Everyday memory deficits in ecstasy-polydrug users

A meta-analysis on the relationship between subjective cognitive failures as measured by the cognitive failures questionnaire (CFQ) and objective performance on executive function tasks

The Cognitive Failures Questionnaire (CFQ) has been widely used as a measure of subjective cognitive function in everyday life for decades. However, the evidence on how it relates to objective performance on executive function tasks is mixed. One possible reason for these mixed results is that the CFQ has selective relationships with some aspects of executive function and not others. Here, therefore, we classified tasks according to an influential framework of executive functions-switching, updating, inhibition, and we also considered the Sustained Attention to Response Task (SART) as a category because it was custom designed to gauge cognitive failures. We synthesized a large body of available evidence and performed four Bayesian meta-analyses on the relationship between CFQ scores and objective performance on executive function tasks in these four categories. Results suggested that CFQ scores were associated with objective performance on SART (18 effect sizes, μ = -.19, BF10 = 18.03, i.e., 18.03 times more evidence of a relationship versus no relationship), updating working memory (49 effect sizes, μ = -.06, BF10 = 17.80), and inhibition tasks (41 effect sizes, μ = -.07, BF10 = 15.40), whereas there was not definitive evidence regarding switching (34 effect sizes, μ = -.06, BF10 = .50, i.e., two times greater evidence for no relationship). This suggests that subjective cognitive function can predict objective performance on at least some executive function tasks. We discuss methodological and theoretical factors that constrain the maximum observable correlation and consider the relative insights that subjective measures versus task performance provide.

Translation, cross-cultural adaptation, and validation of the Persian version of Everyday Memory Questionnaire-Revised (EMQ-R) in patients with multiple sclerosis

PURPOSE

The present research translated and validated the Persian version of the Everyday Memory Questionnaire-Revised (EMQ-R) in patients with multiple sclerosis (MS).

METHODS

A two-step study was performed in the current work. First, the scale was translated and culturally adopted to Persian. In the second step, the translated questionnaire was presented to 150 patients with MS and 50 individuals in the control group. Then, construct validity (factor analysis and clinical validity) and reliability measures (test-retest reliability and internal consistency) were computed for this questionnaire.

RESULTS

Patients with MS obtained higher scores in EMQ-R than the control group (p < .001). The findings of the Kaiser-Meyer-Olkin and Bartlett test approved the sampling adequacy for computing the factor analysis (p < .001). The accuracy of the three-dimensional structure was confirmed by confirmatory factor analysis (CFA). Findings of test-retest (ICC = .95, 95%CI .91-.98, p < .001) and internal consistency revealed a satisfactory value (α = .95, p < .001).

CONCLUSIONS

Satisfactory findings for construct validity and high values for reliability revealed that the Persian version of EMQ-R is a reliable and valid scale to measure the everyday memory of patients with MS in the cognitive assessments of this group.IMPLICATIONS FOR REHABILITATIONPersian EMQ-R is a valid, reliable, fast, and easy to administer tool for evaluating the beliefs and insights of patients suffering from MS or other clinical conditions about their cognitive dysfunctions, in day-to-day lives with some differentiation between memory and attentional difficulties. This questionnaire can be a practical clinical tool for the assessment of the cognitive deficits, which might not be detected via formal neuropsychological assessments, and could be a valuable scale to measure the effects of treatment approaches to level up memory function in a way that could be generalized to daily life performance.

Recreational drug use and prospective memory

Prospective memory (PM) impairment in recreational drug users has been documented in recent years. However, most studies on the effects of drugs on PM contain several methodological challenges, such as small sample size (< 100 participants), unrepresentative sample type (e.g., student or patient), short abstinence period (< 7 days), and lack of control of potential confounds (e.g., sleep and IQ). The present study investigated the possible consequences of recreational drug use on prospective memory, using self-report and lab-based prospective memory measures while overcoming the methodological challenges. The sample was composed of 47 non-users (27 females, age range from 18 to 50 +) and 53 drug users (21 females, age range from 18 to 50 +). Recreational drug users reported significantly more deficits in the long-term episodic, short-term habitual, and internally cued PM failures subscales of the Prospective Memory Questionnaire. However, these deficits were eliminated after controlling for covariates (e.g., age, sleep quality, general health, alcohol usage). Recreational drug users also performed worse than non-users in the short-term, long-term, event-based, and time-based PM subscales of the Royal Prince Alfred Prospective Memory Test. These results remained significant after controlling for the covariates. Drug users demonstrated greater impairments on time-based and long-term PM tasks thought to be linked with executive functioning. Taken together, the present study provides further support for recreational drug-related deficits in PM and highlights a dissociation between self-report and lab-based PM measures.

