Gender Differences in Neurocognitive Functioning Among Alcohol-Dependent Russian Patients

Sex-difference in the association between social drinking, structural brain aging and cognitive function in older individuals free of cognitive impairment

Background

We investigated a potential sex difference in the relationship between alcohol consumption, brain age gap and cognitive function in older adults without cognitive impairment from the population-based Mayo Clinic Study of Aging.

Methods

Self-reported alcohol consumption was collected using the food-frequency questionnaire. A battery of cognitive testing assessed performance in four different domains: attention, memory, language, and visuospatial. Brain magnetic resonance imaging (MRI) was conducted using 3-T scanners (Signa; GE Healthcare). Brain age was estimated using the Brain-Age Regression Analysis and Computational Utility Software (BARACUS). We calculated the brain age gap as the difference between predicted brain age and chronological age.

Results

The sample consisted of 269 participants [55% men (n=148) and 45% women (n=121) with a mean age of 79.2 ± 4.6 and 79.5 ± 4.7 years respectively]. Women had significantly better performance compared to men in memory, (1.12 ± 0.87 vs 0.57 ± 0.89, P<0.0001) language (0.66 ± 0.8 vs 0.33 ± 0.72, P=0.0006) and attention (0.79 ± 0.87 vs 0.39 ± 0.83, P=0.0002) z-scores. Men scored higher in visuospatial skills (0.71 ± 0.91 vs 0.44 ± 0.90, P=0.016). Compared to participants who reported zero alcohol drinking (n=121), those who reported alcohol consumption over the year prior to study enrollment (n=148) scored significantly higher in all four cognitive domains [memory: F3,268 = 5.257, P=0.002, Language: F3,258 = 12.047, P<0.001, Attention: F3,260 = 22.036, P<0.001, and Visuospatial: F3,261 = 9.326, P<0.001] after correcting for age and years of education. In addition, we found a significant positive correlation between alcohol consumption and the brain age gap (P=0.03). Post hoc regression analysis for each sex with language z-score revealed a significant negative correlation between brain age gap and language z-scores in women only (P=0.008).

Conclusion

Among older adults who report alcohol drinking, there is a positive association between higher average daily alcohol consumption and accelerated brain aging despite the fact that drinkers had better cognitive performance compared to zero drinkers. In women only, accelerated brain aging is associated with worse performance in language cognitive domain. Older adult women seem to be vulnerable to the negative effects of alcohol on brain structure and on certain cognitive functions.

Subregion and sex differences in ethanol activation of cholinergic and glutamatergic cells in the mesopontine tegmentum

Ethanol engages cholinergic signaling and elicits endogenous acetylcholine release. Acetylcholine input to the midbrain originates from the mesopontine tegmentum (MPT), which is composed of the laterodorsal tegmentum (LDT) and the pedunculopontine tegmental nucleus (PPN). We investigated the effect of acute and chronic ethanol administration on cholinergic and glutamatergic neuron activation in the PPN and LDT in male and female mice. We show that ethanol activates neurons of the PPN and not the LDT in male mice. Chronic 15 daily injections of 2 g/kg ethanol induced Fos expression in cholinergic and glutamatergic PPN neurons in male mice, whereas ethanol did not increase cholinergic and glutamatergic neuronal activation in the LDT. A single acute 4 g/kg injection, but not a single 2 g/kg injection, induced cholinergic neuron activation in the male PPN but not the LDT. In contrast, acute or chronic ethanol at either dose or duration had no effect on the activation of cholinergic or glutamatergic neurons in the MPT of female mice. Female mice had higher baseline level of activation in cholinergic neurons compared with males. We also found a population of co-labeled cholinergic and glutamatergic neurons in the PPN and LDT which were highly active in the saline- and ethanol-treated groups in both sexes. These findings illustrate the complex differential effects of ethanol across dose, time point, MPT subregion and sex.

Subregion and sex differences in ethanol activation of cholinergic and glutamatergic cells in the mesopontine tegmentum

Ethanol engages cholinergic signaling and elicits endogenous acetylcholine release. Acetylcholine input to the midbrain originates from the mesopontine tegmentum (MPT), which is composed of the laterodorsal tegmentum (LDT) and the pedunculopontine tegmental nucleus (PPN). We investigated the effect of acute and chronic ethanol administration on cholinergic and glutamatergic neuron activation in the PPN and LDT in male and female mice. We show that ethanol selectively activates neurons of the PPN and not the LDT in male mice. Acute 4.0 g/kg and chronic 15 daily injections of 2.0 g/kg i.p. ethanol induced Fos expression in cholinergic and glutamatergic PPN neurons in male mice, whereas cholinergic and glutamatergic neurons of the LDT were unresponsive. In contrast, acute or chronic ethanol at either dose or duration had no effect on the activation of cholinergic or glutamatergic neurons in the MPT of female mice. Female mice had higher level of baseline activation in cholinergic neurons compared with males. We also found a population of co-labeled cholinergic and glutamatergic neurons in the PPN and LDT which were highly active in the saline- and ethanol-treated groups in both sexes. These findings illustrate the complex differential effects of ethanol across dose, time point, MPT subregion and sex.

