Author: Torkel Klingberg, MD, PhD, Professor of Cognitive Neuroscience at the Karolinska Institute
Working memory deficits occur in many conditions
There is a normal variability from individual to individual in working memory capacity. In the individual, capacity can also be temporarily decreased due to stress or lack of sleep. Moreover, there is a normal decline in capacity with aging, starting around 25-30 years of age, with a decline of about 5-10% per decade.

Except for this normal variability, working memory capacity is also affected in a range of clinical conditions, affecting the neural systems underlying working memory. Studies on both animals and humans have shown that the prefrontal and parietal cortexes are essential for working memory performance; as is the basal ganglia, as well as correct dopaminergic transmission. When these systems are affected, working memory is impaired.

Stroke affecting the frontal lobe is associated with working memory deficits, as are traumatic brain injuries (Robertson and Murre, 1999). In these cases, the working memory deficits lead to attention and planning problems. Attention Deficit Hyperactivity Disorder (ADHD and ADD) is associated with disturbances of both the frontal lobe and the dopaminergic system, and is consequently also associated with working memory deficits. Learning disability is another prevalent condition, in children and in adults, which can be defined as academic difficulties that are not due to inadequate opportunity to learn, general intelligence, nor to physical/emotional disorders, but to basic disorders in specific psychological processes. It has been shown that learning disability can be directly linked to deficits in working memory (Gathercole and Pickering, 2000).

ADHD is a widespread and serious disorder with a key WM component
ADHD is a disorder which includes severe problems of attention, impulsivity and hyperactivity. ADHD affects 3-5% of children between 6-16 years, which makes it the most common neuropsychiatric disorder. When children with ADHD grow older, the hyperactivity decreases, but problems of inattention, which often lead to academic and occupational failure, remain in the majority of cases. ADHD has a strong genetic component, with heritability estimated around 70%. Deficits in working memory are thought to be of central importance in explaining many cognitive and behavioral problems in ADHD (Barkley, 1997; Castellanos and Tannock, 2002; Rapport et al. , 2000; Westerberg et al., 2004). Westerberg et al. (2004) com¬pared working memory tasks with other tasks and showed that children had most problems with working memory tasks. A meta-analysis of 46 studies (Martinussen et al., 2005) confirmed the WM deficits in ADHD, and also showed that the deficits are most pronounced in the visuo-spatial domain.

Can working memory be improved?
Torkel Klingberg, MD PhD, has conducted research at Karolinska Institutet for several years concerning the neural basis of working memory and working memory deficits in children. Working memory capacity has generally been held to be a fixed property of the individual.However, Klingberg, Helena Westerberg, Ph.D., and others at the Department for Neuropediatrics at Astrid Lind¬gren’s Children’s Hospital (part of Karolinska University Hospital), started to develop methods for improving working memory in 1999. These methods are influenced by animal research on mechanisms for training induced plasticity (Buonomano and Merzenich, 1998). Development was conducted in collaboration with Jonas Beckeman and David Skoglund, professional game developers who helped solve technical issues and helped make the training more rewarding.

The training consists of a specific set of working memory tasks that are performed on a computer, where the difficulty level is adjusted according to a specific algorithm. The users complete a fixed number of trials every day, taking about 30-40 minutes daily. This is done for five days a week over five weeks. During training, performance results are saved and can be used for later analysis.

The program is called Cogmed RM, and has been developed by Cogmed Systems AB.

Author: Torkel Klingberg, MD, PhD, Professor of Cognitive Neuroscience at the Karolinska Institute
Summary

Working memory is the ability to keep information online for a brief period of time, which is essential for many cognitive tasks such as control of attention and problem solving. In contrast to what was previously assumed, we have shown that systematic training can improve working memory capacity, in both children and adults. Brain imaging studies also show that working memory training leads to increased brain activity in the prefrontal and parietal cortex. Improving working memory capacity leads to better performance on several tasks that require working memory and control of attention and it translates to increased attentiveness in everyday life.

