Widespread and sustained cognitive deficits in alcoholism: a meta-analysis

Unfairness sensitivity and equity in severe alcohol use disorder: Insights from the ultimatum game

OBJECTIVES

Severe alcohol use disorder (SAUD) is characterized by social interaction difficulties that play a key role in the persistence of this addictive state. Biased social decision-making might underpin such interpersonal problems. Previous studies exploring social decision-making in SAUD used the ultimatum game - an economic game evaluating sensitivity to unfairness (for the responder) and equity (for the proposer) - and showed increased unfairness sensitivity in SAUD. However, these studies used one-shot designs that are not representative of real-life interactions and focused only on responders, letting much of the phenomenon unexplored.

METHODS

Thirty-five recently detoxified patients with SAUD and 34 matched control participants played four iterated ultimatum games, with variations according to the role (responder vs. proposer) and strategy used by their virtual opponent (fair/easy vs. unfair/difficult). Participants then completed social cognition tasks and psychopathological questionnaires.

RESULTS

As responders, patients with SAUD did not reject fair or unfair offers more often than controls, which contradicts the unfairness sensitivity previously highlighted in one-shot ultimatum games. As proposers, patients with SAUD made more generous offers than controls and did not adapt to their opponent's strategy, which resulted in poorer economic outcomes.

CONCLUSIONS

Patients with SAUD do not display an unfairness sensitivity but are less able to adapt to their opponent, which has detrimental consequences, namely poorer outcomes. They behave differently during one-shot and repeated interactions, probably because - due to their social cognition impairments - they need more time to understand their opponent and overcome their a priori social biases.

Alcohol effects on associative and sensorimotor cortico-thalamo-basal ganglia circuits alter decision making and alcohol intake

Much of the behavioral repertoire of humans and other vertebrates is learned and controlled through the function of brain circuits involving the cortex, thalamus and Basal Ganglia (for simplicity we will refer to this as the Cortico-Thalamo-Basal Ganglia, or CTBG, circuitry). As the name implies, these circuits include the different regions of cortex and thalamus, as well as BG subregions including the striatum, globus pallidus (GP), substantia nigra (SN)/ventral tegmental area (VTA), and the subthalamic nucleus (STN). This circuitry has developed evolutionarily to provide overarching control of actions following discrete environmental events as well as self-initiated actions. Several parallel CTBG circuits have been identified and linked to different aspects of action control under different circumstances. Research in experimental psychology and Neuroscience has established how different CTBG circuits contribute to control of actions based on environmental circumstances and past learning history. There is also a large and growing body of evidence that misused substances, including alcohol, act on cells within these circuits. These actions promote acute intoxication and drug seeking and contribute to changes in behavior induced by chronic alcohol exposure, withdrawal and relapse. Alcohol exposure also influences which of the different CTBG circuits has the strongest influence on behavior. This review will cover the relevant circuitry and describe the current state of knowledge as to how alcohol alters CTBG circuit function and control of behavior. Studies in rodents, non-human primates and humans will be discussed. Finally, ideas for future research directions in this area will be considered.

The Ubiquity of Cognitive Impairment in Human Illness: a Systematic Review of Meta-Analyses

OBJECTIVE

Cognitive dysfunction occurs in many neurological, psychiatric, and other health conditions. This review aimed to characterize the breadth and degree of cognitive morbidity associated with varied health conditions.

METHOD

We systematically reviewed Medline, EMBASE, and Cochrane databases for meta-analyses of cognitive dysfunction associated with any health condition. Meta-analyses were eligible if they reviewed studies that compared patients with health conditions to healthy controls on cognitive testing and provided effect sizes.

RESULTS

We found 91 meta-analyses for 94 health conditions. Among >800,297 participants, healthy controls out-performed clinical participants in every condition on cognitive testing. Mean effect sizes ranged from -2.02 to -0.00 across conditions and were ≤ -0.5 on average, denoting moderate to very severe dysfunction for 41% of them.

CONCLUSIONS

Cognitive dysfunction is ubiquitous in medicine. Both primary care and specialist physicians likely treat patients with cognitive dysfunction. Depending on its severity, cognitive dysfunction can affect treatment adherence, everyday functioning, quality of life, and the capacity to provide informed consent for treatment. These findings highlight the transdiagnostic nature of cognitive symptoms and the potential value of establishing collaborations between physicians and clinical neuropsychologists to integrate cognitive assessment into patient care. Even brief assessments can identify cognitive deficits that likely affect treatment adherence and functional outcomes.

Neural correlates of executive dysfunction in alcohol use disorder: preliminary evidence from 18F-FDG-PET

Neuroimaging studies have shown that cognitive impairments in Alcohol Use Disorder (AUD), particularly involving executive functions, reflect widespread structural and functional brain alterations. However, these findings mostly result from magnetic resonance imaging (MRI). To complement previous MRI findings with a more direct measure of brain metabolism, we therefore explored the neural bases of executive impairments in AUD using FDG-PET. Twenty-three AUD patients and 18 healthy controls underwent a neurocognitive assessment, and patients also an 18F-FDG-PET scan. Using as reference for brain metabolism a FDG-PET dataset of age-matched healthy controls, we assessed a relationship between executive impairment and regional hypometabolism in AUD patients, while also considering a possible moderating age effect. Compared with controls, AUD patients exhibited widespread hypometabolism in the anterior/midcingulate cortex, fronto-insular cortex, and medial precuneus, supporting the hypothesis that their impaired executive performance might reflect an altered transition from automatic to controlled processing. Patients' worse executive performance reflected in higher metabolism in the midcingulate cortex and medial precuneus, suggesting a possible compensatory neural mechanism. This relationship was moderated by age in the right anterior insula, where the decrease of metabolism is steeper, in older patients, at the lowest level of cognitive performance. This finding suggests that an age-related decrease in the compensatory capacity of the insular node of the salience network might contribute to cognitive decline in older patients. While supporting the use of FDG-PET to improve the understanding of AUD-related cognitive decline, and differential diagnosis in older patients, these findings might help design personalized innovative treatment protocols.

The repeatable battery for the assessment of neuropsychological status (RBANS) and substance use disorders: a systematic review

BACKGROUND

Cognitive deficits are prevalent among substance use disorder (SUD) patients and affect treatment retention and outcome. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a well-researched instrument in diverse patient groups and has the potential to serve as an effective and accurate method for identifying cognitive impairment in SUD patients. This systematic review examines the RBANS' ability to detect cognitive impairment in SUD patients. Limitations of knowledge and the need for further research are discussed.

METHODS

We conducted a systematic search using PsycINFO, Medline, and Cochrane databases to identify relevant studies and articles on applying RBANS in SUD. No time limits were imposed on the search. Search words were RBANS, substance use disorder, drug use disorder, and alcohol use disorder, and the most common specific types of drugs (e.g., opiates, cannabis, and methamphetamine).

RESULTS

A systematic search identified 232 articles, of which 17 were found eligible and included in the review. Most studies examined patient groups using either alcohol, methamphetamine, or opioids. The results are presented in the form of a narrative review. We identified some evidence that the RBANS can detect group differences between SUD patients and healthy controls, but the findings were somewhat inconsistent. The literature search revealed little information about cognitive profiles, reliability, factor structure, and construct and criterion validity.

CONCLUSIONS

The evidence concerning the validity and usefulness of the RBANS in SUD populations is scarce. Future research should investigate cognitive profiles, reliability, factor structure, and construct and criterion validity.

Combined stress and alcohol exposure: Synergistic effects on alcohol-seeking behaviors and neuroinflammation

Posttraumatic stress disorder and alcohol use disorder are frequently co-occurring conditions that can create a synergistic effect, worsening symptoms of both disorders. This heightened comorbidity suggests a shared pathological basis rooted in maladaptive learning process that amplifies drug- and fear-related behaviors. The present study investigates the combined effects of stress and chronic alcohol exposure on alcohol-seeking behaviors and neuroinflammation in male and female rats. Additionally, we investigate the potential of metabotropic glutamate receptor type 5 (mGlu5) modulation as a therapeutic strategy for this co-occurring condition. Adult Wistar rats received restraint stress (Stress), chronic intermittent ethanol (CIE) vapor inhalation, both (Stress + CIE), or no exposure (Control). We assessed ethanol self-administration, extinction learning, reinstatement of alcohol-seeking behavior, and tumor necrosis factor-⍺ protein expression in the infralimbic (IfL) and prelimbic subregions of the prefrontal cortex. Additionally, we examined the effects of 3-cyano-N-(1,3-diphenyl-1H-pyrazol-5-yl) benzamide (CDPPB), a mGlu5 positive allosteric modulator, on these outcomes. Stress + CIE exposure significantly increased ethanol self-administration, impaired extinction learning, and heightened reinstatement compared with all other groups. Interestingly, CDPPB treatment improved extinction learning and reduced reinstatement in males but not females. Furthermore, Stress + CIE exposure elevated tumor necrosis factor-⍺ levels specifically in the IfL, and CDPPB normalized this effect in males only. The current study demonstrates a synergistic effect of stress and alcohol exposure on alcohol-seeking behaviors and suggests a potential role for neuroinflammation in the IfL. Our findings also highlight sex-specific therapeutic strategies targeting mGlu5 signaling to prevent relapse in individuals with comorbid posttraumatic stress disorder and alcohol use disorder. SIGNIFICANCE STATEMENT: This research demonstrates that combined stress and alcohol exposure worsen alcohol-seeking behavior in rats, potentially via neuroinflammation in the infralimbic cortex, a region known to be involved in extinction learning. Notably, metabotropic glutamate receptor type 5 modulation was able to prevent alcohol-seeking behaviors and inflammation in a sex-dependent manner. These findings pave the way for developing personalized treatments to prevent relapse in individuals with co-occurring posttraumatic stress disorder/alcohol use disorder.

