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Ferreira S, Virgolino A, Ribeiro C, Pombo S, Bacelar-Nicolau L. Effectiveness of Neuropsychological Rehabilitation in the Recovery of Executive Deficits in Patients with Alcohol Use Disorder: A Systematic Review Protocol. ACTA MEDICA PORT 2024; 37:262-266. [PMID: 37668530 DOI: 10.20344/amp.19804] [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: 02/18/2023] [Accepted: 06/29/2023] [Indexed: 09/06/2023]
Abstract
INTRODUCTION Changes in executive functions associated with alcohol consumption are frequently found in alcohol use disorder. Neuropsychological rehabilitation can play an essential role as an effective treatment in the recovery from these deficits, leading to the maintenance of abstinence. However, there are still some uncertainties regarding its impact on the recovery of deficits in executive functions. Our purpose is to present a protocol for a systematic review aiming to assess which neuropsychological rehabilitation programs are effective in the recovery of executive deficits in patients with alcohol use disorder. METHODS We will search the following databases: PubMed, Cochrane Library (CENTRAL), Web of Science, and Scopus, as well as the list of references of the identified studies. Screening, data extraction, and synthesis, as well as evaluation of the risk of bias, will be carried out by two reviewers independently, using ROBINS-I and RoB 2. Disagreements will be resolved using a third additional reviewer. Primary outcomes will correspond to changes in executive functions, following a neuropsychological rehabilitation program in patients with alcohol use disorder. The evidence will be synthesized using a narrative description of neuropsychological rehabilitation programs and the indicators of their effectiveness will be identified. The neuropsychological rehabilitation programs for executive functions will be assessed considering their different components and their impact on the recovery of these functions. The review described in this protocol will allow the development of guidelines for the design of more effective rehabilitation programs for clinical populations with alcohol use disorder.
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Affiliation(s)
- Sónia Ferreira
- Unidade de Tratamento e Reabilitação de Alcoólicos. Centro Hospitalar Psiquiátrico de Lisboa. Lisboa; Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
| | - Ana Virgolino
- Instituto de Saúde Ambiental. Faculdade de Medicina. Universidade de Lisboa. Lisboa; Laboratório Associado TERRA. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
| | - Cristina Ribeiro
- Faculdade de Medicina. Universidade de Lisboa. Lisboa; Instituto de Medicina Preventiva e Saúde Pública. Clínica Universitária de Medicina Geral e Familiar. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
| | - Samuel Pombo
- Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
| | - Leonor Bacelar-Nicolau
- Instituto de Saúde Ambiental. Faculdade de Medicina. Universidade de Lisboa. Lisboa; Laboratório Associado TERRA. Faculdade de Medicina. Universidade de Lisboa. Lisboa; Instituto de Medicina Preventiva e Saúde Pública & Área Disciplinar Autónoma de Bioestatística (Laboratório de Biomatemática). Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
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Faltinsen E, Todorovac A, Staxen Bruun L, Hróbjartsson A, Gluud C, Kongerslev MT, Simonsen E, Storebø OJ. Control interventions in randomised trials among people with mental health disorders. Cochrane Database Syst Rev 2022; 4:MR000050. [PMID: 35377466 PMCID: PMC8979177 DOI: 10.1002/14651858.mr000050.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Control interventions in randomised trials provide a frame of reference for the experimental interventions and enable estimations of causality. In the case of randomised trials assessing patients with mental health disorders, many different control interventions are used, and the choice of control intervention may have considerable impact on the estimated effects of the treatments being evaluated. OBJECTIVES To assess the benefits and harms of typical control interventions in randomised trials with patients with mental health disorders. The difference in effects between control interventions translates directly to the impact a control group has on the estimated effect of an experimental intervention. We aimed primarily to assess the difference in effects between (i) wait-list versus no-treatment, (ii) usual care versus wait-list or no-treatment, and (iii) placebo interventions (all placebo interventions combined or psychological, pharmacological, and physical placebos individually) versus wait-list or no-treatment. Wait-list patients are offered the experimental intervention by the researchers after the trial has been finalised if it offers more benefits than harms, while no-treatment participants are