Neurological and cognitive alterations induced by MDMA in humans

3,4 Methylenedioxymethamphetamine generally referred to as MDMA or 'ecstasy' is a ring-substituted phenethylamine stimulant which produces powerful empathogenic effects. Use of MDMA remains popular despite prohibition, and potential long-term negative consequences of repeated use. MDMA produces its acute subjective effects primarily by stimulating the release of serotonin via action at the serotonin transporter (SERT). There is evidence that MDMA administration may lead to long lasting neurotoxic effects on serotonin neurons in primates, and reductions in markers of central serotonin axons, and axon terminals in animals. In humans, demonstration of serotonergic neurotoxicity is much more difficult to identify, and much of the research is complicated by confounding issues of polysubstance use, genetic and environmental factors and reliance on self-reports of previous drug use. We do not review the mechanisms for neurotoxicity in detail as they are covered elsewhere in this special issue. There is a large body of literature, however, which has investigated potential cognitive and neurocognitive consequences of repeated MDMA use. Here we review the literature on cognition, and neuroimaging studies that have investigated structural and functional brain changes associated with ecstasy use.

Illegal drug use and prospective memory: A systematic review

Illegal drug use is proposed to interfere with neurobiological functioning by damaging the neurotransmitter communication systems that are believed to be responsible for cognitive abilities, including perception, attention, and memory. This review specifically examined effects of illegal drug use on prospective memory (PM) - memory for future actions. Twenty- seven studies spanning 14 years were included in this review which were divided into two broad categories based on testing methods used: self-report and lab-based testing methods. The quality of the included studies was assessed across five categories: sample type, sample size, abstinence period, testing methods and control for confounding factors. The overall quality of evidence was good for six studies and moderate for sixteen studies and low for five studies. The results from the studies employing self-report were inconsistent as illegal drug users exhibited PM deficits in some studies, but not in others. However, the studies with lab-based testing methods demonstrated more consistent findings with illegal drug users scoring worse than non-users on various PM tests. There were also consistent findings on the link between the dosage of drug taken and level of PM deficit. Based on the literature, there is moderate evidence that illegal drug use impairs PM ability. We recommend that further lab-based studies be conducted to assess dose-response effects on drug-specificity.

The effects of licit and illicit recreational drugs on prospective memory: a meta-analytic review

RATIONALE

There are no recent reports summarising the magnitude of prospective memory (PM) impairments in recreational drug users.

OBJECTIVE

We performed a meta-analysis of studies (with a parallel group design) examining PM performance in users of common recreational drugs (including alcohol and tobacco) who were not intoxicated during testing. Studies were also evaluated for the presence of methodological bias.

METHODS

Twenty-seven studies were included in the meta-analysis following literature searches of MEDLINE, EMBASE and PsycINFO. Effect sizes (standardised mean difference; SMD) were calculated separately for the effects of alcohol, cannabis, ecstasy, methamphetamine and tobacco use. The influences of drug use and study characteristics on effect sizes were explored using meta-regressions. Sources of study bias were also assessed.

RESULTS

Heavy drinkers and regular drug users tended to perform worse than controls on event and time-based PM tasks. Effect sizes (standardised mean differences; SMDs) for event-based PM impairment across the different drug-using groups/heavy drinkers ranged between - 1.10 and - 0.49, with no 95% CI crossing 0.00. SMDs for time-based PM ranged between - 0.98 and - 0.70. Except for the CIs associated with the ES for smokers' time-based PM performance, no CIs crossed 0.00.

CONCLUSIONS

Although all drug-using groups showed moderate-large impairments in event and time-based PM, effect sizes had low precision and moderate-high levels of heterogeneity. In addition, several methodological and reporting issues were identified in the majority of studies. As such, considerable uncertainty remains regarding the role of confounds and the magnitude of PM impairments in non-intoxicated recreational drug users.

Adults with developmental dyslexia show selective impairments in time-based and self-initiated prospective memory: Self-report and clinical evidence

BACKGROUND

Prospective memory (PM; memory for delayed intentions) would seem to be impaired in dyslexia but evidence is currently limited in scope.

AIMS

There is a need, therefore, firstly, to explore PM under controlled conditions using a broader range of PM tasks than used previously and, secondly, to determine whether objectively measured and self-reported PM problems can be found in the same individuals with dyslexia.

