EXECUTIVE DYSFUNCTION AS A RISK MARKER FOR SUBSTANCE ABUSE: THE ROLE OF IMPULSIVE PERSONALITY TRAITS...
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EXECUTIVE DYSFUNCTION AS A RISK MARKER FOR SUBSTANCE ABUSE: EXECUTIVE DYSFUNCTION AS A RISK MARKER FOR SUBSTANCE ABUSE: THE ROLE OF IMPULSIVE PERSONALITY TRAITS THE ROLE OF IMPULSIVE PERSONALITY TRAITS Sara L. Dolan 1 , Antoine Bechara 2 , Peter E. Nathan 3 1 Brown University Center for Alcohol and Addiction Studies Providence, RI; Brown University Center for Alcohol and Addiction Studies Providence, RI; ; 2 Department of Neurology, University of Iowa College of Medicine Iowa City, IA; Department of Neurology, University of Iowa College of Medicine Iowa City, IA; 3 University of Iowa Department of Psychology and College of Public Health, Iowa City, IA University of Iowa Department of Psychology and College of Public Health, Iowa City, IA Introduction Objectives Methods Results Summary / Conclusions References Bechara , A. et al (1994). Cognition, 50 , 7‑15. Bechara, A. et al (2001). Neuropsychologia, 39(4): 376- 89. Bechara, A. et al (2002) Neuropsychologia, 40, 1690- 1705. Heaton, R. et al. (1993) Wisconsin Card Sorting Test Manual: Revised and expanded. Odessa: Beck, A. et al (1996). San Antonio, TX: The Psychological Corporation.Psychological Assessment Resources, Inc. Hepp, H. et al (1996). Schizophrenia Research, 22 , 187- 195 Reitan, R. & Wolfson, D. (1986). In Wedding, D. & Horton, A.M. (Eds.), The neuropsychology handbook: Behavioral and clinical perspectives. (pp. 134-160). Wechsler, D. (1997). Wechsler Adult Intelligence Scale- Third Edition. Administration and scoring manual. The Psychological Corporation: San Antonio, TX. PARTICIPANTS PARTICIPANTS • Substance Dependent Individuals Substance Dependent Individuals (SDI; n = 38) in inpatient treatment (SDI; n = 38) in inpatient treatment for alcohol and / or stimulant for alcohol and / or stimulant dependence dependence • Abstinent for ≥ 15 days Abstinent for ≥ 15 days FH+ (n = 20) FH+ (n = 20) FH- (n = 18) FH- (n = 18) • Comparison (NC; n = 30) Comparison (NC; n = 30) • Community-dwelling Community-dwelling FH+ (n = 12) FH+ (n = 12) FH- (n = 18) FH- (n = 18) • SDI display an executive function deficit SDI display an executive function deficit compared to comparison subjects compared to comparison subjects • FH confers a further decrement in performance FH confers a further decrement in performance on WCST in SDI but not comparison participants on WCST in SDI but not comparison participants --No FH effect on IGT --No FH effect on IGT • FH effects may be differential – dorsolateral FH effects may be differential – dorsolateral PFC but not ventromedial PFC PFC but not ventromedial PFC --DLPFC but not VMPFC function --DLPFC but not VMPFC function seems to be an important risk marker seems to be an important risk marker • The relationship between substance dependence The relationship between substance dependence status and neuropsychological test status and neuropsychological test performances was related to UPPS Urgency performances was related to UPPS Urgency scores (impulsivity) scores (impulsivity) • Stroop and IGT performances support Bechara Stroop and IGT performances support Bechara et al.’s concept of “motor” and “cognitive” et al.’s concept of “motor” and “cognitive” impulsiveness, respectively impulsiveness, respectively --SDI are impaired in multiple types --SDI are impaired in multiple types of impulsiveness of impulsiveness • These types of impulsiveness may be These types of impulsiveness may be conceptually related to UPPS Urgency conceptually related to UPPS Urgency --Thinking before acting, not --Thinking before acting, not considering the consequences of one’s actions considering the consequences of one’s actions 1. To replicate previous findings To replicate previous findings ( (Bechara et al., 2001) showing that showing that a measure of decision-making -- the a measure of decision-making -- the Iowa Gambling Task -- is a sensitive Iowa Gambling Task -- is a sensitive measure of executive dysfunction in measure of executive dysfunction in substance abusers substance abusers 2. 