Reduced resource optimization in male alcoholics: N400 in a lexical decision paradigm

Predictors of chronicity in alcohol use disorder: an evoked response potential study

INTRODUCTION

Evoked response potentials (ERP) can reliably map key neurocognitive processes which are putatively responsible for chronic alcohol use disorder (AUD). Aim of the present study was to study P300 auditory odd ball and N400 visual semantic incongruity paradigm mapping executive functions rubric as a potential biomarker predicting chronicity in AUDs. Methodology: 60 right handed 18 to 54 years age subjects were divided into chronic "CAD" and non chronic alcohol dependence "NAD" in addition to healthy control "HC" (N = 30). Subjects were assessed by Addiction Severity Index (ASI), P300 auditory odd ball paradigm in midline region and visual N400 semantic incongruity task in centro-parietal region in a cross sectional design. Results: All the three groups differed significantly for P300 and N400 amplitude in all the leads with maximum attenuation seen in CAD. On discriminant function analysis (DFA), P300 Pz and N 400 C2 amplitude values could accurately classified 78.3% subjects. Composite sensitivity and specificity of the two predictor variables differentiating CAD subjects from NAD were 79.31 and 77.41%. receiver operating characteristic curve generated an area under the curve of .758 and .847 i.e., "fair to good" ability to predict CAD from NAD. Conclusion: We conclude that specific ERP paradigm can be used as a state marker to map the cognitive deficits and as a biomarker to detect chronic AUDs.

Failure to utilize feedback during explicit decision-making task in alcohol-dependent patients

BACKGROUND

Patients who are diagnosed with alcohol-dependent syndrome (ADS) are shown to have neuropsychological deficits, especially executive function (EF) deficits. Among the EFs, decision-making is one such function which has consistently been shown to be impaired in people who are dependent on alcohol, compared to controls. Decision-making in this population is usually assessed with gambling-type tasks. However, some of these tasks are ambiguous, work on chance factors, rarely match with real-life gambling situations, and/or involve nonconscious mechanisms.

MATERIALS AND METHODS

The current study compared 26 male patients with ADS (P-ADS) with equal number of their nonalcohol-dependent male siblings on sensation seeking and explicit gambling task (EGT). EGT is similar to the Iowa gambling task in administration, but varies from it as it involves a single outcome and provides unambiguous, explicit, and continuous feedback for the participants.

RESULTS AND CONCLUSION

The results did not show any significant relationship between decision-making variables and sensation seeking. However, despite unambiguous, explicit, and continuous feedback, patients showed significantly poor decision-making as compared to the siblings of the P-ADS group. This study throws light on why people who are addicted to alcohol have difficulties in decision-making, despite knowing the adverse effects.

Endophenotype best practices

This review examines the current state of electrophysiological endophenotype research and recommends best practices that are based on knowledge gleaned from the last decade of molecular genetic research with complex traits. Endophenotype research is being oversold for its potential to help discover psychopathology relevant genes using the types of small samples feasible for electrophysiological research. This is largely because the genetic architecture of endophenotypes appears to be very much like that of behavioral traits and disorders: they are complex, influenced by many variants (e.g., tens of thousands) within many genes, each contributing a very small effect. Out of over 40 electrophysiological endophenotypes covered by our review, only resting heart, a measure that has received scant advocacy as an endophenotype, emerges as an electrophysiological variable with verified associations with molecular genetic variants. To move the field forward, investigations designed to discover novel variants associated with endophenotypes will need extremely large samples best obtained by forming consortia and sharing data obtained from genome wide arrays. In addition, endophenotype research can benefit from successful molecular genetic studies of psychopathology by examining the degree to which these verified psychopathology-relevant variants are also associated with an endophenotype, and by using knowledge about the functional significance of these variants to generate new endophenotypes. Even without molecular genetic associations, endophenotypes still have value in studying the development of disorders in unaffected individuals at high genetic risk, constructing animal models, and gaining insight into neural mechanisms that are relevant to clinical disorder.

Endophenotypes for Alcohol Use Disorder: An Update on the Field

The endophenotype concept was first proposed as a strategy to use (purportedly) genetically simpler phenotypes in gene identification studies for psychiatric disorders, and is distinct from the closely related concept of intermediate phenotypes. In the area of alcohol use disorder (AUD) research, two candidate endophenotypes have produced replicable genetic associations: level of response to alcohol and neurophysiology markers (e.g., event-related oscillations and event-related potentials). Additional candidate endophenotypes from the cognitive, sensory, and neuroimaging literatures show promise, although more evidence is needed to fully evaluate their potential utility. Translational approaches to AUD endophenotypes have helped characterize the underlying neurobiology and genetics of AUD endophenotypes and identified relevant pharmacological interventions. Future research that capitalizes on the polygenic nature of endophenotypes and emphasizes endophenotypes that may change across development will enhance the usefulness of this concept to understand the genetically-influenced pathways toward AUD.

