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Hausman HK, Alexander GE, Cohen R, Marsiske M, DeKosky ST, Hishaw GA, O'Shea A, Kraft JN, Dai Y, Wu S, Woods AJ. Primary outcome from the augmenting cognitive training in older adults study (ACT): A tDCS and cognitive training randomized clinical trial. Brain Stimul 2023; 16:904-917. [PMID: 37245842 PMCID: PMC10436327 DOI: 10.1016/j.brs.2023.05.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/08/2023] [Accepted: 05/24/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND There is a need for effective interventions to stave off cognitive decline in older adults. Cognitive training has variably produced gains in untrained tasks and daily functioning. Combining cognitive training with transcranial direct current stimulation (tDCS) may augment cognitive training effects; however, this approach has yet to be tested on a large-scale. OBJECTIVE This paper will present the primary findings of the Augmenting Cognitive Training in Older Adults (ACT) clinical trial. We hypothesize that receiving active stimulation with cognitive training will result in greater improvements on an untrained fluid cognition composite compared to sham following intervention. METHODS 379 older adults were randomized, and 334 were included in intent-to-treat analyses for a 12-week multidomain cognitive training and tDCS intervention. Active or sham tDCS was administered at F3/F4 during cognitive training daily for two weeks then weekly for 10 weeks. To assess the tDCS effect, we fitted regression models for changes in NIH Toolbox Fluid Cognition Composite scores immediately following intervention and one year from baseline controlling for covariates and baseline scores. RESULTS Across the entire sample, there were improvements in NIH Toolbox Fluid Cognition Composite scores immediately post-intervention and one year following baseline; however, there were no significant tDCS group effects at either timepoint. CONCLUSIONS The ACT study models rigorous, safe administration of a combined tDCS and cognitive training intervention in a large sample of older adults. Despite potential evidence of near-transfer effects, we failed to demonstrate an additive benefit of active stimulation. Future analyses will continue to assess the intervention's efficacy by examining additional measures of cognition, functioning, mood, and neural markers.
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Affiliation(s)
- Hanna K Hausman
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA; Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Gene E Alexander
- Department of Psychiatry, Neuroscience and Physiological Sciences Graduate Interdisciplinary Programs, and BIO5 Institute, University of Arizona and Arizona Alzheimer's Disease Consortium, Tucson, AZ, USA; Brain Imaging, Behavior and Aging Laboratory, Department of Psychology and Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, AZ, USA
| | - Ronald Cohen
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA; Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Michael Marsiske
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA; Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Steven T DeKosky
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA; Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Georg A Hishaw
- Department of Psychiatry, Neuroscience and Physiological Sciences Graduate Interdisciplinary Programs, and BIO5 Institute, University of Arizona and Arizona Alzheimer's Disease Consortium, Tucson, AZ, USA
| | - Andrew O'Shea
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA; Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Jessica N Kraft
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA; Department of Neuroscience, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Yunfeng Dai
- Department of Biostatistics, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Samuel Wu
- Department of Biostatistics, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Adam J Woods
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA; Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.
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Chen YH, Yang J, Wu H, Beier KT, Sawan M. Challenges and future trends in wearable closed-loop neuromodulation to efficiently treat methamphetamine addiction. Front Psychiatry 2023; 14:1085036. [PMID: 36911117 PMCID: PMC9995819 DOI: 10.3389/fpsyt.2023.1085036] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/03/2023] [Indexed: 02/25/2023] Open
Abstract
Achieving abstinence from drugs is a long journey and can be particularly challenging in the case of methamphetamine, which has a higher relapse rate than other drugs. Therefore, real-time monitoring of patients' physiological conditions before and when cravings arise to reduce the chance of relapse might help to improve clinical outcomes. Conventional treatments, such as behavior therapy and peer support, often cannot provide timely intervention, reducing the efficiency of these therapies. To more effectively treat methamphetamine addiction in real-time, we propose an intelligent closed-loop transcranial magnetic stimulation (TMS) neuromodulation system based on multimodal electroencephalogram-functional near-infrared spectroscopy (EEG-fNIRS) measurements. This review summarizes the essential modules required for a wearable system to treat addiction efficiently. First, the advantages of neuroimaging over conventional techniques such as analysis of sweat, saliva, or urine for addiction detection are discussed. The knowledge to implement wearable, compact, and user-friendly closed-loop systems with EEG and fNIRS are reviewed. The features of EEG and fNIRS signals in patients with methamphetamine use disorder are summarized. EEG biomarkers are categorized into frequency and time domain and topography-related parameters, whereas for fNIRS, hemoglobin concentration variation and functional connectivity of cortices are described. Following this, the applications of two commonly used neuromodulation technologies, transcranial direct current stimulation and TMS, in patients with methamphetamine use disorder are introduced. The challenges of implementing intelligent closed-loop TMS modulation based on multimodal EEG-fNIRS are summarized, followed by a discussion of potential research directions and the promising future of this approach, including potential applications to other substance use disorders.
