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Pabst A, d'Argembeau A, de Longueville X, de Timary P, Maurage P. Social episodic memory in severe alcohol use disorder: Positive encoding bias and negative bias in accessibility of interpersonal information. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024. [PMID: 38925609 DOI: 10.1111/acer.15344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Alterations in higher-order social cognition are well documented in individuals with severe alcohol use disorder (SAUD). However, the basic mechanisms underpinning them are not well understood. This knowledge gap hampers the development of targeted therapeutic interventions. Here, we investigated whether individuals with SAUD show abnormalities in social episodic memory processes, which may represent relevant candidate mechanisms for alterations in social cognition. METHODS Recently detoxified patients with SAUD and matched healthy controls (HCs) completed two experimental tasks. We first used a Social Recognition Task in 40 SAUD patients and 40 HCs to measure the participants' ability to implicitly memorize the facial identity and emotion of novel interpersonal cues (i.e., dynamic facial expressions of anger and happiness). We then used a Social Memory Accessibility Task in 29 SAUD patients and 30 HCs) to measure participants' access to and fluency for already existing social memories by asking them to retrieve as many specific positive and negative interpersonal events as possible within equal time limits. RESULTS In the Social Recognition Task, we found that, compared to HCs, patients with SAUD had a globally lower recognition performance for the facial identities of novel social stimuli, but a preserved bias toward positive information. Conversely, in the social memory accessibility task, patients showed greater access to and fluency for negative interpersonal memories than controls (no group differences were observed for positive ones), resulting in a negative accessibility bias. CONCLUSIONS This exploration of episodic social memory in individuals with SAUD showed (1) a preserved bias for the encoding of positive versus negative novel social information, and (2) greater access to negative than positive interpersonal memories. These results enhance our understanding of socio-affective processing in individuals with SAUD and identify social memory alterations that may contribute to social cognition and interpersonal difficulties.
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Affiliation(s)
- Arthur Pabst
- Louvain Experimental Psychopathology Research Group (LEP), Psychological Science Research Institute, UCLouvain, Louvain-la-Neuve, Belgium
| | - Arnaud d'Argembeau
- Psychology and Neuroscience of Cognition Laboratory (PsyNCog), University of Liège, Liège, Belgium
| | | | - Philippe de Timary
- Louvain Experimental Psychopathology Research Group (LEP), Psychological Science Research Institute, UCLouvain, Louvain-la-Neuve, Belgium
- Department of Adult Psychiatry, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institute of Neuroscience (IoNS), Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Pierre Maurage
- Louvain Experimental Psychopathology Research Group (LEP), Psychological Science Research Institute, UCLouvain, Louvain-la-Neuve, Belgium
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Teixeira J, Pinheiro M, Pereira GÁ, Nogueira P, Guerreiro M, Castanho M, do Couto FS. Predicting alcohol relapse post-detoxification: The role of cognitive impairments in alcohol use disorder patients. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:918-927. [PMID: 38494444 DOI: 10.1111/acer.15302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/21/2024] [Accepted: 02/29/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Studies on early abstinence suggest that cognitive function is significantly reduced in the first year of abstinence, which raises the question of whether it is relevant to early relapse in patients with substance use disorders. This study investigates the extent to which impairments in executive function and memory predict alcohol relapse in patients with alcohol use disorder (AUD). Understanding these relationships is crucial for improving therapeutic approaches to prevent relapse in patients with AUD. METHODS We selected 116 adult patients (79 male and 37 female) diagnosed with AUD based on DSM-5 criteria, all of whom were undergoing alcohol detoxification treatment. A comprehensive array of neuropsychological tests was administered to assess global cognition, memory, and executive functions. Patients' alcohol use was monitored monthly during a 6-month follow-up period. Logistic regression and Cox regression were used to explore the relationship between cognitive function and the likelihood of alcohol relapse. RESULTS Impairments in global cognition, semantic and phonemic fluency, cognitive flexibility, and learning ability during detoxification were significant predictors of relapse in AUD patients, showing similar predictive values at both 3 and 6 months post-treatment. An abnormal Montreal Cognitive Assessment (MoCA) score increased the risk of relapse by 123% (HR: 2.227), and impairments in both semantic and phonemic fluency each increased the risk by 142% (HR: 2.423). Additionally, abnormal performance on the MoCA, Trail Making Test Part B (TMT-B), and California Verbal Learning Test (CVLT) was associated with a higher number of drinking days at 3 months (IRR: 3.764; IRR: 2.237; IRR: 2.738, respectively) and abnormal MoCA and TMT-B scores at 6 months (IRR: 2.451; IRR: 1.859, respectively). CONCLUSIONS The MoCA test is a valuable tool for predicting relapse risk in AUD patients undergoing detoxification treatment, with similar predictive value for relapse at 3 or 6 months. Learning ability needs to be assessed and their impairments considered in the treatment of AUD patients. Future research should explore strategies for managing patients with impairments in memory and learning ability to enhance treatment effectiveness and prevent relapse.
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Affiliation(s)
- Joana Teixeira
- Unidade de Alcoologia e Novas Dependências, Centro Hospitalar Psiquiátrico de Lisboa, Lisbon, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | | | - Gabriela Álvares Pereira
- Unidade de Neuropsicologia, Centro Hospitalar Psiquiátrico de Lisboa, Lisbon, Portugal
- Faculty of Human Sciences, Católica Research Centre for Psychological, Family and Social Wellbeing (CRC-W), Universidade Católica Portuguesa, Lisbon, Portugal
| | - Paulo Nogueira
- NOVA National School of Public Health, Public Health Research Center, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
- Instituto de Saúde Ambiental, Faculdade de Medicina Universidade de Lisboa, Lisbon, Portugal
- Laboratório para a Sustentabilidade do Uso da Terra e dos Serviços dos Ecossistemas - TERRA, Lisbon, Portugal
- CIDNUR - Centro de Investigação, Inovação e Desenvolvimento em Enfermagem de Lisboa, Escola Superior de Enfermagem de Lisboa, Lisbon, Portugal
| | | | - Miguel Castanho
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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Kamarajan C, Pandey AK, Chorlian DB, Meyers JL, Kinreich S, Pandey G, Subbie-Saenz de Viteri S, Zhang J, Kuang W, Barr PB, Aliev F, Anokhin AP, Plawecki MH, Kuperman S, Almasy L, Merikangas A, Brislin SJ, Bauer L, Hesselbrock V, Chan G, Kramer J, Lai D, Hartz S, Bierut LJ, McCutcheon VV, Bucholz KK, Dick DM, Schuckit MA, Edenberg HJ, Porjesz B. Predicting Alcohol-Related Memory Problems in Older Adults: A Machine Learning Study with Multi-Domain Features. Behav Sci (Basel) 2023; 13:bs13050427. [PMID: 37232664 DOI: 10.3390/bs13050427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023] Open
Abstract
Memory problems are common among older adults with a history of alcohol use disorder (AUD). Employing a machine learning framework, the current study investigates the use of multi-domain features to classify individuals with and without alcohol-induced memory problems. A group of 94 individuals (ages 50-81 years) with alcohol-induced memory problems (the memory group) were compared with a matched control group who did not have memory problems. The random forests model identified specific features from each domain that contributed to the classification of the memory group vs. the control group (AUC = 88.29%). Specifically, individuals from the memory group manifested a predominant pattern of hyperconnectivity across the default mode network regions except for some connections involving the anterior cingulate cortex, which were predominantly hypoconnected. Other significant contributing features were: (i) polygenic risk scores for AUD, (ii) alcohol consumption and related health consequences during the past five years, such as health problems, past negative experiences, withdrawal symptoms, and the largest number of drinks in a day during the past twelve months, and (iii) elevated neuroticism and increased harm avoidance, and fewer positive "uplift" life events. At the neural systems level, hyperconnectivity across the default mode network regions, including the connections across the hippocampal hub regions, in individuals with memory problems may indicate dysregulation in neural information processing. Overall, the study outlines the importance of utilizing multidomain features, consisting of resting-state brain connectivity data collected ~18 years ago, together with personality, life experiences, polygenic risk, and alcohol consumption and related consequences, to predict the alcohol-related memory problems that arise in later life.
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Affiliation(s)
- Chella Kamarajan
- Henri Begleiter Neurodynamics Lab, Department of Psychiatry and Behavioral Science, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Ashwini K Pandey
- Henri Begleiter Neurodynamics Lab, Department of Psychiatry and Behavioral Science, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - David B Chorlian
- Henri Begleiter Neurodynamics Lab, Department of Psychiatry and Behavioral Science, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Jacquelyn L Meyers
- Henri Begleiter Neurodynamics Lab, Department of Psychiatry and Behavioral Science, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Sivan Kinreich
- Henri Begleiter Neurodynamics Lab, Department of Psychiatry and Behavioral Science, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Gayathri Pandey
- Henri Begleiter Neurodynamics Lab, Department of Psychiatry and Behavioral Science, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Stacey Subbie-Saenz de Viteri
- Henri Begleiter Neurodynamics Lab, Department of Psychiatry and Behavioral Science, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Jian Zhang
- Henri Begleiter Neurodynamics Lab, Department of Psychiatry and Behavioral Science, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Weipeng Kuang
- Henri Begleiter Neurodynamics Lab, Department of Psychiatry and Behavioral Science, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Peter B Barr
- Henri Begleiter Neurodynamics Lab, Department of Psychiatry and Behavioral Science, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Fazil Aliev
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ 08854, USA
| | - Andrey P Anokhin
- Department of Psychiatry, School of Medicine, Washington University, St. Louis, MO 63110, USA
| | | | - Samuel Kuperman
- Department of Psychiatry, University of Iowa, Iowa City, IA 52242, USA
| | - Laura Almasy
- The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Alison Merikangas
- The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sarah J Brislin
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ 08854, USA
| | - Lance Bauer
- Department of Psychiatry, University of Connecticut, Farmington, CT 06030, USA
| | - Victor Hesselbrock
- Department of Psychiatry, University of Connecticut, Farmington, CT 06030, USA
| | - Grace Chan
- Department of Psychiatry, University of Iowa, Iowa City, IA 52242, USA
- Department of Psychiatry, University of Connecticut, Farmington, CT 06030, USA
| | - John Kramer
- Department of Psychiatry, University of Iowa, Iowa City, IA 52242, USA
| | - Dongbing Lai
- Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Sarah Hartz
- Department of Psychiatry, School of Medicine, Washington University, St. Louis, MO 63110, USA
| | - Laura J Bierut
- Department of Psychiatry, School of Medicine, Washington University, St. Louis, MO 63110, USA
| | - Vivia V McCutcheon
- Department of Psychiatry, School of Medicine, Washington University, St. Louis, MO 63110, USA
| | - Kathleen K Bucholz
- Department of Psychiatry, School of Medicine, Washington University, St. Louis, MO 63110, USA
| | - Danielle M Dick
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ 08854, USA
| | - Marc A Schuckit
- Department of Psychiatry, University of California, San Diego, CA 92103, USA
| | | | - Bernice Porjesz
- Henri Begleiter Neurodynamics Lab, Department of Psychiatry and Behavioral Science, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
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Cognitive impairment in the co-occurrence of alcohol dependence and major depression: neuropsychological assessment and event-related potentials analyses. Heliyon 2022; 8:e09899. [PMID: 35874061 PMCID: PMC9305349 DOI: 10.1016/j.heliyon.2022.e09899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/25/2021] [Accepted: 07/01/2022] [Indexed: 11/21/2022] Open
Abstract
To evaluate the putative detrimental effect of Major Depressive Disorder (MDD) on the cognitive impairment associated with Alcohol Dependence (AD), we contrasted the neuropsychological profile and behavioral responses of AD subjects, MDD individuals, and in those with a co-occurring AD-MDD diagnosis (DD). Patients and healthy subjects completed a comprehensive neuropsychological battery and were recorded for P200, P300, and N450 event-related potentials during memory and Stroop tasks. AD subjects exhibited a generalized detrimental neuropsychological performance; in contrast, in MDD individuals, impairment was limited to discrete domains. Notably, the deficits were distinctive in DD cases. A P200 increased amplitude in MDD, a decrease in P300 amplitude in AD, and increased latency of P300 in DD patients were the overt electrophysiological abnormalities identified. Dual patients also exhibited a distinct pattern of behavioral responses, particularly apparent during high-demand cognitive tasks. Specific ERP adjustments were associated with the short-term fluoxetine treatment in DD and MDD subjects; the SSRI also improved altered baseline performance in learning and cognitive flexibility in DD subjects. In conclusion, the neuropsychological and behavioral alterations detected in the co-occurrence of AD-MDD did not seem to be merely the sum of the negative contributions of the independent disorders. Dual diagnosis (DD) patients exhibited a distinctive pattern of cognitive impairments compared to single diagnosis subjects. The ERP alterations identified were not shared among affected groups. Dual patients exhibited idiosyncratic behavioral responses. Impaired executive functions in DD subjects improved with SSRI medication. Neuropsychological and behavioral alterations are not explained as the sum of negative contributions of individual diagnosis.
