Neuroplastic and cognitive impairment in substance use disorders: a therapeutic potential of cognitive stimulation

Cognitive impairments in substance use disorders have been extensively researched, especially since the advent of cognitive and computational neuroscience and neuroimaging methods in the last 20 years. Conceptually, altered cognitive function can be viewed as a hallmark feature of substance use disorders, with documented alterations in the well-known “executive” domains of attention, inhibition/regulation, working memory, and decision-making. Poor cognitive (sometimes referred to as “top-down”) regulation of downstream motivational processes—whether appetitive (reward, incentive salience) or aversive (stress, negative affect)—is recognized as a fundamental impairment in addiction and a potentially important target for intervention. As addressed in this special issue, cognitive impairment is a transdiagnostic domain; thus, advances in the characterization and treatment of cognitive dysfunction in substance use disorders could have benefit across multiple psychiatric disorders. Toward this general goal, we summarize current findings in the abovementioned cognitive domains of substance use disorders, while suggesting a potentially useful expansion to include processes that bothprecede(precognition) andsupersede(social cognition) what is usually thought of as strictly cognition. These additional two areas have received relatively less attention but phenomenologically and otherwise are important features of substance use disorders. The review concludes with suggestions for research and potential therapeutic targeting of both the familiar and this more comprehensive version of cognitive domains related to substance use disorders.

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Treatment of Comorbid Affective and Substance Use Disorders Therapeutic Potential of Anticonvulsants

American Journal on Addictions ◽

10.3109/10550499808998353 ◽

1998 ◽

Vol 7 (3) ◽

pp. 210-220 ◽

Cited By ~ 1

Author(s):

Stephen J. Donovan ◽

Edward V. Nunes

Keyword(s):

Substance Use ◽

Substance Use Disorders ◽

Therapeutic Potential

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Therapeutic potential of NMDA receptor antagonists in the treatment of alcohol and substance use disorders

Expert Opinion on Investigational Drugs ◽

10.1517/13543784.9.10.2233 ◽

2000 ◽

Vol 9 (10) ◽

pp. 2233-2248 ◽

Cited By ~ 28

Author(s):

Adam Bisaga ◽

Piotr Popik ◽

Anton Y Bespalov ◽

Wojciech Danysz

Keyword(s):

Substance Use ◽

Nmda Receptor ◽

Substance Use Disorders ◽

Therapeutic Potential ◽

Nmda Receptor Antagonists ◽

Receptor Antagonists

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Screening Tools for Cognitive Impairment in Adults with Substance Use Disorders: A Systematic Review

Journal of the International Neuropsychological Society ◽

10.1017/s135561772100103x ◽

2021 ◽

pp. 1-24

Author(s):

Katherine Y. Ko ◽

Nicole Ridley ◽

Shayden D. Bryce ◽

Kelly Allott ◽

Angela Smith ◽

...

Keyword(s):

Systematic Review ◽

Substance Use ◽

Cognitive Impairment ◽

Diagnostic Accuracy ◽

Substance Use Disorders ◽

Classification Accuracy ◽

Risk Of Bias ◽

Screening Tools ◽

Cognitive Screening ◽

Screening Measures

ABSTRACT Objectives: Cognitive impairment is common in individuals with substance use disorders (SUDs), yet no evidence-based guidelines exist regarding the most appropriate screening measure for use in this population. This systematic review aimed to (1) describe different cognitive screening measures used in adults with SUDs, (2) identify substance use populations and contexts these tools are utilised in, (3) review diagnostic accuracy of these screening measures versus an accepted objective reference standard, and (4) evaluate methodology of included studies for risk of bias. Methods: Online databases (PsycINFO, MEDLINE, Embase, and CINAHL) were searched for relevant studies according to pre-determined criteria, and risk of bias and applicability was assessed using the Quality Assessment of Diagnostic Accuracy Studies–2 (QUADAS–2). At each review phase, dual screening, extraction, and quality ratings were performed. Results: Fourteen studies met inclusion, identifying 10 unique cognitive screening tools. The Montreal Cognitive Assessment (MoCA) was the most common, and two novel screening tools (Brief Evaluation of Alcohol-Related Neuropsychological Impairments [BEARNI] and Brief Executive Function Assessment Tool [BEAT]) were specifically developed for use within SUD populations. Twelve studies reported on classification accuracy and relevant psychometric parameters (e.g., sensitivity and specificity). While several tools yielded acceptable to outstanding classification accuracy, there was poor adherence to the Standards for Reporting Diagnostic Accuracy Studies (STARD) across all studies, with high or unclear risk of methodological bias. Conclusions: While some screening tools exhibit promise for use within SUD populations, further evaluation with stronger methodological design and reporting is required. Clinical recommendations and future directions for research are discussed.

