Clinical Clinical features and cognitive features and cognitive impairments in methamphetamine impairments in methamphetamine use disorder use disorder Min Zhao, M.D & Ph.D., Prof. of Psychiatry Shanghai Mental Health Center Shanghai Mental Health Center Shanghai Jiao Tong University School Shanghai Jiao Tong University School of Medicine of Medicine April 22-24, 2015, Hangzhou, China April 22-24, 2015, Hangzhou, China
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Clinicalfeatures and cognitive impairments in methamphetamine use disorder Clinical features and cognitive impairments in methamphetamine use disorder.
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ClinicalClinical features and cognitive features and cognitive impairments in methamphetamine impairments in methamphetamine use disorderuse disorderMin Zhao, M.D & Ph.D., Prof. of Psychiatry
Shanghai Mental Health CenterShanghai Mental Health Center
Shanghai Jiao Tong University School of MedicineShanghai Jiao Tong University School of Medicine
April 22-24, 2015, Hangzhou, ChinaApril 22-24, 2015, Hangzhou, China
MA recreational use have increased dramatically in recent yearsThe second most widely abused drugs 38% are ATS users in 2013 in China 90% new drug usersAnnual prevalence of drug use at the global level, by illicit drug category, 2009-2010
18%
6.6%
42.1%
20.6%Nu
mb
er o
f re
sist
ed d
rug
u
sers
in C
hin
a (m
illio
n)
Background
NNCC, 2013 UNODC, 2013
Consequences of chronic MA useprolonged psychiatric symptoms (Scott, 2007)
Depression, anxiety and so on
Conginitive impairments
Poor quality of life, stress
HIV/AIDS risk, and other psychosocial consequences
Background
MA abuse associates with substantial neurotoxicityImpact multiple neurotransmitter systems,
e.g. Dopamine (DA), serotonin, glutamate (Volz, 2007)
Background
MA use relates with brain structural and functional abnormotiesStructural
Part 2. Cognitive functions among ATS dependent patients
Aim: to understand the cognitive function and its
changes after MA abstinence for 6 months
Case control and longitudinal study Subjects: MA=54, HC=58 Inclusion criteria:
(1) more than 9 years of education; (2) aged between 18 and 45 years old; (3) Han nationality and proficient at Chinese (4) normal or corrected-to-normal vision and hearing.
Exclusive criteria: (1) physical or neurological illnesses affecting cognitive
function (e.g., stroke, seizure, or a severe head injury);(2) other Axis I disorder of DSM-IV criteria; (3) use of cognitive enhancing drugs within 6 months of
study enrollment; and (4) substance dependence other than nicotine, within the
past 5 years.
Part 2. Cognitive functions among ATS dependent patients
Measurements:The cognitive assessments: the CogState
batteryWHO-quality of life instrument (WHOQOL-BREF) Social Adaptation Self-evaluation Scale (SASS) Beck depression scale-II CogState Battery: 8 dimensions, baseline, 3, 6
months afterInternational shopping list task (ISL, verbal memory)Detection Task (DET, processing speed) Identification Task (IDN, tapping attention/vigilance)One Card Learning Task (OCL, visual memory)Two Back Task (TWOB, working memory)Social Emotional Cognition Task (SEC, social cognition)Continuous Paired Association Learning Task (CPAL,
spatial working) The Groton Maze Learning Task (GML, memoryproblem
solving and error monitoring)
Part 2. Cognitive functions among ATS dependent patients
Demographics data and drug use history
MA group (n=54)HC group (n=58)
χ2 or t P
Male$, n (%) 40 (74.1%) 37 (63.8%) 1.37 0.503Age#(years), mean (SD) 33.89 (7.47) 30.52 (6.55) 2,54 0.12
Years of Education#, mean (SD) 9.80 (1.83)*** 14.26 (3.70) 8.18 <0.001
Married$, n (%) 16(29.63%) *** 36 (62.07%) 11.83 <0.001
Smoking$, n (%) 5 (90.74%) *** 36 (62.07%) 12.56 <0.001
Employed within the last year, n (%) 24 (44.4%)
MA onset age (years), mean (SD) 28.78 (8.59)Years of MA use, mean (SD) 4.14 (3.42)Days of abstinence, mean (SD) 44.85 (20.65)Heroin users 5 years ago before study entry, n (%)
22 (40.7%)
Part 2. Cognitive functions among ATS dependent patients
The psychological wellbeing of MA addicts
MA group (n =54) HC group (n=58) t value P
SASS 31.98 (6.95) 35.97(6.51) 3.13 0.002
WHO-QOL
Physical health 24.46 (3.54) 26.40 (3.21) 3.03 0.003
Psychological health 18.48 (4.18) 21.67 (3.40) 4.44 <0.001
