Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, 1977 Butler Blvd., Ste. E4.163, Houston, TX 77030, USA.
Neuropharmacology. 2013 Jan;64:472-8. doi: 10.1016/j.neuropharm.2012.06.064. Epub 2012 Jul 13.
The purpose of the present study was to determine the effects of modafinil, escitalopram, and modafinil + escitalopram administration on neurocognition in a sample of long-term, high-dose cocaine users.
Sixty-one cocaine-dependent individuals were randomly assigned to receive placebo (n = 14), modafinil, 200 mg, once daily (n = 16), escitalopram, 20 mg, once daily (n = 16), or modafinil and escitalopram, once daily (n = 15), for five days on an inpatient basis. Urinanalysis was used to confirm abstinence from cocaine on the day of admission and the next five days. Baseline neurocognitive assessment, which included measures of attention/information processing, episodic memory, and working memory, was conducted immediately after the washout phase and prior to the administration of modafinil. The follow-up assessment was conducted after participants had received modafinil or placebo for five days.
Repeated-measures, mixed model analysis of variance showed that modafinil administration was associated with significantly improved performance on two measures of working memory span (mean n-back span, maximum n-back span) and a trend toward significant improvement on a measure of visual working memory (visual accuracy) and two measures of sustained attention, consistency of response time (Variability) and reduced impulsivity (Perseveration). Modafinil administration did not modulate performance on measures of information processing speed or episodic memory. Escitalopram did not modulate performance on measures of cognition, either alone or in combination with modafinil.
This study provides initial data showing that, in a sample of long-term, high-dose cocaine users, administration of psychotropic medications, such as modafinil, can improve performance on measures of working memory. Moreover, it confirms the utility of studying the interactive effects of psychotropic medications to confirm the manner in which the candidate medications independently and interactively affect neurocognition. These effects are likely relevant in the treatment of cocaine dependence, in which the remediation of impaired working memory may be associated with improved treatment outcomes. This article is part of a Special Issue entitled 'Cognitive Enhancers'.
本研究旨在确定莫达非尼、依地普仑和莫达非尼+依地普仑给药对长期、高剂量可卡因使用者的神经认知的影响。
61 名可卡因依赖者被随机分配接受安慰剂（n=14）、莫达非尼 200mg 每日一次（n=16）、依地普仑 20mg 每日一次（n=16）或莫达非尼和依地普仑每日一次（n=15），连续五天住院治疗。尿分析用于确认入院当天和接下来五天内可卡因的禁欲。基线神经认知评估，包括注意力/信息处理、情景记忆和工作记忆的测量，在洗脱期后立即进行，然后进行莫达非尼给药。在参与者接受莫达非尼或安慰剂五天后进行随访评估。
重复测量混合模型方差分析显示，莫达非尼给药与两个工作记忆广度的测量（平均 n 回跨度、最大 n 回跨度）显著改善相关，并且在视觉工作记忆（视觉准确性）和两个持续注意力测量（反应时一致性）的测量上有显著改善趋势，冲动性降低（持续）。莫达非尼给药不会调节信息处理速度或情景记忆的测量。依地普仑单独或与莫达非尼联合给药均不会调节认知的测量。
本研究提供了初步数据，表明在长期、高剂量可卡因使用者样本中，给予精神药物（如莫达非尼）可改善工作记忆测量的表现。此外，它证实了研究精神药物相互作用的效用，以确认候选药物独立和相互作用影响神经认知的方式。这些影响可能与可卡因依赖的治疗相关，在治疗中，改善受损的工作记忆可能与改善治疗结果相关。本文是特刊“认知增强剂”的一部分。
