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. 2015 Sep 30;2(3):1-8.

Citicoline Treatment Improves Measures of Impulsivity and Task Performance in Chronic Marijuana Smokers: A Pilot BOLD fMRI Study

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Free PMC article

Citicoline Treatment Improves Measures of Impulsivity and Task Performance in Chronic Marijuana Smokers: A Pilot BOLD fMRI Study

Staci A Gruber et al. Int J Neurol Neurother. .
Free PMC article

Abstract

Objective: Citicoline is an endogenous nucleotide that has historically been used to treat stroke, traumatic brain injury, and cognitive dysfunction. Research has also shown that citicoline treatment is associated with improved cognitive performance in substance-abusing populations. We hypothesized that marijuana (MJ) smokers who received citicoline would demonstrate improvement in cognitive performance as well as increased neural efficiency during tasks of cognitive control relative to those who received placebo.

Method: The current study tested this hypothesis by examining the effects of citicoline in treatment-seeking chronic MJ smokers. In an 8-week double-blind, placebo-controlled study, 19 MJ smokers were randomly assigned via a double-blind procedure to the citicoline (8 Males, 2 Females) or placebo group (9 Males, 0 Females). All participants completed fMRI scanning at baseline and after 8 weeks of treatment during two cognitive measures of inhibitory processing, the Multi Source Interference Test (MSIT) and Stroop Color Word Test, and also completed the Barratt Impulsiveness Scale (BIS-11), a self-report measure of impulsivity.

Results: Following the 8 week trial, MJ smokers treated with citicoline demonstrated significantly lower levels of behavioral impulsivity, improved task accuracy on both the MSIT and Stroop tasks, and exhibited significantly different patterns of brain activation relative to baseline levels and relative to those who received placebo.

Conclusions: Findings suggest that citicoline may facilitate the treatment of MJ use disorders by improving the cognitive skills necessary to fully engage in comprehensive treatment programs.

Keywords: Citicoline; Executive function; Impulsivity; Marijuana; Stroop Color Word Test; fMRI.

Figures

Figure 1
Figure 1. Barratt Impulsiveness Scale (BIS) Scores and Percent Improvement After 8-Week Citicoline Treatment
A.) After 8 weeks of treatment, the citicoline-treated group showed a significant reduction in attentional impulsivity compared to the placebo-treated group (t(17) = 2.20, p = .02, 1-tailed). B.) The citicoline-treated group showed greater percent improvement from baseline to week 8 for all BIS subscales as well as total BIS scores. Note: since lower scores are indicative of reduced impulsivity, percent improvement has been reciprocally plotted to aid visualization. Positive values indicate greater reduction of impulsivity.
Figure 2
Figure 2. Multi Source Interference Test (MSIT) Percent Improvement of Performance Accuracy and Reaction Time After 8-Week Citicoline Treatment
A.) At baseline, the citicoline and placebo-treated groups exhibited similar reaction time during the interference condition of the MSIT; however, by week 8 the citicoline-treated group exhibited a trend for slower reaction times than the placebo-treated group. Further, the citicoline-treated group generally performed the task more slowly at week 8 than at baseline, while the placebo-treated group performed the task significantly faster over time (t(17) = 2.32, p = .02, 1-tailed). B.) The citicoline-treated group showed greater percent improvement from baseline to week 8 during both the control and interference conditions of the MSIT.
Figure 3
Figure 3. Stroop Color Word Test: Performance Accuracy after 8-Weeks of Citicoline Treatment
The citicoline-treated group showed greater percent improvement relative to the placebo-treated group during the Interference condition of the Stroop between baseline and 8 weeks of treatment.
Figure 4
Figure 4. fMRI Analysis of the Multi-Source Interference Task (MSIT): Interference-Control Condition
Analyses of MSIT (Interference task minus Control task) activation revealed a shift from posterior to more anterior ACC activation, with a corresponding slight increase in total voxel cluster size from baseline to treatment week 8 in the citicoline-treated group. The placebo-treated group also demonstrated activation in posterior ACC at baseline, but following 8 weeks of treatment, activation shifted slightly more anteriorly and remained in posterior and mid ACC. (k = total cluster size with p < 0.01(uncorrected) and a threshold of ≥ 10 voxels).
Figure 5
Figure 5. fMRI Analysis of the Stroop Color Word Task: Interference – Color Naming
Activation during Stroop (Interference condition minus the Color Naming condition) highlighted a shift from posterior/midcingulate to genual cingulate activation and a corresponding reduction in total voxel cluster size in the citicoline-treated group. The placebo-treated group demonstrated a pattern of posterior ACC activation at baseline which persisted at the 8 week scan, with only minor midcingulate activation and an increase in total voxel cluster size. (k=total cluster size with p < 0.01(uncorrected) and a threshold of ≥ 10 voxels).

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