Effects of alcoholism severity and smoking on executive neurocognitive function

Effects of a Two-Month Exercise Training Program on Concurrent Non-Opiate Substance Use in Opioid-Dependent Patients during Substitution Treatment

BACKGROUND

This randomized controlled trial aimed to evaluate the effects of a two-month exercise intervention on the concurrent non-opiate substance use (alcohol, cocaine, cannabis, and benzodiazepines) in opioid users during their medication treatment.

METHODS

Ninety opioid users (41 females) in methadone and buprenorphine medication treatment were randomly divided into four groups: (a) buprenorphine experimental (BEX; n = 26, aged 41.9 ± 6.1 yrs); (b) buprenorphine control (BCON; n = 25, aged 41.9 ± 5.6 yrs); (c) methadone experimental (MEX; n = 20, aged 46.7 ± 6.6 yrs); and (d) methadone control (MCON; n = 19, aged 46.1 ± 7.5 yrs). The experimental groups (BEX and MEX) followed an aerobic exercise training program on a treadmill for 20 min at 70% HRmax, 3 days/week for 8 weeks. Socio-demographic, anthropometric, and clinical characteristics, as well as non-opioid drug use in days and quantity per week, were assessed before and after the intervention period.

RESULTS

Following the exercise training, the weekly non-opioid substance consumption (days) decreased (p < 0.05) in both exercise groups and was lower in BEX compared to MEX, while no differences were observed (p > 0.05) between the control groups (BCON vs. MCON) or compared to their baseline levels. Similarly, the daily amount of non-opiate substance intake was reduced (p < 0.05) post-training in BEX and MEX, whereas it did not differ (p > 0.05) in BCON and MCON compared to the baseline.

CONCLUSIONS

The two-month exercise intervention reduced the non-opioid drug use in both the methadone and buprenorphine substitution groups compared to the controls, suggesting that aerobic exercise training may be an effective strategy for treating patients with OUDs.

Impact of Alcohol Use, Traumatic Stress, and Cigarette Smoking on Cognitive Functioning in Veterans With Co-occurring Alcohol Use Disorder and Posttraumatic Stress Disorder

INTRODUCTION

Alcohol use disorder (AUD) and PTSD have high rates of co-occurrence in U.S. Military Veterans resulting in incrementally worse functional outcomes relative to having either one of these disorders alone. Cognitive dysfunction can impede one's ability to benefit from standard behavioral AUD and PTSD treatments. Cigarette smoking is also highly prevalent among U.S. Military Veterans, and cognitive dysfunction is associated with chronic cigarette use among individuals with AUD and PTSD independently. However, much less is known about to what extent cigarette smoking further impairs cognitive functioning in individuals with both co-occurring AUD and PTSD.

MATERIALS AND METHODS

U.S. Veterans with co-occurring AUD and PTSD (n = 162) completed a comprehensive cognitive assessment covering various domains: working memory, processing speed, mental switching, cognitive inhibition, auditory-verbal learning, auditory-verbal memory, and verbal fluency. To examine the impact of alcohol use, traumatic stress, and cigarette smoking on cognitive function, we conducted a three-way interaction examining the moderated effects of smoking status on the association between alcohol use and PTSD symptoms on a composite domain of global cognition.

RESULTS

Smoking status in Veterans with co-occurring AUD and PTSD moderated the relationship between alcohol use and global cognition (P = .042), such that higher levels of alcohol use in the past week were related to worse global cognitive function among Veterans cigarette smokers (P = .015) but not among nonsmokers (P = .833). On follow-up analyses of individual cognitive domains, greater alcohol use in the past week was associated with lower cognitive inhibition in smokers but not nonsmokers, with traumatic stress symptoms moderating this effect (P = .039). Additionally, smoking status moderated the relationship between alcohol use and auditory-verbal learning, such that there was a differential relationship between alcohol use and auditory-verbal learning between smokers and nonsmokers.

CONCLUSIONS

Overall, results provide evidence for the compounding impact of alcohol use, traumatic stress, and cigarette smoking on cognitive functioning. Impaired cognitive performance on a global level as well as on individual domains of cognitive inhibition and auditory-verbal learning were evident. Cognitive dysfunction may impede a Veteran's ability to benefit from therapeutic treatment, and these cognitive domains may represent potential targets for cognitive training efforts. Further, study results support smoking cessation initiatives and smoke-free policies enacted at Veterans Affairs healthcare facilities and medical centers.

The role of frailty, social networks, and depression in self-neglect in an older Chinese population: A cross-sectional descriptive study

OBJECTIVES

To identify the role of frailty, social networks, and depression in self-neglect in an older Chinese population.

METHODS

The study was conducted in 521 older adults recruited from four community healthcare centers in a district in Beijing, China. Participants were investigated by a set of questionnaires.

RESULTS

Frailty (β=0.150, p=0.759) was not associated with self-neglect of older adults. Social isolation (β=1.980, p<0.001) and depression (β=3.606, p<0.001) were both factors associated with self-neglect in older adults.

CONCLUSION

Management of depression and improvement of social networks of older adults should be incorporated into interventional strategies to effectively control self-neglect. Understanding self-neglect and its associated factors will ultimately contribute to the intervention development and well-being of older adults.

Is there a causal relationship between executive function and liability to mental health and substance use? A Mendelian randomization approach

Poorer performance in tasks testing executive function (EF) is associated with a range of psychopathologies such as schizophrenia, major depressive disorder (MDD) and anxiety, as well as smoking and alcohol consumption. We used two-sample bidirectional Mendelian randomization to examine whether these may reflect causal relationships and the direction of causation. We used genome-wide association study summary data (N = 17 310 to 848 460) for a common EF factor score (cEF), schizophrenia, MDD, anxiety, smoking initiation, alcohol consumption, alcohol dependence and cannabis use disorder (CUD). We found evidence of increased cEF on reduced schizophrenia liability (OR = 0.10; CI: 0.05 to 0.19; p-value = 3.43 × 10^-12), MDD liability (OR = 0.52; CI: 0.38 to 0.72; p-value = 5.23 × 10^-05), drinks per week (β = -0.06; CI: -0.10 to -0.02; p-value = 0.003) and CUD liability (OR = 0.27; CI: 0.12 to 0.61; p-value = 1.58 × 10^-03). We also found evidence of increased schizophrenia liability (β = -0.04; CI: -0.04 to -0.03; p-value = 3.25 × 10^-27) and smoking initiation on decreased cEF (β = -0.06; CI: -0.09 to -0.03; p-value = 6.11 × 10^-05). Our results indicate potential causal relationships between cEF and mental health and substance use. Further studies are required to improve our understanding of the underlying mechanisms of these effects, but our results suggest that EF may be a promising intervention target for mental health and substance use.

Assessing the attentional bias of smokers in a virtual reality anti-saccade task using eye tracking

INTRODUCTION

Cognitive biases (among them attentional bias, AB) are considered an important factor in the development, maintenance, and recurrence of addiction. However, traditional paradigms to measure AB have been criticized regarding external validity and methodical issues. Therefore, and because the neurophysiological correlates of anti-saccade tasks are known, we implemented a novel smoking anti-saccade task in virtual reality (VR) to measure AB and inhibitory control in different contexts and with higher ecological validity.

METHODS

Smokers (n = 20) and non-smokers (n = 20) were tested on a classic pro- and anti-saccade task, a VR anti-saccade task and a VR attention fixation task (all containing smoking-related and neutral stimuli) while eye-tracking data was collected. Two VR contexts (park and office room) were applied.

RESULTS

Saccade latencies were significantly higher for the smoking group in the VR anti-saccade task. However, this effect did not differ between smoking-related and neutral stimuli, thus overall no AB was observed. Instead, AB was only present in the park context. Additionally, saccade latencies and error rates were significantly higher in the park context.

CONCLUSIONS

Results indicate impaired inhibitory control in smokers relative to non-smokers. The lack of evidence for a general AB might be due to the lower severity of smoking dependence in the smoking sample. Instead, results suggest context specificity of AB. Implications for smoking cessation interventions in the field of inhibitory control training and attention bias modification are discussed.

Active Cigarette Smoking Is Associated With Increased Age-Related Decline on Measures of Visuospatial Learning and Memory and Executive Function in Alcohol Use Disorder

AIMS

The goal of this study was to determine if active cigarette smoking in Veterans with alcohol use disorder (AUD) was associated with greater age-related neurocognitive decline.

METHODS

Veterans with AUD, in residential treatment (n = 125; 47 ± 14 years of age, min = 24, max = 76, 29 ± 26 days of abstinence), completed measures of executive functions, learning and memory, processing speed and working memory. Actively smoking AUD (AsAUD, n = 47) were active daily cigarette smokers; former smoking AUD (FsAUD, n = 45) were predominately daily smokers prior to study but did not smoke at the time of study; non-smoking AUD (NsAUD, n = 33) never used cigarettes or smoked 'only a few times' during lifetime.