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Psychiatric Disorders and Mild Cognitive Impairment in Older Veterans With Subjective Memory Complaints

Innovation in Aging ◽

10.1093/geroni/igaa057.944 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 295-295

Author(s):

Mia Delgadillo ◽

Megan Frank ◽

Aidan Boese ◽

Tilman Schulte ◽

J Kaci Fairchild

Keyword(s):

Older Adults ◽

Substance Use ◽

Cognitive Impairment ◽

Anxiety Disorder ◽

Psychiatric Disorder ◽

Psychiatric Disorders ◽

Substance Use Disorders ◽

Subjective Memory Complaints ◽

Subjective Memory ◽

Memory Complaints

Abstract Psychiatric disorders pose a unique risk for Alzheimer’s disease (AD). Prior research indicates psychiatric disorders in MCI increase AD vulnerability. Less research has been done to understand how psychiatric disorders may affect the development of MCI. Understanding these potentially modifiable risk factors is important as they may represent a potential target of intervention for secondary prevention of AD. The present study examines the relationship between psychiatric disorders and amnestic MCI (aMCI) in a sample of Veterans with subjective memory complaints. The sample included 150 older adults with subjective memory complaints (90% male, age = 70.6±8.2). aMCI diagnosis was based upon performance on the delayed recall trials of the Rey Auditory Verbal Learning Test and Logical Memory II of the Wechsler Memory Scale-4th edition. Psychiatric disorders (e.g., Mood Disorders, Anxiety Disorders, and Substance Use Disorders) were assessed using the Mini Neuropsychiatric Interview for DSM-IV. Logistic regression modeling demonstrated that diagnosis of anxiety disorders, but not mood or substance use disorders, was significantly associated with aMCI status. Specifically, older adults with an anxiety disorder were less likely to have aMCI than those older adults without an anxiety disorder. Additional analyses revealed that within those with aMCI (n=107), persons with a psychiatric disorder were significantly younger than those without a psychiatric disorder by an average of 6 years. These findings support prior research on the complex relationship of anxiety and cognitive impairment as well as suggest that those with psychiatric disorders may be at risk for developing aMCI at younger ages.

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ARE SUBSTANCE USE DISORDERS ASSOCIATED WITH FRAILTY IN US OLDER VETERANS WITH COGNITIVE IMPAIRMENT?

American Journal of Geriatric Psychiatry ◽

10.1016/j.jagp.2020.01.183 ◽

2020 ◽

Vol 28 (4) ◽

pp. S149-S150

Author(s):

Aakashi Shah ◽

Raquel Aparicio-Ugarriza ◽

Amar Morani ◽

Mercedes Rodriquez-Suarez ◽

Jorge G. Ruiz

Keyword(s):

Substance Use ◽

Cognitive Impairment ◽

Substance Use Disorders

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Therapeutic Potential of Peroxisome Proliferator-Activated Receptor (PPAR) Agonists in Substance Use Disorders: A Synthesis of Preclinical and Human Evidence

Cells ◽

10.3390/cells9051196 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1196 ◽

Cited By ~ 1

Author(s):

Justin Matheson ◽

Bernard Le Foll

Keyword(s):

Substance Use ◽

Substance Use Disorders ◽

Therapeutic Potential ◽

Pilot Trial ◽

Brain Regions ◽

Peroxisome Proliferator ◽

Consistent Finding ◽

Ppar Γ ◽

Ppar Agonists ◽

Ppar Ligands

Targeting peroxisome proliferator-activated receptors (PPARs) has received increasing interest as a potential strategy to treat substance use disorders due to the localization of PPARs in addiction-related brain regions and the ability of PPAR ligands to modulate dopamine neurotransmission. Robust evidence from animal models suggests that agonists at both the PPAR-α and PPAR-γ isoforms can reduce both positive and negative reinforcing properties of ethanol, nicotine, opioids, and possibly psychostimulants. A reduction in the voluntary consumption of ethanol following treatment with PPAR agonists seems to be the most consistent finding. However, the human evidence is limited in scope and has so far been less promising. There have been no published human trials of PPAR agonists for treatment of alcohol use disorder, despite the compelling preclinical evidence. Two trials of PPAR-α agonists as potential smoking cessation drugs found no effect on nicotine-related outcomes. The PPAR-γ agonist pioglitazone showed some promise in reducing heroin, nicotine, and cocaine craving in two human laboratory studies and one pilot trial, yet other outcomes were unaffected. Potential explanations for the discordance between the animal and human evidence, such as the potency and selectivity of PPAR ligands and sex-related variability in PPAR physiology, are discussed.

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