Department of Clinical & Experimental Psychology, University of Huelva, Avda. Fuerzas Armadas, 21017 Huelva, Spain.
Department of Clinical & Experimental Psychology, University of Huelva, Avda. Fuerzas Armadas, 21017 Huelva, Spain; Red de Trastornos Adictivos, University of Granada, Campus de Cartuja S/N, 18071 Granada, Spain.
Neurosci Biobehav Rev. 2016 Dec;71:772-801. doi: 10.1016/j.neubiorev.2016.09.030. Epub 2016 Oct 25.
This systematic review aims to examine growing evidence linking cognitive-executive functions with addiction treatment outcomes, and to discuss significant cognitive predictors drawing upon addiction neuroscience theory. We conducted a systematic search to identify studies using measures of general cognition and executive functions in patients with substance use disorders for the purpose of predicting two treatment outcomes: therapeutic adherence and relapse. Forty-six studies were selected, and sample characteristics, timing of assessments, and cognitive measures were analyzed. We observed significant methodological differences across studies, resulting in substantial variability in the relationships between cognitive-executive domains and treatment outcomes. Notwithstanding this variability, we found evidence of associations, of medium effect size, between general cognition and treatment adherence, and between reward-based decision-making and relapse. The link between general cognition and treatment adherence is consistent with emerging evidence linking limited cognitive-executive resources with less ability to benefit from talk therapies. The link between reward-based decision-making and relapse accords with decision neuroscience models of addiction. Findings may inform preclinical and clinical research concerning addiction treatment mechanisms.
本系统评价旨在考察认知-执行功能与成瘾治疗结果之间日益增多的关联证据，并根据成瘾神经科学理论讨论重要的认知预测因素。我们进行了系统检索，以确定使用物质使用障碍患者的一般认知和执行功能测量来预测两种治疗结果的研究：治疗依从性和复发。选择了 46 项研究，并分析了样本特征、评估时间和认知测量。我们观察到研究之间存在显著的方法学差异，导致认知-执行领域与治疗结果之间的关系存在很大的可变性。尽管存在这种可变性，但我们发现一般认知与治疗依从性之间存在关联，且具有中等效应大小，以及奖励决策与复发之间存在关联。一般认知与治疗依从性之间的联系与新兴证据一致，该证据表明有限的认知-执行资源与从谈话疗法中获益的能力降低有关。奖励决策与复发之间的联系与成瘾的决策神经科学模型一致。研究结果可能为成瘾治疗机制的临床前和临床研究提供信息。
