Effects of Cognitive Training in Methadone Maintenance Patients

认知训练对美沙酮维持治疗患者的影响

• 批准号: 8145330
• 负责人: MIRIAM Z. MINTZER
• 金额: $ 19.89万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2013-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8145330
• 关键词: Affect; American; Analgesics; Automobile Driving; Brain; Clinical; Cognitive; Cognitive remediation; Complex; Decision Making; Drug abuse; Drug usage; Exhibits; Functional disorder; Grant; Health; Heroin; Impaired cognition; Impairment; Individual; Learning; Matched Group; Measures; Methadone; Opiate Addiction; Opioid; Outcome Measure; Participant; Patients; Performance; Pharmaceutical Preparations; Population; Procedures; Process; Public Health; Recording of previous events; Relative (related person); Severities; Short-Term Memory; Substance abuse problem; Surveys; Testing; Time; Training; Treatment outcome; United States Substance Abuse and Mental Health Services Administration; Workplace; addiction; aged; base; clinically relevant; cognitive function; cognitive training; daily functioning; design; drug abuser; executive function; healthy volunteer; improved; indexing; innovation; methadone maintenance; opioid abuse; psychosocial; public health relevance; response; secondary outcome; substance abuse treatment; substance abuser

DESCRIPTION (provided by applicant): Opioid dependence is a significant public health problem. Individuals with opioid dependence exhibit frontal brain dysfunction and cognitive impairment. In addition to potentially affecting the ability to perform daily activities such as driving a car or performing complex tasks in the workplace, cognitive impairment may affect the ability to participate in and benefit from cognitive/psychosocial aspects of substance abuse treatment. Yet, few studies have attempted to remediate cognitive functions in substance abusers, and no study has specifically targeted opioid dependence. Working memory (WM) is a critical cognitive function whose core component is the 'central executive' (set of executive functions), and is a necessary building block for the performance of other cognitive functions. WM is impaired in opioid dependence and has been shown to modulate inhibitory control and decision making in substance abusers and to predict substance abuse treatment outcomes. The proposed theoretically driven cognitive training procedure (WM Training) targets working memory, and has been shown to increase working memory capacity in a variety of clinical populations (including conditions associated with frontal dysfunction) and to transfer to other cognitive domains, which is rarely observed in training studies. This innovative study will test the effects of 25 sessions of WM Training in a controlled design with 3 groups: methadone maintenance patients (MMP) who perform WM Training (MMP TRAIN), MMP who do not perform WM Training (MMP CONTROL), and healthy volunteers who perform WM Training (HV TRAIN). A battery of state-of-the art cognitive measures will be administered before and after training, and substance abuse treatment outcomes will be included as secondary outcomes. Specific Aim 1 is to test the hypothesis that MMP TRAIN will show improved performance on the trained working memory tasks at the end versus the beginning of WM Training. Specific Aim 2 is to test the hypothesis that MMP TRAIN will show significantly greater improvement in working memory and other cognitive tasks, relative to MMP CONTROL. Specific Aim 3 is to test the hypothesis that HV TRAIN will show improved working memory and cognitive performance after relative to before WM Training (as a replication within the study of previous WM Training studies). Secondary aims are to compare the magnitude of improved performance following WM Training in MMP relative to healthy volunteers without drug abuse histories, and to test whether MMP show improved substance abuse treatment outcomes following WM Training. Study findings will provide clinically relevant information about the potential of cognitive training to improve cognitive functioning in opioid dependent patients, and will enhance scientific understanding of learning capacity and the malleability of frontally based cognitive processes to training procedures in opioid dependence. In addition to the broad implications for daily functioning, definitively establishing the effects of cognitive training on cognitive functions is a necessary first step in the systematic study of training effects on substance abuse treatment outcomes. PUBLIC HEALTH RELEVANCE: Individuals with opioid dependence exhibit cognitive impairment, which may affect daily functioning and substance abuse treatment outcomes. This study will test the ability of an innovative and theoretically based cognitive training procedure to improve cognitive functioning in methadone maintenance patients.

描述（由申请人提供）：阿片类药物依赖是一个重大的公共卫生问题。阿片类药物依赖的个体表现为额叶脑功能障碍和认知障碍。除了可能影响日常活动（如开车或在工作场所执行复杂任务）的能力外，认知障碍还可能影响参与药物滥用治疗的认知/社会心理方面并从中受益的能力。然而，很少有研究试图修复药物滥用者的认知功能，也没有研究专门针对阿片类药物依赖。工作记忆（WM）是一种重要的认知功能，其核心部分是“中央执行”（一组执行功能），是其他认知功能的必要组成部分。WM在阿片类药物依赖中受损，并已被证明可调节药物滥用者的抑制控制和决策，并预测药物滥用治疗结果。提出的理论驱动的认知训练程序（WM训练）以工作记忆为目标，并已被证明可以增加各种临床人群（包括与额叶功能障碍相关的条件）的工作记忆容量，并转移到其他认知领域，这在训练研究中很少观察到。这项创新的研究将在对照设计中测试25次WM训练的效果，分为三组：美沙酮维持患者（MMP）进行WM训练（MMP TRAIN），不进行WM训练的MMP （MMP CONTROL）和进行WM训练（HV TRAIN）的健康志愿者。在训练前后将实施一系列最先进的认知措施，并将药物滥用治疗结果列为次要结果。具体目的1是验证MMP训练在训练结束时比WM训练开始时在训练后的工作记忆任务上表现更好的假设。具体目标2是验证MMP训练在工作记忆和其他认知任务方面比MMP控制有更大改善的假设。具体目标3是验证HV训练后相对于WM训练前的工作记忆和认知表现改善的假设（作为先前WM训练研究的重复研究）。次要目的是比较WM培训后MMP与无药物滥用史的健康志愿者的表现改善程度，并检验WM培训后MMP是否显示出药物滥用治疗结果的改善。研究结果将为认知训练改善阿片类药物依赖患者认知功能的潜力提供临床相关信息，并将加强对阿片类药物依赖训练过程中学习能力和额叶认知过程可塑性的科学理解。除了对日常功能的广泛影响外，明确确定认知训练对认知功能的影响是系统研究训练对药物滥用治疗结果影响的必要第一步。