable simultaneous comparisons of lipid profiles across multiple samples under identical conditions. With the methods described, we demonstrate significant reductions in phosphatidylinositol and increases in phosphatidylcholine in the frontal white matter of chronic ethanol-fed rats. Together with the use of a novel rapid peak alignment protocol, this approach facilitates reliable inter- and intra-group comparisons of MALDI-IMS data from experimental models and could be extended to human disease states, including using archival specimens.

Differential Early Mechanistic Frontal Lobe Responses to Choline Chloride and Soy Isoflavones in an Experimental Model of Fetal Alcohol Spectrum Disorder

Fetal alcohol spectrum disorder (FASD) is the most common preventable cause of neurodevelopmental defects, and white matter is a major target of ethanol neurotoxicity. Therapeutic interventions with choline or dietary soy could potentially supplement public health preventive measures. However, since soy contains abundant choline, it would be important to know if its benefits are mediated by choline or isoflavones. We compared early mechanistic responses to choline and the Daidzein+Genistein (D+G) soy isoflavones in an FASD model using frontal lobe tissue to assess oligodendrocyte function and Akt-mTOR signaling. Long Evans rat pups were binge administered 2 g/Kg of ethanol or saline (control) on postnatal days P3 and P5. P7 frontal lobe slice cultures were treated with vehicle (Veh), Choline chloride (Chol; 75 µM), or D+G (1 µM each) for 72 h without further ethanol exposures. The expression levels of myelin oligodendrocyte proteins and stress-related molecules were measured by duplex enzyme-linked immunosorbent assays (ELISAs), and mTOR signaling proteins and phosphoproteins were assessed using 11-plex magnetic bead-based ELISAs. Ethanol's main short-term effects in Veh-treated cultures were to increase GFAP and relative PTEN phosphorylation and reduce Akt phosphorylation. Chol and D+G significantly modulated the expression of oligodendrocyte myelin proteins and mediators of insulin/IGF-1-Akt-mTOR signaling in both control and ethanol-exposed cultures. In general, the responses were more robust with D+G; the main exception was that RPS6 phosphorylation was significantly increased by Chol and not D+G. The findings suggest that dietary soy, with the benefits of providing complete nutrition together with Choline, could be used to help optimize neurodevelopment in humans at risk for FASD.

Dietary Soy Prevents Alcohol-Mediated Neurocognitive Dysfunction and Associated Impairments in Brain Insulin Pathway Signaling in an Adolescent Rat Model

BACKGROUND

Alcohol-related brain degeneration is linked to cognitive-motor deficits and impaired signaling through insulin/insulin-like growth factor type 1 (IGF-1)-Akt pathways that regulate cell survival, plasticity, metabolism, and homeostasis. In addition, ethanol inhibits Aspartyl-asparaginyl-β-hydroxylase (ASPH), a downstream target of insulin/IGF-1-Akt signaling and an activator of Notch networks. Previous studies have suggested that early treatment with insulin sensitizers or dietary soy could reduce or prevent the long-term adverse effects of chronic ethanol feeding.

OBJECTIVE

The goal of this study was to assess the effects of substituting soy isolate for casein to prevent or reduce ethanol's adverse effects on brain structure and function.

METHODS

Young adolescent male and female Long Evans were used in a 4-way model as follows: Control + Casein; Ethanol + Casein; Control + Soy; Ethanol + Soy; Control = 0% ethanol; Ethanol = 26% ethanol (caloric). Rats were fed isocaloric diets from 4 to 11 weeks of age. During the final experimental week, the Morris Water maze test was used to assess spatial learning (4 consecutive days), after which the brains were harvested to measure the temporal lobe expression of the total phospho-Akt pathway and downstream target proteins using multiplex bead-based enzyme-linked immunosorbent assays (ELISAs) and duplex ELISAs.

RESULTS

Ethanol inhibited spatial learning and reduced brain weight, insulin signaling through Akt, and the expression of ASPH when standard casein was provided as the protein source. The substitution of soy isolate for casein largely abrogated the adverse effects of chronic ethanol feeding. In contrast, Notch signaling protein expression was minimally altered by ethanol or soy isolate.

CONCLUSIONS

These novel findings suggest that the insulin sensitizer properties of soy isolate may prevent some of the adverse effects that chronic ethanol exposure has on neurobehavioral function and insulin-regulated metabolic pathways in adolescent brains.

A coordinate-based meta-analysis of white matter alterations in patients with alcohol use disorder

INTRODUCTION

Besides the commonly described gray matter (GM) deficits, there is growing evidence of significant white matter (WM) alterations in patients with alcohol use disorder (AUD). WM changes can be assessed using volumetric and diffusive magnetic resonance imaging methods, such as voxel-based morphometry (VBM) and diffusion tensor imaging (DTI). The aim of the present meta-analysis is to investigate the spatial convergence of the reported findings on WM alterations in AUD.

METHODS

Systematic literature search on PubMed and further databases revealed 18 studies eligible for inclusion, entailing a total of 462 AUD patients and 416 healthy controls (up to January 18, 2021). All studies that had used either VBM or DTI whole-brain analyzing methods and reported results as peak-coordinates in standard reference space were considered for inclusion. We excluded studies using approaches non-concordant with recent guidelines for neuroimaging meta-analyses and studies investigating patient groups with Korsakoff syndrome or other comorbid substance use disorders (except tobacco).

RESULTS

Anatomical likelihood estimation (ALE) revealed four significant clusters of convergent macro- and microstructural WM alterations in AUD patients that were assigned to the genu and body of the corpus callosum, anterior and posterior cingulum, fornix, and the right posterior limb of the internal capsule.

DISCUSSION

The changes in WM could to some extent explain the deteriorations in motor, cognitive, affective, and perceptual functions seen in AUD. Future studies are needed to clarify how WM alterations vary over the course of the disorder and to what extent they are reversible with prolonged abstinence.

