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Yuan W, Chen M, Wang DW, Li QH, Yin YY, Li B, Wang HR, Hu J, Gong YD, Yuan TF, Yu TG. Computational markers of risky decision-making predict for relapse to alcohol. Eur Arch Psychiatry Clin Neurosci 2024; 274:353-362. [PMID: 37148307 DOI: 10.1007/s00406-023-01602-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 03/29/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Relapse remains the major challenge in treatment of alcohol use disorder (AUD). Aberrant decision-making has been found as important cognitive mechanism underlying relapse, but factors associated with relapse vulnerability are unclear. Here, we aim to identify potential computational markers of relapse vulnerability by investigating risky decision-making in individuals with AUD. METHODS Forty-six healthy controls and fifty-two individuals with AUD were recruited for this study. The risk-taking propensity of these subjects was investigated using the balloon analog risk task (BART). After completion of clinical treatment, all individuals with AUD were followed up and divided into a non-relapse AUD group and a relapse AUD group according to their drinking status. RESULTS The risk-taking propensity differed significantly among healthy controls, the non-relapse AUD group, and the relapse AUD group, and was negatively associated with the duration of abstinence in individuals with AUD. Logistic regression models showed that risk-taking propensity, as measured by the computational model, was a valid predictor of alcohol relapse, and higher risk-taking propensity was associated with greater risk of relapse to drink. CONCLUSION Our study presents new insights into risk-taking measurement and identifies computational markers that provide prospective information for relapse to drink in individuals with AUD.
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Affiliation(s)
- Wei Yuan
- Department of Addiction Medicine, Shandong Mental Health Center, Jinan, 250014, China
| | - Meng Chen
- Brain and Cognitive Neuroscience Research Center, Liaoning Normal University, Dalian, 116029, China
| | - Duan-Wei Wang
- Department of Addiction Medicine, Shandong Mental Health Center, Jinan, 250014, China
| | - Qian-Hui Li
- Division of Gastroenterology, Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, 518107, China
| | - Yuan-Yuan Yin
- School of Mental Health, Wenzhou Medical University, Wenzhou, 325035, China
| | - Bin Li
- Department of Addiction Medicine, Shandong Mental Health Center, Jinan, 250014, China
| | - Hai-Rong Wang
- Department of Addiction Medicine, Shandong Mental Health Center, Jinan, 250014, China
| | - Ji Hu
- School of Life Science and Technology, ShanghaiTech University, Shanghai, 201210, China
| | - Yuan-Dong Gong
- Department of Addiction Medicine, Shandong Mental Health Center, Jinan, 250014, China.
| | - Ti-Fei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China.
| | - Tian-Gui Yu
- Department of Addiction Medicine, Shandong Mental Health Center, Jinan, 250014, China.
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2
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Galkin SA, Bokhan NA. [Features of the reward-based decision-making in patients with alcohol use disorders]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:37-43. [PMID: 36843457 DOI: 10.17116/jnevro202312302137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Foreign studies increasingly emphasize the role of reward-based cognitive decision-making and its contribution to alcohol and drug abuse. Unfortunately, such studies are extremely few in Russia. Given the importance of the insufficiency of cognitive functions, primarily the decision-making process based on reward, among the risk factors of addictive pathology, increasing the severity of alcoholism, reducing the effectiveness of its therapy and rehabilitation, research in this direction is extremely relevant. This review summarizes and systematizes current data on the features of the cognitive decision-making process based on reward in patients with alcohol dependence. An analysis of the literature has shown that reward-based decision making is an important component of addictive behavior. Patients with alcohol dependence, as well as people, who abuse alcohol, demonstrate clear impairment of this cognitive function. Thus, the relative value of diagnosing disorders in decision-making in modern psychiatry is beyond doubt. It is recommended to include the above tests in the diagnostic complex of a psychiatrist, along with standard psychometric tools.
