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Fitzpatrick-Schmidt T, Oral E, Welsh DA, Molina PE, Ferguson TF, Edwards S. Moderate-to-severe cognitive impairment is associated with both recent and chronic alcohol misuse in people with HIV: The New Orleans alcohol use in HIV (NOAH) study. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024. [PMID: 38825691 DOI: 10.1111/acer.15378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 04/21/2024] [Accepted: 05/06/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) profoundly impacts the nervous system, leading to neurological deficits including HIV-associated neurocognitive disorder (HAND). HAND represents the most common neurological comorbidity among people with HIV (PWH), and alcohol use may exacerbate cognitive deficits, especially in vulnerable populations. This study investigated relationships between alcohol use and cognition in an underserved cohort of PWH, on the hypothesis that alcohol misuse exacerbates cognitive deficits. METHODS Data collected from participants (n = 259; 66.7% male; mean age 52 ± 10 years) enrolled in the New Orleans Alcohol Use in HIV (NOAH) study were utilized for cross-sectional analysis. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), and alcohol use was comprehensively measured using four metrics: the Alcohol Use Disorders Identification Test (AUDIT), 30-day timeline follow back (TLFB), lifetime drinking history, and phosphatidylethanol (PEth) levels. RESULTS The average MoCA score among participants was 20.7 ± 4.5, with 86.5% demonstrating cognitive impairment (MoCA < 26). Individuals with MoCA scores below 18 (moderately or severely cognitively impaired) had a higher frequency of recent severe alcohol misuse and greater lifetime alcohol consumption. Participants at increased risk for AUD (AUDIT ≥ 16) also had worse global cognition and memory task performance than those with lower AUDIT scores; this was particularly true among those aged 50 and older. Analysis of the MoCA sub-score data indicated that participants with increased AUD risk had impairments in the cognitive domains of language and memory. CONCLUSIONS Our findings demonstrate a high prevalence of cognitive impairment in the NOAH cohort and suggest that alcohol misuse contributes to global cognitive deficits in PWH, especially among individuals aged 50 and older. Further exploration of the impact of alcohol use on specific cognitive domains, including memory and language, should incorporate additional cognitive tasks. These findings highlight the importance of considering alcohol use and AUD risk as significant factors that may exacerbate cognitive deficits in vulnerable populations, including older PWH.
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Affiliation(s)
- Taylor Fitzpatrick-Schmidt
- Comprehensive Alcohol-HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Department of Physiology, School of Medicine, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Alcohol & Drug Abuse Center of Excellence, LSU Health Sciences Center, New Orleans, Louisiana, USA
| | - Evrim Oral
- Comprehensive Alcohol-HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Biostatistics, School of Public Health, LSU Health Sciences Center, New Orleans, Louisiana, USA
| | - David A Welsh
- Comprehensive Alcohol-HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Alcohol & Drug Abuse Center of Excellence, LSU Health Sciences Center, New Orleans, Louisiana, USA
| | - Patricia E Molina
- Comprehensive Alcohol-HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Department of Physiology, School of Medicine, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Alcohol & Drug Abuse Center of Excellence, LSU Health Sciences Center, New Orleans, Louisiana, USA
| | - Tekeda F Ferguson
- Comprehensive Alcohol-HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Department of Physiology, School of Medicine, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Alcohol & Drug Abuse Center of Excellence, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Epidemiology, School of Public Health, LSU Health Sciences Center, New Orleans, Louisiana, USA
| | - Scott Edwards
- Comprehensive Alcohol-HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Department of Physiology, School of Medicine, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Alcohol & Drug Abuse Center of Excellence, LSU Health Sciences Center, New Orleans, Louisiana, USA
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Mewton L, Visontay R, Hughes G, Browning C, Wen W, Topiwala A, Draper B, Crawford JD, Brodaty H, Sachdev PS. Longitudinal alcohol-related brain changes in older adults: The Sydney Memory and Ageing Study. Addict Biol 2024; 29:e13402. [PMID: 38797559 PMCID: PMC11128337 DOI: 10.1111/adb.13402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 03/25/2024] [Accepted: 04/22/2024] [Indexed: 05/29/2024]
Abstract
Increases in harmful drinking among older adults indicate the need for a more thorough understanding of the relationship between later-life alcohol use and brain health. The current study investigated the relationships between alcohol use and progressive grey and white matter changes in older adults using longitudinal data. A total of 530 participants (aged 70 to 90 years; 46.0% male) were included. Brain outcomes assessed over 6 years included total grey and white matter volume, as well as volume of the hippocampus, thalamus, amygdala, corpus callosum, orbitofrontal cortex and insula. White matter integrity was also investigated. Average alcohol use across the study period was the main exposure of interest. Past-year binge drinking and reduction in drinking from pre-baseline were additional exposures of interest. Within the context of low-level average drinking (averaging 11.7 g per day), higher average amount of alcohol consumed was associated with less atrophy in the left (B = 7.50, pFDR = 0.010) and right (B = 5.98, pFDR = 0.004) thalamus. Past-year binge-drinking was associated with poorer white matter integrity (B = -0.013, pFDR = 0.024). Consuming alcohol more heavily in the past was associated with greater atrophy in anterior (B = -12.73, pFDR = 0.048) and posterior (B = -17.88, pFDR = 0.004) callosal volumes over time. Across alcohol exposures and neuroimaging markers, no other relationships were statistically significant. Within the context of low-level drinking, very few relationships between alcohol use and brain macrostructure were identified. Meanwhile, heavier drinking was negatively associated with white matter integrity.
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Affiliation(s)
- Louise Mewton
- The Matilda Centre for Mental Health and Substance Use, Faculty of Medicine and HealthUniversity of SydneySydneyAustralia
| | - Rachel Visontay
- The Matilda Centre for Mental Health and Substance Use, Faculty of Medicine and HealthUniversity of SydneySydneyAustralia
| | - Gerard Hughes
- Centre for Healthy Brain Ageing, Faculty of Medicine and HealthUniversity of New South WalesSydneyAustralia
| | - Catherine Browning
- Centre for Healthy Brain Ageing, Faculty of Medicine and HealthUniversity of New South WalesSydneyAustralia
| | - Wei Wen
- Centre for Healthy Brain Ageing, Faculty of Medicine and HealthUniversity of New South WalesSydneyAustralia
| | - Anya Topiwala
- Nuffield Department Population Health, Big Data InstituteUniversity of OxfordOxfordUK
| | - Brian Draper
- Centre for Healthy Brain Ageing, Faculty of Medicine and HealthUniversity of New South WalesSydneyAustralia
| | - John D. Crawford
- Centre for Healthy Brain Ageing, Faculty of Medicine and HealthUniversity of New South WalesSydneyAustralia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, Faculty of Medicine and HealthUniversity of New South WalesSydneyAustralia
| | - Perminder S. Sachdev
- Centre for Healthy Brain Ageing, Faculty of Medicine and HealthUniversity of New South WalesSydneyAustralia
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Lindberg O, Ahlner F, Tsevis T, Pereira JB, Westman E, Skoog I, Wahlund LO. Effects of current alcohol use on brain volume among older adults in the Gothenburg H70 Birth Cohort study 2014-16. Eur Arch Psychiatry Clin Neurosci 2024; 274:363-373. [PMID: 37725137 PMCID: PMC10914911 DOI: 10.1007/s00406-023-01691-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 08/26/2023] [Indexed: 09/21/2023]
Abstract
Brain gray- and white matter changes is well described in alcohol-dependent elderly subjects; however, the effect of lower levels of alcohol consumption on the brain is poorly understood. We investigated the impact of different amounts of weekly alcohol consumption on brain structure in a population-based sample of 70-year-olds living in Gothenburg, Sweden. Cross-sectional data from 676 participants from The Gothenburg H70 Birth Cohort Study 2014-16 were included. Current alcohol consumers were divided into seven groups based on self-reported weekly amounts of alcohol consumption in grams (g) (0-50 g/week, used as reference group, 51-100 g/week, 101-150 g/week, 151-200 g/week, 201-250 g/week, 251-300 g/week, and > 300 g/week). Subcortical volumes and cortical thickness were assessed on T1-weighted structural magnetic resonance images using FreeSurfer 5.3, and white matter integrity assessed on diffusion tensor images, using tract-based statistics in FSL. General linear models were carried out to estimate associations between alcohol consumption and gray- and white matter changes in the brain. Self-reported consumption above 250 g/week was associated with thinning in the bilateral superior frontal gyrus, the right precentral gyrus, and the right lateral occipital cortex, in addition to reduced fractional anisotropy (FA) and increased mean diffusivity (MD) diffusively spread in many tracts all over the brain. No changes were found in subcortical gray matter structures. These results suggest that there is a non-linear relationship between alcohol consumption and structural brain changes, in which loss of cortical thickness only occur in non-demented 70-year-olds who consume more than 250 g/week.
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Affiliation(s)
- Olof Lindberg
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Neo Floor 7 SE, 141 83, Huddinge, Stockholm, Sweden.