not offered the experimental intervention by the researchers. SEARCH METHODS In March 2018, we searched MEDLINE, PsycInfo, Embase, CENTRAL, and seven other databases and six trials registers. SELECTION CRITERIA We included randomised trials assessing patients with a mental health disorder that compared wait-list, usual care, or placebo interventions with wait-list or no-treatment . DATA COLLECTION AND ANALYSIS Titles, abstracts, and full texts were reviewed for eligibility. Review authors independently extracted data and assessed risk of bias using Cochrane's risk of bias tool. GRADE was used to assess the quality of the evidence. We contacted researchers working in the field to ask for data from additional published and unpublished trials. A pre-planned decision hierarchy was used to select one benefit and one harm outcome from each trial. For the assessment of benefits, we summarised continuous data as standardised mean differences (SMDs) and dichotomous data as risk ratios (RRs). We used risk differences (RDs) for the assessment of adverse events. We used random-effects models for all statistical analyses. We used subgroup analysis to explore potential causes for heterogeneity (e.g. type of placebo) and sensitivity analyses to explore the robustness of the primary analyses (e.g. fixed-effect model). MAIN RESULTS We included 96 randomised trials (4200 participants), ranging from 8 to 393 participants in each trial. 83 trials (3614 participants) provided usable data. The trials included 15 different mental health disorders, the most common being anxiety (25 trials), depression (16 trials), and sleep-wake disorders (11 trials). All 96 trials were assessed as high risk of bias partly because of the inability to blind participants and personnel in trials with two control interventions. The quality of evidence was rated low to very low, mostly due to risk of bias, imprecision in estimates, and heterogeneity. Only one trial compared wait-list versus no-treatment directly but the authors were not able to provide us with any usable data on the comparison. Five trials compared usual care versus wait-list or no-treatment and found a SMD -0.33 (95% CI -0.83 to 0.16, I² = 86%, 523 participants) on benefits. The difference between all placebo interventions combined versus wait-list or no-treatment was SMD -0.37 (95% CI -0.49 to -0.25, I² = 41%, 65 trials, 2446 participants) on benefits. There was evidence of some asymmetry in the funnel plot (Egger's test P value of 0.087). Almost all the trials were small. Subgroup analysis found a moderate effect in favour of psychological placebos SMD -0.49 (95% CI -0.64 to -0.30; I² = 53%, 39 trials, 1656 participants). The effect of pharmacological placebos versus wait-list or no-treatment on benefits was SMD -0.14 (95% CI -0.39 to 0.11, 9 trials, 279 participants) and the effect of physical placebos was SMD -0.21 (95% CI -0.35 to -0.08, I² = 0%, 17 trials, 896 participants). We found large variations in effect sizes in the psychological and pharmacological placebo comparisons. For specific mental health disorders, we found significant differences in favour of all placebos for sleep-wake disorders, major depressive disorder, and anxiety disorders, but the analyses were imprecise due to sparse data. We found no significant differences in harms for any of the comparisons but the analyses suffered from sparse data. When using a fixed-effect model in a sensitivity analysis on the comparison for usual care versus wait-list and no-treatment, the results were significant with an SMD of -0.46 (95 % CI -0.64 to -0.28). We reported an alternative risk of bias model where we excluded the blinding domains seeing how issues with blinding may be seen as part of the review investigation itself. However, this did not markedly change the overall risk of bias profile as most of the trials still included one or more unclear bias domains. AUTHORS' CONCLUSIONS We found marked variations in effects between placebo versus no-treatment and wait-list and between subtypes of placebo with the same comparisons. Almost all the trials were small with considerable methodological and clinical variability in factors such as mental health population, contents of the included control interventions, and outcome domains. All trials were assessed as high risk of bias and the evidence quality was low to very low. When researchers decide to use placebos or usual care control interventions in trials with people with mental health disorders it will often lead to lower estimated effects of the experimental intervention than when using wait-list or no-treatment controls. The choice of a control intervention therefore has considerable impact on how effective a mental health treatment appears to be. Methodological guideline development is needed to reach a consensus on future standards for the design and reporting of control interventions in mental health intervention research.