Advances in Electrophysiological Research

Electrophysiological measures of brain function are effective tools to understand neurocognitive phenomena and sensitive indicators of pathophysiological processes associated with various clinical conditions, including alcoholism. Individuals with alcohol use disorder (AUD) and their high-risk offspring have consistently shown dysfunction in several electrophysiological measures in resting state (i.e., electroencephalogram) and during cognitive tasks (i.e., event-related potentials and event-related oscillations). Researchers have recently developed sophisticated signal-processing techniques to characterize different aspects of brain dynamics, which can aid in identifying the neural mechanisms underlying alcoholism and other related complex disorders.These quantitative measures of brain function also have been successfully used as endophenotypes to identify and help understand genes associated with AUD and related disorders. Translational research also is examining how brain electrophysiological measures potentially can be applied to diagnosis, prevention, and treatment.

The use of current source density as electrophysiological correlates in neuropsychiatric disorders: A review of human studies

The use of current source density (CSD), the Laplacian of the scalp surface voltage, to map the electrical activity of the brain is a powerful method in studies of cognitive and affective phenomena. During the last few decades, mapping of CSD has been successfully applied to characterize several neuropsychiatric conditions such as alcoholism, schizophrenia, depression, anxiety disorders, childhood/developmental disorders, and neurological conditions (i.e., epilepsy and brain lesions) using electrophysiological data from resting state and during cognitive performance. The use of CSD and Laplacian measures has proven effective in elucidating topographic and activation differences between groups: i) patients with a specific diagnosis vs. healthy controls, ii) subjects at high risk for a specific diagnosis vs. low risk or normal controls, and iii) patients with specific symptom(s) vs. patients without these symptom(s). The present review outlines and summarizes the studies that have employed CSD measures in investigating several neuropsychiatric conditions. The advantages and potential of CSD-based methods in clinical and research applications along with some of the limitations inherent in the CSD-based methods are discussed in the review, as well as future directions to expand the implementation of CSD to other potential clinical applications. As CSD methods have proved to be more advantageous than using scalp potential data to understand topographic and source activations, its clinical applications offer promising potential, not only for a better understanding of a range of psychiatric conditions, but also for a variety of focal neurological disorders, including epilepsy and other conditions involving brain lesions and surgical interventions.

Event-related potentials in substance use disorders: a narrative review based on articles from 1984 to 2012

Mechanisms that mediate the transition from occasional, controlled, drug use to the impaired control that characterizes severe dependence are still a matter of investigation. The etiology of substance use disorders (SUDs) is complex, and in this context of complexity, the concept of "endophenotype," has gained extensive popularity in recent years. The main aim of endophenotypes is to provide a simpler, more proximal target to discover the biological underpinnings of a psychiatric syndrome. In this view, neurocognitive and neurophysiological impairments that suggest functional impairments associated with SUDs have been proposed as possible endophenotypes. Because of its large amplitude and relatively easy elicitation, the most studied of the cognitive brain event-related potentials (ERPs), the P300 component, has been proposed as one possible candidate. However, if a P300 amplitude alteration is a common finding in SUDs, it is also observable in other psychiatric afflictions, suggesting that the associations found may just reflect a common measure of brain dysfunction. On this basis, it has been proposed that a multivariate endophenotype, based on a weighted combination of electrophysiological features, may provide greater diagnostic classification power than any single endophenotype. The rationale for investigating multiple features is to show that combining them provides extra useful information that is not available in the individual features, leading ultimately to a multivariate phenotype.The aim of the present article is to outline the potential usefulness of this kind of "combined electrophysiological procedure" applied to SUDs. We present a review of ERP studies, combining data from people with SUD, family members, and normal control subjects, to verify whether the combination of 4ERPs (P50, MMN, P300, and N400) may produce profiles of cortical anomalies induced by different types of SUD (alcohol vs cocaine vs cannabis vs heroin).

Spatio-temporal processing of words and nonwords: hemispheric laterality and acute alcohol intoxication

This study examined neurofunctional correlates of reading by modulating semantic, lexical, and orthographic attributes of letter strings. It compared the spatio-temporal activity patterns elicited by real words (RW), pseudowords, orthographically regular, pronounceable nonwords (PN) that carry no meaning, and orthographically illegal, nonpronounceable nonwords (NN). A double-duty lexical decision paradigm instructed participants to detect RW while ignoring nonwords and to additionally respond to words that refer to animals (AW). Healthy social drinkers (N=22) participated in both alcohol (0.6 g/kg ethanol for men, 0.55 g/kg for women) and placebo conditions in a counterbalanced design. Whole-head MEG signals were analyzed with an anatomically-constrained MEG method. Simultaneously acquired ERPs confirm previous evidence. Spatio-temporal MEG estimates to RW and PN are consistent with the highly replicable left-lateralized ventral visual processing stream. However, the PN elicit weaker activity than other stimuli starting at ~230 ms and extending to the M400 (magnetic equivalent of N400) in the left lateral temporal area, indicating their reduced access to lexicosemantic stores. In contrast, the NN uniquely engage the right hemisphere during the M400. Increased demands on lexicosemantic access imposed by AW result in greater activity in the left temporal cortex starting at ~230 ms and persisting through the M400 and response preparation stages. Alcohol intoxication strongly attenuates early visual responses occipito-temporally overall. Subsequently, alcohol selectively affects the left prefrontal cortex as a function of orthographic and semantic dimensions, suggesting that it modulates the dynamics of the lexicosemantic processing in a top-down manner, by increasing difficulty of semantic retrieval.