Working Memory is a key function necessary for critical cognitive tasks
Working memory is the ability to keep and manipulate information online for a brief period of time. This ability can be measured for example by testing how many digits a subject can repeat back after hearing them once (verbal working memory) or how many positions a subject can remember after seeing them once (visual working memory).

In daily life we use working memory to remember plans or instructions of what to do next. But keeping information online is a very basic function that has proved to be of central importance in a wide range of cognitive tasks. Verbal working memory is necessary for comprehending long sentences; and verbal working memory capacity predicts performance on reading comprehension in the scholastic aptitude test (SAT) (Daneman and Carpenter, 1980). Working memory is also important for control of attention, and to maintain task-relevant information during problem solving. More generally, working memory has been suggested to be the single most important factor in determining general intellectual ability (SüB et al., 2002). About 50% of differences between individuals in non-verbal IQ can be explained by differences in working memory capacity (Conway et al., 2003).

More recently, it has also become clear that there is a strong link between working memory capacity and the ability to resist distractions and irrelevant information. One study used the so called “cocktail party effect”, i.e. our ability to focus on one voice despite noisy surroundings, and showed that this ability is related to working memory capacity (Conway et al., 2001). Recent studies have also shown that low working memory is related to being “off-task” and daydreaming (Kane et al., 2007). These psychological studies are consistent with neuroimaging studies, which have shown that subjects with higher working memory capacity are less likely to store irrelevant information (Vogel et al., 2005). The prefrontal cortex is important in providing this “filtering” of irrelevant information, and subjects with higher working memory capacity have a higher prefrontal activity and are better at filtering out distractors (McNab and Klingberg, 2008).

When people have deficits in working memory, they are often experienced as “inattention problems”, e.g. to have problems focusing on reading a text; or “memory problems”, e.g. forgetting what to do in the few seconds of walking from one room to the another, or being easily distracted while trying to focus on a task. In children the problem is often remembering what to do next, which makes them unable to finish an activity according to plan.

In conclusion, working memory allows us to hold on to information in order to complete a task, and is especially important in any cognitively demanding environment with irrelevant distractions.

By Jessica B. Konopa

ADHD isn’t just a kid’s problem. An estimated 2 to 4 percent of adults live with the disorder. Half of those who have ADHD as children continue to have it when they grow up. In fact, it often goes undiagnosed. Many adults who have ADHD had it when they were kids, but were never diagnosed.

Like kids with ADHD, adults who suffer from the disorder often:

•Have a hard time completing tasks they consider boring or difficult
•Are distracted easily
•Are forgetful
•Are prone to losing things

In addition, they may fidget and easily lose their tempers. They often feel hyperactive and can’t relax.
These behaviors often interfere with an adult’s ability to work or have relationships. ADHD can interfere with an adult’s ability to:
•Stay organized
•Manage time
•Complete tasks that require concentration

Adults with ADHD may have a problem with jobs that use these skills. As a result, they may change jobs a lot or experience conflict at the office.

ADHD can make personal relationships difficult, too. It can be hard for people with ADHD to share their feelings with others. They may also find it hard to pay attention when other people are speaking. This can create strained conversations. An estimated 75 percent of adults with ADHD have emotional problems. All of these things can make it difficult for adults to maintain long-term relationships and friendships. Adults with ADHD often have marital problems, battle depression, or may abuse alcohol or drugs. At first glance, ADHD may seem daunting for adults. However, they can often overcome it by making small changes to the way they do things. This includes:

•Breaking large tasks into smaller ones
•Making lists to keep track of things that need to be done
•Communicating when they need help

In reality, research indicates that only 10 percent of adults with ADHD experience problems in their daily lives. About 50 percent report that their ADHD sometimes interferes with their daily lives. Finally, about 33 percent of adults say they have learned to manage their symptoms or no longer suffer from ADHD symptoms.

Not sure if you have ADHD? Your health care provider will be able to evaluate you and diagnose ADHD, if appropriate. Your provider will also help you develop a plan to manage it.