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Affiliation(s)
- Erlend Faltinsen
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Adnan Todorovac
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
| | | | - Asbjørn Hróbjartsson
- Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Mickey T Kongerslev
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ole Jakob Storebø
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
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Santiago A, Carré A, Miranda R, Lemogne C, LeStrat Y, Benyamina A, Perney P, Luquiens A. Study protocol for an online randomised controlled trial among non-treatment seeking problem gamblers: training inhibition in online problem gambling (TRAIN-online) trial. BMJ Open 2021; 11:e051641. [PMID: 34848517 PMCID: PMC8634281 DOI: 10.1136/bmjopen-2021-051641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Development of fully internet-based programs could provide a new avenue to improve access to healthcare for problem gamblers. In this project, we aim to assess the efficacy of a web-based cognitive intervention targeting inhibitory control among problem gamblers, using a randomised controlled design. As impaired inhibitory control is involved in self-regulation difficulties in behavioural addictions, it represents a particularly relevant cognitive process to target for an online psychological intervention. METHODS AND ANALYSIS This will be a single-blinded, randomised, comparative therapeutic web-based, controlled trial. Up to 200 non-treatment seeking adult problem gamblers with a Problem Gambling Severity Index-recent (PGSI-recent) score ≥5 will be included. The intervention will be a computerised cognitive training program targeting inhibitory skills. The comparator, an active control, will be a computerised neutral sensorial program. Both programs will be carried out under similar conditions: biweekly online training for 6 weeks and optional telephone support will be offered to patients for debriefing. The main objective of the study is to assess the clinical efficacy of the online cognitive training program at 6 weeks, measured with the PGSI-recent. The secondary objectives are to assess the efficacy on the gambling behaviour assessed by the account-based gambling data, on the self-reported gambling practice, and on the inhibition performance at the neuropsychological level at 6, 14 and 52 weeks. We will also assess the acceptability of this program and the preferred level of guidance. Data analysis will be in intention-to-treat. ETHICS AND DISSEMINATION This randomized controlled trial will be executed in compliance with the Helsinki Declaration, and was approved by the local ethics boards (Comité de Protection des Personnes) in October 2017. The findings will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03673800.
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Affiliation(s)
- Antoine Santiago
- Addiction Team, CESP, Villejuif, Île-de-France, France
- Department of Addictology, Nîmes University Hospital, Nimes, Languedoc-Roussillon, France
| | - Arnaud Carré
- Addiction Team, CESP, Villejuif, Île-de-France, France
- LIP/PC2S, Université Savoie Mont-Blanc, Chambery, Rhône-Alpes, France
| | - Ruben Miranda
- Addiction Team, CESP, Villejuif, Île-de-France, France
- Adult Neurodeveloppment Center, Department of Psychiatry, Pitié-Salpêtrière Hospital, AP-HP, Paris, Île-de-France, France
| | - Cédric Lemogne
- Department of Psychiatry, Georges Pompidou European Hospital, AP-HP, Paris, Île-de-France, France
| | - Yann LeStrat
- U1266, Institute of Psychiatry and Neurosciences of Paris, Paris, Île-de-France, France
- Department of Psychiatry, Louis-Mourier Hospital, AP-HP, Colombes, Île-de-France, France
| | - Amine Benyamina
- Addiction Team, CESP, Villejuif, Île-de-France, France
- Department of Psychiatry and Addictology, Paul Brousse Hospital, AP-HP, Villejuif, Île-de-France, France
| | - Pascal Perney
- Department of Addictology, Nîmes University Hospital, Nimes, Languedoc-Roussillon, France
| | - Amandine Luquiens
- Addiction Team, CESP, Villejuif, Île-de-France, France
- Department of Addictology, Nîmes University Hospital, Nimes, Languedoc-Roussillon, France
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Caetano T, Pinho MS, Ramadas E, Clara C, Areosa T, Dixe MDA. Cognitive Training Effectiveness on Memory, Executive Functioning, and Processing Speed in Individuals With Substance Use Disorders: A Systematic Review. Front Psychol 2021; 12:730165. [PMID: 34489833 PMCID: PMC8418081 DOI: 10.3389/fpsyg.2021.730165] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 07/20/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Cerebral neuroplasticity is compromised due to substance abuse. There is damage to neuronal areas that are involved in memory and executive functioning. Treatments with worse outcomes are often associated with cognitive deficits that have resulted from substance dependence. However, there is evidence that cognitive training can lead to improvements in cognitive functions and can be useful when treating addictions. This systematic review aims to synthesize evidence on the effectiveness of cognitive training in memory, executive functioning, and processing speed in individuals with substance use disorder (SUD). Methods: The Joanna Briggs Institute's PICO strategy was used to develop this systematic literature review. Four databases were searched (PubMed, the Cochrane Library, Web of Science, and PsycINFO) to identify controlled randomized clinical studies and quasi-experimental studies, in English, Portuguese, and Spanish, from 1985 to 2019. The literature found was examined by two independent reviewers, who assessed the quality of studies that met the inclusion criteria. The Cochrane risk-of-bias tool for the randomized controlled trials and the ROBINS-I tool for non-randomized studies were used to assess the risk of bias. In data extraction, the Cochrane Handbook for Systematic Reviews was considered. Results: From a total of 470 studies, 319 were selected for analysis after the elimination of duplicates. According to the inclusion criteria defined, 26 studies were eligible and evaluated. An evaluation was performed considering the participant characteristics, countries, substance type, study and intervention details, and key findings. Of the 26 selected studies, 14 considered only alcoholics, six included participants with various SUD (alcohol and other substances), three exclusively looked into methamphetamine-consuming users and another three into opioid/methadone users. Moreover, 18 studies found some kind of cognitive improvement, with two of these reporting only marginally significant effects. One study found improvements only in measures similar to the training tasks, and two others had ambiguous results. Conclusions: The included studies revealed the benefits of cognitive training with regard to improving cognitive functions in individuals with SUD. Memory was the most scrutinized cognitive function in this type of intervention, and it is also one of the areas most affected by substance use. Systematic Review Registration: [PROSPERO], identifier [CRD42020161039].