Concurrent impact of PTSD symptoms and alcohol use on working memory and executive functioning in a U.S. adult sample

Despite high comorbidity between posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) and well-documented independent impacts of each condition on cognitive functioning, few studies have explored the concurrent effects of PTSD and AUD on cognitive control. Recent intervention studies have explored working memory (WM) and executive functioning (EF) as potential treatment targets to improve outcomes for both PTSD and AUD, but there is a need to elucidate concurrent impacts of each condition to inform intervention development. The present study examined WM and EF performance in a sample of U.S. adults in relation to current PTSD symptom and alcohol use (AU) severity. We hypothesized that there would be main effects of both PTSD symptoms and AU severity on WM and EF outcomes, with an exploration of interaction effects. A sample of 112 participants (79% white, 61% female) recruited from a larger survey study also completed follow-up WM and EF tasks. Results did not support our hypotheses regarding main effects of PTSD and AU severity on WM and EF outcomes. Significant age effects were observed on WM measures such that higher age was associated with reduced performance. An interaction effect was detected for one EF measure (decision-making), such that decision-making performances were relatively stable at low to subthreshold PTSD symptoms regardless of AU severity but declined with increasing AU at clinically elevated PTSD symptoms. Findings reflect new information regarding the impact of concurrent PTSD and AU severity on EF, and implications for future research and intervention development are discussed.

Childhood maltreatment and adult aggression: The moderating role of neurocognitive ability and substance use

BACKGROUND

Achieving positive intervention outcomes for aggressive behaviour in adulthood is challenging. This difficulty is enhanced by the complex presentations of those engaging in such behaviours and the impact this has on their engagement with interventions.

OBJECTIVE

This study assessed the cumulative impact of childhood maltreatment, substance use, and neurocognitive ability (working memory, cognitive flexibility, decision making, response inhibition, and cognitive control) on aggressive behaviour in adulthood.

PARTICIPANTS AND SETTING

Adult participants (N = 179; 69 % female) recruited from the community, and clinical and forensic services, aged 18 to 81 (M = 40.5, SD = 15.9).

METHODS

Participants completed an online Qualtrics survey and remote neurocognitive testing via Inquisit.

RESULTS

We implemented an a priori approach, assessing three-way interactions between childhood maltreatment, substance use, neurocognitive ability, and aggression. No three-way interactions were significant. We then utilised a data-driven modelling approach, using automatic linear forward stepwise modelling to identify the most important variables for predicting aggression. Four were significant: physical maltreatment (b = 0.053, p < .001), drug use risk level (b = 0.015, p < .001), poorer response inhibition (b = 0.001, p = .016), and the interaction between poorer response inhibition and physical maltreatment (b = 0.205, p = .017).

CONCLUSIONS

Physical maltreatment in childhood, drug use risk level, and response inhibition impact significantly on adult aggression, indicating a need for early intervention for children who have experienced maltreatment. Consideration should be given to how maltreatment in childhood may impact on ability to engage with interventions as an adult, particularly response inhibition difficulties that may hinder skill implementation.

Cannabidiol (CBD) modulates the transcriptional profile of ethanol-exposed human dermal fibroblast cells

Cannabidiol (CBD) is abundant in the Cannabis sativa plant and exhibits complex immunomodulatory, anxiolytic, antioxidant, and antiepileptic properties. Several studies suggest that CBD could be used for different purposes in alcohol use disorder (AUD) and alcohol-related injuries to the brain and the liver. In this study, we focused on analyzing transcriptional alterations in human dermal fibroblasts (HDFs) cell line challenged simultaneously with ethanol and CBD as an ethanol-protective agent. We aimed to expose the genes and pathways responsible for at least some of the CBD effects in those cells that can be related to the AUD. Transcriptome analysis was performed using HDFs cell line that expresses both cannabinoid receptors and can metabolize ethanol through alcohol dehydrogenase activity. Fibroblasts are also responsible for the progression of liver fibrosis, a common comorbidity in AUD. With the use of a cellular test, we found that CBD at the lowest applied concentration (0.75 μM) was able to stimulate depressed metabolism and reduce the level of apoptosis of cells treated with different concentrations of ethanol to the level observed in the control cells. Similar observations were made at the transcriptome level, in which cells treated with ethanol and CBD had similar expression profiles to the control cells. CBD also affects several genes connected with extracellular matrix formation (especially its collagen constituent), which can have potential implications for, e.g., fibrosis process.

Interneuron-selective HCN channel knockdown in prelimbic cortex of female rats mimics effects of chronic ethanol exposure

Our laboratory has previously shown that chronic ethanol exposure elicits enhanced working memory performance in female, but not male, adult Sprague-Dawley rats, indicative of a fundamental sex difference in cortical plasticity. Recent studies have furthermore revealed that females display markedly reduced HCN-mediated channel activity in inhibitory Martinotti interneurons after chronic ethanol exposure that is similarly not observed in males. From these observations we hypothesized that alcohol induces facilitated working memory performance via down-regulation of these channels' activity specifically within interneurons. To test this hypothesis, we employed a Pol-II compatible shRNA expression system to elicit targeted knockdown of HCN channel activity in these cells, and measured performance on a delayed Non-Match-to-Sample (NMS) T-maze test to gauge effects on working memory performance. A significant baseline enhancement of working memory performance with HCN channel knockdown was observed, indicative of a critical role for interneuron-expressed HCNs in maintaining optimal cortical network activity during cognitively-demanding tasks. Consistent with previous observations, ethanol exposure resulted in enhanced NMS T-maze performance, however elevated working memory performance was observed in both scram- and hcn-shRNA infected groups after alcohol administration. We therefore conclude that interneuron-expressed HCN channels, despite representing a minor population of total cortical HCN expression, contribute substantially to maintaining working memory processes. Downregulated HCN channel activity, though, does not alone appear sufficient to manifest alcohol-induced enhancement of working memory performance observed in female rats during acute withdrawal.

Late-Life Alcohol Exposure Does Not Exacerbate Age-Dependent Reductions in Mouse Spatial Memory and Brain TFEB Activity

Alcohol consumption is believed to affect Alzheimer's disease (AD) risk, but the contributing mechanisms are not well understood. A potential mediator of the proposed alcohol-AD connection is autophagy, a degradation pathway that maintains organelle and protein homeostasis. Autophagy is regulated through the activity of Transcription factor EB (TFEB), which promotes lysosome and autophagy-related gene expression. The purpose of this study is to explore whether chronic alcohol consumption worsens the age-related decline in TFEB-mediated lysosomal biogenesis in the brain and exacerbates cognitive decline associated with aging. To explore the effect of alcohol on brain TFEB and autophagy, we exposed young (3-month-old) and aged (23-month-old) mice to two alcohol-feeding paradigms and assessed biochemical, transcriptome, histology, and behavioral endpoints. In young mice, alcohol decreased hippocampal nuclear TFEB staining but increased SQSTM1/p62, LC3-II, ubiquitinated proteins, and phosphorylated Tau. Hippocampal TFEB activity was lower in aged mice than it was in young mice, and Gao-binge alcohol feeding did not worsen the age-related reduction in TFEB activity. Morris Water and Barnes Maze spatial memory tasks were used to characterize the effects of aging and chronic alcohol exposure (mice fed alcohol for 4 weeks). The aged mice showed worse spatial memory acquisition in both tests. Alcohol feeding slightly impaired spatial memory in the young mice, but had little effect or even slightly improved spatial memory acquisition in the aged mice. In conclusion, aging produces greater reductions in brain autophagy flux and impairment of spatial memory than alcohol consumption.

The effects of previous detoxifications on intelligence, speed, attention, and executive functioning in patients with moderate to severe alcohol use disorder

INTRODUCTION AND AIMS

Repeatedly undergoing supervised, medical, detoxification from chronic alcohol use may contribute to impairments in neurocognitive functioning of patients with an alcohol use disorder (AUD). Unsupervised, non-medical, detoxification, however, may also contribute to neurocognitive impairments, given the absence of first choice prescription medication to counteract severe withdrawal effects. So far, findings from previous studies are inconclusive and specifically effects of non-medical detoxifications are not investigated yet. Using an association modeling approach, this study investigates whether intelligence, speed, attention, and executive functioning are influenced by previous medical and/or non-medical detoxifications.

METHODS

A total of 106 participants with AUD underwent a clinical medical supervised detoxification. Basic characteristics of the patient were recorded including the number of previous medical and non-medical detoxifications. Neuropsychological assessment was conducted after 6 weeks of abstinence.

RESULTS

The amount of previous medical detoxifications (F (1, 87) = 4.108, P = .046) and the group of medical detoxifications (F(1, 87) = 4734, P = .032), predicted performance on one out of 14 dependent variables, i.e. the "d2 Number of Signs" task. Though "Age of onset of daily alcohol use" contributed significantly to this relationship, the change of the regression coefficient of the model was ˂10%. The number of non-medical or total amount of previous detoxifications did not predict any of the dependent variables.

CONCLUSION

The results indicate limited evidence of a linear association between either medical, non-medical, or total amount of previous detoxifications and measures of intelligence, speed, attention, or executive functioning, while controlling for relevant confounders.

