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5 How to integrate the neuropsychological assessment as key information for relevant clinical decisions in AUD treatment? Early after the cessation of alcohol drinking, a neuropsychological assessment enables clinicians to offer AUD patients the best treatment options according to their neuropsychological profile. When neuropsychological abilities are preserved, patients can benefit from usual treatment. When patients exhibit mild-tomoderate neuropsychological deficits, they can be referred to midterm care units to permit spontaneous cognitive recovery without drinking potentially favored by neuropsychological rehabilitation. After several weeks, they can be reevaluated: a significant neuropsychological recovery would allow attending usual treatment, while persisting neuropsychological deficits would require specialized care, just as patients with severe neuropsychological deficits, including neuropsychological rehabilitation programs.
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Introduction
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Rationale
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Citations
... Executive functioning deficits in AUD are pronounced and pose liability for continued use and relapse [101,102,103,104]. Of these EF deficits, behavioral control (impulsivity), Content courtesy of Springer Nature, terms of use apply. ...
Purpose of review
This article utilizes a pre-existing framework in the field of addiction to comprehensively capture the effects of classic psychedelics (psilocybin, lysergic acid diethylamide, dimethyltryptamine, and mescaline) for the treatment of alcohol use disorder (AUD).
Recent findings
Basic science, preclinical, and clinical studies support the influence of psychedelics on all 3 core domains of addiction, comprising negative emotionality (including depression and anxiety), incentive salience (including craving and compulsive use) and executive functioning (including impulsivity and cognitive flexibility). However, systematic investigation using objective measures to evaluate these domains in AUD is needed.
Summary
We close by discussing limitations and challenges in the field of psychedelic science, and propose future research directions to advance our understanding of the psychological and neurobiological basis of clinical improvement. Conceptualizing future research under this 3-domain framework may assist the refinement of psychedelic-assisted treatments and the development of personalized medicine approaches for AUD.
... Follow-Back, 160 Indeed, one phase-I study of 5-MeO-DMT that used individualized dosing regimens (2, 6, 12, and 18 mg) seems to support this. 82 179,180 Notably, several authors posit that abstinence of alcohol leads to (partial) recovery of neuropsychological functioning. 181,182 Yet, others argue that impairments persist even after sobriety. ...
Alcohol use disorder (AUD) remains one of the most prevalent psychiatric disorders worldwide with high economic costs. Current treatment options show modest efficacy and relapse rates are high. Furthermore, there are increases in the treatment gap and few new medications have been approved in the past 20 years. Recently, psychedelic‐assisted therapy with psilocybin and lysergic acid diethylamide has garnered significant attention in the treatment of AUD. Yet, they require significant amounts of therapist input due to prolonged subjective effects (~4–12 h) leading to high costs and impeding implementation. Accordingly, there is an increasing interest in the rapid and short‐acting psychedelic 5‐methoxy‐N,N‐dimethyltryptamine (5‐MeO‐DMT). This paper offers a first look at potential therapeutic mechanisms for AUD by reviewing the current literature on 5‐MeO‐DMT. Primarily, 5‐MeO‐DMT is able to induce mystical experiences and ego‐dissolution together with increases in psychological flexibility and mindfulness. This could decrease AUD symptoms through the alleviation of psychiatric mood‐related comorbidities consistent with the negative reinforcement and self‐medication paradigms. In addition, preliminary evidence indicates that 5‐MeO‐DMT modulates neural oscillations that might subserve ego‐dissolution (increases in gamma), psychological flexibility and mindfulness (increases in theta), and the reorganization of executive control networks (increases in coherence across frequencies) that could improve emotion regulation and inhibition. Finally, animal studies show that 5‐MeO‐DMT is characterized by neuroplasticity, anti‐inflammation, 5‐HT2A receptor agonism, and downregulation of metabotropic glutamate receptor 5 with clinical implications for AUD and psychiatric mood‐related comorbidities. The paper concludes with several recommendations for future research to establish the purported therapeutic mechanisms of action.