Alcohol and Brain Development in Adolescents and Young Adults: A Systematic Review of the Literature and Advisory Report of the Health Council of the Netherlands

Young people, whose brains are still developing, might entail a greater vulnerability to the effects of alcohol consumption on brain function and development. A committee of experts of the Health Council of the Netherlands evaluated the state of scientific knowledge regarding the question whether alcohol negatively influences brain development in young people. A systematic literature search for prospective studies was performed in PubMed and PsychINFO, for longitudinal studies of adolescents or young adults ranging between 12 and 24 y of age at baseline, investigating the relation between alcohol use and outcome measures of brain structure and activity, cognitive functioning, educational achievement, or alcohol use disorder (AUD), with measures at baseline and follow-up of the outcome of interest. Data were extracted from original articles and study quality was assessed using the Newcastle-Ottawa Scale. A total of 77 studies were included, 31 of which were of sufficient quality in relation to the study objectives. There were indications that the gray matter of the brain develops abnormally in young people who drink alcohol. In addition, the more often young people drink or the younger they start, the higher the risk of developing AUD later in life. The evidence on white matter volume or quality, brain activity, cognitive function, and educational achievement is still limited or unclear. The committee found indications that alcohol consumption can have a negative effect on brain development in adolescents and young adults and entails a risk of later AUD. The committee therefore considers it a wise choice for adolescents and young adults not to drink alcohol.

Changes in the brain directly following alcohol consumption-a study of healthy male individuals, with the use of proton magnetic resonance spectroscopy (1HMRS) and diffusion (DWI)

AIMS

To use proton magnetic resonance spectroscopy (1HMRS) and diffusion weighted imaging (DWI) to identify ethanol in the brain directly after consumption, and examine changes in brain metabolite levels and brain microstructure relative to the duration of time following exposure to alcohol.

METHODS

The study involved 44 male volunteers (18-55 years). All brain changes were assessed in the frontal lobes, occipital lobes, basal ganglia and cerebellum, however the detailed analyses focused on the frontal lobes. All participants were examined four times, i.e. before and 0.5-hour, 1 hour and 2 hours after consumption of 150 mL pure vodka (60 g of ethanol).

RESULTS

The highest ethanol levels were identified between 0.5 and 1 hour following alcohol intake. There were significant increases in the concentrations of lipids and lactates approximately one hour after alcohol consumption, and the concentration levels were found to normalise during the following two hours. Some statistically insignificant trends of changes were found for tCr, tCho, mI, GABA, Glc, Glx and tNAA. For the DWI and ADC (Apparent Diffusion Coefficient of water) values, the findings showed statistically insignificant decrease and increase, followed by a tendency towards normalisation. Similar associations in changes of metabolite concentrations and DWI and ADC values were found in the other locations investigated in the study.

CONCLUSION

A single dose of alcohol as used in this experiment produces increases in lipids and lactates in brain tissues that appear reversible.

The associations of comorbid substance use disorders and psychiatric conditions with adolescent brain structure and function: A review

Adolescence is a period of rapid neural and behavioral development that often precipitates substance use, substance use disorders (SUDs), and other psychopathology. While externalizing disorders have been closely linked to SUD epidemiologically, the comorbidity of internalizing disorders and SUD is less well understood. Neuroimaging studies can be used to measure structural and functional developments in the brain that mediate the relationship between psychopathology and SUD in adolescence. Externalizing disorders and SUD are both associated with structural and functional changes in the basal ganglia and prefrontal cortex in adolescence. The neural mechanisms underlying internalizing disorders and SUD are less clear, but evidence points to involvement of the amygdala and prefrontal cortex. We also highlight independent contributions of SUD, which may vary in certain ways by the substances assessed. A deeper understanding of the neural basis of the relationship between psychopathology and SUD will allow for more informed interventions in this critical developmental stage.

Effects of Question Type and Order When Measuring Peak Consumption of Risky Drinking Events

AIMS

There is new interest in measuring alcohol consumption during risky drinking events, but there is little guidance on how to best ask such questions. In this study, we contrast two different types of questions on peak consumption over a single heavy drinking occasion. We used a general question that ask respondents to recall the total amount consumed (total consumption question), and location-specific questions that ask respondents to recall consumption in each drinking location (location-specific peak consumption, LSPC).

METHODS

Heavy drinkers (≥11 Australian Standard Drinks (ASD) per occasion for males, ≥8 for females) from the second wave of a prospective cohort study were recruited via landline random digit dial from Melbourne in 2012. Respondents were randomly assigned to surveys of different question order, and either first received total consumption (n = 127) or LSPC questions (n = 147). T-tests compared peak consumption between categories stratified by sex and consumption tercile.

RESULTS

Mean peak consumption was 12.5 ASD. Irrespective of question order, consumption amounts for total consumption and LSPC questions were not significantly different for both sexes. However, drinkers in the highest tercile asked LSPC questions first provided significantly higher consumption estimates in response to the total consumption question than in response to the LSPC questions.

CONCLUSION

At a population level, LSPC and total consumption questions produce similar estimates of peak consumption for risky drinking events. Except for heavy drinkers, general consumption questions may be sufficient when asking about these drinking events in consumption surveys, without the greater response burden of longer LSPC questions.

Adolescent substance use and functional connectivity between the ventral striatum and hippocampus

Neurodevelopmental explanations for adolescent substance use have focused on heightened sensitivity of mesolimbic circuitry, centered on the ventral striatum (VS). Recent evidence suggests that, relative to adults, adolescents show a stronger link between reinforcement learning and episodic memory for rewarding outcomes and greater functional connectivity between the VS and hippocampus, which may reflect a heightened reward modulation of memory. However, a link between VS-hippocampal circuitry and adolescent substance use has yet to be established. Two separate studies were conducted to evaluate whether variation in VS-hippocampal resting-state functional connectivity (rs-FC) predicts subsequent adolescent substance use exposure. A pilot study (Study 1) was conducted in 19 youth recruited from a high sociodemographic risk population (N = 19; mean age = 13.3 SD = 1.4; 14 females; 47% Black Non-Hispanic, 32% White Non-Hispanic). To replicate results of Study 1, Study 2 utilized data from the National Consortium on Adolescent Neurodevelopment and Alcohol (N = 644; mean age = 16.3 SD = 2.5; 339 females; 11% Black Non-Hispanic, 11% Hispanic/Latino, 66% White Non-Hispanic). Resting-state fMRI data were collected at a baseline time point and lifetime and past year self-reported substance use was collected at a follow up visit. Regression models tested whether baseline VS-hippocampal rs-FC predicted substance use exposure at follow up, as measured by an index score reflecting the number of substance classes (e.g., alcohol, marijuana) tried and overall frequency of use. Across both studies, higher VS-hippocampal rs-FC at baseline predicted greater substance use exposure at follow up (pFWE < 0.05). These data provide the first evidence linking increased VS-hippocampal connectivity with greater adolescent substance use exposure. Results fit with the emerging idea that variation in adolescent substance use may relate to not only individual differences in mesolimbic sensitivity to reward, but also to an individuals' memory sensitivity to reward as measured by connectivity between canonical memory and reward regions.