Chronic ethanol exposure produces long-lasting, subregion-specific physiological adaptations in RMTg-projecting mPFC neurons

Chronic ethanol exposure produces neuroadaptations in the medial prefrontal cortex (mPFC) that are thought to facilitate maladaptive behaviors that interfere with recovery from alcohol use disorder. Despite evidence that different cortico-subcortical projections play distinct roles in behavior, few studies have examined the physiological effects of chronic ethanol at the circuit level. The rostromedial tegmental nucleus (RMTg) is functionally altered by chronic ethanol exposure. Our recent work identified dense input from the mPFC to the RMTg, yet the effects of chronic ethanol exposure on this circuitry is unknown. In the current study, we examined physiological changes after chronic ethanol exposure in prelimbic (PL) and infralimbic (IL) mPFC neurons projecting to the RMTg. Adult male Long-Evans rats were injected with fluorescent retrobeads into the RMTg and rendered dependent using a 14-day chronic intermittent ethanol (CIE) vapor exposure paradigm. Whole-cell patch-clamp electrophysiological recordings were performed in fluorescently-labeled (RMTg-projecting) and -unlabeled (projection-undefined) layer 5 pyramidal neurons 7-10 days following ethanol exposure. CIE exposure significantly increased intrinsic excitability as well as spontaneous excitatory and inhibitory postsynaptic currents (sE/IPSCs) in RMTg-projecting IL neurons. In contrast, no lasting changes in excitability were observed in RMTg-projecting PL neurons, although a CIE-induced reduction in excitability was observed in projection-undefined PL neurons. CIE exposure also increased the frequency of sEPSCs in RMTg-projecting PL neurons. These data uncover novel subregion- and circuit-specific neuroadaptations in the mPFC following chronic ethanol exposure and reveal that the IL mPFC-RMTg projection is uniquely vulnerable to long-lasting effects of chronic ethanol exposure. This article is part of the Special Issue on "PFC circuit function in psychiatric disease and relevant models".

I Feel I Remember: The Phenomenology of Autobiographical Recall in Individuals with Alcohol Use Disorder

INTRODUCTION

Beyond the memory deficits classically observed in individuals with alcohol use disorder (IwAUD), research has recently focused on the study of autobiographical memory (AM) processes in IwAUD by analysing the content of AM narratives, and the implications for self-conception have been discussed. However, little is known about how IwAUD subjectively experience autobiographical recall.

METHODS

Thirty-seven IwAUD and 37 control participants were invited to perform an AM task that involved recalling memories for 4 life periods (2 important memories per period). Then, they assessed their subjective experience during AM recall using 6 phenomenological scales evaluating emotional valence, emotional intensity, sensory details, distancing, sharing, and vividness. Anxiety and depression symptoms, interoceptive sensibility, and difficulties in emotion regulation were also measured.

RESULTS

The IwAUD experienced greater distancing during AM recall, except during childhood AM recall, indicating that IwAUD are more prone to feeling that the person they are today is different from the person in their retrieved AMs. Very few intergroup differences were observed for AMs from childhood, adolescence-young adulthood, and adulthood, and a greater number of differences were observed for AMs from the last year: the IwAUD experienced AMs with a more negative valence, greater emotional intensity, fewer sensory details, greater distancing, and less sharing. A positive correlation was observed between distancing and interoceptive sensibility in the IwAUD group.

CONCLUSION

Although these results suggest good preservation of autonoetic consciousness in IwAUD, except for more recent AMs, it is insufficient for IwAUD to experience a sense of self-continuity. This difficulty in maintaining a continuous sense of self may constitute a risk for AUD relapse.

Towards a Non-pharmacological Intervention on Apathy in Korsakoff's Syndrome: A Systematic Narrative Review Across Different Clinical Conditions

Abstract

Apathy is a quantitative reduction of goal-directed activity, which can be observed in relation to behavior, cognition, emotions and social interaction. It is an invalidating behavioral symptom that is frequently present across different psychiatric conditions and neurocognitive disorders including Korsakoff's Syndrome (KS). In fact, apathy is one of the most severe behavioral symptoms of KS and has a major impact on the lives of patients and their relatives and other informal caregivers. However, guidelines for the treatment of apathy in KS are currently not available. This systematic narrative review provides a transdiagnostic overview of the effectiveness of different types of non-pharmacological interventions on apathy across different study populations that at symptom-level share characteristics with KS. This evidence may inform the development of an intervention targeting apathy in KS. The included study populations are dementia (due to Alzheimer's disease, or vascular dementia), Parkinson's disease, schizophrenia and traumatic brain injury. Through a stepped selection approach and with regard to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 22 systematic reviews and 32 empirical articles on the non-pharmacological treatment of apathy were identified. The results show a variety of effective non-pharmacological interventions on apathy. In conditions with severe cognitive impairments, successful interventions did not rely on intrinsic motivation, self-monitoring, or illness insight of the patients, but depend on external stimulation and behavioral activation. Since apathy is a multidimensional construct, identification of the extent and type of apathetic behavior before starting an intervention is highly recommended. Furthermore, it is important to adjust the treatment to the patients' personal interests and needs and embedded in daily care.

Trial registration

CRD42022298464 (PROSPERO).

Targeting muscarinic receptors for the treatment of alcohol use disorders: Opportunities and hurdles for clinical development

Emerging evidence suggests muscarinic acetylcholine receptors represent novel targets to treat alcohol use disorder. In this review, we draw from literature across medicinal chemistry, molecular biology, addiction and learning/cognition fields to interrogate the proposition for muscarinic receptor ligands in treating various aspects of alcohol use disorder, including cognitive dysfunction, motivation to consume alcohol and relapse. In support of this proposition, we describe cholinergic dysfunction in the pathophysiology of alcohol use disorder at a network level, including alcohol-induced adaptations present in both human post-mortem brains and reverse-translated rodent models. Preclinical behavioural pharmacology implicates specific muscarinic receptors, in particular, M4 and M5 receptors, as potential therapeutic targets worthy of further interrogation. We detail how these receptors can be selectively targeted in vivo by the use of subtype-selective allosteric modulators, a strategy that overcomes the issue of targeting a highly conserved orthosteric site bound by acetylcholine. Finally, we highlight the intense pharma interest in allosteric modulators of muscarinic receptors for other indications that provide an opportunity for repurposing into the alcohol use disorder space and provide some currently unanswered questions as a roadmap for future investigation.

Is severe alcohol use disorder really associated with increased utilitarian moral judgment? Exploration using the CNI model

OBJECTIVES

The psychology of moral decision-making classically contrasts utilitarianism (based on consequences) and deontology (based on moral norms). Previous studies capitalizing on this dichotomy have suggested the presence of a utilitarian bias among patients with severe alcohol use disorder (SAUD). We aimed to further disentangle the processes involved in such bias through a more validated approach, the CNI model of moral decision-making. This model allows to go further than the classical approach by distinguishing sensitivity to consequences (C), to moral norms (N), and general preference for inaction over action (I) in response to moral dilemmas.

METHODS

Thirty-four recently detoxified patients with SAUD and 34 matched control participants completed a battery of 48 dilemmas derived from the CNI model, as well as social cognition tasks.

RESULTS

In contrast with the utilitarian bias suggested in previous studies based on the classical approach, patients with SAUD did not show an increased sensitivity to consequences in comparison with control participants. However, they showed a reduced sensitivity to moral norms, as well as a greater action tendency. These biases were not related to social cognition deficits.

CONCLUSIONS

Patients with SAUD are not more utilitarian than healthy controls, this previously reported bias being artificially generated by the methodological limits of the classical approach. Instead, they present a reduced sensitivity to moral norms and an action bias, which might impact their interpersonal relations and contribute to the social isolation frequently reported in this population, thus identifying moral decision-making as a new therapeutic lever in SAUD.

Ethanol drinking sex-dependently alters cortical IL-1β synaptic signaling and cognitive behavior in mice

Individuals with alcohol use disorder (AUD) struggle with inhibitory control, decision making, and emotional processing. These cognitive symptoms reduce treatment adherence, worsen clinical outcomes, and promote relapse. Neuroimmune activation is a key factor in the pathophysiology of AUD, and targeting this modulatory system is less likely to produce unwanted side effects compared to directly targeting neurotransmitter dysfunction. Notably, the cytokine interleukin-1β (IL-1β) has been broadly associated with the cognitive symptoms of AUD, though the underlying mechanisms are not well understood. Here we investigated how chronic intermittent 24-hour access two bottle choice ethanol drinking affects medial prefrontal cortex (mPFC)-related cognitive function and IL-1 synaptic signaling in male and female C57BL/6J mice. In both sexes, ethanol drinking decreased reference memory and increased mPFC IL-1 receptor 1 (IL-1R1) mRNA levels. In neurons, IL-1β can activate either pro-inflammatory or neuroprotective intracellular pathways depending on the isoform of the accessory protein (IL-1RAcP) recruited to the IL-1R1 complex. Moreover, ethanol drinking sex-dependently shifted mPFC IL-1RAcP isoform gene expression and IL-1β regulation of mPFC GABA synapses, both of which may contribute to female mPFC resiliency and male mPFC susceptibility. This type of signaling bias has become a recent focus of rational drug development. Therefore, in addition to increasing our understanding of how IL-1β sex-dependently contributes to mPFC dysfunction in AUD, our current findings also support the development of a new class of pharmacotherapeutics based on biased IL-1 signaling.

Sex differences in distributed error-related neural activation in problem-drinking young adults

BACKGROUND

Detecting and responding to errors is central to goal-directed behavior and cognitive control and is thought to be supported by a network of structures that includes the anterior cingulate cortex and anterior insula. Sex differences in the maturational timing of cognitive control systems create differential periods of vulnerability for psychiatric conditions, such as substance use disorders.

