Cognitive Training Effectiveness on Memory, Executive Functioning, and Processing Speed in Individuals With Substance Use Disorders: A Systematic Review

Background: Cerebral neuroplasticity is compromised due to substance abuse. There is damage to neuronal areas that are involved in memory and executive functioning. Treatments with worse outcomes are often associated with cognitive deficits that have resulted from substance dependence. However, there is evidence that cognitive training can lead to improvements in cognitive functions and can be useful when treating addictions. This systematic review aims to synthesize evidence on the effectiveness of cognitive training in memory, executive functioning, and processing speed in individuals with substance use disorder (SUD). Methods: The Joanna Briggs Institute’s PICO strategy was used to develop this systematic literature review. Four databases were searched (PubMed, the Cochrane Library, Web of Science, and PsycINFO) to identify controlled randomized clinical studies and quasi-experimental studies, in English, Portuguese, and Spanish, from 1985 to 2019. The literature found was examined by two independent reviewers, who assessed the quality of studies that met the inclusion criteria. The Cochrane risk-of-bias tool for the randomized controlled trials and the ROBINS-I tool for non-randomized studies were used to assess the risk of bias. In data extraction, the Cochrane Handbook for Systematic Reviews was considered. Results: From a total of 470 studies, 319 were selected for analysis after the elimination of duplicates. According to the inclusion criteria defined, 26 studies were eligible and evaluated. An evaluation was performed considering the participant characteristics, countries, substance type, study and intervention details, and key findings. Of the 26 selected studies, 14 considered only alcoholics, six included participants with various SUD (alcohol and other substances), three exclusively looked into methamphetamine-consuming users and another three into opioid/methadone users. Moreover, 18 studies found some kind of cognitive improvement, with two of these reporting only marginally Caetano et al. Cognitive Training in Substance Use Disorders significant effects. One study found improvements only in measures similar to the training tasks, and two others had ambiguous results. Conclusions: The included studies revealed the benefits of cognitive training with regard to improving cognitive functions in individuals with SUD. Memory was the most scrutinized cognitive function in this type of intervention, and it is also one of the areas most affected by substance use.info:eu-repo/semantics/publishedVersio

Making the case for mobile cognition: EEG and sports performance

In the high stakes world of International sport even the smallest change in performance can make the difference between success and failure, leading sports professionals to become increasingly interested in the potential benefits of neuroimaging. Here we describe evidence from EEG studies that either identify neural signals associated with expertise in sport, or employ neurofeedback to improve performance. Evidence for the validity of neurofeedback as a technique for enhancing sports performance remains limited. By contrast, progress in characterizing the neural correlates of sporting behavior is clear: frequency domain studies link expert performance to changes in alpha rhythms, whilst time-domain studies link expertise in response evaluation and motor output with modulations of P300 effects and readiness potentials. Despite early promise, however, findings have had relatively little impact for sports professionals, at least in part because there has been a mismatch between lab tasks and real sporting activity. After selectively reviewing existing findings and outlining limitations, we highlight developments in mobile EEG technology that offer new opportunities for sports neuroscience

Airline Pilots in Recovery From Alcoholism: A Quantitative Study of Cognitive Change

In order to perform their duties, airline pilots must have no clinical diagnosis of mental illness or any substance use disorder. However, provisions have been in place since the 1970s that provide for a return to work for airline pilots with alcohol problems. To date, over 5,000 airline pilots have undergone rehabilitation for Alcohol Use Disorder (AUD) and successfully returned to work. An important gap in the literature remains with regard to what extent improvements in cognitive performance may be experienced by airline pilots who complete treatment and to what extent age influences the amount of change. This study examined the archival data of 95 male Caucasian pilots who were assessed for cognitive performance shortly after entry to 30-day inpatient treatment and approximately 5 months later during the return to work evaluation. A nonexperimental within subjects design compared pre- and post-treatment scores on the Wechsler Adult Intelligence Scale-IV (WAIS-IV) full scale and 4 index scores as well as differences for age groups (25 to 44, 45 to 54, and 55 to 64). Repeated measures ANOVA revealed that there were significant gains on all WAIS-IV measures pre-post treatment for AUD. MANOVA results indicated no differences between age groups. These findings support current Federal Aviation Administration program practices with regard to returning airline pilots to work following rehabilitation and a sufficient period of abstinence. The potential of this study to promote the agenda of social change may be substantive for raising awareness of the cognitive deficits associated with AUD and how these may impact the safety of flight operations

PRECLINICAL DEVELOPMENT OF PHYTOCANNABINOID- AND ENDOCANNABINOID- BASED PHARMACOTHERAPIES FOR THE TREATMENT OF ETHANOL-INDUCED NEURODEGENERATION