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Abstract
BACKGROUND Alcohol use disorder (AUD) is associated with cognitive deficits but little is known to what degree this is caused by genetically influenced traits, i.e. endophenotypes, present before the onset of the disorder. The aim of the current study was to investigate to what degree family history (FH) of AUD is associated with cognitive functions. METHODS Case-control cross-sectional study at an outpatient addiction research clinic. Treatment-seeking AUD patients (n = 106) were compared to healthy controls (HC; n = 90), matched for age and sex. The HC group was further subdivided into AUD FH positive (FH+; n = 47) or negative (FH-; n = 39) based on the Family Tree Questionnaire. Participants underwent psychiatric and substance use assessments, completed the Barratt Impulsiveness Scale and performed a comprehensive battery of neuropsychological tests assessing response inhibition, decision making, attention, working memory, and emotional recognition. RESULTS Compared to HC, AUD patients exhibited elevated self-rated impulsivity (p < 0.001; d = 0.62), as well as significantly poorer response inhibition (p = 0.001; d = 0.51), attention (p = 0.021; d = 0.38) and information gathering in decision making (p = 0.073; d = 0.34). Similar to AUD patients, FH+ individuals exhibited elevated self-rated impulsivity (p = 0.096; d = 0.46), and in addition significantly worse future planning capacity (p < 0.001; d = 0.76) and prolonged emotional recognition response time (p = 0.010; d = 0.60) compared to FH-, while no other significant differences were found between FH+ and FH-. CONCLUSIONS Elevated impulsivity, poor performance in future planning and emotional processing speed may be potential cognitive endophenotypes in AUD. These cognitive domains represent putative targets for prevention strategies and treatment of AUD.
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Affiliation(s)
- Lotfi Khemiri
- Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Johan Franck
- Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Nitya Jayaram-Lindström
- Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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Chaudhury S, Vijay P, Khan A, Sowmya AV, Chaudhari B, Saldanha D. Cognitive deficits in alcohol dependence—A case–control analytical study. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_921_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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7
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Ottonello M, Torselli E, Caneva S, Fiabane E, Vassallo C, Pistarini C. Mental Imagery Skills in Alcohol-Dependent Subjects and Their Associations With Cognitive Performance: An Exploratory Study During Residential Rehabilitation. Front Psychiatry 2021; 12:741900. [PMID: 34912249 PMCID: PMC8666508 DOI: 10.3389/fpsyt.2021.741900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/10/2021] [Indexed: 11/15/2022] Open
Abstract
People in alcohol-detoxification experience deficits in motor and non-motor functions including cognitive performance. Imagery, the cognitive process of generating visual, auditory or kinesthetic experiences in the mind without the presence of external stimuli, has been little studied in Alcohol Use Disorders (AUD). This pilot study aims to observe the cognitive abilities useful for the inspection, maintenance, generation and manipulation of images in these patients during residential rehabilitation and investigate the relationships with their cognitive performance. Thirty-six subjects who completed the 28-day rehabilitation program for alcohol addiction, completed the Mental Imagery Test (MIT) and Neuropsychological Battery (ENB-2). The global score at MIT did not show pathological scores. The 11.1% of AUD patients showed an impaired global score in the cognitive performance and the 5.7% with scoring at limits of norm. Significant correlations were found between Mental Imagery abilities and ENB-2 subscale and stepwise regression analysis showed the close association between the ability of imagery (Mental Imagery Test) and the overall cognitive performance (ENB-2) in alcohol dependent patients and this relationship is stronger than other cognitive tasks.
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Affiliation(s)
- Marcella Ottonello
- Department of Physical and Rehabilitation Medicine of Genova Nervi Institute, Istituti Clinici Scientifici (ICS) Maugeri Spa SB, Genoa, Italy
| | - Elisa Torselli
- School of Psychotherapy, Miller Institute for Behavioral and Cognitive Therapy, Genoa, Italy
| | - Stefano Caneva
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Elena Fiabane
- Department of Physical and Rehabilitation Medicine of Genova Nervi Institute, Istituti Clinici Scientifici (ICS) Maugeri Spa SB, Genoa, Italy
| | - Claudio Vassallo
- Department of Physical and Rehabilitation Medicine of Genova Nervi Institute, Istituti Clinici Scientifici (ICS) Maugeri Spa SB, Genoa, Italy
| | - Caterina Pistarini
- Department of Neurorehabilitation Medicine of Pavia Institute, Istituti Clinici Scientifici (ICS) Maugeri, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Spa SB, Pavia, Italy
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8
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Venkatesan UM, Rabinowitz AR, Wolfert SJ, Hillary FG. Duration of post-traumatic amnesia is uniquely associated with memory functioning in chronic moderate-to-severe traumatic brain injury. NeuroRehabilitation 2021; 49:221-233. [PMID: 34397431 DOI: 10.3233/nre-218022] [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: 11/15/2022]
Abstract
BACKGROUND Disrupted memory circuitry may contribute to post-traumatic amnesia (PTA) after traumatic brain injury (TBI). It is unclear whether duration of PTA (doPTA) uniquely impacts memory functioning in the chronic post-injury stage. OBJECTIVE To examine the relationship between doPTA and memory functioning, independent of other cognitive abilities, in chronic moderate-to-severe TBI. METHODS Participants were 82 individuals (median chronicity = 10.5 years) with available doPTA estimates and neuropsychological data. Composite memory, processing speed (PS), and executive functioning (EF) performance scores, as well as data on subjective memory (SM) beliefs, were extracted. DoPTA-memory associations were evaluated via linear modeling of doPTA with memory performance and clinical memory status (impaired/unimpaired), controlling for PS, EF and demographic covariates. Interrelationships between doPTA, objective memory functioning, and SM were assessed. RESULTS DoPTA was significantly related to memory performance, even after covariate adjustment. Impairment in memory, but not PS or EF, was associated with a history of longer doPTA. SM was associated with memory performance, but unrelated to doPTA. CONCLUSIONS Findings suggest a specific association between doPTA-an acute injury phenomenon-and chronic memory deficits after TBI. Prospective studies are needed to understand how underlying mechanisms of PTA shape distinct outcome trajectories, particularly functional abilities related to memory processing.
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Affiliation(s)
- Umesh M Venkatesan
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA.,Department of Psychology, Pennsylvania State University, University Park, PA, USA
| | - Amanda R Rabinowitz
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA.,Department of Psychology, Pennsylvania State University, University Park, PA, USA
| | - Stephanie J Wolfert
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA.,Department of Psychology, Pennsylvania State University, University Park, PA, USA
| | - Frank G Hillary
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA.,Department of Psychology, Pennsylvania State University, University Park, PA, USA
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Zhang P, Zhu X, Yan J, Liu J. Identification of Immunosuppressive Medication Nonadherence Factors Through a Combined Theory Model in Renal Transplant Recipients: 6-12. Front Pharmacol 2021; 12:655836. [PMID: 34122077 PMCID: PMC8187913 DOI: 10.3389/fphar.2021.655836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/07/2021] [Indexed: 01/23/2023] Open
Abstract
Background: Immunosuppressive medication (IM) nonadherence is associated with poor transplant outcomes. Therefore, it is of great importance to identify predictive factors with IM nonadherence. We aimed to improve the predicted capacity of the theory of planned behavior (TPB) by adding health belief model's (HBM) variables in renal transplant patients (RTPs). Methods: This cross-sectional study distributed questionnaires to patients who had undergone renal transplant and follow-up regularly in the transplant center of Third Xiangya Hospital in China. The self-developed questionnaire collected data in three aspects: general data questionnaire, TPB, HBM-specific questionnaire, and Basel Assessment of Adherence to Immunosuppressive Medications scale. Results: A total of 1,357 of 1,480 patients completed the survey, with a participation rate of 91.69% and IM nonadherence rate of 33.53%. The marital status, household income, preoperative drinking history, the time after transplantation, and religion showed independent predictive factors with IM nonadherence (p < 0.05). Strikingly, adding HBM variables to the TPB theory model significantly increased its prediction ability to IM nonadherence (52%). Also, HBM manifested the highest coefficient of effect (-0.620). Particularly, perceived barriers and perceived seriousness, the variables of the HBM model, played a vital influence on medication nonadherence (-0.284 and 0.256). Conclusion: Our study here reveals the first investigation of the combined effects of the TPB and HBM model on IM nonadherence in Chinese RTPs, which could significantly improve the predictive ability of any single model. Meanwhile, future interventions should be conducted to both increase perceived seriousness and reduce perceived barriers for taking IM, which will effectively decrease IM nonadherence rates and improve transplant outcomes.
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Affiliation(s)
- Pengpeng Zhang
- Department of Transplantation, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Xiao Zhu
- Department of Transplantation, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Jin Yan
- The Nursing Department, the Third Xiangya Hospital of Central South University, Changsha, China
| | - Jia Liu
- Department of Transplantation, The Third Xiangya Hospital of Central South University, Changsha, China.,The Nursing School of Central South University, Changsha, China
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Contractor AA, Banducci AN, Weiss NH. Critical considerations for the positive memory-posttraumatic stress disorder model. Clin Psychol Psychother 2021; 29:81-91. [PMID: 33870586 DOI: 10.1002/cpp.2599] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 11/05/2022]
Abstract
Posttraumatic stress disorder (PTSD) includes changes in processes such as encoding and retrieval for both traumatic and positive memories. However, most work has predominantly focused on traumatic memories. Thus, Contractor and colleagues proposed a Positive Memory-PTSD model, which highlighted potential benefits associated with and mechanisms underlying positive memory retrieval/processing among individuals reporting PTSD symptoms. To enhance research on and clinical impacts of this model, the current review provides critical considerations for the Positive Memory-PTSD model. Drawing from emerging research and clinical observations, we (i) clarify that the model addresses specific versus overgeneral positive memories; (ii) underscore the importance of considering the heterogeneity in, and transitionary nature of, affect processes following positive memory retrieval; and (iii) highlight the rationale for considering trauma type/count and co-occurring conditions, as potential moderators of relations between positive memory processing and PTSD. Hereby, we provide an updated Positive Memory-PTSD model and implications for positive memory interventions drawing from this model.
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Affiliation(s)
| | - Anne N Banducci
- The National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Nicole H Weiss
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
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11
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Effects of excessive violent video game playing on verbal memory: an event-related brain potentials study. Cogn Process 2021; 22:487-500. [PMID: 33661449 DOI: 10.1007/s10339-021-01018-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 02/04/2021] [Indexed: 10/22/2022]
Abstract
The goal of the study was to investigate temporal dynamics of excessive violent game playing. We compared behavioral data and event-related potentials (ERPs) of excessive video game players (EVGPs, n = 21) and non-players (NPs, n = 21) using a classical learning, cued recall and recognition paradigm, featuring violent and non-violent words. During the recognition phase, EVGPs performed better for violent words, but worse for non-violent words compared to NPs. Also, EVGPs showed slower reaction times than NPs when responding to new violent words. We found significant group differences in parietal P300 and FN400 amplitudes. The EVGP group showed larger P300 amplitudes for violent words, and more negative FN400 amplitudes for new violent words compared to NPs. The results imply that EVGPs differ from NPs in their cognitive and ERP responses to violent and non-violent verbal stimuli. The cognitive processes of EVGPs are consistent with a model of attention and memory bias rather than with desensitization to violence.
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12
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Laniepce A, Lahbairi N, Cabé N, Pitel AL, Rauchs G. Contribution of sleep disturbances to the heterogeneity of cognitive and brain alterations in alcohol use disorder. Sleep Med Rev 2021; 58:101435. [PMID: 33578081 DOI: 10.1016/j.smrv.2021.101435] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/22/2020] [Accepted: 10/27/2020] [Indexed: 12/28/2022]
Abstract
Cognitive and brain alterations are common in alcohol use disorder and vary importantly from one patient to another. Sleep disturbances are also very frequent in these patients and remain largely neglected even though they can persist after drinking cessation. Sleep disturbances may be the consequence of specific brain alterations, resulting in cognitive impairments. But sleep disruption may also exacerbate alcohol-related brain abnormalities and cognitive deficits through common pathophysiological mechanisms. Besides, sleep disturbances seem a vulnerability factor for the development of alcohol use disorder. From a clinical perspective, sleep disturbances are known to affect treatment outcome and to increase the risk of relapse. In this article, we conducted a narrative review to provide a better understanding of the relationships between sleep disturbances, brain and cognition in alcohol use disorder. We suggest that the heterogeneity of brain and cognitive alterations observed in patients with alcohol use disorder could at least partially be explained by associated sleep disturbances. We also believe that sleep disruption could indirectly favor relapse by exacerbating neuropsychological impairments required in psychosocial treatment and for the maintenance of abstinence. Implications for clinical practice as well as perspectives for future research are proposed.