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Affiliation(s)
- Tânia Caetano
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.,Center for Innovative Care and Health Technology (ciTechcare), Polytechnic of Leiria, Leiria, Portugal.,VillaRamadas International Treatment Centre, Research and Innovation Department, Leiria, Portugal
| | - Maria Salomé Pinho
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Eduardo Ramadas
- Center for Innovative Care and Health Technology (ciTechcare), Polytechnic of Leiria, Leiria, Portugal.,VillaRamadas International Treatment Centre, Research and Innovation Department, Leiria, Portugal
| | - Cátia Clara
- VillaRamadas International Treatment Centre, Research and Innovation Department, Leiria, Portugal
| | - Timóteo Areosa
- Center for Innovative Care and Health Technology (ciTechcare), Polytechnic of Leiria, Leiria, Portugal
| | - Maria Dos Anjos Dixe
- Center for Innovative Care and Health Technology (ciTechcare), Polytechnic of Leiria, Leiria, Portugal
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Nardo T, Batchelor J, Berry J, Francis H, Jafar D, Borchard T. Cognitive Remediation as an Adjunct Treatment for Substance Use Disorders: A Systematic Review. Neuropsychol Rev 2021; 32:161-191. [PMID: 33871785 DOI: 10.1007/s11065-021-09506-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 04/06/2021] [Indexed: 11/28/2022]
Abstract
Substance use disorders are associated with diverse neuropsychological impairments, with deficits in memory and executive functioning commonly observed. Cognitive remediation has been shown to be effective in other populations with cognitive impairments in these domains, including those with psychiatric disorders and acquired brain injuries, and it has been hypothesised to be similarly effective for those in treatment for substance use disorders. We aimed to systematically review the evidence for cognitive remediation interventions administered as an adjunct treatment to substance use rehabilitation. Studies were included if participants were receiving substance use treatment, if improving cognitive functioning was the main focus of the intervention and if they used an experimental design with a control condition receiving treatment-as-usual or an active control intervention. Two independent reviewers agreed on the final selection of 32 studies, encompassing cognitive remediation for working memory, memory, executive functioning and general cognition. Significant differences between intervention and control groups for cognitive test results and treatment outcomes were extracted and compared across treatment approaches. The review found considerable heterogeneity across studies, including in the types of interventions, the nature of participants and the outcome measures used. Further, a lack of quality studies with sufficient power meant that limited conclusions could be drawn, highlighting a need for further replication and research. However, findings indicate that cognitive remediation remains a promising potential avenue for improving cognition and treatment outcomes for those in treatment for substance use disorders. Protocol submitted prospectively to PROSPERO 30.09.2019, CRD42020150978.
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Affiliation(s)
- Talia Nardo
- Macquarie University, North Ryde, NSW, 2109, Australia.
