Chronic cannabis use affects cerebellum dependent visuomotor adaptation.

BACKGROUND: Cannabis is one of the most commonly used substances in the world. However, its effects on human cognition are not yet fully understood. Although the cerebellum has the highest density of cannabinoid receptor type 1 (CB1R) in the human brain, literature on how cannabis use affects cerebellar-dependent learning is sparse. This study examined the effect of chronic cannabis use on sensorimotor adaptation, a cerebellar-mediated task, which has been suggested to depend on endocannabinoid signaling. METHODS: Chronic cannabis users (n = 27) with no psychiatric comorbidities and healthy, cannabis-naïve controls (n = 25) were evaluated using a visuomotor rotation task. Cannabis users were re-tested after 1 month of abstinence (n = 13) to assess whether initial differences in performance would persist after cessation of use. RESULTS: Cannabis users showed lower adaptation rates compared to controls at the first time point. However, this difference in performance did not persist when participants were retested after one month of abstinence (n = 13). Healthy controls showed attenuated implicit learning in the late phase of the adaptation during re-exposure, which was not present in cannabis users. This explains the lack of between group differences in the second time point and suggests a potential alteration of synaptic plasticity required for cerebellar learning in cannabis users. CONCLUSIONS: Overall, our results suggest that chronic cannabis users show alterations in sensorimotor adaptation, likely due to a saturation of the endocannabinoid system after chronic cannabis use.

"Doctor, Can I Drink an Alcohol-Free Beer?" Low-Alcohol and Alcohol-Free Drinks in People with Heavy Drinking or Alcohol Use Disorders: Systematic Review of the Literature.

No- and low-alcohol drinks (NoLo) have been proposed as a potential way forward for the reduction in the alcohol burden of disease. So far, there is scarce synthesized evidence on the effects of these products on people with alcohol use disorder (AUD), or with a heavy or high-risk drinking pattern. The aim of the present study is to systematically review the evidence of the use of NoLo drinks in these populations. A total of 4045 records were screened and 10 studies were included in the review. Craving and desire to drink have been found to increase after the consumption of NoLo drinks in patients with AUD. The increase in craving correlates with the severity of alcohol dependence. In addition, in this population, alcohol-related cues might trigger physiological responses similar to those experienced when using alcohol. Furthermore, as mentioned, in some of the studies, consumption was shown to increase as the %ABV or verbal descriptors indicate lower alcohol. Last, according to the epidemiological data, heavy drinkers tend to use NoLo drinks on top of their usual alcohol consumption rather than as part of regular drinking patterns. Further studies should be conducted in people with AUD or people with a high-risk drinking pattern to provide new insight to guide clinicians, patients, and other stakeholders to make evidence-based informed decisions.

Rehabilitation Gaming System for Alcohol-Related Cognitive Impairment: A Pilot Usability Study.

AIMS: Cognitive impairment in patients with alcohol use disorder (AUD) is highly prevalent, and it negatively impacts treatment outcome. However, this condition is neither systematically assessed nor treated. Thus, we aimed to explore the usability of a virtual reality-based protocol ('Rehabilitation Gaming System', RGS) for patients with AUD. METHODS: Twenty AUD patients (50% also cognitive impairment) underwent a single session of the RGS protocol (four cognitive training tasks, 10 minutes each). System Usability Scale (SUS) and Post-Study System Usability Questionnaire (PSSUQ) were applied to assess the RGS usability and patients' satisfaction with it. Also, the Perceived Competence Scale was administered to assess the patients' feelings of competence when using the training protocol. Comparisons of the responses to these questionnaires were performed between AUD patients with cognitive impairment and those without cognitive impairment. RESULTS: RGS usability was very positively rated (median SUS score = 80, Interquartile Range, IQR = 68.13-86-88). No significant differences were found in the median SUS scores for any of the sociodemographic or clinical variables, excepting for gender (women median score = 85; IQR = 80-94.38 vs. men median score = 71.25; IQR = 61.25-89.25; P-value = 0.035). The quality of the information provided by the RGS training scenarios and the usability were positively rated (PSSUQ), and patients experienced high feelings of competence. CONCLUSIONS: The RGS has been found to be usable in the short term and patients with AUD stated to be satisfied with it. Future larger, randomized trials are needed to explore the effectiveness of this tool to help overcome the cognitive deficits in AUD patients.

Motivational Interviewing for Cannabis Use Disorders: A Systematic Review and Meta-Analysis.