- Neuropsychiatric Epidemiology, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Centre for Ageing and Health (AgeCap), Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
| | - Felicia Ahlner
- Neuropsychiatric Epidemiology, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Centre for Ageing and Health (AgeCap), Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Theofanis Tsevis
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Neo Floor 7 SE, 141 83, Huddinge, Stockholm, Sweden
| | - Joana B Pereira
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Neo Floor 7 SE, 141 83, Huddinge, Stockholm, Sweden
| | - Eric Westman
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Neo Floor 7 SE, 141 83, Huddinge, Stockholm, Sweden
- Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ingmar Skoog
- Neuropsychiatric Epidemiology, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Centre for Ageing and Health (AgeCap), Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Psychiatry, Cognition and Old Age Psychiatry Clinic, Gothenburg, Sweden
| | - Lars-Olof Wahlund
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Neo Floor 7 SE, 141 83, Huddinge, Stockholm, Sweden
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Kurihara K, Shiroma A, Koda M, Shinzato H, Takaesu Y, Kondo T. Age-related cognitive decline is accelerated in alcohol use disorder. Neuropsychopharmacol Rep 2023; 43:587-595. [PMID: 37926928 PMCID: PMC10739134 DOI: 10.1002/npr2.12395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/26/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023] Open
Abstract
This study aimed to examine potential cognitive impairments in patients with alcohol use disorder (AUD), and explore the factors affecting them. We recruited 97 inpatients with AUD, showing superficially normal cognitive function (mini-mental state examination score ≥24) for this study. We assessed cognitive function after a 4-week post-abstinence period using the Brief Assessment of Cognition in Schizophrenia-Japanese version (BACS-J). Relationships between BACS-J subcategory/composite raw scores and Z-scores (deviation from standard data in healthy Japanese) and background factors such as age, sex, education, smoking status, mini-mental state examination score, body mass index, systolic blood pressure, severity of depression, alcohol consumption, and laboratory findings were analyzed. Multiple regression analysis showed that the age (p < 0.001) and total bilirubin level (p = 0.014) were worsening factors for the BACS-J composite raw score, whereas education (p < 0.001) was a protective factor. An inverse correlation was apparent between the age and the composite Z-score of the BACS-J (r = -0.431, p < 0.001). Receiver operating characteristic (ROC) analysis identified 53 years as the cutoff age for predicting more than -2SD cognitive decline from the normal standard, with a high negative predictive value (95%). Patients with AUD aged ≥53 years showed more pronounced impairments in verbal memory, working memory, verbal fluency, and attention than those younger than 53 years (p < 0.05). These findings clearly demonstrate accelerated age-related cognitive decline in patients with AUD, especially those aged ≥53 years, suggesting the necessity of early intervention in patients with AUD to prevent progressive cognitive impairment and preserve their quality of life.
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Affiliation(s)
- Kazuhiro Kurihara
- Department of Neuropsychiatry, Graduate School of MedicineUniversity of the RyukyusOkinawaJapan
| | - Ayano Shiroma
- Department of Neuropsychiatry, Graduate School of MedicineUniversity of the RyukyusOkinawaJapan
| | - Munenaga Koda
- Graduate School of Technology, Industrial and Social SciencesTokushima UniversityTokushimaJapan
| | - Hotaka Shinzato
- Department of Neuropsychiatry, Graduate School of MedicineUniversity of the RyukyusOkinawaJapan
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Graduate School of MedicineUniversity of the RyukyusOkinawaJapan
| | - Tsuyoshi Kondo
- Department of Neuropsychiatry, Graduate School of MedicineUniversity of the RyukyusOkinawaJapan
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5
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Staudt J, Kok T, de Haan HA, Walvoort SJW, Egger JIM. Neurocognitive Recovery in Abstinent Patients with Alcohol Use Disorder: A Scoping Review for Associated Factors. Neuropsychiatr Dis Treat 2023; 19:2039-2054. [PMID: 37790802 PMCID: PMC10544223 DOI: 10.2147/ndt.s424017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/25/2023] [Indexed: 10/05/2023] Open
Abstract
Objective Studies have reported inconsistent results regarding the extent to which neurocognitive recovery occurs in abstinent patients with alcohol use disorder (AUD). In addition to abstinence, other factors may have influenced this process and contributed to the inconsistencies. This review examines the factors investigated in this regard and describes the possible influence of each factor based on the evidence collected. Methodology PubMed was systematically searched for articles published between January 2000 and July 2023. Longitudinal humane studies investigating neurocognitive recovery in abstinent adult AUD patients were included. Studies with a cross-sectional design were excluded, as were studies that did not classify AUD according to the DSM-IV or 5 criteria, only examined binge use, did not report neuropsychological outcomes or duration of abstinence, or where neurological disorders were present. Results Sixteen categories of factors were distinguished from 31 full-text articles. Consistent patterns were found, indicating an association between neurocognitive recovery and the "smoking" and 'brain volume" factors. Consistent patterns were also found indicating that there is no relationship with "quantities of alcohol used" and "education level." A similar consistent pattern was also found for "polysubstance use", "gender" and "verbal reading", but the number of studies is considered limited. The association with "age" is studied frequently but with inconsistent findings. The remaining eight factors were regarded as understudied. Conclusion The clearest patterns emerging from the evidence are a predominantly negative influence of smoking on neurocognitive recovery, associations between changes in brain area volume and neurocognitive recovery, and no association between neurocognitive recovery and the amount of alcohol consumed, as measured by self-report, nor with educational attainment. Future research on the understudied factors and factors with inconsistent evidence is needed, preferably through longitudinal designs with multiple assessment periods starting after at least two weeks of abstinence.
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Affiliation(s)
- Jeroen Staudt
- Tactus Addiction Treatment, Deventer, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Tim Kok
- Tactus Addiction Treatment, Deventer, the Netherlands
| | - Hein A de Haan
- Tactus Addiction Treatment, Deventer, the Netherlands
- Nijmegen Institute for Scientist Practitioners in Addiction, Radboud University, Nijmegen, the Netherlands
| | | | - Jos I M Egger
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
- Centre of Excellence for Korsakoff and Alcohol Related Cognitive Disorders, Vincent van Gogh Institute for Psychiatry, Venray, the Netherlands
- Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Venray, the Netherlands
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6
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Li Y, Wang H, Li X, Shu H, Wang S, Luo S, Li X, Yu Y. Resting-state functional MRI investigation of the effect of long-term alcohol exposure on the brain function in rhesus monkey. Neurosci Lett 2023; 813:137438. [PMID: 37579869 DOI: 10.1016/j.neulet.2023.137438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/25/2023] [Accepted: 08/11/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND This study was aimed to investigate the effect of long-term exposure of alcohol on the resting-state brain functions in rhesus monkey by using the 3.0 T resting-state functional magnetic resonance imaging (rsfMRI). MATERIALS AND METHODS The animal models were developed by exposing six male rhesus monkeys to alcohol for different time points: P0 (non-exposed), P1 (1 month), P2 (3 months), P3 (6 months), and P4 (36 months). A multi-period rsfMRI scan was performed before and after exposure of animals to alcohol. The collected data were analyzed by the fractional amplitude of low frequency fluctuations (fALFF) and the regional homogeneity (ReHo) method, and the different brain regions were compared for their respective functions through differences in the fALFF and ReHo values. RESULTS The results showed statistical significances in different brain regions. The left superior parietal lobule and the left fusiform gyrus showed statistically different fALFF values (p < 0.01). Similarly, the left medial orbital gyrus and the right postcentral gyrus showed statistically different ReHo values (p < 0.01). CONCLUSION The long-term exposure of rhesus monkeys to alcohol mainly induced changes in four parts of the brain, including the left superior parietal lobule, left fusiform gyrus, left medial orbital gyrus, and the right postcentral gyrus. These changes in different brain parts, over the study period, with most significant changes found within 6 months of exposure of rhesus monkeys to alcohol.
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Affiliation(s)
- Yan Li
- Department of Radiology, the First Affiliated Hospital of Anhui Medical University, Hefei, China; Anhui Public Health Clinical Center, Hefei, China
| | - Haibao Wang
- Department of Radiology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiaoshu Li
- Department of Radiology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hongmin Shu
- Department of Radiology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Song Wang
- Department of Radiology, the First Affiliated Hospital of Anhui Medical University, Hefei, China; Anhui Public Health Clinical Center, Hefei, China
| | - Shilei Luo
- Department of Radiology, the First Affiliated Hospital of Anhui Medical University, Hefei, China; Anhui Public Health Clinical Center, Hefei, China
| | - Xiaohu Li
- Department of Radiology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yongqiang Yu
- Department of Radiology, the First Affiliated Hospital of Anhui Medical University, Hefei, China.
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Jo Nixon S, Garcia CC, Lewis B. WOMEN'S USE OF ALCOHOL: NEUROBIOBEHAVIORAL CONCOMITANTS AND CONSEQUENCES. Front Neuroendocrinol 2023:101079. [PMID: 37269931 DOI: 10.1016/j.yfrne.2023.101079] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/02/2023] [Accepted: 05/27/2023] [Indexed: 06/05/2023]
Abstract
In this narrative review, we draw from historical and contemporary literature to explore the impact of alcohol consumption on brain and behavior among women. We examine three domains: 1) the impact of alcohol use disorder (AUD) on neurobiobehavioral outcomes, 2) its impact on social cognition/emotion processing, and 3) alcohol's acute effects in older women. There is compelling evidence of alcohol-related compromise in neuropsychological function, neural activation, and brain structure. Investigations of social cognition and alcohol effects in older women represent emerging areas of study. Initial analyses suggest that women with AUD show significant deficits in emotion processing, a finding also observed in older women who have consumed a moderate dose of alcohol. Critically, despite the long-recognized need for programmatic interrogation of alcohol's effect in women, studies with sufficient numbers of women for meaningful analysis represent a small proportion of the literature, constraining interpretation and generalization.
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Affiliation(s)
- Sara Jo Nixon
- University of Florida, Department of Psychiatry, Gainesville, FL; University of Florida, Department of Psychology, Gainesville, FL; University of Florida, Department of Neuroscience, Gainesville; University of Florida, Center for Addiction Research & Education, Gainesville, FL.
| | - Christian C Garcia
- University of Florida, Department of Psychiatry, Gainesville, FL; University of Florida, Center for Addiction Research & Education, Gainesville, FL
| | - Ben Lewis
- University of Florida, Department of Psychiatry, Gainesville, FL; University of Florida, Department of Psychology, Gainesville, FL; University of Florida, Department of Neuroscience, Gainesville; University of Florida, Center for Addiction Research & Education, Gainesville, FL
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8
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Longitudinal brain age prediction and cognitive function after stroke. Neurobiol Aging 2023; 122:55-64. [PMID: 36502572 DOI: 10.1016/j.neurobiolaging.2022.10.007] [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: 03/25/2022] [Revised: 09/19/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
Advanced age is associated with post-stroke cognitive decline. Machine learning based on brain scans can be used to estimate brain age of patients, and the corresponding difference from chronological age, the brain age gap (BAG), has been investigated in a range of clinical conditions, yet not thoroughly in post-stroke neurocognitive disorder (NCD). We aimed to investigate the association between BAG and post-stroke NCD over time. Lower BAG (younger appearing brain compared to chronological age) was found associated with lower risk of post-stroke NCD up to 36 months after stroke, even among those showing no evidence of impairments 3 months after hospital admission. For patients with no NCD at baseline, survival analysis suggested that higher baseline BAG was associated with higher risk of post-stroke NCD at 18 and 36 months. In conclusion, a younger appearing brain is associated with a lower risk of post-stroke NCD.