References

1.National Resource Center on AD/HD. (2008, February). The Disorder Named ADHD – What We Know – Info Sheets on AD/HD. Retrieved August 24, 2010, from http://www.help4adhd.org/about/what/WWK1.
2.WebMD. (2005, October 1). Attention-deficit hyperactivity disorder: ADHD in adults. Retrieved August 24, 2010, from http://www.webmd.com/add-adhd/guide/adhd-adults
3.Preidt, R. (2003, June 25). National ADHD education campaign launched. HealthDayNews. Retrieved August 24, 2010, from http://www.healthscout.com/template.asp?page=newsdetail&ap=1&id=513770
4.WebMD. (2006, May 31). ADHD guide: Treatment overview. Retrieved August 24, 2010, from http://www.webmd.com/add-adhd/tc/attention-deficit-hyperactivity-disorder-adhd-treatment-overview

Written by Wendy Leonard, MPH
The most common cause of dementia is Alzheimer’s disease (AD). AD is a progressive and irreversible brain disorder. The actual cause of AD is unknown. AD slowly damages, and then destroys, a person’s memory, judgment, reasoning skills, personality, autonomy, and bodily functions.

The disease specifically affects several components of the brain. These include:
•a gradual loss of brain cells, called neurons
•damage to neurons so they no longer function properly
•the loss of neural connections—called synapses— where messages are passed from neuron to neuron

Forgetfulness: A Normal Part of Aging?

It’s normal to sometimes forget things, but as we age, it often takes longer to learn new skills or remember words, names, or where we left our glasses. Of course, this does not mean an individual has dementia. In fact, scientists have found that healthy older adults perform just as well as their young counterparts on complex and learning tests—if given extra time to complete.

However, there’s a difference between occasional forgetfulness and behavior that may be cause for concern. Not recognizing a familiar face, trouble performing common tasks (such as using the telephone or driving home); or being unable to comprehend or recall recent information are all red flags that need to be checked by a medical professional.

Who Gets AD?

Also known as late-onset Alzheimer’s disease, AD is primarily a disease of the elderly. The first noticeable symptoms can occur as early as age 60.

When AD runs in families, it’s called familial Alzheimer’s disease (FAD).

AD sometimes can affect people as young as 30. This type of AD is called early-onset AD. It is rare and affects less than one out of every 1,000 people with AD.

The underlying cause or causes of AD, and specific risk factors, remain unclear. Yet experts believe AD is likely due to a combination of environmental and genetic factors. Lifestyle choices, such as diet, exercise, and staying mentally active like learning new skills, also are factors.
About 5.3 million Americans have AD, according to the National Institutes of Health (NIH). That number will only climb as the elderly population rises.

AD is the sixth leading cause of death in the U.S. and the fifth leading in Americans age 65 and older. Worldwide, approximately 24 million people have AD.

What’s Being Done?

Scientists are working to better understand AD in order to create more effective early diagnostic tools, improve treatments, and perhaps even discover a cure.

In terms of what’s immediately available, there are numerous reputable resources and services for people who suffer with AD and their loved ones and caregivers. Some current treatment options even may slow the progression of AD, however, their effectiveness varies and diminishes over time.

By Annie Murphy Paul
College-admission letters go out this month, and most recipients (and their parents) will place great importance on which universities said yes and which said no. A growing body of evidence, however, suggests that the most significant thing about college is not where you go, but what you do once you get there. Historian and educator Ken Bain has written a book on this subject, What the Best College Students Do, that draws a road map for how students can get the most out of college, no matter where they go.

As Bain details, there are three types of learners: surface, who do as little as possible to get by; strategic, who aim for top grades rather than true understanding; and deep learners, who leave college with a real, rich education. Bain then introduces us to a host of real-life deep learners: young and old, scientific and artistic, famous or still getting there. Although they each have their own insights, Bain identifies common patterns in their stories:

Pursue passion, not A’s. When he was in college, says the eminent astrophysicist Neil deGrasse Tyson, he was “moved by curiosity, interest and fascination, not by making the highest scores on a test.” As an adult, he points out, “no one ever asks you what your grades were. Grades become irrelevant.” In his experience as a student and a professor, says Tyson, “ambition and innovation trump grades every time.”