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Affiliation(s)
- Alice Laniepce
- Normandie Univ, UNICAEN, PSL Université de Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000 Caen, France
| | - Najlaa Lahbairi
- Normandie Univ, UNICAEN, PSL Université de Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000 Caen, France
| | - Nicolas Cabé
- Normandie Univ, UNICAEN, PSL Université de Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000 Caen, France; Service d'Addictologie, Centre Hospitalier Universitaire de Caen, 14000 Caen, France
| | - Anne-Lise Pitel
- Normandie Univ, UNICAEN, PSL Université de Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000 Caen, France; Institut Universitaire de France (IUF), France
| | - Géraldine Rauchs
- Normandie Univ, UNICAEN, PSL Université de Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000 Caen, France.
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Begdache L, Kianmehr H, Sabounchi N, Marszalek A, Dolma N. Common and differential associations between levels of alcohol drinking, gender-specific neurobehaviors and mental distress in college students. Trends Neurosci Educ 2020; 19:100129. [PMID: 32475479 DOI: 10.1016/j.tine.2020.100129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 04/27/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Binge drinking is associated with poor academic behaviors and performance. Excessive alcohol drinking induces molecular changes and neurobehaviors that support use of other substances and alter cognitive functions. The purpose of this study was to compare neurobehaviors and academic effort among college students with low alcohol use with those of high alcohol consumption and build conceptual models that represent the integration of the different variables. METHOD College students from several U.S colleges were assessed through an anonymous online survey for alcohol use, academic performance, lifestyle factors and mental distress. RESULTS Our results depicted common neurobehaviors and differential responses to high alcohol use. CONCLUSION The common responses in young men and women with high alcohol use are reflective of a hyperactive limbic system. The different responses involve cognitive aptitudes, typically controlled by cortical regions and affected by levels of brain connectivity known to be dissimilar between men and women.
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Affiliation(s)
- Lina Begdache
- Department of Health and Wellness Studies, Binghamton University, POB 6000, Binghamton, NY 13902, United States.
| | - Hamed Kianmehr
- Department of Pharmaceutical Outcomes & Policy University of Florida.
| | - Nasim Sabounchi
- Department of Health Policy and Management, CUNY Graduate School of Public Health and Health Policy, United States
| | - Anna Marszalek
- Department of Biological Sciences, Binghamton University, United States
| | - Ngawang Dolma
- Department of Biological Sciences, Binghamton University, United States
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Caneva S, Ottonello M, Torselli E, Pistarini C, Spigno P, Fiabane E. Cognitive Impairments in Early-Detoxified Alcohol-Dependent Inpatients and Their Associations with Socio-Demographic, Clinical and Psychological Factors: An Exploratory Study. Neuropsychiatr Dis Treat 2020; 16:1705-1716. [PMID: 32764946 PMCID: PMC7369414 DOI: 10.2147/ndt.s254369] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/20/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Cognitive impairment is common among patients with alcohol use disorder (AUD). However, neuropsychological assessment is not usually included as routine practice in alcohol rehabilitation programs. The aim of this study was to describe qualitatively the cognitive deficits in early-detoxified AUD patients undergoing rehabilitation and to explore relevant associations with socio-demographic, clinical and psychological factors. PATIENTS AND METHODS Forty-one patients with a diagnosis of AUD were consecutively recruited from a residential rehabilitation hospital in Northern Italy. Cognitive impairment was assessed using the Brief Neuropsychological Examination 2 (ENB-2). Anxiety, depression and severity of alcohol dependence were also evaluated using validated self-report questionnaires. Alcohol relapse was investigated 1 month after discharge. RESULTS Overall, 31.7% of AUD patients showed cognitive impairments according to the global score scale. However, 70.7% had an impaired performance on at least one test of the ENB-2, with particular regard to executive function, visuospatial and memory domains. Age, education and abstinence at admission were the most relevant factors associated with cognitive deficits in this clinical population. CONCLUSION The detection of cognitive impairments is essential in order to adapt alcohol rehabilitation treatment to patients with cognitive deficits and enhance clinical outcomes.
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Affiliation(s)
- Stefano Caneva
- Department of Physical and Rehabilitation Medicine, ICS Maugeri Spa SB, Institute of Genoa Nervi, Genoa, Italy
| | - Marcella Ottonello
- Department of Physical and Rehabilitation Medicine, ICS Maugeri Spa SB, Institute of Genoa Nervi, Genoa, Italy
| | - Elisa Torselli
- Department of Physical and Rehabilitation Medicine, ICS Maugeri Spa SB, Institute of Genoa Nervi, Genoa, Italy.,Miller Institute for Behavioral and Cognitive Therapy, Genoa, Italy
| | - Caterina Pistarini
- Department of Physical and Rehabilitation Medicine, ICS Maugeri Spa SB, Scientific Institute of Pavia, Genoa, Italy
| | - Paola Spigno
- Department of Physical and Rehabilitation Medicine, ICS Maugeri Spa SB, Institute of Genoa Nervi, Genoa, Italy
| | - Elena Fiabane
- Department of Physical and Rehabilitation Medicine, ICS Maugeri Spa SB, Institute of Genoa Nervi, Genoa, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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Venkatesan UM, Margolis SA, Tremont G, Festa EK, Heindel WC. Forward to the past: Revisiting the role of immediate recognition in the assessment of episodic memory. J Clin Exp Neuropsychol 2019; 42:160-170. [DOI: 10.1080/13803395.2019.1697210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Seth A. Margolis
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Geoffrey Tremont
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Elena K. Festa
- Department of Cognitive, Linguistic, and Psychological Sciences, Brown University, Providence, RI, USA
| | - William C. Heindel
- Department of Cognitive, Linguistic, and Psychological Sciences, Brown University, Providence, RI, USA
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16
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Morley KC, Lagopoulos J, Logge W, Chitty K, Moustafa AA, Haber PS. Brain N-Acetyl Aspartate and associations with cognitive impairment in alcohol dependent patients. J Clin Exp Neuropsychol 2019; 42:111-117. [DOI: 10.1080/13803395.2019.1685078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Kirsten C. Morley
- NHMRC Centre of Research Excellence in Mental Health and Substance Use, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Jim Lagopoulos
- Sunshine Coast Mind and Neuroscience – Thompson Institute, University of Sunshine Coast, Maroochydore, Australia
| | - Warren Logge
- NHMRC Centre of Research Excellence in Mental Health and Substance Use, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Kate Chitty
- School of Pharmacology, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Ahmed A. Moustafa
- School of Social Sciences and Psychology, Western Sydney University, Sydney, Australia
| | - Paul S. Haber
- NHMRC Centre of Research Excellence in Mental Health and Substance Use, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia
- Drug Health Services, Royal Prince Alfred Hospital, Sydney, Australia
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Abstract
OBJECTIVE To review deficits in emotional processing and social cognition potentially contributing to the dysfunctional emotion regulation and difficulties with interpersonal relationships observed in individuals with alcohol use disorder (AUD) and to provide directions for future research. METHOD First is presented a review of emotional and social-cognitive impairments in recently detoxified AUD individuals that include alexithymia, difficulties in decoding others' emotions, and reduced theory of mind and empathy skills. Social cognition disorders in AUD pose different issues discussed, such as whether (1) these deficits are consequences of excessive alcohol consumption or premorbid risk factors for addiction, (2) emotional and social impairments impede positive treatment outcome, (3) recovery of social abilities is possible with sustained abstinence, and (4) AUD patients are unaware of their emotional and social dysfunctions. Finally, current knowledge on structural and functional brain correlates of these deficits in AUD are reviewed. RESULTS Emotional and social-cognitive functions affected in AUD can potentially compromise efforts to initiate and maintain abstinence by hampering efficacy of clinical treatment. Such dysfunction can obstruct efforts to enable or reinstate higher-order abilities such as emotional self-regulation, motivation to change, success in interpersonal/social interactions, and emotional insight and awareness of social dysfunctions (i.e., accurate metacognition). CONCLUSIONS The present review highlights the need to account for emotional processing and social cognition in the evaluation and rehabilitation of alcohol-related neurocognitive disorders and to consider psychotherapeutic treatment involving remediation of emotional and social skills as implemented in psychiatric and neurological disorders. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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18
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Crowe SF, Cammisuli DM, Stranks EK. Widespread Cognitive Deficits in Alcoholism Persistent Following Prolonged Abstinence: An Updated Meta-analysis of Studies That Used Standardised Neuropsychological Assessment Tools. Arch Clin Neuropsychol 2019; 35:31-45. [DOI: 10.1093/arclin/acy106] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 12/11/2018] [Accepted: 12/19/2018] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
This study presents an updated meta-analysis replicating the study of (Stavro, K., Pelletier, J., & Potvin, S. (2013). Widespread and sustained cognitive deficits in alcoholism: A meta-analysis. Addiction Biology, 18, 203–213. doi:10.1111/j.1369-1600.2011.00418.x) regarding the cognitive functioning of alcoholics as a function of time abstinent.
Methods
A total of 34 studies (including a total of 2,786 participants) that met pre-determined inclusion and exclusion criteria were included in the analyses. The alcoholics were categorised into recently detoxified alcoholics (0–31 days sober), alcoholics 32–365 days sober and alcoholics >365 days sober consistent with the previous study. The current study employed more stringent control on the tests included in the analysis to include only those tasks described in contemporary neuropsychological test compendia. Forty-seven percent of the papers surveyed were not include in the previous meta-analysis.
Results
The results indicated that there was a diffuse and pervasive pattern of cognitive deficit among recently detoxified alcoholics and that these deficits, particularly with regard to memory functioning, persisted even in longer term abstinent alcoholics. This was inconsistent with the prior meta-analysis which contended that significant cognitive recovery was possible after as little as 1 year.
Conclusion
The persisting cognitive deficits were noted across a wide range of cognitive functions, supporting the notion of a diffuse rather than a specific compromise of cognition in alcoholism following discontinuation, as measured using standardised neuropsychological tests. Limitations on the finding included the fact that it was a cross-sectional rather than a longitudinal analysis, was subject to heterogeneity of method, had low representation of females in the samples, and had fewer studies of long-term sober samples.
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Affiliation(s)
- Simon F Crowe
- School of Psychology and Public Health, La Trobe University, Victoria, Australia
| | - Davide M Cammisuli
- Department of Surgical, Medical, Molecular, and Critical Area Pathology, Pisa University Medical School, Pisa, Italy
| | - Elizabeth K Stranks
- School of Psychology and Public Health, La Trobe University, Victoria, Australia
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Béracochéa D, Mons N, David V. Targeting the Glucocorticoid Receptors During Alcohol Withdrawal to Reduce Protracted Neurocognitive Disorders. Front Psychiatry 2019; 10:580. [PMID: 31620025 PMCID: PMC6759466 DOI: 10.3389/fpsyt.2019.00580] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 07/23/2019] [Indexed: 11/13/2022] Open
Abstract
Persistent regional glucocorticoid (GC) dysregulation in alcohol-withdrawn subjects emerges as a key factor responsible for protracted molecular and neural alterations associated with long-term cognitive dysfunction. Regional brain concentrations of corticosterone vary independently from plasma concentrations in alcohol-withdrawn subjects, which may account for the treatment of alcohol withdrawal-induced persistent pathology. Thus, from a pharmacological point of view, a main issue remains to determine the relative efficacy of compounds targeting the GC receptors to attenuate or suppress the long-lasting persistence of brain regional GC dysfunctions in abstinent alcoholics, as well as persistent changes of neural plasticity. Data from animal research show that acting directly on GC receptors during the withdrawal period, via selective antagonists, can significantly counteract the development and persistence of cognitive and neural plasticity disorders during protracted abstinence. A critical remaining issue is to better assess the relative long-term efficacy of GC antagonists and other compounds targeting the corticotropic axis activity such as gamma-aminobutyric acid A (GABAA) and GABAB agonists. Indeed, benzodiazepines (acting indirectly on GABAA receptors) and baclofen (agonist of the GABAB receptor) are the compounds most widely used to reduce alcohol dependence. Clinical and preclinical data suggest that baclofen exerts an effective and more powerful counteracting action on such persistent cognitive and endocrine dysfunctions as compared to diazepam, even though its potential negative effects on memory processes, particularly at high doses, should be better taken into account.
