1. Effects of Binge Drinking Patterns on Cognitive Functions in College Students Abstract Binge drinking among college students has been associated with cognitive impairment and changes in brain function, particularly impairment related to executive and spatial working memory functions. This study administered measures of impulsivity, cognition, mood, and drinking patterns to 296 college students. Binge drinking was defined as a pattern of drinking that brings estimated BAC to 0.08 gram-percent or above. All students were 18 to 21 years of age and in their first year of college; 151 women and 145 men. Exclusion criteria: brain injury with loss of consciousness > 24 hrs., concussion with LOC within 30 days, other neurological disorder, or DSM –IV-TR Axis I psychotic disorders (Clinical interview-MINI). Measures administered: Beck II Depression Inventory State-Trait Anxiety test, the Balloon Analogue Risk Task (BART), Groton Maze Learning Test, one-back and two-back tests. Groups: never drank; drink but never binge; binged but not in last 30 days; and binged in last 30 days. Consistent with the literature, females were significantly more likely to binge. Females demonstrated significantly more impulsivity on the BART. When comparing binge categories, those who drink but do not binge demonstrated the lowest impulsivity on the BART. On both the one-back and two-back, those who have ever binged showed significantly poorer performance than either drinkers who never binge or nondrinkers. On Groton Mazes those who binged in the last 30 days made significantly more errors than any other group. These data lend support to the notion that binge drinking is particularly detrimental to cognitive functions, particularly executive functions and spatial learning. Introduction It is hypothesized that students with binge drinking behaviors will show diminished cognitive function in frontal and temporal mediated domains, i.e. executive function and working memory tasks, as compared to non-binge social drinkers and teetotalers. Additionally, it is hypothesized that males and females with binge drinking behaviors will exhibit differing levels of cognitive dysfunction, with females showing greater effects of binge drinking. B inge drinking refers to the excessive drinking of alcohol often with harmful consequences (Midanik et al., 1996; Wechsler et al., 1994) including cognitive effects. The aim of the current study is to provide additional validation to this existing evidence and to illuminate new findings in the matter. There have been several different definitions of binge drinking. For example, it has been proposed that number of drinks in a row differentiates binge drinkers and non-binge drinkers (Wechsler and Austin, 1998). The National Institute of Alcohol Abuse and Alcoholism (NIAAA) have approved the following definition: “A ‘binge’ is a pattern of drinking alcohol that brings BAC to about 0.08 gram-percent or above. For the typical adult, this pattern corresponds to consuming 5 or more drinks (male), or 4 or more drinks (female), in about 2 hours (NIAAA, 2004). For the current study, a “binge” will be determined using this definition. To test the major study hypotheses the key variable will be frequency of binge drinking. Hunt (1993) has suggested that binge drinkers may be more at risk of developing brain damage. Furthermore, these results showed that females may exhibit greater responses to the effects of alcohol misuse. Binge alcohol exposure in adult rats has been shown to cause necrotic neurodegeneration after as little as two days of exposure (Obernier et al., 2002). This issue is compounded by the fact that college students are still in a period of brain development. Adolescence is a period of significant neuro-maturation with enhanced cerebral efficiency, increased myelination and selective synaptic pruning (Brown et al., 2000). The more rapidly developing adolescent brain may be more vulnerable to alcohol damage than the adult brain. The PFC, fundamental to behavioral and affect self regulation, does not mature functionally until mid-to-late adolescence and modulates risk-taking behavior (Spear, 2000). Binge drinking can be considered analogous to repeated withdrawals from alcohol. It has been proposed that binge drinking may lead to brain damage and resultant cognitive dysfunction similar to the neurotoxicity induced by repeated withdrawals from alcohol in dependent animals and humans (Crews et