Get comfortable with failure. When he was still a college student, comedian Stephen Colbert began working with an improvisational theater in Chicago. “That really opened me up in ways I hadn’t expected,” he tells Bain. “You must be O.K. with bombing. You have to love it.” Colbert adds, “Improvisation is a great educator when it comes to failing. There’s no way you are going to get it right every time.”

Make a personal connection to your studies. In her sophomore year in college, Eliza Noh, now a professor of Asian-American studies at California State University at Fullerton, took a class on power in society: who has it, how it’s used. “It really opened my eyes. For the first time in my life, I realized that learning could be about me and my interests, about who I was,” Noh tells Bain. “I didn’t just listen to lectures, but began to use my own experiences as a jumping-off point for asking questions and wanting to pursue certain concepts.”

Read and think actively. Dean Baker, one of the few economists to predict the economic collapse of 2008, became fascinated in college by the way economic forces shape people’s lives. His studies led him to reflect on “what he believed and why, integrating and questioning,” Bain notes. Baker says: ”I was always looking for arguments in something I read, and then pinpointing the evidence to see how it was used.”

Ask big questions. Jeff Hawkins, an engineer who created the first mobile computing device, organized his college studies around four profound questions he wanted to explore: Why does anything exist? Given that a universe does exist, why do we have the particular laws of physics that we do? Why do we have life, and what is its nature? And given that life exists, what’s the nature of intelligence? For many of the subjects he pursued, Bain notes, “there was no place to ‘look it up,’ no simple answer.”

Cultivate empathy for others. Reyna Grande, author of the novels Across a Hundred Mountains and Dancing with Butterflies, started writing seriously in her junior year in college. “Writing fiction taught Reyna to empathize with the people who populated her stories, an ability that she transferred to her life,” Bain notes: “As a writer, I have to understand what motivates a character, and I see other people as characters in the story of life,” Grande says. “When someone makes mistakes, I always look at what made them act the way they do.”

Set goals and make them real. Tia Fuller, who later became an accomplished saxophone player, began planning her future in college, envisioning the successful completion of her projects. ”I would keep focused on the light at the end of the tunnel, and what that accomplishment would mean,” she tells Bain. “That would help me develop a crystalized vision.”

Find a way to contribute. Joel Feinman, now a lawyer who provides legal services to the poor, was set on his career path by a book he read in college: The Massacre at El Mozote, an account of a 1981 slaughter of villagers in El Salvador. After writing and staging a campus play about the massacre, and traveling to El Salvador, Feinman “decided that I wanted to do something to help people and bring a little justice to the world.”

Read more: http://ideas.time.com/2013/03/13/secrets-of-the-most-successful-college-students/#ixzz2O0ieR0nw

By Dennis Thompson Jr.
Medically reviewed by Pat F. Bass III, MD, MPH

Deep connections exist between chronic pain and depression. A person experiencing chronic pain is more likely than a well person to be depressed. And the connection runs in the other direction, too — depressed people are more likely to complain of chronic aches and pains.

Studies have found that people dealing with chronic pain run three times the risk of developing a mood disorder such as depression or anxiety. About a third of people with persistent pain experience clinical depression.

What’s more, people with depression have three times the risk of chronic pain. “When people have chronic depression over a long period of time, about half of them will develop chronic pain problems without any clear injury to explain that pain,” says Michael Moskowitz, MD, assistant clinical professor for the department of anesthesiology and pain medicine at the University of California, Davis and a board member of the American Pain Foundation.

Pain and Depression Connections

Doctors believe the structure and function of the human brain form the basis of the link between chronic pain and depression:

Brain structure. There is a lot of overlap among the parts of the brain that deal with pain signals and the locations where mood disorders develop. “If you look at the nine places in the brain where pain occurs, six of them are where we experience mood disorders like depression and anxiety,” Dr. Moskowitz says.