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Affiliation(s)
- Yun-Hsuan Chen
- CenBRAIN Neurotech Center of Excellence, School of Engineering, Westlake University, Hangzhou, China
- Institute of Advanced Technology, Westlake Institute for Advanced Study, Hangzhou, China
| | - Jie Yang
- CenBRAIN Neurotech Center of Excellence, School of Engineering, Westlake University, Hangzhou, China
- Institute of Advanced Technology, Westlake Institute for Advanced Study, Hangzhou, China
| | - Hemmings Wu
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Kevin T. Beier
- Department of Physiology and Biophysics, University of California, Irvine, Irvine, CA, United States
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, United States
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, United States
- Department of Pharmaceutical Sciences, University of California, Irvine, Irvine, CA, United States
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, Irvine, CA, United States
| | - Mohamad Sawan
- CenBRAIN Neurotech Center of Excellence, School of Engineering, Westlake University, Hangzhou, China
- Institute of Advanced Technology, Westlake Institute for Advanced Study, Hangzhou, China
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Gallop L, Westwood SJ, Lewis Y, Campbell IC, Schmidt U. Effects of transcranial direct current stimulation in children and young people with psychiatric disorders: a systematic review. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02157-0. [PMID: 36764973 DOI: 10.1007/s00787-023-02157-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/26/2023] [Indexed: 02/12/2023]
Abstract
Transcranial direct current stimulation (tDCS) has demonstrated benefits in adults with various psychiatric disorders, but its clinical utility in children and young people (CYP) remains unclear. This PRISMA systematic review used published and ongoing studies to examine the effects of tDCS on disorder-specific symptoms, mood and neurocognition in CYP with psychiatric disorders. We searched Medline via PubMed, Embase, PsychINFO via OVID, and Clinicaltrials.gov up to December 2022. Eligible studies involved multiple session (i.e., treatment) tDCS in CYP (≤ 25 years old) with psychiatric disorders. Two independent raters assessed the eligibility of studies and extracted data using a custom-built form. Of 33 eligible studies (participant N = 517), the majority (n = 27) reported an improvement in at least one outcome measure of disorder-specific symptoms. Few studies (n = 13) examined tDCS effects on mood and/or neurocognition, but findings were mainly positive. Overall, tDCS was well tolerated with minimal side effects. Of 11 eligible ongoing studies, many are sham-controlled RCTs (n = 9) with better blinding techniques and a larger estimated participant enrolment (M = 79.7; range 15-172) than published studies. Although encouraging, the evidence to date is insufficient to firmly conclude that tDCS can improve clinical symptoms, mood, or cognition in CYP with psychiatric disorders. Ongoing studies appear of improved methodological quality; however, future studies should broaden outcome measures to more comprehensively assess the effects of tDCS and develop dosage guidance (i.e., treatment regimens).
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Affiliation(s)
- Lucy Gallop
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, PO Box 59, London, SE5 8AF, UK.
