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Meta-analyses of clinical neuropsychological tests of executive dysfunction and impulsivity in alcohol use disorder.

ABSTRACT: BACKGROUND:Promising models for cognitive rehabilitation in alcohol treatment rest on a more nuanced understanding of the associated impairments in the multifaceted domains of executive functioning (EF) and impulsivity. OBJECTIVES:This meta-analysis examined the effects of alcohol on the individual subcomponents of EF and impulsivity in recently detoxified participants, including 1) Inhibition & Self-Regulation, 2) Flexibility & Set Shifting, 3) Planning & Problem Solving, 4) Reasoning & Abstraction, and 5) Verbal Fluency. Impulsivity was further examined through an analysis of motor, cognitive, and decisional subcategories. METHOD:Investigators searched, coded, and calculated effect sizes of impairments demonstrated in a broad range of neuropsychological tests for EF. A total of 77 studies were selected covering 48 years of research with a sample size of 5140. RESULTS:Findings ranged from a Hedges' g effect size of 0.803 for Inhibition to a Hedges' g of 0.359 for Verbal Fluency. Results also varied for the individual subcategories of Inhibition, including a large effect size for decisional impulsivity (g = 0.817) and cognitive impulsivity (0.860), and a moderate effect size for motor impulsivity (g = 0.529). The Hayling Test, Wisconsin Card Sorting Test, and Iowa Gambling Task were the measures most sensitive for alcohol effects. CONCLUSION:Planning, problem solving, and inhibitory abilities are significantly affected by alcohol abuse, with decisional and cognitive forms of impulsivity most impacted. Cognitive remediation targeting these deficits might increase the related functions that mediate the ability to moderate or abstain from alcohol, and so lead to improved treatment results.

SUBMITTER: Stephan RA

PROVIDER: S-EPMC6462408 | biostudies-literature | 2017 Jan

REPOSITORIES: biostudies-literature

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Meta-analyses of clinical neuropsychological tests of executive dysfunction and impulsivity in alcohol use disorder.

Stephan Rick A RA Alhassoon Omar M OM Allen Kenneth E KE Wollman Scott C SC Hall Matt M Thomas William J WJ Gamboa Julia M JM Kimmel Chrissy C Stern Mark M Sari Celina C Dalenberg Constance J CJ Sorg Scott F SF Grant Igor I

The American journal of drug and alcohol abuse 20160812 1

<h4>Background</h4>Promising models for cognitive rehabilitation in alcohol treatment rest on a more nuanced understanding of the associated impairments in the multifaceted domains of executive functioning (EF) and impulsivity.<h4>Objectives</h4>This meta-analysis examined the effects of alcohol on the individual subcomponents of EF and impulsivity in recently detoxified participants, including 1) Inhibition & Self-Regulation, 2) Flexibility & Set Shifting, 3) Planning & Problem Solving, 4) Reas ...[more]

PMID: 27712350

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Project description:: Individuals with alcohol use disorder (AUD) manifest a variety of impairments that can be attributed to alterations in specific brain networks. The current study aims to identify features of EEG-based functional connectivity, neuropsychological performance, and impulsivity that can classify individuals with AUD (N = 30) from unaffected controls (CTL, N = 30) using random forest classification. The features included were: (i) EEG source functional connectivity (FC) of the default mode network (DMN) derived using eLORETA algorithm, (ii) neuropsychological scores from the Tower of London test (TOLT) and the visual span test (VST), and (iii) impulsivity factors from the Barratt impulsiveness scale (BIS). The random forest model achieved a classification accuracy of 80% and identified 29 FC connections (among 66 connections per frequency band), 3 neuropsychological variables from VST (total number of correctly performed trials in forward and backward sequences and average time for correct trials in forward sequence) and all four impulsivity scores (motor, non-planning, attentional, and total) as significantly contributing to classifying individuals as either AUD or CTL. Although there was a significant age difference between the groups, most of the top variables that contributed to the classification were not significantly correlated with age. The AUD group showed a predominant pattern of hyperconnectivity among 25 of 29 significant connections, indicating aberrant network functioning during resting state suggestive of neural hyperexcitability and impulsivity. Further, parahippocampal hyperconnectivity with other DMN regions was identified as a major hub region dysregulated in AUD (13 connections overall), possibly due to neural damage from chronic drinking, which may give rise to cognitive impairments, including memory deficits and blackouts. Furthermore, hypoconnectivity observed in four connections (prefrontal nodes connecting posterior right-hemispheric regions) may indicate a weaker or fractured prefrontal connectivity with other regions, which may be related to impaired higher cognitive functions. The AUD group also showed poorer memory performance on the VST task and increased impulsivity in all factors compared to controls. Features from all three domains had significant associations with one another. These results indicate that dysregulated neural connectivity across the DMN regions, especially relating to hyperconnected parahippocampal hub as well as hypoconnected prefrontal hub, may potentially represent neurophysiological biomarkers of AUD, while poor visual memory performance and heightened impulsivity may serve as cognitive-behavioral indices of AUD.

Project description:BackgroundExtensive research indicates that having a positive family history of alcohol use disorder (FHP) and impulsivity are 2 risk factors for problem drinking. To our knowledge, no study has investigated which facets of impulsivity interact with family history to increase risk for problem drinking. The goal of this study was to: (i) examine whether FHP individuals with higher levels of impulsivity are more likely to engage in problematic drinking, and (ii) identify which facets of impulsivity interact with FHP to increase risk for problems.MethodsThe data consisted of a combined sample of 757 participants (50% female, 73% White, mean age = 32.85, SD = 11.31) drawn from the Transdisciplinary Tobacco Use Research Center and the Center for the Translational Neuroscience of Alcohol. Analyses of covariance and cumulative logistic regression models investigated the association of family history and impulsivity-related traits with drinking quantity, frequency, and alcohol-related problems. Models were adjusted for age, sex, race, ethnic group, education level, and data source.ResultsSignificant interactions between impulsivity and family history were found for measures of alcohol-related problems. Specifically, there was a stronger positive association of Barratt Impulsiveness Scale (BIS) poor self-regulation with interpersonal, F(1, 504) = 6.27, p = 0.01, and impulse control alcohol-related problems, F(1, 504) = 6.00, p = 0.01, among FHP compared to FHN individuals. Main effects of family history and impulsivity on alcohol quantity and frequency of use and problems were also found.ConclusionsThese findings suggest that having both a family history of AUD and high BIS poor self-regulation is more strongly associated with alcohol-related consequences in the interpersonal and impulse control domains. Given the heterogeneity of impulsivity, these findings highlight the need for additional research to examine which facets of impulsivity are associated with which alcohol outcomes to narrow phenotypic risk for alcohol misuse.

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Meta-analyses of clinical neuropsychological tests of executive dysfunction and impulsivity in alcohol use disorder.

Publications

Meta-analyses of clinical neuropsychological tests of executive dysfunction and impulsivity in alcohol use disorder.

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