Risky Decision-Making in Adults with Alcohol Use Disorder-A Systematic and Meta-Analytic Review

Alcohol use disorder (AUD) forms a major health concern and is the most common substance use disorder worldwide. The behavioural and cognitive deficits associated with AUD have often been related to impairments in risky decision-making. The aim of this study was to examine the magnitude and type of risky decision-making deficits of adults with AUD, as well as to explore the potential mechanisms behind these deficits. To this end, existing literature comparing risky decision-making task performance of an AUD group to a control group (CG) was systematically searched and analysed. A meta-analysis was performed to address overall effects. In total, 56 studies were included. In the majority of studies (i.e., 68%), the performance of the AUD group(s) deviated from the CG(s) on one or more of the adopted tasks, which was confirmed by a small to medium pooled effect size (Hedges' g = 0.45). This review therefore provides evidence of increased risk taking in adults with AUD as compared to CGs. The increased risk taking may be due to deficits in affective and deliberative decision-making. Making use of ecologically valid tasks, future research should investigate whether risky decision-making deficits predate and/or are consequential to the addiction of adults with AUD.

Sex differences in the acute ethanol effects on object recognition memory: influence of estrous cycle

Effects of acute ethanol (EtOH) on memory depend on several factors, including type of behavioral task. Sex differences in EtOH effects have been reported in humans and animals, and recognition memory can be influenced by circulating sex hormones. The aim of this study was to investigate the influence of sex and estrous cycle in the acute effects of EtOH on novel object recognition memory in rats. Male and female Wistar rats were part of one of the groups: control, 0.6-g/kg EtOH and 1.8-g/kg EtOH (administered intraperitoneally before the training session). The estrous cycle was evaluated by vaginal smear. The task was conducted in an open field arena. During training, animals were exposed to two identical objects, and test sessions were performed 1 h (short-term) and 24 h (long-term) later. One of the objects was changed in each test. Increased novel object exploration was shown by male and female controls in the short- and long-term tests, respectively. In the short-term test, females did not show preference for the novel object, and EtOH 1.8 g/kg impaired performance in males. In the long-term test, both sexes showed object discrimination, and 1.8-g/kg EtOH reduced preference for the new object in male rats. The phase of the cycle, the performance on proestrus was worse compared with other phases, and EtOH failed to impair performance mainly on estrous. In conclusion, while male rats displayed ethanol-induced recognition memory deficit, female rats were unaffected by EtOH impairing effects. In addition, the performance of female rats was influenced by the estrous cycle phases.

Reactive, Adult Neurogenesis From Increased Neural Progenitor Cell Proliferation Following Alcohol Dependence in Female Rats

Hippocampal neurodegeneration is a consequence of excessive alcohol drinking in alcohol use disorders (AUDs), however, recent studies suggest that females may be more susceptible to alcohol-induced brain damage. Adult hippocampal neurogenesis is now well accepted to contribute to hippocampal integrity and is known to be affected by alcohol in humans as well as in animal models of AUDs. In male rats, a reactive increase in adult hippocampal neurogenesis has been observed during abstinence from alcohol dependence, a phenomenon that may underlie recovery of hippocampal structure and function. It is unknown whether reactive neurogenesis occurs in females. Therefore, adult female rats were exposed to a 4-day binge model of alcohol dependence followed by 7 or 14 days of abstinence. Immunohistochemistry (IHC) was used to assess neural progenitor cell (NPC) proliferation (BrdU and Ki67), the percentage of increased NPC activation (Sox2+/Ki67+), the number of immature neurons (NeuroD1), and ectopic dentate gyrus granule cells (Prox1). On day seven of abstinence, ethanol-treated females showed a significant increase in BrdU+ and Ki67+ cells in the subgranular zone of the dentate gyrus (SGZ), as well as greater activation of NPCs (Sox2+/Ki67+) into active cycling. At day 14 of abstinence, there was a significant increase in the number of immature neurons (NeuroD1+) though no evidence of ectopic neurogenesis according to either NeuroD1 or Prox1 immunoreactivity. Altogether, these data suggest that alcohol dependence produces similar reactive increases in NPC proliferation and adult neurogenesis. Thus, reactive, adult neurogenesis may be a means of recovery for the hippocampus after alcohol dependence in females.

Visuoperceptive Impairments in Severe Alcohol Use Disorder: A Critical Review of Behavioral Studies

The present literature review is aimed at offering a comprehensive and critical view of behavioral data collected during the past seventy years concerning visuoperception in severe alcohol use disorders (AUD). To pave the way for a renewal of research and clinical approaches in this very little understood field, this paper (1) provides a critical review of previous behavioral studies exploring visuoperceptive processing in severe AUD, (2) identifies the alcohol-related parameters and demographic factors that influence the deficits, and (3) addresses the limitations of this literature and their implications for current clinical strategies. By doing so, this review highlights the presence of visuoperceptive deficits but also shows how the lack of in-depth studies exploring the visual system in this clinical population results in the current absence of integration of these deficits in the dominant models of vision. Given the predominance of vision in everyday life, we stress the need to better delineate the extent, the specificity, and the actual implications of the deficits for severe AUD.