RESULTS

AsAUD demonstrated greater age-related decline on measures of visuospatial learning and memory, and response inhibition/cognitive flexibility, primarily relative to NsAUD; there were no age-related differences between FsAUD and NsAUD on any measure. There were few significant mean differences between groups across the 15 neurocognitive measures. In AsAUD, higher scores on indices of smoking severity were associated with poorer performance on measures of auditory-verbal learning and memory, response inhibition, set-shifting and working memory. In FsAUD, longer smoking cessation duration was related to lower PTSD, anxiety and depressive symptomatology.

CONCLUSIONS

Active smoking was associated with accelerated age-related decline on cognitive functions implicated in response to common evidence-based AUD interventions. Results suggest that smoking history contributes to the considerable heterogeneity observed in neurocognitive function in early AUD recovery, and reinforce the clinical movement to offer smoking cessation resources concurrent with treatment for AUD.

Association Between Various Types or Statuses of Smoking and Subjective Cognitive Decline Based on a Community Health Survey of Korean Adults

Objectives

The relationship between smoking and subjective cognitive decline (SCD), which is defined as the subjective perception of cognitive decline, is not well known. This study aimed to investigate the relationship of various types of smoking, including E-cigarette smoking and the use of E-liquid, with the incidence of SCD among Korean adults.

Methods

We evaluated the 2018 Korean Community Health Survey data collected from community-dwelling people in Korea. A total of 104,453 non-smokers, 38,607 past smokers, and 26,776 current smokers with eligible data were included in the study. SCD was assessed using the Behavioral Risk Factor Surveillance System. The past or current smoking pack-years throughout each participant's entire life were calculated. Multiple regression analyses were carried out to estimate the adjusted odds ratios (ORs) as measures of the association between each type of smoking and SCD after adjustment for potential confounders.

Results

Compared to no exposure, passive smoking was associated with higher odds of SCD. Compared to non-smokers, past smokers had a higher OR for SCD; however, current smokers did not. There were no significant associations between passive smoking and SCD in the non-smoker and past smoker groups, but there was a significant relationship between them in the current smoker group. While the cumulative dose of smoking was correlated with an increased OR of SCD in each group of current smokers and past smokers, E-cigarette smoking and the use of E-liquid were not associated with higher ORs in the current smoker group.

Conclusion

Our findings support that passive smoking and past smoking are significantly associated with SCD and that more cumulative exposure to smoking is correlated with a higher OR of SCD.

Psychometric Properties of the Revised Dysexecutive Questionnaire in a Non-clinical Population

Aims

The aim of this study was to assess the psychometric properties of the revised self-rated version of the Dysexecutive Questionnaire (DEX-R) within a non-clinical sample.

Methods

The study was hosted online, with 140 participants completing the DEX-R, GAD-2 and PHQ-2. Sixty participants also completed the FrSBe, with 99 additionally completing the DEX-R again 3 weeks later. Correlations with demographic factors and symptoms of anxiety and depression were conducted. Rasch and factor analysis were also used to explore underlying subconstructs.

Results

The DEX-R correlated highly with the FrSBe, indicating sound concurrent validity. Internal consistency, split-half reliability and test-retest reliability were excellent. Age and symptoms of depression and anxiety correlated with DEX-R scores, with older age associated with less dysexecutive problems. The Rasch analysis confirmed the multidimensionality of the rating scale, and a three-factor structure was found relating to activation-self-regulatory, cognitive and social-emotional processes. Frequencies of responses on DEX-R items varied, many were not fully endorsed indicating specific relevance of most but not all items to patients.

Conclusion

Interpretations of DEX-R ratings of dysexecutive problems should consider mood and individual variation. Systematic comparison of DEX-R responses between healthy and clinical groups could help identify a suitable cut off for dysexecutive symptoms.

Acetylcholine Muscarinic M4 Receptors as a Therapeutic Target for Alcohol Use Disorder: Converging Evidence From Humans and Rodents

BACKGROUND

Alcohol use disorder (AUD) is a major socioeconomic burden on society, and current pharmacotherapeutic treatment options are inadequate. Aberrant alcohol use and seeking alters frontostriatal function.

METHODS

We performed genome-wide RNA sequencing and subsequent quantitative polymerase chain reaction and receptor binding validation in the caudate-putamen of human AUD samples to identify potential therapeutic targets. We then back-translated our top candidate targets into a rodent model of long-term alcohol consumption to assess concordance of molecular adaptations in the rat striatum. Finally, we adopted rat behavioral models of alcohol intake and seeking to validate a potential therapeutic target.

RESULTS

We found that G protein-coupled receptors were the top canonical pathway differentially regulated in individuals with AUD. The M₄ muscarinic acetylcholine receptor (mAChR) was downregulated at the gene and protein levels in the putamen, but not in the caudate, of AUD samples. We found concordant downregulation of the M₄ mAChR, specifically on dopamine D₁ receptor-expressing medium spiny neurons in the rat dorsolateral striatum. Systemic administration of the selective M₄ mAChR positive allosteric modulator, VU0467154, reduced home cage and operant alcohol self-administration, motivation to obtain alcohol, and cue-induced reinstatement of alcohol seeking in rats. Local microinjections of VU0467154 in the rat dorsolateral striatum reduced alcohol self-administration and cue-induced reinstatement of alcohol seeking.

CONCLUSIONS

Collectively, these results identify the M₄ mAChR as a potential therapeutic target for the treatment of AUD and the D₁ receptor-positive medium spiny neurons in the dorsolateral striatum as a key site mediating the actions of M₄ mAChR in relation to alcohol consumption and seeking.

Deterioro cognitivo y recuperación espontánea en pacientes con diagnóstico de Consumo Perjudicial o Síndrome de Dependencia Alcohólico

El objetivo de este trabajo era conocer el alcance del deterioro de las funciones cognitivas debido al consumo abusivo de alcohol y su posible recuperación espontánea, así como observar la evolución temporal de esta recuperación, desde el inicio hasta los 24 meses de la abstinencia. Participaron voluntariamente 100 pacientes de ambos sexos, en tratamiento de deshabituación de consumo perjudicial o síndrome de dependencia alcohólico, agrupados en cohortes según tiempo de abstinencia. El grupo control estuvo formado por 20 personas sin antecedentes de alcoholismo, equiparadas con los pacientes en las variables edad, sexo y nivel de estudios. Los datos socio-demográficos y clínicos se recogieron con una anamnesis protocolizada, mientras que para evaluar el deterioro cognitivo se emplearon el Mini-Mental State Examination (MMSE) y el Montreal Cognitive Assessment (MOCA), en sus versiones al español. Para cada participante se obtuvieron 8 variables clínicas y socio-demográficas y 27 variables cognitivas. Se observaron diferencias significativas entre las medidas de las mismas variables cognitivas proporcionadas por ambos instrumentos, siendo más discriminativo el MOCA. Los resultados mostraron que el deterioro y la recuperación espontánea varían para las distintas funciones cognitivas y que los cambios más significativos se dan seis meses después de iniciada la deshabituación y entre los 18 y 24 meses. En base a la evidencia obtenida, atención, memoria y lenguaje se perfilan como las funciones más susceptibles de beneficiarse de un programa de rehabilitación cognitiva, que convendría implementar entre los 6 y 18 meses de abstinencia.

Neurocognitive impairment in Asian childhood cancer survivors: a systematic review

Childhood cancer survivors are at higher risk of developing neurocognitive deficits due to the intensive treatment they received at an early age. Most studies on childhood cancer survivorship have so far focused on the Western populations. Due to the ethnic, genetic, environmental, and cultural differences, clinical data of the Western populations may not be representative of Asian countries. This scoping review systematically summarized the existing clinical evidence of the neurocognitive impairment of Asian childhood cancer survivors. We searched the Embase and Medline databases for studies assessing the neurocognitive functions of survivors in Asia, who were diagnosed with cancer before the age of 19 and completed active treatment. The literature search identified 13 studies involving 2212 participants from five Asian countries: South Korea (n = 4, 30.8%), Taiwan (n = 3, 23.1%), Japan (n = 3, 23.1%), Hong Kong (n = 2, 15.4%), and Thailand (n = 1, 7.7%). The included studies focused on CNS tumors (n = 10, 76.9%), hematological malignancies (n = 7, 53.8%), or heterogeneous cancer diagnoses (n = 3, 23.1%). Collectively, mild-to-moderate impairment in intelligence was observed in 10.0 to 42.8% of survivors, which seemed higher than the reported rate in Western survivors. We speculate that the ethnic and genetic variations in drug responses and susceptibility to adverse chronic toxicities may have contributed to the differences in the prevalence and severity of neurocognitive impairment between these two populations. To better understand the effects of culturally relevant and region-specific environmental risk factors on the post-treatment neurocognitive development in cancer survivors, a holistic approach that addresses the complex interactions between biological, physical, and psychosocial factors is needed. This will aid the development of effective intervention strategies to improve the functional and psychosocial outcomes of cancer survivors in Asian societies.