| | - Samuel J Westwood
- Department of Psychology, School of Social Science, University of Westminster, London, W1W 6UW, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AB, UK
| | - Yael Lewis
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, PO Box 59, London, SE5 8AF, UK
- Hadarim Eating Disorder Unit, Shalvata Mental Health Centre, Hod Hasharon, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Iain C Campbell
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, PO Box 59, London, SE5 8AF, UK
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, PO Box 59, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Rezvanian S, Saraei M, Mohajeri H, Hassani-Abharian P. The Effect of Different Transcranial Direct Current Stimulation (tDCS) Protocols on Drug Craving and Cognitive Functions in Methamphetamine Addicts. Basic Clin Neurosci 2022; 13:349-355. [PMID: 36457875 PMCID: PMC9706295 DOI: 10.32598/bcn.13.2.1929.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/23/2019] [Accepted: 10/24/2020] [Indexed: 06/17/2023] Open
Abstract
INTRODUCTION Drug craving is a major problem in addiction treatment. Neuroimaging research has revealed various areas for drug craving, among which two key areas are the Dorsolateral Prefrontal Cortex (DLPFC) and the cerebellum. The DLPFC is involved in different cognitive tasks, such as inhibitory control over seductive options that promise an immediate reward. The cerebellum is related to cognition and memory and activated by drug-related cues. Therefore, we decided to study the effect of Transcranial Direct Current Stimulation (tDCS) on six different protocols in reducing drug craving and increasing cognitive functions in methamphetamine addicts. METHODS The present study is quasi-experimental, with a pre-test-post-test design and a control group. Based on a simple sampling method, 15 male methamphetamine addicts were recruited from two rehabilitation centers in Tehran City, Iran. The participants were aged 18-65 years with a minimum of 12-month history of methamphetamine dependence. The Visual Analog Scale (VAS), the go/no-go task and the n-back task were administered before and after a single session of tDCS. The tDCS was applied on six protocols: 1) the right DLPFC anodal and the left DLPFC cathodal stimulation, 2) the right DLPFC cathodal and the left DLPFC anodal stimulation, 3) the right DLPFC anodal and the right arm cathodal stimulation, 4) the left DLPFC anodal and the left arm cathodal stimulation, 5) the right cerebellar hemisphere (O2) anodal and the left cerebellar hemisphere (O1) cathodal stimulation, and 6) the right cerebellar hemisphere (O2) cathodal and the left cerebellar hemisphere (O1) anodal stimulation. The data were analyzed by covariance method using SPSS software v. 22. RESULTS Study results indicated that while single-session tDCS effects on craving were not significant, it increased cognitive inhibition, especially in protocol 2: the right DLPFC cathodal and the left DLPFC anodal stimulation. CONCLUSION Single-session tDCS affects craving insignificantly, but it can increase cognitive inhibition significantly. These findings support the results of previous studies on the effects of brain stimulation on reducing drug craving in other drug-type settings. HIGHLIGHTS One session of Transcranial Direct Current Stimulation (tDCS) intervention is ineffective for reducing addiction craving in methamphetamine addicts.DCS intervention significantly increases cognitive inhibition.The best results with tDCS intervention in addiction recovery are use of the right DLPFC cathodal stimulation and left DLPFC anodal stimulation protocol. PLAIN LANGUAGE SUMMARY One of the primary concerns in treating addiction is to choose an effective intervention for reducing craving. tDCS is a non-invasive and safe way of reducing craving, which can be used in different ways to decrease addiction craving and treat addiction. While his study founds that one session of tDCS protocols is not effective in reducing the methamphetamine craving, They are effective for increasing cognitive inhibition, which is essential in addiction recovery and saying no to cravings. This effect on the cognitive inhibition ability has important implications for those seeking new and non-invasive addiction recoveries, especially in methamphetamine addiction.
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Affiliation(s)
- Samira Rezvanian
- Department of Cognitive Psychology, Institute for Cognitive Science Studies, Tehran, Iran
| | - Mohammadamin Saraei
- Department of Psychology, School of Psychology, Islamic Azad University, Tehran Medical Branch, Tehran, Iran
| | - Hossein Mohajeri
- Department of Psychology, Allameh Tabataba’i University, Tehran, Iran
| | - Peyman Hassani-Abharian
- Department of Cognitive Rehabilitation, Institute for Cognitive Science Studies, Tehran, Iran
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Transcranial Direct Current Stimulation Enhances Cognitive Function in Patients with Mild Cognitive Impairment and Early/Mid Alzheimer’s Disease: A Systematic Review and Meta-Analysis. Brain Sci 2022; 12:brainsci12050562. [PMID: 35624949 PMCID: PMC9138792 DOI: 10.3390/brainsci12050562] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/18/2022] [Accepted: 04/22/2022] [Indexed: 11/16/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) i a non-invasive brain stimulation which is considered to have the potential to improve cognitive impairment in patients with mild cognitive impairment (MCI) and Alzheimer’s disease (AD). However, previous studies have been controversial on the therapeutic effect of tDCS. This meta-analysis aimed to evaluate the effects of tDCS on cognitive impairment in patients with MCI and mild-to-moderate AD. Five databases, namely PubMed, EMBASE, MEDLINE, Web of Science and The Cochrane Library, were searched with relative terms to extract the cognitive function changes measured by an objective cognitive scale in the included studies. The meta-analysis results showed that, compared with sham tDCS treatment, the overall cognitive function of patients with AD and MCI was significantly improved (weighted mean difference = 0.99; 95% confidence interval, 0.32 to 1.66; p = 0.004) after tDCS treatment, but the behavioral symptoms, recognition memory function, attention and executive function were not significantly improved. The subgroup analysis showed that the treatment would be more efficacious if the temporal-lobe-related brain areas were stimulated, the number of stimulations was greater than or equal to 10 and the current density was 2.5 mA/cm2. Among them, AD patients benefited more than MCI patients. No cognitive improvement was observed in patients with MCI or AD at different follow-up times after treatment. Our meta-analysis provided important evidence for the cognitive enhancement of tDCS in patients with MCI and mild-to-moderate AD and discussed its underlying mechanisms.