Excessive ethanol consumption, characteristic of alcohol use disorders (AUDs), is associated with widespread neurodegeneration and cognitive and behavioral impairments that may contribute to the chronic and relapsing nature of alcoholism. Therefore, identifying novel targets that can afford neuroprotection will undoubtedly aid current treatment strategies for AUDs. The cannabinoids have been shown to provide neuroprotection in a variety of preclinical models of neurodegeneration; however minimal data is available regarding the use of cannabinoid-based pharmacotherapies for treating ethanol-induced neurodegeneration. Therefore, the current dissertation examined the overarching hypothesis: the cannabinoids are a therapeutic strategy to afford neuroprotection in the context of ethanol-induced neurodegeneration. Importantly, this overarching hypothesis was approached with translational considerations in mind. Specifically, the use of many cannabinoids in the clinic is hindered due to multiple unfavorable pharmacokinetic/pharmacodynamic profiles, including high first pass metabolism and untoward psychoactivity. Therefore, the studies herein were designed to circumvent these PK/PD obstacles. The first set of studies examined whether transdermal delivery of the phytocannabinoid, cannabidiol (CBD), could attenuate binge ethanol induced neurodegeneration. Transdermal CBD afforded neuroprotection in the entorhinal cortex and neuroprotection was similar in magnitude as intraperitoneal administration. The second set of studies found that binge ethanol treatment transiently down-regulated the main CNS cannabinoid receptor, CB1R. Interestingly, these changes were not accompanied by alterations in one of the major endogenous ligands, anandamide (AEA), or other related n-acylethanolamides (NAEs). The latter finding is in contrast to other literature reports demonstrating that endocannabinoid content is substantially elevated in response to a CNS insult. Nevertheless, studies were carried out to determine if administration of the AEA and NAE catabolism inhibitor, URB597, could attenuate binge ethanol induced neurodegeneration. URB597 failed to produce neuroprotection in the entorhinal cortex and dentate gyrus of the hippocampus. However, additional studies found that URB597 failed to elevate AEA in the entorhinal cortex, and in general the biological activity of URB597 was impaired by ethanol exposure. Therefore, with further drug discovery/development efforts, it may be feasible to optimize such treatment strategies. In conclusion, the studies within the current dissertation demonstrated the feasibility of using some cannabinoid-based agents to prevent ethanol-induced neurodegeneration

Cognitive Rehabilitation for Cocaine Use Disorder

Brief Statement of the Problem: Effectively treating cognitive impairment as part of a comprehensive treatment plan for adults with cocaine use disorder (CUD) could potentially improve important clinical outcomes, such as abstinence, quality of life, and treatment completion. Because existing models of cognitive rehabilitation have yielded small to medium effect sizes in improving cognition in CUD, newer models of cognitive rehabilitation are needed to improve cognition more effectively in CUD. Description of the Methods and Procedures Used to Gather Data: This dissertation describes a pilot 12-week, randomized, parallel group outpatient study of treatment-seeking adults with CUD (age 18-65) who were mild-to-moderately cognitively impaired and dissatisfied with their quality of life. Participants were randomized to a “Cog-Rehab” arm (drug counseling + occupational therapy-based cognitive rehabilitation), or to a “Control” arm (drug counseling + psychoeducation/computer exercises).Condensed Summary of the Findings: Study participants had a mean age of 57.5 years (SD 5.8), 30 (96.8%) were male, 19 (61.3%) were Black, 12 (38.7%) were White, 6 (19.4%) were Latino, 15 (48.4%) were single, and had a mean education of 12.8 years (SD 1.4). Some significant between-group effect sizes were found for certain neurocognitive measures (favoring Cog-Rehab arm: attentional bias 1.0 attention 0.7, visual memory 0.8, executive function 1.0) and one functional assessment (favoring Cog-Rehab arm: Drug User Quality of Life Score 0.8). This study was feasible, acceptable, and provides preliminary evidence for efficacy based on effect sizes. MET-R performance was significantly associated only with the overall impulsivity neurocognitive domain (adjusted coefficient 0.8, 95% CI 0.2 to 1.3) on a neurocognitive battery. The MET-R may be uniquely measuring the domain of impulsivity that is not captured by traditional neurocognitive testing

An examination of psychopathy and substance use disorders using magnetic resonance imaging and cluster analysis