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Affiliation(s)
- S A Galkin
- Mental Health Research Institute - Tomsk National Research Medical Center Russian Academy of Science, Tomsk, Russia
| | - N A Bokhan
- Mental Health Research Institute - Tomsk National Research Medical Center Russian Academy of Science, Tomsk, Russia.,Siberian State Medical University, Tomsk, Russia
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3
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Sullivan EV, Zhao Q, Pohl KM, Zahr NM, Pfefferbaum A. Attenuated cerebral blood flow in frontolimbic and insular cortices in Alcohol Use Disorder: Relation to working memory. J Psychiatr Res 2021; 136:140-148. [PMID: 33592385 PMCID: PMC8009820 DOI: 10.1016/j.jpsychires.2021.01.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/12/2021] [Accepted: 01/29/2021] [Indexed: 12/25/2022]
Abstract
Chronic, excessive alcohol consumption is associated with cerebrovascular hypoperfusion, which has the potential to interfere with cognitive processes. Magnetic resonance pulsed continuous arterial spin labeling (PCASL) provides a noninvasive approach for measuring regional cerebral blood flow (CBF) and was used to study 24 men and women with Alcohol Use Disorder (AUD) and 20 age- and sex-matched controls. Two analysis approaches tested group differences: a data-driven, regionally-free method to test for group differences on a voxel-by-voxel basis and a region of interest (ROI) approach, which focused quantification on atlas-determined brain structures. Whole-brain, voxel-wise quantification identified low AUD-related cerebral perfusion in large volumes of medial frontal and cingulate cortices. The ROI analysis also identified lower CBF in the AUD group relative to the control group in medial frontal, anterior/middle cingulate, insular, and hippocampal/amygdala ROIs. Further, years of AUD diagnosis negatively correlated with temporal cortical CBF, and scores on an alcohol withdrawal scale negatively correlated with posterior cingulate and occipital gray matter CBF. Regional volume deficits did not account for AUD CBF deficits. Functional relevance of attenuated regional CBF in the AUD group emerged with positive correlations between episodic working memory test scores and anterior/middle cingulum, insula, and thalamus CBF. The frontolimbic and insular cortical neuroconstellation with dampened perfusion suggests a mechanism of dysfunction associated with these brain regions in AUD.
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Affiliation(s)
- Edith V. Sullivan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA;,Correspondence Edith V. Sullivan, Ph.D., Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine (MC5723), 401 Quarry Road, Stanford, CA 94305-5723, phone: (650) 859-2880, FAX: (650) 859-2743,
| | - Qingyu Zhao
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Kilian M. Pohl
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA;,Center for Health Sciences, SRI International, Menlo Park, CA
| | - Natalie M. Zahr
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA;,Center for Health Sciences, SRI International, Menlo Park, CA
| | - Adolf Pfefferbaum
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA;,Center for Health Sciences, SRI International, Menlo Park, CA
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4
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Canning JR, Schallert MR, Larimer ME. A Systematic Review of the Balloon Analogue Risk Task (BART) in Alcohol Research. Alcohol Alcohol 2021; 57:85-103. [PMID: 33592622 DOI: 10.1093/alcalc/agab004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 12/07/2020] [Accepted: 01/08/2021] [Indexed: 11/15/2022] Open
Abstract
Risk-taking propensity has been crucial to the investigation of alcohol use and consequences. One measure, the balloon analogue risk task (BART), has been used consistently over the past two decades. However, it is unclear how this measure is related to alcohol outcomes. This paper systematically reviews the literature on the BART and alcohol outcomes. First, direct associations between the BART and alcohol use are reviewed including correlations, group comparisons, the BART's prediction of alcohol outcomes and BART performance after consuming alcohol. Then, potential moderators that explain when and for whom the BART is related to alcohol outcomes are reviewed. Finally, potential mechanisms that explain how the BART and alcohol outcomes are related are reviewed. This review reveals patterns in the BART suggesting risk-taking propensity may be related to changes in alcohol use over time; however, there is little evidence to suggest BART scores increase after consuming alcohol. Yet, additional research suggests adjusted average pump scores may be too simplistic for the amount of information the BART captures and understanding individual's patterns of responses on the BART is important for investigating its relation to alcohol outcomes. Finally, this review opens up several future directions for research to understand how risk-taking propensity is related to alcohol outcomes.