| | | | - Jamie Berry
- Macquarie University, North Ryde, NSW, 2109, Australia.,Advanced Neuropsychological Treatment Services, Strathfield South, NSW, 2136, Australia
| | | | - Deyyan Jafar
- Macquarie University, North Ryde, NSW, 2109, Australia
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Gamito P, Oliveira J, Matias M, Cunha E, Brito R, Lopes PF, Deus A. Virtual Reality Cognitive Training Among Individuals With Alcohol Use Disorder Undergoing Residential Treatment: Pilot Randomized Controlled Trial. J Med Internet Res 2021; 23:e18482. [PMID: 33512329 PMCID: PMC7880813 DOI: 10.2196/18482] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 08/10/2020] [Accepted: 11/11/2020] [Indexed: 01/16/2023] Open
Abstract
Background Alcohol use disorder (AUD) has been associated with diverse physical and mental morbidities. Among the main consequences of chronic and excessive alcohol use are cognitive and executive deficits. Some of these deficits may be reversed in specific cognitive and executive domains with behavioral approaches consisting of cognitive training. The advent of computer-based interventions may leverage these improvements, but randomized controlled trials (RCTs) of digital interactive-based interventions are still scarce. Objective The aim of this study is to explore whether a cognitive training approach using VR exercises based on activities of daily living is feasible for improving the cognitive function of patients with AUD undergoing residential treatment, as well as to estimate the effect size for this intervention to power future definitive RCTs. Methods This study consisted of a two-arm pilot RCT with a sample of 36 individuals recovering from AUD in a therapeutic community; experimental group participants received a therapist-guided, VR-based cognitive training intervention combined with treatment as usual, and control group participants received treatment as usual without cognitive training. A comprehensive neuropsychological battery of tests was used both at pre- and postassessments, including measurement of global cognition, executive functions, attention, visual memory, and cognitive flexibility. Results In order to control for potential effects of global cognition and executive functions at baseline, these domains were controlled for in the statistical analysis for each individual outcome. Results indicate intervention effects on attention in two out of five outcomes and on cognitive flexibility in two out of six outcomes, with effect sizes in significant comparisons being larger for attention than for cognitive flexibility. Patient retention in cognitive training was high, in line with previous studies. Conclusions Overall, the data suggest that VR-based cognitive training results in specific contributions to improving attention ability and cognitive flexibility of patients recovering from AUD. Trial Registration ClinicalTrials.gov NCT04505345; https://clinicaltrials.gov/show/NCT04505345
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Affiliation(s)
- Pedro Gamito
- School of Psychology and Life Sciences, Lusófona University, Lisboa, Portugal.,Digital Human-Environment Interaction Lab, Lusófona University, Lisboa, Portugal
| | - Jorge Oliveira
- School of Psychology and Life Sciences, Lusófona University, Lisboa, Portugal.,Digital Human-Environment Interaction Lab, Lusófona University, Lisboa, Portugal
| | - Marcelo Matias
- School of Psychology and Life Sciences, Lusófona University, Lisboa, Portugal
| | - Elsa Cunha
- School of Psychology and Life Sciences, Lusófona University, Lisboa, Portugal
| | - Rodrigo Brito
- Digital Human-Environment Interaction Lab, Lusófona University, Lisboa, Portugal
| | - Paulo Ferreira Lopes
- School of Psychology and Life Sciences, Lusófona University, Lisboa, Portugal.,Digital Human-Environment Interaction Lab, Lusófona University, Lisboa, Portugal
| | - Alberto Deus
- Casa de Saúde do Telhal, Instituto São João de Deus, Sintra, Portugal
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Caballeria E, Oliveras C, Nuño L, Balcells-Oliveró M, Gual A, López-Pelayo H. A systematic review of treatments for alcohol-related cognitive impairment: lessons from the past and gaps for future interventions. Psychol Med 2020; 50:2113-2127. [PMID: 32840195 DOI: 10.1017/s0033291720002925] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Alcohol-related cognitive impairment (ARCI) is highly prevalent among patients with alcohol dependence. Although it negatively influences treatment outcome, this condition is underdiagnosed and undertreated. The aim of this systematic review is to investigate the existing evidence regarding both cognitive and pharmacological interventions for ARCI. We systematically reviewed PubMed, Scopus and Science direct databases up to May 2019 and followed the PRISMA guidelines. The quality of the studies was assessed using the Jadad Scale. Twenty-six studies were eligible for inclusion (14 referring to neuropsychological interventions and 12 to pharmacological treatments). Among neuropsychological interventions, computerised treatments, errorless learning and component method showed positive effects on working memory, memory measures and general cognitive function. On the other hand, thiamine, memantine and methylphenidate improved working memory, long-term memory and general cognitive function. Nevertheless, these studies have several limitations, such as small sample size, lack of replication of the results or low specificity of the interventions. Therefore, no gold-standard intervention can yet be recommended for clinical practice, and further research based on promising strategies (e.g. digital interventions, thiamine) is required.