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Cabrera-Mendoza B, Stertz L, Najera K, Selvaraj S, Teixeira AL, Meyer TD, Fries GR, Walss-Bass C. Within subject cross-tissue analyzes of epigenetic clocks in substance use disorder postmortem brain and blood. Am J Med Genet B Neuropsychiatr Genet 2023; 192:13-27. [PMID: 36056652 PMCID: PMC9742183 DOI: 10.1002/ajmg.b.32920] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/22/2022] [Accepted: 08/16/2022] [Indexed: 12/14/2022]
Abstract
There is a possible accelerated biological aging in patients with substance use disorders (SUD). The evaluation of epigenetic clocks, which are accurate estimators of biological aging based on DNA methylation changes, has been limited to blood tissue in patients with SUD. Consequently, the impact of biological aging in the brain of individuals with SUD remains unknown. In this study, we evaluated multiple epigenetic clocks (DNAmAge, DNAmAgeHannum, DNAmAgeSkinBlood, DNAmPhenoAge, DNAmGrimAge, and DNAmTL) in individuals with SUD (n = 42), including alcohol (n = 10), opioid (n = 19), and stimulant use disorder (n = 13), and controls (n = 10) in postmortem brain (prefrontal cortex) and blood tissue obtained from the same individuals. We found a higher DNAmPhenoAge (β = 0.191, p-value = 0.0104) and a nominally lower DNAmTL (β = -0.149, p-value = 0.0603) in blood from individuals with SUD compared to controls. SUD subgroup analysis showed a nominally lower brain DNAmTL in subjects with alcohol use disorder, compared to stimulant use disorder and controls (β = 0.0150, p-value = 0.087). Cross-tissue analyzes indicated a lower blood DNAmTL and a higher blood DNAmAge compared to their respective brain values in the SUD group. This study highlights the relevance of tissue specificity in biological aging studies and suggests that peripheral measures of epigenetic clocks in SUD may depend on the specific type of drug used.
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Affiliation(s)
- Brenda Cabrera-Mendoza
- PECEM, Faculty of Medicine, Universidad Nacional
Autónoma de México, Mexico City, 04510, Mexico
| | - Laura Stertz
- Louis A. Faillace, MD, Department of Psychiatry and
Behavioral Sciences, McGovern Medical School, University of Texas Health Science
Center at Houston, Houston, TX, 77054, USA
| | - Katherine Najera
- Louis A. Faillace, MD, Department of Psychiatry and
Behavioral Sciences, McGovern Medical School, University of Texas Health Science
Center at Houston, Houston, TX, 77054, USA
| | - Sudhakar Selvaraj
- Louis A. Faillace, MD, Department of Psychiatry and
Behavioral Sciences, McGovern Medical School, University of Texas Health Science
Center at Houston, Houston, TX, 77054, USA
| | - Antonio L. Teixeira
- Louis A. Faillace, MD, Department of Psychiatry and
Behavioral Sciences, McGovern Medical School, University of Texas Health Science
Center at Houston, Houston, TX, 77054, USA
| | - Thomas D. Meyer
- Louis A. Faillace, MD, Department of Psychiatry and
Behavioral Sciences, McGovern Medical School, University of Texas Health Science
Center at Houston, Houston, TX, 77054, USA
| | - Gabriel R. Fries
- Louis A. Faillace, MD, Department of Psychiatry and
Behavioral Sciences, McGovern Medical School, University of Texas Health Science
Center at Houston, Houston, TX, 77054, USA
- Center for Precision Health, School of Biomedical
Informatics, University of Texas Health Science Center at Houston, Houston, TX,
77054, USA
| | - Consuelo Walss-Bass
- Louis A. Faillace, MD, Department of Psychiatry and
Behavioral Sciences, McGovern Medical School, University of Texas Health Science
Center at Houston, Houston, TX, 77054, USA
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10
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Abstract
Alcohol is one of the most widely consumed psychoactive drugs globally. Hazardous drinking, defined by quantity and frequency of consumption, is associated with acute and chronic morbidity. Alcohol use disorders (AUDs) are psychiatric syndromes characterized by impaired control over drinking and other symptoms. Contemporary aetiological perspectives on AUDs apply a biopsychosocial framework that emphasizes the interplay of genetics, neurobiology, psychology, and an individual's social and societal context. There is strong evidence that AUDs are genetically influenced, but with a complex polygenic architecture. Likewise, there is robust evidence for environmental influences, such as adverse childhood exposures and maladaptive developmental trajectories. Well-established biological and psychological determinants of AUDs include neuroadaptive changes following persistent use, differences in brain structure and function, and motivational determinants including overvaluation of alcohol reinforcement, acute effects of environmental triggers and stress, elevations in multiple facets of impulsivity, and lack of alternative reinforcers. Social factors include bidirectional roles of social networks and sociocultural influences, such as public health control strategies and social determinants of health. An array of evidence-based approaches for reducing alcohol harms are available, including screening, pharmacotherapies, psychological interventions and policy strategies, but are substantially underused. Priorities for the field include translating advances in basic biobehavioural research into novel clinical applications and, in turn, promoting widespread implementation of evidence-based clinical approaches in practice and health-care systems.
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11
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Zhao Y, Skandali N, Bethlehem RAI, Voon V. Mesial Prefrontal Cortex and Alcohol Misuse: Dissociating Cross-sectional and Longitudinal Relationships in UK Biobank. Biol Psychiatry 2022; 92:907-916. [PMID: 35589437 DOI: 10.1016/j.biopsych.2022.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 02/24/2022] [Accepted: 03/12/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Alcohol misuse is a major global public health issue. The disorder is characterized by aberrant neural networks interacting with environment and genetics. Dissecting the neural substrates and functional networks that relate to longitudinal changes in alcohol use from those that relate to alcohol misuse cross-sectionally is important to elucidate therapeutic approaches. METHODS To assess how neuroimaging data, including T1, resting-state functional magnetic resonance imaging, and diffusion-weighted imaging, relate to alcohol misuse cross-sectionally and longitudinally in the UK Biobank, this study analyzed range of alcohol misuse in a population-based normative sample of 24,784 participants, ages 45 to 81 years old, in a cross-sectional analysis and a sample of 3070 participants in a longitudinal analysis 2 years later. RESULTS Cross-sectional analysis showed that alcohol use is associated with a reduction in dorsal anterior cingulate cortex and dorsomedial prefrontal cortex gray matter concentration and functional resting-state connectivity (nodal degree: t24,422 = -12.99, p < 1 × 10-17). Reduced dorsal anterior cingulate cortex/dorsomedial prefrontal cortex functional connections to the ventrolateral prefrontal cortex, amygdala, and striatum relate to greater alcohol use. In a longitudinal analysis, higher resting-state nodal degree (t3036 = -3.27, p = .0011) and T1 gray matter concentration in the ventromedial prefrontal cortex relate to reduced alcohol intake frequency 2 years later. Higher ventromedial prefrontal cortex and frontoparietal executive network functional connectivity is associated with lower subsequent drinking longitudinally. CONCLUSIONS Dorsal versus ventromedial prefrontal regions are differentially related to alcohol misuse cross-sectionally or longitudinally in a large UK Biobank normative dataset. Our study provides a comprehensive understanding of the neurobiological substrates of alcohol use as a state or prospectively, thereby providing potential targets for clinical treatment.
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Affiliation(s)
- Ying Zhao
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China; Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
| | - Nikolina Skandali
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | | | - Valerie Voon
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China; Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
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12
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Alcohol-Induced Oxidative Stress and the Role of Antioxidants in Alcohol Use Disorder: A Systematic Review. Antioxidants (Basel) 2022; 11:antiox11071374. [PMID: 35883865 PMCID: PMC9311529 DOI: 10.3390/antiox11071374] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 12/12/2022] Open
Abstract
Alcohol use disorder (AUD) is a highly prevalent, comorbid, and disabling disorder. The underlying mechanism of ethanol neurotoxicity and the involvement of oxidative stress is still not fully elucidated. However, ethanol metabolism has been associated with increased oxidative stress through alcohol dehydrogenase, the microsomal ethanol oxidation system, and catalase metabolic pathways. We searched the PubMed and genome-wide association studies (GWAS) catalog databases to review the literature systematically and summarized the findings focusing on AUD and alcohol abstinence in relation to oxidative stress. In addition, we reviewed the ClinicalTrials.gov resource of the US National Library of Medicine to identify all ongoing and completed clinical trials that include therapeutic interventions based on antioxidants. The retrieved clinical and preclinical studies show that oxidative stress impacts AUD through genetics, alcohol metabolism, inflammation, and neurodegeneration.