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Affiliation(s)
- Jessica R Canning
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Macey R Schallert
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Mary E Larimer
- Department of Psychology, University of Washington, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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5
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Muller AM, Pennington DL, Meyerhoff DJ. Substance-Specific and Shared Gray Matter Signatures in Alcohol, Opioid, and Polysubstance Use Disorder. Front Psychiatry 2021; 12:795299. [PMID: 35115969 PMCID: PMC8803650 DOI: 10.3389/fpsyt.2021.795299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
Substance use disorders (SUD) have been shown to be associated with gray matter (GM) loss, particularly in the frontal cortex. However, unclear is to what degree these regional GM alterations are substance-specific or shared across different substances, and if these regional GM alterations are independent of each other or the result of system-level processes at the intrinsic connectivity network level. The T1 weighted MRI data of 65 treated patients with alcohol use disorder (AUD), 27 patients with opioid use disorder (OUD) on maintenance therapy, 21 treated patients with stimulant use disorder comorbid with alcohol use disorder (polysubstance use disorder patients, PSU), and 21 healthy controls were examined via data-driven vertex-wise and voxel-wise GM analyses. Then, structural covariance analyses and open-access fMRI database analyses were used to map the cortical thinning patterns found in the three SUD groups onto intrinsic functional systems. Among AUD and OUD, we identified both common cortical thinning in right anterior brain regions as well as SUD-specific regional GM alterations that were not present in the PSU group. Furthermore, AUD patients had not only the most extended regional thinning but also significantly smaller subcortical structures and cerebellum relative to controls, OUD and PSU individuals. The system-level analyses revealed that AUD and OUD showed cortical thinning in several functional systems. In the AUD group the default mode network was clearly most affected, followed by the salience and executive control networks, whereas the salience and somatomotor network were highlighted as critical for understanding OUD. Structural brain alterations in groups with different SUDs are largely unique in their spatial extent and functional network correlates.
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Affiliation(s)
- Angela M Muller
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States.,VA Advanced Imaging Research Center (VAARC), San Francisco VA Medical Center, San Francisco, CA, United States
| | - David L Pennington
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States.,San Francisco Veterans Affairs Health Care System (SFVAHCS), San Francisco, CA, United States
| | - Dieter J Meyerhoff
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States.,VA Advanced Imaging Research Center (VAARC), San Francisco VA Medical Center, San Francisco, CA, United States
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6
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Kovács I, Demeter I, Janka Z, Demetrovics Z, Maraz A, Andó B. Different aspects of impulsivity in chronic alcohol use disorder with and without comorbid problem gambling. PLoS One 2020; 15:e0227645. [PMID: 31999707 PMCID: PMC6992191 DOI: 10.1371/journal.pone.0227645] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 12/23/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND AND AIMS Alcohol use disorder (AUD) and problem gambling are highly comorbid disorders. This study aims to explore the role of four aspects of impulsivity (trait concept of impulsivity, choice impulsivity, impulsive aggression and response inhibition/decision-making) in long-term chronic AUD patients with and without problem or pathological gambling symptoms. METHODS Cognitively intact chronic AUD patients were enrolled with (n = 32) and without (n = 71) problem gambling symptoms in an inpatient clinic for chronic alcohol users. Multiple facets of impulsivity, cognitive ability, psychopathological symptoms, alcohol and gambling severity were measured. RESULTS Chronic AUD patients with gambling disorder symptoms showed longer lifetime alcohol consumption, more severe alcohol use and higher psychopathological symptom severity than AUD patients without gambling symptoms. Gambling severity correlated with overall trait impulsivity, but not with choice impulsivity, impulsive aggression or cognitive impulsivity with controlling for lifetime alcohol consumption, lifetime alcohol use and psychopathological symptom severity. High trait impulsivity and non-planning was associated with comorbid gambling symptoms in AUD patients, which was independent of the level of intelligence, age and psychopathological symptoms. CONCLUSION Comorbid gambling disorder symptoms in chronic AUD was connected to more severe alcohol-related variables. Higher trait impulsivity was also linked with gambling disorder symptoms in patients with chronic AUD. This accents the need of special focus on comorbid GD symptoms in AUD, since prognosis and treatment for them may vary.