METHODS

We examined sex differences in error-related activation across an array of distributed brain regions during a Go/No-Go task in young adults with problem alcohol use (N=69; 34 females; M=19.4 years). Regions of interest previously linked to error-related activation, including anterior cingulate cortex, insula, and frontoparietal structures, were selected in a term-based meta-analysis. Individual differences in their responses to false alarm (FA) inhibitory errors relative to "go" trials (FA>GO) and correct rejections (FA>CR) were indexed using multivariate summary measures derived from principal components analysis.

RESULTS

FA>GO and FA>CR activation both revealed a first component that explained the majority of the variance across error-associated regions and displayed the strongest loadings on salience network structures. Compared to females, males exhibited significantly higher levels of the FA>GO component but not the FA>CR component.

CONCLUSIONS

Males exhibit greater salience network activation in response to inhibitory errors, which could be attributed to sex differences in error-monitoring processes or to other functions (e.g., novelty detection). The findings are relevant for the further characterization of sex differences in cognitive control and may have implications for understanding individual differences in those at risk for substance use or other cognitive control disorders.

Five Challenges in Implementing Cognitive Remediation for Patients with Substance Use Disorders in Clinical Settings

Many patients with substance use disorders (SUDs) present cognitive deficits, which are associated with clinical outcomes. Neuropsychological remediation might help rehabilitate cognitive functions in these populations, hence improving treatment effectiveness. Nardo and colleagues (Neuropsychology Review, 32, 161-191, 2022) reviewed 32 studies applying cognitive remediation for patients with SUDs. They underlined the heterogeneity and lack of quality of studies in this research field but concluded that cognitive remediation remains a promising tool for addictive disorders. We capitalize on the insights of this review to identify the key barriers that currently hinder the practical implementation of cognitive remediation in clinical settings. We outline five issues to be addressed, namely, (1) the integration of cognitive remediation in clinical practices; (2) the selection criteria and individual factors to consider; (3) the timing to be followed; (4) the priority across trained cognitive functions; and (5) the generalization of the improvements obtained. We finally propose that cognitive remediation should not be limited to classical cognitive functions but should also be extended toward substance-related biases and social cognition, two categories of processes that are also involved in the emergence and persistence of SUDs.

Benefits of exercise on cognitive impairment in alcohol use disorder following alcohol withdrawal

Although most cognitive impairments induced by prolonged alcohol consumption tend to improve within the initial months of abstinence, there is evidence suggesting certain cognitive deficits may persist. This study aimed to investigate the impact of aerobic exercise on learning and memory in alcohol use disorder (AUD) mice following a period of abstinence from alcohol. We also sought to assess the levels of monoamine neurotransmitters in the hippocampus. To this end, we established an AUD mouse model through a two-bottle choice (sucrose fading mode and normal mode) and chronic intermittent alcohol vapor (combined with intraperitoneal injection) and randomly allocated mice into exercise groups to undergo treadmill training. Learning and memory abilities were assessed through the Morris water maze test and spontaneous activity was evaluated using the open field test. The levels of dopamine, norepinephrine, serotonin, and brain-derived neurotrophic factor in the hippocampus were quantified using enzyme-linked immunoassay (ELISA) kits. The findings reveal that after cessation of alcohol consumption, learning and memory abilities in AUD mice did not completely return to normal levels. The observed enhancement of cognitive functions in AUD mice through aerobic exercise may be attributed to restoring levels of monoamine neurotransmitters in the hippocampus, boosting brain-derived neurotrophic factor (BDNF) concentrations, and facilitating an increase in hippocampal mass. These results offer empirical evidence to support aerobic exercise as a viable therapeutic strategy to alleviate cognitive deficits associated with AUD.

Neurocognitive and clinical profile of male patients with substance use disorder in early remission phase with and without comorbid depression

Substance Use Disorder (SUD) represents one of the most frequent conditions worldwide which commonly coexists with major depressive disorder (MDD). This comorbidity (SUD + MDD) is one of the most prevalent with patients showing certain social and clinical characteristics that could lead to a worsening of their cognitive performance. However, despite these particularities, only a few studies have addressed the possible differences in cognitive performance between patients with SUD + MDD compared with those with SUD-only patients. Therefore, the aim of this study is to examine the clinical and cognitive profile of patients with SUD + MDD vs. SUD-only who are in early remission phase. For this purpose, 271 male patients underwent a clinical and neuropsychological assessment (SUD + MDD group: N = 101; SUD-only group: N = 170). Results indicated that SUD + MDD patients showed worse cognitive performance than SUD in visuospatial reasoning, verbal memory and learning, recognition, and processing speed even after a 3-month period of abstinence. Furthermore, these patients exhibited more self-reported prefrontal symptoms, as well as worse social and clinical conditions. This study indicates that the neurocognitive and clinical profile of patients with SUD + MDD could represent a risk since their characteristics have been associated with poorer recovery and prognosis. Our results could be helpful in clinical practice highlighting the need for cognitive remediation strategies in these populations, providing information that would allow the implementation of more appropriate treatments and preventive strategies.

The Association between Individual Food Groups, Limbic System White Matter Tracts, and Episodic Memory: Initial Data from the Aiginition Longitudinal Biomarker Investigation of Neurodegeneration (ALBION) Study

(1) Background: Many studies link food intake with clinical cognitive outcomes, but evidence for brain biomarkers, such as memory-related limbic white matter (WM) tracts, is limited. We examined the association between food groups, limbic WM tracts integrity, and memory performance in community-dwelling individuals. (2) Methods: We included 117 non-demented individuals (ALBION study). Verbal and visual episodic memory tests were administered, and a composite z-score was calculated. Diffusion tensor imaging tractography was applied for limbic WM tracts (fornix-FX, cingulum bundle-CB, uncinate fasciculus-UF, hippocampal perforant pathway zone-hPPZ). Food intake was evaluated through four 24-h recalls. We applied linear regression models adjusted for demographics and energy intake. (3) Results: We found significant associations between (a) higher low-to-moderate alcohol intake and higher FX fractional anisotropy (FA), (b) higher full-fat dairy intake and lower hPPZ FA, and (c) higher red meat and cold cuts intake and lower hPPZ FA. None of the food groups was associated with memory performance. (4) Conclusions: Despite non-significant associations between food groups and memory, possibly due to participants' cognitive profile and/or compensatory mechanisms, the study documented a possible beneficial role of low-to-moderate alcohol and a harmful role of full-fat dairy and red meat and cold cuts on limbic WM tracts.

Human laboratory models of reward in substance use disorder

Human laboratory models in substance use disorder provide a key intermediary step between highly controlled and mechanistically informative non-human preclinical methods and clinical trials conducted in human populations. Much like preclinical models, the variety of human laboratory methods provide insights into specific features of substance use disorder rather than modelling the diverse causes and consequences simultaneously in a single model. This narrative review provides a discussion of popular models of reward used in human laboratory research on substance use disorder with a focus on the specific contributions that each model has towards informing clinical outcomes (forward translation) and analogs within preclinical models (backward translation). Four core areas of human laboratory research are discussed: drug self-administration, subjective effects, behavioral economics, and cognitive and executive function. Discussion of common measures and models used, the features of substance use disorder that these methods are purported to evaluate, unique issues for measure validity and application, and translational links to preclinical models and special considerations for studies wishing to evaluate homology across species is provided.

Alcohol use disorder and fitness to drive: Discrepancies between health professionals' evaluations and objective measures of alcohol use and cognitive functioning

Aims: In this study, we investigated if health professionals' evaluations of driving ability corresponded with measures of severity of alcohol use and measures of cognitive functions necessary for safely driving a car. Methods: A total of 90 participants from a multicentre study were included. Participants were categorised into three groups: (1) the group judged fit to drive (FIT); (2) the group judged not fit to drive (UNFIT); and (3) the group who had lost their driver's licence due to legal sanctions (LEGAL). The participants' AUDIT scores, earlier treatment episodes and results from neuropsychological tests of reaction time, attention and visuospatial ability were included in the analyses. Results: We found a significant difference in the severity of alcohol use disorder (AUD) and visuospatial abilities between the FIT and UNFIT groups. Half of the UNFIT group had at least mild visuospatial difficulties, compared to only a quarter in the FIT group. There were no group differences in reaction time or attentional measures. The LEGAL group had more severe AUD than the other groups. Conclusion: The FIT group did not perform differently from the UNFIT group on attention and reaction time measures. The UNFIT group had more visuospatial impairments, but even half of this group had normal scores. It is uncertain whether the differences between the two groups are of practical significance. The quality of health professionals' evaluations may be questioned, and the results highlight the need for more reliable and valid criteria for doing fitness to drive evaluations.

Alcohol milestones and internalizing, externalizing, and executive function: longitudinal and polygenic score associations

BACKGROUND

Although the link between alcohol involvement and behavioral phenotypes (e.g. impulsivity, negative affect, executive function [EF]) is well-established, the directionality of these associations, specificity to stages of alcohol involvement, and extent of shared genetic liability remain unclear. We estimate longitudinal associations between transitions among alcohol milestones, behavioral phenotypes, and indices of genetic risk.

METHODS

Data came from the Collaborative Study on the Genetics of Alcoholism (n = 3681; ages 11-36). Alcohol transitions (first: drink, intoxication, alcohol use disorder [AUD] symptom, AUD diagnosis), internalizing, and externalizing phenotypes came from the Semi-Structured Assessment for the Genetics of Alcoholism. EF was measured with the Tower of London and Visual Span Tasks. Polygenic scores (PGS) were computed for alcohol-related and behavioral phenotypes. Cox models estimated associations among PGS, behavior, and alcohol milestones.