The effects of sub-anesthetic ketamine plus ethanol on behaviors and apoptosis in the prefrontal cortex and hippocampus of adolescent rats

Ketamine has become increasingly popular in adolescent drug abusers worldwide. Meanwhile, alcohol is usually used by ketamine users. However, little work has been conducted to examine the chronic combined effects of ketamine and ethanol on adolescent brain. Here we probed into the effects of chronic administration of ketamine at recreational doses alone or combined with ethanol on behaviors and neuron damage in an adolescent rat model. 28-day old rats were treated with either 20 or 30 mg/kg ketamine plus or not plus 10% ethanol daily for 21 days. Depressive like behaviors, anxiety like behavior and memory impairment were tested using open field test, forced swimming test, elevated plus maze and Morris water maze. Apoptosis in prefrontal cortex (PFC) and hippocampus (HIP) were determined by the TdT-mediated dUTP Nick-End Labeling (TUNEL) and protein and mRNA levels of caspase-3, Bax and Bcl-2. Results show that co-application of ketamine and ethanol significantly increased immobility time in the forced swimming test, up-regulated TUNEL positive cells and both protein and mRNA expressions of caspase-3 and Bax, compared with the control group and ketamine and ethanol use alone groups in the PFC, but not in the HIP. Our study suggests that chronic co-administration of ketamine and ethanol results in depressive-like behavior and the caspase-dependent apoptosis in the PFC of adolescent rats' brains.

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.

Impact of neuroimmune activation induced by alcohol or drug abuse on adolescent brain development

Evidence obtained in recent decades has demonstrated that the brain still matures in adolescence. Changes in neural connectivity occur in different regions, including cortical and subcortical structures, which undergo modifications in white and gray matter densities. These alterations concomitantly occur in some neurotransmitter systems and hormone secretion, which markedly influence the refinement of certain brain areas and neural circuits. The immaturity of the adolescent brain makes it more vulnerable to the effects of alcohol and drug abuse, whose use can trigger long-term behavioral dysfunction. This article reviews the action of alcohol and drug abuse (cannabis, cocaine, opioids, amphetamines, anabolic androgenic steroids) in the adolescent brain, and their impact on both cognition and behavioral dysfunction, including predisposition to drug abuse in later life. It also discusses recent evidence that indicates the role of the neuroimmune system response and neuroinflammation as mechanisms that participate in many actions of ethanol and drug abuse in adolescence, including the neurotoxicity and alterations in neurocircuitry that contribute to the dysfunctional behaviors associated with addiction. The new data suggest the therapeutic potential of anti-inflammatory targets to prevent the long-term consequences of drug abuse in adolescence.

Application of Research Domain Criteria to childhood and adolescent impulsive and addictive disorders: Implications for treatment

The Research Domain Criteria (RDoC) initiative provides a large-scale, dimensional framework for the integration of research findings across traditional diagnoses, with the long-term aim of improving existing psychiatric treatments. A neurodevelopmental perspective is essential to this endeavor. However, few papers synthesizing research findings across childhood and adolescent disorders exist. Here, we discuss how the RDoC framework may be applied to the study of childhood and adolescent impulsive and addictive disorders in order to improve neurodevelopmental understanding and to enhance treatment development. Given the large scope of RDoC, we focus on a single construct highly relevant to addictive and impulsive disorders - initial responsiveness to reward attainment. Findings from genetic, molecular, neuroimaging and other translational research methodologies are highlighted.

Adolescent brain cognitive development (ABCD) study: Overview of substance use assessment methods

One of the objectives of the Adolescent Brain Cognitive Development (ABCD) Study (https://abcdstudy.org/) is to establish a national longitudinal cohort of 9 and 10 year olds that will be followed for 10 years in order to prospectively study the risk and protective factors influencing substance use and its consequences, examine the impact of substance use on neurocognitive, health and psychosocial outcomes, and to understand the relationship between substance use and psychopathology. This article provides an overview of the ABCD Study Substance Use Workgroup, provides the goals for the workgroup, rationale for the substance use battery, and includes details on the substance use module methods and measurement tools used during baseline, 6-month and 1-year follow-up assessment time-points. Prospective, longitudinal assessment of these substance use domains over a period of ten years in a nationwide sample of youth presents an unprecedented opportunity to further understand the timing and interactive relationships between substance use and neurocognitive, health, and psychopathology outcomes in youth living in the United States.

A neurodevelopment and neuroplasticity-based framework for early intervention in psychotic disorders

In recent years there has been growing interest in early intervention in psychotic disorders and a number of clinical and research programmes have been developed. The clinical staging model has been an essential part of early intervention as it provides the rationale of existing programmes. In medicine, clinical staging is a valuable approach in disorders where primary pathology is progressive in nature. However, the clinical staging model of psychosis has been proposed without establishing first that schizophrenia is a primarily progressive disorder. In reviewing existing evidence, this current paper argues that cross-sectional data interpreted as supportive of clinical staging data does not consider the effects of sampling bias, problems in reliability in assessing 'soft symptoms', or false positives. Longitudinal neurobiological studies do not provide a convincing case for primarily progressive pathology in schizophrenia. Clinical progression in schizophrenia can be better conceptualised as neuroplastic changes in response to interaction between core developmental pathology and environmental stimuli. An alternative rationale for early and continuous intervention targeting neurodevelopmental abnormality and neuroplastic changes, as well as medical and psychological comorbidities, is proposed in this paper.

Role of the innate immune system in the neuropathological consequences induced by adolescent binge drinking

Adolescence is a critical stage of brain maturation in which important plastic and dynamic processes take place in different brain regions, leading to development of the adult brain. Ethanol drinking in adolescence disrupts brain plasticity and causes structural and functional changes in immature brain areas (prefrontal cortex, limbic system) that result in cognitive and behavioral deficits. These changes, along with secretion of sexual and stress-related hormones in adolescence, may impact self-control, decision making, and risk-taking behaviors that contribute to anxiety and initiation of alcohol consumption. New data support the participation of the neuroimmune system in the effects of ethanol on the developing and adult brain. This article reviews the potential pathological bases that underlie the effects of alcohol on the adolescent brain, such as the contribution of genetic background, the perturbation of epigenetic programming, and the influence of the neuroimmune response. Special emphasis is given to the actions of ethanol in the innate immune receptor toll-like receptor 4 (TLR4), since recent studies have demonstrated that by activating the inflammatory TLR4/NFκB signaling response in glial cells, binge drinking of ethanol triggers the release of cytokines/chemokines and free radicals, which exacerbate the immune response that causes neuroinflammation/neural damage as well as short- and long-term neurophysiological, cognitive, and behavioral dysfunction. Finally, potential treatments that target the neuroimmune response to treat the neuropathological and behavioral consequences of adolescent alcohol abuse are discussed.