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Affiliation(s)
- Ildikó Kovács
- Department of Psychiatry, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Ildikó Demeter
- Department of Psychiatry, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Zoltán Janka
- Department of Psychiatry, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Zsolt Demetrovics
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Aniko Maraz
- Institute für Psychologie, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Bálint Andó
- Department of Psychiatry, Faculty of Medicine, University of Szeged, Szeged, Hungary
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7
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Courtney KE, Infante MA, Brown GG, Tapert SF, Simmons AN, Smith TL, Schuckit MA. The Relationship Between Regional Cerebral Blood Flow Estimates and Alcohol Problems at 5-Year Follow-Up: The Role of Level of Response. Alcohol Clin Exp Res 2019; 43:812-821. [PMID: 30924954 DOI: 10.1111/acer.13998] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 02/28/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Acute alcohol consumption is associated with temporarily increased regional cerebral blood flow (CBF). The extent of this increase appears to be moderated by individual differences in the level of response (LR) to alcohol's subjective effects. The low LR phenotype is a known risk factor for the development of alcohol problems. This study investigates how the low LR phenotype relates to the relationship between alcohol-related changes in CBF and alcohol problems 5 years later. METHODS Young adults (ages 18 to 25) were selected based on their LR to alcohol and underwent a neuroimaging protocol including arterial spin labeling and functional scans. These participants were recontacted ~5 years later and assessed on alcohol outcomes. A final sample of 107 subjects (54 low and 53 high LR subjects) was included in the analyses. Whole-brain analysis revealed 5 clusters of significant alcohol-induced, versus placebo-induced, CBF changes that were consistent with a previous report. Peak alcohol-placebo CBF response was extracted from these regions and, along with the LR group, submitted to a hierarchical linear regression predicting alcohol problems. Analyses controlled for age, sex, and baseline alcohol problems. RESULTS In the regression analysis, greater alcohol-placebo CBF difference in the right middle/superior/inferior frontal gyri and bilateral anterior cingulate gyri clusters predicted greater future alcohol problems for the low LR group, whereas this relationship was not found to be significant in the high LR group. CONCLUSIONS This study demonstrates a clinically important relationship between CBF and future alcohol problems, particularly in individuals with a low LR phenotype. These initial results help to elucidate the neurobiological pathways involved in the development of alcohol use disorders for individuals with low LR.
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Affiliation(s)
- Kelly E Courtney
- Department of Psychiatry , University of California San Diego, La Jolla, California
| | | | - Gregory G Brown
- Department of Psychiatry , University of California San Diego, La Jolla, California.,Veteran's Affairs Healthcare System , San Diego, California
| | - Susan F Tapert
- Department of Psychiatry , University of California San Diego, La Jolla, California
| | - Alan N Simmons
- Department of Psychiatry , University of California San Diego, La Jolla, California.,Veteran's Affairs Healthcare System , San Diego, California
| | - Tom L Smith
- Department of Psychiatry , University of California San Diego, La Jolla, California
| | - Marc A Schuckit
- Department of Psychiatry , University of California San Diego, La Jolla, California
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8
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Vuletic D, Dupont P, Robertson F, Warwick J, Zeevaart JR, Stein DJ. Methamphetamine dependence with and without psychotic symptoms: A multi-modal brain imaging study. NEUROIMAGE-CLINICAL 2018; 20:1157-1162. [PMID: 30380522 PMCID: PMC6205927 DOI: 10.1016/j.nicl.2018.10.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 10/14/2018] [Accepted: 10/21/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Methamphetamine dependence can lead to psychotic symptoms which may be mediated by frontal, striatal, limbic, and thalamic regions. There are few neuroimaging data that allow comparison of individuals with methamphetamine dependence who do, and do not, have psychosis. Two complementary imaging techniques were employed to investigate neurocircuitry associated with methamphetamine dependence with and without psychotic symptoms. METHODS Three groups of participants were recruited: methamphetamine dependent (MAA) (N = 11), methamphetamine dependent with psychotic symptoms (MAP) (N = 14), and controls (N = 14). Resting brain glucose metabolism was measured using [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET) and cerebral perfusion was assessed using arterial spin labelling (ASL) magnetic resonance imaging. RESULTS Methamphetamine abusers (MAA and MAP groups) had decreased glucose metabolism compared to healthy controls in the left insula, left precentral gyrus, and the anterior cingulate cortex. Compared to MAA participants, MAP participants had 1) decreased glucose metabolism in the left precentral gyrus and the left inferior frontal gyrus and 2) increased glucose metabolism in the putamen and pallidum. MAP participants also had increased cerebral perfusion in the right putamen and right pallidum compared to MAA. CONCLUSION Findings support the involvement of frontal, striatal, and limbic regions in methamphetamine dependence. Furthermore, they indicate that glucose metabolism and cerebral perfusion in these regions are disrupted in methamphetamine dependent individuals with psychotic symptoms.