METHODS AND PROCEDURES

The responses of 30 adults with dyslexia were compared with those of 30 IQ-matched adults without dyslexia on a self-report and a clinical measure of PM.

OUTCOMES AND RESULTS

Dyslexia-related deficits were shown on the clinical measure overall and, more particularly, when PM responses had to be made to cues based on time rather than environmental events. Adults with dyslexia were also more likely to forget to carry out an intention under naturalistic conditions 24h later. On the self-report questionnaire, the group with dyslexia reported significantly more frequent problems with PM overall, despite using more techniques to aid their memory. In particular, problems were identified with longer-term PM tasks and PM which had to be self-initiated.

CONCLUSIONS AND IMPLICATIONS

Dyslexia-related PM deficits were found under both laboratory and everyday conditions in the same participants; the first time that this has been demonstrated. These findings support previous experimental research which has highlighted dyslexia-related deficits in PM when the enacting of intentions is based on time cues and/or has to be self-initiated rather than being in prompted by environmental events.

A systematic review of the relationship between psychological disorders or substance use and self-reported cognitive failures

INTRODUCTION

Cognitive failures are errors in normal everyday functioning. Individuals with psychological disorders may possess heightened vulnerability. We sought to review the literature on cognitive failures in psychological disorders to determine the nature of this association, and whether failures relate to neuropsychological performance. We also examine the relationship between cognitive failures and substance use since it is relevant to everyday cognition and co-occurs in many psychological disorders.

METHODS

We conducted a systematic review of self-reported cognitive failures in psychological disorders and substance use, identifying 21 papers in total.

RESULTS

Papers identified studied trauma, mood, and anxiety disorders, and schizophrenia. Substance use papers included nicotine, alcohol, cannabis, and ecstasy use. Cognitive failures were increased in some but not all papers; the most consistent findings were for depression, PTSD, and daily smokers of nicotine. Subjective failures did not correlate closely with neuropsychological outcomes in any disorders. We were unable to discern distinct profiles of failures for each disorder; rather they may reflect emotional dysregulation more broadly.

CONCLUSIONS

The real world cognitive experiences of people with psychological disorders may differ to their performance in the clinic or lab. It is important that self-reports of minor cognitive issues are considered as both a potential risk and a maintaining factor of illness. Substance use also needs to be considered in assessing cognitive failures.

Involvement of medial prefrontal cortex alpha-2 adrenoceptors on memory acquisition deficit induced by arachidonylcyclopropylamide, a cannabinoid CB1 receptor agonist, in rats; possible involvement of Ca2+ channels

Functional interactions between cannabinoid and alpha-2 adrenergic systems in cognitive control in the medial prefrontal cortex (mPFC) seem possible. The present study evaluated the possible role of alpha-2 adrenoceptors of the prefrontal cortex on effect of arachidonylcyclopropylamide (ACPA), a cannabinoid CB1 receptor (CB1R) agonist, in adult male Wistar rats. The animals were bilaterally implanted with chronic cannulae in the mPFC, trained in a step-through task, and tested 24 h after training to measure step-through latency. Results indicate that pre-training microinjection of ACPA (0.05 and 0.5 μg/rat) and clonidine (alpha-2 adrenoceptor agonist; 1 and 2 μg/rat) reduce memory acquisition. Pre-training subthreshold dose of clonidine (0.5 µg/rat) restored memory-impairing effect of ACPA (0.05 and 0.5 µg/rat). On the other hand, pre-training administration of the alpha-2 adrenoceptor antagonist yohimbine in all doses used (0.5, 1, and 2 μg/rat) did not affect memory acquisition by itself, while a subthreshold dose of yohimbine (2 µg/rat) potentiated memory impairment induced by ACPA (0.005 µg/rat). Finally, a subthreshold dose of SKF96365 (a Ca(2+) channel blocker) blocked clonidine and yohimbine effect of memory responses induced by ACPA. In conclusion, these data indicate that mPFC alpha-2 adrenoceptors play an important role in ACPA-induced amnesia and Ca(2+) channels have a critical role this phenomenon.

Effects of ecstasy/polydrug use on memory for associative information

RATIONALE

Associative learning underpins behaviours that are fundamental to the everyday functioning of the individual. Evidence pointing to learning deficits in recreational drug users merits further examination.

OBJECTIVES

A word pair learning task was administered to examine associative learning processes in ecstasy/polydrug users.

