title: Severity of neuropsychological impairment in cocaine and alcohol addiction: association with metabolism in the prefrontal cortex.
abstract: We used exploratory and confirmatory statistical approaches to study the severity of neuropsychological (NP) impairment in 42 crack/cocaine addicted subjects and in 112 comparison subjects (40 alcoholics and 72 controls). Twenty neuropsychological test indices most reliably defining predetermined cognitive domains were submitted to exploratory factor analysis. A four-dimensional model of neurocognitive function was derived: Verbal Knowledge, Visual Memory, Verbal Memory, and Attention/Executive functioning accounted for 63% of the variance. We then examined this model's association with resting glucose metabolism in the brain reward circuit measured with 2-deoxy-2[18F]fluoro-D-glucose positron emission tomography. Results revealed that (1) cocaine addicted individuals had a generalized mild level of neurocognitive impairment (<1 S.D. below control mean); and (2) controlling for age and education, relative metabolism in the dorsolateral prefrontal cortex significantly predicted the Visual Memory and Verbal Memory factors and relative metabolism in the anterior cingulate gyrus significantly predicted the Attention/Executive factor. Nevertheless, it remains to be determined whether metabolic changes in these regions are associated with addiction. Our results also suggest that compared to cocaine, alcohol has a more detrimental effect on Attention/Executive functioning, as assessed with traditional NP measures. We conclude that relative to other psychopathological disorders (such as schizophrenia), the severity of neuropsychological impairment in cocaine addiction is modest, albeit not indicative of the absence of neurocognitive dysfunction. The impact of such small differences in performance on quality of life, and possibly on craving and relapse, may be substantial. Tasks that simulate real-life decision-making or that target specific putative cognitive-behavioral or motivational-emotional mechanisms might offer greater sensitivity in characterizing the changes that accompany addiction to drugs. Obtaining valid estimates of alcohol use in cocaine addicted subjects is essential in characterizing neurocognitive functioning in individuals addicted to drugs.
authors.affiliation: Brookhaven National Laboratory, P.O. Box 5000, Upton, NY 11973-5000, USA. rgoldstein@bnl.gov
authors.forename: Rita Z
authors.initials: RZ
authors.lastname: Goldstein
authors.forename: Andreana C
authors.initials: AC
authors.lastname: Leskovjan
authors.forename: Anne L
authors.initials: AL
authors.lastname: Hoff
authors.forename: Robert
authors.initials: R
authors.lastname: Hitzemann
authors.forename: Francine
authors.initials: F
authors.lastname: Bashan
authors.forename: Sahib Singh
authors.initials: SS
authors.lastname: Khalsa
authors.forename: Gene-Jack
authors.initials: GJ
authors.lastname: Wang
authors.forename: Joanna S
authors.initials: JS
authors.lastname: Fowler
authors.forename: Nora D
authors.initials: ND
authors.lastname: Volkow
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000000981:diagnostic imaging* / Q000534:rehabilitation; D001786:Blood Glucose / Q000378:metabolism; D001931:Brain Mapping; D019970:Cocaine-Related Disorders / Q000000981:diagnostic imaging* / Q000534:rehabilitation; D004734:Energy Metabolism / Q000187:drug effects*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006179:Gyrus Cinguli / Q000000981:diagnostic imaging / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009415:Nerve Net / Q000000981:diagnostic imaging / Q000187:drug effects; D009483:Neuropsychological Tests / Q000706:statistics & numerical data*; D017397:Prefrontal Cortex / Q000000981:diagnostic imaging / Q000187:drug effects*; D011594:Psychometrics / Q000706:statistics & numerical data; D012201:Reward; D014055:Tomography, Emission-Computed
chemical_list: D001786:Blood Glucose; D019788:Fluorodeoxyglucose F18