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Affiliation(s)
- Daniella Vuletic
- Department of Psychiatry and MRC Unit on Risk & Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa.
| | - Patrick Dupont
- Radiochemistry, the South African Nuclear Energy Corporation (Necsa), North West Province, South Africa; Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium.
| | - Frances Robertson
- Department of Human Biology, University of Cape Town, Cape Town, South Africa.
| | - James Warwick
- Department of Nuclear Medicine, University of Stellenbosch and Tygerberg hospital, Cape Town, South Africa.
| | - Jan Rijn Zeevaart
- Radiochemistry, the South African Nuclear Energy Corporation (Necsa), North West Province, South Africa.
| | - Dan J Stein
- Department of Psychiatry and MRC Unit on Risk & Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa.
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9
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Topiwala H, Terrera GM, Stirland L, Saunderson K, Russ TC, Dozier MF, Ritchie CW. Lifestyle and neurodegeneration in midlife as expressed on functional magnetic resonance imaging: A systematic review. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2018; 4:182-194. [PMID: 29955662 PMCID: PMC6021545 DOI: 10.1016/j.trci.2018.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction Lifestyle factors may influence brain health in midlife. Functional magnetic resonance imaging is a widely used tool to investigate early changes in brain health, including neurodegeneration. In this systematic review, we evaluate the relationship between lifestyle factors and neurodegeneration in midlife, as expressed using functional magnetic resonance imaging. Methods We searched MEDLINE, EMBASE, and PsycINFO combining subject headings and free text terms adapted for each database. Articles were screened, and their quality was assessed independently by two reviewers before final inclusion in the review. Results We screened 4116 studies and included 29 in the review. Seven lifestyle factors, such as alcohol, cognitive training, excessive internet use, fasting, physical training, smoking, and substance misuse, were identified in this review. Discussion Cognitive and physical trainings appear to be associated with a neuroprotective effect, whereas alcohol misuse, smoking, and substance misuse appear to be associated with neurodegeneration. Further research is required into the effects of excessive internet use and fasting.
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Affiliation(s)
- Hinesh Topiwala
- Centre for Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Graciela Muniz Terrera
- Centre for Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Lucy Stirland
- Centre for Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Kathryn Saunderson
- Centre for Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Tom C Russ
- Centre for Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
| | | | - Craig W Ritchie
- Centre for Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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10
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Murray DE, Durazzo TC, Schmidt TP, Murray TA, Abé C, Guydish J, Meyerhoff DJ. Regional cerebral blood flow in opiate dependence relates to substance use and neuropsychological performance. Addict Biol 2018. [PMID: 28627790 DOI: 10.1111/adb.12523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Neuroimaging of opiate-dependent individuals indicates both altered brain structure and function. Magnetic resonance-based arterial spin labeling has been used to measure noninvasively cerebral blood flow (i.e. perfusion) in alcohol, tobacco and stimulant dependence; only one arterial spin labeling paper in opiate-dependent individuals demonstrated frontal and parietal perfusion deficits. Additional research on regional brain perfusion in opiate dependence and its relationship to cognition and self-regulation (impulsivity, risk taking and decision making) may inform treatment approaches for opiate-dependent individuals. Continuous arterial spin labeling magnetic resonance imaging at 4 T and neuropsychological measures assessed absolute brain perfusion levels, cognition and self-regulation in 18 cigarette smoking opiate-dependent individuals (sODI) stable on buprenorphine maintenance therapy. The sODI were compared with 20 abstinent smoking alcohol-dependent individuals (a substance-dependent control group), 35 smoking controls and 29 nonsmoking controls. sODI had lower perfusion in several cortical and subcortical regions including regions within the brain reward/executive oversight system compared with smoking alcohol-dependent individuals and nonsmoking controls. Perfusion was increased in anterior cingulate cortex and globus pallidus of sODI. Compared with all other groups, sODI had greater age-related declines in perfusion in most brain reward/executive oversight system and some other regions. In sODI, lower regional perfusion related to greater substance use, higher impulsivity and weaker visuospatial skills. Overall, sODI showed cortical and subcortical hypoperfusion and hyperperfusion. Relating to neuropsychological performance and substance use quantities, the frontal perfusion alterations are clinically relevant and constitute potential targets for pharmacological and cognitive-based therapeutic interventions to improve treatment outcome in opiate dependence.