Cigarette smoking history is associated with poorer recovery in multiple neurocognitive domains following treatment for an alcohol use disorder

Cigarette smoking is associated with neurocognitive dysfunction in various populations, including those seeking treatment for an alcohol use disorder (AUD). This study compared the rate and extent of recovery on measures of processing speed, executive functions, general intelligence, visuospatial skills and working memory in treatment-seeking alcohol dependent individuals (ALC) who were never-smokers (nvsALC), former-smoker (fsALC), and active smokers (asALC), over approximately 8 months of abstinence from alcohol. Methods: ALC participants were evaluated at approximately 1 month of abstinence (AP1; n = 132) and reassessed after 8 months of sobriety (AP2; n = 54). Never-smoking controls (CON; n = 33) completed a baseline and follow-up (n = 19) assessment approximately 9 months later. Domains evaluated were executive functions, general intelligence, processing speed, visuospatial skills and working memory; a domain composite was formed from the arithmetic average of the foregoing domains. nvsALC showed greater improvement than fsALC, asALC and CON on most domains over the AP1-AP2 interval. fsALC demonstrated greater recovery than asALC on all domains except visuospatial skills; fsALC also showed greater improvements than CON on general intelligence, working memory and domain composite. asALC did not show significant improvement on any domain over the AP1-AP2 interval. At 8 months of abstinence, asALC were inferior to CON and nvsALC on multiple domains, fsALC performed worse than nvsALC on several domains, but nvsALC were not different from CON on any domain. Our results provide robust evidence that smoking status influenced the rate and extent of neurocognitive recovery between 1 and 8 months of abstinence in this ALC cohort. Chronic smoking in AUD likely contributes to the considerable heterogeneity observed in neurocognitive recovery during extended abstinence. The findings provide additional strong support for the benefits of smoking cessation and the increasing clinical movement to offer smoking cessation resources concurrent with treatment for AUD.

Effects of abstinence of alcohol on neurocognitive functioning in patients with alcohol dependence syndrome

AIMS

Alcohol dependence causes impairment of neurocognitive functions. Abstinence for some time leads to improvement in neurocognitive functions. This study was conducted with the aim to observe the effects of abstinence on neurocognition.

METHODS

The current study was an observational, single group with longitudinal design exploring the effect of abstinence on neuropsychological functioning and further exploring correlation of clinical factors with neuropsychological functioning in patients with Alcohol Dependence Syndrome (ADS). Sixty consecutive male patients of ADS meeting inclusion and exclusion criteria were inducted. Neurocognitive tests were applied at baseline, one month and three months of abstinence.

RESULTS

All neurocognitive functions showed significant improvement at three-time intervals (p < 0.05) except for visuomotor function, for which improvement was statistically insignificant (p > 0.05) at one month. The difference for scores on verbal fluency, working memory, set-shifting (WCST total trials and perseverative errors) and visuomotor function from 0 to 3 months was significant (p < 0.05). There was significant interaction (p < 0.05) between duration of regular but non-dependent use, total duration of use, duration of dependence, average intake per day, last intake and time period with verbal fluency, working memory, set -shifting (for WCST total trials, total errors, perseverative errors and non-perseverative errors) and visuomotor function.

CONCLUSION

The study showed improvement in neurocognitive functions with abstinence over three months, suggesting the need to address these cognitive deficits in the early part of abstinence. Also, correlates for drinking history were identified which may help in the future for the prevention and management of cognitive deficits in ADS patients.

Increasing Smoking Cessation Adherence: Do We Need to Consider the Role of Executive Function and Rumination?

Despite the cost and health consequences, a large number of people continue to smoke cigarettes worldwide every day. Notwithstanding, there have been a number of interventions to help people stop smoking but, in general, these have produced only limited success, and better interventions are needed. Accruing evidence affirmed that rumination and executive function play a pivotal role in cigarette smoking behavior, and in this editorial, we describe and discuss the key findings between these constructs and smoking, and argue that an impairment in executive functions does not act alone, but interacts with rumination by directing attention to depressive thoughts, thereby reducing the ability of smokers to engage in constructive behaviors, such as quitting smoking. Finally, we offer a new theory-driven model based on a deep understanding of the interactions between executive functions and rumination and potential moderator effects.

Neuropsychological dysfunctions among chronic schizophrenia patients, alcohol dependence cases, and normal subjects: A comparative study

AIM

The aim of this study is to assess the neuropsychological profiles of chronic schizophrenia and alcohol-dependent subjects.

MATERIALS AND METHODS

This hospital-based cross-sectional study included 30 chronic schizophrenia patients, 30 alcohol-dependent patients and 30-matched normal controls. Demographic and clinical data were collected on a self-designed pro forma. Positive and Negative Syndrome Scale (PANSS) and Severity of Alcohol Dependence Questionnaire (SADQ-C) were administered to chronic schizophrenia and alcohol-dependent patients, respectively. The AIIMS Comprehensive Neuropsychological Battery in Hindi (Adult Form) was used to assess neuropsychological dysfunctions.

RESULTS

Neuropsychological dysfunctions were found in 83.3% of chronic schizophrenia patients, 36.7% alcohol dependents and none of the normal subjects. In comparison to normal subjects, schizophrenia patients had significantly more dysfunctions in neuropsychological-domains such as motor, tactile, visual, receptive and expressive speech, reading, writing, arithmetic, memory, and intellectual processes. A significant positive correlation was found between the PANSS total score and T scores of most of the clinical scales except motor and visual scales; the PANSS general psychopathology score and T scores of most of the clinical scales except motor visual and pathognomonic scales; the PANSS negative score and T scores of most of the clinical scales except visual scale; and the PANSS positive score and T scores of receptive speech, arithmetic, and memory scales. In comparison to normal subjects, the alcohol dependents had significantly more dysfunctions in neuropsychological-domains such as motor, tactile, visual, receptive and expressive speech, reading, writing, arithmetic, and memory. A significant positive correlation was found between the SADQ total scale and T scores of clinical scales such as expressive speech, writing, arithmetic, intellectual processes, left hemisphere, and total battery scales.

CONCLUSIONS

Neuropsychological dysfunction was significantly more common and severe in chronic schizophrenia patients than in alcohol-dependent patients. In comparison to alcohol dependents, the chronic schizophrenia patients had more dysfunctions in neuropsychological-domains such as tactile, arithmetic, memory, and intellectual processes.

Microstructural damage of white-matter tracts connecting large-scale networks is related to impaired executive profile in alcohol use disorder

Alcohol Use Disorders (AUD) is associated with negative consequences on global functioning, likely reflecting chronic changes in brain morphology and connectivity. Previous attempts to characterize cognitive impairment in AUD addressed patients' performance in single domains, without considering their cognitive profile as a whole. While altered cognitive performance likely reflects abnormal white-matter microstructural properties, to date no study has directly addressed the relationship between a proxy of patients' cognitive profile and microstructural damage. To fill this gap we aimed to characterize the microstructural damage pattern, and its relationship with cognitive profile, in treatment-seeking AUD patients. Twenty-two AUD patients and 18 healthy controls underwent a multimodal MRI protocol including diffusion tensor imaging (DTI), alongside a comprehensive neurocognitive assessment. We used a principal component analysis (PCA) to identify superordinate components maximally explaining variability in cognitive performance, and whole-brain voxelwise analyses to unveil the neural correlates of AUD patients' cognitive impairment in terms of different white-matter microstructural features, i.e. fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD). PCA revealed a basic executive component, significantly impaired in AUD patients, associated with tasks tapping visuo-motor processing speed, attention and working-memory. Within a widespread pattern of white-matter damage in patients, we found diverse types of relationship linking WM microstructure and executive performance: (i) in the whole sample, we observed a linear relationship involving MD/RD metrics within both 'superficial' white-matter systems mediating connectivity within large-scale brain networks, and deeper systems modulating their reciprocal connections; (ii) in AUD patients vs. controls, a performance-by-group interaction highlighted a MD/AD pattern involving two frontal white-matter systems, including the genu of corpus callosum and cingulum bundle, mediating structural connectivity among central executive, salience and default mode networks. Alterations of prefrontal white-matter pathways are suggestive of abnormal structural connectivity in AUD, whereby a defective interplay among large-scale networks underpins patients' executive dysfunction. These findings highlight different directions for future basic and translational research aiming to tailor novel rehabilitation strategies and assess their functional outcomes.

Retinal Nerve Fiber Layer in Patients with Alcohol Use Disorder

The objectives of the present study are to determine the effects of alcohol use on the retinal nerve fiber layer (RNFL) thickness and macular thickness of abstinent patients with alcohol use disorders (AUD) and to assess whether it correlates with alcohol consumption and/or cognitive impairment. This was a prospective, observational study that included 21 patients (42 eyes) and 21 controls (42 eyes). Patients met the criteria for early remission AUD at the moment of inclusion. We used optical coherence tomography to assess retinal thickness. Macular thickness in the group of AUD patients was lower in all quadrants (p < 0.05), with the exception of the peripheral and central. Regarding the nerve fiber layer in the macular and papilla areas, we found no significant differences. At the retina ganglion cell layer and in the nerve fiber of the macula, we found significant differences in all quadrants (p < 0.05), with the exception of the superior and superior nasal area, for the right eye. For the left eye, the only differences were found in the lower quadrant. Finally, when comparing the AUD patients to the controls, we found significant reductions in the ganglion cell layer of the macula in all quadrants in the former. There was a significant correlation between these findings and cognitive impairment (measured with the Test de Detección de Deterioro Cognitivo en Alcoholismo (TEDCA)), but not with alcohol consumption. Alcohol consumption is correlated with retinal harm and related cognitive decline.