Ethanol-Induced White Matter Atrophy Is Associated with Impaired Expression of Aspartyl-Asparaginyl-β-Hydroxylase (ASPH) and Notch Signaling in an Experimental Rat Model

Alcohol-induced white matter (WM) degeneration is linked to cognitive-motor deficits and impairs insulin/insulin-like growth factor (IGF) and Notch networks regulating oligodendrocyte function. Ethanol downregulates Aspartyl-Asparaginyl-β-Hydroxylase (ASPH) which drives Notch. These experiments determined if alcohol-related WM degeneration was linked to inhibition of ASPH and Notch. Adult Long Evans rats were fed for 3, 6 or 8 weeks with liquid diets containing 26% ethanol (caloric) and in the last two weeks prior to each endpoint they were binged with 2 g/kg ethanol, 3×/week. Controls were studied in parallel. Histological sections of the frontal lobe and cerebellar vermis were used for image analysis. Frontal WM proteins were used for Western blotting and duplex ELISAs. The ethanol exposures caused progressive reductions in frontal and cerebellar WM. Ethanol-mediated frontal WM atrophy was associated with reduced expression of ASPH, Jagged 1, HES-1, and HIF-1α. These findings link ethanol-induced WM atrophy to inhibition of ASPH expression and signaling through Notch networks, including HIF-1α.

The age of onset of substance use is related to the coping strategies to deal with treatment in men with substance use disorder

BACKGROUND

The age of onset of substance use (OSU) as well as the coping strategies (CS) influence both the development and the course of Substance Use Disorders (SUD). We aim to examine the differences in the CS applied to deal with treatment in men with SUD, considering whether the age of OSU had begun at age 16 or earlier (OSU ≤ 16) or at 17 years or later (OSU ≥ 17), as well as the associations of the CS with clinical variables were studied.

METHODS

A total of 122 patients with at least three months of abstinence, 60 with OSU≤16 and 62 with OSU≥17, were evaluated through the Coping Strategies Inventory and clinical assessment tools.

RESULTS

The OSU≤16 patients were younger and presented a worse clinical state. Compared to the norms, the SUD patients were less likely to use adaptive CS, although this was more remarkable for the OSU≤16 group. Furthermore, the OSU≤16 patients presented a CS pattern of higher Disengagement, with lesser use of Social Support and higher Problem Avoidance and Social Withdrawal. In the whole SUD sample, the severity of addiction, number of relapses and age of OSU (as a continuous variable) were related to maladaptive coping. Nevertheless, the cut-off age of OSU modulated these results.

CONCLUSIONS

The OSU≤16 was a risk factor for presenting greater clinical severity and a more dysfunctional CS profile to deal with treatment. Thus, the cut-off age considered has allowed us to differentiate SUD patients with more vulnerability to present worse clinical prognosis who may require specific prevention and rehabilitation strategies discussed throughout this work.

Specificity of executive functioning and processing speed problems in common psychopathology

OBJECTIVE

Interest continues in neuropsychological measures as cross-disorder intermediate phenotypes in understanding psychopathology. A central question concerns their specificity versus generalizability to particular forms of psychopathology, particularly for executive functioning (EF) and response speed. Three conceptual models examining these relationships were tested to clarify this picture at different levels in the diagnostic hierarchy.

METHOD

Participants (total n = 641, age 18-60) yielded complete structured diagnostic interviews and a neuropsychological test battery comprising measures of executive function, processing speed, and IQ. Repeated measures multivariate analysis of variance, linear regression, and structural equation modeling (SEM) were used to test (a) a specificity model, which proposes that individual disorders are associated with component EF processes and speed; (b) a severity model, which proposes that the total number of comorbid disorders explain poor EF and/or slow speed; and (c) a higher-order dimensional model, which proposes that internalizing versus externalizing disorders are differentially related to EF or speed.

RESULTS

EF effects were best explained by a specificity model, with distinct aspects of EF related to attention deficit hyperactivity disorder versus antisocial substance use disorders. Speed, on the other hand, emerged as a general indicator of externalizing psychopathology in the dimensional model, as well as overall severity of psychopathology in the severity model.

CONCLUSIONS

Granular approaches are likely to be most productive for linking EF to psychopathology, whereas response speed has underused potential as an endophenotype for psychopathology liability. Results are discussed in terms of an integrated conceptualization of neuropsychological processes and putative neural systems involved in general and specific aspects of psychopathology. (PsycINFO Database Record

Global white matter microstructural abnormalities associated with addiction liability score in drug naïve youth

Abnormalities in brain white matter (WM) structure have been reported in youths having a family history of substance use disorders (SUDs). It was hypothesized that these abnormalities constitute features of the liability for SUDs transmitted across generations. The association between severity of intergenerational risk for SUD, measured by the Transmissible Liability Index (TLI), and white matter microstructure was examined. Diffusion tensor imaging (DTI) measured WM microstructure in forty-four drug-naïve 10-14 year-olds (N = 19 with parental SUD). Metrics of WM microstructure (i.e., fractional anisotropy, radial diffusivity, mean diffusivity and axial diffusivity) were quantified across the whole brain and in four tracts of interest: anterior corona radiata, superior and inferior longitudinal fasciculi and superior fronto-occipital fasciculi. The TLI was completed by the youths, their parents and, when available, their teachers. The relationship between WM structure and TLI score across the entire group was evaluated using linear multiple regression and between group comparisons were also examined. Fractional anisotropy and radial diffusivity in multiple tracts across the brain were significantly associated with TLI scores. Confirming and extending prior research, the findings indicate that global atypicality in WM tracts was linearly related to liability for eventual SUD development in drug naïve youths.