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Feasibility and Benefits of Intermittent Multiple tDCS Courses With Concomitant Language Training in Semantic Dementia: A Case Report. Indian J Psychol Med 2022; 45:315-317. [PMID: 37152392 PMCID: PMC10159555 DOI: 10.1177/02537176211072208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Alizadehgoradel J, Nejati V, Sadeghi Movahed F, Imani S, Taherifard M, Mosayebi-Samani M, Vicario CM, Nitsche MA, Salehinejad MA. Repeated stimulation of the dorsolateral-prefrontal cortex improves executive dysfunctions and craving in drug addiction: A randomized, double-blind, parallel-group study. Brain Stimul 2020; 13:582-593. [DOI: 10.1016/j.brs.2019.12.028] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 12/22/2019] [Accepted: 12/26/2019] [Indexed: 01/13/2023] Open
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Sharifi-Fardshad M, Mehraban-Eshtehardi M, Shams-Esfandabad H, Shariatirad S, Molavi N, Hassani-Abharian P. Modulation of Drug Craving in Crystalline-Heroin Users by Transcranial Direct Current Stimulation of Dorsolateral Prefrontal Cortex. ADDICTION & HEALTH 2019; 10:173-179. [PMID: 31105915 PMCID: PMC6511397 DOI: 10.22122/ahj.v10i3.613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background Drug craving, the main cause of relapse and a major motivator for drug use, is a challenging obstacle in substance use treatment. Transcranial direct current stimulation (tDCS), a non-invasive neuromodulatory technique, has shown promising outcomes in treating different neuropsychiatric disorders such as drug addiction, more specifically on drug craving. The aim in the current study was to examine the effects of applying tDCS on dorsolateral prefrontal cortex (DLPFC) in reducing drug cravings in former crystalline-heroin users enrolled in methadone maintenance (MMT) programs. Methods The present study was a semi-experimental, crossover study with pre/post-test, and a control group. 40 right-handed men were selected from former crystalline-heroin users enrolled in MMT programs in Tehran, Iran. They were then divided into two matched groups based on age, education, and age of onset crystalline-heroin abuse. Desire for Drug Questionnaire (DDQ) was administered two times to all of the subjects, before first brain stimulation, and at the end of the last session. Experimental group received TDCS on DLPFC, and sham stimulation was applied on control subjects. The data were analyzed by analysis of covariance (ANCOVA) method using SPSS software. Findings The study results indicated anodal tDCS over right and cathodal TDCS over left DLPFC, and in parallel with sham, significantly decreased drug cravings among former crystalline-heroin users (P < 0.050). Conclusion This study showed that applying TDCS on DLPFC of former crystalline-heroin users reduces drug craving. The findings of this study expanded the results of previous studies on effects of this neuromodulatory technique for drug craving reduction in other drug type settings.