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Abstract
OBJECTIVE Given the aging population of people with HIV (PWH), along with increasing rates of binge drinking among both PWH and the general older adult population, this study examined the independent and interactive effects of HIV, binge drinking, and age on neurocognition. METHOD Participants were 146 drinkers stratified by HIV and binge drinking status (i.e., ≥4 drinks for women and ≥5 drinks for men within approximately 2 h): HIV+/Binge+ (n = 30), HIV-/Binge+ (n = 23), HIV+/Binge- (n = 55), HIV-/Binge- (n = 38). All participants completed a comprehensive neuropsychological battery measuring demographically-corrected global and domain-specific neurocognitive T scores. ANCOVA models examined independent and interactive effects of HIV and binge drinking on neurocognitive outcomes, adjusting for overall alcohol consumption, lifetime substance use, sex, and age. Subsequent multiple linear regressions examined whether HIV/Binge group moderated the relationship between age and neurocognition. RESULTS HIV+/Binge+ participants had worse global neurocognition, processing speed, delayed recall, and working memory than HIV-/Binge- participants (p's < .05). While there were significant main effects of HIV and binge drinking, their interaction did not predict any of those neurocognitive outcomes (p's > .05). Significant interactions between age and HIV/Binge group showed that HIV+/Binge+ participants demonstrated steeper negative relationships between age and neurocognitive outcomes of learning, delayed recall, and motor skills compared to HIV-/Binge- participants (p's < .05). CONCLUSIONS Results showed adverse additive effects of HIV and binge drinking on neurocognitive functioning, with older adults demonstrating the most vulnerability to these effects. Findings support the need for interventions to reduce binge drinking, especially among older PWH.
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14
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Bralet MC, Mitelman SA, Goodman CR, Lincoln S, Hazlett EA, Buchsbaum MS. Fluorodeoxyglucose positron emission tomography scans in patients with alcohol use disorder. Alcohol Clin Exp Res 2022; 46:994-1010. [PMID: 35451074 DOI: 10.1111/acer.14845] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/17/2022] [Accepted: 04/16/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Diminished uptake of fluorodeoxyglucose (FDG) has been observed in patients with alcohol use disorder (AUD) but little statistical contrast of the regional brain deficits has been undertaken. This study examined prefrontal cortex inter-regional Brodmann area differences to delineate patterns associated with behavioral, neurotransmitter, and general toxicity hypotheses of cerebral involvement in AUD. METHODS We obtained data from FDG positron emission tomography (PET) and anatomical magnetic resonance imaging (MRI) for 87 patients with AUD and 41 age- and sex-matched healthy volunteers. Patients were alcohol dependent and had negative breathalyzer tests at the time of imaging. They were assessed with the Beck Depression Inventory, Alcohol Urge Questionnaire, Obsessive Compulsive Drinking Scale, Spielberger State/Trait Anxiety Scale, Buss-Durkee Hostility Inventory, and the Drinker Inventory of Consequences (DrInC). PET images were co-registered to MRI and both voxel × voxel statistical mapping and stereotaxic regions of interest were obtained. RESULTS Compared with healthy volunteers, patients with AUD had lower relative metabolic rates in the frontal, temporal, and parietal lobes, localizable most prominently to the dorsolateral and nearly all orbital prefrontal cortex, superior temporal gyrus, and inferior parietal lobule. In contrast, metabolic rates in the medial orbitofrontal and anterior cingulate cortex, and the subcortical structures (thalamus, cerebellum, ventral striatum, and the dorsal raphe nucleus) in patients were significantly greater. The severity of alcohol-related consequences as assessed by the DrInC scale was most highly associated with lower metabolism in the caudate, dorsolateral prefrontal, frontopolar, and anteroposterior cingulate cortex. CONCLUSIONS Despite widespread metabolic abnormalities, decreases in AUD were most marked in frontal executive areas, consistent with diminished impulse control, and increases were most prominent in the striatum and cingulate areas, consistent with a suppressed reward system.
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Affiliation(s)
- Marie-Cécile Bralet
- Crisalid Unit (FJ5), CHI Clermont de l'Oise, Clermont, France.,Inserm Unit U669, Maison de Solenn, Universities Paris, Paris, France.,GDR 3557 Recherche Psychiatrie, Paris, France
| | - Serge A Mitelman
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Psychiatry, Division of Child and Adolescent Psychiatry, Elmhurst Hospital Center, Elmhurst, New York, USA
| | - Chelain R Goodman
- Department of Radiation Oncology, Division of Radiation Oncology, University of Texas, Austin, Texas, USA
| | - Samantha Lincoln
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Erin A Hazlett
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Mental Illness Research, Education, and Clinical Center (VISN 2), James J. Peters VAMC, Bronx, New York, USA
| | - Monte S Buchsbaum
- Departments of Psychiatry and Radiology, University of California, San Diego, San Diego, California, USA.,Departments of Psychiatry and Radiology, University of California, Irvine, Irvine, California, USA
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15
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Carlsson CM. Management of Dementia. Continuum (Minneap Minn) 2022; 28:885-900. [PMID: 35678408 DOI: 10.1212/con.0000000000001132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article describes an approach to managing patients following a diagnosis of dementia, including medical management, nonpharmacologic strategies, safety interventions, caregiver support, mobilization of community resources, and advanced care planning. RECENT FINDINGS Dementia clinical syndromes are frequently caused by mixed pathologies, leading to varied clinical presentations that include memory loss, behavioral changes, communication challenges, safety concerns, and loss of independent function. Medications for treating dementia currently target cognitive and behavioral symptoms, although disease-modifying therapies for Alzheimer disease may be making their way into widespread clinical practice soon. Identification and treatment of co-occurring medical problems, such as obstructive sleep apnea, adverse medication effects, mood disorders, hearing loss, pain, alcohol misuse, and vascular risk factors, may mitigate the impact of these conditions on cognitive decline. Mobilization of clinical and community-based interprofessional teams will ensure that people with dementia and their care partners have the expertise, support, and access to resources they need. Addressing goals of care early in the disease course will allow people with dementia to contribute to their care plan by expressing their wishes. SUMMARY Developing a structured approach to treating common causes of dementia and related comorbid medical conditions, identifying a local network of interprofessional clinical and community-based referrals, and providing readily available educational resources will help clinicians provide quality dementia care management that extends beyond the clinic visit. Encouraging patients and families to engage in clinical research will advance the identification of effective therapies, preventive strategies, and quality care models for the future.
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16
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Diagnosis of Idiopathic Premature Ovarian Failure by Color Doppler Ultrasound under the Intelligent Segmentation Algorithm. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2645607. [PMID: 35664646 PMCID: PMC9159869 DOI: 10.1155/2022/2645607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/19/2022] [Accepted: 04/22/2022] [Indexed: 11/17/2022]
Abstract
The aim of this study was to explore the application value of transvaginal color Doppler ultrasound based on the improved mean shift algorithm in the diagnosis of idiopathic premature ovarian failure (POF). In this study, 80 patients with idiopathic POF were selected and included in the experimental group, and 40 volunteers who underwent health examinations during the same period were selected and included in the control group, who underwent transvaginal Doppler ultrasound examination. At the same time, an improved mean shift algorithm was proposed based on artificial intelligence technology and applied to ultrasound image processing. In addition, the ovarian artery parameters of patients were compared in two groups, including peak systolic flow rate (PSV), diastolic flow rate (EDV), resistance index (RI), and pulsatile index (PI). The results showed that the relative difference degree (RDD) of the segmentation results of the algorithm in this study was significantly lower than that of Snake, Live_wire, and the traditional mean shift algorithm, while the relative overlap degree (ROD) and Dice coefficient were opposite, and the differences were significant (P<0.05). The mediolateral diameter of control group was 2.87±0.31cm, and the anteroposterior diameter was 1.86±0.28 cm; while those were 2.11±0.36 cm and 1.13±0.34 cm, respectively, in the experimental group, showing significant differences between the groups (P<0.05). Of the 80 patients in the experimental group, 132 cases with ovarian arteries were found; among 40 patients in the experimental group, 76 cases were found with ovarian arteries, and the hemodynamic detection rate of the experimental group was significantly lower than that of the control group (P<0.05). The ovarian artery parameters PI, RI, and S/D of the experimental group were significantly higher than those of the control group, and the differences were statistically significant (P<0.05). The results showed that the segmentation results of the improved algorithm in this study were more superior to the segmentation results of other algorithms. The regional information loss of the segmentation results was not serious, and the resolution was higher and the definition was higher. The transvaginal color Doppler ultrasound based on the artificial intelligence segmentation algorithm can clearly show the functional status and hemodynamics of the patient's ovaries. The ovarian artery parameters PI and RI can be used as specific indicators for evaluating the POF.
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17
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Ayenigbara IO. Preventive Measures against the Development of Dementia in Old Age. Korean J Fam Med 2022; 43:157-167. [PMID: 35610962 PMCID: PMC9136504 DOI: 10.4082/kjfm.21.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/07/2022] [Indexed: 11/03/2022] Open
Abstract
Dementia is a neurological condition characterized by numerous types of central nervous system diseases, which gradually deteriorates an individual’s reasoning, rational thinking, and judgment abilities. As a serious public health concern that currently affects more than 50 million older adults, dementia is one of the most significant causes of incapacity, disability, and dependency among older adults. As new cases are expected to increase exponentially in the next three decades, dementia, which is not a normal feature of healthy aging despite the fact that it generally affects older adults disproportionately, requires enormous management and care efforts due to its associated socioeconomic, psychological, and physical burdens that involve the patient, their caregivers, guardians, family members, and society at large. Presently, there is no cure for dementia; however, this condition could be prevented. This narrative review aimed to provide a broad overview of studies detailing the alternative lifestyle modification-centered preventive measures against dementia. A comprehensive search of key databases to find articles related to this topic revealed that participating in regular physical activities, healthy eating and dieting, avoiding all forms of smoking, avoiding air pollutants, halting or reducing alcohol consumption, exercising the mind and being socially dynamic, getting enough rest and establishing good sleeping habits, infection prevention, stress prevention, avoidance of injuries, preventing the effects of social isolation and lockdowns, continuing education, and depression prevention are protective measures against the development of dementia.