Marijuana Use Is Associated with Behavioral Approach and Depressive Symptoms in Adolescents and Emerging Adults

BACKGROUND

Repeated CB1 binding due to THC results in downregulation of the endocannabinoid system in cortex and limbic regions, perhaps disrupting frontolimbic functioning. This is particularly a concern in young adults who are still undergoing neurodevelopment in frontal and limbic regions. Such disruptions may be linked to increased depressive symptoms, anxiety symptoms, and executive dysfunction, and decreased behavioral approach.

OBJECTIVES

Here we examine the influence of young adult marijuana use on anxiety, depressive symptoms, behavioral approach, and executive dysfunction. The influence of alcohol and gender were also assessed.

METHODS

84 participants (42 MJ, 42 controls) aged 18-25 were balanced for gender (39 F). Exclusion criteria included: MRI contraindications, left handed, comorbid Axis-I disorders, major medical or neurologic disorders, prenatal issues, or prenatal alcohol/illicit drug exposure, or excessive other drug use. Participants completed the FrsBE, BIS/BAS, State-Trait Anxiety Inventory (State), and BDI-II. Multiple regressions were run to predict anxiety, depressive symptoms, behavioral approach, and executive dysfunction from MJ group status, past year alcohol use, gender, and MJ*gender interactions, controlling for cotinine and ecstasy.

RESULTS

MJ group predicted increased depressive symptoms (p =.049). Decreased fun-seeking (p =.04), reward response (p =.01), and BAS total (p =.01) were predicted by MJ group. Gender predicted decreased reward responsiveness in females (p =.049) and decreased BIS in females (p =.03). Female marijuana users had increased anxiety symptoms (p =.04) and increased disinhibition (p =.04). Increased cotinine predicted increased drive (p =.046), reward responsiveness (p =.008) and BAS Total (p =.02). Apathy and Executive Dysfunction were not predicted by any measures. All results had small effect sizes.

CONCLUSIONS/IMPORTANCE

Depressive symptoms were greater in MJ users, while behavioral approach was decreased. Cotinine levels predicted increased behavioral approach. Female MJ users also had greater anxiety and disinhibition. In sum, these findings suggest sub-clinical threshold deficits related to regular marijuana use that are indicative of a need to prevent marijuana use in adolescents and young adults.

Neurobiological signatures associated with alcohol and drug use in the human adolescent brain

Magnetic resonance (MR) techniques provide opportunities to non-invasively characterize neurobiological milestones of adolescent brain development. Juxtaposed to the critical finalization of brain development is initiation of alcohol and substance use, and increased frequency and quantity of use, patterns that can lead to abuse and addiction. This review provides a comprehensive overview of existing MR studies of adolescent alcohol and drug users. The most common alterations reported across substance used and MR modalities are in the frontal lobe (63% of published studies). This is not surprising, given that this is the last region to reach neurobiological adulthood. Comparatively, evidence is less consistent regarding alterations in regions that mature earlier (e.g., amygdala, hippocampus), however newer techniques now permit investigations beyond regional approaches that are uncovering network-level vulnerabilities. Regardless of whether neurobiological signatures exist prior to the initiation of use, this body of work provides important direction for ongoing prospective investigations of adolescent brain development, and the significant impact of alcohol and substance use on the brain during the second decade of life.

Learning and Memory Performance After Withdrawal of Agent Abuse: A Review

Context

Agent abuse is a dire predicament worldwide. Learning and memory deficits stemming from the withdrawal of such agents is an increasingly burning issue for researchers.

Evidence Acquisition

The present review revisits the literature generated by far pertaining to the research on memory and cognition deficiencies after withdrawal of agent abuse and corresponding mechanisms.

Results

Deficiency on spatial memory, episodic memory and working memory are common after withdrawal of agent abuse.

Conclusions

The present review suggests that memory dysfunction may result from withdrawal of agent abuse.

Harmonizing DTI measurements across scanners to examine the development of white matter microstructure in 803 adolescents of the NCANDA study

Neurodevelopment continues through adolescence, with notable maturation of white matter tracts comprising regional fiber systems progressing at different rates. To identify factors that could contribute to regional differences in white matter microstructure development, large samples of youth spanning adolescence to young adulthood are essential to parse these factors. Recruitment of adequate samples generally relies on multi-site consortia but comes with the challenge of merging data acquired on different platforms. In the current study, diffusion tensor imaging (DTI) data were acquired on GE and Siemens systems through the National Consortium on Alcohol and NeuroDevelopment in Adolescence (NCANDA), a multi-site study designed to track the trajectories of regional brain development during a time of high risk for initiating alcohol consumption. This cross-sectional analysis reports baseline Tract-Based Spatial Statistic (TBSS) of regional fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (L1), and radial diffusivity (LT) from the five consortium sites on 671 adolescents who met no/low alcohol or drug consumption criteria and 132 adolescents with a history of exceeding consumption criteria. Harmonization of DTI metrics across manufacturers entailed the use of human-phantom data, acquired multiple times on each of three non-NCANDA participants at each site's MR system, to determine a manufacturer-specific correction factor. Application of the correction factor derived from human phantom data measured on MR systems from different manufacturers reduced the standard deviation of the DTI metrics for FA by almost a half, enabling harmonization of data that would have otherwise carried systematic error. Permutation testing supported the hypothesis of higher FA and lower diffusivity measures in older adolescents and indicated that, overall, the FA, MD, and L1 of the boys were higher than those of the girls, suggesting continued microstructural development notable in the boys. The contribution of demographic and clinical differences to DTI metrics was assessed with General Additive Models (GAM) testing for age, sex, and ethnicity differences in regional skeleton mean values. The results supported the primary study hypothesis that FA skeleton mean values in the no/low-drinking group were highest at different ages. When differences in intracranial volume were covaried, FA skeleton mean reached a maximum at younger ages in girls than boys and varied in magnitude with ethnicity. Our results, however, did not support the hypothesis that youth who exceeded exposure criteria would have lower FA or higher diffusivity measures than the no/low-drinking group; detecting the effects of excessive alcohol consumption during adolescence on DTI metrics may require longitudinal study.