... 16 The variety of attentional functions determined that the potential mechanisms of their influence on timing process were distinct. 9 Selective attention, an ability to focus attention on target information and suppress potentially distracting stimuli, 3 can influence time perception by prioritising attention to timed stimuli. 9 In SET, selective attention primarily regulates the switching delay that connects the pacemaker to the accumulator. ...
Alcohol use disorder (AUD) has been associated with attentional deficits and impairments of working memory. Meanwhile, attention and working memory are critical for time perception. However, it remains unclear how time perception alters in AUD patients and how attention and working memory affect their time perception. The current study aims to clarify the time perception characteristics of AUD patients and the cognitive mechanisms underlying their time perception dysfunction. Thirty‐one patients (three of them were excluded) with AUD and thirty‐one matched controls completed the Time Bisection Task, Attention Network Test and Digital Span Backward Test to assess their abilities in time perception, attention network and working memory, respectively. The results showed that, after controlling for anxiety, depression, and impulsivity, AUD patients had a lower proportion of ‘long’ responses at intervals of 600, 750, 900, 1050 and 1200 ms. Furthermore, they displayed higher subjective equivalence points and higher Weber ratios compared to controls. Moreover, AUD patients showed impaired alerting and executive control networks as well as reduced working memory resources. Only working memory resources mediated the impact of AUD on time perception. In conclusion, our findings suggested that the duration underestimation in AUD patients is predominantly caused by working memory deficits.
... 10,11 ARBD is non-degenerative, and the cognitive impairment component can be halted or reversed if appropriate support and management are provided. [12][13][14][15] These improvements have been noted not only at the functional, biochemical and structural levels using neuroimaging techniques, but also behaviourally using neuropsychological assessment. For example, improved white matter tract integrity, 16,17 grey matter volumes 18 and neuronal viability markers 19 have been observed following cessation of alcohol intake. ...
Individuals with alcohol-related brain damage (ARBD) represent a population whose healthcare needs often go unmet. This is the result of a lack of not only an awareness surrounding the condition by healthcare professionals, but also healthcare service inclusion and delivery, more broadly. The Coronavirus 2019 (COVID-19) pandemic and the associated lockdowns dramatically affected the accessibility and availability of addiction services globally, while also driving changes in alcohol consumption among the most vulnerable. In the absence of change, this culmination of increased high-risk drinking behaviour, lack of awareness by healthcare professionals and severely limited service delivery for individuals living with ARBD post COVID-19, represents a perfect storm that is rapidly approaching our health and care services worldwide. Collectively, this will reduce positive health outcomes in an already at-risk group.
... For both groups, nonetheless, as students acquired semantic memory through their equine coursework, a relationship was seen with emotional safety; however, this was a weak correlation limiting the conclusions that can be made at this time between emotional safety and semantic memory. Nonetheless, cognitive information is often acquired through specific events evoking episodic memory, which gives a more personal context to the development of memory [43]. Similarly, Silva dos Santos et al. [7] reported an emotional response to learning even with indirect interaction with animals, finding personal experience gives context to the subject matter being learned. ...
Effective teaching requires an educational environment that promotes learning, and yet, developing such an environment can be challenging within today’s agricultural-based classroom for educators due to the trend to a more virtual teaching format and less hands-on learning. Animal interaction, particularly equine activities, has been shown to assist educators in the development of an emotionally safe environment for promoting learning. However, research is lacking as to whether the interaction with the animal needs to be direct or indirect within the collegiate educational environment to observe benefits. Therefore, the objective of this study was to determine the impact of equine interaction, both direct and indirect, within an educational environment on the emotional safety and learning for the college student within the agricultural-based classroom. Three course types were observed within the agricultural-based educational environment that included courses with no equine interaction (Group A) and courses with equine interaction, both direct (Group B) and indirect (Group C) interaction with the horse. Indirect interaction included items such as observation of equine handling via a video or gaining knowledge from reading online materials, but not engaging in direct, hands-on activities with the horse. Development of emotional safety within the students enrolled within these courses was measured using a self-reporting emotional safety evaluation. Due to the structure of the scale, a decrease in emotional safety indicated a positive change. Learning, both development of semantic and procedural memory, was measured using a student-completed knowledge examination and an instructor-completed skill evaluation, respectively. While significant improvement in emotional safety was not observed within any of the course types, a weak negative correlation was found between emotional safety and semantic memory for students enrolled in equine courses, both direct (R = −0.55, R2 = 0.28) and indirect (R = −0.25, R2 = 0.06) interaction, finding as emotional safety scores lowered to the ideal range that knowledge improved. In addition, students within equine courses showed semantic memory development in specific areas of equine sciences (Group B: Grooming/Tacking, p = 0.03; Group C: Equine Behavior, p = 0.04) and direct equine interaction resulted in development of equine-based procedural memory in all four skill areas measured within the study (p = 0.00). As such, learning is promoted through equine interaction, whether direct or indirect interaction, within the agricultural-based classroom, suggesting that both forms of equine interaction can be a valuable educational tool for the instructor within the collegiate setting.