Executive Impairment in Alcohol Use Disorder Reflects Structural Changes in Large-Scale Brain Networks: A Joint Independent Component Analysis on Gray-Matter and White-Matter Features

Alcohol Use Disorder (AUD) entails chronic effects on brain structure. Neurodegeneration due to alcohol toxicity is a neural signature of executive impairment typically observed in AUD, previously related to both gray-matter volume/density and white-matter abnormalities. Recent studies highlighted the role of meso-cortico-limbic structures supporting the salience and executive networks, in which the extent of neurostructural damage is significantly related to patients’ executive performance. Here we aim to integrate multimodal information on gray-matter and white-matter features with a multivariate data-driven approach (joint Independent Component Analysis, jICA), and to assess the relationship between the extent of damage in the resulting neurostructural superordinate components and executive profile in AUD. Twenty-two AUD patients and 18 matched healthy controls (HC) underwent a Magnetic Resonance Imaging (MRI) protocol, alongside clinical and neuropsychological examinations. We ran jICA on five neurostructural features, including gray-matter density and different diffusion tensor imaging metrics. We extracted 12 Independent Components (ICs) and compared the resulting mixing coefficients in patients vs. HC. Finally, we correlated significant ICs with executive and clinical variables. One out of 12 ICs (IC11) discriminated patients from healthy controls and correlated positively both with executive performance in all subjects, and with lifetime duration of alcohol abuse in patients. In line with previous related evidence, this component involved widespread gray-matter and white-matter patterns including key nodes and fiber tracts of salience, default-mode and central executive networks. These findings highlighted the role of multivariate data integration as a valuable approach revealing superordinate hallmarks of neural changes related to cognition in neurological and psychiatric populations.

Polygenic liability for schizophrenia predicts shifting-specific executive function deficits and tobacco use in a moderate drinking community sample

Individuals with schizophrenia have higher lifetime rates of substance use disorders than the general population, and research suggests high comorbidity rates may be partially explained by shared genetic influences related to common underlying etiology. Moreover, deficits in executive functions are thought to be central to the diagnosis of schizophrenia and are likewise associated with alcohol and tobacco use. The current study examined the associations between schizophrenia polygenic risk scores and tobacco and alcohol use and the mediation of these associations by executive function sub-domains. Results from the Psychiatric Genomics Consortium's meta-analysis of genome-wide association studies of schizophrenia were used to calculate polygenic risk scores in a sample of moderate drinkers. Schizophrenia risk scores were significantly associated with shifting-specific executive function deficits and tobacco use phenotypes. However, risk scores were not significantly associated with alcohol use and executive functions were not significantly associated with either tobacco or alcohol use. These findings extend previous research by suggesting that genetic risk for schizophrenia may be associated with specific sub-domains of executive function as well as smoking. The lack of a relation with alcohol use suggests genetic factors related to schizophrenia and executive functioning may not influence drinking in a non-disordered, social-drinking sample.

Intelligence Test Scores Before and After Alcohol-Related Disorders-A Longitudinal Study of Danish Male Conscripts

Background

Existing studies on intellectual consequences of alcohol‐related disorders are primarily cross‐sectional and compare intelligence test scores of individuals with and without alcohol‐related disorders, hence mixing the influence of alcohol‐related disorders and predisposing factors such as premorbid intelligence. In this large‐scale study, the primary aim was to estimate associations of alcohol‐related disorders with changes in intelligence test scores from early adulthood to late midlife.

Methods

Data were drawn from a follow‐up study on middle‐aged men, which included a re‐examination of the same intelligence test as completed in young adulthood at military conscription (total analytic sample = 2,499). Alcohol‐related hospital diagnoses were obtained from national health registries, whereas treatment for alcohol problems was self‐reported at follow‐up. The analyses included adjustment for year of birth, retest interval, baseline intelligence quotient (IQ) score, education, smoking, alcohol consumption, and psychiatric and somatic comorbidity.

Results

Individuals with alcohol‐related hospital diagnoses (8%) had a significantly lower baseline IQ score (95.0 vs. 100.5, p < 0.001) and a larger decline in IQ scores from baseline to follow‐up (−8.5 vs. −4.8, p < 0.001) than individuals without such diagnoses. The larger decline in IQ scores with alcohol‐related hospital diagnoses remained statistically significant after adjustment for all the covariates. Similar results were revealed when IQ scores before and after self‐reported treatment for alcohol problems (10%) were examined.

Conclusions

Individuals with alcohol‐related disorders have a lower intelligence test score both in young adulthood and in late midlife, and these disorders, moreover, seem to be associated with more age‐related decline in intelligence test scores. Thus, low mean intellectual ability observed in individuals with alcohol‐related disorders is probably a result of both lower premorbid intelligence and more intellectual decline.

A fractionated analysis of hot and cool self-regulation in cigarette smokers from different socioeconomic backgrounds

Smoking cigarettes and low socioeconomic status (SES) are both related to impaired cognition. However, it is unknown whether people of lower SES, who comprise most tobacco smokers worldwide, are more susceptible to cognitive impairment associated with smoking. In this non-randomized, cross-sectional study we investigated the effects of cigarette smoking, SES and their interaction on dissociable executive or “cool” and “hot” measures of behavioural self-regulation. Participants (n = 80) were selected among young physically and mentally healthy smokers and non-smokers who had graduated high school and were from different SES backgrounds. Cool self-regulation was measured by executive function tasks that tap inhibition, updating, shifting, dual tasking, planning, access to long-term memory (semantic fluency), and working memory capacity. Hot measures assessed self-reported impulsivity, delay discounting and risk taking. Exposure to tobacco (cotinine, exhaled carbon monoxide, tobacco dependence, cigarette consumption) was assessed to determine to what extent it mediated the cognitive effects of smoking. Nicotine abstinence and its acute effects were controlled, as were sex, age, schooling, and psychiatric symptoms despite the fact that smokers and non-smokers were selected as being as similar as possible in these demographic characteristics. Lower SES (less years of parental schooling) was associated with worse performance on tasks that measured all cool domains except dual tasking and fluency, while smoking status was related to impaired delayed discounting and impulsivity (hot domains), effects that were not mediated by tobacco exposure. Smoking and SES, however, did not interact. In short, impaired performance in measures of most cool skills was associated with SES irrespective of smoking status; in contrast, regardless of SES, smokers showed specific impairment in hot self-regulation domains (more difficulty resisting immediate temptations and weighing future consequences of actions). Possible explanations for the lack of mediation of tobacco exposure on hot skills of smokers are discussed.

Identifying Inhibitory Subcomponents Associated with Changes in Binge Drinking Behavior: A 6-Month Longitudinal Design

BACKGROUND

Links between response inhibition and young adult problematic drinking (e.g., binge drinking) have been established, but only to an extent. Considering the presence of some inconsistent findings associated with these 2 variables, this study proposes the need to investigate the extent in which different inhibitory subcomponents are associated with binge drinking behaviors of the same sample.

METHODS

Through the use of a 6-month longitudinal design, changes in Alcohol Use Questionnaire (AUQ) binge score of 163 college students (50.3% female) with a mean age of 21.06 years (SD = 1.83) were correlated with performance on 3 different inhibitory control tasks. Each task was selected to assess separate inhibitory subcomponents: Stop Signal Task (e.g., cancellation of a response), Go/No-Go Task (e.g., withholding of a response), and Simon Task (e.g., inhibiting response interference). Response inhibition was also compared between 2 groups, those who had a substantial increase in AUQ binge score during participation (inAUQ) and those who had a substantial decrease in AUQ binge score (deAUQ).

RESULTS

A significant correlation was found with a change in AUQ binge score and stop signal reaction time among females only, where an increase in binge drinking score positively correlated with a reduced ability to cancel an already-initiated inhibitory response. Differences in inhibitory performance, where inAUQ performed worse than deAUQ, approached significance.

CONCLUSIONS

The results suggest that the cancellation of a prepotent response, as opposed to the withholding of response or interference inhibition, is a more sensitive inhibitory measure associated with increases in binge drinking behavior among female young adult college students. Further exploration of inhibitory subcomponents relative to substance use is greatly needed (e.g., more extensive longitudinal designs and neuroimaging techniques).

Neuropsychological Performance in Alcohol Dependent Patients: A One-Year Longitudinal Study

OBJECTIVE

Despite several studies that have highlighted the harmful effects of alcohol consumption on cognitive functions it remains unclear whether certain brain areas are more sensitive than others are or whether alcohol causes widespread cognitive deficit. Moreover, the role of continued abstinence has yet to be clarified regarding the quality of recovery on the different cognitive domains. The aim of this 1-year longitudinal study was to evaluate the recovery of cognitive deficits in the medium (6 months) and long term (12 months) after the interruption of drinking.

