Abstract
BackgroundAlcohol use disorder (AUD) has been associated with diverse physical and mental morbidities. Among the main consequences of chronic and excessive alcohol use are cognitive and executive deficits. Some of these deficits may be reversed in specific cognitive and executive domains with behavioral approaches consisting of cognitive training. The advent of computer-based interventions may leverage these improvements, but randomized controlled trials (RCTs) of digital interactive-based interventions are still scarce.ObjectiveThe aim of this study is to explore whether a cognitive training approach using VR exercises based on activities of daily living is feasible for improving the cognitive function of patients with AUD undergoing residential treatment, as well as to estimate the effect size for this intervention to power future definitive RCTs.MethodsThis study consisted of a two-arm pilot RCT with a sample of 36 individuals recovering from AUD in a therapeutic community; experimental group participants received a therapist-guided, VR-based cognitive training intervention combined with treatment as usual, and control group participants received treatment as usual without cognitive training. A comprehensive neuropsychological battery of tests was used both at pre- and postassessments, including measurement of global cognition, executive functions, attention, visual memory, and cognitive flexibility.ResultsIn order to control for potential effects of global cognition and executive functions at baseline, these domains were controlled for in the statistical analysis for each individual outcome. Results indicate intervention effects on attention in two out of five outcomes and on cognitive flexibility in two out of six outcomes, with effect sizes in significant comparisons being larger for attention than for cognitive flexibility. Patient retention in cognitive training was high, in line with previous studies.ConclusionsOverall, the data suggest that VR-based cognitive training results in specific contributions to improving attention ability and cognitive flexibility of patients recovering from AUD.Trial RegistrationClinicalTrials.gov NCT04505345; https://clinicaltrials.gov/show/NCT04505345
Highlights
Alcohol is a psychoactive substance that acts on the central nervous system, leading to dependence while causing severe physical, mental, and social problems [1]
The use of virtual reality (VR) tasks for computerized cognitive training (CCT) is better suited to promote the transfer of skills to everyday living, as these tasks are closer to real-life activities than most of the exercises used in classic cognitive training [23]
The results found in this study converge with previous research [19,20] in which patients with Alcohol use disorder (AUD) who underwent cognitive training showed greater cognitive improvements, in areas related to executive functions, than those who did not undergo any particular cognitive treatment
Summary
Alcohol is a psychoactive substance that acts on the central nervous system, leading to dependence while causing severe physical, mental, and social problems [1]. Alcohol abuse is associated with diverse brain modifications [3], both at the structural and functional levels related to long-term, transient, or compensatory effects of alcohol [4], which have an impact on the integrity of the prefrontal brain cortex [5], causing deficits across a wide range of cognitive skills. These effects are evident at the level of executive dysfunction, including attention, inhibitory control, behavioral control [3], verbal fluency, and decision making, similar to the effects of other substances, such as cannabis and cocaine [6].
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