Understanding Attentional Biases in Severe Alcohol Use Disorder: A Combined Behavioral and Eye-Tracking Perspective.

RATIONALE: Severe alcohol use disorder (SAUD) is a psychiatric condition linked to cerebral and cognitive consequences. SAUD is notably characterized by an overactivation of the reflexive/reward system when confronted with alcohol-related cues. Such overreactivity generates a preferential allocation of attentional resources toward these cues, labeled as attentional biases (AB). Theoretical assumptions have been made regarding the characteristics of AB and their underlying processes. While often considered as granted, these assumptions remain to be experimentally validated. AIMS: We first identify the theoretical assumptions made by previous studies exploring the nature and role of AB. We then discuss the current evidence available to establish their validity. We finally propose research avenues to experimentally test them. METHODS: Capitalizing on a narrative review of studies exploring AB in SAUD, the current limits of the behavioral measures used for their evaluation are highlighted as well as the benefits derived from the use of eye-tracking measures to obtain a deeper understanding of their underlying processes. We describe the issues related to the theoretical proposals on AB and propose research avenues to test them. Four experimental axes are proposed, respectively, related to the determination of (a) the genuine nature of the mechanisms underlying AB; (b) their stability over the disease course; (c) their specificity to alcohol-related stimuli and (d) their reflexive or controlled nature. CONCLUSIONS: This in-depth exploration of the available knowledge related to AB in SAUD, and of its key limitations, highlights the theoretical and clinical interest of our innovative experimental perspectives capitalizing on eye-tracking measures

Management and 1-Year Outcomes of Patients With Newly Diagnosed Atrial Fibrillation and Chronic Kidney Disease: Results From the Prospective GARFIELD - AF Registry.

Background Using data from the GARFIELD - AF (Global Anticoagulant Registry in the FIELD -Atrial Fibrillation), we evaluated the impact of chronic kidney disease ( CKD ) stage on clinical outcomes in patients with newly diagnosed atrial fibrillation ( AF ). Methods and Results GARFIELD - AF is a prospective registry of patients from 35 countries, including patients from Asia (China, India, Japan, Singapore, South Korea, and Thailand). Consecutive patients enrolled (2013-2016) were classified with no, mild, or moderate-to-severe CKD , based on the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative guidelines. Data on CKD status and outcomes were available for 33 024 of 34 854 patients (including 9491 patients from Asia); 10.9% (n=3613) had moderate-to-severe CKD , 16.9% (n=5595) mild CKD , and 72.1% (n=23 816) no CKD . The use of oral anticoagulants was influenced by stroke risk (ie, post hoc assessment of CHA 2 DS 2- VAS c score), but not by CKD stage. The quality of anticoagulant control with vitamin K antagonists did not differ with CKD stage. After adjusting for baseline characteristics and antithrombotic use, both mild and moderate-to-severe CKD were independent risk factors for all-cause mortality. Moderate-to-severe CKD was independently associated with a higher risk of stroke/systemic embolism, major bleeding, new-onset acute coronary syndrome, and new or worsening heart failure. The impact of moderate-to-severe CKD on mortality was significantly greater in patients from Asia than the rest of the world ( P=0.001). Conclusions In GARFIELD - AF , moderate-to-severe CKD was independently associated with stroke/systemic embolism, major bleeding, and mortality. The effect of moderate-to-severe CKD on mortality was even greater in patients from Asia than the rest of the world. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 01090362

Vasovagal syncope initiating ventricular fibrillation in a healthy subject.

A 62-year-old man with cured lymphoma as only significant medical history experienced a first reflex syncope after prolonged orthostatic posture, with cardiac arrest. Prolonged asystole was followed by ventricular fibrillation needing external defibrillation. The defibrillator provided complete recordings. Thorough investigation revealed no cardiac abnormalities apart from a few right ventricular outflow tract premature complexes. This patient benefitted from implantation of an ICD for ventricular fibrillation secondary to reflex syncope, usually considered benign

Positive Attitude Toward Alcohol Predicts Actual Consumption in Young Adults: An Ecological Implicit Association Test.

OBJECTIVE: Excessive alcohol drinking, particularly among college students, is a major health concern worldwide. The implicit associations between alcohol-related concepts and affective attributes have been repeatedly postulated as a reliable predictor of these drinking behaviors. The Implicit Association Test (IAT) is considered one of the most reliable tasks for measuring these associations and their impact on actual alcohol consumption. However, the majority of these tests used verbal materials as stimuli, thus being unadapted to some categories of participants. The present study aims to develop a new IAT, using pictures exclusively as stimuli, to provide a cross-cultural and language-independent evaluation of implicit associations that is more closely related to real-life drinking contexts. METHOD: Sixty-five undergraduate young adults took part in this study. A new visual IAT was used to measure the implicit association between alcohol cues and alcohol-related positive attributes. Pictorial stimuli, previously validated, were used to represent both target (alcohol vs. soft drinks) and attribute (positive vs. neutral affective states) categories in seven successive experimental blocks. The IAT was followed by self-reported measures of explicit alcohol-related expectancies and alcohol consumption. RESULTS: The new IAT highlighted significant implicit associations between positively valenced and alcohol-related representations conveyed by pictures, with good internal consistency, thus proving its validity and reliability. Importantly, regression analyses showed that these implicit associations are a strong predictor of self-reported alcohol consumption. CONCLUSIONS: This visual IAT further underscores that positive implicit associations with alcohol constitute an important factor in predicting effective alcohol-related behaviors and offers a more ecological and cross-cultural way to test these associations in non-alcohol-dependent populations. Moreover, this version of the IAT might be implemented in prevention and prophylactic programs

