Medicine, Nursing and Health Sciences

Cognitive impairment and cognitive recovery in substance related disorders

A/Prof. Antonio Verdejo-GarciaCatania, July 2015

Cognition and Outcomes 2

Outline1. Cognition -- What is it (for)?

2. Subtyping/Matching

3. Prediction

4. Cognitive remediation

Cognition and Outcomes 3

Updating and management OF input-independent info FOR goal-achievement and decision-making

Cognition and Outcomes 4

3 D 5 B 1 H / 1 3 5 B D H

DX

D

RED GREEN BLUE

RED GREEN BLUE

Cognition and Outcomes 5Moreno-López et al. (2012)

6

Gray Matter

White MatterMoreno-López et al. (2012)

Factor Analysis of Executive Functions

Components Measures Factor Load

h2

Updating Letter Number Sequencing

0.5-0.8 0.53-0.73

Inhibition Stroop 0.7-0.8 0.51-0.63

Switching Wisconsin Card Sorting Test

0.5-0.9 0.45-0.74

Decision-making Iowa Gambling Task

0.9 0.83

Verdejo-García & Perez-Garcia (2007)

Stimulants vs Opiate users

IGT Performance

-8

-6

-4

-2

0

2

4

6

8

10

block 1 block 2 block 3 block 4 block 5

Bloque

IGT

Sco

re [

(C+

D)

- (A

+B

)] Cocaine

Heroin

Controls

0

20

40

60

80

100

120

FAS DesignFluency

LNS Arithmetic Digits SpatialSpan

Similarities CBT

Neuropsych. Tests (Updating)

Ra

w s

co

res

Cocaine

Heroin

Controls

-5

0

5

10

15

20

25

30

Stroop 5DT Interference 5DT Shifting

Neuropsych. Tests (Inhibition)

Ra

w s

co

res

Cocaine

Heroin

Controls

*

0

10

20

30

40

50

60

70

Category Test Go/No Go WCST

Neuropsych. Tests (Shifting)

Ra

w s

co

res

(E

rro

rs)

Cocaine

Heroin

Controls

*

*

Verdejo-García & Perez-Garcia (2007)

Cognition and Outcomes 9

Components Prevalence Rate Drug of choice

w/greater deficits

Working memory 62.2 % C=H

Response Inhibition 38.3 % C>H

Shifting 27.3 % C>H

Global Impairment 68.8 %

Focus of current interventions (MI or CBT)

Life goals

Self-control and self-monitoring

Avoid risk

Cognition and Outcomes 10

Focus of current interventions (MI or CBT)

Life goals

Self-control and self-monitoring

Avoid risk

Cognition and Outcomes 11

Mismatch between impaired working

memory, inhibition or decision-making

and treatment re

quisites

What cognition may add…

Subtyping/Matching

Prediction

Focused interventions

Cognition and Outcomes 12

Neuropsychological Assessment

Cognitive Rehabilitation

Cognition and Outcomes 13Albein-Urios et al. (2013, 2014)

Cognition and Outcomes 14

LCA of trait and cognitive impulsivity scores in 96

addiction clients

Albein-Urios et al. (2014)

Cognition and Outcomes 15

Albein-Urios et al. (2013)

Cognition and Outcomes 16

Albein-Urios et al. (2013)

Cognition and Outcomes 17

Albein-Urios et al. (2013)

Cognition and Outcomes 18

Albein-Urios et al. (2013)

Medicine, Nursing and Health Sciences

Prediction of at risk clients

Key cognitive processes

Delay Discounting

Decision-making

Cognition and Outcomes 20

Delay discounting

28th February 2011Presentation title 21

Marshmallows! http://www.youtube.com/watch?v=QX_oy9614HQ

Peters and Buchel (2011) TICS: 11(5)

22Christakou et al. (2011)

Delay discounting in addiction

Presentation title 23

Albein-Urios et al. (2014)

Delay Discounting longitudinally predicts who stay in treatment

Cognition and Outcomes 24

Stevens, Verdejo-Garcia et al. (2014)

Treatment readiness correlate with brain fitness

28th February 2011Cognition and Outcomes 25

Moreno-Lopez et al. (2014)

Bechara et al. (2005)

Decision-making

Bechara et al. (2005)

Decision-making in addiction

28

Verdejo-Garcia et al. (2007)

Association with severity of cocaine use

29

COCAINE GRAMS/ WEEK

IGT

TOTA

L SCORE

876543210

100

50

0

-50

Scatterplot of IGT TOTAL SCORE vs COCAINE GRAMS/ WEEK

Verdejo-Garcia et al. (2007)

Using the Iowa Gambling Task to predict relapse

Baseline assessments (~2 weeks after treatment commencement) and classification:

Insensitivity to future consequences Hypersensitivity to reward Intact

Follow-up –3 months after baseline assessments, to provide a 3 cm hair sample to assess drug relapse.

Cognition and Outcomes 30

Verdejo-Garcia et al. (2014)

Outcome: Cocaine hair concentrations 3 months after treatment onset

31

Verdejo-Garcia et al. 2014

32

Verdejo-Garcia et al. 2014

Outcome: Cocaine hair concentrations 3 months after treatment onset

Medicine, Nursing and Health Sciences

Cognitive enhancement interventions

CognitionClinical

Outcomes

Amenable to Interventions

✔

✔ ?

28th February 2011Presentation title 34

Wiers and colleagues

Wiers and colleagues

Cognitive training of skills needed to:

Set personal goals – tailored (“mental blackboard”) Resist interference (“automatic pilot”)

Boredom Stress Habits

Quality control – from external to self-generated feedback

Practice when and how utilise them in daily life

DD

BB

CC

AAAutomatic pilot STOP! Present Mindedness

Back to Goal

State your Decision

Quality control!

GMT

Alfonso et al. (2011)

DD

BB

CC

AAAutomatic pilot STOP! Present Mindedness

Meditation motives (e.g., endurance, willpower)

When distracted Back to motive

Interoceptive scanning Decision-making

MFN

Alfonso et al. (2011)

STOP!Present-mindedness exercise.

-8

-6

-4

-2

0

2

4

6

8

10

Time Pre- Time Post-

IGT

Net

sco

re

GMT+MF

STx * *

Goal Management Training Long-term

goals Decision-making in the Iowa Gambling Task

Alfonso et al. (2011)

Conclusions Most substance dependent clients have executive

thinking deficits

Deficient skills are paradoxically prerequisites of addiction treatments we currently apply

There is potential to recovery, and cognitive training can improve treatment outcomes

TP Nov 2013Cognition and Outcomes 42

Acknowledgements Funding

– Monash Strategic Grant Scheme– Red de Trastornos Adictivos, Universidad de Granada

Turning Point Drug and Alcohol Centre

– Dan Lubman– Victoria Manning

Verdejo-Garcia’s group:

– MJ Fernandez-Serrano– Laura Moreno-Lopez– Jose M Martinez-Gonzalez– Jose C Perales– Oscar Lozano– Natalia Albein

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Thank you!

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