METHODS

After assignment to either single or divided attention conditions, 44 ecstasy/polydrug users and 48 non-users were presented with 80 word pairs at encoding. Following this, four types of stimuli were presented at the recognition phase: the words as originally paired (old pairs), previously presented words in different pairings (conjunction pairs), old words paired with new words, and pairs of new words (not presented previously). The task was to identify which of the stimuli were intact old pairs.

RESULTS

Ecstasy/ploydrug users produced significantly more false-positive responses overall compared to non-users. Increased long-term frequency of ecstasy use was positively associated with the propensity to produce false-positive responses. It was also associated with a more liberal signal detection theory decision criterion value. Measures of long term and recent cannabis use were also associated with these same word pair learning outcome measures. Conjunction word pairs, irrespective of drug use, generated the highest level of false-positive responses and significantly more false-positive responses were made in the divided attention condition compared to the single attention condition.

CONCLUSIONS

Overall, the results suggest that long-term ecstasy exposure may induce a deficit in associative learning and this may be in part a consequence of users adopting a more liberal decision criterion value.

Mechanisms underlying the link between cannabis use and prospective memory

While the effects of cannabis use on retrospective memory have been extensively examined, only a limited number of studies have focused on the links between cannabis use and prospective memory. We conducted two studies to examine the links between cannabis use and both time-based and event-based prospective memory as well as potential mechanisms underlying these links. For the first study, 805 students completed an online survey designed to assess cannabis consumption, problems with cannabis use indicative of a disorder, and frequency of experiencing prospective memory failures. The results showed small to moderate sized correlations between cannabis consumption, problems with cannabis use, and prospective memory. However, a series of mediation analyses revealed that correlations between problems with cannabis use and prospective memory were driven by self-reported problems with retrospective memory. For the second study, 48 non-users (who had never used cannabis), 48 experimenters (who had used cannabis five or fewer times in their lives), and 48 chronic users (who had used cannabis at least three times a week for one year) were administered three objective prospective memory tests and three self-report measures of prospective memory. The results revealed no objective deficits in prospective memory associated with chronic cannabis use. In contrast, chronic cannabis users reported experiencing more internally-cued prospective memory failures. Subsequent analyses revealed that this effect was driven by self-reported problems with retrospective memory as well as by use of alcohol and other drugs. Although our samples were not fully characterized with respect to variables such as neurological disorders and family history of substance use disorders, leaving open the possibility that these variables may play a role in the detected relationships, the present findings indicate that cannabis use has a modest effect on self-reported problems with prospective memory, with a primary problem with retrospective memory appearing to underlie this relationship.

Cannabis-related deficits in real-world memory

BACKGROUND

Research shows that cannabis users exhibit deficits in prospective memory (PM) and executive function, which persist beyond acute intoxication. However, many studies rely on self-reports of memory failures or use laboratory-based measures that may not mimic functional deficits in the real world. The present study aimed to assess real-world memory functioning.

METHOD

Twenty cannabis-only users and 20 non-illicit drug users were recruited. Participants completed a substance use inventory and a mood scale, followed by a non-immersive virtual reality task assessing PM and executive functioning. The task involved the participant playing the role of an office worker for the day and performing routine office duties. A number of subscales were used to assess facets of executive function (planning, adaptive thinking, creative thinking, selection, prioritisation) and PM (time-based, event-based and action-based PM).

RESULTS

Multivariate analysis of variance revealed cannabis users performed worse overall on the task, with poor performance on the planning, time-based PM and event-based PM subscales. In addition, indices of cannabis (length, dose, frequency, total use) were correlated with performance on these three subscales.

CONCLUSIONS

The present study expands on previously established research, providing support for the cannabis-related deficits in PM and executive functioning, and the role of different aspects of cannabis use in these deficits.

Prospective memory deficits in Ecstasy users: effects of longer ongoing task delay interval

Ecstasy use has been associated with neurotoxicity and neurocognitive impairment in a variety of domains, including prospective memory (ProM), which involves the delayed execution of a previously encoded intention in response to a specific cue. The present study adopted the multiprocess theory of ProM to evaluate the hypothesis that Ecstasy users would evidence differentially impaired ProM on longer versus shorter ongoing task delays. Ecstasy (n = 31) users, high-risk alcohol users (n = 21), and healthy nonusers (n = 31) completed the short (2-min) and long (15-min) delay ProM scales of the Memory for Intentions Screening Test. Results showed a significant group by ProM delay interaction, such that Ecstasy users performed comparably to the comparison groups on short-delay trials, but were impaired on long-delay ProM, particularly for time-based cues. Among the Ecstasy users, long-delay ProM was positively associated with risky decision making, but not with retrospective memory or other aspects of executive functions. These findings suggest that Ecstasy users may be particularly susceptible to deficits in strategic target monitoring and maintenance of cue-intention pairings over longer ProM delays. Findings are discussed in the context of their potential everyday functioning (e.g., academic, vocational) and treatment implications for Ecstasy users.