Understanding alcohol use disorders with neuroelectrophysiology

Neurocognitive deficits associated with impairments in various brain regions and neural circuitries, particularly involving frontal lobes, have been associated with chronic alcoholism, as well as with a predisposition to develop alcohol use and related disorders (AUDs). AUD is a multifactorial disorder caused by complex interactions between behavioral, genetic, and environmental liabilities. Neuroelectrophysiologic techniques are instrumental in understanding brain and behavior relationships and have also proved very useful in evaluating the genetic diathesis of alcoholism. This chapter describes findings from neuroelectrophysiologic measures (electroencephalogram, event-related potentials, and event-related oscillations) related to acute and chronic effects of alcohol on the brain and those that reflect underlying deficits related to a predisposition to develop AUDs and related disorders. The utility of these measures as effective endophenotypes to identify and understand genes associated with brain electrophysiology, cognitive networks, and AUDs has also been discussed.

Lexical decision as an endophenotype for reading comprehension: an exploration of an association

Based on numerous suggestions in the literature, we evaluated lexical decision (LD) as a putative endophenotype for reading comprehension by investigating heritability estimates and segregation analyses parameter estimates for both of these phenotypes. Specifically, in a segregation analysis of a large sample of families, we established that there is little to no overlap between genes contributing to LD and reading comprehension and that the genetic mechanism behind LD derived from this analysis appears to be more complex than that for reading comprehension. We conclude that in our sample, LD is not a good candidate as an endophenotype for reading comprehension, despite previous suggestions from the literature. Based on this conclusion, we discuss the role and benefit of the endophenotype approach in studies of complex human cognitive functions.

Event-Related Theta Power during Lexical-Semantic Retrieval and Decision Conflict is Modulated by Alcohol Intoxication: Anatomically Constrained MEG

Language processing is commonly characterized by an event-related increase in theta power (4-7 Hz) in scalp EEG. Oscillatory brain dynamics underlying alcohol's effects on language are poorly understood despite impairments on verbal tasks. To investigate how moderate alcohol intoxication modulates event-related theta activity during visual word processing, healthy social drinkers (N = 22, 11 females) participated in both alcohol (0.6 g/kg ethanol for men, 0.55 g/kg for women) and placebo conditions in a counterbalanced design. They performed a double-duty lexical decision task as they detected real words among non-words. An additional requirement to respond to all real words that also referred to animals induced response conflict. High density whole-head MEG signals and midline scalp EEG data were decomposed for each trial with Morlet wavelets. Each person's reconstructed cortical surface was used to constrain noise-normalized distributed minimum norm inverse solutions for theta frequencies. Alcohol intoxication increased reaction time and marginally affected accuracy. The overall spatio-temporal pattern is consistent with the left-lateralized fronto-temporal activation observed in language studies applying time-domain analysis. Event-related theta power was sensitive to the two functions manipulated by the task. First, theta estimated to the left-lateralized fronto-temporal areas reflected lexical-semantic retrieval, indicating that this measure is well suited for investigating the neural basis of language functions. While alcohol attenuated theta power overall, it was particularly deleterious to semantic retrieval since it reduced theta to real words but not pseudowords. Second, a highly overlapping prefrontal network comprising lateral prefrontal and anterior cingulate cortex was sensitive to decision conflict and was also affected by intoxication, in agreement with previous studies indicating that executive functions are especially vulnerable to alcohol intoxication.

N4 component responses to pre-pulse startle stimuli in young adults: relationship to alcohol dependence

Both physiological and behavioral studies provide evidence to suggest that deficits in frontal cortical control circuits may contribute to the risk for developing alcohol dependence. Event-related potential (ERP) and eye blink responses to startle and short delay prepulse-plus-startle stimuli, and psychiatric diagnoses were investigated in young adult (age 18-30 years) men (n=135) and women (n=205) Mexican Americans. Women displayed a significant increase in the amplitude of the eye blink response to both the startle and pre-pulse-plus-startle stimuli. None of the psychiatric diagnoses were associated with differences in eye blink responses. ERP responses to the startle and prepulse-plus startle stimuli included a negative polarity wave at approximately 400 ms that was of the highest amplitude in the frontal leads (N4S). Women were found to have significantly higher amplitude N4S responses than men. Participants with alcohol dependence demonstrated significantly less inhibition and more facilitation of the N4S component by the pre-pulse stimuli. This finding was not associated with a diagnosis of: any other drug dependence disorder (including nicotine), anxiety or affective disorder, or conduct/antisocial personality disorder. The present study suggests that gender and a lifetime diagnosis of alcohol dependence may selectively contribute to this frontal late wave electrophysiological response to prepulse-plus-startle stimuli.