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Affiliation(s)
- Mona Sharifi-Fardshad
- PhD Candidate, Department of Health Psychology, School of Psychology, Karaj Branch, Islamic Azad University, Karaj AND Institute for Cognitive Science Studies, Brain and Cognition Clinic, Tehran, Iran
| | - Mehdi Mehraban-Eshtehardi
- PhD Candidate, Department of Health Psychology, School of Psychology, Rudehen Branch, Islamic Azad University, Rudehen AND Institute for Cognitive Science Studies, Brain and Cognition Clinic, Tehran, Iran
| | - Hassan Shams-Esfandabad
- Associate Professor, Department of Psychology, School of Social Sciences, Imam Khomeini International University, Qazvin, Iran
| | - Schwann Shariatirad
- General Practitioner, Students Research Center of International Campus, Tehran University of Medical Sciences, Tehran, Iran
| | - Nader Molavi
- PhD Candidate, Department of Addiction Studies, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Peyman Hassani-Abharian
- Assistant Professor, Department of Cognitive Rehabilitation, Institute for Cognitive Science Studies, Brain and Cognition Clinic, Tehran, Iran
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Naish KR, Vedelago L, MacKillop J, Amlung M. Effects of neuromodulation on cognitive performance in individuals exhibiting addictive behaviors: A systematic review. Drug Alcohol Depend 2018; 192:338-351. [PMID: 30317162 PMCID: PMC8995136 DOI: 10.1016/j.drugalcdep.2018.08.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND There is growing interest in non-invasive brain stimulation techniques as treatments for addictive disorders. While multiple reviews have examined the effects of neuromodulation on craving and consumption, there has been no review of how neuromodulation affects cognitive functioning in addiction. This systematic review examined studies of the cognitive effects of transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS) in individuals exhibiting addictive behavior. METHODS Articles were identified through searches in PubMed and PsycINFO conducted in October 2017. Eligible studies investigated the effects of tDCS or TMS on cognitive task performance in participants reporting substance use (e.g., alcohol, tobacco, or drugs) or addictive behaviors (e.g., gambling). Tasks were organized into five domains: (1) Inhibitory control, (2) Risk-taking, (3) Impulsive choice (delay discounting), (4) Executive function, and (5) Implicit biases. RESULTS Twenty-four articles met the inclusion criteria. Fifty-seven percent of studies used tDCS and 43% used TMS, with nearly all studies (96%) targeting the dorsolateral prefrontal cortex. Ten studies reported significant within-subject modulation of cognitive functioning associated with active TMS or tDCS, with the same number reporting no change in cognitive performance. Of four studies that included both an experimental and control participant group, three showed between-group differences in the effects of neuromodulation. CONCLUSIONS While positive effects in several studies suggest that tDCS and TMS improve cognitive functioning in addiction, there is substantial heterogeneity across studies. We discuss person-related and methodological factors that could explain inconsistencies, and propose individualized stimulation protocols may sharpen the cognitive effects of neuromodulation in addiction.
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Affiliation(s)
- Katherine R. Naish
- Peter Boris Centre for Addictions Research, St. Joseph’s Healthcare Hamilton and McMaster University 100 West 5th Street, Hamilton, Ontario, L8P 3R2, Canada
| | - Lana Vedelago
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton and McMaster University, 100 West 5th Street, Hamilton, Ontario, L8P 3R2, Canada.
| | - James MacKillop
- Peter Boris Centre for Addictions Research, Michael G. DeGroote Centre for Medicinal Cannabis Research, St. Joseph's Healthcare Hamilton and McMaster University, 100 West 5th Street, Hamilton, Ontario, L8P 3R2, Canada.
| | - Michael Amlung
- Peter Boris Centre for Addictions Research, Michael G. DeGroote Centre for Medicinal Cannabis Research, St. Joseph's Healthcare Hamilton and McMaster University, 100 West 5th Street, Hamilton, Ontario, L8P 3R2, Canada.
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Klauss J, Anders QS, Felippe LV, Ferreira LVB, Cruz MA, Nitsche MA, Nakamura-Palacios EM. Lack of Effects of Extended Sessions of Transcranial Direct Current Stimulation (tDCS) Over Dorsolateral Prefrontal Cortex on Craving and Relapses in Crack-Cocaine Users. Front Pharmacol 2018; 9:1198. [PMID: 30405414 PMCID: PMC6206545 DOI: 10.3389/fphar.2018.01198] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 09/28/2018] [Indexed: 02/02/2023] Open
Abstract
Background: Non-invasive brain stimulation such as transcranial direct current stimulation (tDCS) has been investigated as additional therapeutic tool for drug use disorder. In a previous study, we showed that five sessions of tDCS applied bilaterally over the dorsolateral prefrontal cortex (dlPFC) reduced craving to the use of crack-cocaine in inpatients from a specialized clinic. In the present study, we examine if an extended number of sessions of the same intervention would reduce craving even further and affect also relapses to crack-cocaine use. Methods: A randomized, double-blind, sham-controlled, clinical trial with parallel arms was conducted (https://clinicaltrials.gov/ct2/show/NCT02091167). Crack-cocaine patients from two private and one public clinics for treatment of drug use disorder were randomly allocated to two groups: real tDCS (5 cm × 7 cm, 2 mA, for 20 min, cathodal over the left dlPFC and anodal over the right dlPFC, n = 19) and sham-tDCS (n = 16). Real or sham-tDCS was applied once a day, every other day, in a total of 10 sessions. Craving was monitored by a 5-item obsessive compulsive drinking scale once a week (one time before, three times during and once after brain stimulation) over about 5 weeks and relapse was monitored after their discharge from clinics for up to 60 days. Results: Craving scores progressively decreased over five measurements in both sham- and real tDCS groups. Corrected Hedges’ within-group (initial and final) effect sizes of craving scores were of 0.77 for the sham-tDCS and of 0.97 for the real tDCS group. The between-groups effect size was of 0.34, in favor of the real tDCS group over sham-tDCS group. Relapse rates were high and quite similar between groups in the 30- and 60-days follow-up after discharge from the hospital. Conclusion: Extended repetitive bilateral tDCS over the dlPFC had no add-on effects over regular treatment when considering craving and relapses to the crack-cocaine use in a sample of crack-cocaine patients with severe use disorder. Different tDCS montages targeting other cortical regions and perhaps additional extension of sessions need to be investigated to reach more efficiency in managing craving and relapses to crack-cocaine use.