Sex differences in stress-related alcohol use

Rates of alcohol use disorder (AUD) have increased in women by 84% over the past ten years relative to a 35% increase in men. This substantive increase in female drinking is alarming given that women experience greater alcohol-related health consequences compared to men. Stress is strongly associated with all phases of alcohol addiction, including drinking initiation, maintenance, and relapse for both women and men, but plays an especially critical role for women. The purpose of the present narrative review is to highlight what is known about sex differences in the relationship between stress and drinking. The critical role stress reactivity and negative affect play in initiating and maintaining alcohol use in women is addressed, and the available evidence for sex differences in drinking for negative reinforcement as it relates to brain stress systems is presented. This review discusses the critical structures and neurotransmitters that may underlie sex differences in stress-related alcohol use (e.g., prefrontal cortex, amygdala, norepinephrine, corticotropin releasing factor, and dynorphin), the involvement of sex and stress in alcohol-induced neurodegeneration, and the role of ovarian hormones in stress-related drinking. Finally, the potential avenues for the development of sex-appropriate pharmacological and behavioral treatments for AUD are identified. Overall, women are generally more likely to drink to regulate negative affect and stress reactivity. Sex differences in the onset and maintenance of alcohol use begin to develop during adolescence, coinciding with exposure to early life stress. These factors continue to affect alcohol use into adulthood, when reduced responsivity to stress, increased affect-related psychiatric comorbidities and alcohol-induced neurodegeneration contribute to chronic and problematic alcohol use, particularly for women. However, current research is limited regarding the examination of sex in the initiation and maintenance of alcohol use. Probing brain stress systems and associated brain regions is an important future direction for developing sex-appropriate treatments to address the role of stress in AUD.

Problem Drinking, Alcohol Expectancy, and Thalamic Resting-State Functional Connectivity in Nondependent Adult Drinkers

Alcohol misuse is associated with thalamic dysfunction. The thalamus comprises subnuclei that relay and integrate information between cortical and subcortical structures. However, it is unclear how the subnuclei contribute to thalamic dysfunctions in problem drinking. We investigated resting-state functional connectivity (rsFC) of thalamic subregions in 107 nondependent drinkers (57 women), using masks delineated by white matter tractography. Thalamus was parceled into motor, somatosensory, visual, premotor, frontal association, parietal association, and temporal association subregions. Whole-brain linear regression, each against Alcohol Use Disorders Identification Test (AUDIT) and positive alcohol expectancy (AE) score with age as a covariate, was performed for each seed, for men and women combined, and separately. Overall, problem drinking was associated with increased thalamic connectivities, whereas AE was associated with a mixed pattern of increased and decreased connectivities. Motor, premotor, somatosensory, and frontal association thalamic connectivity with bilateral caudate head was positively correlated with AUDIT score in men and women combined. Connectivity of the right caudate head with frontal association and premotor thalamus was also positively correlated with AE score in men and women combined. In contrast, motor and premotor thalamic connectivity with a number of cortical and subcortical structures showed sex differences in the correlation each with AUDIT and AE score. In mediation analyses, AE score completely mediated the correlation between thalamic caudate connectivity and AUDIT score, whereas the model where AE contributed to problem drinking and, in turn, altered thalamic caudate connectivity was not supported. To conclude, thalamic subregional rsFCs showed both shared and distinct changes and sex differences in association with problem drinking and AE. Increased thalamic caudate connectivity may contribute to problem drinking via enhanced AE. The findings suggest the importance of examining thalamic subdivisions and sex in investigating the functional roles of thalamus in problem drinking.

Development of a Contextualized Version of the Multiple Errands Test for People with Substance Dependence

BACKGROUND

Substance dependence is associated with deficits in several areas of executive functioning, such as planning and multitasking. Traditional tests of executive functioning have been criticized for their low ecological validity. Shallice and Burgess (1991) developed the Multiple Errands Test (MET), where participants are required to perform multiple tasks in a real-world setting. In this study, we aimed to adapt the MET for use in populations with substance dependence.

OBJECTIVES

This study aimed to: (1) examine the applicability of a contextualized version of the Multiple Errands Test, namely, the Multiple Errands Test - Contextualized Version (MET-CV); (2) study the testing context reliability and convergent validity of MET-CV scores; (3) compare the performance of people with substance dependence to a control group.

METHODS

Data were collected from 60 participants with substance dependence and 30 healthy controls. Both groups performed a neuropsychological assessment, which consisted of the MET-CV and traditional neuropsychological tests (Letter Number Sequencing, Zoo Map Test, Revised Strategy Application Test, Information Sampling Test, Stockings of Cambridge).

