Cerebral white matter recovery in abstinent alcoholics: A multimodality magnetic resonance study

Centre for Imaging of Neurodegenerative Diseases, Veterans Administration Medical Centre, San Francisco, USA.
Brain (Impact Factor: 9.2). 04/2010; 133(Pt 4):1043-53. DOI: 10.1093/brain/awp343
Source: PubMed


Most previous neuroimaging studies of alcohol-induced brain injury and recovery thereof during abstinence from alcohol used a single imaging modality. They have demonstrated widespread microstructural, macrostructural or metabolite abnormalities that were partially reversible with abstinence, with the cigarette smoking potentially modulating these processes. The goals of this study were to evaluate white matter injury and recovery thereof, simultaneously with diffusion tensor imaging, magnetic resonance imaging and spectroscopy in the same cohort; and to evaluate the relationships between outcome measures of similar regions. We scanned 16 non-smoking and 20 smoking alcohol-dependent individuals at 1 week of abstinence from alcohol and 22 non-smoking light drinkers using a 1.5 T magnetic resonance scanner. Ten non-smoking alcohol-dependent individuals and 11 smoking alcohol-dependent individuals were re-scanned at 1 month of abstinence. All regional diffusion tensor imaging, magnetic resonance imaging and spectroscopic outcome measures were calculated over comparable volumes of frontal, temporal, parietal and occipital white matter. At 1 week of abstinence and relative to non-smoking light drinkers, non-smoking alcohol-dependent individuals had higher mean diffusivity in frontal, temporal and parietal white matter (all P<0.008), whereas smoking alcohol-dependent individuals had elevated mean diffusivity only in frontal white matter (P=0.03). Smoking alcohol-dependent individuals demonstrated lower concentrations of N-acetyl-aspartate (a marker of neuronal viability) in frontal white matter (P=0.03), whereas non-smoking alcohol-dependent individuals had lower N-acetyl-aspartate in parietal white matter (P=0.05). These abnormalities were not accompanied by detectable white matter atrophy. However, the patterns of white matter recovery were different between non-smoking alcohol-dependent individuals and smoking alcohol-dependent individuals. In non-smoking alcohol-dependent individuals, the increase in fractional anisotropy of temporal white matter (P=0.003) was accompanied by a pattern of decreases mean diffusivity in all regions over 1 month of abstinence; no corresponding changes were observed in smoking alcohol-dependent individuals. In contrast, a pattern of white matter volume increase in frontal and temporal lobes was apparent in smoking alcohol-dependent individuals but not in non-smoking alcohol-dependent individuals. These results were not accompanied by significant changes in metabolite concentrations. Finally, there were no consistent patterns of association between measures obtained with different imaging modalities, either cross-sectionally or longitudinally. These data demonstrate significant white matter improvements with abstinence from alcohol, reflected either as microstructural recovery or volumetric increases that depend on the smoking status of the participants. We believe our results to be important, as they demonstrate that use of a single imaging modality provides an incomplete picture of neurobiological processes associated with alcohol-induced brain injury and recovery thereof that may even lead to improper interpretation of results.