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Affiliation(s)
- Israel Oluwasegun Ayenigbara
- School and Community Health Education Unit, Department of Health Education, University of Ibadan, Ibadan, Nigeria
- *Corresponding Author: Israel Oluwasegun Ayenigbara Tel: +234-8139177538, Fax: +234-809-810-3043, E-mail:
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18
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Luciana M, Collins PF. Neuroplasticity, the Prefrontal Cortex, and Psychopathology-Related Deviations in Cognitive Control. Annu Rev Clin Psychol 2022; 18:443-469. [PMID: 35534121 DOI: 10.1146/annurev-clinpsy-081219-111203] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A basic survival need is the ability to respond to, and persevere in the midst of, experiential challenges. Mechanisms of neuroplasticity permit this responsivity via functional adaptations (flexibility), as well as more substantial structural modifications following chronic stress or injury. This review focuses on prefrontally based flexibility, expressed throughout large-scale neuronal networks through the actions of excitatory and inhibitory neurotransmitters and neuromodulators. With substance use disorders and stress-related internalizing disorders as exemplars, we review human behavioral and neuroimaging data, considering whether executive control, particularly cognitive flexibility, is impaired premorbidly, enduringly compromised with illness progression, or both. We conclude that deviations in control processes are consistently expressed in the context of active illness but operate through different mechanisms and with distinct longitudinal patterns in externalizing versus internalizing conditions.
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Affiliation(s)
- Monica Luciana
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, USA; ,
| | - Paul F Collins
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, USA; ,
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19
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The Relaxin-3 Receptor, RXFP3, Is a Modulator of Aging-Related Disease. Int J Mol Sci 2022; 23:ijms23084387. [PMID: 35457203 PMCID: PMC9027355 DOI: 10.3390/ijms23084387] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/08/2022] [Accepted: 04/12/2022] [Indexed: 12/12/2022] Open
Abstract
During the aging process our body becomes less well equipped to deal with cellular stress, resulting in an increase in unrepaired damage. This causes varying degrees of impaired functionality and an increased risk of mortality. One of the most effective anti-aging strategies involves interventions that combine simultaneous glucometabolic support with augmented DNA damage protection/repair. Thus, it seems prudent to develop therapeutic strategies that target this combinatorial approach. Studies have shown that the ADP-ribosylation factor (ARF) GTPase activating protein GIT2 (GIT2) acts as a keystone protein in the aging process. GIT2 can control both DNA repair and glucose metabolism. Through in vivo co-regulation analyses it was found that GIT2 forms a close coexpression-based relationship with the relaxin-3 receptor (RXFP3). Cellular RXFP3 expression is directly affected by DNA damage and oxidative stress. Overexpression or stimulation of this receptor, by its endogenous ligand relaxin 3 (RLN3), can regulate the DNA damage response and repair processes. Interestingly, RLN3 is an insulin-like peptide and has been shown to control multiple disease processes linked to aging mechanisms, e.g., anxiety, depression, memory dysfunction, appetite, and anti-apoptotic mechanisms. Here we discuss the molecular mechanisms underlying the various roles of RXFP3/RLN3 signaling in aging and age-related disorders.
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20
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Associations between alcohol consumption and gray and white matter volumes in the UK Biobank. Nat Commun 2022; 13:1175. [PMID: 35246521 PMCID: PMC8897479 DOI: 10.1038/s41467-022-28735-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 01/26/2022] [Indexed: 12/11/2022] Open
Abstract
Heavy alcohol consumption has been associated with brain atrophy, neuronal loss, and poorer white matter fiber integrity. However, there is conflicting evidence on whether light-to-moderate alcohol consumption shows similar negative associations with brain structure. To address this, we examine the associations between alcohol intake and brain structure using multimodal imaging data from 36,678 generally healthy middle-aged and older adults from the UK Biobank, controlling for numerous potential confounds. Consistent with prior literature, we find negative associations between alcohol intake and brain macrostructure and microstructure. Specifically, alcohol intake is negatively associated with global brain volume measures, regional gray matter volumes, and white matter microstructure. Here, we show that the negative associations between alcohol intake and brain macrostructure and microstructure are already apparent in individuals consuming an average of only one to two daily alcohol units, and become stronger as alcohol intake increases.
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21
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Noël X, Saeremans M, Kornreich C, Chatard A, Jaafari N, D'Argembeau A. Reduced calibration between subjective and objective measures of episodic future thinking in alcohol use disorder. Alcohol Clin Exp Res 2022; 46:300-311. [PMID: 35181906 DOI: 10.1111/acer.14763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND A reduced capacity to mentally simulate future scenarios could be of clinical importance in alcohol use disorder (AUD). However, little is known about the mechanisms underlying episodic future thinking (EFT) impairment in AUD. METHODS We tested patients with severe AUD using two measures of EFT: the individual's own subjective experience of their imaginings (phenomenology) and the objective number of details included in imagined events, as assessed by an independent observer (examination). The comparison between the two measures allowed us to investigate the extent to which the subjective and objective characteristics of EFT are calibrated in healthy and AUD participants matched for age, education, and gender. The possible impact of cognitive functioning and disturbed mood on EFT measures was also investigated. RESULTS In terms of objective details of EFT, patients with AUD (n = 40) generated fewer episodic components and more non-episodic components than control participants (n = 40), even when controlling for cognitive functioning. However, self-ratings of phenomenological characteristics indicated that participants with AUD perceived imagined future events at a similar level of detail as control participants. Additionally, there was a significant correlation between objective and subjective measures in healthy individuals but not in the AUD group. A higher depression score in the AUD group was not associated with the EFT measures. CONCLUSIONS These results suggest a distorted self-assessment of the richness of imagined future events in individuals with AUD. We discuss these apparent limitations in metacognitive abilities and verbal descriptions of imagined events among individuals with AUD and their clinical implications.
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Affiliation(s)
- Xavier Noël
- Laboratoire de Psychologie Médicale et d'Addictologie, ULB Neuroscience Institute (UNI), CHU Brugmann-Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Mélanie Saeremans
- Laboratoire de Psychologie Médicale et d'Addictologie (ULB), Brugmann University Hospital, Brussels, Belgium
| | - Charles Kornreich
- Laboratoire de Psychologie Médicale et d'Addictologie, ULB Neuroscience Institute (UNI), CHU Brugmann-Université Libre de Bruxelles (U.L.B.), Brussels, Belgium.,Laboratoire de Psychologie Médicale et d'Addictologie (ULB), Brugmann University Hospital, Brussels, Belgium
| | - Armand Chatard
- UMR-7295 CNRS, Faculté de Psychologie, Université de Poitiers, Poitiers, France
| | - Nemet Jaafari
- Unité de Recherche Clinique Pierre Deniker du Centre Hospitalier Henri Laborit, INSERM CIC-P 1402, Poitiers, France.,INSERM U 1084 Laboratoire Expérimental et Clinique en Neurosciences, University of Poitiers, Poitiers, France
| | - Arnaud D'Argembeau
- Unité de Recherche en Psychologie et Neuroscience Cognitives, Université de Liège, Liège, Belgium
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22
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Simon L, Edwards S, Molina PE. Pathophysiological Consequences of At-Risk Alcohol Use; Implications for Comorbidity Risk in Persons Living With Human Immunodeficiency Virus. Front Physiol 2022; 12:758230. [PMID: 35115952 PMCID: PMC8804300 DOI: 10.3389/fphys.2021.758230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/13/2021] [Indexed: 12/14/2022] Open
Abstract
At-risk alcohol use is a significant risk factor associated with multisystemic pathophysiological effects leading to multiorgan injury and contributing to 5.3% of all deaths worldwide. The alcohol-mediated cellular and molecular alterations are particularly salient in vulnerable populations, such as people living with HIV (PLWH), diminishing their physiological reserve, and accelerating the aging process. This review presents salient alcohol-associated mechanisms involved in exacerbation of cardiometabolic and neuropathological comorbidities and their implications in the context of HIV disease. The review integrates consideration of environmental factors, such as consumption of a Western diet and its interactions with alcohol-induced metabolic and neurocognitive dyshomeostasis. Major alcohol-mediated mechanisms that contribute to cardiometabolic comorbidity include impaired substrate utilization and storage, endothelial dysfunction, dysregulation of the renin-angiotensin-aldosterone system, and hypertension. Neuroinflammation and loss of neurotrophic support in vulnerable brain regions significantly contribute to alcohol-associated development of neurological deficits and alcohol use disorder risk. Collectively, evidence suggests that at-risk alcohol use exacerbates cardiometabolic and neurocognitive pathologies and accelerates biological aging leading to the development of geriatric comorbidities manifested as frailty in PLWH.
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23
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Guo X, Yan T, Chen M, Ma X, Li R, Li B, Yang A, Chen Y, Fang T, Yu H, Tian H, Chen G, Zhuo C. Differential effects of alcohol-drinking patterns on the structure and function of the brain and cognitive performance in young adult drinkers: A pilot study. Brain Behav 2022; 12:e2427. [PMID: 34808037 PMCID: PMC8785638 DOI: 10.1002/brb3.2427] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION This study was aimed to determine how different patterns of alcohol consumption drive changes to brain structure and function and their correlation with cognitive impairments in young adult alcohol drinkers. METHODS In this study, we enrolled five groups participants and defined as: long-term abstinence from alcohol (LA), binge drinking (BD), long-term low dosage alcohol consumption but exceeding the safety drinking dosage (LD), long-term alcohol consumption of damaging dosage (LDD), and long-term heavy drinking (HD). All participants underwent magnetic resonance imaging (MRI) and functional MRI (fMRI) to acquire data on brain structure and function, including gray matter volume (GMV), fractional amplitude of low-frequency fluctuation (fALFF), regional homogeneity (ReHo), functional connectivity (FC), and brain network properties. The cognitive ability was evaluated with the California Verbal Learning Test (CVLT), intelligence quotient (IQ), and short delay free recall (SDFR). RESULTS Compared to LA, GMV significantly decreased in the brain regions in VN, SMN, and VAN in the alcohol-drinking groups (BD, LD, LDD, and HD). ReHo was significantly enhanced in the brain regions in VN, SMN, and VAN, while fALFF significantly increased in the brain regions in VN and SMN. The number of intra- and inter-modular connections within networks (VN, SMN, sensory control network [SCN], and VAN) and their connections to other modules were abnormally changed. These changes adversely affected cognition (e.g., IQ, CVLT, SDFR). CONCLUSION Despite the small sample size, this study provides new evidence supporting the need for young people to abstain from alcohol to protect their brains. These findings present strong reasoning for updating anti-alcohol slogans and guidelines for young people in the future.