2. To further evaluate various aspects To further evaluate various aspects of executive cognitive function in of executive cognitive function in recently-detoxified substance recently-detoxified substance dependent individuals (SDI) as dependent individuals (SDI) as compared to non-SDI compared to non-SDI 3. 3. To determine the effects of family To determine the effects of family history of substance use disorders history of substance use disorders on executive function in substance on executive function in substance abusers and comparisons abusers and comparisons 4. 4. To examine impulsivity as a To examine impulsivity as a covariate of the relationship covariate of the relationship between family history and executive between family history and executive function in SDI and non-SDI function in SDI and non-SDI Figure 1. Iowa Gambling Task 0 2 4 6 8 10 12 14 16 B lock 1 B lock 2 B lock 3 B lock 4 B lock 5 IG T B locks (20 C ards per B lock) IG T T o ta l S c o re (C+ S ubstance D ependentFH + S ubstance D ependentFH - C om parison FH + C om parison FH - Table 1 E ffect of F amily H istory Status on the Comparison of Substance Dependent and Comparison Participants on Neuropsychological T ask Performance Substance D ependent Com parison One-W ay ANCOVA NeuropsychologicalTest FH + (n = 20) FH -(n = 18) FH + (n = 12) FH -(n = 18) F p -value W C ST (R aw Scores) TotalErrors 11.99 + 2.44 20.16 + 4.35 14.28 + 3.39 11.78 + 2.67 2.17 0.10 d,f Perseverative Errors 6.32 + 1.35 10.33 + 1.54 8.19 + 1.88 6.53 + 1.46 1.71 0.18 f Non-Perseverative Errors 5.67 + 1.20 9.83 + 1.37 6.10 + 1.67 5.25 + 1.30 2.43 0.07 d.f # CategoriesC om pleted 5.06 + 0.21 5.44 + 0.24 5.62 + 0.30 5.91 + 0.09 1.63 0.19 f TM T -B (Tim e to com plete in seconds) 52.89 + 4.61 64.86 + 5.25 49.59 + 6.40 50.26 + 5.02 1.57 0.21 DigitSpan (Num ber ofDigits Achieved) Forward 6.92 + 0.29 6.20 + 0.33 7.71 + 0.40 7.14 + 0.32 2.48 0.07 h Backw ard 4.63 + 0.31 4.49 + 0.39 4.82 + 0.47 5.55 + 0.37 1.48 0.23 Difference (Forw ard – Backward) 2.29 + 0.37 1.71 + 0.42 2.90 + 0.52 1.59 + 0.41 1.91 0.14 i Stroop (T-Scores) W ord 47.18 + 1.68 44.86 + 1.92 55.85 + 2.34 51.40 + 1.84 2.48 0.07 b Color 46.07 + 1.57 45.04 + 1.79 53.17 + 2.18 50.88 + 1.71 2.97 0.04 b,e Color-Word 49.36 + 2.00 45.93 + 2.28 56.65 + 2.78 52.35 + 2.18 2.53 0.07 b Interference 51.57 + 1.50 48.60 + 1.71 52.51 + 2.07 50.03 + 1.64 0.97 0.41 Iow a G am bling Task N etScore ((C +D )-(A +B)) -2.18 + 7.29 -2.02 + 8.31 22.86 + 10.13 24.86 + 7.95 2.41 0.08 c,g Block 3 10.23 + 0.99 10.95 + 1.13 13.23 + 1.37 13.59 + 1.08 1.77 0.16 c Block 4 10.59 + 1.20 10.83 + 1.37 14.02 + 1.67 15.39 + 1.31 2.47 0.07 a,b Block 5 10.41 + 1.19 9.84 + 1.35 14.97 + 1.65 14.40 + 1.30 2.58 0.06 a,b Effects of Covariates • Age and education were nonsignificant covariates of Age and education were nonsignificant covariates of the relationship between substance use disorders / FH the relationship between substance use disorders / FH status and executive functioning. status and executive functioning. • BDI-II symptoms significantly reduced the main effect BDI-II symptoms significantly reduced the main effect of FH on neuropsychological test performances of FH on neuropsychological test performances • Impulsivity (UPPS) did significantly