Effects of tDCS Paired with Cognitive Training on Brain Networks associated with Alcohol Use Disorder in Veterans

经颅直流电刺激 (tDCS) 与认知训练相结合对退伍军人酒精使用障碍相关大脑网络的影响

基本信息

批准号：
10426031
负责人：
KELVIN O. LIM
金额：
--
依托单位：
MINNEAPOLIS VA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-01-01 至 2024-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10426031
关键词：
Abstinence Adaptive Behaviors Address Affect Alcohol dependence Automobile Driving Brain Caring Chiroptera Clinical Trials Cognition Cognitive Corpus striatum structure Coupled Data Diagnosis Effectiveness Epidemic Functional Magnetic Resonance Imaging Future Goals Healthcare Systems Impaired cognition Individual Inpatients Intervention Intervention Studies Measures Mediating Neuronal Plasticity Parietal Participant Patients Population Prefrontal Cortex Randomized Recording of previous events Recovery Relapse Research Proposals Rest Testing Thalamic structure Time Treatment outcome United States United States Department of Veterans Affairs Veterans Yang addiction alcohol abstinence alcohol misuse alcohol use disorder base binge drinking brain circuitry chronic alcohol ingestion cognitive change cognitive control cognitive performance cognitive training drinking behavior follow-up improved neural circuit neural network neuromechanism neuroregulation novel placebo group post intervention primary outcome randomized controlled study relating to nervous system research and development seal substance use therapy development treatment program

项目摘要

Alcohol misuse is an epidemic among Veterans in the United States. Nearly 1/3 of Veterans have a lifetime history of Alcohol Use Disorder (AUD). Across Veteran and civilian populations, about 60% of those entering treatment will relapse within one year. Paradoxically, chronic alcohol use is associated with cognitive impairments and changes in their underlying neural circuitry, that interfere with adaptive behavior needed for successful recovery. However, these cognitive impairments and their underlying neural substrates are promising new targets for interventions that can reduce relapse rates. Evidence suggests that cognitive training can improve cognition in individuals with AUD, strengthen neural networks mediating cognition, and improve treatment outcome. However, cognitive training is effort intensive, has small effect sizes, and may have limited durability. Evidence suggests that addiction is mediated by a dysfunctional cortico-striatal neurocircuitry characterized by excess striatal activity (driving substance use) coupled with hypoactive prefrontal cortex (impaired cognitive control). Resting-state functional connectivity (RSFC) data has identified a promising circuit-based target for the treatment of addiction. Individuals who have achieved long-term abstinence from alcohol (~7 years of abstinence) have higher RSFC in prefrontally-mediated networks (e.g. prefrontal-striatal, prefrontal-parietal, prefrontal-insular, prefrontal-thalamic networks) than controls or those with short-term abstinence (6-10 weeks of abstinence). Moreover, lower prefrontal RSFC during short-term abstinence can predict subsequent relapse. The primary objective of this study is to investigate the use of a novel neuroplasticity based intervention that combines cognitive training and transcranial direct current stimulation (tDCS) neuromodulation to enhance frontal-striatal RSFC and cognition, with the goal to improve treatment outcomes and increase abstinence in Veterans with AUD. This research proposal will address the following Specific Aims (SAs): SA1) Compare brain network changes between active tDCS vs. sham tDCS (placebo) groups, when both groups receive cognitive training. RSFC changes will be measured with functional magnetic resonance imaging data collected pre- and post-intervention. Hypothesis: Active tDCS, compared to sham tDCS will produce a significantly greater increase in prefrontal-striatal RSFC. SA2) Evaluate cognitive changes between active tDCS vs. sham tDCS (placebo) groups. Hypothesis: Active tDCS, compared to sham tDCS, will produce a significantly greater improvement in cognitive performance measures. SA3) Compare the effects of active tDCS vs. sham tDCS on drinking behavior over a 2 month follow-up period. Our primary outcome will be to compare binge drinking days per week w ithin the 2 months after the intervention between AUD participants who receive active tDCS vs. sham. Hypothesis: Active tDCS, compared to sham tDCS, will produce significantly fewer binge drinking days per week i n the 2 months following the intervention. Cognitive impairment and its underlying neural mechanisms affect alcohol addiction treatment outcomes. We propose the first study to examine how tDCS-augmented cognitive training affects cognition and its related brain circuitry in alcohol use disorder in Veterans, which will provide critical information to guide future research and treatment development.

在美国，近 1/3 的退伍军人一生中酗酒是一种流行病。在退伍军人和平民中，大约 60% 的人有酒精使用障碍 (AUD) 史。矛盾的是，长期饮酒与认知能力有关。其潜在神经回路的损伤和变化，干扰了所需的适应性行为然而，这些认知障碍及其潜在的神经基础是成功恢复的。有证据表明，认知训练有望成为降低复发率的干预措施的新目标。可以改善 AUD 患者的认知能力，增强介导认知能力的神经网络，并改善然而，认知训练需要大量努力，效果较小，并且效果可能有限。耐用性。有证据表明，成瘾是由功能失调的皮质纹状体神经回路介导的，其特征是过度的纹状体活动（驱动物质使用）加上前额皮质功能低下（认知受损）控制）. 静息态功能连接（RSFC）数据已经确定了一个有希望的基于电路的目标已实现长期戒酒（约 7 年）的个人。禁欲）在前额介导网络（例如前额-纹状体、前额-顶叶、前额叶-岛叶网络、前额叶-丘脑网络）优于对照组或短期戒酒者（6-10 周）此外，短期戒断期间前额叶 RSFC 的降低可以预测随后的复发。本研究的主要目的是研究一种基于神经可塑性的新型干预措施的使用，该干预措施结合认知训练和经颅直流电刺激(tDCS) 神经调节来增强额叶-纹状体 RSFC 和认知，目标是改善治疗结果并提高戒断率退伍军人用澳元。该研究提案将解决以下具体目标（SA）：SA1）比较大脑网络变化活跃 tDCS 组与假 tDCS（安慰剂）组之间的比较，当两组都接受 RSFC 认知训练时。将使用术前和术后收集的功能磁共振成像数据来测量变化干预后假设：与假 tDCS 相比，主动 tDCS 会产生显着更大的效果。前额叶纹状体 RSFC 增加。SA2)评估主动 tDCS 与假 tDCS 之间的认知变化（安慰剂）组假设：与假 tDCS 相比，产生 tDCS 的效果显着更大。认知表现测量的改善。SA3)比较主动 tDCS 与假 tDCS 对认知能力的影响。 2 个月随访期间的饮酒行为。我们的主要结果是比较酗酒天数接受主动 tDCS 的 AUD 参与者与接受主动 tDCS 的 AUD 参与者之间的干预后 2 个月内每周假假设：与假 tDCS 相比，主动 tDCS 会显着减少酗酒天数。干预后 2 个月内每周一次。认知障碍及其潜在的神经机制影响酒精成瘾的治疗结果。提出第一项研究来检验 tDCS 增强认知训练如何影响认知及其相关退伍军人酒精使用障碍的大脑回路，这将为指导未来的研究提供关键信息和治疗的发展。