Brain function. Some of the neurotransmitters that the brain uses to receive and process pain signals also are used to regulate mood. These include serotonin and norepinephrine. It’s no coincidence that most drugs used to treat mood disorders have been found to be effective when used for pain relief.

Chronic pain and chronic depression both can alter your brain structure and chemistry, with each condition influencing the other. As Moskowitz explains, “Your brain changes every day of your life, with connections made and broken all the time. The brain remodels all the time due to the stimulus it gets.”

“What actually happens in the brain is a kind of expansionism,” Moskowitz continues. “The nerve cells dedicated to pain branch into a new area when there’s chronic pain. With mood and pain sharing so many areas, sometimes they’re kind of encroaching into each other’s areas.”

How to Manage Pain and Depression

How do you manage pain in the face of chronic depression, and how do you treat depression in someone who is experiencing chronic pain? Medical experts believe you need to treat both conditions simultaneously, with initial emphasis on whichever one occurred first.

“You have to look at what the person presents with,” Moskowitz says. “If it comes from the mood, you start with the mood first. If it started from an injury, you start with the cause of the pain first.”

Pain management can be achieved through the use of pain medications and physical therapy, while also tackling depression through exercise, psychotherapy, and antidepressant drugs. Some techniques like progressive muscle relaxation, cognitive-behavioral therapy, and meditation can help with both manage pain and depression.

The goal is to help the brain rewire itself out of both chronic conditions. “You’re retraining the brain to move back to a more normal state,” Moskowitz says.

Mar. 15, 2013 — Secondary school students who follow an in-class mindfulness programme report reduced indications of depression, anxiety and stress up to six months later. Moreover, these students were less likely to develop pronounced depression-like symptoms. The study, conducted by Professor Filip Raes (Faculty of Psychology and Educational Sciences, KU Leuven), is the first to examine mindfulness in a large sample of adolescents in a school-based setting.

Mindfullness is a form of meditation therapy focused on exercising ‘attentiveness’. Depression is often rooted in a downward spiral of negative feelings and worries. Once a person learns to more quickly recognise these feelings and thoughts, he or she can intervene before depression sinks in.

While mindfulness has already been widely tested and applied in patients with depression, this is the first time the method has been studied in a large group of adolescents in a school-based setting, using a randomised controlled design. The study was carried out at five middle schools in Flanders, Belgium. About 400 students between the ages of 13 and 20 took part. The students were divided into a test group and a control group. The test group received mindfulness training, and the control group received no training. Before the study, both groups completed a questionnaire with questions indicative of depression, stress or anxiety symptoms. Both groups completed the questionnaire again directly after the training, and then a third time six months later.

Before the start of the training, both the test group (21%) and the control group (24%) had a similar percentage of students reporting evidence of depression. After the mindfulness training, that number was significantly lower in the test group: 15% versus 27% in the control group. This difference persisted six months after the training: 16% of the test group versus 31% of the control group reported evidence of depression. The results suggest that mindfulness can lead to a decrease in symptoms associated with depression and, moreover, that it protects against the later development of depression-like symptoms.

The study was carried out in cooperation with the Belgian not-for-profit Mindfulness and with support from the Go for Happiness Foundation.

Written by Natasha Tracy
The specific causes of anxiety disorders are unknown, in spite of one-in-eight Americans being affected by them. As with most mental illnesses, anxiety disorders are thought to be caused by a combination of factors. It’s likely genetic, psychological and environmental factors come together to cause anxiety disorders. Medical conditions are also known to cause an anxiety disorder.

Medical Causes of an Anxiety Disorder

While anxiety can be experienced by anyone, for many people an anxiety disorder is linked to an underlying medical issue. In some cases, a medical issue may cause an anxiety disorder. In other cases, anxiety and the medical condition may be related, but the medical condition may not have caused the anxiety disorder.

