Working memory: a critical factor underlying alcohol reduction intervention response

 描述（由申请人提供）：拟议项目的目标是研究工作记忆（WM）网络在减少酒精消费中的预测作用，在一组HIV阳性重度饮酒者中，接受动机访谈（MI）干预。危险酒精使用（HAU）在艾滋病毒感染者（PLWH）中很常见，估计HAU在这一人群中的比例在5-33%之间（4-7）。在这一人群中，危险的酒精使用有许多有害的后果，其中包括增加以下风险：艾滋病毒传播，合并症的医疗条件恶化，合并症的精神病诊断和其他心理社会后果。为了有效地干预酒精使用，重要的是要了解认知能力影响干预效果的机制。先前的研究表明，在行为干预之前，WM能力与干预结果相关（11-12）。工作记忆的基本作用被定义为一种记忆形式，它支持内部表征的临时存储和维护，并介导对这些表征的控制操作（13-14）。工作记忆的一个关键组成部分是语音回路，它支持存储基于语音的信息的过程，因此它可以被操纵（13）。多元智能的一个关键要素，涉及语音回路资源的使用，是客户改变谈话的要素。客户改变谈话是干预成功的最一致的预测因素之一，因为用语言表达改变谈话可以帮助解决矛盾心理，这可以帮助个人朝着行为改变的更大可能性移动（15-16）。MI是治疗酒精问题最有效的行为疗法之一。然而，没有研究直接调查WM网络的预测作用，作为MI后饮酒减少的预测因子。我们的目的是检查WM网络使用功能磁共振成像（fMRI）血氧水平依赖（BOLD）的反应，在n-回（0-回和2-回）任务，静息状态功能连接分析，以及WM的能力，使用认知措施，以评估是否基线WM的能力是预测酒精减少，在MI干预。我们将测试是否减少功能磁共振成像BOLD激活WM感兴趣的区域（ROI）在n-back性能预测酒精减少接受MI干预的个人。我们还将评估更高的基线神经认知WM能力（N-back表现，字母数字排序，Trails，Stroop）是否预测MI后更大的酒精减少。最后，我们将确定是否较高的基线完全独立水平（即，WM ROI之间的功能连接）预测接受MI的个体在6个月时饮酒量减少。这项研究的结果将有助于理解与行为干预成功反应相关的机制。此外，了解与对MI的积极反应相关的潜在神经网络的变化，可以为未来的干预提供信息，这些干预可能侧重于在行为酒精减少干预之前增强WM能力。

 DESCRIPTION (provided by applicant): The goal of the proposed project is to examine the predictive role of working memory (WM) networks in reduced alcohol consumption, among a group of HIV positive heavy drinkers, receiving a Motivational Interviewing (MI) intervention. Hazardous alcohol use (HAU) is common in people living with HIV (PLWH) with estimates of HAU between 5-33% in this population (4-7). There are many deleterious consequences of hazardous alcohol use in this population, which include increased risk of: HIV transmission, exacerbation of comorbid medical conditions, comorbid psychiatric diagnoses, and other psychosocial consequences. In order to effectively intervene upon alcohol use, it is important to understand the mechanisms by which cognitive abilities impact intervention effectiveness. Previous studies have suggested that WM abilities, prior to behavioral intervention, are associated with intervention outcome (11-12). The basic role of WM has been defined as a form of memory that supports the temporary storage and maintenance of internal representations and mediates the controlled manipulation of these representations (13-14). A critical component of WM is the phonological loop which supports the process of storing speech based information, so that it can be manipulated (13). A critical element of MI, which involves the use of phonological loop resources, is the element of client change talk. Client change talk is among the most consistent predictors of intervention success because verbalizing change talk can help to resolve ambivalence, which can help move the individual toward a greater likelihood of behavior change (15-16). MI is one of the most effective behavioral treatments for problems with alcohol. However, no studies have directly investigated the predictive role of WM networks, as predictors of drinking reduction following MI. We aim to examine WM networks using functional magnetic resonance imaging (fMRI) blood oxygen level dependent (BOLD) response during n-back (0-back and 2-back) tasks, resting state functional connectivity analyses, as well as WM abilities using cognitive measures, to evaluate whether baseline WM abilities are predictive of alcohol reduction, in response to MI intervention. We will test whether decreased fMRI BOLD activation in WM regions of interest (ROI) during n-back performance predict alcohol reduction among individuals receiving MI intervention. We will also evaluate whether higher baseline neurocognitive WM abilities (N-back performance, Letter Number Sequencing, Trails, Stroop) predict greater alcohol reduction in response to MI. Finally, we will determine if higher baseline Total Independence levels (i.e., functional connectivity) between WM ROIs predict reduced alcohol consumption at 6 months, among individuals receiving MI. Findings from this research will contribute to an understanding of mechanisms associated with successful response to behavioral intervention. Furthermore, understanding changes in the underlying neural networks associated with positive response to MI, may inform future interventions, which may focus on enhancing WM abilities, prior to behavioral alcohol reduction intervention.