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Available from: Dieter Johannes Meyerhoff, Mar 25, 2014
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    • "A recent meta-analysis found that length of abstinence was significantly, inversely associated with the magnitude of WM atrophy in alcohol-dependent patients (Monnig et al., 2013b). Furthermore, a follow-up DTI study reported increases in FA in a group of alcohol-dependent patients but did not found any differences in FA between smoking alcohol-dependent individuals and nonsmoking alcohol-dependent individuals and light drinkers over 1 month of abstinence (Gazdzinski et al., 2010). Similarly, we also found that long-term abstinent alcohol-dependent patients' FA values did not differ from those of controls. "
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    ABSTRACT: A number of diffusion tensor imaging (DTI) studies have reported substantial white matter (WM) abnormalities in alcohol-dependent patients. These studies were usually performed in recovering alcohol-dependent patients who had been abstinent for days to several weeks. The current study was designed to examine WM microstructure and decision-making in a sample of long-term abstinent alcohol-dependent patients. The study included 12 subjects with alcohol dependence who had been abstinent for at least 6 months before testing and scanning and 13 healthy control subjects. The Iowa Gambling Task (IGT) was used to measure decision-making. We found that the long-term abstinent alcohol-dependent group had significantly higher radial and axial diffusivity (RD and AD, respectively) values in frontal, temporal and parietal WM than was found in the healthy control group despite showing no difference in fractional anisotropy (FA) values in comparison to controls. In conclusion, we found widespread WM changes in long-term abstinent alcohol-dependent patients compared with healthy controls. Our findings suggested that AD and RD should be included in analyses of DTI data in addition to the more commonly studied FA. In the current study, FA values of the detoxified alcoholics had recovered and were comparable to those of the controls, whereas significant changes in AD and RD were still observed in some clusters in the frontal, parietal and temporal lobes of detoxified alcoholics even after 27.8 months.
    Psychiatry Research: Neuroimaging 10/2014; 224(1). DOI:10.1016/j.pscychresns.2014.07.006 · 2.42 Impact Factor
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    • "It is well established that medical, psychiatric and substance use disorders and cigarette smoking are highly prevalent in alcohol use disorders (Mertens et al. 2005; Durazzo & Meyerhoff 2007; Hasin et al. 2007; Moss, Chen & Yi 2010). Cigarette smoking in nonclinical samples (Durazzo, Meyerhoff & Nixon 2010, 2012, 2013) and in alcohol use disorders (Durazzo et al. 2007a, 2011a, 2014b; Gazdzinski et al. 2008, 2010; Luhar et al. 2013) is associated with significant morphological abnormalities, primarily in the anterior frontal, posterior parietal and mesial temporal regions. "
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    ABSTRACT: The trajectory of regional volume changes during the first year of sustained abstinence in those recovering from an alcohol use disorder is unclear because previous research typically employed only two assessment points. To better understand the trajectory of regional brain volume recovery in treatment-seeking alcohol-dependent individuals (ALC), regional brain volumes were measured after 1 week, 1 month and 7.5 months of sustained abstinence via magnetic resonance imaging at 1.5 T. ALC showed significant volume increases in frontal, parietal and occipital gray matter (GM) and white matter (WM), total cortical GM and total lobar WM, thalamus and cerebellum, and decreased ventricular volume over 7.5 months of abstinence. Volume increases in regional GM were significantly greater over 1 week to 1 month than from 1 month to 7.5 months of abstinence, indicating a non-linear rate of change in regional GM over 7.5 months. Overall, regional lobar WM showed linear volume increases over 7.5 months. With increasing age, smoking ALC showed lower frontal and total cortical GM volume recovery than non-smoking ALC. Despite significant volume increases, ALC showed smaller GM volumes in all regions, except the frontal cortex, than controls after 7.5 months of abstinence. ALC and controls showed no regional WM volume differences at any assessment point. In non-smoking ALC only, increasing regional GM and WM volumes were related to improving processing speed. Findings may indicate a differential rate of recovery of cell types/cellular components contributing to GM and WM volume during early abstinence, and that GM volume deficits persist after 7.5 months of sustained sobriety in this ALC cohort.
    Addiction Biology 08/2014; 20(5). DOI:10.1111/adb.12180 · 5.36 Impact Factor
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    • "e matter microstructural integrity of pathways interconnecting the basal ganglia and cerebellum or those providing proprio - ceptive and / or vestibular input . As indicated by our previous longitudinal research on the neurobiological and neurocog - nitive effects of smoking in various populations ( Durazzo et al . , 2006a , 2007b , 2012a , 2013 ; Gazdzinski et al . , 2008 , 2010 ; Mon et al . , 2009 ; Pennington et al . , 2013 ) , this new report provides additional impetus for studying the poten - tially beneficial effects of smoking cessation on neurobiology , cognition , and balance in AUD and other conditions with high smoking comorbidities ."
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    ABSTRACT: Background Static postural instability is common in alcohol-dependent individuals (ALC). Chronic alcohol consumption has deleterious effects on the neural and perceptual systems subserving postural stability. However, little is known about the effects of chronic cigarette smoking on postural stability and its changes during abstinence from alcohol.MethodsA modified Fregly ataxia battery was administered to a total of 115 smoking (sALC) and nonsmoking ALC (nsALC) and to 71 smoking (sCON) and nonsmoking light/nondrinking controls (nsCON). Subgroups of abstinent ALC were assessed at 3 time points (TPs; approximately 1, 5, 34 weeks of abstinence from alcohol); a subset of nsCON was retested at 40 weeks. We tested whether cigarette smoking affects postural stability in CON and in ALC during extended abstinence from alcohol, and we used linear mixed effects modeling to measure change across TPs within ALC.ResultsChronic smoking was associated with reduced performance on the Sharpened Romberg eyes-closed task in abstinent ALC at all 3 TPs and in CON. The test performance of nsALC increased significantly between 1 and 32 weeks of abstinence, whereas the corresponding increases for sALC between 1 and 35 weeks were nonsignificant. With long-term abstinence from alcohol, nsALC recovered into the range of nsCON and sALC recovered into the range of sCON. Static postural stability decreased with age and correlated with smoking variables but not with drinking measures.Conclusions Chronic smoking was associated with reduced static postural stability with eyes closed and with lower increases of postural stability during abstinence from alcohol. Smoking cessation in alcohol dependence treatment may facilitate recovery from static postural instability during abstinence.
    Alcoholism Clinical and Experimental Research 04/2014; 38(6). DOI:10.1111/acer.12409 · 3.21 Impact Factor
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