RESUMEN
Modafinil is a candidate compound for the treatment of cocaine addiction that binds to the dopamine transporter (DAT) in healthy humans, as observed by positron emission tomography (PET). This mechanism, analogous to that of cocaine, might mediate a putative therapeutic effect of modafinil on cocaine dependence, though the binding of modafinil to DAT has never been assessed in cocaine-dependent patients. We aimed at quantifying the DAT availability during a controlled treatment by modafinil, and its clinical and psychometric correlates in cocaine-dependent patients at the onset of abstinence initiation. Twenty-nine cocaine-dependent male patients were enrolled in a 3-month trial for cocaine abstinence. Modafinil was used in a randomized double-blind placebo-controlled design and was administered as follows: 400 mg/day for 26 days, then 300 mg/day for 30 days, and 200 mg/day for 31 days. Participants were examined twice during a 17-day hospitalization for their DAT availability using PET and [(11)C]-PE2I and for assessments of craving, depressive symptoms, working memory, and decision-making. Cocaine abstinence was further assessed during a 10-week outpatient follow-up period. Baseline [(11)C]-PE2I-binding potential covaried with risk taking and craving index in striatal and extrastriatal regions. A 65.6% decrease of binding potential was detected in patients receiving modafinil for 2 weeks, whereas placebo induced no significant change. During hospitalization, an equivalent improvement in clinical outcomes was observed in both treatment groups, and during the outpatient follow-up there were more therapeutic failures in the modafinil-treated group. Therefore, these results do not support the usefulness of modafinil to treat cocaine addiction.
Asunto(s)
Compuestos de Bencidrilo/farmacología , Encéfalo/efectos de los fármacos , Encéfalo/metabolismo , Trastornos Relacionados con Cocaína/prevención & control , Proteínas de Transporte de Dopamina a través de la Membrana Plasmática/metabolismo , Adulto , Compuestos de Bencidrilo/administración & dosificación , Encéfalo/diagnóstico por imagen , Ansia/efectos de los fármacos , Toma de Decisiones/efectos de los fármacos , Depresión , Método Doble Ciego , Humanos , Masculino , Memoria a Corto Plazo/efectos de los fármacos , Persona de Mediana Edad , Modafinilo , Nortropanos , Tomografía de Emisión de PositronesRESUMEN
BACKGROUND: Alcohol-related neuropsychological impairments mainly affect episodic memory, working memory, and visuospatial abilities, as well as executive and motor functioning. These impairments can prevent alcoholic patients (ALs) early in abstinence from benefiting fully from treatment and reduce their ability to remain abstinent. A neuropsychological assessment seems essential for making the relevant clinical decisions. However, very few alcohol treatment departments have the financial and human resources needed to conduct an extensive neuropsychological examination of each AL. The goal of this study was therefore to assess the validity and the psychometric properties of the Brief Evaluation of Alcohol-Related Neuropsychological Impairments (BEARNI), a new screening tool especially designed to assess alcohol-related neuropsychological impairments. METHODS: A total of 254 healthy controls (HCs) completed the BEARNI, and 58 of them also performed an extensive neuropsychological battery. Seventy-three ALs underwent both the BEARNI and the neuropsychological battery. This extensive neuropsychological battery of proven classification accuracy served as the reference (i.e., gold standard) for determining the ALs' cognitive status. RESULTS: An exploratory factor analysis validated the BEARNI's underlying structure, highlighting 5 factors that reflected visuospatial abilities, executive functions, ataxia, verbal episodic memory, and verbal working memory. The standardization of each BEARNI subtest and the 2 total scores revealed that this test has sufficient diagnostic accuracy for the detection of ALs with cognitive and motor impairments. CONCLUSIONS: This study indicates that the BEARNI is a useful screening tool in clinical settings for detecting ALs' motor and cognitive impairments.
Asunto(s)
Alcoholismo/diagnóstico , Alcoholismo/psicología , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/psicología , Pruebas Neuropsicológicas/normas , Adulto , Alcoholismo/epidemiología , Trastornos del Conocimiento/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Cocaine has become a public health problem. Several studies have shown that cocaine addiction is associated with multiple cognitive damages, such as memory, inhibitory control, attention and executive functions. A French cohort of cocaine addicted patients was divided into two groups: CCU (Current cocaine users) and abstainers. Their cognitive abilities were compared to a control group and associations with clinical determinants were assessed. The CCU group and the abstainers had episodic memory, working memory and inhibitory control disabilities compared to the control group. Both the CCU and the abstainers group had the same cognitive abilities but their clinical determinants for these cognitive abilities differed. In the CCU group, exposure to cocaine seemed to have a negative impact on cognition especially inhibitory control, memory and impulsivity. In the abstainers group, craving and depression impeded cognition.