Possible medical causes include:1
•Heart disease
•Diabetes
•Seizures
•Thyroid problems (such as hypothyroidism or hyperthyroidism)
•Asthma
•Drug abuse and withdrawal (alcohol and benzodiazepines may particularly cause anxiety)
•Rare tumors that produce certain “fight-or-flight” hormones
•Muscle cramps or spasms
•And many others

While most anxiety disorders develop in childhood and young adulthood, a medical cause is more likely if the anxiety disorder develops later in life. While common, anxiety disorders related to substance abuse or withdrawal are often undiagnosed. Various medications may also cause anxiety disorder symptoms.

Genetic Causes of Anxiety Disorders

While an exact gene hasn’t been pinpointed, it’s thought that genetics play a role in causing anxiety disorders, or at least for increasing the risk of getting an anxiety disorder. Anxiety disorders and genetics have been shown to be linked through chromosomal irregularities, among other things. These findings are confirmed by studies using twins.

The link between anxiety disorders and genetics is better understood for specific disorders. For example, in panic disorder, a gene mutation that leads to dysfunction in the chemical systems of the brain has been identified. Additional likely genetic links include:
•An abnormal increased function in some brain receptors; an abnormal decreased function in others
•An imbalance of chemicals, like cortisol, linked to feelings of stress
•Impaired carbon dioxide receptors, leading to a state of chronic hyperventilation

Obsessive-compulsive disorder has shown a strong genetic link with a genetic influence of 45% – 65% in children and 27% – 47% in adults.

THURSDAY, Feb. 28, 2013 By John Gever, Senior Editor, MedPage Today(MedPage Today) — Institutionalized dementia patients who received a tailored educational program on good eating habits were less likely to show symptoms of depression 6 months later, results of a Taiwanese study indicated.

Mean scores on the Chinese version of the Cornell Scale for Depression in Dementia declined 0.73 points among patients assigned to a individualized program, whereas a control group receiving usual care showed an average increase of 0.79 points, according to Li-Chan Lin, PhD, RN, of National Yang-Ming University in Taipei, Taiwan, and Hua-Shan Wu, PhD, RN, of Shan Medical University in Taichung, Taiwan.

A third study arm, in which patients received a non-individualized version of the educational program, showed no change in depression scores, the researchers reported online in the Journal of Advanced Nursing.

Nutritional status and body mass index likewise increased with the individualized program, decreased in the control group, and showed little change with the non-individualized program, Lin and Wu indicated.

“The improvement in nutritional status may have led to reduced fatigue and increased vitality,” they wrote. “Once the participants perceived the improvements in their health, pessimism, the sense of multiple illnesses, hopelessness, or even worthlessness seldom emerged.”

Multiple aspects of proper nutrition are often compromised in dementia. As Lin and Wu explained, “identifying foods, transferring foods, chewing, and swallowing” become progressively difficult for patients with cognitive deficits. Moreover, several previous studies have linked poor nutritional status to depression, in otherwise healthy adults as well as in those with dementia.

In the current study, Lin and Wu tested an approach combining a technique called “spaced retrieval” with Montessori-type methods aimed at helping dementia patients eat more and eat more regularly.

Spaced retrieval is a teaching method to help people with information recall. It involves challenging the person to remember something for increasing time intervals. If it is successfully recalled after 2 minutes, a second challenge will require recall after 4 minutes. When recall fails, the challenge is done again at the last successful interval.

Lin and Wu chose Montessori-based activities to reinforce healthy eating behaviors because cognitive abilities in dementia patients in some ways resemble those of young children.

The combination of the two techniques “activate the effects of repetition priming and procedural memory in the nondeclarative memory,” the researchers explained, leading to development of desired habits.

They randomized 90 patients to usual care or two versions of the program. Both versions were built around sessions lasting 35-40 minutes three times a week. The training focused on eight basic eating behaviors, from remembering mealtimes to swallowing after chewing.

In the individualized program, training was progressively intensified for individual patients if they demonstrated mastery at a given level. The number of sessions also depended on individual patients’ needs, such that participants with mild dementia could receive up to 23 sessions whereas the maximum in moderate or severe dementia was 35.