RESULTS

The MET-CV has adequate testing context reliability and moderate convergent validity relative to traditional planning measures. People with substance dependence (PWSD) showed significant deficits in executive function tests compared to healthy controls, most notably on the MET-CV rather than on traditional neuropsychological tests.

CONCLUSIONS

The MET-CV can be feasibly applied in the context of therapeutic communities treatment in PWSD. The MET-CV showed adequate reliability and validity, and detected planning deficits in PWSD. (JINS, 2018, 24, 347-359).

Sex differences in visual-spatial working memory: A meta-analysis

Visual-spatial working memory measures are widely used in clinical and experimental settings. Furthermore, it has been argued that the male advantage in spatial abilities can be explained by a sex difference in visual-spatial working memory. Therefore, sex differences in visual-spatial working memory have important implication for research, theory, and practice, but they have yet to be quantified. The present meta-analysis quantified the magnitude of sex differences in visual-spatial working memory and examined variables that might moderate them. The analysis used a set of 180 effect sizes from healthy males and females drawn from 98 samples ranging in mean age from 3 to 86 years. Multilevel meta-analysis was used on the overall data set to account for non-independent effect sizes. The data also were analyzed in separate task subgroups by means of multilevel and mixed-effects models. Results showed a small but significant male advantage (mean d = 0.155, 95 % confidence interval = 0.087-0.223). All the tasks produced a male advantage, except for memory for location, where a female advantage emerged. Age of the participants was a significant moderator, indicating that sex differences in visual-spatial working memory appeared first in the 13-17 years age group. Removing memory for location tasks from the sample affected the pattern of significant moderators. The present results indicate a male advantage in visual-spatial working memory, although age and specific task modulate the magnitude and direction of the effects. Implications for clinical applications, cognitive model building, and experimental research are discussed.

Gender Differences in Cognitive Functioning in Older Alcohol-Dependent Patients

BACKGROUND

Alcohol dependence is associated with impairments in cognition, especially in later life. Previous studies suggest that excessive drinking has more negative impact on cognition in women than in men.

OBJECTIVES

In this study, differences in cognition between male and female older, alcohol-dependent patients were examined.

METHOD

Older alcohol-dependent inpatients (N = 164, 62.2% men, mean age 62.6 ± 6.4) underwent neuropsychological tests of sensitivity to interference, mental flexibility, and visual processing.

RESULTS

No gender differences were found in age, educational level, estimated premorbid verbal intelligence, and sensitivity to interference. Duration of alcohol dependence was longer for men than for women. Men performed better than women on visual processing, and women better than men on mental flexibility. The superior mental flexibility of women remained significant after adjustment for duration of alcohol dependence. Conclusions/Importance: Older alcohol-dependent inpatients performed below average on cognitive tasks, which suggests that long-term excessive alcohol use negatively affects cognition. Our study does not demonstrate more severe cognitive impairment in women than in men.

Posttraumatic stress disorder and alcohol dependence: Epidemiology and order of onset

OBJECTIVE

Posttraumatic stress disorder (PTSD) and alcohol dependence (AD) frequently co-occur; however, epidemiologic studies of temporal associations between PTSD and AD are limited. The aims of this study were (a) to investigate the bidirectional associations between PTSD and AD and (b) to examine demographic and clinical correlates of order-of-onset among individuals with PTSD and AD.

METHOD

Participants were 11,103 adults (60.6% women; Mage = 48.7 years, SD = 15.9) from the National Epidemiologic Survey on Alcohol and Related Conditions who endorsed lifetime alcohol consumption and DSM-IV PTSD Criterion A trauma exposure (American Psychiatric Association, 2000). Cox proportional hazards models with time-dependent covariates were used to evaluate bidirectional associations between PTSD and AD. Sex differences were assessed using stratified analyses.

RESULTS

After adjusting for demographic, trauma, and alcohol characteristics, PTSD was associated with greater likelihood of subsequent AD (hazard ratio [HR] = 1.359, 95% CI = 1.357-1.362), and AD was associated with greater likelihood of subsequent PTSD (HR = 1.274, 95% CI = 1.271-1.277). Bidirectional associations between PTSD and AD were stronger for women compared with men. Among individuals with PTSD and AD, initial onset of PTSD was associated with younger age of first potentially traumatic event. Initial onset of AD was associated with earlier initiation of alcohol use, earlier onset of heavy alcohol use, family history of alcohol problems, and history of generalized anxiety disorder and social anxiety disorder for women but not men. Initial AD was associated with lifetime panic disorder for men and women.

CONCLUSIONS

Etiology of PTSD and AD is heterogeneous, and order of onset may reflect differing risk pathways. (PsycINFO Database Record

Deficits in attention performance are associated with insufficiency of slow-wave sleep in insomnia

OBJECTIVE

Cognitive impairment is associated with insomnia. However, there is a lack of evidence suggesting a link between insomnia and cognitive dysfunction in objective testing. The objectives of our current study were to assess the differences in components of attentional performance between primary insomnia patients and normal-sleeping controls and to examine potential predictors of attention impairment in patients with insomnia.

