Effects of tDCS Paired with Cognitive Training on Brain Networks associated with Alcohol Use Disorder in Veterans

经颅直流电刺激 (tDCS) 与认知训练相结合对退伍军人酒精使用障碍相关大脑网络的影响

• 批准号: 10578726
• 负责人: KELVIN O. LIM
• 金额: --
• 依托单位: MINNEAPOLIS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-01 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10578726
• 关键词: Abstinence; Adaptive Behaviors; Affect; Alcohol dependence; Automobile Driving; Brain; Caring; Clinical Trials; Cognition; Cognitive; Corpus striatum structure; Coupled; Data; Diagnosis; Effectiveness; Epidemic; Functional Magnetic Resonance Imaging; Future; Goals; Healthcare Systems; Impaired cognition; Individual; Inpatients; Intervention; Intervention Studies; Measures; Mediating; Neuronal Plasticity; Parietal; Participant; Patients; Placebos; Population; Prefrontal Cortex; Randomized; Recording of previous events; Recovery; Relapse; Research Proposals; Rest; Testing; Thalamic structure; Time; Treatment outcome; United States; United States Department of Veterans Affairs; Veterans; addiction; alcohol abstinence; alcohol misuse; alcohol use disorder; binge drinking; brain circuitry; chronic alcohol ingestion; cognitive change; cognitive control; cognitive performance; cognitive training; drinking behavior; follow-up; improved; long term abstinence; neural; neural circuit; neural network; neuromechanism; neuroregulation; novel; post intervention; primary outcome; randomized, controlled study; research and development; seal; substance use; therapy development; transcranial direct current stimulation; treatment program

Alcohol misuse is an epidemic among Veterans in the United States. Nearly 1/3 of Veterans have a lifetime history of Alcohol Use Disorder (AUD). Across Veteran and civilian populations, about 60% of those entering treatment will relapse within one year. Paradoxically, chronic alcohol use is associated with cognitive impairments and changes in their underlying neural circuitry, that interfere with adaptive behavior needed for successful recovery. However, these cognitive impairments and their underlying neural substrates are promising new targets for interventions that can reduce relapse rates. Evidence suggests that cognitive training can improve cognition in individuals with AUD, strengthen neural networks mediating cognition, and improve treatment outcome. However, cognitive training is effort intensive, has small effect sizes, and may have limited durability. Evidence suggests that addiction is mediated by a dysfunctional cortico-striatal neurocircuitry characterized by excess striatal activity (driving substance use) coupled with hypoactive prefrontal cortex (impaired cognitive control)​.​ Resting-state functional connectivity (RSFC) data has identified a promising circuit-based target for the treatment of addiction. Individuals who have achieved long-term abstinence from alcohol (~7 years of abstinence) have higher RSFC in prefrontally-mediated networks (e.g. prefrontal-striatal, prefrontal-parietal, prefrontal-insular, prefrontal-thalamic networks) th​an controls or those with short-term abstinence (6-10 weeks of abstinence). Moreover, lower prefrontal RSFC during short-term abstinence can predict subsequent relapse. The ​primary objective​ of this study is to investigate the use of a novel neuroplasticity based intervention that combines ​cognitive training​ and ​transcranial direct current stimulation ​(tDCS) neuromodulation​ to enhance frontal-striatal RSFC and cognition, with the goal to improve treatment outcomes and increase abstinence in Veterans with AUD. This research proposal will address the following ​Specific Aims (SAs)​: ​SA1) ​Compare brain network changes between active tDCS vs. sham tDCS (placebo) groups, ​when both groups receive cognitive training​. RSFC changes will be measured with functional magnetic resonance imaging data collected pre- and post-intervention. ​Hypothesis:​ ​Active tDCS, compared to sham tDCS will produce a significantly greater increase in prefrontal-striatal RSFC. ​SA2) ​Evaluate cognitive changes between active tDCS vs. sham tDCS (placebo) groups. ​Hypothesis:​ ​Active tDCS, compared to sham tDCS, will produce a significantly greater improvement in cognitive performance measures. ​SA3) ​Compare the effects of active tDCS vs. sham tDCS on drinking behavior over a 2 month follow-up period.​ ​Our primary outcome will be to compare binge drinking days per week​ w​ ithin the 2 months after the intervention between AUD participants who receive active tDCS vs. sham. ​Hypothesis:​ ​Active tDCS, compared to sham tDCS, will produce significantly fewer binge drinking days per week​ i​ n the 2 months following the intervention. Cognitive impairment and its underlying neural mechanisms affect alcohol addiction​ treatment outcomes​. We propose the first study to examine how tDCS-augmented cognitive training affects cognition and its related brain circuitry in alcohol use disorder in Veterans, which will provide critical information to guide future research and treatment development.

酗酒在美国退伍军人中是一种流行病。近三分之一的退伍军人一生 酒精使用障碍史(AUD)在退伍军人和平民人口中，约60%的人进入 治疗将在一年内复发。矛盾的是，长期饮酒与认知能力有关 他们潜在神经回路的损伤和变化，干扰了适应行为 恢复成功。然而，这些认知障碍及其潜在的神经基础是 可以降低复发率的干预措施有望实现新的目标。有证据表明，认知训练 可以改善AUD患者的认知，加强神经网络调节认知，并改善 治疗结果。然而，认知训练是努力密集型的，效果小，而且可能有限。 耐用性。 有证据表明，成瘾是由功能失调的皮质-纹状体神经回路介导的，其特征是 纹状体活动过度(使用驱动力物质)，加上前额叶皮质活动不足(认知受损) 控制)​.​静息状态功能连通性(Rsfc)数据已经确定了一个基于电路的有前途的目标 对上瘾的治疗。长期戒酒(约7年)的个人 节欲)在前额叶调节的网络(例如前额-纹状体，前额-顶叶， 前额叶-岛叶、前额叶-丘脑网络)​和对照组或短期戒断者(6-10周 禁欲)。此外，短期戒毒期间较低的前额叶RSFC可以预测随后的复发。 这项研究的主要目标​​是调查一种新的基于神经可塑性的干预措施的使用，该干预措施 结合​认知训练​和​经颅直流电刺激​(TDCs)神经调节​来增强 额叶-纹状体RSFC和认知，目的是改善治疗结果和增加戒断 患有澳元的退伍军人。 这项研究建议将解决以下​特定目标(SA)​：​SA 1)​比较脑网络的变化 在活动TDCs和假TDCs(安慰剂)组之间，当两组都接受认知训练时，​​。RSFC 将使用之前和之前收集的功能磁共振成像数据来测量变化 干预后。​假说：​​激活的tDCs，与假的tDCs相比，会产生明显更大的 前额-纹状体RSFC增加。​Sa2)​评估活动TDC与假TDC之间的认知变化 (安慰剂)组。​假说：​​激活的TDC，与假TDC相比，将产生明显更大的 认知表现测量的改进。​sa3)​比较了主动tdcs与假tdcs对 在2个月的随访期内的饮酒行为。​​我们的主要结果是比较酗酒天数 每周​w​在接受主动TDC的AUD参与者之间的干预后2个月内 假的。​假说：与假​​相比，活跃的tdcd会显著减少酗酒天数。 Per Week​I​n n干预后2个月。 认知障碍及其潜在的神经机制影响酒精成瘾​治疗结果​。我们 提出第一项研究，考察tdcs增强的认知训练如何影响认知及其相关因素。 退伍军人酒精使用障碍的大脑回路，这将为未来的研究提供关键信息 和治疗方法的发展。