多物质使用障碍中的神经认知与抑制控制：与酒精使用障碍的比较及戒断后的变化
Neurocognition and inhibitory control in polysubstance use disorders: Comparison with alcohol use disorders and changes with abstinence.
作者信息
Schmidt Thomas P, Pennington David L, Cardoos Stephanie L, Durazzo Timothy C, Meyerhoff Dieter J
机构信息
a Department of Radiology , Northern California Institute for Research and Education , San Francisco , CA , USA.
b Department of Radiology , San Francisco Veterans Affairs Medical Center , San Francisco , CA , USA.
出版信息
J Clin Exp Neuropsychol. 2017 Feb;39(1):22-34. doi: 10.1080/13803395.2016.1196165. Epub 2016 Oct 3.
INTRODUCTION
Intact neurocognition and early cognitive recovery during abstinence are important for substance use treatment outcome. Yet, little is known about them in the largest group of treatment seekers today, individuals with polysubstance use disorders (PSU). This study primarily contrasted PSU and individuals with an alcohol use disorder (AUD) on neurocognitive and inhibitory control measures and, secondarily, measured changes during abstinence in PSU.
METHOD
At one month of abstinence from all substances except tobacco, 36 PSU and 69 AUD completed neurocognitive assessments of executive function, general intelligence, auditory-verbal learning/memory, visuospatial learning/memory/skills, processing speed, working memory, fine motor skills, and cognitive efficiency. The groups were also assessed on inhibitory control measures of self-reported impulsivity, risk-taking, and decision-making. Seventeen PSU repeated the assessments after approximately four months of abstinence. All cross-sectional and longitudinal analyses included smoking status as a possible confound.
RESULTS
At baseline, PSU performed significantly worse than AUD on auditory-verbal memory and on an inhibitory control measure of impulsivity. Polysubstance users showed trends to worse performance than AUD on general intelligence, auditory-verbal learning, and a decision-making task. Between one and four months of abstinence, PSU showed significant improvements on several neurocognitive and inhibitory control measures.
CONCLUSIONS
Polysubstance users exhibit distinct differences in neurocognition and inhibitory control compared to AUD. Between one and four months of abstinence, neurocognition and inhibitory control improve in PSU. This neurocognitive recovery in some domains of abstinent PSU is influenced by smoking status. These results underscore the clinical value of select methods to augment neurocognitive recovery in PSU through appropriate interventions.
引言
戒断期间完整的神经认知功能和早期认知恢复对物质使用治疗结果很重要。然而，在当今最大的寻求治疗人群——多物质使用障碍（PSU）个体中，我们对这些情况知之甚少。本研究主要对比了PSU个体与酒精使用障碍（AUD）个体在神经认知和抑制控制指标上的差异，其次，测量了PSU个体在戒断期间的变化。
方法
在除烟草外所有物质戒断一个月时，36名PSU个体和69名AUD个体完成了对执行功能、一般智力、听觉语言学习/记忆、视觉空间学习/记忆/技能、处理速度、工作记忆、精细运动技能和认知效率的神经认知评估。两组还接受了自我报告的冲动性、冒险行为和决策等抑制控制指标的评估。17名PSU个体在戒断约四个月后重复了这些评估。所有横断面和纵向分析都将吸烟状况作为一个可能的混杂因素纳入。
结果
在基线时，PSU个体在听觉语言记忆和冲动性抑制控制指标上的表现明显比AUD个体差。多物质使用者在一般智力、听觉语言学习和一项决策任务上的表现有比AUD个体更差的趋势。在戒断1至4个月期间，PSU个体在多项神经认知和抑制控制指标上有显著改善。
结论
与AUD个体相比，多物质使用者在神经认知和抑制控制方面表现出明显差异。在戒断1至4个月期间，PSU个体的神经认知和抑制控制能力有所改善。戒断的PSU个体某些领域的这种神经认知恢复受吸烟状况影响。这些结果强调了通过适当干预增强PSU个体神经认知恢复的特定方法的临床价值。
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