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We conducted a systematic analysis of the studies, which utilized the methods of cognitive function assessment in Russianspeaking practice for the identification of cognitive impairments in patients with substance use disorder and HIV infection. We searched the relevant studies in the following electronic database: ELIBRARY, PubMed, Embase, and PsycInfo (searched in April 2020). We included articles published in the past 20 years (from 2000 to 2020). The literature review, data extraction, and presentation were conducted based on the PRISMA statement. The majority of the papers included cross-sectional studies. In the studies, they included patients with substance use disorder, the co-occurrence of HIV infection was not controlled as a potential confounder. Researchers applied qualitative or quantitative methods and their combination, as well as screening instruments. The most popular cognitive assessment methods in research among the Russian-speaking population included the following: Luria memory words test, Schulte table, WAIS subscales, and Mini-Mental State Examination (MMSE). The important future direction is the development of the standardized assessment specifically designed to use in patients with substance use disorder, including those who also live with HIV infection.
... In addition, alcohol-related neuropsychological impairments have been widely described in the literature, being executive functions, with working and episodic memory frequently affected [42]. Many experimental paradigms have been used to evaluate the memory deficits in alcohol-treated rats. ...
Wernicke–Korsakoff syndrome (WKS) is induced by thiamine deficiency (TD) and mainly related to alcohol consumption. Frontal cortex dysfunction has been associated with impulsivity and disinhibition in WKS patients. The pathophysiology involves oxidative stress, excitotoxicity and inflammatory responses leading to neuronal death, but the relative contributions of each factor (alcohol and TD, either isolated or in interaction) to these phenomena are still poorly understood. A rat model was used by forced consumption of 20% (w/v) alcohol for 9 months (CA), TD hit (TD diet + pyrithiamine 0.25 mg/kg, i.p. daily injections the last 12 days of experimentation (TDD)), and both combined treatments (CA+TDD). Motor and cognitive performance and cortical damage were examined. CA caused hyperlocomotion as a possible sensitization of ethanol-induced excitatory effects and recognition memory deficits. In addition, CA+TDD animals showed a disinhibited-like behavior which appeared to be dependent on TDD. Additionally, combined treatment led to more pronounced alterations in nitrosative stress, lipid peroxidation, apoptosis and cell damage markers. Correlations between injury signals and disinhibition suggest that CA+TDD disrupts behaviors dependent on the frontal cortex. Our study sheds light on the potential disease-specific mechanisms, reinforcing the need for neuroprotective therapeutic approaches along with preventive treatments for the nutritional deficiency in WKS.
... Alcohol-related neuropsychological impairments have been widely described in the literature, being executive functions, working and episodic memory frequently affected [48]. Many experimental paradigms have been used to evaluate memory deficits in alcohol-treated rats. ...