Introduction to the special issue: Substance use and the adolescent brain: Developmental impacts, interventions, and longitudinal outcomes

Adolescent substance abuse is a major public health problem, particularly given the negative brain and behavioral consequences that often occur during and following acute intoxication. Negative outcomes appear to be especially pronounced when substance use is initiated in the early adolescent years, perhaps due to neural adaptations that increase risk for substance use disorders into adulthood. Recent models to explain these epidemiological trends have focused on brain-based vulnerabilities to use as well as neurodevelopmental aberrations associated with initiation of use in substance naïve samples or through the description of case-control differences between heavy users and controls. Within this research, adolescent alcohol and marijuana users have shown relative decreases in regional gray matter volumes, substance-specific alterations in white matter volumes, deviations in microstructural integrity in white matter tracts that regulate communication between subcortical areas and higher level regulatory control regions, and deficits in functional connectivity. How these brain anomalies map onto other types of youth risk behavior and later vulnerabilities represent major questions for continued research. This special issue addresses these compelling and timely questions by introducing new methodologies, empirical relationships, and perspectives from major leaders in this field.

Endoplasmic Reticulum Stress and Ethanol Neurotoxicity

Ethanol abuse affects virtually all organ systems and the central nervous system (CNS) is particularly vulnerable to excessive ethanol exposure. Ethanol exposure causes profound damages to both the adult and developing brain. Prenatal ethanol exposure induces fetal alcohol spectrum disorders (FASD) which is associated with mental retardation and other behavioral deficits. A number of potential mechanisms have been proposed for ethanol-induced brain damage; these include the promotion of neuroinflammation, interference with signaling by neurotrophic factors, induction of oxidative stress, modulation of retinoid acid signaling, and thiamine deficiency. The endoplasmic reticulum (ER) regulates posttranslational protein processing and transport. The accumulation of unfolded or misfolded proteins in the ER lumen triggers ER stress and induces unfolded protein response (UPR) which are mediated by three transmembrane ER signaling proteins: pancreatic endoplasmic reticulum kinase (PERK), inositol-requiring enzyme 1 (IRE1), and activating transcription factor 6 (ATF6). UPR is initiated to protect cells from overwhelming ER protein loading. However, sustained ER stress may result in cell death. ER stress has been implied in various CNS injuries, including brain ischemia, traumatic brain injury, and aging-associated neurodegeneration, such as Alzheimer's disease (AD), Huntington's disease (HD), Amyotrophic lateral sclerosis (ALS), and Parkinson's disease (PD). However, effects of ethanol on ER stress in the CNS receive less attention. In this review, we discuss recent progress in the study of ER stress in ethanol-induced neurotoxicity. We also examine the potential mechanisms underlying ethanol-mediated ER stress and the interaction among ER stress, oxidative stress and autophagy in the context of ethanol neurotoxicity.

Differential Contributions of Alcohol and Nicotine-Derived Nitrosamine Ketone (NNK) to White Matter Pathology in the Adolescent Rat Brain

AIM

Epidemiologic studies have demonstrated high rates of smoking among alcoholics, and neuroimaging studies have detected white matter atrophy and degeneration in both smokers and individuals with alcohol-related brain disease (ARBD). These findings suggest that tobacco smoke exposure may be a co-factor in ARBD. The present study examines the differential and additive effects of tobacco-specific nitrosamine (NNK) and ethanol exposures on the structural and functional integrity of white matter in an experimental model.

METHODS

Adolescent Long Evans rats were fed liquid diets containing 0 or 26% ethanol for 8 weeks. In weeks 3-8, rats were treated with nicotine-derived nitrosamine ketone (NNK) (2 mg/kg, 3×/week) or saline by i.p. injection. In weeks 7-8, the ethanol group was binge-administered ethanol (2 g/kg; 3×/week).

RESULTS

Ethanol, NNK and ethanol + NNK caused striking degenerative abnormalities in white matter myelin and axons, with accompanying reductions in myelin-associated glycoprotein expression. Quantitative RT-PCR targeted array and heatmap analyses demonstrated that ethanol modestly increased, whereas ethanol + NNK sharply increased expression of immature and mature oligodendroglial genes, and that NNK increased immature but inhibited mature oligodendroglial genes. In addition, NNK modulated expression of neuroglial genes in favor of growth cone collapse and synaptic disconnection. Ethanol- and NNK-associated increases in FOXO1, FOXO4 and NKX2-2 transcription factor gene expression could reflect compensatory responses to brain insulin resistance in this model.

CONCLUSION

Alcohol and tobacco exposures promote ARBD by impairing myelin synthesis, maturation and integrity via distinct but overlapping mechanisms. Public health measures to reduce ARBD should target both alcohol and tobacco abuses.

Neuropsychological Performance in Polyconsumer Men Under Treatment. Influence of Age of Onset of Substance Use

Neurocognition is a key factor in the development and maintenance of Substance Use Disorders (SUD). However, there are still several aspects that need to be studied in this area. In this study, we elucidate the influence of age of onset of substance use (OSU) on the clinical course and neuropsychological performance of substance use disorder (SUD) patients, as well as to explore the influence of years of education, duration of drug use and premorbid intelligence quotient (IQ) on the cognitive results obtained. An exhaustive neuropsychological battery was used to assess different cognitive domains in 80 male polyconsumers, 41 with earlier OSU (16 years or before: OSU ≤ 16) and 39 with later OSU (17 years or later: OSU ≥ 17). The patients were under treatment with at least 4 months of abstinence confirmed by urinalysis. The OSU ≤ 16 group presented a worse clinical state, as well as a lower premorbid IQ and worse performance in processing speed, visual perception and planning skills. The duration of drug use may account for the differences in planning and processing speed. In this work we discuss the premorbid or acquired nature of the cognitive deficits found.

Alcohol confounds relationship between cannabis misuse and psychosis conversion in a high-risk sample

OBJECTIVE

Cannabis use has been examined as a predictor of psychosis in clinical high-risk (CHR) samples, but little is known about the impact of other substances on this relationship.

METHOD

Substance use was assessed in a large sample of CHR participants (N = 370, mean age = 18.3) enrolled in the multisite North American Prodrome Longitudinal Study Phase 1 project. Three hundred and forty-one participants with cannabis use data were divided into groups: No Use (NU, N = 211); Cannabis Use without impairment (CU, N = 63); Cannabis Abuse/Dependence (CA/CD, N = 67). Participants (N = 283) were followed for ≥2 years to determine psychosis conversion.

RESULTS

Alcohol (45.3%) and cannabis (38.1%) were the most common substances. Cannabis use groups did not differ on baseline attenuated positive symptoms. Seventy-nine of 283 participants with cannabis and follow-up data converted to psychosis. Survival analysis revealed significant differences between conversion rates in the CA/CD group compared with the No Use (P = 0.031) and CU group (P = 0.027). CA/CD also significantly predicted psychosis in a regression analysis, but adjusting for alcohol use weakened this relationship.