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Affiliation(s)
- Elsa Caballeria
- Grup Recerca Addiccions Clínic (GRAC-GRE). Department of Psychiatry, Clinical Institute of Neuroscience, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, RETICS (Red de Trastornos adictivos), University of Barcelona, Villarroel, 170, 08036Barcelona, Spain
| | - Clara Oliveras
- Grup Recerca Addiccions Clínic (GRAC-GRE). Department of Psychiatry, Clinical Institute of Neuroscience, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, RETICS (Red de Trastornos adictivos), University of Barcelona, Villarroel, 170, 08036Barcelona, Spain
| | - Laura Nuño
- Grup Recerca Addiccions Clínic (GRAC-GRE). Department of Psychiatry, Clinical Institute of Neuroscience, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, RETICS (Red de Trastornos adictivos), University of Barcelona, Villarroel, 170, 08036Barcelona, Spain
| | - Mercedes Balcells-Oliveró
- Grup Recerca Addiccions Clínic (GRAC-GRE). Department of Psychiatry, Clinical Institute of Neuroscience, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, RETICS (Red de Trastornos adictivos), University of Barcelona, Villarroel, 170, 08036Barcelona, Spain
| | - Antoni Gual
- Grup Recerca Addiccions Clínic (GRAC-GRE). Department of Psychiatry, Clinical Institute of Neuroscience, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, RETICS (Red de Trastornos adictivos), University of Barcelona, Villarroel, 170, 08036Barcelona, Spain
| | - Hugo López-Pelayo
- Grup Recerca Addiccions Clínic (GRAC-GRE). Department of Psychiatry, Clinical Institute of Neuroscience, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, RETICS (Red de Trastornos adictivos), University of Barcelona, Villarroel, 170, 08036Barcelona, Spain
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Sampedro-Piquero P, Ladrón de Guevara-Miranda D, Pavón FJ, Serrano A, Suárez J, Rodríguez de Fonseca F, Santín LJ, Castilla-Ortega E. Neuroplastic and cognitive impairment in substance use disorders: a therapeutic potential of cognitive stimulation. Neurosci Biobehav Rev 2019; 106:23-48. [DOI: 10.1016/j.neubiorev.2018.11.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 10/15/2018] [Accepted: 11/23/2018] [Indexed: 01/08/2023]
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Berry J, Jacomb I, Lunn J, Sedwell A, Shakeshaft A, Kelly PJ, Sarrami P, James M, Russell S, Nardo T, Barker D, Holmes J. A stepped wedge cluster randomised trial of a cognitive remediation intervention in alcohol and other drug (AOD) residential treatment services. BMC Psychiatry 2019; 19:70. [PMID: 30760250 PMCID: PMC6372999 DOI: 10.1186/s12888-019-2044-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 01/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Executive functioning impairment is common in substance use disorder and is a major risk factor for poor treatment outcomes, including treatment drop-out and relapse. Cognitive remediation interventions seek to improve executive functioning and offer a promising approach to increase the efficacy of alcohol and other drug (AOD) treatments and improve long-term therapeutic outcomes. This protocol describes a study funded by the NSW Agency for Clinical Innovation that assesses the effectiveness of delivering a six-week group-based intervention of cognitive remediation in an ecologically valid sample of people attending residential AOD treatment services. We primarily aim to investigate whether cognitive remediation will be effective in improving executive functioning and treatment retention rates. We will also evaluate if cognitive remediation may reduce long-term AOD use and rates of health service utilisation, as well as improve personal goal attainment, quality of life, and client satisfaction with treatment. In addition, the study will involve an economic analysis of the cost of delivering cognitive remediation. METHODS/DESIGN The study uses a stepped wedge cluster randomised design, where randomisation will occur at the cluster level. Participants will be recruited from ten residential AOD treatment services provided by the non-government sector. The intervention will be delivered in 12 one-hour group-based sessions over a period of six weeks. All participants who are expected to receive treatment for the duration of the six-week intervention will be asked to participate in the study. The clusters of participants who are randomly assigned to the treatment condition will complete cognitive remediation in addition to treatment as usual (TAU). Primary and secondary outcome assessments will be conducted at pre-cognitive remediation/TAU phase, post-cognitive remediation/TAU phase, two-month follow-up, four-month follow-up, six-month follow-up, and eight-month follow-up intervals. DISCUSSION This study will provide comprehensive data on the effect of delivering a cognitive remediation intervention within residential AOD treatment services. If shown to be effective, cognitive remediation may be incorporated as an adjunctive intervention in current treatment programs. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Register (ANZCTR): ACTRN12618001190291 . Prospectively registered 17th July 2018.