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Affiliation(s)
- Donna E. Murray
- Center for Imaging of Neurodegenerative Diseases (CIND); San Francisco VA Medical Center; San Francisco CA USA
- Department of Radiology and Biomedical Imaging; University of California San Francisco; San Francisco CA USA
| | - Timothy C. Durazzo
- Department of Psychiatry and Behavioral Sciences; Stanford University School of Medicine; Stanford CA USA
- VA Palo Alto Health Care System; Mental Illness Research and Education Clinical Centers, Sierra-Pacific War Related Illness and Injury Study Center; Palo Alto CA USA
| | - Thomas P. Schmidt
- Center for Imaging of Neurodegenerative Diseases (CIND); San Francisco VA Medical Center; San Francisco CA USA
- Department of Radiology and Biomedical Imaging; University of California San Francisco; San Francisco CA USA
| | - Troy A. Murray
- Center for Imaging of Neurodegenerative Diseases (CIND); San Francisco VA Medical Center; San Francisco CA USA
| | - Christoph Abé
- Department of Clinical Neuroscience, Osher Center; Karolinska Institute; Stockholm Sweden
| | - Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies; University of California San Francisco; San Francisco CA USA
| | - Dieter J. Meyerhoff
- Center for Imaging of Neurodegenerative Diseases (CIND); San Francisco VA Medical Center; San Francisco CA USA
- Department of Radiology and Biomedical Imaging; University of California San Francisco; San Francisco CA USA
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11
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Kovács I, Richman MJ, Janka Z, Maraz A, Andó B. Decision making measured by the Iowa Gambling Task in alcohol use disorder and gambling disorder: a systematic review and meta-analysis. Drug Alcohol Depend 2017; 181:152-161. [PMID: 29055269 DOI: 10.1016/j.drugalcdep.2017.09.023] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 09/21/2017] [Accepted: 09/22/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND AIMS Gambling disorder (GD) and alcohol use disorder (AD) have similar features, such as elevated impulsivity and decision-making deficits, which are directly linked to relapse and poor therapeutic outcomes. Our aim was to assess decision-making characteristics in GD and AD patients compared to healthy controls (HC) based on one of the most frequently used measures of decision-making: the Iowa Gambling Task (IGT). METHODS In our systematic literature search of three databases, we identified 1198 empirical articles that mentioned decision-making deficits with the use of the IGT in patients diagnosed with either AD or GD. Possible effects were calculated using meta-analysis. In the end, 17 studies (including 1360 participants) were suitable for inclusion in the meta-analysis reporting data for 23 group contrasts. RESULTS The random effects estimate indicated impaired IGT performance in both AD patients (N=500; d=-0.581, CI:-89.5<δ<-26.6%) and an even greater deficit in GD patients (N=292; d=-1.034, CI:-156.1<δ<50.7%) compared to HCs. Sampling variances were calculated for both AD (v1=0.0056) and GD groups (v2=0.0061), from which the z-score was calculated (z=-21.0785; p<0.05), which indicates a statistically significant difference between AD and GD groups. No significant moderating effects of age, gender or education were found. CONCLUSIONS There is enough evidence to support that decision-making deficit associated with addictive disorders, and that the deficit is more expressed in gambling disorder than in alcohol use disorder. Impaired decision-making plays an important part in poor therapeutic outcomes, thus provides a promising opportunity for cognitive intervention.
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Affiliation(s)
- Ildikó Kovács
- Department of Psychiatry, Faculty of Medicine, University of Szeged, Kálvária Ave. 57, H-6725, Szeged, Hungary.
