Cognitive Training for Nicotine Dependence

尼古丁依赖的认知训练

• 批准号: 8145276
• 负责人: MATTHEW M KURTZ
• 金额: $ 63.59万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 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 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8145276
• 关键词: Abstinence; Address; Adherence; Aftercare; Age; Anterior; Attention; Attenuated; Automobile Driving; Back; Bilateral; Brain; Buffers; Clinical; Clinical Trials; Cognition; Cognitive; Cognitive deficits; Cognitive remediation; Comorbidity; Computer Assisted; Computers; Control Groups; Data; Dorsal; Educational Intervention; Exercise; Foundations; Fractals; Functional Magnetic Resonance Imaging; Hour; Impaired cognition; Inferior frontal gyrus; Intervention; Intervention Studies; Measures; Medial; Medical; Memory impairment; Neurocognitive; Nicotine Dependence; Online Systems; Outcome; Participant; Patient Self-Report; Performance; Persons; Pharmaceutical Preparations; Prefrontal Cortex; Prevalence; Public Health; Randomized Clinical Trials; Recovery; Relapse; Reporting; Research; Research Personnel; Risk; Role; Schizophrenia; Science; Short-Term Memory; Signal Transduction; Smoker; Smoking; Symptoms; Time; Training; Translating; Treatment Efficacy; Withdrawal; base; cingulate cortex; clinical practice; cognitive function; cognitive training; computerized; craving; design; executive function; follow-up; frontal lobe; functional restoration; functional status; improved; intervention effect; nicotine patch; novel; open label; primary outcome; public health relevance; response; secondary outcome; smoking cessation; smoking relapse; success; therapeutic target; therapy design

DESCRIPTION (provided by applicant): 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. PUBLIC HEALTH RELEVANCE: The proposed research focuses on nicotine dependence, one of the most important medical and public health problems. The science is built upon a firm foundation of empirical evidence supporting cognition as a target for nicotine dependence treatment, thus driving the field forward from observational data to clinical intervention. The novel web-based computerized cognitive training intervention is "portable" and can be easily translated to clinical practice for the treatment for nicotine dependence.

描述（由申请人提供）：认知障碍通常由试图戒烟的吸烟者报告。这些症状促使重新吸烟，也许是为了改善这些缺陷，使功能恢复到戒烟前的水平。事实上，客观评估认知障碍会增加吸烟复发的风险，这支持了戒断相关认知障碍是帮助戒烟的重要治疗目标的前提。提出的随机临床试验将评估认知补救训练（CRT）干预，以改善戒烟诱导的认知障碍，提高寻求治疗的吸烟者的戒烟成功率。具体来说，我们将评估计算机辅助CRT是否能提高尼古丁贴片疗法的戒烟成功率，尼古丁贴片疗法是美国最广泛使用的戒烟药物，340名吸烟者将接受尼古丁贴片疗法，加上：(a)计算机辅助CRT或(b)基于随机分配的认知刺激控制（CSC）干预。CRT干预是一个为期12周的标准化课程（共36小时）的计算机认知练习，旨在缓冲吸烟者的认知缺陷，增加吸烟复发的风险。CSC （control condition）是一种主动干预，旨在解决注意力和计算机刺激的非特异性影响。CRT或CSC将在目标戒烟日期前4周开始。标准的8周开放标签尼古丁贴片治疗将在两种研究条件下的参与者的目标戒烟日期开始。在6个月的随访中，主要结果将是生化验证的点流行性禁欲。次要结果包括治疗结束时的戒烟率、复发时间和戒烟恢复率。关键的中间终点包括认知表现和脑功能（主要）的变化，以及渴望、功能状态和依从性。为了检查与CRT和CSC相关的治疗前和治疗后脑功能的变化，将获取一部分参与者（n=50）在治疗前和治疗后完成神经认知任务时的BOLD fMRI数据。因此，除了评估一种新型CRT干预的疗效外，本研究还将为认知功能在吸烟复发中的作用提供关键的机制理解。