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Affiliation(s)
- Jamie Berry
- Macquarie University, Balaclava Road, North Ryde, NSW 2109 Australia
- Advanced Neuropsychological Treatment Services, PO Box 4070, Strathfield South, NSW 2136 Australia
| | - Isabella Jacomb
- Macquarie University, Balaclava Road, North Ryde, NSW 2109 Australia
| | - Jo Lunn
- We Help Ourselves, PO Box 1779, Rozelle, NSW 2039 Australia
| | - Antoinette Sedwell
- Agency for Clinical Innovation, Level 4, 67 Albert Ave, Chatswood, NSW 2067 Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052 Australia
| | - Peter J Kelly
- Illawarra Health and Medical Research Institute and the School of Psychology, Faculty of Social Sciences, University of Wollongong, Building 41, Room 128, Wollongong, NSW 2522 Australia
| | - Pooria Sarrami
- Agency for Clinical Innovation, Level 4, 67 Albert Ave, Chatswood, NSW 2067 Australia
- South Western Sydney Clinical School, University of New South Wales, Goulburn St, Liverpool, NSW 2170 Australia
| | - Megan James
- Agency for Clinical Innovation, Level 4, 67 Albert Ave, Chatswood, NSW 2067 Australia
| | - Skye Russell
- Agency for Clinical Innovation, Level 4, 67 Albert Ave, Chatswood, NSW 2067 Australia
| | - Talia Nardo
- Macquarie University, Balaclava Road, North Ryde, NSW 2109 Australia
| | - Daniel Barker
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Jennifer Holmes
- Ministry of Health NSW, 73 Miller St, North Sydney, NSW 2060 Australia
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Luquiens A, Miranda R, Benyamina A, Carré A, Aubin HJ. Cognitive training: A new avenue in gambling disorder management? Neurosci Biobehav Rev 2018; 106:227-233. [PMID: 30359663 DOI: 10.1016/j.neubiorev.2018.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 09/10/2018] [Accepted: 10/18/2018] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Cognitive deficits are being robustly documented in gambling disorder. Cognitive training has been increasingly investigated as a treatment of substance use disorders. Four training components have been listed to date: cognitive bias, response inhibition, working memory, and goal-directed. This review aimed at the identification of use and efficacy findings in cognitive training in gambling disorder. METHODS We conducted a systematic search to identify use and efficacy data of cognitive training in gambling disorder. No use or efficacy data was available. DISCUSSION AND PERSPECTIVES Studies assessing cognitive training in gambling disorder are being conducted and first results should be upcoming. Methodological challenges have been identified. Several candidate target cognitive functions of training programs are being investigated, relying on the most documented impairments in gambling disorder, inhibition, reward sensitivity and decision making. Gambling-specific or neutral environments are to be distinguished clearly and do not rely on similar assumptions, i.e. general vulnerability or vulnerability expressed only in the specific context of gambling. Proper control groups with placebo conditions should be implemented. Assessment of efficacy should include clinical and neuropsychological assessments to give information of underlying mechanisms of action.
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Affiliation(s)
- Amandine Luquiens
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France.
| | - Ruben Miranda
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | - Amine Benyamina
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | - Arnaud Carré
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, LIP/PC2S, 38000, Grenoble, France
| | - Henri-Jean Aubin
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
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Kiluk BD, Buck MB, Devore KA, Babuscio TA, Nich C, Carroll KM. Performance-Based Contingency Management in Cognitive Remediation Training: A Pilot Study. J Subst Abuse Treat 2016; 72:80-88. [PMID: 27590364 DOI: 10.1016/j.jsat.2016.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 07/12/2016] [Accepted: 08/04/2016] [Indexed: 01/13/2023]
Abstract
Impairments in attention, working memory, and executive function are common among substance users and may adversely affect SUD treatment outcomes. The ability of cognitive remediation (CR) interventions to improve these deficits is hindered in part because levels of engagement in CR training may be inadequate to achieve benefit. This pilot study aimed to increase CR engagement and improve outcome by implementing contingency management (CM) procedures that reinforce performance improvements on CR tasks. Participants were forty individuals (50% male; 65% African American) in an outpatient substance use treatment facility with mild cognitive impairment who had ≥30-days of abstinence from alcohol and drugs. They were randomized to standard (CR-S; n=21) or CM-enhanced (CR-CM; n=19) cognitive remediation training. CR consisted of 1-hour sessions, three times per week for four weeks (12 sessions). A neuropsychological assessment battery was administered prior to and after the four-week intervention. Both groups had high rates of CR session attendance (mean CR-S=11.7, CR-CM=10.9 sessions). Performance on 8 of the 9 CR tasks significantly improved over time for both conditions, with the CR-CM condition demonstrating greater improvement on a CR Sequenced Recall task [F(1,37)=5.81, p<.05]. Significant improvement was also evident on 4 of 9 neuropsychological assessment measures, with the CR-CM condition showing differential improvement on the Trail Making Test - Part B [F (1,37)=5.34, p<.05]. These findings support the feasibility of using CM procedures to enhance substance users' engagement with CR training and suggest the potential value of more research in this area.
