Post on 02-Jan-2016
Medicine, Nursing and Health Sciences
Cognitive impairment and cognitive recovery in substance related disorders
A/Prof. Antonio Verdejo-GarciaCatania, July 2015
Cognition and Outcomes 2
Outline1. Cognition -- What is it (for)?
2. Subtyping/Matching
3. Prediction
4. Cognitive remediation
Cognition and Outcomes 3
Updating and management OF input-independent info FOR goal-achievement and decision-making
Factor Analysis of Executive Functions
Components Measures Factor Load
h2
Updating Letter Number Sequencing
0.5-0.8 0.53-0.73
Inhibition Stroop 0.7-0.8 0.51-0.63
Switching Wisconsin Card Sorting Test
0.5-0.9 0.45-0.74
Decision-making Iowa Gambling Task
0.9 0.83
Verdejo-García & Perez-Garcia (2007)
Stimulants vs Opiate users
IGT Performance
-8
-6
-4
-2
0
2
4
6
8
10
block 1 block 2 block 3 block 4 block 5
Bloque
IGT
Sco
re [
(C+
D)
- (A
+B
)] Cocaine
Heroin
Controls
0
20
40
60
80
100
120
FAS DesignFluency
LNS Arithmetic Digits SpatialSpan
Similarities CBT
Neuropsych. Tests (Updating)
Ra
w s
co
res
Cocaine
Heroin
Controls
-5
0
5
10
15
20
25
30
Stroop 5DT Interference 5DT Shifting
Neuropsych. Tests (Inhibition)
Ra
w s
co
res
Cocaine
Heroin
Controls
*
0
10
20
30
40
50
60
70
Category Test Go/No Go WCST
Neuropsych. Tests (Shifting)
Ra
w s
co
res
(E
rro
rs)
Cocaine
Heroin
Controls
*
*
Verdejo-García & Perez-Garcia (2007)
Cognition and Outcomes 9
Components Prevalence Rate Drug of choice
w/greater deficits
Working memory 62.2 % C=H
Response Inhibition 38.3 % C>H
Shifting 27.3 % C>H
Global Impairment 68.8 %
Focus of current interventions (MI or CBT)
Life goals
Self-control and self-monitoring
Avoid risk
Cognition and Outcomes 10
Focus of current interventions (MI or CBT)
Life goals
Self-control and self-monitoring
Avoid risk
Cognition and Outcomes 11
Mismatch between impaired working
memory, inhibition or decision-making
and treatment re
quisites
What cognition may add…
Subtyping/Matching
Prediction
Focused interventions
Cognition and Outcomes 12
Neuropsychological Assessment
Cognitive Rehabilitation
Cognition and Outcomes 14
LCA of trait and cognitive impulsivity scores in 96
addiction clients
Albein-Urios et al. (2014)
Delay discounting
28th February 2011Presentation title 21
Marshmallows! http://www.youtube.com/watch?v=QX_oy9614HQ
Peters and Buchel (2011) TICS: 11(5)
Delay Discounting longitudinally predicts who stay in treatment
Cognition and Outcomes 24
Stevens, Verdejo-Garcia et al. (2014)
Treatment readiness correlate with brain fitness
28th February 2011Cognition and Outcomes 25
Moreno-Lopez et al. (2014)
Association with severity of cocaine use
29
COCAINE GRAMS/ WEEK
IGT
TOTA
L SCORE
876543210
100
50
0
-50
Scatterplot of IGT TOTAL SCORE vs COCAINE GRAMS/ WEEK
Verdejo-Garcia et al. (2007)
Using the Iowa Gambling Task to predict relapse
Baseline assessments (~2 weeks after treatment commencement) and classification:
Insensitivity to future consequences Hypersensitivity to reward Intact
Follow-up –3 months after baseline assessments, to provide a 3 cm hair sample to assess drug relapse.
Cognition and Outcomes 30
Verdejo-Garcia et al. (2014)
Medicine, Nursing and Health Sciences
Cognitive enhancement interventions
CognitionClinical
Outcomes
Amenable to Interventions
✔
✔ ?
Cognitive training of skills needed to:
Set personal goals – tailored (“mental blackboard”) Resist interference (“automatic pilot”)
Boredom Stress Habits
Quality control – from external to self-generated feedback
Practice when and how utilise them in daily life
DD
BB
CC
AAAutomatic pilot STOP! Present Mindedness
Back to Goal
State your Decision
Quality control!
GMT
Alfonso et al. (2011)
DD
BB
CC
AAAutomatic pilot STOP! Present Mindedness
Meditation motives (e.g., endurance, willpower)
When distracted Back to motive
Interoceptive scanning Decision-making
MFN
Alfonso et al. (2011)
STOP!Present-mindedness exercise.
-8
-6
-4
-2
0
2
4
6
8
10
Time Pre- Time Post-
IGT
Net
sco
re
GMT+MF
STx * *
Goal Management Training Long-term
goals Decision-making in the Iowa Gambling Task
Alfonso et al. (2011)
Conclusions Most substance dependent clients have executive
thinking deficits
Deficient skills are paradoxically prerequisites of addiction treatments we currently apply
There is potential to recovery, and cognitive training can improve treatment outcomes
TP Nov 2013Cognition and Outcomes 42
Acknowledgements Funding
– Monash Strategic Grant Scheme– Red de Trastornos Adictivos, Universidad de Granada
Turning Point Drug and Alcohol Centre
– Dan Lubman– Victoria Manning
Verdejo-Garcia’s group:
– MJ Fernandez-Serrano– Laura Moreno-Lopez– Jose M Martinez-Gonzalez– Jose C Perales– Oscar Lozano– Natalia Albein
43