METHODS

We studied 36 patients (age 40.39 ± 12.36 years; 57.1% male) with insomnia and 25 normal-sleeping controls (age 39.88 ± 12.50 years; 52.9% male) who underwent one-night polysomnography followed by Multiple Sleep Latency Test (MSLT) and Attention Network Task (ANT). ANT reflected three attentional networks termed the alerting, orienting, and executive control networks.

RESULTS

After controlling for age, gender, body mass index, depression, anxiety, and education levels, patients with insomnia scored higher on the executive control variable of the ANT compared with normal-sleeping controls (96.75 ± 7.60 vs. 57.00 ± 10.49, p = 0.01). This higher score was independently associated with insufficiency of slow-wave sleep during nighttime sleep (β = -0.38, p = 0.04).

CONCLUSION

Our findings suggest that insomnia is associated with deficits in executive control of attention and that the underlying mechanism may be insufficiency of slow-wave sleep in chronic insomnia.

Sex differences in alcohol-related neurobehavioral consequences

In this chapter, we review existing research regarding sex differences in alcohol's effects on neurobehavioral functions/processes. Drawn largely from laboratory studies, literature regarding acute alcohol administration and chronic alcohol misuse is explored focusing on commonly employed neuropsychologic domains (e.g., executive function, visuospatial skills, learning and memory, gait and balance), neurophysiologic measures (e.g., electroencephalography and event-related potentials), and structural and functional neuroimaging (e.g., magnetic resonance imaging (MRI), functional MRI, diffusion tensor imaging, positron emission tomography, and magnetic resonance spectroscopy). To provide a historical perspective on the development of these questions, we have included reference to early and more recent research. Additionally, specific biases, knowledge gaps, and continuing controversies are noted.

Planning deficits in polysubstance dependent users: Differential associations with severity of drug use and intelligence

BACKGROUND

Polysubstance use is associated with alterations in different components of executive functioning such as working memory and response inhibition. Nevertheless, less attention has been given to executive planning skills, which are required to benefit of low structured interventions. This study examines the association between severity of use of cocaine, heroin, alcohol, fluid and crystallized intelligence and planning tasks varying on degree of structure.

METHODS

Data were collected from 60 polysubstance users and 30 healthy controls. Cognitive assessment consisted of three planning tasks with different structure levels: Stockings of Cambridge, Zoo Map test, and Multiple Errands Test.

RESULTS

Polysubstance users had significant planning deficits across the three tasks compared to healthy controls. Hierarchical regression models showed that severity of drug use and fluid and crystallized intelligence significantly explained performance in all the planning tasks. However, these associations were higher for low-structured real world tasks. These low-structured tasks also showed a unique association with crystallized but not fluid intelligence.

CONCLUSION

Drug abuse is negatively associated with planning abilities, and intelligence is positively associated with planning performance in real-world tasks.

Neurocognitive Functioning and Treatment Outcome Following Detoxification Among Asian Alcohol-Dependent Inpatients

BACKGROUND

The prevalence of alcohol use disorders in Asia is increasing and relapse among treated populations remains the norm, not the exception. The extent to which cognitive impairment influences clinical outcome remains unclear, with research dominated by studies of Caucasian populations.

OBJECTIVES

This study examines behavioral and self-reported cognitive functioning in detoxified alcohol-dependent (AD) patients in Singapore and its association with outcome.

METHODS

The cognitive performance of 30 recently-detoxified AD inpatients and 30 demographically-matched controls was compared using visuospatial memory, working memory, set-shifting, planning and reflection impulsivity tests of the CANTAB®, and self-reported dysexecutive symptoms and everyday cognitive difficulties. Patients' alcohol use and self-reported cognitive functioning were reassessed 3-months post-discharge.

RESULTS

Compared to matched controls, AD inpatients exhibited significantly poorer fluid intelligence, visuospatial memory, working memory, set-shifting flexibility and planning/organization, but not reflection impulsivity. In support of Western studies, a significant proportion (three-quarters) were "clinically impaired" on subtests. Significant reductions were observed in alcohol units, frequency and dependency scores at follow-up, though improvements in self-reported cognitive functioning were limited to abstainers. Baseline cognitive performance did not differentiate those who had abstained from alcohol and relapsed at follow-up.

CONCLUSIONS/IMPORTANCE

Memory and executive functioning impairments were evident among Asian AD patients alongside self-reported cognitive difficulties, thus cognitively demanding psychological interventions may have limited impact during early detoxification. Future studies can build on these findings, with larger samples and measurement of moderating and mediating factors to extend our understanding of how cognitive impairment influences outcome.

