Title slide with an image

Title slide with an image

Medicine, Nursing and Health Sciences Cognitive impairment and cognitive recovery in substance related disorders A/Prof. Antonio Verdejo-Garcia Catania, July 2015 Outline 1. Cognition -- What is it (for)? 2. Subtyping/Matching 3. Prediction 4. Cognitive remediation Cognition and Outcomes

2 Updating and management OF input-independent info FOR goal-achievement and decision-making Cognition and Outcomes 3 3D5B1H/ 135BDH RED GREEN BLUE D

RED GREEN BLUE X D Cognition and Outcomes 4 Moreno-Lpez et al. (2012) Cognition and Outcomes 5

Gray Matter Moreno-Lpez et al. (2012) White Matter 6 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-Garca & Perez-Garcia (2007) Stimulants vs Opiate users 120 30

80 20 Raw scores Raw scores 25 Cocaine Heroin Controls 100

60 40 Cocaine Heroin Controls 15 10 5 20 0

0 FAS Design Fluency LNS Arithmetic Digits Spatial Span

Similarities -5 CBT * Stroop Neuropsych. Tests (Updating) Raw scores (Errors)

60 Cocaine Heroin 50 Controls 40 30 20 *

10 0 Category Test 5DT Shifting IGT Performance * Go/No Go Neuropsych. Tests (Shifting) WCST

IGT Score [(C+D) - (A+B)] 70 5DT Interference Neuropsych. Tests (Inhibition) 10 8 6 4 2 0 -2 -4

-6 -8 Cocaine Heroin Controls block 1 block 2 block 3 block 4

block 5 Bloque Verdejo-Garca & Perez-Garcia (2007) 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 % Cognition and Outcomes 9 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) g n i rk n g o Self-control and self-monitoring ed w aki r m i a n p

o i Avoid risk m i s i c n s e e e t e

d i s r w i t o u e q n b e o

i r h tc hibit ent a m , in m s t i a M o ry e r t

m and e m Life goals Cognition and Outcomes 11 What cognition may add Subtyping/Matching Prediction Focused interventions Neuropsychological

Assessment Cognitive Rehabilitation Cognition and Outcomes 12 Albein-Urios et al. (2013, 2014) Cognition and Outcomes 13 LCA of trait and cognitive impulsivity scores in 96

addiction clients Albein-Urios et al. (2014) Cognition and Outcomes 14 Albein-Urios et al. (2013) 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 Medicine, Nursing and Health Sciences Prediction of at risk clients

Key cognitive processes Delay Discounting Decision-making Cognition and Outcomes 20 Delay discounting Marshmallows! http://www.youtube.com/watch?v=QX_oy9614HQ Peters and Buchel (2011) TICS: 11(5)

Presentation title 28th February 2011 21 Christakou et al. (2011) 22 Delay discounting in addiction Albein-Urios et al. (2014) Presentation title

23 Delay Discounting longitudinally predicts who stay in treatment Stevens, Verdejo-Garcia et al. (2014) Cognition and Outcomes 24 Treatment readiness correlate with brain fitness Moreno-Lopez et al. (2014)

Cognition and Outcomes 28th February 2011 25 Decision-making Bechara et al. (2005) Bechara et al. (2005) Decision-making in addiction Verdejo-Garcia et al. (2007)

28 Association with severity of cocaine use Scatterplot of IGT TOTAL SCORE vs COCAINE GRAMS/ WEEK IGT TOTAL SCORE 100 50 0 -50

0 1 2 3 4 5 COCAINE GRAMS/ WEEK 6 7

8 Verdejo-Garcia et al. (2007) 29 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. Verdejo-Garcia et al. (2014)

Cognition and Outcomes 30 Outcome: Cocaine hair concentrations 3 months after treatment onset Verdejo-Garcia et al. 2014 31 Outcome: Cocaine hair concentrations 3 months after treatment onset Verdejo-Garcia et al. 2014 32

Medicine, Nursing and Health Sciences Cognitive enhancement interventions Cognition Amenable to Interventions ?

Clinical Outcomes Presentation title 28th February 2011 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 GMT Automatic pilot STOP! Present Mindedness Back to Goal

A B State your Decision Quality control! C D Alfonso et al. (2011) MFN Automatic pilot STOP! Present Mindedness Meditation motives (e.g., endurance, willpower)

A B Interoceptive scanning Decisionmaking When distracted Back to motive C D Alfonso et al. (2011) Goal Management Training Long-term goals

Decision-making in the Iowa Gambling Task 10 8 STOP! Present-mindedness exercise. IGT Net score 6 GMT+MF STx

* * 4 2 0 -2 -4 -6 -8 Time Pre- Time Post-

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 Cognition and Outcomes TP Nov 2013

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-Garcias group:

MJ Fernandez-Serrano Laura Moreno-Lopez Jose M Martinez-Gonzalez Jose C Perales Oscar Lozano Natalia Albein 43 Thank you! 44

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