affect the Impulsivity (UPPS) did significantly affect the relationship btw. Substance abuse/FH on executive relationship btw. Substance abuse/FH on executive function function --When “Urgency” (UPPS) scores were added as a --When “Urgency” (UPPS) scores were added as a covariate, the main effect of substance dependence was covariate, the main effect of substance dependence was no longer significant no longer significant •Substance abusers have deficits in executive functioning --These deficits have been correlated with impulsivity •Individuals with a family history of substance abuse may also have similar, albeit more subtle, deficits •The Iowa Gambling Task is a measure sensitive to these deficits in substance abusers (Bechara et al., 2001;2002) --May be more sensitive to executive dysfunction than Wisconsin Card Sorting Test (Bechara et al., 2001) Neuropsychological Assessment Battery Wisconsin Card Sorting Test (WCST; Wisconsin Card Sorting Test (WCST; Heaton et al., 1993 ) ) Trailmaking Test-B (TMT-B; Trailmaking Test-B (TMT-B; Reitan & Wolfson, 1986 ) ) Digit Span from the WAIS-III ( Digit Span from the WAIS-III (Wechsler, 1997 ) ) Stroop Color Word Test (Stroop; Stroop Color Word Test (Stroop; Hepp et al., 1996 ) ) Iowa Gambling Task (IGT; Iowa Gambling Task (IGT; Bechara et al., 1994 ) ) Beck Depression Inventory (BDI-II; Beck Depression Inventory (BDI-II; Beck et a., 1996) Table 2. The Relationship of UPPS Subscales to Neuropsychological Test Performance. Urgency (Lack of) Premeditati on (Lack of) Perseverenc e Sensation Seeking TMT-A .18 -.25* .23 -.34** TMT-B .37** .13 .21 -.14 SCWT-W -.37** .06 -.16 .14 SCWT-C -.40*** -.11 -.16 .06 SCWT-CW -.47*** -.07 -.11 .01 SCWT-Int -.27* -.05 -.02 ,01 WCST-TotErr .25* .12 .17 -.02 WCST-PerErr .24 .11 .16 -.04 WCST NonPerErr .25* .13 .16 .00 Digits Forward -.17 .07 .02 .19 Digits Backward -.24 .09 .10 .17 IGT Net Score -.21 -.24 -.05 -.14
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Transcript of EXECUTIVE DYSFUNCTION AS A RISK MARKER FOR SUBSTANCE ABUSE: THE ROLE OF IMPULSIVE PERSONALITY TRAITS...
EXECUTIVE DYSFUNCTION AS A RISK MARKER FOR SUBSTANCE ABUSE: EXECUTIVE DYSFUNCTION AS A RISK MARKER FOR SUBSTANCE ABUSE: THE ROLE OF IMPULSIVE PERSONALITY TRAITSTHE ROLE OF IMPULSIVE PERSONALITY TRAITS
Sara L. Dolan1, Antoine Bechara2, Peter E. Nathan3
1Brown University Center for Alcohol and Addiction Studies Providence, RI;Brown University Center for Alcohol and Addiction Studies Providence, RI;; 2Department of Neurology, University of Iowa College of Medicine Iowa City, IA; Department of Neurology, University of Iowa College of Medicine Iowa City, IA; 3University of Iowa Department of Psychology and College of Public Health, Iowa City, IAUniversity of Iowa Department of Psychology and College of Public Health, Iowa City, IA
Introduction
Objectives
Methods
Results Summary / Conclusions
References
Bechara , A. et al (1994). Cognition, 50, 7‑15.
Bechara, A. et al (2001). Neuropsychologia, 39(4):376-89.
Bechara, A. et al (2002) Neuropsychologia, 40, 1690-1705.
Heaton, R. et al. (1993) Wisconsin Card Sorting Test Manual: Revised and expanded. Odessa: Beck, A. et al (1996). San Antonio, TX: The Psychological Corporation.Psychological Assessment Resources, Inc.
Hepp, H. et al (1996). Schizophrenia Research, 22, 187-195
Reitan, R. & Wolfson, D. (1986). In Wedding, D. & Horton, A.M. (Eds.), The neuropsychology handbook: Behavioral and clinical perspectives. (pp. 134-160).
Wechsler, D. (1997). Wechsler Adult Intelligence Scale-Third Edition. Administration and scoring manual. The Psychological Corporation: San Antonio, TX.
Whiteside, S. P. & Lynam, D. R. (2003). Experimental & Clinical Psychopharmacology, 11, 210-217.
