[Cognitive deficits in epilepsy].

Cognitive deficits are common in people with epilepsy and may have impact on education, work, and personal life. Furthermore, cognitive symptoms are often present before seizure onset and often persist upon seizure freedom. As presented in this review, epilepsy is more than just seizures and alike epileptic activity, cognitive dysfunction is a symptom of underlying pathophysiology of the brain and a condition which needs to be addressed when the diagnosis of epilepsy is set. Early identification of cognitive difficulties, relevant rehabilitation plans, and uniform and easily accessible communication across sectors are needed.

Applied strategy in the Iowa Gambling Task: Comparison of individuals with Parkinson's disease to healthy controls.

INTRODUCTION: Decision-making impairments in Parkinson's disease (PD) have frequently been measured using the Iowa Gambling Task (IGT), though results have been inconsistent. At present, task performance has primarily been evaluated based on the total IGT score, and there is a need for further analysis of the strategy of older individuals with PD and healthy control (HC) participants in IGT. OBJECTIVE: The present study aims to explore possible impairments in IGT performance in individuals with PD compared to healthy controls using strategy analysis, extending previous results on this subject, and to discuss potential effects of medication on task performance. METHODS: 67 individuals with PD and 29 HC participants completed the IGT. Results were analyzed to evaluate impairments, applied strategies, presence of subgroups, and potential effects of medication on performance. RESULTS: Both groups obtained a low overall IGT score and individuals with PD had significantly lower total IGT scores compared to HC participants. Regression analysis showed a small, but significant relationship between levodopa and dopamine agonist dosage and total IGT score, indicating that medication level could be a marker of level of executive functions. Subgroups of advantageous and disadvantageous choosers differed significantly in deck preferences for both groups. CONCLUSION: Individuals with PD were significantly impaired in IGT performance, both in overall scores and in detailed analyses, and they utilized an inefficient strategy during task performance. However, HC participants also presented with a suboptimal strategy and results suggest the presence of subgroups in both individuals with PD and HC participants, which may reflect age-related changes. These results are in line with previous research on performance of older individuals and alternative deck preferences in the IGT and underline the importance of considering the applied strategy in the evaluation of IGT performance.

The myeloarchitecture of impulsivity: premature responding in youth is associated with decreased myelination of ventral putamen.

Impulsivity has been suggested as a neurocognitive endophenotype conferring risk across a number of neuropsychiatric conditions, including substance and behavioural addictions, eating disorders, and attention deficit/hyperactivity disorder. We used a paradigm with interspecies translation validity (the four-choice serial reaction time task, 4CSRTT) to assess 'waiting' impulsivity in a youth sample (N = 99, aged 16-26 years). We collected magnetization prepared two rapid acquisition gradient echo (MP2RAGE) scans, which enabled us to measure R1, the longitudinal relaxation rate, a parameter closely related to tissue myelin content, as well as quantify grey matter volume. We also assessed inhibitory control (commission errors) on a Go/NoGo task and measured decisional impulsivity (delay discounting) using the Monetary Choice Questionnaire (MCQ). We found R1 of the bilateral ventral putamen was negatively correlated with premature responding, the index of waiting impulsivity on the 4CSRTT. Heightened impulsivity in youth was significantly and specifically associated with lower levels of myelination in the ventral putamen. Impulsivity was not associated with grey matter volume. The association with myelination was specific to waiting impulsivity: R1 was not associated with decisional impulsivity on the MCQ or inhibitory control on the Go/NoGo task. We report that heightened waiting impulsivity, measured as premature responding on the 4CSRTT, is specifically associated with lower levels of ventral putaminal myelination, measured using R1. This may represent a neural signature of vulnerability to diseases associated with excessive impulsivity and demonstrates the added explanatory power of quantifying the mesoscopic organization of the human brain, over and above macroscopic volumetric measurements.

Distraction towards contextual alcohol cues and craving are associated with levels of alcohol use among youth.

BACKGROUND: Controlling drinking behaviour requires the ability to block out distracting alcohol cues in situations in which drinking is inappropriate or harmful. However, at present few studies have investigated whether distraction and response inhibition to contextual alcohol cues are related to alcohol use in adolescents and young adults. We aimed to investigate whether tendencies towards distraction and failures of response inhibition in the presence of contextual alcohol cues, and alcohol craving were associated with higher levels of alcohol consumption, beyond what could be explained by demographic variables. METHODS: To test this, 108 participants (Mean age = 21.7, range = 16-27), whom were both drinkers and non-drinkers performed a modified Go/NoGo task tailored to measure distraction and response inhibition in the presence of alcohol cues relative to neutral stimuli. Alcohol craving was assessed using a visual analogue scale of craving for different types of alcohol cues. Levels of alcohol use and problematic alcohol use were assessed using a self-report measure of number of drinking days in the previous month and the Alcohol Use Disorders Identification Test. Data were analysed using sequential multiple regression using a zero-inflated negative binomial distribution model. RESULTS: Drinking days correlated with distraction but not response inhibition to contextual alcohol cues. Sequential regression analyses revealed that the inclusion of distraction bias accounted for 11% additional variance (significant) in alcohol use, in addition to that explained by demographics alone (17%). Craving for alcohol explained an additional 30% variance (significant) in alcohol use. CONCLUSIONS: The results reported here support the idea that both biased distraction towards alcohol cues and alcohol craving are associated with preceding drinking days, but not necessarily drinking status. Further studies are warranted that address whether cognitive distraction to alcohol-related cues cause or is an effect of alcohol use among youth.

