Methamphetamine, Behavior, and Brain Imaging Richard Rawson, Ph.D. UCLA Integrated Substance Abuse...
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Transcript of Methamphetamine, Behavior, and Brain Imaging Richard Rawson, Ph.D. UCLA Integrated Substance Abuse...
Methamphetamine, Behavior,and Brain Imaging
Richard Rawson, Ph.D.UCLA Integrated Substance Abuse Programs
CATES Methamphetamine ConferenceAugust 20, 2004
Edythe D. London, Ph.D.University of California – Los AngelesDept. Psychiatry & Biobehavioral SciencesLaboratory of Molecular Neuroimaging [email protected]
The content of this presentation is based on the work of:
What are the goals of brain imaging?
Figure out how drugs act.
What are the acute effects?
Characterize addiction.
What’s wrong in the brain? What circuits?
Advance treatment.Provide a rational basis to design medicines or
cognitive-behavioral therapies.
Cortical-limbic circuits mediate emotional and cognitive functions.
Focus on:•orbitofrontal cortex
• cingulate gyrus• insula
• amygdala
Methamphetamine
The orbitofrontal and cingulate cortices participate in emotional experiences and cognitive processing.
R.J. Dolan, 2002
The anterior cingulate and insular cortices participate in emotional experiences.
The amygdala links perception with emotion and memory.
Affective State Varies Over Time
Drug-Taking
Dependence
Cessationof Drug Use
craving, negative affectco-morbid psychiatric
conditions
Relapse
Withdrawal
Positiv
e Affe
ct
Methamphetamine users have Methamphetamine users have cognitive deficits in early abstinence.cognitive deficits in early abstinence.
•working memory
•learning
•abstract thinking
• logic
113 (3.4) 113 (3.4) ****124 (3.4) 124 (3.4) Words Remembered Words Remembered
19.5 (1.8) 19.5 (1.8) **24.0 (1.3)24.0 (1.3)Discrimination Learning Discrimination Learning (# correct)(# correct)
20.5 (3.0)20.5 (3.0)
Controls Controls (n = 23)(n = 23)
35.3 (3.8) 35.3 (3.8) ****
MAMA (n = 21)(n = 21)
LearningLearning Selective RemindingSelective Reminding
Reminders (#)Reminders (#)
Cognitive DeficitsCognitive Deficits
significant from control, *p<.05; **p <.01
63.1 (2.2)63.1 (2.2) 54 (2.3) **Digit symbol (# correct)Working Memory
HypothesesHypotheses
Methamphetamine abusers in early abstinencehave affective deficits as well.
These deficits reflect dysfunction in specific brain regions.
Depression Scores in Abstinent Depression Scores in Abstinent Methamphetamine UsersMethamphetamine Users
0
2
4
6
8
10
12
1 2 3 4 5
Weeks of MA AbstinenceWeeks of MA Abstinence
BD
I Sco
re
control control
Methamphetamine craving drops Methamphetamine craving drops dramatically over 3 weeks.dramatically over 3 weeks.
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
1 2 3 4 5
Weeks of MA Abstinence
VA
S S
core
• MA and control groups
• Urine drug screens to show MA use
• Abstinence maintained on a research ward
• PET scan and cognitive tests
• PET scan -- FDG/auditory CPT
MethodsMethods
Fluorodeoxyglucose (FDG)is injected as a tracer for brain metabolism.
[18F]-labeled 2-deoxyglucose (FDG) is used in neurology, cardiology and oncology to study glucose metabolism. In cardiology, [18F]-labeled FDG can be used to measure regional myocardial glucose metabolism. Although glucose is not the primary metabolic fuel of the myocardium, glucose utilization has been extensively studied as a metabolic marker in both diseased and normal myocardium. Because [18F]-labeled FDG measures glucose metabolism it is also useful for tumor localization and quantitation. FDG is potentially useful in differentiating benign from malignant forms of stimulated osteoblastic activity because of the high metabolic activity of many types of aggressive tumors.
[ Tracers TOC | Back to Doses ] Copyright © 1998 Crump Institute for Biogical Imaging. Web Curator
PET Scanning A Nuclear Medicine procedure
Detectors linked to a computer system reconstruct an image.
Whole brain metabolismis not abnormal in early abstinence from methamphetamine.