PARTICIPANTSPARTICIPANTS•Substance Dependent Individuals (SDI; n = Substance Dependent Individuals (SDI; n = 38) in inpatient treatment for alcohol and / or 38) in inpatient treatment for alcohol and / or stimulant dependencestimulant dependence
•Abstinent for ≥ 15 daysAbstinent for ≥ 15 days FH+ (n = 20)FH+ (n = 20) FH- (n = 18)FH- (n = 18)
•Comparison (NC; n = 30)Comparison (NC; n = 30)•Community-dwellingCommunity-dwelling FH+ (n = 12)FH+ (n = 12) FH- (n = 18)FH- (n = 18)
•SDI display an executive function deficit compared to SDI display an executive function deficit compared to comparison subjectscomparison subjects•FH confers a further decrement in performance on WCST in FH confers a further decrement in performance on WCST in SDI but not comparison participants SDI but not comparison participants
--No FH effect on IGT--No FH effect on IGT•FH effects may be differential – dorsolateral PFC but not FH effects may be differential – dorsolateral PFC but not ventromedial PFCventromedial PFC --DLPFC but not VMPFC function seems to be an --DLPFC but not VMPFC function seems to be an important risk markerimportant risk marker•The relationship between substance dependence status The relationship between substance dependence status and neuropsychological test performances was related to and neuropsychological test performances was related to UPPS Urgency scores (impulsivity)UPPS Urgency scores (impulsivity)•Stroop and IGT performances support Bechara et al.’s Stroop and IGT performances support Bechara et al.’s concept of “motor” and “cognitive” impulsiveness, concept of “motor” and “cognitive” impulsiveness, respectivelyrespectively
--SDI are impaired in multiple types of --SDI are impaired in multiple types of impulsivenessimpulsiveness
•These types of impulsiveness may be conceptually These types of impulsiveness may be conceptually related to UPPS Urgencyrelated to UPPS Urgency --Thinking before acting, not considering the --Thinking before acting, not considering the consequences of one’s actionsconsequences of one’s actions
1. To replicate previous findings (To replicate previous findings (Bechara et al., 2001) showing that a measure of decision- showing that a measure of decision-making -- the Iowa Gambling Task -- is a making -- the Iowa Gambling Task -- is a sensitive measure of executive dysfunction in sensitive measure of executive dysfunction in substance abuserssubstance abusers
2.2.To further evaluate various aspects of To further evaluate various aspects of executive cognitive function in recently-executive cognitive function in recently-detoxified substance dependent individuals detoxified substance dependent individuals (SDI) as compared to non-SDI(SDI) as compared to non-SDI
3.3.To determine the effects of family history of To determine the effects of family history of substance use disorders on executive substance use disorders on executive function in substance abusers and function in substance abusers and comparisonscomparisons
4.4.To examine impulsivity as a covariate of the To examine impulsivity as a covariate of the relationship between family history and relationship between family history and executive function in SDI and non-SDIexecutive function in SDI and non-SDI
Figure 1. Iowa Gambling Task
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Block 1 Block 2 Block 3 Block 4 Block 5
IGT Blocks (20 Cards per Block)
IGT
To
tal
Sc
ore
(C
+D
)-(A
+B
)
SubstanceDependent FH+
SubstanceDependent FH-
Comparison FH+
Comparison FH-
Table 1 Effect of Family History Status on the Comparison of Substance Dependent and Comparison Participants on Neuropsychological Task Performance
Substance Dependent Comparison One-Way
ANCOVA Neuropsychological Test FH+ (n = 20) FH- (n = 18) FH+ (n = 12) FH- (n = 18) F p-value WCST (Raw Scores)