RESULTS

Externalizing phenotypes (e.g. conduct disorder symptoms) were associated with future initiation and drinking problems (hazard ratio (HR)⩾1.16). Internalizing (e.g. social anxiety) was associated with hazards for progression from first drink to severe AUD (HR⩾1.55). Initiation and AUD were associated with increased hazards for later depressive symptoms and suicidal ideation (HR⩾1.38), and initiation was associated with increased hazards for future conduct symptoms (HR = 1.60). EF was not associated with alcohol transitions. Drinks per week PGS was linked with increased hazards for alcohol transitions (HR⩾1.06). Problematic alcohol use PGS increased hazards for suicidal ideation (HR = 1.20).

CONCLUSIONS

Behavioral markers of addiction vulnerability precede and follow alcohol transitions, highlighting dynamic, bidirectional relationships between behavior and emerging addiction.

Cognitive deficits persisting in patients with alcohol dependence syndrome after detoxification

Background

Alcohol-related cognitive deficits (ARCDs) have received little clinical recognition due to doubts regarding the etiopathogenesis and lack of consensus in the diagnostic guidelines.

Aim

The present study aimed at evaluating the pattern of cognitive deficits in patients of alcohol dependence without dementia, and assessing the relationship between these subtle cognitive deficits and alcohol use parameters.

Materials and Methods

The study included randomly selected, consenting, non-delirious patients of alcohol dependence syndrome (ADS) without dementia, admitted in the de-addiction ward. Cognition was assessed by Mini Mental State Examination (MMSE) of the Diagnostic Interview for Genetic Studies at admission and after 7 days of detoxification. "T-test" was used to assess cognitive improvement and residual deficits, while correlation analysis was used to compare the relationship between alcohol use parameters and MMSE scores.

Results

We recruited 63 male patients with mean age of 38.62 (±9.61) years. Significant improvement was noted in cognition post-detoxification. However, most of the subjects had subtle cognitive deficits which may fall within the realm of ARCD, mainly in domains of attention/concentration, recall, language, and visuo-constructional skills (P < 0.05). The cognitive deficits correlated with duration and severity of alcohol dependence (P < 0.05), however, were independent of daily alcohol quantity.

Conclusion

Subtle cognitive deficits may persist in patients of ADS without dementia, even after successful detoxification. They may be easily missed despite contact with mental health professionals, as these deficits may only be evident on neuro-psychological testing.

Subjective and objective assessments of executive functions are independently predictive of aggressive tendencies in patients with substance use disorder

BACKGROUND AND AIMS

Impairments in executive functions have been found to influence violent behavior. Executive functions are crucial in the treatment of patients with substance use disorders because substance use generally impairs cognitive processes and is therefore detrimental for executive functions thereby reducing control of behavior and thus of consumption impulses. We studied correlations between subjective, i.e. self-report, and objective, i.e. behavior-based, assessment of executive functions and the predictive validity of these measures for aggression in patients with substance use disorder.

METHODS

The study included 64 patients with a diagnosed substance use disorder who were convicted according to the German Criminal Code for crimes they committed in the context of their disorder and were therefore in treatment in forensic psychiatric departments in Germany. Multiple self-report and behavior-based instruments were used to assess executive functions, appetitive and facilitative aggression as well as clinical and sociodemographic variables.

RESULTS

Participants showed impaired executive functions, and measures of executive functions predicted aggressive tendencies and violent offenses. Despite ecological validity of the findings, the subjective and objective assessments of executive functions did not correlate with each other, which corroborates studies in other clinical settings.

CONCLUSIONS

We discuss that this finding may be due to the conceptual differences between subjective and objective measures. Therefore, self-report and behavior-based measures should not be used as proxies of each other but as complementary measures that are useful for comprehensive diagnostics of cognitive impairments and assessment of risks for violent behavior.

Cognitive Alterations Associated with Remission and Alcohol Dependence Severity in Ethnically Diverse Patients of Siberia

Background

Impaired cognition in individuals with alcohol dependence may be associated with increased relapse risk. It has been recorded in more than half of patients during six months after treatment. In certain ethnic groups, for example, Tuvinians, the indigenous people of Siberia, relapses occur in extremely short periods of one to three months after treatment. An approach currently used to alcohol dependence treatment may be less effective for these patients.

Objective

The study aimed to investigate cognitive sequelae in indigenous Tuvinian patients with alcohol dependence.

Methods

The sample included 166 patients, 74 of indigenous ethnicity (Tuvinians) and 92 non-indigenous white patients. Data on inhibitory control, cognitive flexibility, attention, and working memory were collected from all the patients and processed using cluster analysis. The clustering data were then complemented by indicators of disorder dynamics, impulsivity, and emotion regulation.

Results

The clustering procedure revealed groups with severe cognitive sequelae. More than four-fold attention decrease was found in 43.5% of non-indigenous patients, and more impaired cognitive flexibility was revealed among 60.8% of indigenous patients. Groups with severe cognitive sequelae had higher impulsivity, maladaptive emotion regulation, more hospitalizations, faster disease progression, and shorter remissions. The latter was significantly reduced to 90 days on average in the severe group of indigenous patients versus 135 days of remission in the non-indigenous severe group.

Conclusion

Results obtained may advance tailored intervention in alcohol-dependent patients of the indigenous Tuvinian ethnicity. While little is still known about the alcohol dependence course and consequences in the indigenous Tuvinians of Siberia, this study contributes to the global mental health data on alcohol abuse and dependence in indigenous communities.

Changes in processing speed during early abstinence from alcohol dependence

BACKGROUND

Processing speed is a task-independent construct underpinning more complex goal-related abilities. Processing speed is impaired in alcohol dependence (AD) and is linked to relapse, as are the functions it underpins. Reliable measurement of processing speed may allow tracking of AD recovery trajectories and identify patients requiring additional support.

AIMS

To assess changes in reaction time (RT) from baseline (at the start of a detoxification programme) across early abstinence.

METHODS

Vibrotactile RT was assessed in early recovery between days 3 and 7 of treatment in 66 individuals with AD (25 females; aged 19-74, 44.60 ± 10.60 years) and against 35 controls tested on one occasion (19 females; 41.00 ± 13.60), using two multivariate multiple regressions. A mixed multivariate analysis of covariance (MANCOVA) of available AD data (n = 45) assessed change in RT between timepoints and between treatment settings (outpatient vs inpatient).

RESULTS

The group (AD vs control) significantly predicted choice RT at baseline and follow-up but did not significantly predict simple RT or RT variability, which is inconsistent with previous findings. At follow-up, mental fatigue was also predicted by the group, and MANCOVA indicated that this had worsened in inpatients but improved in outpatients.

CONCLUSIONS

Recovery of RT measures so early in the treatment journey was not in line with previous research which indicates persisting deficits. The interaction between setting and timepoint indicates that despite being typically less medically complex, outpatients require ongoing support and monitoring during their recovery.

Self-Reported Disability Type and Risk of Alcohol-Induced Death - A Longitudinal Study Using Nationally Representative Data

BACKGROUND

Disability is associated with alcohol misuse and drug overdose death, however, its association with alcohol-induced death remains understudied.

OBJECTIVE

To quantify the risk of alcohol-induced death among adults with different types of disabilities in a nationally representative longitudinal sample of US adults.

METHODS

Persons with disabilities were identified among participants ages 18 or older in the Mortality Disparities in American Communities (MDAC) study (n = 3,324,000). Baseline data were collected in 2008 and mortality outcomes were ascertained through 2019 using the National Death Index. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were estimated for the association between disability type and alcohol-induced death, controlling for demographic and socioeconomic covariates.

RESULTS

During a maximum of 12 years of follow-up, 4000 alcohol-induced deaths occurred in the study population. In descending order, the following disability types displayed the greatest risk of alcohol-induced death (compared to adults without disability): complex activity limitation (aHR = 1.7; 95% CI = 1.3-2.3), vision limitation (aHR = 1.6; 95% CI = 1.2-2.0), mobility limitation (aHR = 1.4; 95% CI = 1.3-1.7), ≥2 limitations (aHR = 1.4; 95% CI = 1.3-1.6), cognitive limitation (aHR = 1.2; 95% CI = 1.0-1.4), and hearing limitation (aHR = 1.0; 95% CI = 0.9-1.3).

CONCLUSIONS

The risk of alcohol-induced death varies considerably by disability type. Efforts to prevent alcohol-induced deaths should be tailored to meet the needs of the highest-risk groups, including adults with complex activity (i.e., activities of daily living - "ALDs"), vision, mobility, and ≥2 limitations. Early diagnosis and treatment of alcohol use disorder within these populations, and improved access to educational and occupational opportunities, should be considered as prevention strategies for alcohol-induced deaths.

Sex-difference in the association between social drinking, structural brain aging and cognitive function in older individuals free of cognitive impairment

Background

We investigated a potential sex difference in the relationship between alcohol consumption, brain age gap and cognitive function in older adults without cognitive impairment from the population-based Mayo Clinic Study of Aging.

Methods

Self-reported alcohol consumption was collected using the food-frequency questionnaire. A battery of cognitive testing assessed performance in four different domains: attention, memory, language, and visuospatial. Brain magnetic resonance imaging (MRI) was conducted using 3-T scanners (Signa; GE Healthcare). Brain age was estimated using the Brain-Age Regression Analysis and Computational Utility Software (BARACUS). We calculated the brain age gap as the difference between predicted brain age and chronological age.