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Affiliation(s)
- Daniel Béracochéa
- Université de Bordeaux, Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, Pessac, France.,CNRS UMR 5287, Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, Pessac, France
| | - Nicole Mons
- Université de Bordeaux, Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, Pessac, France.,CNRS UMR 5287, Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, Pessac, France
| | - Vincent David
- Université de Bordeaux, Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, Pessac, France.,CNRS UMR 5287, Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, Pessac, France
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20
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Khemiri L, Brynte C, Stunkel A, Klingberg T, Jayaram-Lindström N. Working Memory Training in Alcohol Use Disorder: A Randomized Controlled Trial. Alcohol Clin Exp Res 2018; 43:135-146. [PMID: 30462837 PMCID: PMC6587824 DOI: 10.1111/acer.13910] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/14/2018] [Indexed: 11/29/2022]
Abstract
Background Alcohol use disorder (AUD) is associated with cognitive deficits such as impaired executive functions, which are hypothesized to contribute to the progression of the disease and worsen treatment outcome. Training of working memory (WM) to improve cognitive functions and thereby reduce alcohol use has been proposed as a novel treatment strategy. Methods Patients with AUD (n = 50) who were recruited to an outpatient addiction clinic were randomized to receive 5 weeks of active WM training or control training. Participants had weekly follow‐up visits, and all cognitive training sessions were done online at home. Primary outcomes were WM function and change in self‐reported heavy drinking. Secondary outcomes were craving, other drinking outcomes, and performance on a range of neuropsychological tasks from the Cambridge Neuropsychological Test Automated Battery. Results The active training group demonstrated a significantly greater improvement in verbal WM compared with the control group. No statistically significant effect of training was found on the primary drinking outcome, but a trend was observed indicating that WM training reduces the number of drinks per drinking occasion. WM training had no statistically significant effect on any of the other neuropsychological tasks. Conclusions Cognitive training can improve WM function in individuals with AUD, suggesting that such interventions are feasible to administer in this patient population. The results do not support an effect of WM training on heavy drinking or transfer effects to other cognitive domains. Future studies should evaluate WM training as an adjunct to evidence‐based treatments for AUD to assess potential synergistic effects.
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Affiliation(s)
- Lotfi Khemiri
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Christoffer Brynte
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Angela Stunkel
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Torkel Klingberg
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Nitya Jayaram-Lindström
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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21
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Dias BF, Rezende LO, Malloy-Diniz LF, Paula JJD. Relationship between visuospatial episodic memory, processing speed and executive function: are they stable over a lifespan? ARQUIVOS DE NEURO-PSIQUIATRIA 2018; 76:89-92. [PMID: 29489962 DOI: 10.1590/0004-282x20170186] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 11/06/2017] [Indexed: 11/21/2022]
Abstract
The present study evaluated the association between episodic memory, executive function and processing speed in a sample with different age ranges. We tested the hypothesis that processing speed, executive function and memory are more strongly associated during childhood and old age. We evaluated 571 participants, aged six to 92 years, divided into four age groups: children/adolescents, young adults, middle-aged adults and older adults. Correlation analyses suggested that the shared variance between the processing speed and memory is strong in childhood but weak across other age ranges. Executive function, however, had a stronger association both in childhood and in old age, when compared with the intermediate stages. We conclude that the effects of processing speed and executive function on memory are not stable across human development. These functions may be compensatory mechanisms for memory functioning in childhood and old age.
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Affiliation(s)
| | | | | | - Jonas Jardim de Paula
- Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte MG, Brasil.,Universidade Federal de Minas Gerais, Belo Horizonte MG, Brasil
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22
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Paz AL, Rosselli M, Conniff J. Identifying Inhibitory Subcomponents Associated with Changes in Binge Drinking Behavior: A 6-Month Longitudinal Design. Alcohol Clin Exp Res 2018; 42:1815-1822. [PMID: 29969149 DOI: 10.1111/acer.13830] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 06/29/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Links between response inhibition and young adult problematic drinking (e.g., binge drinking) have been established, but only to an extent. Considering the presence of some inconsistent findings associated with these 2 variables, this study proposes the need to investigate the extent in which different inhibitory subcomponents are associated with binge drinking behaviors of the same sample. METHODS Through the use of a 6-month longitudinal design, changes in Alcohol Use Questionnaire (AUQ) binge score of 163 college students (50.3% female) with a mean age of 21.06 years (SD = 1.83) were correlated with performance on 3 different inhibitory control tasks. Each task was selected to assess separate inhibitory subcomponents: Stop Signal Task (e.g., cancellation of a response), Go/No-Go Task (e.g., withholding of a response), and Simon Task (e.g., inhibiting response interference). Response inhibition was also compared between 2 groups, those who had a substantial increase in AUQ binge score during participation (inAUQ) and those who had a substantial decrease in AUQ binge score (deAUQ). RESULTS A significant correlation was found with a change in AUQ binge score and stop signal reaction time among females only, where an increase in binge drinking score positively correlated with a reduced ability to cancel an already-initiated inhibitory response. Differences in inhibitory performance, where inAUQ performed worse than deAUQ, approached significance. CONCLUSIONS The results suggest that the cancellation of a prepotent response, as opposed to the withholding of response or interference inhibition, is a more sensitive inhibitory measure associated with increases in binge drinking behavior among female young adult college students. Further exploration of inhibitory subcomponents relative to substance use is greatly needed (e.g., more extensive longitudinal designs and neuroimaging techniques).
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Affiliation(s)
- Andres L Paz
- Department of Psychology, Charles Schmidt College of Science, Florida Atlantic University, Davie, Florida
| | - Monica Rosselli
- Department of Psychology, Charles Schmidt College of Science, Florida Atlantic University, Davie, Florida
| | - Joshua Conniff
- Department of Psychology, Charles Schmidt College of Science, Florida Atlantic University, Davie, Florida
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23
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Carbia C, López-Caneda E, Corral M, Cadaveira F. A systematic review of neuropsychological studies involving young binge drinkers. Neurosci Biobehav Rev 2018; 90:332-349. [DOI: 10.1016/j.neubiorev.2018.04.013] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 04/13/2018] [Accepted: 04/13/2018] [Indexed: 12/27/2022]
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24
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Brion M, Dormal V, Lannoy S, Mertens S, de Timary P, Maurage P. Imbalance between cognitive systems in alcohol-dependence and Korsakoff syndrome: An exploration using the Alcohol Flanker Task. J Clin Exp Neuropsychol 2018; 40:820-831. [DOI: 10.1080/13803395.2018.1438371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Mélanie Brion
- Laboratory for Experimental Psychopathology, Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Valérie Dormal
- Laboratory for Experimental Psychopathology, Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Séverine Lannoy
- Laboratory for Experimental Psychopathology, Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Serge Mertens
- Department of Neuropsychiatry, Saint-Martin Hospital, Dave, Belgium
| | - Philippe de Timary
- Laboratory for Experimental Psychopathology, Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
- Department of Adult Psychiatry, St Luc Hospital and Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Pierre Maurage
- Laboratory for Experimental Psychopathology, Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
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25
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Klenowski PM. Emerging role for the medial prefrontal cortex in alcohol-seeking behaviors. Addict Behav 2018; 77:102-106. [PMID: 28992574 DOI: 10.1016/j.addbeh.2017.09.024] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/01/2017] [Accepted: 09/27/2017] [Indexed: 01/01/2023]
Abstract
The medial prefrontal cortex (mPFC) plays an important role in high-order executive processes and sends highly organized projections to sub-cortical regions controlling mood, motivation and impulsivity. Recent preclinical and clinical studies have demonstrated alcohol-induced effects on the activity and composition of the PFC which are implicated in associative learning processes and may disrupt executive control over impulsivity, leading to an inability to self-limit alcohol intake. Animal studies have begun to dissect the role of the mPFC circuitry in alcohol-seeking behavior and withdrawal, and have identified a key role for projections to sub-cortical sites including the extended amygdala and the nucleus accumbens (NAc). Importantly, these studies have highlighted that alcohol can have contrasting effects on the mPFC compared to other addictive substances and also produce differential effects on the structure and activity of the mPFC following short-term versus long-term consumption. Because of these differences, how the mPFC influences the initial aspects of alcohol-seeking behavior and how we can better understand the long-term effects of alcohol use on the activity and connectivity of the mPFC need to be considered. Given the lack of preclinical data from long-term drinking models, an increased focus should be directed towards identifying how long-term alcohol use changes the mPFC, in order to provide new insights into the mechanisms underlying the transition to dependence.
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26
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Schulte T, Jung YC, Sullivan EV, Pfefferbaum A, Serventi M, Müller-Oehring EM. The neural correlates of priming emotion and reward systems for conflict processing in alcoholics. Brain Imaging Behav 2017; 11:1751-1768. [PMID: 27815773 PMCID: PMC5418124 DOI: 10.1007/s11682-016-9651-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Emotional dysregulation in alcoholism (ALC) may result from disturbed inhibitory mechanisms. We therefore tested emotion and alcohol cue reactivity and inhibitory processes using negative priming. To test the neural correlates of cue reactivity and negative priming, 26 ALC and 26 age-matched controls underwent functional MRI performing a Stroop color match-to-sample task. In cue reactivity trials, task-irrelevant emotion and alcohol-related pictures were interspersed between color samples and color words. In negative priming trials, pictures primed the semantic content of an alcohol or emotion Stroop word. Behaviorally, both groups showed response facilitation to picture cue trials and response inhibition to primed trials. For cue reactivity to emotion and alcohol pictures, ALC showed midbrain-limbic activation. By contrast, controls activated frontoparietal executive control regions. Greater midbrain-hippocampal activation in ALC correlated with higher amounts of lifetime alcohol consumption and higher anxiety. With negative priming, ALC exhibited frontal cortical but not midbrain-hippocampal activation, similar to the pattern observed in controls. Higher frontal activation to alcohol-priming correlated with less craving and to emotion-priming with fewer depressive symptoms. The findings suggest that neurofunctional systems in ALC can be primed to deal with upcoming emotion- and alcohol-related conflict and can overcome the prepotent midbrain-limbic cue reactivity response.
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Affiliation(s)
- T Schulte
- Neuroscience Program, Biosciences Division, SRI International, Menlo Park, CA, 94025-3493, USA.
- Pacific Graduate School of Psychology, Palo Alto University, Palo Alto, CA, USA.
| | - Y-C Jung
- Deptartment of Psychiatry & Beh. Sci, Stanford University, Stanford, CA, USA
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, South Korea
| | - E V Sullivan
- Deptartment of Psychiatry & Beh. Sci, Stanford University, Stanford, CA, USA
| | - A Pfefferbaum
- Neuroscience Program, Biosciences Division, SRI International, Menlo Park, CA, 94025-3493, USA
- Deptartment of Psychiatry & Beh. Sci, Stanford University, Stanford, CA, USA
| | - M Serventi
- Neuroscience Program, Biosciences Division, SRI International, Menlo Park, CA, 94025-3493, USA
- Deptartment of Psychiatry & Beh. Sci, Stanford University, Stanford, CA, USA
| | - E M Müller-Oehring
- Neuroscience Program, Biosciences Division, SRI International, Menlo Park, CA, 94025-3493, USA
- Deptartment of Psychiatry & Beh. Sci, Stanford University, Stanford, CA, USA
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Noël X, Jaafari N, Bechara A. Addictive behaviors: Why and how impaired mental time matters? PROGRESS IN BRAIN RESEARCH 2017; 235:219-237. [PMID: 29054290 DOI: 10.1016/bs.pbr.2017.07.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Mental time travel (MTT) allows navigation into the past, the future, and the minds of others, and it subserves future-oriented decision-making. Impaired MTT has been associated with a tendency to over-rely on the present, which is a characteristic of addictive behaviors. We here discuss the possible relationship between impaired autographical memory, future-oriented MTT, shortened time horizons, suboptimal social cognition, and poor decision-making in individuals with drug and gambling use disorders. We elaborate on how impaired MTT could compromise the process of change in addiction recovery and the effectiveness of psychotherapy. We argue that facilitating MTT represents, for individuals with addictive behaviors, an important process to enhance readiness to change, and to improve the quality and the efficiency of psychosocial interventions that focus on "emotional correction."
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Affiliation(s)
- Xavier Noël
- Laboratoire de Psychologie Médicale et d'Addictologie, Université Libre de Bruxelles (ULB), Brussels, Belgium.
| | - Nematollah Jaafari
- Unité de Recherche Clinique Intersectorielle en Psychiatrie à vocation régionale Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, France; Université de Poitiers-INSERM CIC-P 1402 CHU de Poitiers-INSERM U 1084, Experimental and Clinical Neuroscience Laboratory-Groupement de Recherche CNRS, Poitiers, France
| | - Antoine Bechara
- Brain and Creativity Institute, University of Southern California, Los Angeles, CA, United States
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Brion M, D'Hondt F, Lannoy S, Pitel AL, Davidoff DA, Maurage P. Crossmodal processing of emotions in alcohol-dependence and Korsakoff syndrome. Cogn Neuropsychiatry 2017; 22:436-451. [PMID: 28885888 DOI: 10.1080/13546805.2017.1373639] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Decoding emotional information from faces and voices is crucial for efficient interpersonal communication. Emotional decoding deficits have been found in alcohol-dependence (ALC), particularly in crossmodal situations (with simultaneous stimulations from different modalities), but are still underexplored in Korsakoff syndrome (KS). The aim of this study is to determine whether the continuity hypothesis, postulating a gradual worsening of cognitive and brain impairments from ALC to KS, is valid for emotional crossmodal processing. METHODS Sixteen KS, 17 ALC and 19 matched healthy controls (CP) had to detect the emotion (anger or happiness) displayed by auditory, visual or crossmodal auditory-visual stimuli. Crossmodal stimuli were either emotionally congruent (leading to a facilitation effect, i.e. enhanced performance for crossmodal condition compared to unimodal ones) or incongruent (leading to an interference effect, i.e. decreased performance for crossmodal condition due to discordant information across modalities). Reaction times and accuracy were recorded. RESULTS Crossmodal integration for congruent information was dampened only in ALC, while both ALC and KS demonstrated, compared to CP, decreased performance for decoding emotional facial expressions in the incongruent condition. CONCLUSIONS The crossmodal integration appears impaired in ALC but preserved in KS. Both alcohol-related disorders present an increased interference effect. These results show the interest of more ecological designs, using crossmodal stimuli, to explore emotional decoding in alcohol-related disorders. They also suggest that the continuum hypothesis cannot be generalised to emotional decoding abilities.