METHODS

Forty-one alcohol-dependent patients were recruited from two outpatient treatment facilities and cognitive functions were compared on a control group of forty healthy controls. The patients were then re-assessed at 6 and 12 months. Changes in neuropsychological measures were evaluated with repeated measures analysis of variance (ANOVA). We also compared 1-year follow-up scores with control data (unpaired t tests) to identify tests on which significant differences persisted.

RESULTS

Patients performed significantly worse than controls in all cognitive domains investigated and this cognitive impairment was evident in recently abstinent patients. A year of abstinence resulted in a significant improvement in all cognitive domains assessed after detoxification from alcohol. After year 1, alcoholic subjects had returned to normal levels compared to healthy controls on all domains except for general non-verbal intelligence, verbal memory and some visuospatial skills.

CONCLUSION

Our results support the hypothesis of widespread impairment resulting from alcohol consumption. The recovery of cognitive functions is not homogeneous during prolonged abstinence.

Early onset tobacco cigarette smokers exhibit deficits in response inhibition and sustained attention

BACKGROUND

Initiation of cigarette smoking during adolescence coincides with structural and cognitive neuromaturation. Thus, early onset smokers (EOS; initiated <16 years old) may be at unique risk of altered development of executive function relative to late onset smokers (LOS; initiated >16 years old). This study quantified the effects of age of smoking onset on response impulsivity and inhibitory control using a novel smoking Go/NoGo task (Luijten et al., 2011).

METHODS

Nicotine deprived adult EOS (n = 10) and LOS (n = 10) and adult healthy non-smokers (HNS; n = 10) were shown smoking-related and neutral images with either a blue (Go) or yellow (NoGo) frame. Participants were instructed to respond to blue-framed Go trials quickly and accurately, and withhold responding for yellow-framed NoGo trials.

RESULTS

EOS made more Go response accuracy errors (p ≤ 0.02) and failed more frequently to inhibit responses to NoGo trials (p < 0.02) than LOS and HNS. EOS also made more errors in inhibiting responses to smoking-related (p ≤ 0.02) and neutral (p ≤ 0.02) NoGo trials. EOS reported greater baseline craving for cigarette smoking than LOS (p < 0.04), and craving was significantly associated with greater omission errors (p ≤ 0.04).

CONCLUSIONS

EOS exhibited greater difficulty than LOS in responding accurately to Go stimuli and withholding responses to both smoking and neutral NoGo stimuli, indicating greater response impulsivity, poor attention, and deficits in response inhibition. These findings suggest that EO smoking, in particular, contributes to diminished task-related attention and inhibitory control behaviors in adulthood and provide support for the tobacco-induced neurotoxicity of adolescent cognitive development (TINACD) theory (DeBry and Tiffany, 2008).

Dietary inflammatory index and memory function: population-based national sample of elderly Americans

The objective of this study was to examine the association between dietary inflammatory potential and memory and cognitive functioning among a representative sample of the US older adult population. Cross-sectional data from the 2011-2012 and 2013-2014 National Health and Nutrition Examination Survey were utilised to identify an aggregate sample of adults 60-85 years of age (n 1723). Dietary inflammatory index (DII®) scores were calculated using 24-h dietary recall interviews. Three memory-related assessments were employed, including the Consortium to Establish a Registry for Alzheimer's disease (CERAD) Word Learning subset, the Animal Fluency test and the Digit Symbol Substitution Test (DSST). Inverse associations were observed between DII scores and the different memory parameters. Episodic memory (CERAD) (b adjusted=-0·39; 95 % CI -0·79, 0·00), semantic-based memory (Animal Fluency Test) (b adjusted=-1·18; 95 % CI -2·17, -0·20) and executive function and working-memory (DSST) (b adjusted=-2·80; 95 % CI -5·58, -0·02) performances were lowest among those with the highest mean DII score. Though inverse relationships were observed between DII scores and memory and cognitive functioning, future work is needed to further explore the neurobiological mechanisms underlying the complex relationship between inflammation-related dietary behaviour and memory and cognition.

Anterior insula activation during inhibition to smoking cues is associated with ability to maintain tobacco abstinence

Relapse to smoking after initial abstinence is a major clinical challenge with significant public health consequences. At the brain and behavioral level, those who relapse to tobacco smoking have both greater cue-reactivity and lower inhibitory control than those who remain abstinent. Little is known about neural activation during inhibitory control tasks in the presence of drug-related cues. In the current study, tobacco smokers (SMK; n = 22) and non-smoking controls (CON; n = 19) completed a Go/NoGo task involving smoking cues during a functional magnetic resonance imaging (fMRI) scan. Following the scan session, smokers were required to quit smoking, and maintenance of abstinence was evaluated as part of a 12-week smoking cessation trial. We evaluated pre-cessation brain activity during NoGo trials in smokers who were versus were not able to quit smoking. We then compared fMRI and inhibitory control measures between smokers and non-smokers. We did not find differences between SMK and CON in performance or activation to smoking or neutral cues. However, compared to SMK who relapsed, SMK who attained biochemically-validated abstinence at the end of the smoking cessation trial had greater neural activation in the anterior insula during NoGo trials specifically with smoking-related cues. Results indicate that within SMK, decreased inhibitory control activation during direct exposure to drug-related stimuli may be a marker of difficulty quitting and relapse vulnerability.

•

Smokers and controls showed no differences in performance or activation to smoking or neutral cues.

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Abstinent smokers compared to relapsers had greater activation in the insula during NoGo trials with smoking-related cues.

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Within smokers, decreased NoGo activation during exposure to drug-related cues may be a marker of relapse vulnerability.

Resisting the urge to smoke: inhibitory control training in cigarette smokers

Impaired response inhibition is an important factor in tobacco dependence. We examined the effects of inhibitory control training (ICT) on inhibition, smoking resistance and cigarette use. Smokers (n = 55) abstained from smoking for 12 h prior to testing. On the test day, participants recorded cigarette use and completed pre-training measures of global and cue-specific (smoking-related) response inhibition. Participants were randomized to either an active or a control ICT group. The active group was required to repeatedly inhibit a response towards smoking cues (100%), while the control group was required to inhibit a response towards smoking and neutral cues with equal frequency (50%). Participants performed post-training measures of response inhibition, smoking resistance and cigarette use. Inhibition data did not indicate time (pre-training, post-training) × group (active training, control training) or time × group × cue (smoking, neutral) interactions. There was weak evidence that smokers in the active group were more likely to resist smoking than those in the control group. Cigarette use data did not indicate a time × group interaction. Our data suggest that ICT may enhance the ability to resist smoking, indicating that training may be a promising adjunct to smoking pharmacotherapy.

Executive function fails to predict smoking outcomes in a clinical trial to motivate smokers to quit

BACKGROUND

Executive function (EF) is considered an important mediator of health outcomes. It is hypothesized that those with better EF are more likely to succeed in turning their intentions into actual health behaviors. Prior studies indicate EF is associated with smoking cessation. Experimental and longitudinal studies, however, have yielded mixed results. Few studies have examined whether EF predicts post-treatment smoking behavior. Fewer still have done so prospectively in a large trial. We sought to determine if EF predicts quit attempts and cessation among community smokers in a large randomized trial evaluating the efficacy of motivational interventions for encouraging cessation.

METHODS

Participants (N=255) completed a baseline assessment that included a cognitive battery to assess EF (Oral Trail Making Test B, Stroop, Controlled Oral Word Association Test). Participants were then randomized to 4 sessions of Motivational Interviewing or Health Education or one session of Brief Advice to quit. Quit attempts and cessation were assessed at weeks 12 and 26.

RESULTS

In regression analyses, none of the EF measures were statistically significant predictors of quit attempts or cessation (all ps>0.20).

CONCLUSIONS

Our data did not support models of health behavior that emphasize EF as a mediator of health outcomes. Methodological shortcomings weaken the existing support for an association between EF and smoking behavior. We suggest methodological improvements that could help move this potentially important area of research forward.

A Conceptual Neurocognitive Affect-Related Model for the Promotion of Exercise Among Obese Adults

PURPOSE OF REVIEW

Obesity remains a prominent societal threat and burden despite well-promoted prevention and treatment strategies, such as regular engagement in physical activity. Obese individuals, in particular, may be prone to inactivity as a result of a variety of displeasure-related parameters resulting from exercise, such as dyspnea, for instance.

RECENT FINDINGS

This brief conceptual review discusses the integral roles of exercise-induced affective responses within a novel conceptual-based neurocognitive affect-related model. Specifically, this model includes three pathways: (1) pathway A proposes that neurocognition, and especially, executive function-based cognition, may play an influential role in fostering exercise-induced affective responses, (2) pathway B connects an individual's affective response from exercise to their future exercise behavior, and (3) pathway C suggests a cyclical, bi-directional relationship with executive function indirectly influencing future exercise behavior via affective responses to exercise, and exercise itself playing an important role in executive functioning. Future studies should empirically test this model, which may have utility for promoting exercise among the obese population.