al., 2001; Duka et al., 2004, 2003; Stephens and Duka, 2008; Stephens et al., 2005; Veatch and Gonzalez, 1999). Glenn et al. (1988) found that the number of withdrawals was linked to poor memory in adult alcoholics. DeCuir, D. 1, Ginley, M. 2, Raskin, S. 1, Tennen, H. 3, Austad, C. 4, Fallahi, C. R. 4, Wood, R.M. 4, Glahn, D. 2, & Pearlson, G. 2 Dept. of Psychology and Neuroscience, Trinity College 1, Hartford, CT. Olin Neuropsychiatry Research Center 2, The Institute of Living, Hartford Hospital, Hartford, CT. Dept. of Community Medicine and Psychiatry, UConn Health Center 3, Farmington, CT. Dept. of Psychology, Central Connecticut State University 4, New Britain, CT. Methods Participants 296 participants were first year students ages 18-21 (151 female, 145 male) recruited from two area colleges, Trinity College (n = 98) and Central Connecticut State University (n = 198). Recruiting was accomplished through school email, flyers, and classroom visits. Participants were excluded based on history of major brain injury with loss of consciousness of more than twenty- four hours, multiple sclerosis (MS) or cerebral palsy, seizure disorder, any concussion with loss of consciousness within prior thirty days, current or previous brain tumor, or DSM-IV-TR Axis I psychotic disorders. In addition to the neuropsychology battery, each participant provided demographics information at the initial session. Moreover, each participant was given a clinical interview using the MINI DSM-IV-TR. Participants which were diagnosed with Axis I psychotic disorders were excluded from the study. Each participant was individually consented with appropriate IRB approved consent forms. Results Discussion Drinking behaviors were classified into four discrete groups: teetotalers, non-binge social drinkers, those who have binged in last thirty days, and those binged in their lifetime, but not last thirty days. This distinct classification proved to be especially important. When the same analyses were performed with only two groups, non-binge and binge, no significant differences were found in any of the cognitive measures. This means that when students binge, as well as frequency of binge drinking is a key factor in determining their level of dysfunction. Moreover, this is correlated to the age of onset at which binge drinking began, as the age when binge episodes began may strongly correspond to the level of dysfunction exhibited. In addition, there may be unique effects which emerge from recent binge episodes, i.e. within the last thirty days, which differ from the prolonged effects of binging over a number of years. Results demonstrated a significant group effect among those who have binged in the last 30 days and those who have not in terms of alcohol and substance use disorders. According to MINI diagnosis, this group is more likely to have an Alcohol Use Disorder (AUD) (Fig. 1). The variable MoodEPI is a combination of hypomanic, manic, and depressive episodes. The results demonstrated that those who have binged in the last 30 days are more likely to have experienced one of these episodes as compared to teetotalers. This is consistent with previous literature which also found less positive mood among binge drinkers (Townshend and Duka, 2005) as compared to non-binge drinkers, but inconsistent with another study which found that binge drinkers had lower trait anxiety and depression as compared to a group of teetotalers (Hartley et al. 2004). Therefore, results do not allow for a determination of causality. Furthermore, results identified a significant difference (Fig. 3) between binge in lifetime but not past 30 days and those who have binged in the past 30 days in the Groton Maze Learning Recall, a test of declarative memory, such that participants who have binged in the last 30 days are more impaired (Fig. 9), and performed the poorest among all binge categories. This finding is also consistent with previous literature and the hypothesis of the current study. References Midanik LT, Tam TW, Greenfield TK, Caetano R. Risk functions for alcohol- related problems in a 1988 US National Sample. Addition 1996; 91:1427-37 [discussion 1439-56]. Wechsler H, Davenport A, Dowdall G, Moeykens B, Castillo S. Health and behavioral consequences of binge drinking in college. A national survey of students at 140 campuses. Jama 1994; 272:1672-7. Wechsler H, Austin SB. Binge drinking: the five/four measure. J Stud Alcohol 1998; 59:122-4 