BACKGROUND: Cannabis is one of the most used drugs worldwide. There is no gold standard treatment for cannabis use disorder (CUD). Motivational interviewing (MI) has shown efficacy in some substance use disorders. Therefore, a systematic review was conducted to assess the effectiveness of MI in CUD. METHODS: Randomized controlled trials or open-label studies published until September 2019 from 3 different databases (Pubmed, Scopus, and PsycINFO) were included, following the PRISMA guidelines and a predetermined set of criteria for article selection. Meta-analyses were conducted. The end point was determined as month 3, and 4 outcomes were analysed (abstinence rates, reduction in frequency of use, reduction in quantity of use, and reduction in cannabis use disorder symptoms) in 2 populations (adolescents and adults). RESULTS: Forty studies were identified, of which 24 were performed in adults and 16 in adolescents. MI showed efficacy in achieving abstinence in both adults (odds ratio [OR] = 3.84, 95% confidence interval [CI] 2.40-6.16, p < 0.0001) and adolescents (OR = 2.02, 95% CI 1.42-2.89, p < 0.0001). MI showed efficacy in reducing frequency and quantity of use in adults but not in adolescents. Those adults who were in the MI group consumed less joints per day than those in the control group (mean difference = -0.69 joints per day, 95% CI -0.84 to -0.53, p < 0.001), and they consumed on less days per month (mean difference = -3.9 days per month, 95% CI -7.47 to -0.34, p = 0.0317) than those in the control group. CONCLUSIONS: MI is an effective intervention to reduce cannabis use and achieve abstinence, especially among adults and patients with no prior history of psychotic disorder. Further investigation is needed to assess the effect on CUD symptoms. MI should be included in guidelines for treating cannabis use disorder as one of the essential psychological interventions.

A systematic review of treatments for alcohol-related cognitive impairment: lessons from the past and gaps for future interventions.

Alcohol-related cognitive impairment (ARCI) is highly prevalent among patients with alcohol dependence. Although it negatively influences treatment outcome, this condition is underdiagnosed and undertreated. The aim of this systematic review is to investigate the existing evidence regarding both cognitive and pharmacological interventions for ARCI. We systematically reviewed PubMed, Scopus and Science direct databases up to May 2019 and followed the PRISMA guidelines. The quality of the studies was assessed using the Jadad Scale. Twenty-six studies were eligible for inclusion (14 referring to neuropsychological interventions and 12 to pharmacological treatments). Among neuropsychological interventions, computerised treatments, errorless learning and component method showed positive effects on working memory, memory measures and general cognitive function. On the other hand, thiamine, memantine and methylphenidate improved working memory, long-term memory and general cognitive function. Nevertheless, these studies have several limitations, such as small sample size, lack of replication of the results or low specificity of the interventions. Therefore, no gold-standard intervention can yet be recommended for clinical practice, and further research based on promising strategies (e.g. digital interventions, thiamine) is required.

Cerebellar alterations in cannabis users: A systematic review.

Cannabis is the most used illicit substance in the world. As many countries are moving towards decriminalization, it is crucial to determine whether and how cannabis use affects human brain and behavior. The role of the cerebellum in cognition, emotion, learning, and addiction is increasingly recognized. Because of its high density in CB1 receptors, it is expected to be highly affected by cannabis use. The aim of this systematic review is to investigate how cannabis use affects cerebellar structure and function, as well as cerebellar-dependent behavioral tasks. Three databases were searched for peer-reviewed literature published until March 2018. We included studies that focused on cannabis effects on cerebellar structure, function, or cerebellar-dependent behavioral tasks. A total of 348 unique records were screened, and 40 studies were included in the qualitative synthesis. The most consistent findings include (1) increases in cerebellar gray matter volume after chronic cannabis use, (2) alteration of cerebellar resting state activity after acute or chronic use, and (3) deficits in memory, decision making, and associative learning. Age of onset and higher exposure to cannabis use were frequently associated with increased cannabis-induced alterations. Chronic cannabis use is associated with alterations in cerebellar structure and function, as well as with deficits in behavioral paradigms that involve the cerebellum (eg, eyeblink conditioning, memory, and decision making). Future studies should consider tobacco as confounding factor and use standardized methods for assessing cannabis use. Paradigms exploring the functional activity of the cerebellum may prove useful as monitoring tools of cannabis-induced impairment.

Cognitive impairment induced by benzodiazepine use disorder and its reversibility: a case report. / Deterioro cognitivo secundario a trastorno por uso de benzodiacepinas y su reversibilidad: a propósito de un caso.

Letter to the editor.

El consumo crónico de benzodiacepinas es un hecho cada vez más frecuente en nuestro país a pesar de que la eficacia a largo plazo es escasa y los efectos adversos notables. Haciendo incapié en los efectos sobre la cognición, tema todavía en debate, presentamos un caso de deterioro cognitivo asociado a consumo crónico de hipno-sedantes benzodiacepínicos y la mejoría clínica y de las pruebas neuropsicológicas tras su retirada. Creemos así mismo necesaria la concienciación del personal sanitario para el empleo adecuado de dichos fármacos y así disminuir las consecuencias a largo plazo de los mismos y con ello mejorar la calidad de vida y funcionalidad de nuestros pacientes.