Investigation of Cognitive Improvement in Alcohol-Dependent Inpatients Using the Montreal Cognitive Assessment (MoCA) Score

Background. Cognitive dysfunction is a common feature in alcohol use disorders. Its persistence following alcohol detoxification may impair quality of life and increase the risk of relapse. We analyzed cognitive impairment changes using the Montreal Cognitive Assessment (MoCA) score in a large sample of alcohol-dependent inpatients hospitalized for at least 4 weeks. Method. This was an observational longitudinal survey. Inclusion criteria were alcohol dependence (DSM-IV) and alcohol abstinence for at least one week. The MoCA test was administered on admission and at discharge. Results. 236 patients were included. The mean MoCA score significantly increased from 22.1 ± 3.7 on admission to 25.11 ± 3.12 at discharge. The corresponding effect-size of improvement was high, 1.1 [95% CI 1.0–1.2]. The degree of improvement was inversely correlated with the baseline MoCA score. The rate of high and normal, that is, >26, MoCA values increased from 15.8% on admission to 53.8% at discharge. MoCA score improvement was not correlated with the total length of abstinence prior to admission. Conclusion. The MoCA score seems to be a useful tool for measuring changes in cognitive performance in alcohol-dependent patients. A significant improvement in cognitive function was observed whatever the degree of impairment on admission and even after a long abstinence period.

Neurocognition and inhibitory control in polysubstance use disorders: Comparison with alcohol use disorders and changes with abstinence

INTRODUCTION

Intact neurocognition and early cognitive recovery during abstinence are important for substance use treatment outcome. Yet, little is known about them in the largest group of treatment seekers today, individuals with polysubstance use disorders (PSU). This study primarily contrasted PSU and individuals with an alcohol use disorder (AUD) on neurocognitive and inhibitory control measures and, secondarily, measured changes during abstinence in PSU.

METHOD

At one month of abstinence from all substances except tobacco, 36 PSU and 69 AUD completed neurocognitive assessments of executive function, general intelligence, auditory-verbal learning/memory, visuospatial learning/memory/skills, processing speed, working memory, fine motor skills, and cognitive efficiency. The groups were also assessed on inhibitory control measures of self-reported impulsivity, risk-taking, and decision-making. Seventeen PSU repeated the assessments after approximately four months of abstinence. All cross-sectional and longitudinal analyses included smoking status as a possible confound.

RESULTS

At baseline, PSU performed significantly worse than AUD on auditory-verbal memory and on an inhibitory control measure of impulsivity. Polysubstance users showed trends to worse performance than AUD on general intelligence, auditory-verbal learning, and a decision-making task. Between one and four months of abstinence, PSU showed significant improvements on several neurocognitive and inhibitory control measures.

CONCLUSIONS

Polysubstance users exhibit distinct differences in neurocognition and inhibitory control compared to AUD. Between one and four months of abstinence, neurocognition and inhibitory control improve in PSU. This neurocognitive recovery in some domains of abstinent PSU is influenced by smoking status. These results underscore the clinical value of select methods to augment neurocognitive recovery in PSU through appropriate interventions.

Effects of cigarette smoking and alcohol use on neurocognition and BDNF levels in a Chinese population

OBJECTIVE

Few studies have examined the potential interactive effect of both smoking and drinking on cognition. Brain-derived neurotrophic factor (BDNF) plays a critical role in cognition. This is the first study to examine the neurocognitive consequences of cigarette smoking combined with chronic alcohol consumption and their relationship to serum BDNF levels in a Chinese Han population.

MATERIALS AND METHODS

We recruited 191 healthy male subjects, including 47 isolated smokers, 31 isolated chronic alcohol users, 58 combined smokers and chronic alcohol users, and 55 non-smokers and non-alcohol users. We then compared the repeatable battery for the assessment of neuropsychological status (RBANS) scores and serum BDNF levels in these four groups.

RESULTS

When compared to the non-smoking + non-alcohol-using group, the smoking group performed worse on immediate memory, attention, language, and RBANS total score. There were no significant differences in the RBANS scores between the alcohol-using group and non-smoking + non-alcohol-using group, or between the smoking group and smoking + alcohol-using group. We did not find an association between BDNF and smoking or drinking status or between BDNF and cognitive performance. In the smoking group, there was a significant correlation between BDNF and carbon monoxide concentration, and between BDNF and the Fagerstrom Test for Nicotine Dependence (FTND) total score.

CONCLUSIONS

Our results suggest that smoking is associated with cognitive decline, but not with BDNF levels in a normal population. However, smoking severity is positively associated with BDNF levels. Concomitant alcohol use does not worsen the cognitive decline caused by smoking.

The Synergistic Impact of Excessive Alcohol Drinking and Cigarette Smoking upon Prospective Memory

The independent use of excessive amounts of alcohol or persistent cigarette smoking have been found to have a deleterious impact upon Prospective Memory (PM: remembering future intentions and activities), although to date, the effect of their concurrent use upon PM is yet to be explored. The present study investigated the impact of the concurrent use of drinking excessive amounts of alcohol and smoking cigarettes (a "Polydrug" group) in comparison to the combined effect of the single use of these substances upon PM. The study adopted a single factorial independent groups design. The Cambridge Prospective Memory Test (CAMPROMPT) is a test of both time-based and event-based PM and was used here to measure PM. The CAMPROMPT was administered to 125 adults; an excessive alcohol user group (n = 40), a group of smokers who drink very little alcohol (n = 20), a combined user group (the "Polydrug" group) who drink excessively and smoke cigarettes (n = 40) and a non-drinker/low alcohol consumption control group (n = 25). The main findings revealed that the Polydrug users recalled significantly fewer time-based PM tasks than both excessive alcohol users p < 0.001 and smokers p = 0.013. Polydrug users (mean = 11.47) also remembered significantly fewer event-based PM tasks than excessive alcohol users p < 0.001 and smokers p = 0.013. With regards to the main aim of the study, the polydrug users exhibited significantly greater impaired time-based PM than the combined effect of single excessive alcohol users and cigarette smokers p = 0.033. However, no difference was observed between polydrug users and the combined effect of single excessive alcohol users and cigarette smokers in event-based PM p = 0.757. These results provide evidence that concurrent (polydrug) use of these two substances has a synergistic effect in terms of deficits upon time-based PM. The observation that combined excessive drinking and cigarette smoking leads to a greater impairment in time-based PM may be of paramount importance, given the key role PM plays in everyday independent living.

Development of a Conceptual Model for Smoking Cessation: Physical Activity, Neurocognition, and Executive Functioning

PURPOSE

Considerable research has shown adverse neurobiological effects of chronic alcohol use, including long-term and potentially permanent changes in the structure and function of the brain; however, much less is known about the neurobiological consequences of chronic smoking, as it has largely been ignored until recently. In this article, we present a conceptual model proposing the effects of smoking on neurocognition and the role that physical activity may play in this relationship as well as its role in smoking cessation.

METHODS

Pertinent published peer-reviewed articles deposited in PubMed delineating the pathways in the proposed model were reviewed.

RESULTS

The proposed model, which is supported by emerging research, demonstrates a bidirectional relationship between smoking and executive functioning. In support of our conceptual model, physical activity may moderate this relationship and indirectly influence smoking behavior through physical activity-induced changes in executive functioning.

CONCLUSIONS

Our model may have implications for aiding smoking cessation efforts through the promotion of physical activity as a mechanism for preventing smoking-induced deficits in neurocognition and executive function.

Health-enhancing multibehavior and medical multimorbidity

OBJECTIVE

To examine the association of multibehavior on multimorbidity.

PATIENTS AND METHODS

Data from the 2005-2006 National Health and Nutrition Examination Survey were used. The study duration was from October 20, 2013, through December 16, 2014. A multimorbidity index variable was created that indicated the number of 14 morbidities that each patient had. A multibehavior index variable was created that indicated the number of 4 health-enhancing behaviors each participant had; physical activity was assessed via accelerometry, dietary behavior was assessed via an interview, smoking was determined via cotinine levels, and sleep duration was self-reported.

RESULTS

For the entire sample of 2048 participants, those with 1, 2, 3, and 4 health behaviors, compared with 0 health behaviors, had a 35% (odds ratio [OR], 0.65; 95% CI, 0.47-0.90; P=.01), 44% (OR, 0.56; 95% CI, 0.38-0.82; P=.006), 63% (OR, 0.37; 95% CI, 0.26-0.51; P<.001), and 69% (OR, 0.31; 95% CI, 0.19-0.52; P<.001) reduced odds of being multimorbid, respectively. Only physical activity (β=-.46) and sleep (β=-.23) were independently associated with multimorbidity, and only 2 health behavior combinations were associated with multimorbidity: physical activity and sleep (β=-.17) and physical activity and nonsmoking (β=-.16).

CONCLUSIONS

Americans engaging in more health behaviors were less likely to be multimorbid. Physical activity was independently, as well is in combination with other health behaviors, associated with multimorbidity. Implications for developing a multibehavior-multimorbidity framework to treat the patients' holistic needs is discussed.

Exercise and cognitive function: a randomized controlled trial examining acute exercise and free-living physical activity and sedentary effects

OBJECTIVE

To simultaneously examine the effects of acute exercise intensity and free-living physical activity and sedentary behavior on cognitive function in young, healthy adults.