Crews, F. T. & Chandler, L. J. in Alcohol induced brain damage (eds. Hunt, W. A. & Nixon, S. J.) 355-71 (NIAAA Monograph, Rockville, MD, 1993). Obernier JA, Bouldin TW, Crews FT. Binge ethanol exposure in adult rats causes necrotic cell death. Alcohol Clin Exp Res 2002a;26:547-57 Brown, S. A., Tapert, S. F., Granholm, E. & Delis, D. C. Neurocognitive functioning of adolescents: effects of protracted alcohol use. Alcoholism: Clinical & Experimental Research 24, 164-71 (2000) Spear, L. P. The adolescent brain and age-related behavioral manifestations. Neurosci Biobehav Rev 24, 417-63 (2000). Crews, F. T., Braun, C. J., Hoplight, B., Switzer, R. C., 3rd & Knapp, D. J. Binge ethanol consumption causes differential brain damage in young adolescent rats compared with adult rats. Alcoholism: Clinical & Experimental Research 24, 1712-23 (2001). Glenn, S. W., Parsons, O. A., Sinha, R. & Stevens, L. The effects of repeated withdrawals from alcohol on the memory of male and female alcoholics. Alcohol & Alcoholism 23, 337-42 (1988). Townshend JM, Duka T. Binge drinking, cognitive performance and mood in a population of young social drinkers. Alcohol Clin Exp Res 2005; 29:317-25 Hartley, D. E., Elsabagh, S. & File, S. E. Binge drinking and sex: effects on mood and cognitive function in healthy young volunteers. Pharmacology, Biochemistry & Behavior 78, 611-9 (2004). Acknowledgements NIAAA Grant AA016599 For reprints contact sarah.raskin@trincoll.edu Materials Neuropsychological Testing Participants were administered a two hour cognitive neuropsychology battery using the Cogstate TM (CogState Ltd.) and JAva NEuropsychological Test (JANET) (Glahn et al., 2007) testing platforms. The Cogstate neuropsychology tests consisted of the following tasks: the One Back, a measure of attention; the Two Back a measure of executive function, working memory, and attention; the Groton Maze Learning task, a measure of spatial problem solving, and executive function; the Groton Maze Learning Recall task, a measure of declarative memory; Visual Paired Associate Learning, a measure of declarative memory. The JANET software included the following tests: the Digit Symbol task, a measure of speed-of-processing; the Balloon Analogue Risk Task, a measure of inhibition; the Penn Conditional Exclusion Test, a measure of executive function and working memory. Non-Cognitive Assessment In order to elucidate and assess drinking behaviors, participants were administered the Self-Rating Effects of Alcohol (SREA), Modified Timeline Follow-back (TFLB), and Alcohol Effects Questionnaire (AEQ) (Rohsenhow). Measures to determine psychological symptoms included the Beck II Depression Inventory (BDI) (Beck et al., 1997) and State-trait Anxiety Inventory (STAI) (Spielberger et al., 1970). Procedure Computerized Measures Cognitive assessment was completed by each participant on individual laptop computers with the examiner present. The first set of tests was part of the Cogstate testing platform. The first test administered was the Groton Maze Learning task, taking approximately 10 minutes to complete. Second, participants were administered the n-back, consisting of the one back and two back tests. Each of these tests was approximately 10 minutes in length. Next, participants completed the Continuous Paired Associate Learning task (CPAL), about 10 minutes in length. As a final measure, participants were administered one additional trial of the Groton Maze Learning task as a test of recall. The next set of cognitive tests was part of the JANET testing platform. The JANET testing platform includes detailed, step by step instructions for each of the tests within the platform. Participants were instructed to follow along with these instructions and complete the tests at their own pace. First, Participants were administered the Digit Symbol, then the Penn Conditional Exclusion Test (PCET), and finally the Balloon Analogue Risk Task (BART). Each of these tests was about 10 minutes in length, for a total of 30 minutes. There was an interval of approximately 5 minutes in between the testing platforms for participants to rest. Upon completion of these tests, participants then used the online system to create login credentials in order to access the initial, online survey Fig. 1. Alcohol Use Disorder among Binge Cat. Fig. 2. Mood Episodes among Binge Categories Fig. 3. Groton Maze Recall Performance (Declarative) Fig. 4. Penn Conditional Exclusion Test (Executive)