Results

The sample consisted of 269 participants [55% men (n=148) and 45% women (n=121) with a mean age of 79.2 ± 4.6 and 79.5 ± 4.7 years respectively]. Women had significantly better performance compared to men in memory, (1.12 ± 0.87 vs 0.57 ± 0.89, P<0.0001) language (0.66 ± 0.8 vs 0.33 ± 0.72, P=0.0006) and attention (0.79 ± 0.87 vs 0.39 ± 0.83, P=0.0002) z-scores. Men scored higher in visuospatial skills (0.71 ± 0.91 vs 0.44 ± 0.90, P=0.016). Compared to participants who reported zero alcohol drinking (n=121), those who reported alcohol consumption over the year prior to study enrollment (n=148) scored significantly higher in all four cognitive domains [memory: F3,268 = 5.257, P=0.002, Language: F3,258 = 12.047, P<0.001, Attention: F3,260 = 22.036, P<0.001, and Visuospatial: F3,261 = 9.326, P<0.001] after correcting for age and years of education. In addition, we found a significant positive correlation between alcohol consumption and the brain age gap (P=0.03). Post hoc regression analysis for each sex with language z-score revealed a significant negative correlation between brain age gap and language z-scores in women only (P=0.008).

Conclusion

Among older adults who report alcohol drinking, there is a positive association between higher average daily alcohol consumption and accelerated brain aging despite the fact that drinkers had better cognitive performance compared to zero drinkers. In women only, accelerated brain aging is associated with worse performance in language cognitive domain. Older adult women seem to be vulnerable to the negative effects of alcohol on brain structure and on certain cognitive functions.

Liraglutide Reduces Alcohol Consumption, Anxiety, Memory Impairment, and Synapse Loss in Alcohol Dependent Mice

Glucagon-like peptide 1 (GLP-1) analogues have been commercialized for the management of type 2 diabetes. Recent studies have underscored GLP-1's role as a modulator of alcohol-related behavior. However, the role of the GLP-1 analogue liraglutide on alcohol-withdrawal responses have not been fully elucidated. Liraglutide binds to the G-protein-coupled receptor and activates an adenylyl cyclase and the associated classic growth factor signaling pathway, which acts growth factor-like and neuroprotective properties. The underlying neurobiological mechanisms of liraglutide on alcohol withdrawal remains unknown. This study endeavored to explore the effects of liraglutide on the emotion and memory ability of alcohol-withdrawal mice, and synaptic morphology in the medial prefrontal cortex (mPFC) and the hippocampus (HP), and thus affects the relapse-like drinking of alcohol-withdrawal mice. The alcohol-withdrawal group was reintroduced to a 20% v/v alcohol and water through the two-bottle choice for four consecutive days, a period referred to as alcohol re-drinking. Male C57BL/6J mice were exposed to a regimen of 20% alcohol and water for a duration of 6 weeks. This regimen established the two-bottle choice model of alcohol exposure. Learning capabilities, memory proficiency, and anxiety-like behavior were evaluated using the Morris water maze, open field, and elevated plus maze paradigms. Furthermore, synaptic morphology and the levels of synaptic transport-related proteins were assessed via Golgi staining and Western Blot analysis after a two-week alcohol deprivation period. Alcohol re-drinking of alcohol-withdrawal mice was also evaluated using a two-bottle choice paradigm. Our findings indicate that liraglutide can substantially decrease alcohol consumption and preference (p < 0.05) in the alcohol group and enhance learning and memory performance (p < 0.01), as well as alleviate anxiety-like behavior (p < 0.01) of alcohol-withdrawal mice. Alcohol consumption led to a reduction in dendritic spine density in the mPFC and HP, which was restored to normal levels by liraglutide (p < 0.001). Furthermore, liraglutide was found to augment the levels of synaptic transport-related proteins in mice subjected to alcohol withdrawal (p < 0.01). The study findings corroborate that liraglutide has the potential to mitigate alcohol consumption and ameliorate the memory impairments and anxiety induced by alcohol withdrawal. The therapeutic efficacy of liraglutide might be attributed to its role in counteracting synapse loss in the mPFC and HP regions and thus prevented relapse-like drinking in alcohol-withdrawal mice.

The potential of 5-methoxy-N,N-dimethyltryptamine in the treatment of alcohol use disorder: A first look at therapeutic mechanisms of action

Alcohol use disorder (AUD) remains one of the most prevalent psychiatric disorders worldwide with high economic costs. Current treatment options show modest efficacy and relapse rates are high. Furthermore, there are increases in the treatment gap and few new medications have been approved in the past 20 years. Recently, psychedelic-assisted therapy with psilocybin and lysergic acid diethylamide has garnered significant attention in the treatment of AUD. Yet, they require significant amounts of therapist input due to prolonged subjective effects (~4-12 h) leading to high costs and impeding implementation. Accordingly, there is an increasing interest in the rapid and short-acting psychedelic 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT). This paper offers a first look at potential therapeutic mechanisms for AUD by reviewing the current literature on 5-MeO-DMT. Primarily, 5-MeO-DMT is able to induce mystical experiences and ego-dissolution together with increases in psychological flexibility and mindfulness. This could decrease AUD symptoms through the alleviation of psychiatric mood-related comorbidities consistent with the negative reinforcement and self-medication paradigms. In addition, preliminary evidence indicates that 5-MeO-DMT modulates neural oscillations that might subserve ego-dissolution (increases in gamma), psychological flexibility and mindfulness (increases in theta), and the reorganization of executive control networks (increases in coherence across frequencies) that could improve emotion regulation and inhibition. Finally, animal studies show that 5-MeO-DMT is characterized by neuroplasticity, anti-inflammation, 5-HT2A receptor agonism, and downregulation of metabotropic glutamate receptor 5 with clinical implications for AUD and psychiatric mood-related comorbidities. The paper concludes with several recommendations for future research to establish the purported therapeutic mechanisms of action.

A Meta-Analysis of Functional Neuroimaging Studies of Ketamine Administration in Healthy Volunteers

Ketamine administration leads to a psychotomimetic state when taken in large bolus doses, making it a valid model of psychosis. Therefore, understanding ketamine's effects on brain functioning is particularly relevant. This meta-analysis focused on neuroimaging studies that examined ketamine-induced brain activation at rest and during a task. Included are 10 resting-state studies and 23 task-based studies, 9 of which were measuring executive functions. Using a stringent statistical threshold (TFCE <0.05), the results showed increased activity at rest in the dorsal anterior cingulate cortex (ACC), and increased activation of the right Heschl's gyrus during executive tasks, following ketamine administration. Uncorrected results showed increased activation at rest in the right (anterior) insula and the right-fusiform gyrus, as well as increased activation during executive tasks in the rostral ACC. Rest-state studies highlighted alterations in core hubs of the salience network, while task-based studies suggested an impact on task-irrelevant brain regions. Increased activation in the rostral ACC may indicate a failure to deactivate the default mode network during executive tasks following ketamine administration. The results are coherent with alterations found in schizophrenia, which confer external validity to the ketamine model of psychosis. Studies investigating the neural mechanisms of ketamine's antidepressant action are warranted.

The neurocognitive correlates of non-substance addictive behaviors

Neurocognitive deficits have been implicated as transdiagnostic risk markers of substance use disorders. However, these have yet to be comprehensively evaluated in other, non-substance addictions. In a large, general community sample (N = 475) the present study evaluated the neurocognitive correlates of problem alcohol use and three non-substance-related addictive behaviors: addictive eating (AE), problematic pornography use (PPU), and problematic use of the internet (PUI), to identify potential shared and distinct neurocognitive correlates. A sample of Australian residents (54.4 % female M[SD] age = 32.4[11.9] years) completed a comprehensive online assessment of neurocognitive tasks tapping into eight distinct expert-endorsed domains purportedly associated with addiction. Multiple linear regressions with bootstrapping were used to examine associations among each addictive behavior of interest and neurocognition, trait impulsivity, and compulsivity, as well as key covariates. Neurocognition was differentially associated with each addictive behavior. None of the neurocognitive domains were significantly associated with problematic alcohol use or AE (p >.05), poorer performance monitoring was significantly associated with higher levels of PPU and PUI (β = -0.10, p =.049; β = -0.09, p =.028), and a preference for delayed gratification was associated with more severe PUI (β = -0.10, p =.025). Our findings have theoretical implications for how we understand non-substance addiction and suggest the need for a more nuanced approach to studying addictive behaviors that take into account the underlying neurocognitive mechanisms associated with each type of addiction.

Late-Life Alcohol Exposure Does Not Exacerbate Age-Dependent Reductions in Mouse Spatial Memory and Brain TFEB Activity

Alcohol consumption is believed to affect Alzheimer's disease (AD) risk, but the contributing mechanisms are not well understood. A potential mediator of the proposed alcohol-AD connection is autophagy, a degradation pathway that maintains organelle and protein homeostasis. Autophagy is in turn regulated through the activity of Transcription factor EB (TFEB), which promotes lysosome and autophagy-related gene expression. To explore the effect of alcohol on brain TFEB and autophagy, we exposed young (3-month old) and aged (23-month old) mice to two alcohol-feeding paradigms and assessed biochemical, transcriptome, histology, and behavioral endpoints. In young mice, alcohol decreased hippocampal nuclear TFEB staining but increased SQSTM1/p62, LC3-II, ubiquitinated proteins, and phosphorylated Tau. Hippocampal TFEB activity was lower in aged mice than it was in young mice, and Gao-binge alcohol feeding did not worsen the age-related reduction in TFEB activity. To better assess the impact of chronic alcohol exposure, we fed young and aged mice alcohol for four weeks before completing Morris Water and Barnes Maze spatial memory testing. The aged mice showed worse spatial memory on both tests. While alcohol feeding slightly impaired spatial memory in the young mice, it had little effect or even slightly improved spatial memory in the aged mice. These findings suggest that aging is a far more important driver of spatial memory impairment and reduced autophagy flux than alcohol consumption.