PATIENTS AND METHODS

Using a counterbalanced, crossover, randomized controlled design, 87 young adults (mean age, 21.4 years) completed various cognitive assessments with and without an acute bout of exercise preceding the assessment. Participants were randomized into 1 of 4 groups to complete a 30-minute bout of acute exercise: control (no exercise), light intensity (40%-50% of predicted maximum heart rate [HR(max)]), moderate intensity (51%-70% of predicted HR(max)), or vigorous intensity (71%-85% of predicted HR(max)). Subjectively and objectively determined (accelerometry) physical activity and sedentary behavior were assessed to examine the association between these free-living behaviors and cognitive function. The study duration was August 26, 2013, to September 11, 2014.

RESULTS

Concentration-related cognition (mean ± SD Feature Match test score) was significantly higher after a 30-minute acute bout of moderate-intensity exercise (145.1±26.9) compared with cognitive assessment without exercise (121.3±19.2; P=.004). Furthermore, questionnaire-determined sedentary behavior was inversely associated with visual attention and task switching (Trail Making Test A score) (β=-0.23; P=.04). Last, estimated cardiorespiratory fitness (volume of maximum oxygen consumption) was positively associated with reasoning-related cognitive function (Odd One Out test score) (β=0.49; P=.05); when adding metabolic equivalent of task minutes per week to this model, the results were not significant (β=0.47; P=.07).

CONCLUSION

These findings provide some support for acute moderate-intensity exercise, sedentary behavior, and cardiorespiratory fitness being associated with executive functioning-related cognitive function in young, healthy adults.

Alcohol use disorder with and without stimulant use: brain morphometry and its associations with cigarette smoking, cognition, and inhibitory control

OBJECTIVE

Little is known about the effects of polysubstance use and cigarette smoking on brain morphometry. This study examined neocortical brain morphometric differences between abstinent polysubstance dependent and alcohol-only dependent treatment seekers (ALC) as well as light drinking controls (CON), the associations of cigarette smoking in these polysubstance users (PSU), and morphometric relationships to cognition and inhibitory control.

METHODS

All participants completed extensive neuropsychological assessments and 4 Tesla brain magnetic resonance imaging. PSU and ALC were abstinent for one month at the time of study. Parcellated morphological data (volume, surface area, thickness) were obtained with FreeSurfer methodology for the following bilateral components: dorso-prefrontal cortex (DPFC), anterior cingulate cortex (ACC), orbitofrontal cortex (OFC), and insula. Regional group differences were examined and structural data correlated with domains of cognition and inhibitory control.

RESULTS

PSU had significantly smaller left OFC volume and surface area and trends to smaller right DPFC volume and surface area compared to CON; PSU did not differ significantly from ALC on these measures. PSU, however, had significantly thinner right ACC than ALC. Smoking PSU had significantly larger right OFC surface area than non-smoking PSU. No significant relationships between morphometry and quantity/frequency of substance use, alcohol use, or age of onset of heavy drinking were observed. PSU exhibited distinct relationships between brain structure and processing speed, cognitive efficiency, working memory and inhibitory control that were not observed in ALC or CON.

CONCLUSION

Polysubstance users have unique morphometric abnormalities and structure-function relationships when compared to individuals dependent only on alcohol and light drinking controls. Chronic cigarette smoking is associated with structural brain irregularities in polysubstance users. Further elucidation of these distinctive characteristics could help inform the development of targeted and thus potentially more effective treatments in this large but understudied population.

Imagery vividness ratings during exposure treatment for posttraumatic stress disorder as a predictor of treatment outcome

Within exposure-based trauma treatments for posttraumatic stress disorder (PTSD), imagery vividness during imaginal exposure of the traumatic memory is an understudied but potentially important predictor of treatment outcome. Further, to our knowledge, this relationship has only been studied in women to date, and never among individuals with PTSD and substance use disorders which could impact ability to produce vivid mental imagery and its impact. The current study investigated whether imagery vividness ratings during in-session exposure predicted post-treatment PTSD symptom severity in a sample of men and women with comorbid PTSD and substance use disorders, and also examined whether gender moderated this relationship. A sample of 71 participants who received an exposure-based trauma treatment were included in the analyses. PTSD symptom severity was assessed using both the Clinician Administered PTSD Scale (CAPS) and the Impact of Event Scale-Revised (IES-R). Results varied according to method of assessing PTSD symptom severity. Higher imagery vividness was associated with better treatment outcome when assessed by the CAPS, with vividness in later sessions relating more strongly to outcome than vividness in earlier sessions. With the IES-R, higher imagery vividness ratings predicted more favorable treatment outcome for men, but less favorable treatment outcomes for women. Findings are discussed in the context of using imagery vividness to maximize treatment outcomes and future research directions involving scientific replication.

Startle-response based tasks and laboratory measures of impulsivity in abstinent alcoholic patients

AIMS

It is well known that impulsivity is a risk factor for the development of Addictive Disorders, and more specifically Alcohol Use Disorders (AUD). Recently, the Startle-Response Based Tasks (SRBT) and its different forms of plasticity have been found to be impaired in the alcoholic population. This is the first study to explore the correlation between impulsivity laboratory tasks and the SRBT test, in order to determine whether impulsivity and startle response (SR) could be related and in turn, explain their association with Alcohol Dependence (AD).

METHODS

SUBJECTS

40 men, who met DSM-IV criteria for AD and had been abstinent for at least one month. Impulsivity was assessed using three laboratory tests: Continuous Performance Test (CPT), Stop-Signal Task (SST) and Differential Reinforcement for Low-Rate Responding (DRL6). Patients also underwent the SR test. They were compared to 40 matched controls.

RESULTS

Impulsivity laboratory measures tasks (SST and commissions of the CPT) correlated positively with the magnitude of SR (P < 0.05) and with habituation (P < 0.05). Scores on DRL6 correlated negatively with the magnitude of SR (P < 0.05). This was not found in the control group.

CONCLUSIONS

The fact that impulsivity laboratory measures and the SR are correlated in patients but not in controls, could imply the existence of a common link for these two measures in alcoholic patients. Our findings support the hypothesis of the existence of two different vulnerability pathways for the development of AUD: anxiety and disinhibitory behaviour.

Executive Functioning in Alcohol Use Studies: A Brief Review of Findings and Challenges in Assessment

There is a wealth of research about the links between executive functioning (EF) and alcohol use. However, difficulty may arise in interpreting findings because of the variability between studies regarding the specific components of EF measured, as well as the variability of tasks used to examine each EF construct. The current article considers each of these problems within the context of a literature review that focuses on two topics: (1) the efficacy of EF in predicting alcohol use and alcohol-related consequences, and (2) the effect of acute alcohol intoxication on EF task performance. An additional goal was to identify and describe commonly used EF measures with the intention of providing alcohol researchers information on the assessment of different EF domains. Our findings indicate that there is strong evidence supporting a relation between EF difficulties (particularly response inhibition and information updating) and alcohol use, with additional evidence of a significant interaction between EF and implicit associations on alcohol use. In contrast, research supporting a link between set shifting abilities and later alcohol use is scarce. Additionally, this review found evidence of alcohol acutely affecting many EF processes (particularly response inhibition). Overall, there is a need to replicate these findings with commonly used EF tasks (versus developing numerous tasks within individual laboratories) to better advance our understanding of the relation between EF and alcohol use.

Smoking impedes executive function and related prospective memory

OBJECTIVE

This study assessed both executive function (EF) and prospective memory (PM) in a group of current smokers (CS) to observe whether deficits in both sets of memory processes co-existed in smokers, comparing this group with a group who had never smoked (NS).

METHOD

An existing-groups design was used to compare smokers with the NS group on a Reserve Digit Span Task (RDST) that measured EF and the Cambridge Prospective Memory Test (CAMPROMPT) measuring PM. Age, mood, other drug use and IQ were also measured and controlled for in the study.

RESULTS

After omitting anyone using an illegal substance and observing no between-group differences in age, gender, anxiety, depression, alcohol use and IQ, the CS group performed significantly worse on the RDST and recalled significantly fewer time-based and event-based tasks on CAMPROMPT, compared with the NS group.

CONCLUSIONS

Both EF and PM deficits were evident in the same cohort of CS when compared with a NS group, a finding which is novel in the current literature. Since both EF and PM are interrelated in that they share common resources in the brain, the finding that both sets of deficits co-existed in smokers suggests that persistent cigarette smoking impedes these underlying resources.

Alcohol Consumption and Executive Functions in Adolescents: A Systematic Review

Objetivo: el consumo de alcohol entre los estudiantes universitarios se ha convertido en una preocupación creciente en los últimosaños, por lo que este estudio fue desarrollado con el objetivo de identificar el consumo de esta sustancia entre los estudiantes de enfermería.Método: se trata de un estudio transversal desarrollado en una universidad privada en la ciudad de Río de Janeiro, Brasil, con 161estudiantes que respondieron a un cuestionario autoadministrado que contiene información sociodemográfica, preguntas seleccionadasdel Alcohol Use Disorders Identification Test y otros aspectos relacionados con el consumo de bebidas alcohólicas. Resultados: alta proporción(67,7 %) de los estudiantes de enfermería entrevistados reportó ser consumidores de alcohol, y el 32,1 % de ellos estaban en laorgía de consumo estándar, y casi la mitad (45,9 %) de los consumidores están expuestos al riesgo de desarrollar problemas relacionadoscon el consumo de esta sustancia. Resultados: están preocupados por el consumo de bebidas alcohólicas de los estudiantes de enfermeríaque participaron en este estudio, ya que son los futuros profesionales que inevitablemente actúan como educadores y motivadorespara la adopción de conductas saludables en la población. Conclusión: por lo tanto, se necesitan políticas y programas para prevenir elconsumo excesivo de alcohol en esta población.

