Neural Phenotypes of Impulsive Choice in Recovery from Alcohol Dependence

描述(由申请人提供)：该项目有两个具体目标：SA1。A)量化和表征AD与对照组在决策过程中大脑对延迟、概率和奖赏大小的反应的参数变化。B)量化大脑连接中断与阿尔茨海默病患者冲动增强的相关性。SA2.确定通过行为冲动的神经底物的表型变化可以预测复发的程度。方法：从当地居民治疗项目中招募80名新近戒断的AD患者。将从普通公众和患者的非酒精依赖朋友中招募40名对照对象。受试者将在他们最初戒酒后的3个月内接受跟踪。他们将通过计算机化和问卷调查来评估他们的冲动。患者将保留饮酒日记，以便在研究期间捕获复发的所有因素。他们将在首次就诊时接受功能和解剖MRI评估，以量化神经对冲动选择的基本要素的反应，并评估大脑连接性的功能和解剖变化的程度。统计模型将把来自大脑成像的信息与复发的可能性联系起来。相关性：这项研究中定义的神经图谱将提高对折扣行为作为AD复发预测因素的基本要素的理解。AD患者选择机制的定量描述将为个性化治疗方案的定制提供有价值的信息。这将直接影响未来的治疗方法，不仅是在酒精中毒方面，而且在总体上也会对药物滥用和成瘾行为产生影响。这些知识将使药物滥用治疗方案的资金得到更有效的使用。 与公共卫生相关：酗酒是一个跨越社会经济界限的普遍问题，是导致大量医疗发病率和经济负担的原因。该项目使用功能磁共振成像来测量冲动决策中的个体表型差异，并将这些表型特征的基本要素与短期内从酒精依赖中恢复的可能性联系起来。我们预测，可量化的神经图谱的发展将为个性化治疗方案的定制提供有价值的信息；加深对大脑功能与酒精依赖康复临床过程的关系的理解，将对其他成瘾和神经精神障碍的治疗产生影响。

DESCRIPTION (provided by applicant): The project has two Specific Aims: SA1. a) Quantify and characterize the parametric variation of cerebral response to delay, probability, and reward magnitude during decision making in AD vs Controls. b) Quantify disruptions of cerebral connectivity as a correlate of increased impulsivity in AD. SA2. Determine the extent to which relapse can be predicted by phenotypic variation in the neural substrates of behavioral impulsivity. METHODS: Eighty recently abstinent AD subjects will be recruited from local residential treatment programs. Forty control subjects will be recruited from the general public and non alcohol dependent friends of the patients. Subjects will be followed for 3 months after their initial sobriety date. They will be evaluated monthly with computerized and questionnaire measures of impulsivity. Patients will keep a drinking diary to allow capture of all elements of relapse during the study period. They will undergo a functional and anatomical MRI evaluation at the initial visit to quantify the neural response to cardinal elements of impulsive choice and to assess the extent of functional and anatomical changes in cerebral connectivity. A statistical model will relate information from brain imaging to the likelihood of relapse. RELEVANCE: The neural profiles defined in this study will improve understanding of the cardinal elements of discounting behavior as a predictor of relapse in AD. Quantitative profiles of mechanisms of choice in AD individuals will provide valuable information for the tailoring of individual treatment regimens. This will directly impact future treatment approaches not only in alcoholism but also for substance abuse and addictive behaviors in general. This knowledge will allow funding for substance abuse treatment programs to be used more effectively. PUBLIC HEALTH RELEVANCE: Alcoholism is a widespread problem that crosses socioeconomic boundaries and is the cause of substantial medical morbidity and economic burden. This project uses functional magnetic resonance imaging to measure individual phenotypic differences in impulsive decision making and relate the cardinal elements of these phenotypic profiles to the likelihood of short-term recovery from alcohol dependence. We predict that development of quantifiable neural profiles will provide valuable information for the tailoring of individual treatment regimens; a deepened understanding of the relationship of brain function to the clinical course of recovery from alcohol dependence has implications for treatment of other addictions and neuropsychiatric disorders.