For patients assigned to the non-individualized program, training intensity was stepped up only when more than half the participants had shown mastery. The number of sessions was fixed at 24 over an 8-week period.

Patients were recruited from veterans’ homes in Taiwan. About 40 percent had scores on the Chinese version of the Mini-Mental State Examination of 6 t0 11 (severe dementia), and another 40 percent had scores of 12 to 17 (moderate dementia).

From 4 percent to 18 percent of each study arm were taking antidepressants, 32 percent to 45 percent were taking antipsychotic medications, and 20 percent to 29 percent were on anti-anxiety drugs.

Mean BMI at baseline ranged from 20.3 to 22.9 in the three arms. Scores on the Chinese version of the Mini-Nutritional Assessment averaged 19.2 to 21.5. On the Cornell depression scale, mean baseline scores were 0.26 to 1.55.

Over the 6-month post-training evaluation period, changes in Cornell and nutritional scores were strongly correlated in the individualized intervention group, with an R2 value of 0.44. Changes in nutritional scores also correlated strongly and significantly in this group with nutritional scores at baseline.

“The greatest improvement of nutritional status and depressive symptoms resulting from the individualized intervention occurred between the immediate post-training period and the 1-month follow-up,” Lin and Wu noted.

They suggested that, therefore, additional “booster sessions” may be helpful in maintaining or increasing the short-term gains.

Limitations to the study included its restriction to residents of veterans’ homes and the small number of outcome measures.

Source: Eating Helps Dementia Patients Avoid Depression

By Monte Morin They call it “pre-drinking,” “pre-partying” or “pre-funking,” and it usually involves chugging cheap alcoholic drinks before heading out to a bar, club or sporting event.

While addiction experts estimate that 65% to 75% of college-age youths engage in such boozy behavior, a Swiss study concludes that such “pre-loaded” evenings are far more likely to end in blackouts, unprotected sex, unplanned drug use or injury.
“Pre-drinking is a pernicious drinking pattern,” said coauthor Florian Labhart, a researcher at Addiction Info Switzerland, in Lausanne. “Excessive consumption and adverse consequences are not simply related to the type of people who pre-drink, but rather to the practice of pre-drinking itself.”
The study, to be published in an upcoming issue of Alcoholism: Clinical & Experimental Research, examined the drinking habits of more than 250 Swiss students.

For five weeks, the test subjects were surveyed via Internet and cellphone text messages. Each Thursday, Friday and Saturday night, the students were questioned hourly about how many drinks they had just consumed.

Researchers found that when students drank prior to going to a bar or club, they drank more than the would otherwise. On average, pre-drinking students consumed seven drinks, and students who drank only at a bar or event consumed just over four drinks.

This increased drinking was associated with a greater likelihood of blackouts, hangovers, absences from work or school or alcohol poisoning. Pre-drinkers were also found to engage more often in unintended drug use, unsafe sex, drunken driving or violent behavior.

The study found that while students who drank only at a bar or club stood an 18% chance of experiencing negative consequences, students who drank beforehand stood a 24% chance of seeing their evening end in mishap.

Study authors cited several motivations for pre-drinking, which practitioners also called “pre-gaming,” “pre-loading” or “frontloading.”

“Reasons given for pre-drinking include saving money, getting in the mood for partying, becoming intoxicated and socializing with friends or facilitating contacts with potential sexual partners,” the authors wrote.

Shannon R. Kenney, a sociology professor at Loyola Marymount University in Los Angeles, said pre-drinking behavior was likely as prevalent, or more so, in the United States, where the legal drinking age was much higher. In Switzerland, youths can legally purchase alcohol at age 16.

Kenney, who did not participate in the study, said the concept of pre-drinking has only recently been studied by addiction experts. Because of its risky nature and prevalence, she said, it warranted closer examination.

Study authors noted several possible shortcomings in their study. Among them was that only students with Internet capable cellphones could participate. Also, the study questions were extremely short, so that they could be read on a small cellphone screen or answered by someone in an intoxicated state.