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Affiliation(s)
- Mélanie Brion
- a Laboratory for Experimental Psychopathology , Psychological Sciences Research Institute, Université catholique de Louvain , Louvain-la-Neuve , Belgium
| | - Fabien D'Hondt
- b Univ. Lille, CNRS , UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives , Lille , France.,c CHU Lille , Clinique de Psychiatrie, CURE , Lille , France
| | - Séverine Lannoy
- a Laboratory for Experimental Psychopathology , Psychological Sciences Research Institute, Université catholique de Louvain , Louvain-la-Neuve , Belgium
| | - Anne-Lise Pitel
- d INSERM, École Pratique des Hautes Études , Université de Caen-Basse Normandie, Unité U1077, GIP Cyceron, CHU Caen , Caen , France
| | - Donald A Davidoff
- e Harvard Medical School , Boston , MA , USA.,f Department of Neuropsychology , McLean Hospital , Belmont , USA
| | - Pierre Maurage
- a Laboratory for Experimental Psychopathology , Psychological Sciences Research Institute, Université catholique de Louvain , Louvain-la-Neuve , Belgium
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Le Berre AP, Fama R, Sullivan EV. Executive Functions, Memory, and Social Cognitive Deficits and Recovery in Chronic Alcoholism: A Critical Review to Inform Future Research. Alcohol Clin Exp Res 2017; 41:1432-1443. [PMID: 28618018 PMCID: PMC5531758 DOI: 10.1111/acer.13431] [Citation(s) in RCA: 213] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 06/04/2017] [Indexed: 12/13/2022]
Abstract
Alcoholism is a complex and dynamic disease, punctuated by periods of abstinence and relapse, and influenced by a multitude of vulnerability factors. Chronic excessive alcohol consumption is associated with cognitive deficits, ranging from mild to severe, in executive functions, memory, and metacognitive abilities, with associated impairment in emotional processes and social cognition. These deficits can compromise efforts in initiating and sustaining abstinence by hampering efficacy of clinical treatment and can obstruct efforts in enabling good decision making success in interpersonal/social interactions, and awareness of cognitive and behavioral dysfunctions. Despite evidence for differences in recovery levels of selective cognitive processes, certain deficits can persist even with prolonged sobriety. Herein is presented a review of alcohol-related cognitive impairments affecting component processes of executive functioning, memory, and the recently investigated cognitive domains of metamemory, social cognition, and emotional processing; also considered are trajectories of cognitive recovery with abstinence. Finally, in the spirit of critical review, limitations of current knowledge are noted and avenues for new research efforts are proposed that focus on (i) the interaction among emotion-cognition processes and identification of vulnerability factors contributing to the development of emotional and social processing deficits and (ii) the time line of cognitive recovery by tracking alcoholism's dynamic course of sobriety and relapse. Knowledge about the heterochronicity of cognitive recovery in alcoholism has the potential of indicating at which points during recovery intervention may be most beneficial.
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Affiliation(s)
- Anne-Pascale Le Berre
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Rosemary Fama
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
- Neuroscience Program, SRI International, Menlo Park, CA 94025, USA
| | - Edith V. Sullivan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
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Brion M, D'Hondt F, Pitel AL, Lecomte B, Ferauge M, de Timary P, Maurage P. Executive functions in alcohol-dependence: A theoretically grounded and integrative exploration. Drug Alcohol Depend 2017; 177:39-47. [PMID: 28554151 DOI: 10.1016/j.drugalcdep.2017.03.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 02/13/2017] [Accepted: 03/10/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Alcohol-dependence is related to large-scale cognitive impairments, particularly for executive functions (EF). These deficits persist even after long-term abstinence and have a major impact on patients' everyday life and relapse risk. Earlier studies, based on multi-determined tasks, mostly focused on inhibition and did not offer a theoretically-grounded and exhaustive view of the differential deficit across EF. The present paper proposes a model-based exploration of EF in alcohol-dependent individuals (ALC), to precisely compare the specific deficit related to each executive subcomponent. METHODS Forty-seven recently detoxified ALC were compared to 47 matched healthy participants on a nine-tasks validated neuropsychological battery, simultaneously exploring and comparing the three main executive subcomponents (shifting, updating, and inhibition). Psychopathological comorbidities were also controlled for. RESULTS Reaction time indexes revealed a global slowing down among ALC, whatever the EF explored. Accuracy indexes revealed a moderate deficit for inhibition tasks but a massive impairment for shifting and updating ones. Complementary analyses indicated that the executive deficits observed were centrally related to alcohol-dependence, while comorbid depressive symptoms appeared to intensify the deficits observed. CONCLUSIONS By offering a direct comparison between the three major EF, these results showed that alcohol-related executive deficits extend beyond the classically described inhibition impairment. This impairment encompasses each EF subcomponent, as ALC actually presented stronger deficits for updating and shifting abilities. This first observation of a multifaceted EF deficit stresses the need for an individualized evaluation and rehabilitation of EF during and/or after the detoxification process.
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Affiliation(s)
- Mélanie Brion
- Laboratory for Experimental Psychopathology, Psychological Sciences Research Institute, Université catholique de Louvain,10 Place C. Mercier, B-1348 Louvain-la-Neuve, Belgium
| | - Fabien D'Hondt
- Univ. Lille, CNRS UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, psyCHIC team,1 Place de Verdun, F-59045 Lille, France; CHU Lille, Clinique de Psychiatrie, CURE, F-59000, Lille, France
| | - Anne-Lise Pitel
- INSERM, École Pratique des Hautes Études, Université de Caen-Normandie, Unité U1077, GIP Cyceron, CHU Caen, F-14000 Caen, France
| | - Benoît Lecomte
- Department of Neuropsychiatry, Saint-Martin Hospital, 84 rue Saint-Hubert, B-5100 Dave, Belgium
| | - Marc Ferauge
- Department of Addiction Rehabilitation, Beau-Vallon Hospital, 205 rue de Bricgniot, B-5002 Saint-Servais, Belgium
| | - Philippe de Timary
- Laboratory for Experimental Psychopathology, Psychological Sciences Research Institute, Université catholique de Louvain,10 Place C. Mercier, B-1348 Louvain-la-Neuve, Belgium; Department of Adult Psychiatry, St Luc Hospital and Institute of Neuroscience, Université catholique de Louvain,10 Avenue Hippocrate, B-1200 Brussels, Belgium
| | - Pierre Maurage
- Laboratory for Experimental Psychopathology, Psychological Sciences Research Institute, Université catholique de Louvain,10 Place C. Mercier, B-1348 Louvain-la-Neuve, Belgium.
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Hanak C, Benoit J, Fabry L, Hein M, Verbanck P, de Witte P, Walter H, Dexter DT, Ward RJ. Changes in Pro-Inflammatory Markers in Detoxifying Chronic Alcohol Abusers, Divided by Lesch Typology, Reflect Cognitive Dysfunction. Alcohol Alcohol 2017; 52:529-534. [DOI: 10.1093/alcalc/agx043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 06/12/2017] [Indexed: 12/14/2022] Open
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Martelli C, Petillion A, Brunet-Lecomte M, Miranda Marcos R, Chanraud S, Amirouche A, Letierce A, Kostogianni N, Lemaitre H, Aubin HJ, Blecha L, Reynaud M, Martinot JL, Benyamina A. Neuropsychological Impairment in Detoxified Alcohol-Dependent Subjects with Preserved Psychosocial Functioning. Front Psychiatry 2017; 8:193. [PMID: 29033861 PMCID: PMC5626858 DOI: 10.3389/fpsyt.2017.00193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 09/19/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chronic alcoholism and its related cognitive impairments are associated with increased social, relational, and professional deficits which have a variable overall impact on social integration. These impairments are known to have varying severities and have rarely been studied among healthy alcohol-dependent subjects with preserved psychosocial functioning. Thus, the objective of this study is to describe neuropsychological performance in this particular population. METHOD Twenty-nine socially adjusted alcohol-dependent men, hospitalized for a first or second withdrawal and abstinent for 3 weeks minimum, were compared to 29 healthy non-alcoholic controls. All subjects underwent clinical and psychiatric examination, neuropsychological tests of memory (M), working memory (WM), and executive functions (EF). Comparisons were performed using Student's t-tests or Mann-Whitney U tests. RESULTS No group differences were found on the Self-Reported Social Adjustment Scale (SAS-SR) or in the Mini-Mental State Examination. Compared to controls, patients had greater episodic, spatial, and WM deficits as well as slightly altered executive functions. In contrast, their executive functions (spontaneous flexibility, criteria generation, rule maintenance, and inhibitory control) were relatively preserved. CONCLUSION Our sample of socially and professionally integrated alcoholic patients shows fewer cognitive deficits than described in previous studies. Our results suggest that early on, alcohol-dependent subjects develop compensatory adaptation processes to preserve social function and adaptation. Minor cognitive impairments should be screened early in the disease to integrate cognitive interventions into the health-care plan to thus eventually prevent further socio-professional marginalization.
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Affiliation(s)
- Catherine Martelli
- AP-HP, Paul Brousse Hospital, Department of Psychiatry and Addictology, Villejuif, France.,INSERM U1018, Centre de recherche en Epidémiologie et Santé des Populations, Villejuif, France.,Université Paris-Sud, Le Kremlin Bicêtre, France
| | - Amélie Petillion
- AP-HP, Paul Brousse Hospital, Department of Psychiatry and Addictology, Villejuif, France
| | - Marine Brunet-Lecomte
- AP-HP, Paul Brousse Hospital, Department of Psychiatry and Addictology, Villejuif, France
| | - Rubén Miranda Marcos
- INSERM, U1000 "Neuroimaging & Psychiatry", IFR49, Orsay, France.,CEA, "Neuroimaging & Psychiatry" U1000 Unit, Hospital Department Frédéric Joliot, Orsay, France
| | - Sandra Chanraud
- Bordeaux University, INCIA, UMR 5287, Talence, France.,CNRS, INCIA, UMR 5287, Talence, France
| | - Ammar Amirouche
- AP-HP, Paul Brousse Hospital, Department of Psychiatry and Addictology, Villejuif, France.,INSERM U1018, Centre de recherche en Epidémiologie et Santé des Populations, Villejuif, France.,Université Paris-Sud, Le Kremlin Bicêtre, France
| | - Alexia Letierce
- AP-HP, Bicêtre Hospital, Clinical Research Unit, Le Kremlin Bicêtre, France
| | - Nikoleta Kostogianni
- AP-HP, Paul Brousse Hospital, Department of Psychiatry and Addictology, Villejuif, France
| | - Hervé Lemaitre
- INSERM, U1000 "Neuroimaging & Psychiatry", IFR49, Orsay, France.,Bordeaux University, INCIA, UMR 5287, Talence, France.,CNRS, INCIA, UMR 5287, Talence, France
| | - Henri-Jean Aubin
- AP-HP, Paul Brousse Hospital, Department of Psychiatry and Addictology, Villejuif, France.,Université Paris-Sud, Orsay, France.,Université Paris Descartes, UMR U797, Paris, France
| | - Lisa Blecha
- AP-HP, Paul Brousse Hospital, Department of Psychiatry and Addictology, Villejuif, France.,INSERM U1018, Centre de recherche en Epidémiologie et Santé des Populations, Villejuif, France.,Université Paris-Sud, Le Kremlin Bicêtre, France
| | - Michel Reynaud
- AP-HP, Paul Brousse Hospital, Department of Psychiatry and Addictology, Villejuif, France.,INSERM U1018, Centre de recherche en Epidémiologie et Santé des Populations, Villejuif, France.,Université Paris-Sud, Le Kremlin Bicêtre, France
| | - Jean-Luc Martinot
- INSERM, U1000 "Neuroimaging & Psychiatry", IFR49, Orsay, France.,CEA, "Neuroimaging & Psychiatry" U1000 Unit, Hospital Department Frédéric Joliot, Orsay, France.,Bordeaux University, INCIA, UMR 5287, Talence, France.,CNRS, INCIA, UMR 5287, Talence, France
| | - Amine Benyamina
- AP-HP, Paul Brousse Hospital, Department of Psychiatry and Addictology, Villejuif, France.,INSERM U1018, Centre de recherche en Epidémiologie et Santé des Populations, Villejuif, France.,Université Paris-Sud, Le Kremlin Bicêtre, France
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Cuervo-Lombard C, Raucher-Chéné D, Barrière S, Van der Linden M, Kaladjian A. Self-defining memories in recently detoxified alcohol-dependent patients. Psychiatry Res 2016; 246:533-538. [PMID: 27821365 DOI: 10.1016/j.psychres.2016.09.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 06/19/2016] [Accepted: 09/24/2016] [Indexed: 11/20/2022]
Abstract
Patients with alcohol dependence have been shown to be impaired in recalling specific autobiographical events, yet little is known on how changes in the memory of these events may impact their self-representation. In this study, we examined Self-Defining Memories (SDMs), a specific type of autobiographical memory that plays a key role in the construction of personal identity, in 25 patients with alcohol dependence, abstinent from alcohol from 10 days to 6 months, compared to 28 control subjects. We observed that SDMs in patients were significantly less specific and included more reference to alcohol than those of controls. Patients also reported more SDMs with negative emotional valence and higher emotional intensity. These results suggest that recently abstinent alcohol-dependent patients may be prone to define themselves by negative events referring to alcohol consumption, which may contribute to an unfavorable perception of their self and subsequently of their ability to remain abstinent. These findings should be taken into account to optimize psychological approaches in the treatment of alcohol-dependence.
