Vonmoos M, Hulka LM, Preller KH, Jenni D, Baumgartner MR, Stohler R et al. Cognitive dysfunctions in recreational and dependent cocaine users: role of attention-deficit hyperactivity disorder, craving and early age at onset. Br J Psychiatry 203: 35-43

MSc, Lea M. Hulka, MSc, Katrin H. Preller, MSc, Daniela Jenni, MSc, Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, University of Zurich, Switzerland
The British journal of psychiatry: the journal of mental science (Impact Factor: 7.99). 05/2013; 203(1). DOI: 10.1192/bjp.bp.112.118091
Source: PubMed


BACKGROUND: Dependent cocaine users consistently display cognitive deficits but cognitive performance of recreational cocaine users has rarely been investigated. AIMS: To examine whether cognitive performance is impaired in relatively pure recreational and dependent cocaine users. METHOD: The cognitive performance of recreational (n = 68) and dependent cocaine users (n = 30) was compared with the performance of stimulant-naive controls (n = 68) employing an extensive neuropsychological test battery. Moreover, the impact of attention-deficit hyperactivity disorder (ADHD) symptoms, craving and early age at onset was analysed. RESULTS: Dependent cocaine users display broad cognitive impairments in the domains of attention, working memory, declarative memory and executive functions. The performance of recreational cocaine users in all four domains was intermediate between that of controls and dependent users and they displayed significant deficits foremost in the domains of attention and working memory. In addition, ADHD symptoms, craving and age at onset were important modulators of cognitive function in cocaine users. CONCLUSIONS: Cognitive deficits occur at a recreational and non-dependent level of cocaine use. Cocaine use and ADHD seem to have mutually aggravating effects on cognitive impairment.