Problematic alcohol use and its impact on liver disease quality of life in a multicenter study of patients with cirrhosis

BACKGROUND

Management of cirrhosis is challenging and has been complicated by the COVID-19 pandemic due to decreased access to care, increased psychological distress, and alcohol misuse. Recently, The National Institute on Alcohol Abuse and Alcoholism has broadened the definition of recovery from alcohol use disorder to include quality of life (QoL) as an indicator of recovery. This study examined the associations of alcohol-associated cirrhosis etiology and problematic drinking with liver disease QoL (LDQoL).

METHODS

Patients with cirrhosis (N=329) were recruited from 3 sites (63% from 2 Veterans Affairs Health Care Systems and 37% from 1 safety net hospital) serving populations that are economically or socially marginalized. Cirrhosis etiology was ascertained by chart review of medical records. Problematic drinking was defined by ≥8 on the Alcohol Use Disorders Identification Test. Multivariable general linear modeling adjusting for age, sex, race/ethnicity, site, pandemic-related stress, and history of anxiety/depressive disorder were conducted. Sensitivity analyses further adjusted for indicators of liver disease severity.

RESULTS

Participants were on average 64.6 years old, 17% female, 58% non-White, 44% with alcohol-associated cirrhosis, and 17% with problematic drinking. Problematic drinking was significantly associated with worse LDQoL scores in the overall scale and in the memory/concentration and health distress subscales. These associations remained significant after adjusting for indicators of liver disease severity, including Model for End-Stage Liver Disease-Sodium score and decompensated cirrhosis status.

CONCLUSIONS

Among patients with cirrhosis, problematic drinking was associated with worse LDQoL, especially in the domains of memory/concentration and health distress. Assessment and awareness of cognitive deficits and negative emotionality within the context of cirrhosis and problematic drinking may help clinicians provide better integrated care for this population.

Recovery of neuropsychological function following abstinence from alcohol in adults diagnosed with an alcohol use disorder: Systematic review of longitudinal studies

BACKGROUND

Alcohol use disorders (AUD) associate with structural and functional brain differences, including impairments in neuropsychological function; however, reviews (mostly cross-sectional) are inconsistent with regards to recovery of such functions following abstinence. Recovery is important, as these impairments associate with treatment outcomes and quality of life.

OBJECTIVE(S)

To assess neuropsychological function recovery following abstinence in individuals with a clinical AUD diagnosis. The secondary objective was to assess predictors of neuropsychological recovery in AUD.

METHODS

Following the preregistered protocol (PROSPERO: CRD42022308686), APA PsycInfo, EBSCO MEDLINE, CINAHL, and Web of Science Core Collection were searched between 1999-2022. Study reporting follows the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis, study quality was assessed using the JBI Checklist for Cohort Studies. Eligible studies were those with a longitudinal design that assessed neuropsychological recovery following abstinence from alcohol in adults with a clinical diagnosis of AUD. Studies were excluded if participant group was defined by another or co-morbid condition/injury, or by relapse. Recovery was defined as function reaching 'normal' performance.

RESULTS

Sixteen studies (AUD n = 783, controls n = 390) were selected for narrative synthesis. Most functions demonstrated recovery within 6-12 months, including sub-domains within attention, executive function, perception, and memory, though basic processing speed and working memory updating/tracking recovered earlier. Additionally, verbal fluency was not impaired at baseline (while verbal function was not assessed compared to normal levels), and concept formation and reasoning recovery was inconsistent.

CONCLUSIONS

These results provide evidence that recovery of most functions is possible. While overall robustness of results was good, methodological limitations included lack of control groups, additional methods to self-report to confirm abstinence, description/control for attrition, statistical control of confounds, and of long enough study durations to capture change.

Whole Brain and Corpus Callosum Fractional Anisotropy Differences in Patients with Cognitive Impairment

Diffusion tensor imaging (DTI) is an MRI analysis method that could help assess cognitive impairment (CI) in the ageing population more accurately. In this research, we evaluated fractional anisotropy (FA) of whole brain (WB) and corpus callosum (CC) in patients with normal cognition (NC), mild cognitive impairment (MCI), and moderate/severe cognitive impairment (SCI). In total, 41 participants were included in a cross-sectional study and divided into groups based on Montreal Cognitive Assessment (MoCA) scores (NC group, nine participants, MCI group, sixteen participants, and SCI group, sixteen participants). All participants underwent an MRI examination that included a DTI sequence. FA values between the groups were assessed by analysing FA value and age normative percentile. We did not find statistically significant differences between the groups when analysing CC FA values. Both approaches showed statistically significant differences in WB FA values between the MCI-SCI and MCI-NC groups, where the MCI group participants showed the highest mean FA and highest mean FA normative percentile results in WB.

Measuring self-regulation in everyday life: Reliability and validity of smartphone-based experiments in alcohol use disorder

Self-regulation, the ability to guide behavior according to one's goals, plays an integral role in understanding loss of control over unwanted behaviors, for example in alcohol use disorder (AUD). Yet, experimental tasks that measure processes underlying self-regulation are not easy to deploy in contexts where such behaviors usually occur, namely outside the laboratory, and in clinical populations such as people with AUD. Moreover, lab-based tasks have been criticized for poor test-retest reliability and lack of construct validity. Smartphones can be used to deploy tasks in the field, but often require shorter versions of tasks, which may further decrease reliability. Here, we show that combining smartphone-based tasks with joint hierarchical modeling of longitudinal data can overcome at least some of these shortcomings. We test four short smartphone-based tasks outside the laboratory in a large sample (N = 488) of participants with AUD. Although task measures indeed have low reliability when data are analyzed traditionally by modeling each session separately, joint modeling of longitudinal data increases reliability to good and oftentimes excellent levels. We next test the measures' construct validity and show that extracted latent factors are indeed in line with theoretical accounts of cognitive control and decision-making. Finally, we demonstrate that a resulting cognitive control factor relates to a real-life measure of drinking behavior and yields stronger correlations than single measures based on traditional analyses. Our findings demonstrate how short, smartphone-based task measures, when analyzed with joint hierarchical modeling and latent factor analysis, can overcome frequently reported shortcomings of experimental tasks.

Predicting alcohol use with subjective and objective measures of cognitive function in healthy college students

Objective: The current study examined the association between subjective and objective cognitive measures and alcohol use in college students. Objective cognitive impairment is associated with alcohol use, however subjective cognitive impairment remains understudied in at-risk populations. Participants: Data were collected from 140 undergraduate students at a mid-sized private university. Methods: We used the Behavior Rating Inventory for Executive Function-Adult (BRIEF-A) and the Rey-Osterrieth Complex Figure Task (ROCF) as our subjective and objective measures of cognitive functioning respectively. Results: In our regression model, the BRIEF-A was significantly associated with the AUDIT in college students such that more poorly perceived cognitive functioning predicted higher degrees of problematic drinking. However, the relationship between the ROCF and drinking was less clear. Conclusions: Our study shows that perception of one's cognitive functioning is related to alcohol use and may be a potential risk factor for hazardous drinking in college students. Our results also suggest that subjective functioning is more strongly related to alcohol use than objective functioning, however further research is needed to replicate our results.

Anterior cingulate metabolite levels, memory, and inhibitory control in abstinent men and women with alcohol use disorder

Alcohol use disorder (AUD) has been shown to have harmful cognitive and physiological effects, including altered brain chemistry. Further, although men and women may differ in vulnerability to the neurobiological effects of AUD, the results of existing studies have been conflicting. We examined brain metabolite levels and cognitive functions in a cross-section of men with AUD (AUDm) and women with AUD (AUDw) to determine the degree of abnormalities after extended periods of abstinence (mean, 6 years) and to evaluate gender differences in neuropsychological and metabolite measures. Participants were 40 abstinent individuals with AUD (22 AUDw, 18 AUDm) and 50 age-equivalent non-AUD comparison participants (26 NCw, 24 NCm). Proton magnetic resonance spectroscopy (MRS) was employed at 3 Tesla to acquire metabolite spectra from the dorsal anterior cingulate cortex (dACC). Brain metabolites N-acetyl aspartate (NAA), choline (Cho), myo-Inositol (mI), and glutamate & glutamine (Glx) were examined relative to measures of memory and inhibitory control. Metabolite levels did not differ significantly between AUD and NC groups. Memory and inhibitory-control impairments were observed in the AUD group. There also were significant group-specific associations between metabolite ratios and measures of inhibitory control. There were no group-by-gender interactions for the four metabolite ratios. These findings demonstrate that brain metabolite levels in men and women with AUD, following long-term abstinence, do not differ from individuals without AUD. The data also provide preliminary evidence of sustained associations between metabolite levels and measures of inhibitory control, a functional domain important for curtailing harmful drinking.

Impaired Executive Functioning Associated with Alcohol-Related Neurocognitive Disorder including Korsakoff's Syndrome

(1) Background: chronic alcohol use is consistently associated with impaired executive functioning, but its profile across the spectrum from mild to major alcohol-related cognitive impairment is, to date, unclear. This study aims to compare executive performances of patients with alcohol-induced neurocognitive disorder, including Korsakoff's syndrome (KS), by using a computerized assessment battery allowing a fine-grained and precise neuropsychological assessment; (2) Methods: performances of 22 patients with alcohol-related cognitive impairment (ARCI) and 20 patients with KS were compared to those of 22 matched non-alcoholic controls. All participants were diagnosed in accordance with DSM-5-TR criteria and were at least six weeks abstinent from alcohol prior to assessment. Executive function was evaluated using four subtests of Cambridge Neuropsychological Test Automated Battery (CANTAB®); (3) Results: significant differences between groups were found on spatial working memory (updating), sustained attention and inhibitory control, set shifting, and planning. Healthy controls performed significantly better than both patient groups (Games-Howell post hoc; p < 0.05), but no differences in performance were found between the ARCI and KS group; (4) Conclusions: ARCI and KS patients showed significant executive impairments, most prominent in updating, set-shifting and general planning abilities. Findings suggest equivalent levels of executive function in ARCI and KS patients. Our results highlight executive function as a significant hallmark of alcohol-induced neurocognitive disorder and stipulate the importance of early assessment and evaluation of skills to guide treatment.