The effect of alcohol administration on human timing: a comparison of prospective timing, retrospective timing and passage of time judgements

Previous research suggests that human timing may be affected by alcohol administration. The current study aimed to expand on previous research by examining the effect of alcohol on prospective timing, retrospective timing and passage of time judgements. A blind between-subjects design was employed in which participants were either administered 0 g of alcohol per kilogramme of body weight (placebo), 0.4 g/kg (low dose) or 0.6g/kg (high dose). Participants completed four types of temporal task; verbal estimation and temporal generalisation, a retrospective timing task and a passage of time judgement task. A high dose of alcohol resulted in overestimations of duration relative to the low dose and placebo group in the verbal estimation task. A high dose of alcohol was also associated with time passing more quickly than normal. Alcohol had no effect on retrospective judgements. The results suggest that a high dose of alcohol increases internal clock speed leading to over-estimations of duration on prospective timing tasks, and the sensation of time passing more quickly than normal. The absence of an effect of alcohol on retrospective timing supports the suggestion that retrospective judgements are not based on the output of an internal clock.

Prospective memory functioning among ecstasy/polydrug users: evidence from the Cambridge Prospective Memory Test (CAMPROMPT)

RATIONALE

Prospective memory (PM) deficits in recreational drug users have been documented in recent years. However, the assessment of PM has largely been restricted to self-reported measures that fail to capture the distinction between event-based and time-based PM. The aim of the present study is to address this limitation.

OBJECTIVES

Extending our previous research, we augmented the range laboratory measures of PM by employing the CAMPROMPT test battery to investigate the impact of illicit drug use on prospective remembering in a sample of cannabis only, ecstasy/polydrug and non-users of illicit drugs, separating event and time-based PM performance. We also administered measures of executive function and retrospective memory in order to establish whether ecstasy/polydrug deficits in PM were mediated by group differences in these processes.

RESULTS

Ecstasy/polydrug users performed significantly worse on both event and time-based prospective memory tasks in comparison to both cannabis only and non-user groups. Furthermore, it was found that across the whole sample, better retrospective memory and executive functioning was associated with superior PM performance. Nevertheless, this association did not mediate the drug-related effects that were observed. Consistent with our previous study, recreational use of cocaine was linked to PM deficits.

CONCLUSIONS

PM deficits have again been found among ecstasy/polydrug users, which appear to be unrelated to group differences in executive function and retrospective memory. However, the possibility that these are attributable to cocaine use cannot be excluded.

Everyday and prospective memory deficits in ecstasy/polydrug users

The impact of ecstasy/polydrug use on real-world memory (i.e. everyday memory, cognitive failures and prospective memory [PM]) was investigated in a sample of 42 ecstasy/polydrug users and 31 non-ecstasy users. Laboratory-based PM tasks were administered along with self-reported measures of PM to test whether any ecstasy/polydrug-related impairment on the different aspects of PM was present. Self-reported measures of everyday memory and cognitive failures were also administered. Ecstasy/polydrug associated deficits were observed on both laboratory and self-reported measures of PM and everyday memory. The present study extends previous research by demonstrating that deficits in PM are real and cannot be simply attributed to self-misperceptions. The deficits observed reflect some general capacity underpinning both time- and event-based PM contexts and are not task specific. Among this group of ecstasy/polydrug users recreational use of cocaine was also prominently associated with PM deficits. Further research might explore the differential effects of individual illicit drugs on real-world memory.

Update on ecstasy

After years of declining use in the United States, youth consumption of ecstasy has increased significantly. Although ecstasy (3, 4-methylenedioxymethamphetamine) is known to be a drug with detrimental effects, users view the drug as a safe and attractive social lubricant. To update and clarify misperceptions, this article reviews current evidence regarding ecstasy's side effects and risks and encourages honest discussion focusing on risk-reduction behaviors.

