Impact of Alcohol Use, Traumatic Stress, and Cigarette Smoking on Cognitive Functioning in Veterans With Co-occurring Alcohol Use Disorder and Posttraumatic Stress Disorder.
Impact of Alcohol Use, Traumatic Stress, and Cigarette Smoking on Cognitive Functioning in Veterans With Co-occurring Alcohol Use Disorder and Posttraumatic Stress Disorder.
复制标题
饮酒、创伤性应激和吸烟对同时患有酒精使用障碍和创伤后应激障碍的退伍军人认知功能的影响。
DOI：
10.1093/milmed/usac282
复制
发表时间：
2022
影响因子：
1.2
通讯作者：
Pennington,DavidL
中科院分区：
文献类型：
--
作者：
Hua,JessicaPY;Cano,Monique;Batki,StevenL;Pennington,DavidL
酒精使用障碍（AUD）和创伤后应激障碍在美国退伍军人中有很高的共同发生率，导致相对于单独患有其中任何一种疾病的功能结局越来越差。认知功能障碍会阻碍人们从标准行为AUD和PTSD治疗中获益的能力。吸烟在美国退伍军人中也非常普遍，并且认知功能障碍与AUD和PTSD个体的慢性吸烟独立相关。然而，对于吸烟在多大程度上进一步损害患有共同发生的AUD和PTSD的个体的认知功能知之甚少。同时发生AUD和PTSD的退伍军人（n= 162）完成了一项全面的认知评估，涵盖各个领域：工作记忆，处理速度，心理转换，认知抑制，词汇-语言学习，词汇-语言记忆和语言流畅性。为了研究饮酒、创伤性应激和吸烟对认知功能的影响，我们进行了一个三向交互作用研究，研究吸烟状态对饮酒和创伤后应激障碍症状在整体认知复合域之间的关联的调节作用。结果合并AUD和创伤后应激障碍的退伍军人的吸烟状态调节了饮酒和整体认知之间的关系（P= 0.042），因此，在过去一周内饮酒水平较高与退伍军人吸烟者的整体认知功能较差有关（P= 0.015），但与非吸烟者无关（P= 0.833）。在对个体认知领域的随访分析中，在过去一周内更多的酒精使用与吸烟者而不是非吸烟者的较低认知抑制相关，创伤应激症状缓和了这种影响（P= 0.039）。此外，吸烟状态缓和酒精的使用和酒精的口头学习之间的关系，这样，有一个吸烟者和nonsmokers.ConclusionsOverall之间的酒精的使用和酒精的口头学习的差异关系，结果提供证据的复合影响酒精的使用，创伤性应激反应，和吸烟对认知功能。全球层面以及认知抑制和听觉语言学习的各个领域的认知表现受损都很明显。认知功能障碍可能会阻碍退伍军人从治疗中获益的能力，这些认知领域可能是认知训练的潜在目标。此外，研究结果支持在退伍军人事务部医疗保健设施和医疗中心制定的戒烟计划和无烟政策。
IntroductionAlcohol use disorder (AUD) and PTSD have high rates of co-occurrence in U.S. Military Veterans resulting in incrementally worse functional outcomes relative to having either one of these disorders alone. Cognitive dysfunction can impede one’s ability to benefit from standard behavioral AUD and PTSD treatments. Cigarette smoking is also highly prevalent among U.S. Military Veterans, and cognitive dysfunction is associated with chronic cigarette use among individuals with AUD and PTSD independently. However, much less is known about to what extent cigarette smoking further impairs cognitive functioning in individuals with both co-occurring AUD and PTSD.Materials and MethodsU.S. Veterans with co-occurring AUD and PTSD (n= 162) completed a comprehensive cognitive assessment covering various domains: working memory, processing speed, mental switching, cognitive inhibition, auditory-verbal learning, auditory-verbal memory, and verbal fluency. To examine the impact of alcohol use, traumatic stress, and cigarette smoking on cognitive function, we conducted a three-way interaction examining the moderated effects of smoking status on the association between alcohol use and PTSD symptoms on a composite domain of global cognition.ResultsSmoking status in Veterans with co-occurring AUD and PTSD moderated the relationship between alcohol use and global cognition (P= .042), such that higher levels of alcohol use in the past week were related to worse global cognitive function among Veterans cigarette smokers (P= .015) but not among nonsmokers (P= .833). On follow-up analyses of individual cognitive domains, greater alcohol use in the past week was associated with lower cognitive inhibition in smokers but not nonsmokers, with traumatic stress symptoms moderating this effect (P= .039). Additionally, smoking status moderated the relationship between alcohol use and auditory-verbal learning, such that there was a differential relationship between alcohol use and auditory-verbal learning between smokers and nonsmokers.ConclusionsOverall, results provide evidence for the compounding impact of alcohol use, traumatic stress, and cigarette smoking on cognitive functioning. Impaired cognitive performance on a global level as well as on individual domains of cognitive inhibition and auditory-verbal learning were evident. Cognitive dysfunction may impede a Veteran’s ability to benefit from therapeutic treatment, and these cognitive domains may represent potential targets for cognitive training efforts. Further, study results support smoking cessation initiatives and smoke-free policies enacted at Veterans Affairs healthcare facilities and medical centers.