Sex and gender-related differences in alcohol use and its consequences: Contemporary knowledge and future research considerations

AIMS

To review the contemporary evidence reflecting male/female differences in alcohol use and its consequences along with the biological (sex-related) and psycho-socio-cultural (gender-related) factors associated with those differences.

METHODS

MEDLINE, PubMed, Web of Science, SCOPUS, PsycINFO, and CINAHL databases were searched for relevant publications, which were subsequently screened for the presence/absence of pre-specified criteria for high quality evidence.

RESULTS

Compared to men, more women are lifetime abstainers, drink less, and are less likely to engage in problem drinking, develop alcohol-related disorders or alcohol withdrawal symptoms. However, women drinking excessively develop more medical problems. Biological (sex-related) factors, including differences in alcohol pharmacokinetics as well as its effect on brain function and the levels of sex hormones may contribute to some of those differences. In addition, differences in alcohol effects on behavior may also be driven by psycho-socio-cultural (gender-related) factors. This is evident by variation in the magnitude of differences in alcohol use between countries, decreasing difference in the rates of alcohol consumption in recent generations and other findings. Evidence indicates that both sex and gender-related factors are interacting with alcohol use in complex manner, which differentially impacts the risk for development of the behavioral or medical problems and alcohol use disorders in men and women.

CONCLUSIONS

Discovery of the mechanisms underlying biological (sex-related) as well as psycho-socio-cultural (gender-related) differences in alcohol use and related disorders is needed for development of personalized recommendations for prevention and treatment of alcohol use disorders and related problems in men and women.

Females uniquely vulnerable to alcohol-induced neurotoxicity show altered glucocorticoid signaling

Women are more sensitive to the harmful effects of alcohol (EtOH) abuse than men, yet the underlying mechanisms remain poorly understood. Previous gene expression analysis of the medial prefrontal cortex (mPFC) following a chronic intoxication paradigm using continuous 72 h vapor inhalation found that females, but not males, exhibit an inflammatory response at peak withdrawal that is associated with cell damage. Given that glucocorticoids can function as anti-inflammatories, are known to increase with EtOH exposure, and influence neurotoxicity, we hypothesized that males and females may exhibit an altered corticosterone (CORT) response following chronic intoxication. Analysis of serum CORT levels revealed the expected increase during withdrawal with no difference between males and females, while control males but not females exhibited higher CORT concentrations than naive animals. Glucocorticoid signaling characterized using focused qPCR arrays identified a sexually dimorphic response in the mPFC during withdrawal, particularly among astrocyte-enriched genes. These genes include aquaporin-1 (Aqp1), sphingosine kinase 1 (Sphk1) and connective tissue growth factor (Ctgf); genes associated with inflammatory signaling, and tissue damage and repair. Bioinformatic analysis also revealed activation of inflammatory signaling and cell death pathways in females. Confirmation studies showed that female mice exhibited significant neuronal degeneration within the anterior cingulate cortex (ACC). By contrast, EtOH exposure lead to a significant reduction in cell death in males. Thus, distinct glucocorticoid signaling pathways are associated with sexually dimorphic neurotoxicity, suggesting one mechanism by which EtOH-exposed females are particularly vulnerable to the damaging effects of alcohol in the CNS.

Cognitive and emotional deficits in chronic alcoholics: a role for the cerebellum?

It is now widely accepted that in addition to motor coordination, the cerebellum is also involved in the modulation of cognitive and affective processes. Despite alcoholic cerebellar degeneration (ACD) being the most common form of cerebellar disorder, little systematic investigation of cerebellar-mediated cognitive and affective deficits has occurred in chronic alcoholics. Forty-nine chronic alcoholics and 29 healthy control participants underwent testing of cognitive and affective function, along with measurement of cerebellar ataxia using the International Cooperative Ataxia Rating Scale (Trouillas et al., Journal of the Neurological Sciences 145:205-11, 1997). The alcoholic group demonstrated significantly poorer performance as compared to the control group in a number of domains, including visuospatial and language skills, psychomotor speed, new learning and memory, executive functioning, and emotional regulation and affect processing. There were no differences between the alcoholic and control groups in immediate attention and working memory abilities. Years of heavy drinking and total period of abstinence were found to be the best predictors of cognitive and emotional function in the alcoholic group. After accounting for alcohol chronicity, there was still a relationship between the degree of clinical signs of ACD and some areas of cognitive and emotional functioning, including language, executive functioning, processing speed and affect processing. The results suggest that some of the cognitive and affective deficits observed in chronic alcoholics may be mediated, at least in part, by cerebellar dysfunction. These findings add support to the theory of disruption to bidirectional cerebro-cerebellar circuitry underlying cognitive and affective deficits in chronic alcoholics.