Total Errors 11.99 + 2.44 20.16 + 4.35 14.28 + 3.39 11.78 + 2.67 2.17 0.10 d,f Perseverative Errors 6.32 + 1.35 10.33 + 1.54 8.19 + 1.88 6.53 + 1.46 1.71 0.18 f
Non-Perseverative Errors 5.67 + 1.20 9.83 + 1.37 6.10 + 1.67 5.25 + 1.30 2.43 0.07d.f
# Categories Completed 5.06 + 0.21 5.44 + 0.24 5.62 + 0.30 5.91 + 0.09 1.63 0.19 f
TMT-B (Time to complete in seconds) 52.89 + 4.61 64.86 + 5.25 49.59 + 6.40 50.26 + 5.02 1.57 0.21
Digit Span (Number of Digits Achieved)
Forward 6.92 + 0.29 6.20 + 0.33 7.71 + 0.40 7.14 + 0.32 2.48 0.07h
Backward 4.63 + 0.31 4.49 + 0.39 4.82 + 0.47 5.55 + 0.37 1.48 0.23 Difference (Forward – Backward) 2.29 + 0.37 1.71 + 0.42 2.90 + 0.52 1.59 + 0.41 1.91 0.14 i
Stroop (T-Scores) Word 47.18 + 1.68 44.86 + 1.92 55.85 + 2.34 51.40 + 1.84 2.48 0.07 b Color 46.07 + 1.57 45.04 + 1.79 53.17 + 2.18 50.88 + 1.71 2.97 0.04 b,e
Color-Word 49.36 + 2.00 45.93 + 2.28 56.65 + 2.78 52.35 + 2.18 2.53 0.07 b Interference 51.57 + 1.50 48.60 + 1.71 52.51 + 2.07 50.03 + 1.64 0.97 0.41
Iowa Gambling Task Net Score ((C+D)-(A+B)) -2.18 + 7.29 -2.02 + 8.31 22.86 + 10.13 24.86 + 7.95 2.41 0.08 c,g
Block 3 10.23 + 0.99 10.95 + 1.13 13.23 + 1.37 13.59 + 1.08 1.77 0.16 c Block 4 10.59 + 1.20 10.83 + 1.37 14.02 + 1.67 15.39 + 1.31 2.47 0.07 a,b Block 5 10.41 + 1.19 9.84 + 1.35 14.97 + 1.65 14.40 + 1.30 2.58 0.06 a,b
Effects of Covariates•Age and education were nonsignificant covariates of the Age and education were nonsignificant covariates of the relationship between substance use disorders / FH status and relationship between substance use disorders / FH status and executive functioning.executive functioning.•BDI-II symptoms significantly reduced the main effect of FH on BDI-II symptoms significantly reduced the main effect of FH on neuropsychological test performancesneuropsychological test performances•Impulsivity (UPPS) did significantly affect the relationship btw. Impulsivity (UPPS) did significantly affect the relationship btw. Substance abuse/FH on executive functionSubstance abuse/FH on executive function --When “Urgency” (UPPS) scores were added as a covariate, the --When “Urgency” (UPPS) scores were added as a covariate, the main effect of substance dependence was no longer significantmain effect of substance dependence was no longer significant
•Substance abusers have deficits in executive functioning
--These deficits have been correlated with impulsivity
•Individuals with a family history of substance abuse may also have similar, albeit more subtle, deficits
•The Iowa Gambling Task is a measure sensitive to these deficits in substance abusers (Bechara et al., 2001;2002)
--May be more sensitive to executive dysfunction than Wisconsin Card Sorting Test (Bechara et al., 2001)
Neuropsychological Assessment Battery Wisconsin Card Sorting Test (WCST;Wisconsin Card Sorting Test (WCST; Heaton et al., 1993)) Trailmaking Test-B (TMT-B; Trailmaking Test-B (TMT-B; Reitan & Wolfson, 1986)) Digit Span from the WAIS-III (Digit Span from the WAIS-III (Wechsler, 1997)) Stroop Color Word Test (Stroop; Stroop Color Word Test (Stroop; Hepp et al., 1996)) Iowa Gambling Task (IGT;Iowa Gambling Task (IGT; Bechara et al., 1994)) Beck Depression Inventory (BDI-II; Beck Depression Inventory (BDI-II; Beck et a., 1996) UPPS Impulsive Behavior Scales (UPPS;UPPS Impulsive Behavior Scales (UPPS;Whiteside, SP &
Lynam, DR, 2003))
Table 2. The Relationship of UPPS Subscales to Neuropsychological Test Performance.
Urgency (Lack of) Premeditation
(Lack of) Perseverence
Sensation Seeking
TMT-A .18 -.25* .23 -.34**
TMT-B .37** .13 .21 -.14
SCWT-W -.37** .06 -.16 .14
SCWT-C -.40*** -.11 -.16 .06
SCWT-CW -.47*** -.07 -.11 .01
SCWT-Int -.27* -.05 -.02 ,01
WCST-TotErr .25* .12 .17 -.02
WCST-PerErr .24 .11 .16 -.04
WCST NonPerErr .25* .13 .16 .00
Digits Forward -.17 .07 .02 .19
Digits Backward -.24 .09 .10 .17
IGT Net Score -.21 -.24 -.05 -.14
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