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Affiliation(s)
- Xiaobing Guo
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Tongjun Yan
- Department of Psychiatry, 904th Hospital of PLA, Changzhou, Jiangsu, China
| | - Min Chen
- Institute of Mental Health, Jining Medical University, Jining, China
| | - Xiaoyan Ma
- Department of Alcohol Dependence Management, Tianjin Anding Hospital, Tianjin Medical University Clinical Hospital of Mental Health, Tianjin, China.,Tianjin Anding Hospital, Tianjin Mental Health Center, Key Laboratory of Psychiatry Neuroimaging-Genetics and Co-morbidity (PNGC_Lab) of Tianjin Medical University Clinical Hospital of Mental Health, Nankai University Affiliated Tianjin Anding Hospital, Tianjin, China
| | - Ranli Li
- Department of Alcohol Dependence Management, Tianjin Anding Hospital, Tianjin Medical University Clinical Hospital of Mental Health, Tianjin, China.,Tianjin Anding Hospital, Tianjin Mental Health Center, Key Laboratory of Psychiatry Neuroimaging-Genetics and Co-morbidity (PNGC_Lab) of Tianjin Medical University Clinical Hospital of Mental Health, Nankai University Affiliated Tianjin Anding Hospital, Tianjin, China
| | - Bo Li
- Department of Psychiatry, Tianjin Kangtai Mental Health Hospital, Tianjin, China
| | - Anqu Yang
- Department of Psychiatry, Tianjin Kangtai Mental Health Hospital, Tianjin, China
| | - Yuhui Chen
- Department of Psychiatry, Tianjin Kangtai Mental Health Hospital, Tianjin, China
| | - Tao Fang
- Key Laboratory of Real Time Brain Circuits Tracing of Neurology and Psychiatry (RTBNB_Lab), Tianjin Fourth Center Hospital, Tianjin Medical Affiliated Tianjin Fourth Central Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin, China
| | - Haiping Yu
- Department of Alcohol Dependence Management, Wenzhou Seventh Peoples Hospital, Wenzhou, China
| | - Hongjun Tian
- Key Laboratory of Real Time Brain Circuits Tracing of Neurology and Psychiatry (RTBNB_Lab), Tianjin Fourth Center Hospital, Tianjin Medical Affiliated Tianjin Fourth Central Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin, China
| | - Guangdong Chen
- Department of Alcohol Dependence Management, Wenzhou Seventh Peoples Hospital, Wenzhou, China
| | - Chuanjun Zhuo
- Key Laboratory of Real Time Brain Circuits Tracing of Neurology and Psychiatry (RTBNB_Lab), Tianjin Fourth Center Hospital, Tianjin Medical Affiliated Tianjin Fourth Central Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin, China.,Department of Alcohol Dependence Management, Wenzhou Seventh Peoples Hospital, Wenzhou, China
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Si Y, Wang L, Zhao M. Anti-saccade as a Tool to Evaluate Neurocognitive Impairment in Alcohol Use Disorder. Front Psychiatry 2022; 13:823848. [PMID: 35573351 PMCID: PMC9094713 DOI: 10.3389/fpsyt.2022.823848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 03/23/2022] [Indexed: 11/13/2022] Open
Abstract
It has been widely shown that chronic alcohol use leads to cognitive dysfunctions, especially inhibitory control. In an extension of the traditional approach, this research field has benefited from the emergence of innovative measures, among which is an anti-saccade, allowing direct and sensitive measure of the eye movements indexing attention bias to alcohol-related cues and the capability of inhibiting the reflexive saccades to the cues. During the past decade, there are numerous reports showing that drinkers make more unwanted reflexive saccades and longer latency in the anti-saccade task. These increased errors are usually explained by the deficits in inhibitory control. It has been demonstrated that inhibitory control on eye movement may be one of the earliest biomarkers of the onset of alcohol-related cognitive impairments. This review summarizes how an anti-saccade task can be used as a tool to investigate and assess the cognitive dysfunctions and the early detection of relapsing risk of alcohol dependence.
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Affiliation(s)
- Yuqi Si
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lihui Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China.,CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Sciences, Shanghai, China
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Lannoy S, Sullivan EV. Trajectories of brain development reveal times of risk and factors promoting resilience to alcohol use during adolescence. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2021; 160:85-116. [PMID: 34696880 PMCID: PMC10657639 DOI: 10.1016/bs.irn.2021.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Alcohol use disorder (AUD) is recognized as harmful for the developing brain. Numerous studies have sought environmental and genetic risk factors that predict the development of AUD, but recently identified resilience factors have emerged as protective. This chapter reviews normal processes of brain development in adolescence and emerging adulthood, delineates disturbed growth neurotrajectories related to heavy drinking, and identifies potential endogenous, experiential, and time-linked brain markers of resilience. For example, concurrent high dorsolateral prefrontal activation serving inhibitory control and low nucleus accumbens activation serving reward functions engender positive adaptation and low alcohol use. Also discussed is the role that moderating factors have in promoting risk for or resilience to AUD. Longitudinal research on the effects of all levels of alcohol drinking on the developing brain remains crucial and should be pursued in the context of resilience, which is a promising direction for identifying protective biomarkers against developing AUDs.
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Affiliation(s)
- S Lannoy
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States; Department of Psychiatry, Virginia Commonwealth University, Virginia Institute for Psychiatric and Behavioral Genetics, Richmond, VA, United States
| | - E V Sullivan
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States.
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26
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Bauer LO. Temporal instability in brain activation: a novel paradigm for evaluating the maintenance of attention among substance dependent patients. Psychopharmacology (Berl) 2021; 238:2937-2946. [PMID: 34196741 PMCID: PMC10127227 DOI: 10.1007/s00213-021-05909-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/17/2021] [Indexed: 10/21/2022]
Abstract
RATIONALE Prior studies have demonstrated statistically significant but subtle differences in brain function between patients with a history of substance dependence (SD) and control groups. OBJECTIVES The goal of the present study was to show that variability in brain activation over the trials of a cognitive task is more useful for revealing the putative impact of SD than analyses focusing on the amplitude of activation averaged over trials. The study also tested the additional contribution of antisocial personality disorder (ASPD)-a prevalent comorbidity that promotes both an early onset and more severe course of SD. METHODS Two hundred eleven adults performed two selective attention tasks while P300 event-related electroencephalographic potentials were recorded. They were assigned to one of 3 mutually exclusive groups: no lifetime history of SD or ASPD (n = 67), a SD history but no ASPD (n = 68), or both SD and ASPD (n = 76). RESULTS The major finding was a statistically significant elevation of P300 amplitude inter-trial variability (ITV) in the SD plus ASPD group in comparison to the group with neither attribute. The elevation was detected during both selective attention tasks and most prominent at electrodes sites located over the frontal brain. There were no group differences in P300 amplitude averaged over trials. CONCLUSIONS We conclude from these findings that the ITV of P300 amplitude is an efficient and sensitive biomarker of the maintenance of attention. It is valuable for revealing group differences associated with substance dependence and ASPD. It may ultimately be valuable for detecting improvements resulting from psychostimulant treatment or other interventions, including cognitive remediation.
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Affiliation(s)
- Lance O Bauer
- Department of Psychiatry, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06030, USA.
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27
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Watten RG, Watten VP. Snus and Alcohol: Mutually Rewarding Effects in the Brain? A Matched Controlled Population Study. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2021; 15:11782218211027124. [PMID: 34366668 PMCID: PMC8317241 DOI: 10.1177/11782218211027124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/28/2021] [Indexed: 12/02/2022]
Abstract
Background: The use of moist smokeless tobacco (snus) is increasing in the U.S. and other Western countries, and especially among young people. Snus is associated with several health problems, but the relationship between use of snus and alcohol is scarcely explored. Neuro-cognitive and psychological research suggest an association due to possible mutually rewarding effects in the limbic brain. We investigated this issue in a matched controlled population study. Methods: Matched control group design where drinking habits and alcohol consumption in a group of users of snus (n = 1043, mean age = 35.20; n men = 749, n women = 294) were compared to a control group of non-users matched on age and gender (n = 1043, mean age = 35.65; n men = 749, n women = 294). In addition, we registered background variables such as level of education, income, self-perceived general, dental health, mental health, current depressive symptoms, and BMI. In estimation of alcohol consumption, the background variables were used as covariates in factorial analyses of variance (ANCOVA). Results: Users of snus had lower level of education, lower income, poorer general, dental, and mental health status than non-users, but there were no differences in BMI. Differences in mental health status were related to drinking habits. Users of snus had a higher frequency of drinking, higher frequency of intoxication, and showed more excess drinking. Controlled for background variables users of snus had a 25.2% higher estimated yearly consumption of alcohol in terms of standard units of alcohol on the weekdays, 26.4% higher on weekends and a 60.2% higher yearly excess consumption. Conclusion: Users of snus had an elevated alcohol consumption and another drinking style than non-users. The findings are discussed according to neuro-cognitive and psychopharmacological mechanisms, reward learning and conditioning. The results have implications for prevention, treatment and rehabilitation of alcohol and nicotine dependence.
