Cognitive Training for Nicotine Dependence

项目摘要 试图戒烟的吸烟者通常报告认知障碍。这些症状促使复发， 吸烟，也许可以改善这些缺陷，并恢复功能到戒烟前的水平。的确， 客观评估的认知障碍会增加吸烟复发的风险，支持以下前提： 戒断相关的认知损害是帮助戒烟的重要治疗目标。的 拟议的随机临床试验将评估认知补救训练（CRT）干预， 改善戒断引起的认知障碍，提高寻求治疗的戒烟成功率 吸烟者。具体来说，我们将评估计算机辅助CRT是否能提高尼古丁戒烟成功率 贴片疗法，美国最广泛使用的戒烟药物。 吸烟者将接受尼古丁贴片治疗，加上：（a）计算机辅助CRT或（B）认知 刺激控制（CSC）干预，基于随机分配。CRT干预是为期12周的 标准化课程（共36小时）的计算机认知练习，旨在缓冲吸烟者， 认知缺陷增加吸烟复发风险。CSC（控制条件）是一种主动干预， 以解决注意力和计算机刺激的非特异性影响。CRT或CSC将启动4周 在目标戒烟日期之前。标准的8周开放标签尼古丁贴片治疗将开始在目标 两种研究条件下受试者的退出日期。主要结果将是生化验证点- 6个月随访时的禁欲率。次要结局包括治疗结束时的戒烟率、 复吸率和吸烟失败的恢复率。关键的中间终点包括认知功能的变化， 表现和大脑功能（主要），以及渴望，功能状态和坚持。审查 CRT与CSC相关的治疗前后脑功能变化，BOLD fMRI数据将 在完成神经认知任务的同时，为一组参与者（n=50）在治疗前和治疗后获得。 因此，除了评价一种新的CRT干预的疗效外，这项研究还将提供一个关键的 对认知功能在吸烟复吸中作用的机械理解。

PROJECT SUMMARY Cognitive impairment is commonly reported by smokers attempting to quit. Such symptoms prompt relapse to smoking, perhaps to ameliorate these deficits and restore functioning to pre-cessation levels. Indeed, objectively assessed cognitive impairment increases risk of smoking relapse, supporting the premise that withdrawal-related cognitive impairment is an important therapeutic target to aid in smoking cessation. The proposed randomized clinical trial will evaluate a cognitive remediation training (CRT) intervention to ameliorate abstinence-induced cognitive impairment and improve quitting success in treatment-seeking smokers. Specifically, we will evaluate whether computer-assisted CRT improves quitting success with nicotine patch therapy, the most widely used medication for smoking cessation in the U.S. Three hundred and forty smokers will receive nicotine patch therapy, plus either: (a) computer-assisted CRT or (b) a cognitive stimulation control (CSC) intervention, based on random assignment. The CRT intervention is a 12-week standardized course (36 hours total) of computerized cognitive exercises designed to buffer smokers against cognitive deficits that increase smoking relapse risk. CSC (control condition) is an active intervention designed to address the non-specific effects of attention and computer stimulation. CRT or CSC will be initiated 4 weeks prior to the target quit date. Standard 8-week open-label nicotine patch therapy will commence on the target quit date for participants in both study conditions. The primary outcome will be biochemically verified point- prevalence abstinence at the 6-month follow-up. Secondary outcomes include end of treatment quit rates, time to relapse, and recovery rate from smoking lapses. Key intermediate endpoints include changes in cognitive performance and brain function (primary), as well as craving, functional status, and adherence. To examine pre- to post-treatment changes in brain function associated with CRT vs. CSC, BOLD fMRI data will be acquired for a subset of participants (n=50) pre- and post-treatment while they complete neurocognitive tasks. Thus, in addition to evaluating the efficacy of a novel CRT intervention, this study will provide a critical mechanistic understanding of the role of cognitive function in smoking relapse.