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Affiliation(s)
- Brian D Kiluk
- Yale University School of Medicine, One Long Wharf Drive, New Haven, CT 06511, USA.
| | - Matthew B Buck
- Yale University School of Medicine, One Long Wharf Drive, New Haven, CT 06511, USA
| | - Kathleen A Devore
- Yale University School of Medicine, One Long Wharf Drive, New Haven, CT 06511, USA
| | - Theresa A Babuscio
- Yale University School of Medicine, One Long Wharf Drive, New Haven, CT 06511, USA
| | - Charla Nich
- Yale University School of Medicine, One Long Wharf Drive, New Haven, CT 06511, USA
| | - Kathleen M Carroll
- Yale University School of Medicine, One Long Wharf Drive, New Haven, CT 06511, USA
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Sigmundsdottir L, Longley WA, Tate RL. Computerised cognitive training in acquired brain injury: A systematic review of outcomes using the International Classification of Functioning (ICF). Neuropsychol Rehabil 2016; 26:673-741. [PMID: 26965034 DOI: 10.1080/09602011.2016.1140657] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Computerised cognitive training (CCT) is an increasingly popular intervention for people experiencing cognitive symptoms. This systematic review evaluated the evidence for CCT in adults with acquired brain injury (ABI), focusing on how outcome measures used reflect efficacy across components of the International Classification of Functioning, Disability and Health. Database searches were conducted of studies investigating CCT to treat cognitive symptoms in adult ABI. Scientific quality was rated using the PEDro-P and RoBiNT Scales. Ninety-six studies met the criteria. Most studies examined outcomes using measures of mental functions (93/96, 97%); fewer studies included measures of activities/participation (41/96, 43%) or body structures (8/96, 8%). Only 14 studies (15%) provided Level 1 evidence (randomised controlled trials with a PEDro-P score ≥ 6/10), with these studies suggesting strong evidence for CCT improving processing speed in multiple sclerosis (MS) and moderate evidence for improving memory in MS and brain tumour populations. There is a large body of research examining the efficacy of CCT, but relatively few Level 1 studies and evidence is largely limited to body function outcomes. The routine use of outcome measures of activities/participation would provide more meaningful evidence for the efficacy of CCT. The use of body structure outcome measures (e.g., neuroimaging) is a newly emerging area, with potential to increase understanding of mechanisms of action for CCT.
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Affiliation(s)
- Linda Sigmundsdottir
- a John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Sydney Medical School - Northern, University of Sydney , St Leonards , NSW , Australia.,b Brain Injury Rehabilitation Unit , Liverpool Hospital , Sydney , Australia
| | - Wendy A Longley
- a John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Sydney Medical School - Northern, University of Sydney , St Leonards , NSW , Australia
| | - Robyn L Tate
- a John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Sydney Medical School - Northern, University of Sydney , St Leonards , NSW , Australia
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Rezapour T, DeVito EE, Sofuoglu M, Ekhtiari H. Perspectives on neurocognitive rehabilitation as an adjunct treatment for addictive disorders. PROGRESS IN BRAIN RESEARCH 2016; 224:345-69. [DOI: 10.1016/bs.pbr.2015.07.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Abstract
Conventional wisdom, and even well-reasoned theoretical mechanisms, suggests that the chronic use of psychoactive substances would impair cognitive functioning of individuals. This article summarizes the research literature with regard to specific drugs of abuse. Undoubtedly, acute intoxication and immediate and protracted withdrawal produce transient alterations of cognitions that can persist for weeks to months. Some subtle residual effects remain for up to 1 year for certain drugs. Evidence of irreversible effects is less clear. Even subtle lingering effects can impact treatment efforts, yet they often go undetected or unaddressed.
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Affiliation(s)
- Peter W Vik
- Department of Psychology, Idaho State University, Box 8112, Pocatello, ID 83209, USA.
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