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    • "Research has identified factors that may affect attentional capacities. Among others, patients with substance abuse or dependence, schizophrenia or depression have been shown to exhibit attentional impairments (Boeker et al., 2012; Keefe and Harvey, 2012; Vonmoos et al., 2013). Importantly, time-variant conditions like sleepiness, stress and emotional states have also been related to fluctuating attentional capacities (Dolcos et al., 2011; Oken et al., 2006; Van Dongen et al., 2003). "
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    ABSTRACT: Human cognition relies on attentional capacities which, among others, are influenced by factors like tiredness or mood. Based on their inherent preferences in sleep and wakefulness, individuals can be classified as specific “chronotypes”. The present study investigated how early, intermediate and late chronotypes (EC, IC, LC) differ neurally on an attention-to-motion task. Twelve EC, 18 IC and 17 LC were included into the study. While undergoing functional magnetic resonance imaging (fMRI) scans, subjects looked at vertical bars in an attention-to-motion task. In the STATIONARY condition, subjects focused on a central fixation cross. During Fix-MOVING and Attend-MOVING, bars were moving horizontally. Only during the Attend-MOVING, subjects were required to attend to changes in the velocity of bars and indicate that by button presses. A two-way repeated measures ANOVA probed group by attentional load effects. The dorsolateral prefrontal cortex (DLPFC), insula and anterior cingulate cortex showed group by attention specific activations. Specifically, EC and LC presented attenuated DLPFC activation under high attentional load (Attend-MOVING), while EC showed less anterior insula activation than IC. LC compared to IC exhibited attenuation of superior parietal cortex. Our study reveals that individual sleep preferences are associated with characteristic brain activation in areas crucial for attention and bodily awareness. These results imply that considering sleep preferences in neuroimaging studies is crucial when administering cognitive tasks. Our study also has socio-economic implications. Task performance in non-optimal times of the day (e.g. shift workers), may result in cognitive impairments leading to e.g. increased error rates and slower reaction times.
    Full-text · Article · Feb 2015 · NeuroImage
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    • "Lobule VIII is principally involved in motor and sensorimotor tasks (Stoodley & Schmahmann 2009), but it is also engaged in working memory and other executive function tasks (Stoodley & Schmahmann 2010). Interestingly, both sensorimotor gating and working memory are significantly impaired in cocaine-dependent users (Preller et al. 2013; Vonmoos et al. 2013). Moreover, functional imaging studies have shown that during executive tasks, lobule VIII activation extends to more lateral regions such as the lobule VIIb (Stoodley & Schmahmann 2010). "
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    ABSTRACT: Cocaine addiction involves persistent deficits to unlearn previously rewarded response options, potentially due to neuroadaptations in learning-sensitive regions. Cocaine-targeted prefrontal systems have been consistently associated with reinforcement learning and reversal deficits, but more recent interspecies research has raised awareness about the contribution of the cerebellum to cocaine addiction and reversal. We aimed at investigating the link between cocaine use, reversal learning and prefrontal, insula and cerebellar gray matter in cocaine-dependent individuals (CDIs) varying on levels of cocaine exposure in comparison with healthy controls (HCs). Twenty CDIs and 21 HCs performed a probabilistic reversal learning task (PRLT) and were subsequently scanned in a 3-Tesla magnetic resonance imaging scanner. In the PRLT, subjects progressively learn to respond to one predominantly reinforced stimulus, and then must learn to respond according to the opposite, previously irrelevant, stimulus-reward pairing. Performance measures were errors after reversal (reversal cost), and probability of maintaining response after errors. Voxel-based morphometry was conducted to investigate the association between gray matter volume in the regions of interest and cocaine use and PRLT performance. Severity of cocaine use correlated with gray matter volume reduction in the left cerebellum (lobule VIII), while greater reversal cost was correlated with gray matter volume reduction in a partially overlapping cluster (lobules VIIb and VIII). Right insula/inferior frontal gyrus correlated with probability of maintaining response after errors. Severity of cocaine use detrimentally impacted reversal learning and cerebellar gray matter.
    Full-text · Article · Apr 2014 · Addiction Biology
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    • "One study showed that although cocaine abusers performed significantly more poorly than controls on several neuropsychological tasks, there was no significant relationship between measures of childhood ADHD symptoms and neuropsychological performance (38). On the other hand, more recently, it was observed that ADHD symptoms were important modulators of cognitive function in CDI, suggesting that cocaine-use and ADHD symptoms seem to have mutual aggravating effects in executive impairments (19). "
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    ABSTRACT: Background: Cocaine-dependent individuals (CDI) present executive cognitive function (ECF) deficits, but the impact of psychiatric comorbidities such as Attention-Deficit Hyperactivity Disorder (ADHD) on neuropsychological functioning is still poorly understood. The aim of this study was to investigate if CDI with ADHD (CDI + ADHD) would have a distinct pattern of executive functioning when compared with CDI without ADHD (CDI). Methods: We evaluated 101 adults, including 69 cocaine-dependent subjects (divided in CDI and CDI + ADHD) and 32 controls. ECF domains were assessed with Digits Forward (DF), Digits Backward (DB), Stroop Color Word Test (SCWT), the Wisconsin Card Sorting Test (WCST), and the Frontal Assessment Battery (FAB). DSM-IV criteria for ADHD were used for diagnosis and previous ADHD symptoms (in the childhood) were retrospectively assessed by the Wender-Utah Rating Scale (WURS). Results: There were no significant differences between CDI + ADHD, CDI, and controls in estimated intellectual quotient (IQ), socioeconomic background, education (in years), and pre-morbid IQ (p > 0.05). SCWT and WCST scores did not differ across groups (p > 0.05). Nevertheless, CDI and CDI + ADHD performed more poorly than controls in total score of the FAB (p < 0.05). Also, CDI + ADHD did worse than CDI on DF (F = 4.756, p = 0.011), DB (F = 8.037, p = 0.001), Conceptualization/FAB (F = 4.635, p = 0.012), and Mental flexibility/FAB (F = 3.678, p = 0.029). We did not find correlations between cocaine-use variables and neuropsychological functioning, but previous ADHD symptoms assessed by WURS were negatively associated with DF (p = 0.016) and with the total score of the FAB (p = 0.017). Conclusion: CDI + ADHD presented more pronounced executive alterations than CDI and CDI exhibited poorer cognitive functioning than controls. Pre-existing ADHD symptoms may have a significant negative impact on executive dysfunction in CDI. It remains to be investigated by future studies if symptoms such as impulsivity or a pre-existing ECF dysfunction could represent underlying cognitive endophenotypes that would substantially increase the risk for acquiring addictive disorders.
    Full-text · Article · Oct 2013 · Frontiers in Psychiatry
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