Regier Paul S, Macedo de Arruda Thais Costa, Sinko Laura, Teitelman Anne M, Childress Anna Rose
Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
Psychology and Neuroscience Department, College of Liberal Arts, Temple University, Philadelphia, PA, United States.
Front Psychiatry. 2024 Dec 19;15:1505391. doi: 10.3389/fpsyt.2024.1505391. eCollection 2024.
The ability to adapt to changing circumstances has strong survival value. Individuals with substance use disorders tend to get "stuck" over-responding to drug-reward signals and pursuing drugs despite negative consequences. A lack of flexibility may be tied to impairments in neurocognition, including learning, memory, and executive function. However, results are often mixed, potentially due to heterogeneity in factors such as mental health, personality traits, or prior adversity. This study aimed to identify which factors influence neurocognitive variations within the opioid use disorder (OUD) population. Based on prior literature, we hypothesized that individuals with OUD would show deficits (vs. controls) in one or more neurocognitive domains, and that these cognitive difficulties might be greater in individuals with other known contributors to impaired cognition. This pilot project included 32 individuals receiving medication for OUD and 15 non-substance using controls (NSC). Questionnaires assessed addiction and relapse risk factors, such as impulsiveness, social function, depressive symptoms, and childhood adversity. Neurocognitive performance was measured via the Penn Computerized Neurocognitive Battery (P-CNB), including tasks that probe attention, working memory, episodic memory, cognitive flexibility, and complex cognition, and was compared between the OUD and NSC groups. OUD participants (vs. NSCs) exhibited significantly lower performance on the conditional exclusion task (CET) (Accuracy: 1.11 vs. 2.38, p < 0.001) and the n-Back task (NBT) (F1 Scores: 83% vs. 95%, p < 0.001). Impulsiveness, social function, and depressive symptoms were highly inter-related; however, only higher impulsiveness (r = -.48, p = 0.006) and more social impairment (r = -.47, p = 0.007) significantly correlated with decreased CET (but not n-Back) performance. This pilot study suggests that working memory and cognitive flexibility are impaired in people with OUD and that impulsiveness and social function are key factors in cognitive flexibility impairments in people with OUD. These results may offer insights for larger-scale investigations and potential interventions to reduce relapse risk.
适应不断变化的环境的能力具有很强的生存价值。患有物质使用障碍的个体往往会“陷入困境”，尽管有负面后果，仍会对药物奖励信号过度反应并追求药物。缺乏灵活性可能与神经认知障碍有关，包括学习、记忆和执行功能。然而，结果往往参差不齐，这可能是由于心理健康、人格特质或既往逆境等因素的异质性所致。本研究旨在确定哪些因素会影响阿片类药物使用障碍（OUD）人群的神经认知差异。基于先前的文献，我们假设患有OUD的个体在一个或多个神经认知领域会表现出缺陷（与对照组相比），并且这些认知困难在有其他已知认知受损因素的个体中可能会更大。这个试点项目包括32名接受OUD药物治疗的个体和15名非物质使用对照组（NSC）。问卷调查评估了成瘾和复发风险因素，如冲动性、社交功能、抑郁症状和童年逆境。通过宾夕法尼亚计算机化神经认知测试电池（P-CNB）测量神经认知表现，包括探测注意力、工作记忆、情景记忆、认知灵活性和复杂认知的任务，并在OUD组和NSC组之间进行比较。OUD参与者（与NSC相比）在条件排除任务（CET）（准确率：1.11对2.38，p<0.001）和n-回溯任务（NBT）（F1分数：83%对95%，p<0.001）上表现出显著更低的成绩。冲动性、社交功能和抑郁症状高度相关；然而，只有更高的冲动性（r = -0.48，p = 0.006）和更多的社交障碍（r = -0.47，p = 0.007）与CET成绩下降（但与n-回溯任务无关）显著相关。这项试点研究表明，OUD患者的工作记忆和认知灵活性受损，冲动性和社交功能是OUD患者认知灵活性受损的关键因素。这些结果可能为大规模调查和降低复发风险的潜在干预措施提供见解。