Impulsivity traits and addiction-related behaviors in youth.

Background and aims Impulsivity is a risk factor for addictive behaviors. The UPPS-P impulsivity model has been associated with substance addiction and gambling disorder, but its role in other non-substance addiction-related behaviors is less understood. We sought to examine associations between UPPS-P impulsivity traits and indicators of multiple substance and non-substance addiction-related behaviors in youth with varying involvement in these behaviors. Methods Participants (N = 109, aged 16-26 years, 69% males) were selected from a national survey based on their level of externalizing problems to achieve a broad distribution of involvement in addiction-related behaviors. Participants completed the UPPS-P Questionnaire and standardized questionnaires assessing problematic use of substances (alcohol, cannabis, and other drugs) and non-substances (Internet gaming, pornography, and food). Regression analyses were used to assess associations between impulsivity traits and indicators of addiction-related behaviors. Results The UPPS-P model was positively associated with indicators of all addiction-related behaviors except problematic Internet gaming. In the fully adjusted models, sensation seeking and lack of perseverance were associated with problematic use of alcohol, urgency was associated with problematic use of cannabis, and lack of perseverance was associated with problematic use of other drugs than cannabis. Furthermore, urgency and lack of perseverance were associated with binge eating and lack of perseverance was associated with problematic use of pornography. Discussion and conclusions We emphasize the role of trait impulsivity across multiple addiction-related behaviors. Our findings in at-risk youth highlight urgency and lack of perseverance as potential predictors for the development of addictions and as potential preventative therapeutic targets.

Recommendation to reconsider examining cannabis subtypes together due to opposing effects on brain, cognition and behavior.

Cannabis use represents a major public health issue throughout the globe. Yet, we still lack the most fundamental knowledge on long-term effects of cannabis on neural, cognitive, and behavioral function. Part of this stems from how cannabis has been measured historically. To this end, most empirical examinations of cannabis have consolidated all types of cannabis collectively. However, this approach obscures differences in how cannabinoids operate. In this commentary, we address the contrasting properties of tetrahydrocannabinol (THC) and cannabidiol (CBD) and their opposing effects on cognitive function. In addition, we address the increase in cannabis potency throughout the past two decades and how that impacts generalizability of early data to evaluations of contemporary public health. We underscore the urgent need for future research to disaggregate examination of THC from CBD, along with the importance of measuring cannabis potency to more effectively unravel its influence on cognitive function and other health issues.

A systematic review of impulse control disorders in Parkinson's disease.

Throughout the past decade it has been recognized that dopaminergic medication administered to remedy motor symptoms in Parkinson's disease is associated with an enhanced risk for impulse control disorders and related compulsive behaviors such as hobbyism, punding, and the dopamine dysregulation syndrome. These complications are relatively frequent, affecting 6-15.5% of patients, and they most often appear, or worsen, after initiation of dopaminergic therapy or dosage increase. Recently, impulse control disorders have also been associated with subthalamic nucleus deep brain stimulation. Here we present a systematic overview of literature published between 2000 and January 2013 reporting impulse control disorders in Parkinson's disease. We consider prevalence rates and discuss the functional neuroanatomy, the impact of dopamine-serotonin interactions, and the cognitive symptomatology associated with impulse control disorders in Parkinson's disease. Finally, perspectives for future research and management of impulse control disorders in Parkinson's disease are discussed.

Dopaminergic and clinical correlates of pathological gambling in Parkinson's disease: a case report.

Dopaminergic medication for motor symptoms in Parkinson's disease (PD) recently has been linked with impulse control disorders, including pathological gambling (PG), which affects up to 8% of patients. PG often is considered a behavioral addiction associated with disinhibition, risky decision-making, and altered striatal dopaminergic neurotransmission. Using [(11)C]raclopride with positron emission tomography, we assessed dopaminergic neurotransmission during Iowa Gambling Task performance. Here we present data from a single patient with PD and concomitant PG. We noted a marked decrease in [(11)C]raclopride binding in the left ventral striatum upon gambling, indicating a gambling-induced dopamine release. The results imply that PG in PD is associated with a high dose of dopaminergic medication, pronounced motor symptomatology, young age at disease onset, high propensity for sensation seeking, and risky decision-making. Overall, the findings are consistent with the hypothesis of medication-related PG in PD and underscore the importance of taking clinical variables, such as age and personality, into account when patients with PD are medicated, to reduce the risk of PG.