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

• 批准号: 9888838
• 负责人: KELVIN O. LIM
• 金额: --
• 依托单位: MINNEAPOLIS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-01 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9888838
• 关键词: Abstinence; Adaptive Behaviors; Address; Affect; Alcohol dependence; Alcohol or Other Drugs use; 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; 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; therapy development; treatment program

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) th​an 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.

酗酒是美国退伍军人的流行病。将近1/3的退伍军人有一生 酒精使用障碍史（AUD）。在退伍军人和平民中，约有60％的人进入 治疗将在一年内传播。矛盾的是，慢性饮酒与认知有关 障碍和其潜在神经回路的变化，这种干扰对适应行为所需的干扰 成功恢复。但是，这些认知障碍及其潜在的神经基质是 有望实现可以降低继电器率的干预措施的新目标。证据表明认知培训 可以改善具有AUD，更强大的神经网络的人的认知，并改善介导的认知并改善 治疗结果。但是，认知训练的努力很大，效果尺寸很小，并且可能有限 期间。 有证据表明，成瘾是由功能失调的皮质 - 纹状体神经记录介导的，其特征是 过多的纹状体活性（使用驱动物质）与低触发前额叶皮层结合（认知受损 控制）。静止状态功能连接（RSFC）数据已确定了一个有前途的基于电路的目标 成瘾的治疗。从酒精中长期禁欲的个人（〜7年 禁欲）在前额叶介导的网络中具有较高的RSFC（例如，前额叶，前额叶 - 额叶 - 前额叶 - 独立的，前额叶 - 丘脑网络）比对照或短期禁欲的对照（6-10周 节制）。此外，在短期戒酒期间，较低的前额叶RSFC可以预测随后的缓解。 这项研究的主要目的是研究基于神经可塑性的新型干预措施的使用 结合认知训练和trancranial直流电流刺激（TDCS）神经调节以增强 额叶纹状体RSFC和认知，目的是改善治疗结果并增加戒酒 老兵与aud。 该研究建议将解决以下特定目标（SAS）：SA1）比较大脑网络的变化 当两组都接受认知训练时，在主动TDC与假TDC（安慰剂）组之间。 RSFC 将通过收集的功能性磁共振成像数据来测量变化 干预后。假设：与假TDC相比，主动TDC将产生明显更大的 前额叶纹状体RSFC的增加。 SA2）评估主动TDC与假TDC之间的认知变化 （安慰剂）组。假设：与假TDC相比，主动TDC将产生明显更大的 认知绩效指标的改善。 SA3）比较主动TDC与假TDC对 在2个月的随访期内饮酒行为。我们的主要结果是比较暴饮暴食的日子 在接收活跃TDCS与的AUD参与者之间进行干预后的两个月，每周的每周都会是每周的。 假。假设：与假TDC相比，主动TDC将产生的暴饮暴食天数量明显减少 干预后两个月的每周。 认知障碍及其潜在的神经机制会影响酒精成瘾治疗结果。我们 提案第一项研究，旨在研究TDCS的认知训练如何影响认知及其相关 退伍军人中酒精使用障碍的脑电路，这将提供关键信息来指导未来的研究 和治疗发展。