Psychopathy is a personality disorder that is exemplified by affective and interpersonal characteristics such as grandiosity, pathological lying, manipulative use of others, and a profound lack of empathy, guilt, and remorse. Psychopaths also typically demonstrate a constellation of problematic and dangerous behavioral characteristics including sensation seeking, impulsivity, and both instrumental and reactive aggression. Psychopathy and substance use disorders (i.e., abuse and dependence) are significant sources of financial and emotional burden in the United States, as both are strongly linked to severe and repetitive criminal activity. They are also highly comorbid, with psychopaths being about two to three times more likely to have a drug use disorder than nonpsychopaths. Using structural and functional neuroimaging and cluster analysis, this comorbidity was investigated in a series of studies involving incarcerated adult males and females, incarcerated adolescent males and females, and nonincarcerated adult males and females. Across samples, structural differences related to psychopathic traits were largely consistent, lending support to the idea that a network of regions across the paralimbic system is abnormal, at least structurally. Several of the regions identified in the structural studies were also hypoactive during the viewing of drug cues in a functional magnetic resonance imaging study of craving, suggesting a close link between structural and functional abnormalities. Finally, cluster analysis was used to identify typologies of substance users, and differential correlations with personality and individual differences variables were found. These results suggest that substance users are actually a heterogeneous group in terms of severity, drugs of choice, and personality correlates. This heterogeneity also suggests that individual differences should be taken into account when designing substance use treatment strategies. Analogous to the notion of personalized medicine, this philosophy could be at once both more effective and more efficient when applied to substance use treatment. In turn, the extreme financial and emotional burden that psychopathy and substance use disorders cause could be reduced

Evidence-based guidelines and secondary meta-analysis for the use of transcranial direct current stimulation in neurological and psychiatric disorders

Background: Transcranial direct current stimulation has shown promising clinical results, leading to increased demand for an evidence-based review on its clinical effects. Objective: We convened a team of transcranial direct current stimulation experts to conduct a systematic review of clinical trials with more than 1 session of stimulation testing: pain, Parkinson’s disease motor function and cognition, stroke motor function and language, epilepsy, major depressive disorder, obsessive compulsive disorder, Tourette syndrome, schizophrenia, and drug addiction. Methods: Experts were asked to conduct this systematic review according to the search methodology from PRISMA guidelines. Recommendations on efficacy were categorized into Levels A (definitely effective), B (probably effective), C (possibly effective), or no recommendation. We assessed risk of bias for all included studies to confirm whether results were driven by potentially biased studies. Results: Although most of the clinical trials have been designed as proof-of-concept trials, some of the indications analyzed in this review can be considered as definitely effective (Level A), such as depression, and probably effective (Level B), such as neuropathic pain, fibromyalgia, migraine, post-operative patient-controlled analgesia and pain, Parkinson’s disease (motor and cognition), stroke (motor), epilepsy, schizophrenia, and alcohol addiction. Assessment of bias showed that most of the studies had low risk of biases, and sensitivity analysis for bias did not change these results. Effect sizes vary from 0.01 to 0.70 and were significant in about 8 conditions, with the largest effect size being in postoperative acute pain and smaller in stroke motor recovery (nonsignificant when combined with robotic therapy). Conclusion: All recommendations listed here are based on current published PubMed-indexed data. Despite high levels of evidence in some conditions, it must be underscored that effect sizes and duration of effects are often limited; thus, real clinical impact needs to be further determined with different study designs

Patient-Facing Mobile Apps to Treat High-Need, High-Cost Populations: A Scoping Review

BACKGROUND: Self-management is essential to caring for high-need, high-cost (HNHC) populations. Advances in mobile phone technology coupled with increased availability and adoption of health-focused mobile apps have made self-management more achievable, but the extent and quality of the literature supporting their use is not well defined. OBJECTIVE: The purpose of this review was to assess the breadth, quality, bias, and types of outcomes measured in the literature supporting the use of apps targeting HNHC populations. METHODS: Data sources included articles in PubMed and MEDLINE (National Center for Biotechnology Information), EMBASE (Elsevier), the Cochrane Central Register of Controlled Trials (EBSCO), Web of Science (Thomson Reuters), and the NTIS (National Technical Information Service) Bibliographic Database (EBSCO) published since 2008. We selected studies involving use of patient-facing iOS or Android mobile health apps. Extraction was performed by 1 reviewer; 40 randomly selected articles were evaluated by 2 reviewers to assess agreement. RESULTS: Our final analysis included 175 studies. The populations most commonly targeted by apps included patients with obesity, physical handicaps, diabetes, older age, and dementia. Only 30.3% (53/175) of the apps studied in the reviewed literature were identifiable and available to the public through app stores. Many of the studies were cross-sectional analyses (42.9%, 75/175), small (median number of participants=31, interquartile range 11.0-207.2, maximum 11,690), or performed by an app\u27s developers (61.1%, 107/175). Of the 175 studies, only 36 (20.6%, 36/175) studies evaluated a clinical outcome. CONCLUSIONS: Most apps described in the literature could not be located on the iOS or Android app stores, and existing research does not robustly evaluate the potential of mobile apps. Whereas apps may be useful in patients with chronic conditions, data do not support this yet. Although we had 2-3 reviewers to screen and assess abstract eligibility, only 1 reviewer abstracted the data. This is one limitation of our study. With respect to the 40 articles (22.9%, 40/175) that were assigned to 2 reviewers (of which 3 articles were excluded), inter-rater agreement was significant on the majority of items (17 of 30) but fair-to-moderate on others