Experimental and clinical usefulness of crossmodal paradigms in psychiatry: an illustration from emotional processing in alcohol-dependence

Crossmodal processing (i.e., the construction of a unified representation stemming from distinct sensorial modalities inputs) constitutes a crucial ability in humans' everyday life. It has been extensively explored at cognitive and cerebral levels during the last decade among healthy controls. Paradoxically however, and while difficulties to perform this integrative process have been suggested in a large range of psychopathological states (e.g., schizophrenia and autism), these crossmodal paradigms have been very rarely used in the exploration of psychiatric populations. The main aim of the present paper is thus to underline the experimental and clinical usefulness of exploring crossmodal processes in psychiatry. We will illustrate this proposal by means of the recent data obtained in the crossmodal exploration of emotional alterations in alcohol-dependence. Indeed, emotional decoding impairments might have a role in the development and maintenance of alcohol-dependence, and have been extensively investigated by means of experiments using separated visual or auditory stimulations. Besides these unimodal explorations, we have recently conducted several studies using audio-visual crossmodal paradigms, which has allowed us to improve the ecological validity of the unimodal experimental designs and to offer new insights on the emotional alterations among alcohol-dependent individuals. We will show how these preliminary results can be extended to develop a coherent and ambitious research program using crossmodal designs in various psychiatric populations and sensory modalities. We will finally end the paper by underlining the various potential clinical applications and the fundamental implications that can be raised by this emerging project.

Cognitive functions in abstinent alcohol-dependent patients

The objective of this cross-sectional study was to compare cognitive functioning of abstaining alcohol-dependent (AD) male patients and healthy controls as well as to investigate whether their cognitive performance varied by abstinence length. Forty-two maintaining abstinent (AD) patients and 34 healthy controls were examined. Tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) were used to assess cognitive functions. Differences in cognitive performance were found between AD patients and healthy controls. Nonverbal tasks in cognitive domains such as attention, visual memory and working memory were impaired in AD patients who presented deficits in visual episodic memory, had slower reaction time and reduced working memory span. Patients who were abstinent for less than one year made more errors in both attentional set shifting and working memory tests than healthy controls and patients with longer durations of abstinence. Impairments identified in multiple cognitive domains in abstinent alcohol-dependent subjects suggest functional deficits in extensive brain networks connecting interrelated brain structures. Attentional control and spatial working memory were less impaired in those AD patients who maintained abstinence for at least one year.

Characterization of cerebellar ataxia in chronic alcoholics using the International Cooperative Ataxia Rating Scale (ICARS)

BACKGROUND

Alcoholism is the most common cause of cerebellar dysfunction, yet estimates of the incidence of alcoholic cerebellar degeneration (ACD) vary greatly, with differences in methodologies contributing to these disparate findings. This study set out to characterize the frequency and pattern of clinical signs of ACD in an alcoholic group using the International Cooperative Ataxia Rating Scale (ICARS).

METHODS

We compared the performance of 49 alcoholics and 29 control participants. The relative contributions of demographic and alcohol consumption variables to ICARS scores in the alcoholic group were also examined.

RESULTS

The alcoholic group demonstrated significantly poorer performance on all of the ICARS subscales as compared with the control group. Within the alcoholic group, performance was more impaired on the speech scale than on all of the other scales, except the lower limb component of the kinetic scale, and less impaired on the oculomotor scale compared with all other scales. Years of heavy drinking and lifetime alcohol consumption correlated with total ICARS scores; however, maximum daily consumption was actually negatively correlated with ICARS scores. Of the alcohol history variables, years of heavy drinking was the best predictor of total ICARS scores, making a 19% unique contribution, followed by the period of abstinence from alcohol, which uniquely contributed 7% of the variance. There were high correlations between age and male gender and the alcohol consumption variables; however, age and gender were still found to uniquely contribute 5 and 7% respectively to the variance in total ICARS scores.

CONCLUSIONS

ACD may affect up to two-thirds of chronic alcoholics. Assessing the number of years an individual has been drinking beyond a certain threshold can give a good indication of the likelihood of ACD. Age, gender, and the source of the clinical sample may significantly contribute to the prevalence of ACD and require further detailed investigation.

Initiating moderate to heavy alcohol use predicts changes in neuropsychological functioning for adolescent girls and boys

This study prospectively examines the influence of alcohol on neuropsychological functioning in boys and girls characterized prior to initiating drinking (N = 76, ages 12-14). Adolescents who transitioned into heavy (n = 25; 11 girls, 14 boys) or moderate (n = 11; 2 girls, 9 boys) drinking were compared with matched controls who remained nonusers throughout the approximately 3-year follow-up period (N = 40; 16 girls, 24 boys). For girls, more past year drinking days predicted a greater reduction in visuospatial task performance from baseline to follow-up, above and beyond performance on equivalent measures at baseline (R2Delta = 10%, p < .05), particularly on tests of visuospatial memory (R2Delta = 8%, p < .05). For boys, a tendency was seen for more past year hangover symptoms to predict worsened sustained attention (R2Delta = 7%, p < .05). These preliminary longitudinal findings suggest that initiating moderately heavy alcohol use and incurring hangover during adolescence may adversely influence neurocognitive functioning. Neurocognitive deficits linked to heavy drinking during this critical developmental period may lead to direct and indirect changes in neuromaturational course, with effects that would extend into adulthood.