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Affiliation(s)
- Christine Cuervo-Lombard
- Department of Psychiatry, Reims University Hospital, Reims, France; Department of Psychology, Centre d'Etudes et de Recherche en Psychopathologie et Psychologie de la Santé EA 7411 (CERPPS), Toulouse 2 Jean Jaurès University, Toulouse, France.
| | - Delphine Raucher-Chéné
- Department of Psychiatry, Reims University Hospital, Reims, France; Cognition Santé Socialisation Laboratory, EA 6291, Reims Champagne-Ardenne University, Reims, France
| | - Sarah Barrière
- Department of Psychiatry, Reims University Hospital, Reims, France
| | | | - Arthur Kaladjian
- Department of Psychiatry, Reims University Hospital, Reims, France; Cognition Santé Socialisation Laboratory, EA 6291, Reims Champagne-Ardenne University, Reims, France
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Mora-Simon S, Ladera-Fernandez V, Garcia-Garcia R, Patino-Alonso MC, Perea-Bartolome MV, Unzueta-Arce J, Perez-Arechaederra D, Rodriguez-Sanchez E. Structure of Enhanced Cued Recall Task in the 7 Minute Screen Test. APPLIED NEUROPSYCHOLOGY-ADULT 2016; 24:152-159. [PMID: 27045352 DOI: 10.1080/23279095.2015.1116073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Episodic memory in the 7 Minute Screen is assessed by the Enhanced Cued Recall (ECR) test. The ECR test is composed of three phases, Identification, Immediate Recall, and Free and Cued Recall. However, just the last phase is considered for the total score. We believe that collecting the performance data of the Identification and Immediate Recall phases could provide information regarding possible difficulties or impairments in the different aspects involved in the temporal mnesic process of acquisition of new information, such as in working memory or visual identification. The objective was to assess the goodness of fit for the three phases of the ECR test using a Confirmatory Factor Analysis (CFA) to show if each phase is separated from each other as a different aspect that participates in the mnesic process. A total of 311 participants greater than 65 years were included in this study. Confirmatory factor analyses were conducted for each individual phase. The analyses show that the ECR test consists of three separate phases that identify different steps of the mnesic process. Individual scores for each phase could allow for investigation of patient performance in different aspects of the memory process and could help in further neuropsychological assessment.
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Affiliation(s)
- Sara Mora-Simon
- a Department of Basic Psychology, Psychobiology and Behavioral Sciences Methodology, Faculty of Psychology , University of Salamanca , Salamanca , Spain.,b Primary Care Research Unit, The Alamedilla Health Center, Health Service-SACYL, REDIAPP, IBSAL , Salamanca , Spain
| | - Valentina Ladera-Fernandez
- a Department of Basic Psychology, Psychobiology and Behavioral Sciences Methodology, Faculty of Psychology , University of Salamanca , Salamanca , Spain
| | - Ricardo Garcia-Garcia
- a Department of Basic Psychology, Psychobiology and Behavioral Sciences Methodology, Faculty of Psychology , University of Salamanca , Salamanca , Spain
| | - María C Patino-Alonso
- b Primary Care Research Unit, The Alamedilla Health Center, Health Service-SACYL, REDIAPP, IBSAL , Salamanca , Spain.,c Department of Statistics, Faculty of Medicine , University of Salamanca , Salamanca , Spain
| | - M Victoria Perea-Bartolome
- a Department of Basic Psychology, Psychobiology and Behavioral Sciences Methodology, Faculty of Psychology , University of Salamanca , Salamanca , Spain
| | - Jaime Unzueta-Arce
- a Department of Basic Psychology, Psychobiology and Behavioral Sciences Methodology, Faculty of Psychology , University of Salamanca , Salamanca , Spain
| | - Diana Perez-Arechaederra
- b Primary Care Research Unit, The Alamedilla Health Center, Health Service-SACYL, REDIAPP, IBSAL , Salamanca , Spain
| | - Emiliano Rodriguez-Sanchez
- b Primary Care Research Unit, The Alamedilla Health Center, Health Service-SACYL, REDIAPP, IBSAL , Salamanca , Spain.,d Medicine Department , University of Salamanca , Salamanca , Spain
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Nandrino JL, El Haj M, Torre J, Naye D, Douchet H, Danel T, Cottençin O. Autobiographical Memory Deficits in Alcohol-Dependent Patients with Short- and Long-Term Abstinence. Alcohol Clin Exp Res 2016; 40:865-73. [PMID: 26990362 DOI: 10.1111/acer.13001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 01/07/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Autobiographical memory (AM) enables the storage and retrieval of life experiences that allow individuals to build their sense of identity. Several AM impairments have been described in patients with alcohol abuse disorders without assessing whether such deficits can be recovered. This cross-sectional study aimed to identify whether the semantic (SAM) and episodic (EAM) dimensions of AM are affected in individuals with alcohol dependence after short-term abstinence (STA) or long-term abstinence (LTA). A second aim of this study was to examine the factors that could disrupt the efficiency of semantic and episodic AM (the impact of depression severity, cognitive functions, recent or early traumatic events, and drinking history variables). METHODS After clinical and cognitive evaluations (alcohol consumption, depression, anxiety, IQ, memory performance), AM was assessed with the Autobiographical Memory Interview in patients with recent (between 4 and 6 weeks) and longer (at least 6 months) abstinence. Participants were asked to retrieve the number and nature of traumatic or painful life experiences in recent or early life periods (using the Childhood Traumatic Events Scale). RESULTS The 2 abstinent groups had lower global EAM and SAM scores than the control group. These scores were comparable for both abstinent groups. For childhood events, no significant differences were observed in SAM for both groups compared with control participants. For early adulthood and recent events, both STA and LTA groups had lower scores on both SAM and EAM. Moreover, there was a negative correlation between the length of substance consumption and SAM scores. CONCLUSIONS This study highlighted a specific AM disorder in both episodic and semantic dimensions. These deficits remained after 6 months of abstinence. This AM impairment may be explained by compromised encoding and consolidation of memories during bouts of drinking.
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Affiliation(s)
- Jean-Louis Nandrino
- UMR CNRS 9193, SCALAB Cognitive and Affective Sciences Laboratory, University of Lille, Villeneuve d'Ascq, France
| | - Mohamad El Haj
- UMR CNRS 9193, SCALAB Cognitive and Affective Sciences Laboratory, University of Lille, Villeneuve d'Ascq, France
| | - Julie Torre
- Department of Psychology, University of Lille, Villeneuve d'Ascq, France
| | - Delphine Naye
- Department of Psychology, University of Lille, Villeneuve d'Ascq, France
| | | | | | - Oliver Cottençin
- UMR CNRS 9193, SCALAB Cognitive and Affective Sciences Laboratory, University of Lille, Villeneuve d'Ascq, France.,Addiction Treatment Unit, CHRU Lille, Lille, France
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Brion M, Pitel AL, D'Hondt F. New Perspectives in the Exploration of Korsakoff's Syndrome: The Usefulness of Neurophysiological Markers. Front Psychol 2016; 7:168. [PMID: 26909060 PMCID: PMC4754411 DOI: 10.3389/fpsyg.2016.00168] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/29/2016] [Indexed: 01/17/2023] Open
Abstract
This perspective aims at underlining the usefulness of event-related potentials (ERP) to better understand the brain correlates of Korsakoff’s syndrome (KS), a neuropsychiatric disease characterized by severe memory impairment and most frequently resulting as a neurological complication of alcohol-dependence (AD). While ERP have been broadly used in AD, it has up to now been very little applied in KS or in the comparison of KS and AD. Within the framework of dual-process models, an influential theory postulating that addictive states result from an imbalance between under-activated reflective system and over-activated automatic-affective one, this paper proposes: (1) a brief synthesis of the main results of ERP studies in AD and KS, and (2) new research avenues using ERP to identify the electrophysiological correlates of cognitive and emotional dysfunction in KS. These experimental perspectives aim at exploring the continuity hypothesis, which postulates a gradient of impairments from AD to KS. We conclude on the possibility of developing neuropsychological strategies with electrophysiological follow-up to ensure KS diagnosis and test the efficacy of patient’s neurocognitive rehabilitation.
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Affiliation(s)
- Mélanie Brion
- Laboratory for Experimental Psychopathology, Psychological Sciences Research Institute, Université catholique de Louvain Louvain-la-Neuve, Belgium
| | - Anne-Lise Pitel
- INSERM, Unité U1077, École Pratique des Hautes Études, Université de Caen-Basse Normandie - GIP Cyceron - CHU Caen Caen, France
| | - Fabien D'Hondt
- Laboratory for Experimental Psychopathology, Psychological Sciences Research Institute, Université catholique de Louvain Louvain-la-Neuve, Belgium
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Cabé N, Laniepce A, Ritz L, Lannuzel C, Boudehent C, Vabret F, Eustache F, Beaunieux H, Pitel AL. Troubles cognitifs dans l’alcoolodépendance : intérêt du dépistage dans l’optimisation des prises en charge. Encephale 2016; 42:74-81. [DOI: 10.1016/j.encep.2015.12.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 12/08/2015] [Indexed: 02/08/2023]
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Staples MC, Mandyam CD. Thinking after Drinking: Impaired Hippocampal-Dependent Cognition in Human Alcoholics and Animal Models of Alcohol Dependence. Front Psychiatry 2016; 7:162. [PMID: 27746746 PMCID: PMC5043052 DOI: 10.3389/fpsyt.2016.00162] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 09/13/2016] [Indexed: 12/05/2022] Open
Abstract
Alcohol use disorder currently affects approximately 18 million Americans, with at least half of these individuals having significant cognitive impairments subsequent to their chronic alcohol use. This is most widely apparent as frontal cortex-dependent cognitive dysfunction, where executive function and decision-making are severely compromised, as well as hippocampus-dependent cognitive dysfunction, where contextual and temporal reasoning are negatively impacted. This review discusses the relevant clinical literature to support the theory that cognitive recovery in tasks dependent on the prefrontal cortex and hippocampus is temporally different across extended periods of abstinence from alcohol. Additional studies from preclinical models are discussed to support clinical findings. Finally, the unique cellular composition of the hippocampus and cognitive impairment dependent on the hippocampus is highlighted in the context of alcohol dependence.