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Affiliation(s)
- Reidulf G Watten
- Department of Psychology, Inland Norway University of Applied Sciences, INN University, Norway
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28
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Berenz EC, Edalatian Zakeri S, Demos AP, Paltell KC, Bing-Canar H, Kevorkian S, Ranney R. Negative affect and alcohol craving in trauma-exposed young adult drinkers. Alcohol Clin Exp Res 2021; 45:1479-1493. [PMID: 34241905 DOI: 10.1111/acer.14641] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 05/05/2021] [Accepted: 05/12/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Clinical research indicates that successful posttraumatic stress disorder (PTSD) treatment does not lead to improvements in alcohol use outcomes in comorbid PTSD and alcohol use disorder (AUD). Emerging theory suggests that treating PTSD may not disrupt an association between negative affect and alcohol craving, which underlies negative reinforcement drinking. The goal of the current study was to determine the respective influences of PTSD symptoms, coping motives, and negative affect on trauma and alcohol cue reactivity to inform theoretical models of co-occurring PTSD and AUD. METHODS The sample consisted of 189 young adults (50.3% women; 49.2% current PTSD; 84.0% current AUD) who endorsed interpersonal trauma (e.g., sexual/physical assault) and current weekly alcohol use. Participants completed a trauma and alcohol cue reactivity assessment, in which subjective (e.g., craving, affect) and physiological (i.e., salivation) measures were recorded in response to 4 narrative (i.e., personalized trauma or standard neutral) and in vivo beverage (i.e., personalized alcohol or water) cue combinations. RESULTS Forward-fitted linear mixed-effects (LME) models confirmed that trauma cue-elicited craving was elevated among those high but not low in PTSD symptoms, consistent with prior research and theory. Trauma cue-elicited craving was fully explained by increases in negative affect, with no evidence of a direct effect of trauma cue on craving. PTSD symptoms moderated an association between trauma cue and negative affect (but not negative affect and craving), and coping motives for alcohol moderated an association between negative affect and craving (but not trauma cue and negative affect). CONCLUSIONS This study provides novel laboratory evidence for the respective contributions of negative affect, PTSD symptoms, and coping motives on alcohol craving in trauma-exposed drinkers. It offers a methodological framework in which to evaluate novel strategies that aim to disrupt negative reinforcement drinking in individuals with co-occurring PTSD and AUD.
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Affiliation(s)
- Erin C Berenz
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Alexander P Demos
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
| | - Katherine C Paltell
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
| | - Hanaan Bing-Canar
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
| | - Salpi Kevorkian
- Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Rachel Ranney
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
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29
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Tomasi D, Wiers CE, Manza P, Shokri-Kojori E, Michele-Vera Y, Zhang R, Kroll D, Feldman D, McPherson K, Biesecker C, Schwandt M, Diazgranados N, Koob GF, Wang GJ, Volkow ND. Accelerated Aging of the Amygdala in Alcohol Use Disorders: Relevance to the Dark Side of Addiction. Cereb Cortex 2021; 31:3254-3265. [PMID: 33629726 DOI: 10.1093/cercor/bhab006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/04/2021] [Accepted: 01/07/2021] [Indexed: 02/07/2023] Open
Abstract
Here we assessed changes in subcortical volumes in alcohol use disorder (AUD). A simple morphometry-based classifier (MC) was developed to identify subcortical volumes that distinguished 32 healthy controls (HCs) from 33 AUD patients, who were scanned twice, during early and later withdrawal, to assess the effect of abstinence on MC-features (Discovery cohort). We validated the novel classifier in an independent Validation cohort (19 AUD patients and 20 HCs). MC-accuracy reached 80% (Discovery) and 72% (Validation). MC features included the hippocampus, amygdala, cerebellum, putamen, corpus callosum, and brain stem, which were smaller and showed stronger age-related decreases in AUD than HCs, and the ventricles and cerebrospinal fluid, which were larger in AUD and older participants. The volume of the amygdala showed a positive association with anxiety and negative urgency in AUD. Repeated imaging during the third week of detoxification revealed slightly larger subcortical volumes in AUD patients, consistent with partial recovery during abstinence. The steeper age-associated volumetric reductions in stress- and reward-related subcortical regions in AUD are consistent with accelerated aging, whereas the amygdalar associations with negative urgency and anxiety in AUD patients support its involvement in the "dark side of addiction".
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Affiliation(s)
- Dardo Tomasi
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892, USA
| | - Corinde E Wiers
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892, USA
| | - Peter Manza
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892, USA
| | | | - Yonga Michele-Vera
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892, USA
| | - Rui Zhang
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892, USA
| | - Danielle Kroll
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892, USA
| | - Dana Feldman
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892, USA
| | | | | | - Melanie Schwandt
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892, USA
| | - Nancy Diazgranados
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892, USA
| | - George F Koob
- National Institute on Drug Abuse, Bethesda, MD 21224, USA
| | - Gene-Jack Wang
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892, USA
| | - Nora D Volkow
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892, USA
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30
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Zahr NM, Pohl KM, Kwong AJ, Sullivan EV, Pfefferbaum A. Preliminary Evidence for a Relationship between Elevated Plasma TNFα and Smaller Subcortical White Matter Volume in HCV Infection Irrespective of HIV or AUD Comorbidity. Int J Mol Sci 2021; 22:ijms22094953. [PMID: 34067023 PMCID: PMC8124321 DOI: 10.3390/ijms22094953] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 02/08/2023] Open
Abstract
Classical inflammation in response to bacterial, parasitic, or viral infections such as HIV includes local recruitment of neutrophils and macrophages and the production of proinflammatory cytokines and chemokines. Proposed biomarkers of organ integrity in Alcohol Use Disorders (AUD) include elevations in peripheral plasma levels of proinflammatory proteins. In testing this proposal, previous work included a group of human immunodeficiency virus (HIV)-infected individuals as positive controls and identified elevations in the soluble proteins TNFα and IP10; these cytokines were only elevated in AUD individuals seropositive for hepatitis C infection (HCV). The current observational, cross-sectional study evaluated whether higher levels of these proinflammatory cytokines would be associated with compromised brain integrity. Soluble protein levels were quantified in 86 healthy controls, 132 individuals with AUD, 54 individuals seropositive for HIV, and 49 individuals with AUD and HIV. Among the patient groups, HCV was present in 24 of the individuals with AUD, 13 individuals with HIV, and 20 of the individuals in the comorbid AUD and HIV group. Soluble protein levels were correlated to regional brain volumes as quantified with structural magnetic resonance imaging (MRI). In addition to higher levels of TNFα and IP10 in the 2 HIV groups and the HCV-seropositive AUD group, this study identified lower levels of IL1β in the 3 patient groups relative to the control group. Only TNFα, however, showed a relationship with brain integrity: in HCV or HIV infection, higher peripheral levels of TNFα correlated with smaller subcortical white matter volume. These preliminary results highlight the privileged status of TNFα on brain integrity in the context of infection.
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Affiliation(s)
- Natalie M. Zahr
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA; (K.M.P.); (A.P.)
- Neuroscience Program, SRI International, Menlo Park, CA 94025, USA;
- Correspondence: ; Tel.: +1-650-859-5243
| | - Kilian M. Pohl
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA; (K.M.P.); (A.P.)
- Neuroscience Program, SRI International, Menlo Park, CA 94025, USA;
| | - Allison J. Kwong
- Gastroenterology and Hepatology Medicine, Stanford University School of Medicine, Stanford, CA 94350, USA;
| | | | - Adolf Pfefferbaum
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA; (K.M.P.); (A.P.)
- Neuroscience Program, SRI International, Menlo Park, CA 94025, USA;
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31
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Sullivan EV, Zhao Q, Pohl KM, Zahr NM, Pfefferbaum A. Attenuated cerebral blood flow in frontolimbic and insular cortices in Alcohol Use Disorder: Relation to working memory. J Psychiatr Res 2021; 136:140-148. [PMID: 33592385 PMCID: PMC8009820 DOI: 10.1016/j.jpsychires.2021.01.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/12/2021] [Accepted: 01/29/2021] [Indexed: 12/25/2022]
Abstract
Chronic, excessive alcohol consumption is associated with cerebrovascular hypoperfusion, which has the potential to interfere with cognitive processes. Magnetic resonance pulsed continuous arterial spin labeling (PCASL) provides a noninvasive approach for measuring regional cerebral blood flow (CBF) and was used to study 24 men and women with Alcohol Use Disorder (AUD) and 20 age- and sex-matched controls. Two analysis approaches tested group differences: a data-driven, regionally-free method to test for group differences on a voxel-by-voxel basis and a region of interest (ROI) approach, which focused quantification on atlas-determined brain structures. Whole-brain, voxel-wise quantification identified low AUD-related cerebral perfusion in large volumes of medial frontal and cingulate cortices. The ROI analysis also identified lower CBF in the AUD group relative to the control group in medial frontal, anterior/middle cingulate, insular, and hippocampal/amygdala ROIs. Further, years of AUD diagnosis negatively correlated with temporal cortical CBF, and scores on an alcohol withdrawal scale negatively correlated with posterior cingulate and occipital gray matter CBF. Regional volume deficits did not account for AUD CBF deficits. Functional relevance of attenuated regional CBF in the AUD group emerged with positive correlations between episodic working memory test scores and anterior/middle cingulum, insula, and thalamus CBF. The frontolimbic and insular cortical neuroconstellation with dampened perfusion suggests a mechanism of dysfunction associated with these brain regions in AUD.