| | - Mara J Richman
- Institute of Psychology, Eötvös Loránd University, Izabella Str. 46, H-1064, Budapest, Hungary
| | - Zoltán Janka
- Department of Psychiatry, Faculty of Medicine, University of Szeged, Kálvária Ave. 57, H-6725, Szeged, Hungary
| | - Aniko Maraz
- Institute of Psychology, Eötvös Loránd University, Izabella Str. 46, H-1064, Budapest, Hungary
| | - Bálint Andó
- Department of Psychiatry, Faculty of Medicine, University of Szeged, Kálvária Ave. 57, H-6725, Szeged, Hungary
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12
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Schmidt TP, Pennington DL, Cardoos SL, Durazzo TC, Meyerhoff DJ. Neurocognition and inhibitory control in polysubstance use disorders: Comparison with alcohol use disorders and changes with abstinence. J Clin Exp Neuropsychol 2016; 39:22-34. [PMID: 27690739 DOI: 10.1080/13803395.2016.1196165] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Intact neurocognition and early cognitive recovery during abstinence are important for substance use treatment outcome. Yet, little is known about them in the largest group of treatment seekers today, individuals with polysubstance use disorders (PSU). This study primarily contrasted PSU and individuals with an alcohol use disorder (AUD) on neurocognitive and inhibitory control measures and, secondarily, measured changes during abstinence in PSU. METHOD At one month of abstinence from all substances except tobacco, 36 PSU and 69 AUD completed neurocognitive assessments of executive function, general intelligence, auditory-verbal learning/memory, visuospatial learning/memory/skills, processing speed, working memory, fine motor skills, and cognitive efficiency. The groups were also assessed on inhibitory control measures of self-reported impulsivity, risk-taking, and decision-making. Seventeen PSU repeated the assessments after approximately four months of abstinence. All cross-sectional and longitudinal analyses included smoking status as a possible confound. RESULTS At baseline, PSU performed significantly worse than AUD on auditory-verbal memory and on an inhibitory control measure of impulsivity. Polysubstance users showed trends to worse performance than AUD on general intelligence, auditory-verbal learning, and a decision-making task. Between one and four months of abstinence, PSU showed significant improvements on several neurocognitive and inhibitory control measures. CONCLUSIONS Polysubstance users exhibit distinct differences in neurocognition and inhibitory control compared to AUD. Between one and four months of abstinence, neurocognition and inhibitory control improve in PSU. This neurocognitive recovery in some domains of abstinent PSU is influenced by smoking status. These results underscore the clinical value of select methods to augment neurocognitive recovery in PSU through appropriate interventions.
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Affiliation(s)
- Thomas P Schmidt
- a Department of Radiology , Northern California Institute for Research and Education , San Francisco , CA , USA.,b Department of Radiology , San Francisco Veterans Affairs Medical Center , San Francisco , CA , USA
| | - David L Pennington
- a Department of Radiology , Northern California Institute for Research and Education , San Francisco , CA , USA.,b Department of Radiology , San Francisco Veterans Affairs Medical Center , San Francisco , CA , USA.,c Department of Psychiatry , University of California , San Francisco , CA , USA
| | - Stephanie L Cardoos
- b Department of Radiology , San Francisco Veterans Affairs Medical Center , San Francisco , CA , USA.,c Department of Psychiatry , University of California , San Francisco , CA , USA
| | - Timothy C Durazzo
- d Department of Psychiatry and Behavioral Sciences , Stanford University , Stanford , CA , USA.,e Department of Psychiatry , Veterans Affairs Palo Alto Health Care System , Palo Alto , CA , USA
| | - Dieter J Meyerhoff
- a Department of Radiology , Northern California Institute for Research and Education , San Francisco , CA , USA.,b Department of Radiology , San Francisco Veterans Affairs Medical Center , San Francisco , CA , USA.,f Department of Radiology and Biomedical Imaging , University of California , San Francisco , CA , USA
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Comparison of Regional Brain Perfusion Levels in Chronically Smoking and Non-Smoking Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:8198-213. [PMID: 26193290 PMCID: PMC4515717 DOI: 10.3390/ijerph120708198] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/07/2015] [Accepted: 07/10/2015] [Indexed: 12/20/2022]
Abstract
Chronic cigarette smoking is associated with numerous abnormalities in brain neurobiology, but few studies specifically investigated the chronic effects of smoking (compared to the acute effects of smoking, nicotine administration, or nicotine withdrawal) on cerebral perfusion (i.e., blood flow). Predominately middle-aged male (47 ± 11 years of age) smokers (n = 34) and non-smokers (n = 27) were compared on regional cortical perfusion measured by continuous arterial spin labeling magnetic resonance studies at 4 Tesla. Smokers showed significantly lower perfusion than non-smokers in the bilateral medial and lateral orbitofrontal cortices, bilateral inferior parietal lobules, bilateral superior temporal gyri, left posterior cingulate, right isthmus of cingulate, and right supramarginal gyrus. Greater lifetime duration of smoking (adjusted for age) was related to lower perfusion in multiple brain regions. The results indicated smokers showed significant perfusion deficits in anterior cortical regions implicated in the development, progression, and maintenance of all addictive disorders. Smokers concurrently demonstrated reduced blood flow in posterior brain regions that show morphological and metabolic aberrations as well as elevated beta amyloid deposition demonstrated by those with early stage Alzheimer disease. The findings provide additional novel evidence of the adverse effects of cigarette smoking on the human brain.
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