0
2
4
6
8
10
12
CM
Rg
lc (
mg
/10
0g
/min
)C
MR
glc
(m
g/1
00
g/m
in)
Control Control MAMA
Brain metabolism varies with age in subjects who use methamphetamine chronically – not in control subjects.
789
1011121314
20 30 40 50AGE (years)
Metabolic rate(mg/100 g/min)
MA reduces reserve – less compensation for aging.
Sig
na
l In
ten
sit
y
Sig
na
l In
ten
sit
y
(Wh
ite M
att
er)
(Wh
ite M
att
er)
Age (years)Age (years)
1010
55
00
-- 55
-- 1010
--1515
-- 20202020 3030 4040 5050
White matter density varies with age in White matter density varies with age in methamphetamine users.methamphetamine users.
Regional brain metabolism is abnormal in methamphetamine abusers during early
abstinence.
igACC
pgACC
PosteriorCingulate
VentralStriatum/
2.5
1.5
1
2
33.5
0.5
Control> MA
t-values
MA >Control
5
3
1
2
4
Amygdala
Orbitofrontal Dysfunction in Methamphetamine Abusers
t-values
2.5
1.5
1
2
3
3.5
0.5
Control> MA
MA >Control
5
3
1
2
4
Depressive Symptoms in MA AbusersPositive Covariance with Activity
of Anterior Cingulate and Amygdala
5
3
1
2
4
67
t-values
ACCAmygdala
Anxiety in MA AbusersPositive Covariance with Amygdala Activity
Negatively Covariance with OFC Activity
Amygdala
LateralOrbitofrontal
5
3
2
4
6
7
1
t-values
5
3
1
2
4
Negative Positive Covariance
Loss of Infralimbic Cortical Inhibition of the Amygdala
ACC
Amygdala/Ventral
Striatum
2.5
1.5
1
2
33.5
0.5
Control> MA
t-values
MA >Control
5
3
1
2
4
Cues exaggerated responses
anxiety, craving
OFC
Loss of Cortical Inhibition of Extended Amygdala
OFC
Extended Amygdala
Extended Amygdala
ACC 0ACC
INS INS
OFCControl MA
Infralimbic Cortex Role in Recall of Extinction
Infralimbic neurons signal extinction memory
Habit. + Cond. Extinction Extinction
Habit. Cond. Extinction Extinction
Day 1 Day 2
Seconds after tone onset
% F
ree
zin
g t
o
ton
e
Sham
vmPFC
Lesion
20
10
0
20
10
0
20
10
021-1 0 -1-1 0 01 12 2
vmPFC lesions block recall of extinction Day 1 Day 2
80
60
40
20
0S
pik
es
IL
IL
Adapted from GJ Quirk and DR Gehlert, 2003
Prefrontal Cortex, Amygdala and Conditioning
• GJ Quirk, E Likhtig, JG Pelletier, D Pare Stimulation of Medial Prefrontal Cortex Decreases
the Responsiveness of Central Amygdala Output Neurons. J Neurosci 23:8800 (Sept 24, 2003)
• Rosenkranz, H Moore, A Grace The Prefrontal Cortex Regulates Lateral Amygdala Neuronal Plasticity and Responses to Previously Conditioned Stimuli.
J. Neurosci 23:11054 (Dec 3,2003)
Animal studies:
Conclusions
Cortical dysfunction in methamphetamine dependence
involves cortical regions associated with negative affect:
Orbitofrontal, Cingulate, Insular
Negative affect (depression, anxiety)-- Has direct effects on drug taking
-- Has indirect effects through influencing executive cognitive functions.
Can imaging help to develop effective treatments?
Treatment and Sobriety
Drug Use Behavior
Responsible Behavioral
Choice
Knowledge of affected circuitry canKnowledge of affected circuitry can Identify targets for medications.Identify targets for medications.
Identify brain systems amenable to behavioral therapy.Identify brain systems amenable to behavioral therapy.
Edythe London
Sara Simon Bradley Voytek
Steven Berman Richard Rawson
John Matochik Walter Ling
Aaron Lichtman Varughese Kurian
Mark Mandelkern Ann Shinn
Jennifer Learn Jennifer Bramen
Roger Woods Parvaneh Mohammadian
Collaborating InvestigatorsCollaborating Investigators