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Affiliation(s)
- Miranda C Staples
- Committee on the Neurobiology of Addictive Disorders, The Scripps Research Institute , La Jolla, CA , USA
| | - Chitra D Mandyam
- Committee on the Neurobiology of Addictive Disorders, The Scripps Research Institute , La Jolla, CA , USA
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Ritz L, Lannuzel C, Boudehent C, Vabret F, Bordas N, Segobin S, Eustache F, Pitel AL, Beaunieux H. Validation of a Brief Screening Tool for Alcohol-Related Neuropsychological Impairments. Alcohol Clin Exp Res 2015; 39:2249-60. [DOI: 10.1111/acer.12888] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 08/25/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Ludivine Ritz
- U1077; INSERM; Caen France
- UMR-S1077; Université de Caen Basse-Normandie; Caen France
- UMR-S1077; Ecole Pratique des Hautes Etudes; Caen France
- U1077; Centre Hospitalier Universitaire; Caen France
| | - Coralie Lannuzel
- U1077; INSERM; Caen France
- UMR-S1077; Université de Caen Basse-Normandie; Caen France
- UMR-S1077; Ecole Pratique des Hautes Etudes; Caen France
- U1077; Centre Hospitalier Universitaire; Caen France
| | - Céline Boudehent
- U1077; INSERM; Caen France
- UMR-S1077; Université de Caen Basse-Normandie; Caen France
- UMR-S1077; Ecole Pratique des Hautes Etudes; Caen France
- U1077; Centre Hospitalier Universitaire; Caen France
- Service d'addictologie; Centre Hospitalier Universitaire; Caen France
| | - François Vabret
- U1077; INSERM; Caen France
- UMR-S1077; Université de Caen Basse-Normandie; Caen France
- UMR-S1077; Ecole Pratique des Hautes Etudes; Caen France
- U1077; Centre Hospitalier Universitaire; Caen France
- Service d'addictologie; Centre Hospitalier Universitaire; Caen France
| | - Nadège Bordas
- Centre Hospitalier Universitaire Paul Brousse; Villejuif France
| | - Shailendra Segobin
- U1077; INSERM; Caen France
- UMR-S1077; Université de Caen Basse-Normandie; Caen France
- UMR-S1077; Ecole Pratique des Hautes Etudes; Caen France
- U1077; Centre Hospitalier Universitaire; Caen France
| | - Francis Eustache
- U1077; INSERM; Caen France
- UMR-S1077; Université de Caen Basse-Normandie; Caen France
- UMR-S1077; Ecole Pratique des Hautes Etudes; Caen France
- U1077; Centre Hospitalier Universitaire; Caen France
| | - Anne-Lise Pitel
- U1077; INSERM; Caen France
- UMR-S1077; Université de Caen Basse-Normandie; Caen France
- UMR-S1077; Ecole Pratique des Hautes Etudes; Caen France
- U1077; Centre Hospitalier Universitaire; Caen France
| | - Hélène Beaunieux
- U1077; INSERM; Caen France
- UMR-S1077; Université de Caen Basse-Normandie; Caen France
- UMR-S1077; Ecole Pratique des Hautes Etudes; Caen France
- U1077; Centre Hospitalier Universitaire; Caen France
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Sahakian BJ, Bruhl AB, Cook J, Killikelly C, Savulich G, Piercy T, Hafizi S, Perez J, Fernandez-Egea E, Suckling J, Jones PB. The impact of neuroscience on society: cognitive enhancement in neuropsychiatric disorders and in healthy people. Philos Trans R Soc Lond B Biol Sci 2015; 370:20140214. [PMID: 26240429 PMCID: PMC4528826 DOI: 10.1098/rstb.2014.0214] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2015] [Indexed: 01/23/2023] Open
Abstract
In addition to causing distress and disability to the individual, neuropsychiatric disorders are also extremely expensive to society and governments. These disorders are both common and debilitating and impact on cognition, functionality and wellbeing. Cognitive enhancing drugs, such as cholinesterase inhibitors and methylphenidate, are used to treat cognitive dysfunction in Alzheimer's disease and attention deficit hyperactivity disorder, respectively. Other cognitive enhancers include specific computerized cognitive training and devices. An example of a novel form of cognitive enhancement using the technological advancement of a game on an iPad that also acts to increase motivation is presented. Cognitive enhancing drugs, such as methylphenidate and modafinil, which were developed as treatments, are increasingly being used by healthy people. Modafinil not only affects 'cold' cognition, but also improves 'hot' cognition, such as emotion recognition and task-related motivation. The lifestyle use of 'smart drugs' raises both safety concerns as well as ethical issues, including coercion and increasing disparity in society. As a society, we need to consider which forms of cognitive enhancement (e.g. pharmacological, exercise, lifelong learning) are acceptable and for which groups (e.g. military, doctors) under what conditions (e.g. war, shift work) and by what methods we would wish to improve and flourish.
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Affiliation(s)
- Barbara J Sahakian
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge CB2 0SZ, UK MRC/Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB2 3EB, UK
| | - Annette B Bruhl
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge CB2 0SZ, UK MRC/Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB2 3EB, UK Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland
| | - Jennifer Cook
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge CB2 0SZ, UK
| | - Clare Killikelly
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge CB2 0SZ, UK
| | - George Savulich
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge CB2 0SZ, UK
| | - Thomas Piercy
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge CB2 0SZ, UK
| | - Sepehr Hafizi
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge CB2 0SZ, UK CAMEO North Team, 3 Thorpe Road, Peterborough PE3 6AN, UK
| | - Jesus Perez
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge CB2 0SZ, UK CAMEO South Team, Block 7, Ida Darwin Site, Fulbourn, Cambridge CB21 5EE, UK
| | - Emilio Fernandez-Egea
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge CB2 0SZ, UK MRC/Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB2 3EB, UK
| | - John Suckling
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge CB2 0SZ, UK MRC/Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB2 3EB, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge CB2 0SZ, UK MRC/Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB2 3EB, UK
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Segobin S, Ritz L, Lannuzel C, Boudehent C, Vabret F, Eustache F, Beaunieux H, Pitel AL. Integrity of white matter microstructure in alcoholics with and without Korsakoff's syndrome. Hum Brain Mapp 2015; 36:2795-808. [PMID: 25873017 DOI: 10.1002/hbm.22808] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 03/19/2015] [Accepted: 03/21/2015] [Indexed: 12/11/2022] Open
Abstract
Alcohol dependence results in two different clinical forms: "uncomplicated" alcoholism (UA) and Korsakoff's syndrome (KS). Certain brain networks are especially affected in UA and KS: the frontocerebellar circuit (FCC) and the Papez circuit (PC). Our aims were (1) to describe the profile of white matter (WM) microstructure in FCC and PC in the two clinical forms, (2) to identify those UA patients at risk of developing KS using their WM microstructural integrity as a biomarker. Tract-based spatial statistics and nonparametric voxel-based permutation tests were used to compare diffusion tensor imaging (DTI) data in 7 KS, 20 UA, and 14 healthy controls. The two patient groups were also pooled together and compared to controls. k-means classifications were then performed on mean fractional anisotropy values of significant clusters across all subjects for two fiber tracts from the FCC (the middle cerebellar peduncle and superior cerebellar peduncle) and two tracts from the PC (fornix and cingulum). We found graded effects of WM microstructural abnormalities in the PC of UA and KS. UA patients classified at risk of developing KS using fiber tracts of the PC from DTI data also had the lowest scores of episodic memory. That finding suggests that WM microstructure could be used as a biomarker for early detection of UA patients at risk of developing KS.
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Affiliation(s)
- Shailendra Segobin
- INSERM, Caen, France.,Université De Caen Basse-Normandie, Caen, France.,Ecole Pratique Des Hautes Etudes, Caen, France.,Centre Hospitalier Universitaire, Caen, France
| | - Ludivine Ritz
- INSERM, Caen, France.,Université De Caen Basse-Normandie, Caen, France.,Ecole Pratique Des Hautes Etudes, Caen, France.,Centre Hospitalier Universitaire, Caen, France
| | - Coralie Lannuzel
- INSERM, Caen, France.,Université De Caen Basse-Normandie, Caen, France.,Ecole Pratique Des Hautes Etudes, Caen, France.,Centre Hospitalier Universitaire, Caen, France
| | - Céline Boudehent
- INSERM, Caen, France.,Université De Caen Basse-Normandie, Caen, France.,Ecole Pratique Des Hautes Etudes, Caen, France.,Centre Hospitalier Universitaire, Caen, France.,Centre Hospitalier Universitaire, Service D'addictologie, Caen, France
| | - François Vabret
- INSERM, Caen, France.,Université De Caen Basse-Normandie, Caen, France.,Ecole Pratique Des Hautes Etudes, Caen, France.,Centre Hospitalier Universitaire, Caen, France.,Centre Hospitalier Universitaire, Service D'addictologie, Caen, France
| | - Francis Eustache
- INSERM, Caen, France.,Université De Caen Basse-Normandie, Caen, France.,Ecole Pratique Des Hautes Etudes, Caen, France.,Centre Hospitalier Universitaire, Caen, France
| | - Hélène Beaunieux
- INSERM, Caen, France.,Université De Caen Basse-Normandie, Caen, France.,Ecole Pratique Des Hautes Etudes, Caen, France.,Centre Hospitalier Universitaire, Caen, France
| | - Anne-Lise Pitel
- INSERM, Caen, France.,Université De Caen Basse-Normandie, Caen, France.,Ecole Pratique Des Hautes Etudes, Caen, France.,Centre Hospitalier Universitaire, Caen, France
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Nandrino JL, Gandolphe MC, Alexandre C, Kmiecik E, Yguel J, Urso L. Cognitive and affective theory of mind abilities in alcohol-dependent patients: the role of autobiographical memory. Drug Alcohol Depend 2014; 143:65-73. [PMID: 25107313 DOI: 10.1016/j.drugalcdep.2014.07.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 05/28/2014] [Accepted: 07/07/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Many studies of patients with alcohol dependence (AD) have highlighted their difficulty in identifying both their own emotional state and those of a social partner. We examined (1) the cognitive and affective theory of mind (ToM) abilities of AD patients and (2) how the efficiency of their autobiographical memory (AM) can affect the effectiveness of ToM ability. METHOD In a cross-sectional design, AD patients (N=50) and healthy controls (N=30) completed a ToM movie paradigm (Versailles-Situational Intention Reading, V-SIR) in which they inferred the intentions of characters in movies depicting social interactions, and the "Reading the Mind in the Eyes" Test (RMET), which assessed the emotional dimension of the ToM. AM was investigated using the "Autobiographical Memory Interview" (AMI) to assess both episodic and semantic components of AM. RESULTS Concerning ToM, patients with AD showed lower performance in the RMET than control participants, whereas no difference was observed on the V-SIR test. AD patients had lower scores than controls on the AMI, for both episodic and semantic components and for different periods of life. A multiple linear regression analysis also showed that AM deficits might predict lower ToM performance, especially for the RMET task. CONCLUSIONS Patients with AD have a specific affective ToM deficit. They used episodic memories to perceive the emotions of others, whereas controls used preferentially semantic memories to perform the task. Both these deficits could constitute a risk of relapse and should be a target for psychotherapeutic interventions.
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Affiliation(s)
- Jean-Louis Nandrino
- URECA, EA 1059, Cognitive and Affective Sciences Laboratory, Université Lille 3, Villeneuve d'Ascq, France; Fondation Santé des Etudiants de France, Clinique médico-psychologique, Villeneuve d'Ascq, France.
| | - Marie-Charlotte Gandolphe
- URECA, EA 1059, Cognitive and Affective Sciences Laboratory, Université Lille 3, Villeneuve d'Ascq, France
| | - Charlotte Alexandre
- URECA, EA 1059, Cognitive and Affective Sciences Laboratory, Université Lille 3, Villeneuve d'Ascq, France
| | - Elodie Kmiecik
- URECA, EA 1059, Cognitive and Affective Sciences Laboratory, Université Lille 3, Villeneuve d'Ascq, France
| | - Jacques Yguel
- Service d'alcoologie, Centre Hospitalier d'Avesnes/Helpe, Avesnes-sur-Helpe, France
| | - Laurent Urso
- Service d'addictologie, Centre Hospitalier de Roubaix, Roubaix, France
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Thalamic abnormalities are a cardinal feature of alcohol-related brain dysfunction. Neurosci Biobehav Rev 2014; 54:38-45. [PMID: 25108034 DOI: 10.1016/j.neubiorev.2014.07.023] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 07/11/2014] [Accepted: 07/28/2014] [Indexed: 01/27/2023]
Abstract
Two brain networks are particularly affected by the harmful effect of chronic and excessive alcohol consumption: the circuit of Papez and the frontocerebellar circuit, in both of which the thalamus plays a key role. Shrinkage of the thalamus is more severe in alcoholics with Korsakoff's syndrome (KS) than in those without neurological complication (AL). In accordance with the gradient effect of thalamic abnormalities between AL and KS, the pattern of brain dysfunction in the Papez's circuit results in anterograde amnesia in KS and only mild-to-moderate episodic memory disorders in AL. On the opposite, dysfunction of the frontocerebellar circuit results in a similar pattern of working memory and executive deficits in the AL and KS. Several hypotheses, mutually compatible, can be drawn to explain that the severe thalamic shrinkage observed in KS has different consequences in the neuropsychological profile associated with the two brain networks.
