Altered Gray-Matter Volumes Associated With Betel Quid Dependence

Abstract

Betel quid (BQ) is one of the most commonly consumed psychoactive substances. It has been suggested to be associated with various health issues, especially oral cancer. Evidence also points to possible decreased cognitive functions after long-term BQ chewing, such as attention and inhibition control. The present study aims to investigate the brain structure basis of BQ chewing in Hunan province of China. Twenty-five BQ chewers and 25 controls were recruited to participate in this study. Voxel-based morphormetry analysis revealed that there were three key regions showing structural differences between BQ chewers and controls, including bilateral dorsolateral prefrontal cortex (DLPFC)/insula, ventral medial prefrontal cortex, and left orbitofrontal cortex. Moreover, the GMV in the DLPFC could potentially predict BQ dependence scores, level of daily BQ chewing, and history of BQ chewing. These results suggested that participants who showed BQ chewing dependence may have deficit in inhibition control and affective decision-making, and the level of deficit was dependent on the level of daily BQ chewing, and history of BQ chewing. Understanding the neurobiology features of BQ chewing would help us develop novel ways to diagnose and prevent BQ dependence.

White Matter Integrity Deficit Associated with Betel Quid Dependence

“…25 BQD individuals were recruited from the outpatient department of stomatology at Xiangya Hospital of Central South University. As reported before ( 14 , 18 ), BQD individuals were diagnosed by a licensed MD level psychiatrist, according to the Structured Clinical Interview with DSM-IV criteria. Persons without use of BQ were defined as “healthy subjects,” which were recruited through a combination of targeted site sampling, advertisement, and snowball sampling referrals.…”

“…Participants were excluded if they met criteria for other substance dependence, had a medical history of any neurological or psychiatric disorder, or had claustrophobia/other disease preventing them from MRI scanning. The demographic and clinical characteristics of all participants had been reported in our previous study ( 18 ). This study was carried out in accordance with the recommendations of research ethical committee of Xiangya Hospital of Central South University of Hunan Province, Changsha, China.…”

“…25 BQD individuals finished the behavior interview. The detailed information on the behavioral interview was reported previously ( 18 ). Briefly, they finished the Betel Quid Dependence Scale (BQDS) to test their severity of BQ dependence ( 32 ).…”

“…Recently, BQD individuals have been reported with altered brain structure and function by use of various neuroimaging techniques ( 11 – 18 ). In the aspect of brain structure, our previous work with voxel-based morphormetry analysis suggested that BQD individuals showed less gray matter volume in dorsolateral prefrontal cortex, insula, ventral medial prefrontal cortex (VMPFC), and orbital frontal cortex (OFC) ( 18 ). For the brain function, another work with resting-state fMRI showed BQD individuals had decreased default mode network functional connectivity in VMPFC, OFC, and anterior cingulate cortex ( 14 ).…”

Dysfunction of the Prefrontal Cortex in Betel-Quid–Dependent Chewers

“…Recently, a review systematically assessed previous functional magnetic resonance imaging (fMRI) studies on BQ addiction, and suggested that a key involvement of the prefrontal cortex (PFC) in BQ dependency (21). For example, studies from our group suggested that BQ use was associated with decreased gray matter volumes in bilateral dorsolateral PFC and ventral medial PFC (22), altered white matter integrity in anterior thalamic radiation highly associated with PFC (23), and less cortical thickness in PFC (19). These neuroimaging studies proposed that the role of prefrontal cortical structures in BQ addiction, which plays an important role in cognitive behavioral and emotional changes in various kinds of addiction (24)(25)(26)(27).…”