Brain Morphology at Entry into Treatment for Alcohol Dependence Is Related to Relapse Propensity

Abstract

Background We examined whether any differences in brain volumes at entry into alcohol dependence treatment differentiate subsequent Abstainers from Relapsers. Methods Individuals in alcohol dependence treatment (N=75) underwent magnetic resonance imaging approximately 6 ± 4 days after their last alcoholic drink, and 40 age-matched non-smoking light drinkers were studied as controls. At follow-up 7.8 ± 2.6 months later, 23 alcoholics (31%) had abstained from drinking and 52 (69%) had relapsed. Deformation morphometry compared Relapsers, Abstainers, and light drinkers. Results Compared to light drinkers, future Abstainers had smaller brain tissue volumes in the left amygdala, hippocampal head, and entorhinal cortex, and bilaterally in the thalamus and adjacent subcortical white matter (WM), and had larger volume in the left lateral orbitofrontal region. Compared to light drinkers, future Relapsers had smaller brain tissue volumes in the right middle temporal, occipital, and superior frontal WM. Compared to future Abstainers, future Relapsers had smaller tissue volumes primarily in bilateral orbitofrontal cortex and surrounding WM. Results were virtually unaffected after controlling for common comorbidities. Conclusion At entry into alcohol dependence treatment, the brain structure of future Relapsers differs from that of future Abstainers. Future Relapsers have smaller brain volumes in regions of the mesocorticolimbic reward system that are critically involved in impulse control, emotional regulation, craving, and evaluation and anticipation of stimulus salience and hedonics. Structural abnormalities of this circuitry may confer greater risk for resumption of hazardous drinking after treatment and may contribute to the definition of a neurobiological relapse risk profile in alcohol dependence.

Prediction as a Humanitarian and Pragmatic Contribution from Human Cognitive Neuroscience

“…Both anatomic (Rando et al, 2011) and regional cerebral blood flow (Noel et al, 2002) studies reported that baseline measures of the medial prefrontal cortex were associated with likelihood of relapse. Similarly, patients who relapsed exhibited reduced volumes of medial and/or lateral prefrontal cortex (Durazzo et al, 2011; Cardenas et al, 2011) and reduced white-matter FA in frontal regions (Sorg et al, 2012) relative to patients who sustained abstinence. Broadly, greater reward response to alcohol-related stimuli and lesser strength in cognitive control regions were related to relapse.…”

Human alcohol-related neuropathology

“…Atrophy of gray and white matter structures in the medial thalamic and hypothalamic (mammillary bodies) nuclei correlate with cognitive-behavioral deficits in KS, the most severe form of alcoholic dementia [116]. Atrophy of mesocorticolimbic reward centers predicts tendency to relapse after a period of abstinence [24]. Loss of cholinergic neurons in the nucleus basalis of Meynert accounts for some aspects of cognitive impairment [3].…”

Profiles of impaired, spared, and recovered neuropsychologic processes in alcoholism

“…Investigators have reported reduced alcoholism-related volumes in the mesocorticolimbic system, including medial temporal-lobe structures (Sullivan et al, 1995; Harding et al, 1997; Agartz et al, 1999; Gazdzinski et al, 2005a; Cardenas et al, 2007; Chanraud et al, 2007; Cardenas et al, 2011; Sameti et al, 2011). White matter abnormalities in memory-associated regions also have been reported.…”