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45
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Ritz L, Segobin S, Le Berre AP, Lannuzel C, Boudehent C, Vabret F, Eustache F, Pitel AL, Beaunieux H. Brain structural substrates of cognitive procedural learning in alcoholic patients early in abstinence. Alcohol Clin Exp Res 2014; 38:2208-16. [PMID: 25156613 PMCID: PMC5161765 DOI: 10.1111/acer.12486] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 04/29/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Procedural learning allows for the acquisition of new behavioral skills. Previous studies have shown that chronic alcoholism is characterized by impaired cognitive procedural learning and brain abnormalities affecting regions that are involved in the automation of new cognitive procedures in healthy individuals. The goal of the present study was to investigate the brain structural substrates of cognitive procedural learning in alcoholic patients (ALs) early in abstinence. METHODS Thirty-one ALs and 31 control participants (NCs) performed the Tower of Toronto task (4 daily learning sessions, each comprising 10 trials) to assess cognitive procedural learning. We also assessed episodic and working memory, executive functions, and visuospatial abilities. ALs underwent 1.5T structural magnetic resonance imaging. RESULTS The initial cognitive phase was longer in the AL group than in the NC group, whereas the autonomous phase was shorter. In ALs, the longer cognitive phase was predicted by poorer planning and visuospatial working memory abilities, and by smaller gray matter (GM) volumes in the angular gyrus and caudate nucleus. ALs' planning abilities correlated with smaller GM volume in the angular gyrus. CONCLUSIONS Cognitive procedural learning was impaired in ALs, with a delayed transition from the cognitive to the autonomous phase. This slowdown in the automation of the cognitive procedure was related to lower planning abilities, which may have hampered the initial generation of the procedure to be learned. In agreement with this neuropsychological finding, a persistent relationship was found between learning performance and the GM volumes of the angular gyrus and caudate nucleus, which are usually regarded as markers of planning and initial learning of the cognitive procedure.
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Affiliation(s)
- Ludivine Ritz
- Neuropsychologie cognitive et neuroanatomie fonctionnelle de la mémoire humaine
École pratique des hautes études - Université Caen Normandie - Institut National de la Santé et de la Recherche Médicale - U1077CHU côte de Nacre, bd Henri Becquerel 14033 Caen
| | - Shailendra Segobin
- Neuropsychologie cognitive et neuroanatomie fonctionnelle de la mémoire humaine
École pratique des hautes études - Université Caen Normandie - Institut National de la Santé et de la Recherche Médicale - U1077CHU côte de Nacre, bd Henri Becquerel 14033 Caen
| | - Anne Pascale Le Berre
- Neuropsychologie cognitive et neuroanatomie fonctionnelle de la mémoire humaine
École pratique des hautes études - Université Caen Normandie - Institut National de la Santé et de la Recherche Médicale - U1077CHU côte de Nacre, bd Henri Becquerel 14033 Caen
| | - Coralie Lannuzel
- Neuropsychologie cognitive et neuroanatomie fonctionnelle de la mémoire humaine
École pratique des hautes études - Université Caen Normandie - Institut National de la Santé et de la Recherche Médicale - U1077CHU côte de Nacre, bd Henri Becquerel 14033 Caen
| | - Céline Boudehent
- Neuropsychologie cognitive et neuroanatomie fonctionnelle de la mémoire humaine
École pratique des hautes études - Université Caen Normandie - Institut National de la Santé et de la Recherche Médicale - U1077CHU côte de Nacre, bd Henri Becquerel 14033 Caen
- Service d'Addictologie
CHU Caen - Hôpital Côte de Nacre (Caen) - Avenue de la Côte de Nacre 14033 Caen Cedex 9
| | - François Vabret
- Neuropsychologie cognitive et neuroanatomie fonctionnelle de la mémoire humaine
École pratique des hautes études - Université Caen Normandie - Institut National de la Santé et de la Recherche Médicale - U1077CHU côte de Nacre, bd Henri Becquerel 14033 Caen
- Service d'Addictologie
CHU Caen - Hôpital Côte de Nacre (Caen) - Avenue de la Côte de Nacre 14033 Caen Cedex 9
| | - Francis Eustache
- Neuropsychologie cognitive et neuroanatomie fonctionnelle de la mémoire humaine
École pratique des hautes études - Université Caen Normandie - Institut National de la Santé et de la Recherche Médicale - U1077CHU côte de Nacre, bd Henri Becquerel 14033 Caen
| | - Anne Lise Pitel
- Neuropsychologie cognitive et neuroanatomie fonctionnelle de la mémoire humaine
École pratique des hautes études - Université Caen Normandie - Institut National de la Santé et de la Recherche Médicale - U1077CHU côte de Nacre, bd Henri Becquerel 14033 Caen
| | - Hélène Beaunieux
- Neuropsychologie cognitive et neuroanatomie fonctionnelle de la mémoire humaine
École pratique des hautes études - Université Caen Normandie - Institut National de la Santé et de la Recherche Médicale - U1077CHU côte de Nacre, bd Henri Becquerel 14033 Caen
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Brion M, Pitel AL, Beaunieux H, Maurage P. Revisiting the continuum hypothesis: toward an in-depth exploration of executive functions in korsakoff syndrome. Front Hum Neurosci 2014; 8:498. [PMID: 25071526 PMCID: PMC4081760 DOI: 10.3389/fnhum.2014.00498] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 06/19/2014] [Indexed: 11/24/2022] Open
Abstract
Korsakoff syndrome (KS) is a neurological state mostly caused by alcohol-dependence and leading to disproportionate episodic memory deficits. KS patients present more severe anterograde amnesia than Alcohol-Dependent Subjects (ADS), which led to the continuum hypothesis postulating a progressive increase in brain and cognitive damages during the evolution from ADS to KS. This hypothesis has been extensively examined for memory but is still debated for other abilities, notably executive functions (EF). EF have up to now been explored by unspecific tasks in KS, and few studies explored their interactions with memory. Exploring EF in KS by specific tasks based on current EF models could thus renew the exploration of the continuum hypothesis. This paper will propose a research program aiming at: (1) clarifying the extent of executive dysfunctions in KS by tasks focusing on specific EF subcomponents; (2) determining the differential EF deficits in ADS and KS; (3) exploring EF-memory interactions in KS with innovative tasks. At the fundamental level, this exploration will test the continuum hypothesis beyond memory. At the clinical level, it will propose new rehabilitation tools focusing on the EF specifically impaired in KS.
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Affiliation(s)
- Mélanie Brion
- Laboratory for Experimental Psychopathology, Institute of Psychology, Université Catholique de Louvain , Louvain-la-Neuve , Belgium
| | - Anne-Lise Pitel
- INSERM, École Pratique des Hautes Études, Université de Caen-Basse Normandie, Unité U1077, GIP Cyceron, CHU Caen , Caen , France
| | - Hélène Beaunieux
- INSERM, École Pratique des Hautes Études, Université de Caen-Basse Normandie, Unité U1077, GIP Cyceron, CHU Caen , Caen , France
| | - Pierre Maurage
- Laboratory for Experimental Psychopathology, Institute of Psychology, Université Catholique de Louvain , Louvain-la-Neuve , Belgium
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Wilcox CE, Dekonenko CJ, Mayer AR, Bogenschutz MP, Turner JA. Cognitive control in alcohol use disorder: deficits and clinical relevance. Rev Neurosci 2014; 25:1-24. [PMID: 24361772 DOI: 10.1515/revneuro-2013-0054] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 11/27/2013] [Indexed: 01/25/2023]
Abstract
Cognitive control refers to the internal representation, maintenance, and updating of context information in the service of exerting control over thoughts and behavior. Deficits in cognitive control likely contribute to difficulty in maintaining abstinence in individuals with alcohol use disorders (AUD). In this article, we define three cognitive control processes in detail (response inhibition, distractor interference control, and working memory), review the tasks measuring performance in these areas, and summarize the brain networks involved in carrying out these processes. Next, we review evidence of deficits in these processes in AUD, including both metrics of task performance and functional neuroimaging. Finally, we explore the clinical relevance of these deficits by identifying predictors of clinical outcome and markers that appear to change (improve) with treatment. We observe that individuals with AUD experience deficits in some, but not all, metrics of cognitive control. Deficits in cognitive control may predict clinical outcome in AUD, but more work is necessary to replicate findings. It is likely that performance on tasks requiring cognitive control improves with abstinence, and with some psychosocial and medication treatments. Future work should clarify which aspects of cognitive control are most important to target during treatment of AUD.
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48
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Component processes of memory in alcoholism: pattern of compromise and neural substrates. HANDBOOK OF CLINICAL NEUROLOGY 2014; 125:211-25. [PMID: 25307577 DOI: 10.1016/b978-0-444-62619-6.00013-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Initially, alcohol-related memory deficits were considered only through the prism of Korsakoff's syndrome (KS). It is now clear, however, that chronic alcohol consumption results in memory disorders in alcoholics without ostensible neurologic complications, such as Wernicke's encephalopathy and KS. Most of the principal memory components are affected, including working memory, episodic memory, semantic memory, perceptual memory, and procedural memory. The extent of those cognitive impairments depends on several factors, such as age, gender, nutritional status, and psychiatric comorbidity. While memory disorders, especially episodic memory deficits, are largely definitive in patients with KS, recovery of memory abilities has been described with abstinence in uncomplicated alcoholics. Neuropsychologic impairments, and especially memory disorders, must be evaluated at alcohol treatment entry because they could impede patients from benefiting fully from cognitive and behavioral treatment approaches for alcohol dependence. Screening of memory deficits could also enable clinicians to detect, among alcoholics without ostensible neurologic complications, those at risk of developing permanent and debilitating amnesia that features KS.
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49
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Oscar-Berman M, Valmas MM, Sawyer KS, Ruiz SM, Luhar RB, Gravitz ZR. Profiles of impaired, spared, and recovered neuropsychologic processes in alcoholism. HANDBOOK OF CLINICAL NEUROLOGY 2014; 125:183-210. [PMID: 25307576 PMCID: PMC4515358 DOI: 10.1016/b978-0-444-62619-6.00012-4] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Long-term chronic alcoholism is associated with disparate and widespread residual consequences for brain functioning and behavior, and alcoholics suffer a variety of cognitive deficiencies and emotional abnormalities. Alcoholism has heterogeneous origins and outcomes, depending upon factors such as family history, age, gender, and mental or physical health. Consequently, the neuropsychologic profiles associated with alcoholism are not uniform among individuals. Moreover, within and across research studies, variability among subjects is substantial and contributes to characteristics associated with differential treatment outcomes after detoxification. In order to refine our understanding of alcoholism-related impaired, spared, and recovered abilities, we focus on five specific functional domains: (1) memory; (2) executive functions; (3) emotion and psychosocial skills; (4) visuospatial cognition; and (5) psychomotor abilities. Although the entire brain might be vulnerable in uncomplicated alcoholism, the brain systems that are considered to be most at risk are the frontocerebellar and mesocorticolimbic circuitries. Over time, with abstinence from alcohol, the brain appears to become reorganized to provide compensation for structural and behavioral deficits. By relying on a combination of clinical and scientific approaches, future research will help to refine the compensatory roles of healthy brain systems, the degree to which abstinence and treatment facilitate the reversal of brain atrophy and dysfunction, and the importance of individual differences to outcome.
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Affiliation(s)
- Marlene Oscar-Berman
- Boston University School of Medicine, L-815, 72 E. Newton St., Boston, MA 02118; ; telephone 617-638-4803
| | - Mary M. Valmas
- Boston University School of Medicine, L-815, 72 E. Newton St., Boston, MA 02118; ; telephone 617-638-4803
| | - Kayle S. Sawyer
- Boston University School of Medicine, L-815, 72 E. Newton St., Boston, MA 02118; ; telephone 617-638-4803
| | - Susan Mosher Ruiz
- Boston University School of Medicine, L-815, 72 E. Newton St., Boston, MA 02118; ; telephone 617-638-4803
| | - Riya B. Luhar
- Boston University School of Medicine, L-815, 72 E. Newton St., Boston, MA 02118; ; telephone 617-638-4803
| | - Zoe R. Gravitz
- Boston University School of Medicine, L-815, 72 E. Newton St., Boston, MA 02118; ; telephone 617-638-4803
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Bernardin F, Maheut-Bosser A, Paille F. Cognitive impairments in alcohol-dependent subjects. Front Psychiatry 2014; 5:78. [PMID: 25076914 PMCID: PMC4099962 DOI: 10.3389/fpsyt.2014.00078] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 06/23/2014] [Indexed: 01/19/2023] Open
Abstract
Chronic excessive alcohol consumption induces cognitive impairments mainly affecting executive functions, episodic memory, and visuospatial capacities related to multiple brain lesions. These cognitive impairments not only determine everyday management of these patients, but also impact on the efficacy of management and may compromise the abstinence prognosis. Maintenance of lasting abstinence is associated with cognitive recovery in these patients, but some impairments may persist and interfere with the good conduct and the efficacy of management. It therefore appears essential to clearly define neuropsychological management designed to identify and evaluate the type and severity of alcohol-related cognitive impairments. It is also essential to develop cognitive remediation therapy so that the patient can fully benefit from the management proposed in addiction medicine units.
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Affiliation(s)
- Florent Bernardin
- Service d'Addictologie, CHU Nancy , Vandoeuvre , France ; Faculté de Médecine, Université de Lorraine , Nancy , France
| | | | - François Paille
- Service d'Addictologie, CHU Nancy , Vandoeuvre , France ; Faculté de Médecine, Université de Lorraine , Nancy , France
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