CONCLUSION

The cannabis misuse and psychosis association was confounded by alcohol use. Non-impairing cannabis use was not related to psychosis. Results highlight the need to control for other substance use, so as to not overstate the cannabis/psychosis connection.

Ethanol intake-induced apoptosis in glial cells and axonal disorders in the cerebellar white matter of UChA rats (voluntary ethanol consumers)

Ethanol intake may cause alterations in cellular metabolism altering motricity, learning and cognition. The cerebellum is one of the most susceptible organs to ethanol-related disorders during development, and is associated with oxidative stress-induced apoptosis being crucial for pathogenic consequences. The UChA variety is a special strain of Wistar rat genetically selected and represents a rare model for the studies related to genetic, biochemical, physiological, nutritional, and pharmacological effects of ethanol. We evaluated the structure and apoptosis in the cerebellar white matter of UChA rats. There were two groups of 09 rats: a control group that did not consume ethanol, and an experimental group of UChA rats that consumed ethanol at 10% (v/v) (<2 g ethanol/kg body weight/day). At 120 days old, rats were anaesthetized followed by decapitation, and their cerebella were collected and fixed. Cerebellar sections were subjected to immunohistochemistry for Caspase-3 and XIAP and transmission electron microscopy (TEM). The UChA group showed more glial cells immunoreactive for caspase-3 and less for XIAP than control group. Alcohol consumption affected myelin integrity. Severe ultrastructural damages in UChA group were observed such as disruption of the myelin sheath, disorganization and deformation of its components, and an increase in the interaxonal spaces. In conclusion, our data demonstrated that ethanol induced apoptosis in the glial cells and promoted an intense change in the myelin sheath of UChA rats, which may cause functional disorders.

TLR4 elimination prevents synaptic and myelin alterations and long-term cognitive dysfunctions in adolescent mice with intermittent ethanol treatment

The adolescent brain undergoes important dynamic and plastic cell changes, including overproduction of axons and synapses, followed by rapid pruning along with ongoing axon myelination. These developmental changes make the adolescent brain particularly vulnerable to neurotoxic and behavioral effects of alcohol. Although the mechanisms of these effects are largely unknown, we demonstrated that ethanol by activating innate immune receptors toll-like receptor 4 (TLR4), induces neuroinflammation and brain damage in adult mice. The present study aims to evaluate whether intermittent ethanol treatment in adolescence promotes TLR4-dependent pro-inflammatory processes, leading to myelin and synaptic dysfunctions, and long-term cognitive impairments. Using wild-type (WT) and TLR4-deficient (TLR4-KO) adolescent mice treated intermittently with ethanol (3.0g/kg) for 2weeks, we show that binge-like ethanol treatment activates TLR4 signaling pathways (MAPK, NFκB) leading to the up-regulation of cytokines and pro-inflammatory mediators (COX-2, iNOS, HMGB1), impairing synaptic and myelin protein levels and causing ultrastructural alterations. These changes were associated with long-lasting cognitive dysfunctions in young adult mice, as demonstrated with the object recognition, passive avoidance and olfactory behavior tests. Notably, elimination of TLR4 receptors prevented neuroinflammation along with synaptic and myelin derangements, as well as long-term cognitive alterations. These results support the role of the neuroimmune response and TLR4 signaling in the neurotoxic and behavioral effects of ethanol in adolescence.

Acetaldehyde, not ethanol, impairs myelin formation and viability in primary mouse oligodendrocytes

BACKGROUND

Excessive ethanol (EtOH) drinking is associated with white matter loss in the brain at all stages of life. Myelin-forming oligodendrocytes (OLs) are a major component of white matter, but their involvement in EtOH-mediated white matter loss is unclear. Myelination continues throughout the life with highest rates during fetal development and adolescence. However, little is known about the effects of EtOH and its principal metabolite acetaldehyde (ACD) on OLs at the cellular level.

METHODS

We compared the responses to different concentrations of EtOH or ACD by primary OLs in culture.

RESULTS

EtOH did not cause significant cell death at concentrations lower than 120 mM, even after 24 hours. In comparison, ACD was highly lethal at doses above 50 μM. High concentrations of EtOH (120 mM) and ACD (500 μM) for 24 hours did not reduce myelin in mature OLs. Myelin production and OL differentiation were significantly impaired by 7 days exposure to 500 or 50 μM ACD but not 120 mM EtOH.

CONCLUSIONS

This study shows that OLs are relatively resistant to EtOH, even at a concentration more than 4 times the typical blood EtOH concentrations associated with social drinking (10 to 30 mM). In contrast, OLs are much more sensitive to ACD than EtOH, particularly with long-term exposure. This suggests that part of white matter loss in response to EtOH, especially during high rates of myelin formation, may be due in part to the effects of its principal metabolite ACD.

Neurodevelopmental origin of cognitive impairment in schizophrenia

Cognitive impairment is a common feature of schizophrenia; however, its origin remains controversial. Neurodevelopmental abnormalities clearly play a role in pre-morbid cognitive dysfunction in schizophrenia, yet many authors believe that schizophrenia is characterized by illness-related cognitive decline before and after onset of the psychosis that can be the result of neurodegenerative changes. The main reasons behinds such arguments include, first, the evidence showing that effect sizes of the cognitive deficits in subjects who develop adult schizophrenia gradually increase in the first two decades of life and, second, the fact that there is functional decline in many patients with schizophrenia over the years. In this Editorial, I argue that current evidence suggests that illness-related cognitive impairment is neurodevelopmental in origin and characterized by slower gain (developmental lag) but not cognitive decline continuing throughout the first two decades of life. I introduce a model suggesting that neurodevelopmental abnormality can in fact explain the course of cognitive dysfunction and variations in the trajectory of functional decline throughout the life in individuals with schizophrenia. In this model, the severity of underlying neurodevelopmental abnormality determines the age that cognitive deficits first become apparent and contributes to the cognitive reserve of the individual. Interaction of neurodevelopmental abnormality with clinical symptoms, especially negative symptoms and aging, vascular changes, psychological and iatrogenic factors contributes to the heterogeneity of the functional trajectory observed in this disorder.