A pilot trial of the alpha-1 adrenergic antagonist, prazosin, for alcohol dependence

BACKGROUND

Current medications for alcohol dependence (AD) show only modest efficacy. None target brain noradrenergic pathways. Theory and preclinical evidence suggest that noradrenergic circuits may be involved in alcohol reinforcement and relapse. We therefore tested the alpha-1 adrenergic receptor antagonist, prazosin, as a pharmacotherapy for AD.

METHODS

We randomized 24 participants with AD but without posttraumatic stress disorder to receive either prazosin or placebo in a 6-week, double-blind pilot study. Medication was titrated to a target dose of 4 mg QAM, 4 mg QPM, and 8 mg QHS by the end of week 2. Participants received 5 medical management treatment sessions. Participants were reminded 3 times each day via a text pager to take medications and to call a telephone monitoring system once daily to provide self-reports of alcohol consumption and craving, the primary outcome measures. Results were analyzed using mixed linear regression adjusted for drinking days per week at baseline and week number.

RESULTS

Twenty of the 24 (83%) subjects completed. Among the completers, the prazosin group reported fewer drinking days per week than the placebo group during the final 3 weeks of the study. Since only 1 woman was randomized to placebo and only three women completed the trial, the following results focus on the 17 male completers. The prazosin group reported fewer drinking days per week and fewer drinks per week during the final 3 weeks of the study; average total number of drinking days for the placebo group 5.7 (SEM 1.9) versus 0.9 (SEM 0.5) for the prazosin group, and average total number of drinks 20.8 (SEM 6.5) for the placebo group versus 2.6 (SEM 1.3) for the prazosin group. Rates of adverse events were equivalent across conditions.

CONCLUSIONS

Prazosin holds promise as a pharmacologic treatment for AD and deserves further evaluation in a larger controlled trial.

One-per-occasion or less: are moderate-drinking postmenopausal women really healthier than their nondrinking and heavier-drinking peers?

BACKGROUND

While some reported benefits of moderate drinking are thought to be the direct results of physiological mechanisms associated with consumption, other effects may be attributable to mediating factors. Both explanations suggest that moderate drinkers may be healthier than nondrinking and heavier-drinking peers. The purpose of this study was to determine whether moderate-drinking postmenopausal women report healthier dietary and exercise patterns, and whether they demonstrate better physiological functioning compared with peers. This study also aimed to describe patterns of relationships between alcohol and measures of general health functioning in postmenopausal women.

METHODS

One-hundred and fifteen women aged 50 to 65 participated. Participants completed alcohol interviews, diet and exercise questionnaires, and bone density examination. Blood pressure, height, and weight were assessed, and blood was collected to conduct basic chemistry and complete blood count tests.

RESULTS

Postmenopausal moderate drinkers failed to demonstrate healthier dietary or exercise habits, and did not exhibit significantly better health-functioning compared with peers. They did evidence positive associations between drinking and healthy behavior, and between drinking and cardiovascular health. Relationships between alcohol and blood analytes differed between drinking groups, some of which suggested possible negative health consequences for higher-end drinkers in both drinking groups.

CONCLUSIONS

These data suggested that moderate-drinking postmenopausal women are not significantly healthier than their non- or heavier-drinking peers, but may drink as part of a larger effort to take care of their health. Despite this, even 1-drink-per-drinking-day moderate drinkers may have tendencies toward unhealthy conditions. Limitations include small sample size, inability to assess specific cardiac risk and socioeconomic status, small number of correlations, and clinical relevance of analyte values.

A family history of psychopathology modifies the decrement in cognitive control among patients with HIV/AIDS

The present study was designed to evaluate the effect of HIV/AIDS on cognitive control and to determine if the effect is modified by familial risk for either alcohol or mood disorders. Sixty HIV-1 seropositive and 75 seronegative volunteers were assigned to four subgroups defined by the crossing of a diagnosis of alcohol dependence in the biological father with diagnoses of either major depressive disorder or bipolar disorder in the biological mother. Cognitive control was evaluated during a task in which subjects were asked, on occasion, to inhibit the impulse to respond in the same physical direction as the stimulus and instead respond in the opposite direction. Event related brain potentials and measures of task performance were recorded. The task evoked a negative shift in a late slow potential (SP) as well as an increment in reaction time when cognitive control was challenged. An important finding was an interaction between trial type, HIV/AIDS, and family history: HIV/AIDS and family history each attenuated the negative shift in the SP to such a degree that no further attenuation could be accomplished by the other. The effects of familial risk for alcohol versus mood disorders were equivalent. In conclusion, the absence of change in a late slow potential following a challenge to cognitive control may represent a marker of familial risk for both externalizing and internalizing disorders. The effects of familial risk on this slow potential are sufficiently robust as to attenuate the effects of HIV/AIDS on the probable generators of the response: the anterior cingulate and prefrontal cortex.