Working memory and impulsivity predict marijuana-related problems among frequent users

BACKGROUND

Although marijuana is the most commonly used illicit substance in the US, only a small portion of users go on to develop dependence, suggesting that there are substantial individual differences in vulnerability to marijuana-related problems among users. Deficits in working memory and high trait impulsivity are two factors that may place marijuana users at increased risk for experiencing related problems.

METHODS

Using baseline data from an experimental study that recruited 104 frequent marijuana users (M=71.86% of prior 60 days, SD=22%), we examined the associations of working memory and trait impulsivity with marijuana-related problems.

RESULTS

Lower working memory, as measured by Trail Making Test B, but not short-term memory capacity, predicted more marijuana-related problems. Higher trait impulsivity scores were independently associated with greater number of problems.

CONCLUSIONS

Results suggest that marijuana users with reduced executive cognitive ability are more susceptible to developing problems related to their use. Trait impulsivity and executive working memory appear to be independent risk factors for experiencing marijuana-related problems.

Neurocognition in 1-month-abstinent treatment-seeking alcohol-dependent individuals: interactive effects of age and chronic cigarette smoking

BACKGROUND

Increasing age and chronic cigarette smoking are independently associated with adverse effects on multiple aspects of neurocognition in those seeking treatment for alcohol use disorders. However, the potential interactive effects of age and cigarette smoking on neurocognition in early abstinent alcohol-dependent individuals (ALC) have not investigated.

METHODS

Cross-sectional performances of never-smoking healthy comparison participants (nvsCOM; n = 39) and 1-month-abstinent, treatment-seeking, never-smoking (nvsALC; n = 30), former-smoking (fsALC; n = 21), and actively smoking (asALC; n = 68) ALC were compared on a comprehensive neurocognitive battery. Domains of functioning evaluated were cognitive efficiency, executive functions, fine motor skills, general intelligence, learning and memory, processing speed, visuospatial functions and working memory. Participants were between 26 and 71 years of age at the time of assessment.

RESULTS

asALC showed steeper age-related effects than nvsCOM on the domains of visuospatial learning, auditory-verbal memory, cognitive efficiency, executive functions, processing speed, and fine motor skills. In pairwise comparisons, fsALC and asALC performed more poorly than both nvsCOM and nvsALC on multiple domains; nvsCOM and nvsALC showed no significant differences. Domain scores for the ALC groups generally fell in the low-to-high-average range of functioning. A clinically significant level of impairment was apparent in only 25% of ALC participants on visuospatial learning, visuospatial memory, and fine motor skills domains. Measures of alcohol use or consumption were not significantly related to neurocognition in the ALC cohorts.

CONCLUSIONS

The age-related findings suggest that the combination of active chronic smoking and alcohol dependence in this 1-month-abstinent ALC cohort was associated with greater than normal age-related effects in multiple domains. In general, a low level of clinically significant impairment was observed in the alcohol-dependent participants. The findings from this study, in conjunction with previous research, strongly support smoking cessation interventions for those seeking treatment for alcohol and substance use disorders.

The effects of chronic cigarette smoking on cognitive recovery during early abstinence from alcohol

BACKGROUND

Alcohol use disorders are related to neurocognitive abnormalities during early abstinence in those seeking treatment for alcohol dependence (ALC). Considerable evidence indicates that chronic cigarette smoking is associated with multiple neurocognitive deficiencies. However, very little is known about the effects of chronic smoking on neurocognitive recovery during early abstinence from alcohol. We evaluated whether cigarette smoking interferes with cognitive improvement during early abstinence from alcohol, a period thought important for maintaining long-term sobriety.

METHODS

Neurocognitive functions previously shown to be adversely affected by both alcohol use disorders and chronic cigarette smoking were evaluated. We assessed 35 smoking ALC (sALC) and 34 nonsmoking ALC (nsALC) at approximately 1 and 5 weeks of monitored abstinence.

RESULTS

Although neither group was clinically impaired, both cross-sectional and longitudinal deficiencies were observed in sALC versus nsALC in processing speed, working memory, and auditory-verbal learning and memory. Lifetime alcohol consumption, medical, and psychiatric comorbidities did not predict neurocognitive performance or improvement across assessments. Within sALC, greater drinking and smoking severities were synergistically (more than additively) related to less improvement on visuospatial learning and memory. Former smoking status in the nsALC-mediated group differences in auditory-verbal delayed recall.

CONCLUSIONS

Chronic cigarette smoking appears to negatively impact neurocognition during early abstinence from alcohol. Although the cognitive deficiencies observed in this cohort were not in a clinical range of impairment, they should be considered to enhance treatment efficacy. Our findings lend support to integrating smoking cessation as well as the individual assessment of cognition into early ALC treatment. Additionally, there is a need to elucidate the effects of current and former smoking status in future reports of neurocognition.

Exposure to second-hand smoke damages everyday prospective memory

AIMS

Prospective memory (PM: remembering future intentions and activities) is critical to everyday remembering. This study compared a group of never-smokers who reported regular exposure to second-hand smoke (the SHS group) with a group of current smokers (the CS group) and a group of never-smokers who reported never having been exposed to SHS (the non-SHS group) on objective PM.

DESIGN

An existing groups design was employed to compare the SHS, CS and non-SHS groups.

PARTICIPANTS AND SETTING

Twenty-four SHS, 27 CS and 28 non-SHS were tested on objective PM. All participants were university undergraduates aged between 18-30 years. All participants were tested individually in a laboratory setting.

MEASUREMENTS

The Cambridge Prospective Memory Test (CAMPROMPT) was used to assess objective PM. Age, other drug use, mood and IQ were also measured as covariates in the study.

FINDINGS

The non-SHS group recalled significantly more time-based PM tasks than the SHS group (means = 16.3 versus 13.7, P < 0.001) and significantly more than the CS group (CS mean = 11.6, P < 0.001); and the SHS group recalled significantly more time-based tasks than the CS group (P < 0.002). The non-SHS group recalled significantly more event-based PM tasks than the CS group (means = 15.2 versus 11.3, P < 0.002) with no significant difference between the non-SHS group and SHS group (SHS mean = 14.3, P = 0.234); and the SHS group recalled significantly more event-based tasks than the CS group (P < 0.001).

CONCLUSION

Non-smokers exposed to second-hand smoke may suffer impairment in time-based prospective memory.

Executive cognitive dysfunction and ADHD in cocaine dependence: searching for a common cognitive endophenotype for addictive disorders

BACKGROUND

Cocaine-dependent individuals (CDI) present executive cognitive function (ECF) deficits, but the impact of psychiatric comorbidities such as Attention-Deficit Hyperactivity Disorder (ADHD) on neuropsychological functioning is still poorly understood. The aim of this study was to investigate if CDI with ADHD (CDI + ADHD) would have a distinct pattern of executive functioning when compared with CDI without ADHD (CDI).

METHODS

We evaluated 101 adults, including 69 cocaine-dependent subjects (divided in CDI and CDI + ADHD) and 32 controls. ECF domains were assessed with Digits Forward (DF), Digits Backward (DB), Stroop Color Word Test (SCWT), the Wisconsin Card Sorting Test (WCST), and the Frontal Assessment Battery (FAB). DSM-IV criteria for ADHD were used for diagnosis and previous ADHD symptoms (in the childhood) were retrospectively assessed by the Wender-Utah Rating Scale (WURS).

RESULTS

There were no significant differences between CDI + ADHD, CDI, and controls in estimated intellectual quotient (IQ), socioeconomic background, education (in years), and pre-morbid IQ (p > 0.05). SCWT and WCST scores did not differ across groups (p > 0.05). Nevertheless, CDI and CDI + ADHD performed more poorly than controls in total score of the FAB (p < 0.05). Also, CDI + ADHD did worse than CDI on DF (F = 4.756, p = 0.011), DB (F = 8.037, p = 0.001), Conceptualization/FAB (F = 4.635, p = 0.012), and Mental flexibility/FAB (F = 3.678, p = 0.029). We did not find correlations between cocaine-use variables and neuropsychological functioning, but previous ADHD symptoms assessed by WURS were negatively associated with DF (p = 0.016) and with the total score of the FAB (p = 0.017).

CONCLUSION

CDI + ADHD presented more pronounced executive alterations than CDI and CDI exhibited poorer cognitive functioning than controls. Pre-existing ADHD symptoms may have a significant negative impact on executive dysfunction in CDI. It remains to be investigated by future studies if symptoms such as impulsivity or a pre-existing ECF dysfunction could represent underlying cognitive endophenotypes that would substantially increase the risk for acquiring addictive disorders.