Effects of alcohol use initiation on brain structure in typically developing adolescents

BACKGROUND

Alcohol use in excessive quantities has deleterious effects on brain structure and behavior in adults and during periods of rapid neurodevelopment, such as prenatally. Whether similar outcomes characterize other developmental periods, such as adolescence, and in the context of less extensive use is unknown. Recent cross-sectional studies suggest that binge drinking as well as alcohol use disorders in adolescence are associated with disruptions in white matter microstructure and gray matter volumes.

OBJECTIVES

The current study followed typically developing adolescents from a baseline assessment, where no experience with alcohol was present, through two years, after which some individuals transitioned into regular use.

METHODS

Participants (n = 55) completed MRI scans and behavioral assessments.

RESULTS

Alcohol initiators (n = 30; mean baseline age 16.7 ± 1.3 years), compared to non-users (n = 25; mean baseline age 17.1 ± 1.2 years), showed altered patterns of neurodevelopment. They showed greater-than-expected decreases in cortical thickness in the right middle frontal gyrus from baseline to follow-up as well as blunted development of white matter in the right hemisphere precentral gyrus, lingual gyrus, middle temporal gyrus and anterior cingulate. Diffusion tensor imaging revealed a relative decrease over time in fractional anisotropy in the left caudate/thalamic region as well as in the right inferior frontal occipital fasciculus. Alcohol initiators did not differ from non-users at the baseline assessment; the groups were largely similar in other premorbid characteristics.

CONCLUSIONS

Subclinical alcohol use during mid-to-late adolescence is associated with deviations in neurodevelopment across several brain tissue classes. Implications for continued development and behavior are discussed.

Insula white matter volume linked to binge drinking frequency through enhancement motives in treated adolescents

BACKGROUND

Given the insula's role in the representation of bodily states associated with hedonic (i.e., enhancement motives) and aversive (i.e., craving) aspects of substance use, this longitudinal study examined associations between insula structure (i.e., white matter [WM] and gray matter [GM] volume), enhancement motives for alcohol and cannabis use, craving for alcohol and marijuana, and alcohol and cannabis involvement in treated adolescents. Enhancement motives and craving, as conscious representations of bodily states associated with use, were hypothesized as mediators (i.e., linking mechanisms) of the association between insula volume and substance use.

METHODS

Adolescents (age 14 to 18, N = 30) recruited from substance use treatment reported on enhancement motives and obsession/craving for both alcohol and cannabis at baseline (near the start of treatment), and on alcohol and cannabis involvement (e.g., binge drinking, alcohol abuse/dependence symptom count) at baseline and over 1-year follow-up. Insula WM and GM volumes were determined using FreeSurfer.

RESULTS

Enhancement motives for drinking served as a link between left insula WM volume and frequency of binge drinking at baseline and 1-year follow-up. This novel finding is consistent with the insula's role in representing bodily states (e.g., "high" associated with binge drinking) that can motivate drinking behavior. Although right insula WM volume was positively correlated with obsession/craving for alcohol, and obsession/craving was positively correlated with alcohol outcomes, the indirect effect was not significant. Insula WM volume was not associated with cannabis-related variables. Insula GM volume was not associated with enhancement motives, obsession/craving, or alcohol involvement.

CONCLUSIONS

Enhancement motives for alcohol use, but not obsession/craving for alcohol, provided an important link between left insula WM volume and frequency of binge drinking in treated adolescents. Results are consistent with the insula's role in the processing of hedonic bodily states available to conscious awareness, particularly in the form of enhancement motives for alcohol use.

Executive functioning in alcoholics following an mHealth cognitive stimulation program: randomized controlled trial

Background

The consequences of alcohol dependence are severe and may range from physical disease to neuropsychological deficits in several cognitive domains. Alcohol abuse has also been related to brain dysfunction specifically in the prefrontal cortex. Conventional neuropsychological interventions (paper-and-pencil cognitive stimulation training) have a positive effect but are time-consuming, costly, and not motivating for patients.

Objective

Our goal was to test the cognitive effects of a novel approach to neuropsychological intervention, using mobile technology and serious games, on patients with alcohol dependence.

Methods

The trial design consisted of a two-arm study assessing the cognitive outcomes of neuropsychological intervention with mobile serious games (mHealth) versus control (treatment-as-usual with no neuropsychological intervention) in patients undergoing treatment for alcohol dependence syndrome. Sixty-eight patients were recruited from an alcohol-rehab clinic and randomly assigned to the mHealth (n=33) or control condition (n=35). The intervention on the experimental group consisted of a therapist-assisted cognitive stimulation therapy for 4 weeks on a 2-3 days/week basis.

Results

Fourteen patients dropped out of the study. The results of the neuropsychological assessments with the remaining 54 patients showed an overall increase (P<.05) of general cognitive abilities, mental flexibility, psychomotor processing speed, and attentional ability in both experimental (n=26) and control groups (n=28). However, there was a more pronounced improvement (P=.01) specifically in frontal lobe functions from baseline (mean 13.89, SE 0.58) to follow-up (mean 15.50, SE 0.46) in the experimental group but not in the control group.

Conclusions

The overall increase in general cognitive function for both experimental and control groups supports the beneficial role of existing alcohol treatment protocols aimed at minimizing withdrawal symptoms, but the differential improvements observed in frontal lobe functioning supports the use of mobile serious games for neuropsychological stimulation to overcome executive dysfunction in patients with alcohol dependence. This trial was negative on two neuropsychological/cognitive tests, and positive on one.

Trial Registration

ClinicalTrials.gov NCT01942954; http://www.clinicaltrials.gov/ct2/show/NCT01942954 (Archived by WebCite at http://www.webcitation.org/6OYDqHLwB).

Effects of reward sensitivity and regional brain volumes on substance use initiation in adolescence

This longitudinal study examines associations between baseline individual differences and developmental changes in reward [i.e. behavioral approach system (BAS)] sensitivity and relevant brain structures' volumes to prospective substance use initiation during adolescence. A community sample of adolescents ages 15-18 with no prior substance use was assessed for substance use initiation (i.e. initiation of regular alcohol use and/or any use of other substances) during a 2-year follow-up period and for alcohol use frequency in the last year of the follow-up. Longitudinal 'increases' in BAS sensitivity were associated with substance use initiation and increased alcohol use frequency during the follow-up. Moreover, adolescents with smaller left nucleus accumbens at baseline were more likely to initiate substance use during the follow-up period. This study provides support for the link between developmental increases in reward sensitivity and substance use initiation in adolescence. The study also emphasizes the potential importance of individual differences in volumes of subcortical regions and their structural development for substance use initiation during adolescence.