Everyday memory: self-perception and structural brain correlates in a healthy elderly population

Mapping the cerebral structural correlates of age-related cognitive decline is a growing area of research. The aim of the present study was to investigate the relationship between healthy elderly's perceived memory functioning in daily life, neuropsychological test performance on a standardized test on verbal memory, and cortical thickness and subcortical volumes in brain regions implicated in memory networks, including the medial temporal lobe (MTL). Eighty-three healthy and cognitively well-functioning volunteers aged 60-85 years underwent MRI scans, Everyday Memory Questionnaire (EMQ), and neuropsychological assessment. Both self-perceived memory in daily life related to attention and executive functions and an objective measure of verbal recall (CVLT) were, independently, associated with thickness of the left MTL. The two cognitive variables were uncorrelated, and including both measures in the model nearly doubled the amount of explained variance on MTL thickness. This suggests that measures of perceived everyday memory might substantially inform and supplement studies investigating the relationships between neuropsychological test performance and brain morphology. The results are consistent with a bigger-is-better relationship in the MTL and suggest that EMQ and neuropsychological test performance have detectable and comparable structural correlates in a region critically involved in memory functions in the well-functioning elderly.

Assessing the functional significance of ecstasy-related memory deficits using a virtual paradigm

RATIONALE/OBJECTIVES

Previous research shows that the use of ecstasy results in working memory and executive impairments in some users. The present study sought to assess the functional significance of such deficits using a virtual reality task.

METHODS

Twenty-three ecstasy-polydrug users and 26 nonusers were recruited. Individuals completed a drug use questionnaire measures of sleep quality and fluid intelligence. Participants also completed a virtual reality executive function task in which they play the role of an office worker for the day completing predefined tasks such as prioritising different activities according to their importance, organising the physical office environment and managing the outgoing mail in accordance with a delivery schedule.

RESULTS

MANOVA revealed that ecstasy users performed worse on the virtual reality task overall, and this was due to poorer performance on the planning and selection subscales. Contrary to expectations, ecstasy-polydrug users performed better on the time-based prospective memory subscale. Indices of ecstasy use were correlated with the planning subscale of the virtual task.

CONCLUSIONS

The present study provides further support for ecstasy/polydrug related deficits in executive functioning. As it is possible that this task is more ecologically valid and relevant to day-to-day activities of many users, previous research finding null results on executive function tasks may have underestimated the impact of ecstasy-polydrug use on executive functioning.

Does cannabis use affect prospective memory in young adults?

The aim of the present study was to examine prospective memory impairments associated with cannabis use in young adults. An independent measures design utilising pre-existing groups of users and non-users was employed in which an opportunity sample of 90 undergraduates studying at universities in the north east of England participated. The number of prospective memory failures reported on the Prospective Memory Questionnaire and the number of location-action combinations correctly recalled during a video-based prospective memory task were measured. The number of strategies used to assist memory, level of anxiety and depression, and use of alcohol, nicotine and any other recreational drugs in addition to cannabis were also measured and controlled during the analysis. Analysis revealed no significant differences in the number of self-reported prospective memory failures; however, cannabis users recalled significantly fewer location-action combinations than non-users in the video-based prospective memory task. The findings from the present study suggest that cannabis use has a detrimental effect on prospective memory ability in young adults but users may not be aware of these deficits.

Involvement of inferior parietal lobules in prospective memory impairment during acute MDMA (ecstasy) intoxication: an event-related fMRI study

Prospective memory refers to the realization of delayed intentions. Several studies have shown that 3,4-methylenedioxy-methamphetamine (MDMA) users perform worse on measures of prospective memory as compared to nondrug users. Interpretation of these data may be limited because of polydrug use, psychosocial stressors, and increased psychopathology that have been reported in MDMA users. This study was designed to directly assess the pharmacological effect of MDMA on prospective memory and brain activity in a double-blind, placebo-controlled, cross-over study. Twelve recreational MDMA users received MDMA 75 mg and placebo and performed an objective prospective memory task during functional imaging. During prospective memory task performance subjects were engaged in a foreground task that consisted of a simple reaction time to visual stimuli (Go trials) and a prospective task of withholding a response during trials that were part of a dynamic memory set (No go trials). Behavioral data showed that a single dose of MDMA increased prospective memory failures in the No go trials, and that number of prospective memory failures was positively correlated to MDMA concentration in plasma. Functional imaging showed that MDMA decreased BOLD activation during Go trials in the thalamus (left), putamen (left), precuneus (left), and the inferior parietal lobules (bilateral), as compared to placebo. During No go trials, MDMA reduced BOLD deactivation in the inferior parietal lobules (bilateral), as compared to placebo. It is concluded that the loss of deactivation in inferior parietal lobules may account for increments in memory failures observed during MDMA intoxication.