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Affiliation(s)
- Jaisa Klauss
- Laboratory of Cognitive Sciences and Neuropsychopharmacology, Program of Post-Graduation in Physiological Sciences, Health Sciences Center, Federal University of Espírito Santo, Vitória, Brazil
| | - Quézia Silva Anders
- Laboratory of Cognitive Sciences and Neuropsychopharmacology, Program of Post-Graduation in Physiological Sciences, Health Sciences Center, Federal University of Espírito Santo, Vitória, Brazil
| | - Luna Vasconcelos Felippe
- Laboratory of Cognitive Sciences and Neuropsychopharmacology, Program of Post-Graduation in Physiological Sciences, Health Sciences Center, Federal University of Espírito Santo, Vitória, Brazil
| | - Leonardo Villaverde Buback Ferreira
- Laboratory of Cognitive Sciences and Neuropsychopharmacology, Program of Post-Graduation in Physiological Sciences, Health Sciences Center, Federal University of Espírito Santo, Vitória, Brazil
| | - Mateus Amorim Cruz
- Laboratory of Cognitive Sciences and Neuropsychopharmacology, Program of Post-Graduation in Physiological Sciences, Health Sciences Center, Federal University of Espírito Santo, Vitória, Brazil
| | - Michael Andreas Nitsche
- Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany.,Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
| | - Ester Miyuki Nakamura-Palacios
- Laboratory of Cognitive Sciences and Neuropsychopharmacology, Program of Post-Graduation in Physiological Sciences, Health Sciences Center, Federal University of Espírito Santo, Vitória, Brazil
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Coles AS, Kozak K, George TP. A review of brain stimulation methods to treat substance use disorders. Am J Addict 2018; 27:71-91. [PMID: 29457674 DOI: 10.1111/ajad.12674] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 11/26/2017] [Accepted: 12/16/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Substance use disorders (SUDs) are a leading cause of disability worldwide. While several pharmacological and behavioral treatments for SUDs are available, these may not be effective for all patients. Recent studies using non-invasive neuromodulation techniques including Repetitive Transcranial Magnetic Stimulation (rTMS), Transcranial Direct Current Stimulation (tDCS), and Deep Brain Stimulation (DBS) have shown promise for SUD treatment. OBJECTIVE Multiple studies were evaluated investigating the therapeutic potential of non-invasive brain stimulation techniques in treatment of SUDs. METHOD Through literature searches (eg, PubMed, Google Scholar), 60 studies (2000-2017) were identified examining the effect of rTMS, tDCS, or DBS on cravings and consumption of SUDs, including tobacco, alcohol, cannabis, opioids, and stimulants. RESULTS rTMS and tDCS demonstrated decreases in drug craving and consumption, while early studies with DBS suggest similar results. Results are most encouraging when stimulation is targeted to the Dorsolateral Prefrontal Cortex (DLPFC). CONCLUSIONS Short-term treatment with rTMS and tDCS may have beneficial effects on drug craving and consumption. Future studies should focus on extending therapeutic benefits by increasing stimulation frequency and duration of treatment. SCIENTIFIC SIGNIFICANCE The utility of these methods in SUD treatment and prevention are unclear, and warrants further study using randomized, controlled designs. (Am J Addict 2018;27:71-91).
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Affiliation(s)
- Alexandria S Coles
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Karolina Kozak
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Medical Sciences (IMS), University of Toronto, Toronto, Ontario, Canada
| | - Tony P George
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Medical Sciences (IMS), University of Toronto, Toronto, Ontario, Canada.,Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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