Social relationships 10.50 (2.16) 11.60 (2.66) 2.04 0.018
Environment 25.41 (5.50) 28.52 (9.04) 2.18 0.031
Total score 78.81 (12.30) 86.77 (10.30) 3.7 <0.001
Part 2. Cognitive functions among ATS dependent patients
Cognitive function of MA addicts
MA group HC group
Baseline 3m later 6m later Baseline 3m later 6m later
Part 2. Cognitive functions among ATS dependent patients
-0.10 OCL
IDN0.19
DET0.22
-0.40 TWOB* -0.57
GML**
-1.28 ISL***
-0.62 SEC**
-0.96 CPAL***
-0.44 COMP***
-1.50
-1.20
-0.90
-0.60
-0.30
0.00
0.30
Healthy control means
Z-s
core
s
Figure 3. Magnitude of impairment of relative to healthy controls in the CogState Battery. Abbreviation: ISLT International Shopping List Task, DET Detection Task, IDN Identification Task, OCL One Card Learning Task, ONB One Back Task, CPAL Continuous Paired Association Task, GML Groton Maze Learning Task, SEC social emotional cognition, COMP composite score. Numbers of the figure are Z score. *P<0.05, **P<0.01, ***P<0.001
Part 2. Cognitive functions among ATS dependent patients
Figure 4. Follow-up assessment of cognitive function in the MA and HC groups *P<0.05. Abbreviation: GML Groton Maze Learning Task. ISL International Shopping, SEC social emotional cognition, List Task
** * *
*
Hoffman (2006) √ Morgan (2012) √ Hoffman (2006) ×
Verbal memory Visual memory
Salo (2009a) √ van der Plas (2009) √
Salo (2009b) ×
Working memory
Error monitoring
Attention
Processing speed
Social cognition Kim (2011) √ Payer (2008) √
•MA addicts endure broad cognitive impairments
Verbal memory
• longitudinal : Indicelllo (2010)
• Cross sectional: no improvement in 3 month abstinence
Error monitoring
• longitudinal : Indicelllo (2010)
• Cross sectional : Van der Plas (2010), IGT 、 WCST 、 Stroop
Social cognition • Henry (2009),6-month
abstinence , MA<HC
•MA addcits cognitive impariments could partially improve
MethodsSubjects: MA group (n=28):
over 1 year MA useTotal lifetime MA consumption > 50 g
Health control (n=26): age, sex matched
Inform consent
• fMRI scan• stroop task simultaneously
•Demorgraphic data•Abuse history•Clinical data
•Stroop task training•8min
Part 3. Brain activity of abstinent MA users in word-color interference Stroop task
The words-color interference Stroop taskE-prime 2.0 Block design, psudo-random
congruency incongruency rest
red red/red/red +
•Stimulus presented 2 s •Rest 2-12 s
•Mean 5875ms• reaction time, total errors
•( RTincon—RTcon ) / RTcon
Methods
Part 3. Brain activity of abstinent MA users in word-color interference Stroop task
Duration of abstinence (months) N/A 5.52±1.59 6.41±1.03 3.75±0.82 7.084 <0.001
Age of onseta N/A 26.10±7.15 27.40±6.60 23.50±7.85 1.434 0.163
Duration of drug use (months) N/A 75.93±43.28 74.75±31.04 78.30±63.19 -0.208 0.836
Duration of continuous drug useb (months)
N/A 7.98±13.69 7.53±14.18 8.89±13.32 -0.254 0.802
Average number of grams of MA used per occasionc (gram)
N/A 0.66±0.48 0.55±0.35 0.87±0.64 -1.467 0.169
Part 4.Hippocampal volume in recent abstinent MA users
• No group or gender main effect, group*gender interaction for the
right (p=0.020) but not left (p=0.249) relative hippocampal
volume
• female patients and female controls (t(18) =-1.984, p=0.063), male
patients and male controls (t(37) = 0.802, p=0.427)
Part 4.Hippocampal volume in recent abstinent MA users
• male controls and female controls (t(27) = -4.443, p<0.001) , male patients and female patients (t(28) = -1.303, p=0.203)
• a smaller volume of right hippocampus in female but not in male abstinent MA users compared to healthy controls.
Part 4.Hippocampal volume in recent abstinent MA users
Summery and conclusions
ATS dependent individuals experience high rates of psychaitric symtoms and had poor psychosocial wellbeing (such as depression, anxity, stress, quality of life, social adaption)
ATS dependent individuals show broad cognitive impairments (e.g. memory, working memory, executive function, social cognition) , some cognitive domain(executive function, verbal memory, social cognition) improve after abstinence
ATS dependent individuals appear to have hypo-activity in some brain regions related to cognitive function, and hyper-activity in region related with craving
Hippocampal volume reduction in female but not male recent abstinent MA users