Astrocyte Reactivity and Neurodegeneration in the Female Rat Brain Following Alcohol Dependence

Recent evidence suggests that alcohol use disorder (AUD) may manifest itself differently in women compared to men. Women experience AUDs on an accelerated timeline and may have certain regional vulnerabilities. In male rats, neuronal cell death and astrocyte reactivity are noted following induction of alcohol dependence in an animal model of an AUD. However, the regional and temporal patterns of neurodegeneration and astrocyte reactivity have yet to be fully examined in females using this model. Therefore, adult female rats were exposed to a 4-day binge model of alcohol dependence followed by different periods of abstinence. Histological markers for FluoroJade B, a label of degenerating neurons, and vimentin, a marker for reactive astrocytes, were utilized. The expression of these markers in cortical and limbic regions was quantified immediately after their last dose (e.g., T0), or 2, 7, and 14 days later. Significant neuronal cell death was noted in the entorhinal cortex and the hippocampus, similar to previous reports in males, but also in several cortical regions not previously observed. Vimentin immunoreactivity was noted in the same regions as previously reported, in addition to three novel regions. Vimentin immunoreactivity also occurred at earlier and later time points in some cortical and hippocampal regions. These data suggest that both neuronal cell death and astrocyte reactivity could be more widespread in females compared to males. Therefore, this study provides a framework for specific regions and time points which should be examined in future studies of alcohol-induced damage that include female rats.

Efficacy of covert sensitization for a patient with alcohol use disorder with memory impairment: A case report

Alcohol use disorder is a chronic, relapsing and remitting illness with limited efficacy of pharmacotherapy in preventing relapse. Several non-pharmacological treatment options are usually used to improve treatment outcomes. In this case report, the patient with alcohol use disorder (as per Diagnostic and Statistical Manual 5th edition criteria) had memory impairments, which was seen to limit the effectiveness of cognitive approaches such as motivational enhancement therapy. Covert sensitization, a behavioral technique based on operant conditioning, was considered an alternative option along with pharmacotherapy to enhance abstinence and was seen to be effective in creating an association between alcohol use and unpleasant consequences in the patient. We observed an improvement in subjective craving and motivation to abstain following the therapy sessions. This highlights the use of covert sensitization as an alternative non-pharmacological intervention for patients with alcohol use disorder with cognitive impairments.

Neurocognitive Recovery in Abstinent Patients with Alcohol Use Disorder: A Scoping Review for Associated Factors

Objective

Studies have reported inconsistent results regarding the extent to which neurocognitive recovery occurs in abstinent patients with alcohol use disorder (AUD). In addition to abstinence, other factors may have influenced this process and contributed to the inconsistencies. This review examines the factors investigated in this regard and describes the possible influence of each factor based on the evidence collected.

Methodology

PubMed was systematically searched for articles published between January 2000 and July 2023. Longitudinal humane studies investigating neurocognitive recovery in abstinent adult AUD patients were included. Studies with a cross-sectional design were excluded, as were studies that did not classify AUD according to the DSM-IV or 5 criteria, only examined binge use, did not report neuropsychological outcomes or duration of abstinence, or where neurological disorders were present.

Results

Sixteen categories of factors were distinguished from 31 full-text articles. Consistent patterns were found, indicating an association between neurocognitive recovery and the "smoking" and 'brain volume" factors. Consistent patterns were also found indicating that there is no relationship with "quantities of alcohol used" and "education level." A similar consistent pattern was also found for "polysubstance use", "gender" and "verbal reading", but the number of studies is considered limited. The association with "age" is studied frequently but with inconsistent findings. The remaining eight factors were regarded as understudied.

Conclusion

The clearest patterns emerging from the evidence are a predominantly negative influence of smoking on neurocognitive recovery, associations between changes in brain area volume and neurocognitive recovery, and no association between neurocognitive recovery and the amount of alcohol consumed, as measured by self-report, nor with educational attainment. Future research on the understudied factors and factors with inconsistent evidence is needed, preferably through longitudinal designs with multiple assessment periods starting after at least two weeks of abstinence.

The Complexity of Impulsivity Dimensions among Abstinent Individuals with Substance Use Disorders

Impulsivity is a complex construct that has been operationalized considering personality dimensions (e.g., negative urgency [NU], lack of perseverance [LPe], lack of premeditation [LPr], positive urgency [PU]), and neuropsychological processes (i.e., cognitive disinhibition, motor disinhibition, impulsive decision-making). Empirical research suggested that they could represent core features of substance use disorders (SUDs). However, there are no studies that have comprehensively assessed them among patients with SUDs. Furthermore, the quality of relationships among such domains remains unclear. The current case-control study included 59 abstinent patients with SUDs and 56 healthy controls (HCs). There were two independent assessment phases: i) the administration of UPPS-P impulsive behavior scale; ii) a computerized neuropsychological battery (i.e., Attentional Network Test, Go/No-Go task, Iowa Gambling task). Patients with SUDs reported higher levels of NU and PU than HCs. NU, LPe, and LPr were associated to the co-occurrence of multiple SUDs. Motor disinhibition was the core dimension of SUDs. Cognitive disinhibition and Impulsive decision-making were also associated to SUDs. Self-report and neuropsychological dimensions of impulsivity were not correlated within the clinical group. HCs showed significant associations among these domains of impulsivity. Impulsivity should be viewed as a complex system of personality traits and neuropsychological processes among individuals with SUDs.

A Novel, Expert-Endorsed, Neurocognitive Digital Assessment Tool for Addictive Disorders: Development and Validation Study

BACKGROUND

Many people with harmful addictive behaviors may not meet formal diagnostic thresholds for a disorder. A dimensional approach, by contrast, including clinical and community samples, is potentially key to early detection, prevention, and intervention. Importantly, while neurocognitive dysfunction underpins addictive behaviors, established assessment tools for neurocognitive assessment are lengthy and unengaging, difficult to administer at scale, and not suited to clinical or community needs. The BrainPark Assessment of Cognition (BrainPAC) Project sought to develop and validate an engaging and user-friendly digital assessment tool purpose-built to comprehensively assess the main consensus-driven constructs underpinning addictive behaviors.

OBJECTIVE

The purpose of this study was to psychometrically validate a gamified battery of consensus-based neurocognitive tasks against standard laboratory paradigms, ascertain test-retest reliability, and determine their sensitivity to addictive behaviors (eg, alcohol use) and other risk factors (eg, trait impulsivity).

METHODS

Gold standard laboratory paradigms were selected to measure key neurocognitive constructs (Balloon Analogue Risk Task [BART], Stop Signal Task [SST], Delay Discounting Task [DDT], Value-Modulated Attentional Capture [VMAC] Task, and Sequential Decision-Making Task [SDT]), as endorsed by an international panel of addiction experts; namely, response selection and inhibition, reward valuation, action selection, reward learning, expectancy and reward prediction error, habit, and compulsivity. Working with game developers, BrainPAC tasks were developed and validated in 3 successive cohorts (total N=600) and a separate test-retest cohort (N=50) via Mechanical Turk using a cross-sectional design.

RESULTS

BrainPAC tasks were significantly correlated with the original laboratory paradigms on most metrics (r=0.18-0.63, P<.05). With the exception of the DDT k function and VMAC total points, all other task metrics across the 5 tasks did not differ between the gamified and nongamified versions (P>.05). Out of 5 tasks, 4 demonstrated adequate to excellent test-retest reliability (intraclass correlation coefficient 0.72-0.91, P<.001; except SDT). Gamified metrics were significantly associated with addictive behaviors on behavioral inventories, though largely independent of trait-based scales known to predict addiction risk.

CONCLUSIONS

A purpose-built battery of digitally gamified tasks is sufficiently valid for the scalable assessment of key neurocognitive processes underpinning addictive behaviors. This validation provides evidence that a novel approach, purported to enhance task engagement, in the assessment of addiction-related neurocognition is feasible and empirically defensible. These findings have significant implications for risk detection and the successful deployment of next-generation assessment tools for substance use or misuse and other mental disorders characterized by neurocognitive anomalies related to motivation and self-regulation. Future development and validation of the BrainPAC tool should consider further enhancing convergence with established measures as well as collecting population-representative data to use clinically as normative comparisons.

Alcohol Use Predicts Face Perception Impairments and Difficulties in Face Recognition

Background: Risky alcohol use is related to a variety of cognitive impairments, including memory and visuo-perceptual difficulties. Remarkably, no prior work has assessed whether usage of alcohol can predict difficulties perceiving facial identity. Objectives: Therefore, this study aimed to investigate whether riskier alcohol consumption predicted impairments in face perception and self-reported difficulties in face recognition. Results: Participants (N = 239, male = 77) were over 18 years old and had normal or corrected-to-normal vision. Alcohol use was assessed using the Alcohol Use Disorder Identification Test (AUDIT), while face recognition difficulties were determined by the 20-item Prosopagnosia Index questionnaire (PI20). A subsample of participants (N = 126, male = 51) completed the Cambridge Face Perception task (CFPT) to assess their face perception ability. Multiple linear regressions showed significant models of prediction on both face perception and face recognition when considering AUDIT score and age as predictors. Conclusion: This study suggested, for the first time, that risky alcohol use predicts both poorer visuo-perceptual processing for faces and self-reported difficulties in face recognition.