Wernicke-Korsakoff syndrome (WKS) is induced by thiamine deficiency (TD) and mainly related to alcohol consumption. Frontal cortex dysfunction has been associated to impulsivity and disinhibition in WKS patients. The pathophysiology involves oxidative stress, excitotoxicity and inflammatory responses leading to neuronal death, but the relative contributions of each factor (alcohol and TD, isolate or in interaction) to these phenomena are still poorly understood. A rat model was used by forced consumption of 20% (w/v) alcohol for 9 months (CA), TD hit (TD diet + pyrithiamine 0.25 mg/kg, i.p. daily injections the last 12 days of experimentation; TDD), and both combined treatments (CA+TDD). Motor and cognitive performance and cortical damage were examined. CA caused hyperlocomotion as a possible sensitization of ethanol-induced excitatory effects and recognition memory deficits. In addition, CA+TDD animals showed a disinhibited-like behavior, which appears to be dependent on TDD. Also, combined treatment led to more pronounced alterations in nitrosative stress, lipid peroxidation, apoptosis and cell damage markers. Correlations between injury signals and disinhibition suggest that CA+TDD disrupts behaviors dependent on the frontal cortex. Our study sheds light on the potential disease-specific mechanisms, reinforcing the need for neuroprotective therapeutic approaches along with preventive treatments for the nutritional deficiency in WKS.
... A LCOHOL-RELATED NEUROPSYCHOLOGICAL IMPAIRMENTS have been widely described in the literature. Executive functions, working memory, episodic memory, visuospatial, and motor abilities are, among others, indeed frequently affected by chronic and excessive alcohol consumption (Maillard et al., 2020;Oscar-Berman et al., 2014, for a review). The neuropsychological assessment of patients with alcohol use disorder (AUD) is crucial early after detoxification. ...
Background
The aim of the present study was to determine whether the Brief Evaluation of Alcohol‐Related Neuropsychological Impairments (BEARNI), a screening tool developed to identify neuropsychological deficits in alcohol use disorder (AUD) patients, can also be used for the early identification of AUD patients at risk of developing Korsakoff’s syndrome (KS).
Methods
Eighteen KS patients, 47 AUD patients and 27 healthy controls underwent BEARNI testing (including 5 subtests targeting episodic memory, working memory, executive function, visuospatial abilities, and ataxia) and a comprehensive neuropsychological examination.
Results
Performance of AUD and KS patients on BEARNI subtests was consistent with the results on the standardized neuropsychological assessment. On BEARNI, ataxia and working memory deficits observed in AUD were as severe as those exhibited by KS patients, whereas for visuospatial abilities, a graded effect of performance was found. In contrast, the subtests involving long‐term memory abilities (episodic memory and fluency) were impaired in KS patients only. AUD patients with a score lower than 1.5 points (out of 6) on the episodic memory subtest of BEARNI exhibited the lowest episodic memory performance on the neuropsychological battery and could be considered at risk of developing KS.
Conclusions
These findings suggest that BEARNI is a useful tool for detecting severe memory impairments, suggesting that it could be used for the early identification of AUD patients at high risk of developing KS.
... Modulation of neurochemicals can cause severe consequences in the functioning of various brain region of the central nervous system (CNS) [5], and associated metabolic process [6]. Chronic intake of alcohol causes brain damage, characterized by the cerebral and cerebellar atrophy, leading to impaired neuronal function within the hippocampus and frontal cortex [7,8]. Apart from this, it causes alcoholspecific disorders, such as Wernicke-korsakoff syndrome, hepatic encephalopathy and pellagra. ...
Alcohol use disorder (AUD) is a chronic relapsing disorder, which enforces a person to compulsively seek alcohol, restricting control over alcohol intake leads to emergence of an undesired emotional state during abstinence. There are recent advances for better understanding of neurocircuitry involved in the pathophysiology of AUD. Alcohol interaction with neuronal membrane proteins results in changes in neuronal circuits. It is also linked with the potential medication and their clinical validation concerning their pharmacological targets for alcoholic abstinence. This review covers research work from the past few decades on the therapeutic advances on treatment of alcohol dependence; further detailing the fundamental neurochemical mechanisms after alcohol administration. It also covers interaction of alcohol with GABAergic, glutaminergic, dopaminergic, serotonergic and opioid systems. This review further elaborated the neurobiology of noradrenergic, cholinergic and cannabinoid systems and their interaction with AUD. Elaborative information of potential drug targets under current exploration for AUD treatment with their mechanisms are reported here along with clinical outcomes and the associated side effects.
Graphic Abstract
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