Electrophysiological correlates of performance monitoring in binge drinking: impaired error-related but preserved feedback processing

Objective: Performance monitoring, which allows efficient behavioral regulation using either internal (error processing) or external (feedback processing) cues, has not yet been explored in binge drinking despite its adaptive importance in everyday life, particularly in the regulation of alcohol consumption. Capitalizing on a theoretical model of risky behaviors, the present study aimed at determining the behavioral and electrophysiological correlates of the cognitive (inhibition) and motivational (reward sensitivity) systems during performance monitoring. Methods: Event-related potentials were recorded from 20 binge drinkers and 20 nonbinge drinkers during two experimental tasks, a speeded Go/No-Go Task [investigating internal error processing by Error-Related Negativity (ERN) and error positivity (Pe)] and a Balloon Analogue Risk Task [investigating external feedback processing by Feedback-Related Negativity (FRN) and P3]. Results: While no group differences were observed at the behavioral level, electrophysiological results showed that binge drinkers, despite having intact feedback-related components, presented modified error-monitoring components (i.e. larger ERN amplitude, delayed Pe latency). Conclusions: Internal performance monitoring is impaired in binge drinkers, showing an abnormal automatic processing of response errors (ERN) and a decreased processing of their motivational significance (Pe). Significance: These results suggest that the electrophysiological correlates of inhibitory control allow identifying the specific binge drinking consumption pattern

Executive impairments in binge drinking: evidence for a specific performance monitoring difficulty during alcohol-related processing

This study evaluated inhibition and performance-monitoring abilities through the explicit processing of alcohol cues. Twenty-two binge drinkers (BD) and 22 control participants performed a speeded Go/No-Go task using pictures of alcohol and soft cans as Go and No-Go targets. This task measures inhibitory control and performance monitoring (i.e., task adjustment through errors and feedback processing)during the explicit processing of alcohol cues. Groups did not significantly differ regarding inhibition abilities. However, BD had poorer performance-monitoring abilities, reflected by a difficulty to adjust after errors, especially when theseerrors were related to alcohol cues. These findings suggest that the explicit processing of alcohol cues negatively impacts cognitive abilities among BD

Executive Impairments in Binge Drinking: Evidence for a Specific Performance-Monitoring Difficulty during Alcohol-Related Processing.

This study evaluated inhibition and performance-monitoring abilities through the explicit processing of alcohol cues. Twenty-two binge drinkers (BD) and 22 control participants performed a speeded Go/No-Go task using pictures of alcohol and soft cans as Go and No-Go targets. This task measures inhibitory control and performance monitoring (i.e., task adjustment through errors and feedback processing) during the explicit processing of alcohol cues. Groups did not significantly differ regarding inhibition abilities. However, BD had poorer performance-monitoring abilities, reflected by a difficulty to adjust after errors, especially when these errors were related to alcohol cues. These findings suggest that the explicit processing of alcohol cues negatively impacts cognitive abilities among BD

Can we boost attention and inhibition in binge drinking? Electrophysiological impact of neurocognitive stimulation.

RATIONALE: Binge drinking (i.e. excessive episodic alcohol consumption) among young adults has been associated with deleterious consequences, notably at the cognitive and brain levels. These behavioural impairments and brain alterations have a direct impact on psychological and interpersonal functioning, but they might also be involved in the transition towards severe alcohol use disorders. Development of effective rehabilitation programs to reduce these negative effects as they emerge thus constitutes a priority in subclinical populations. OBJECTIVES: The present study tested the behavioural and electrophysiological impact of neurocognitive stimulation (i.e. transcranial direct current stimulation (tDCS) applied during a cognitive task) to improve attention and inhibition abilities in young binge drinkers. METHODS: Two groups (20 binge drinkers and 20 non-binge drinkers) performed two sessions in a counterbalanced order. Each session consisted of an inhibition task (i.e. Neutral Go/No-Go) while participants received left frontal tDCS or sham stimulation, immediately followed by an Alcohol-related Go/No-Go task, while both behavioural and electrophysiological measures were recorded. RESULTS: No significant differences were observed between groups or sessions (tDCS versus sham stimulation) at the behavioural level. However, electrophysiological measurements during the alcohol-related inhibition task revealed a specific effect of tDCS on attentional resource mobilization (indexed by the N2 component) in binge drinkers, whereas later inhibition processes (indexed by the P3 component) remained unchanged in this population. CONCLUSIONS: The present findings indicate that tDCS can modify the electrophysiological correlates of cognitive processes in binge drinking. While the impact of such brain modifications on actual neuropsychological functioning and alcohol consumption behaviours remains to be determined, these results underline the potential interest of developing neurocognitive stimulation approaches in this population