Venue : BBS Amphitheater
Thesis defense in french
Valentine Chirokoff
INCIA
Team : Motor control and cognition
Thesis directed by Joel Swendsen and Sandra Chanraud
Title
Cognitive processes in Addiction: from Brain to Daily-Life
Abstract
Addiction is a major public health issue characterised by a high relapse rate, potentially sustained by the intensity of the urge to use a substance (craving), and deficits in high- order cognitive functioning. In this thesis, I have used smartphones-based Ecological Momentary Assessment (EMA) to provide repeated measures of inhibition performance, craving, and substance use in patients with different addiction to different substances (alcohol, nicotine, cannabis) and in healthy controls. In parallel, we acquired multimodal brain imaging data of the same patients. The first objective was to quantify the influence of craving dynamics and of momentary inhibition performance on substance use in daily life. A second objective was to determine the association of these variables with underlying anatomofunctional brain connectivity. Using prospective modelling analyses, we first demonstrated that patients exhibit highly unstable craving symptoms whose fluctuations predicted substance use beyond mean intensity. The more unstable the patient’s craving was, the more participants tended to use substances; this relationship was also related to functional connectivity between interoceptive, limbic, and executive brain areas. To further elucidate the factors influencing substances use, our second study aimed to examine the interplay between inhibition performance, craving, and substance use at the momentary level. We highlighted a vicious circle in which substance use at a one-time point predicted higher probabilities of using again later. However, the level of inhibition performance concurrently assessed permitted both 1) to predict a lower use probability at the following time assessment and 2) to break this vicious circle by mediating the link between use and future use. Real-time inhibition performance was also linked to functional connectivity within a fronto-occipito-cerebellar network, itself predicting lower probability of use. Whereas this study did not reveal either an interplay between inhibition and craving or an overlap of their cerebral bases, it emphasised the direct protective effect against use of inhibition and underlying cerebral markers. Finally, we aimed at searching for cerebral markers that could be related to both the cognitive and functional factors highlighted previously. In the last study, we demonstrated that impairments in inhibition was linked to poorer brain integrity in major white matter pathways connecting the frontal cortex to the rest of the brain ; anatomical connectivity was also linked to the measured functional connectivity in fronto-occipito-cerebellar network. Furthermore, white matter integrity in the same network was moderating the effect of inhibition on use, whereby better inhibition was predictive of a lower probability of use in patients with higher white matter integrity indexes. Here, for the first time, psychological data were directly linked to the brain integrity and functioning markers, enabling a multi-level prediction of use which incorporates the strong psychological and biological interaction well characterised in addiction. Moving forward into a clinical perspective, these markers could allow to identify patients at high-risk of use in real-time.
Key words
Addiction ; EMA ; Executive Functions ; craving, cerebral markers
Publications
Jury
Pr Fabien Gierski (Examinateur),
Pr Jean Philippe Ranjeva (Examinateur)
Dr Anne Lise Pitel (Rapporteur)