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Affiliation(s)
- Edith V. Sullivan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA;,Correspondence Edith V. Sullivan, Ph.D., Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine (MC5723), 401 Quarry Road, Stanford, CA 94305-5723, phone: (650) 859-2880, FAX: (650) 859-2743,
| | - Qingyu Zhao
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Kilian M. Pohl
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA;,Center for Health Sciences, SRI International, Menlo Park, CA
| | - Natalie M. Zahr
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA;,Center for Health Sciences, SRI International, Menlo Park, CA
| | - Adolf Pfefferbaum
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA;,Center for Health Sciences, SRI International, Menlo Park, CA
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32
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Abdallah M, Zahr NM, Saranathan M, Honnorat N, Farrugia N, Pfefferbaum A, Sullivan EV, Chanraud S. Altered Cerebro-Cerebellar Dynamic Functional Connectivity in Alcohol Use Disorder: a Resting-State fMRI Study. THE CEREBELLUM 2021; 20:823-835. [PMID: 33655376 PMCID: PMC8413394 DOI: 10.1007/s12311-021-01241-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/31/2021] [Indexed: 12/28/2022]
Abstract
Alcohol use disorder (AUD) is widely associated with cerebellar dysfunction and altered cerebro-cerebellar functional connectivity (FC) that lead to cognitive impairments. Evidence for this association comes from resting-state functional magnetic resonance imaging (rsfMRI) studies that assess time-averaged measures of FC across the duration of a typical scan. This approach, however, precludes the assessment of potentially FC dynamics happening at faster timescales. In this study, using rsfMRI data, we aim at exploring cerebro-cerebellar FC dynamics in AUD patients (N = 18) and age- and sex-matched controls (N = 18). In particular, we quantified group-level differences in the temporal variability of FC between the posterior cerebellum and large-scale cognitive systems, and we investigated the role of the cerebellum in large-scale brain dynamics in terms of the temporal flexibility and integration of its regions. We found that, relative to controls, the AUD group exhibited significantly greater FC variability between the cerebellum and both the frontoparietal executive control (F1,31 = 7.01, p(FDR) = 0.028) and ventral attention (F1,31 = 7.35, p(FDR) = 0.028) networks. Moreover, the AUD group exhibited significantly less flexibility (F1,31 = 8.61, p(FDR) = 0.028) and greater integration (F1,31 = 9.11, p(FDR) = 0.028) in the cerebellum. Finally, in an exploratory analysis, we found distributed changes in the dynamics of canonical large-scale networks in AUD. Overall, this study brings evidence of AUD-related alterations in dynamic FC within major cerebro-cerebellar networks. This pattern has implications for explaining the development and maintenance of this disorder and improving our understating of the cerebellum's involvement in addiction.
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Affiliation(s)
- Majd Abdallah
- Aquitaine Institute of Cognitive and Integrative Neuroscience, UMR CNRS 5287, University of Bordeaux, Bordeaux, France
| | - Natalie M Zahr
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305-5723, USA.,Center for Health Sciences, SRI International, Menlo Park, CA, 94025, USA
| | | | - Nicolas Honnorat
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305-5723, USA.,Center for Health Sciences, SRI International, Menlo Park, CA, 94025, USA
| | | | - Adolf Pfefferbaum
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305-5723, USA.,Center for Health Sciences, SRI International, Menlo Park, CA, 94025, USA
| | - Edith V Sullivan
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305-5723, USA.,Center for Health Sciences, SRI International, Menlo Park, CA, 94025, USA
| | - Sandra Chanraud
- Aquitaine Institute of Cognitive and Integrative Neuroscience, UMR CNRS 5287, University of Bordeaux, Bordeaux, France. .,Laboratory of Neuroimaging and Daily Life, EPHE, PSL, Research University, Bordeaux, France.
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Age differences in brain structural and metabolic responses to binge ethanol exposure in fisher 344 rats. Neuropsychopharmacology 2021; 46:368-379. [PMID: 32580206 PMCID: PMC7852871 DOI: 10.1038/s41386-020-0744-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 06/09/2020] [Accepted: 06/16/2020] [Indexed: 02/08/2023]
Abstract
An overarching goal of our research has been to develop a valid animal model of alcoholism with similar imaging phenotypes as those observed in humans with the ultimate objective of assessing the effectiveness of pharmacological agents. In contrast to our findings in humans with alcohol use disorders (AUD), our animal model experiments have not demonstrated enduring brain pathology despite chronic, high ethanol (EtOH) exposure protocols. Relative to healthy controls, older individuals with AUD demonstrate accelerating brain tissue loss with advanced age. Thus, this longitudinally controlled study was conducted in 4-month old (equivalent to ~16-year-old humans) and 17-month old (equivalent to ~45-year-old humans) male and female Fisher 344 rats to test the hypothesis that following equivalent alcohol exposure protocols, older relative to younger animals would exhibit more brain changes as evaluated using in vivo structural magnetic resonance imaging (MRI) and MR spectroscopy (MRS). At baseline, total brain volume as well as the volumes of each of the three constituent tissue types (i.e., cerebral spinal fluid (CSF), gray matter, white matter) were greater in old relative to young rats. Baseline metabolite levels (except for glutathione) were higher in older than younger animals. Effects of binge EtOH exposure on brain volumes and neurometabolites replicated our previous findings in Wistar rats and included ventricular enlargement and reduced MRS-derived creatine levels. Brain changes in response to binge EtOH treatment were more pronounced in young relative to older animals, negating our hypothesis. Higher baseline glutathione levels in female than male rats suggest that female rats are perhaps protected against the more pronounced changes in CSF and gray matter volumes observed in male rats due to superior metabolic homeostasis mechanisms. Additional metabolite changes including low inositol levels in response to high blood alcohol levels support a mechanism of reversible osmolarity disturbances due to temporarily altered brain energy metabolism.
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Bordia T, Zahr NM. The Inferior Colliculus in Alcoholism and Beyond. Front Syst Neurosci 2020; 14:606345. [PMID: 33362482 PMCID: PMC7759542 DOI: 10.3389/fnsys.2020.606345] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/02/2020] [Indexed: 12/28/2022] Open
Abstract
Post-mortem neuropathological and in vivo neuroimaging methods have demonstrated the vulnerability of the inferior colliculus to the sequelae of thiamine deficiency as occurs in Wernicke-Korsakoff Syndrome (WKS). A rich literature in animal models ranging from mice to monkeys-including our neuroimaging studies in rats-has shown involvement of the inferior colliculi in the neural response to thiamine depletion, frequently accomplished with pyrithiamine, an inhibitor of thiamine metabolism. In uncomplicated alcoholism (i.e., absent diagnosable neurological concomitants), the literature citing involvement of the inferior colliculus is scarce, has nearly all been accomplished in preclinical models, and is predominately discussed in the context of ethanol withdrawal. Our recent work using novel, voxel-based analysis of structural Magnetic Resonance Imaging (MRI) has demonstrated significant, persistent shrinkage of the inferior colliculus using acute and chronic ethanol exposure paradigms in two strains of rats. We speculate that these consistent findings should be considered from the perspective of the inferior colliculi having a relatively high CNS metabolic rate. As such, they are especially vulnerable to hypoxic injury and may be provide a common anatomical link among a variety of disparate insults. An argument will be made that the inferior colliculi have functions, possibly related to auditory gating, necessary for awareness of the external environment. Multimodal imaging including diffusion methods to provide more accurate in vivo visualization and quantification of the inferior colliculi may clarify the roles of brain stem nuclei such as the inferior colliculi in alcoholism and other neuropathologies marked by altered metabolism.
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Affiliation(s)
- Tanuja Bordia
- Neuroscience Program, SRI International, Menlo Park, CA, United States
| | - Natalie M. Zahr
- Neuroscience Program, SRI International, Menlo Park, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
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35
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Abstract
Alcohol use disorder (AUD) commonly is associated with compromise in neurobiological and/or neurobehavioral processes. The severity of this compromise varies across individuals and outcomes, as does the degree to which recovery of function is achieved. This narrative review first summarizes neurobehavioral, neurophysiological, structural, and neurochemical aberrations/deficits that are frequently observed in people with AUD after detoxification. Subsequent sections review improvements across these domains during recovery, taking into account modulators of recovery to the extent permitted. Where appropriate, the discussion includes work integrating outcomes across domains, leveraging the strengths of diverse experimental methods. Interventions to ameliorate neurobiological or neurobehavioral deficits do not constitute a primary objective of this review. However, their consideration is a logical inclusion. Therefore, a limited introduction to existing methods is also presented.
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Affiliation(s)
- Sara Jo Nixon
- Department of Psychiatry, University of Florida, Gainesville, Florida.,Center for Addiction Research & Education, University of Florida, Gainesville, Florida
| | - Ben Lewis
- Department of Psychiatry, University of Florida, Gainesville, Florida.,Center for Addiction Research & Education, University of Florida, Gainesville, Florida
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36
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Luciana M. Risks versus consequences of adolescent and young adult substance use: A focus on executive control. CURRENT ADDICTION REPORTS 2020; 7:453-463. [PMID: 33816055 PMCID: PMC8014909 DOI: 10.1007/s40429-020-00341-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW This review examines the role of executive control processes in the liability for substance misuse and whether substance use, once initiated, leads to subsequent decrements as proposed by neurotoxicity models of substance use disorder (SUD). RECENT FINDINGS As indicated by a number of recent meta-analyses, executive control processes, which include working memory, cognitive flexibility and numerous aspects of attentional, behavioral and emotional control, are impaired in the context of active SUD. Longitudinal studies of behaviorally disinhibited children, individuals with familial risks for SUD, and twins within whom genetic versus environmental influences on behavior can be modeled robustly indicate that relatively poor control is a vulnerability factor for early substance use initiation, binge patterns of use, and subsequent SUD. Evidence of further declines in executive control, once substance use is initiated, is mixed, although a growing number of neuroimaging studies indicate that frontostriatal, frontolimbic, and frontocerebellar systems are altered as a consequence of use. SUMMARY Together these patterns suggest strategies for identifying children and adolescents at high risk for SUD, avenues through which substance-related neurotoxicities can be more reliably detected, and the need to structure prevention efforts in a manner that is developmentally appropriate and perhaps personalized to individual vulnerabilities.
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Affiliation(s)
- Monica Luciana
- Department of Psychology, University of Minnesota, Minneapolis MN, 55455 USA
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Sullivan EV. The Many Levels of Relapse to Drinking: Commentary on Meyerhoff and Durazzo (ACER 2020). Alcohol Clin Exp Res 2020; 44:1714-1716. [PMID: 32623744 DOI: 10.1111/acer.14409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 06/26/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Edith V Sullivan
- From the, Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
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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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