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Pask S, Dell'Olio M, Murtagh FEM, Boland JW. The Effects of Opioids on Cognition in Older Adults With Cancer and Chronic Noncancer Pain: A Systematic Review. J Pain Symptom Manage 2020; 59:871-893.e1. [PMID: 31678462 DOI: 10.1016/j.jpainsymman.2019.10.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 10/17/2019] [Accepted: 10/21/2019] [Indexed: 01/08/2023]
Abstract
CONTEXT Opioids are prescribed to manage moderate-to-severe pain and can be used with older adults; however, they may lead to several adverse effects, including cognitive impairment. OBJECTIVES To identify, appraise, and synthesize evidence on the impact of opioids on cognition in older adults with cancer/chronic noncancer pain, and screening tools/neuropsychological assessments used to detect opioid-induced cognitive impairment. METHODS A systematic literature review following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (international prospective register of systematic reviews registration: CRD42018092943). MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane Library, and Web of Science were searched up to December 2018. Randomized controlled trials, quasi-experimental studies, and observational studies of adults aged 65 years and older with cancer/chronic noncancer pain taking opioids were included. A narrative synthesis was conducted. RESULTS From 4036 records, 10 met inclusion criteria. Five studies used one screening tool, and five studies used a range of neuropsychological assessments; assessing 14 cognitive domains. Most studies demonstrated no effect of opioid use on cognitive domains, whereas four studies showed mixed effects. In particular, attention, language, orientation, psychomotor function, and verbal working/delayed episodic memory were worsened. Changes to cognitive function were predominantly observed in studies with higher mean doses of opioids (120-190.7mg oral morphine equivalent daily dose). CONCLUSION Both improvements and impairments to cognition were observed in studies with higher mean opioid doses. In clinical practice, a brief screening tool assessing attention, language, orientation, psychomotor function, and verbal working/delayed episodic memory may be beneficial to detect worsening cognition in older adults with chronic pain using opioids.
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Affiliation(s)
- Sophie Pask
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom.
| | - Myriam Dell'Olio
- Academy of Primary Care, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Fliss E M Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Jason W Boland
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
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Kroon E, Kuhns L, Hoch E, Cousijn J. Heavy cannabis use, dependence and the brain: a clinical perspective. Addiction 2020; 115:559-572. [PMID: 31408248 PMCID: PMC7027478 DOI: 10.1111/add.14776] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 07/15/2019] [Accepted: 08/07/2019] [Indexed: 12/28/2022]
Abstract
AIMS To summarize and evaluate our knowledge of the relationship between heavy cannabis use, cannabis use disorder (CUD) and the brain. METHODS Narrative review of relevant literature identified through existing systematic reviews, meta-analyses and a PubMed search. Epidemiology, clinical representations, potential causal mechanisms, assessments, treatment and prognosis are discussed. RESULTS Although causality is unclear, heavy and dependent cannabis use is consistently associated with a high prevalence of comorbid psychiatric disorders and learning and memory impairments that seem to recover after a period of abstinence. Evidence regarding other cognitive domains and neurological consequences, including cerebrovascular events, is limited and inconsistent. Abstinence after treatment is only achieved in a minority of cases; treatment targeted at reduction in use appears have some success. Potential moderators of the impact of CUD on the brain include age of onset, heaviness of use, CUD severity, the ratio of ∆9-tetrahydrocannabinol to cannabidiol and severity of comorbid disorders. CONCLUSIONS Current evidence of long-term effects of daily cannabis use and cannabis use disorder on brain-related outcomes is suggestive rather than conclusive, but use is associated with psychiatric morbidity and with cognitive impairments that recover after a period of abstinence.
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Affiliation(s)
- Emese Kroon
- Neuroscience of Addiction Lab, Department of PsychologyUniversity of AmsterdamAmsterdamthe Netherlands
- The Amsterdam Brain and Cognition Center (ABC)University of AmsterdamAmsterdamthe Netherlands
| | - Lauren Kuhns
- Neuroscience of Addiction Lab, Department of PsychologyUniversity of AmsterdamAmsterdamthe Netherlands
- The Amsterdam Brain and Cognition Center (ABC)University of AmsterdamAmsterdamthe Netherlands
| | - Eva Hoch
- Cannabinoid Research and Treatment Group, Department of Psychiatry and PsychotherapyUniversity Hospital, Ludwig Maximilan UniversityMunichGermany
- Division of Clinical Psychology and Psychological Treatment, Department of PsychologyLudwig Maximilian University MunichMunichGermany
| | - Janna Cousijn
- Neuroscience of Addiction Lab, Department of PsychologyUniversity of AmsterdamAmsterdamthe Netherlands
- The Amsterdam Brain and Cognition Center (ABC)University of AmsterdamAmsterdamthe Netherlands
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MMP-9-BDNF pathway is implicated in cognitive impairment of male individuals with methamphetamine addiction during early withdrawal. Behav Brain Res 2019; 366:29-35. [DOI: 10.1016/j.bbr.2019.03.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/04/2019] [Accepted: 03/11/2019] [Indexed: 12/23/2022]
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54
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Bruijnen CJWH, Dijkstra BAG, Walvoort SJW, Markus W, VanDerNagel JEL, Kessels RPC, DE Jong CAJ. Prevalence of cognitive impairment in patients with substance use disorder. Drug Alcohol Rev 2019; 38:435-442. [PMID: 30916448 PMCID: PMC6593747 DOI: 10.1111/dar.12922] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 02/14/2019] [Accepted: 02/18/2019] [Indexed: 02/01/2023]
Abstract
INTRODUCTION AND AIMS Cognitive impairments in substance use disorder predict treatment outcome and are assumed to differ between substances. They often go undetected, thus the current study focuses on the prevalence of and differences in cognitive functioning across substances by means of a cognitive screen at the early stage of addiction treatment. DESIGN AND METHODS The Montreal Cognitive Assessment was administered to outpatients seeking treatment for substance use disorder. Patient characteristics (age, years of regular use, polysubstance use, severity of dependence/abuse, depression, anxiety and stress) were also taken into account. RESULTS A total of 656 patients were included (n = 391 used alcohol, n = 123 used cannabis, n = 100 used stimulants and n = 26 used opioids). The prevalence of cognitive impairments was 31%. Patients using alcohol had a lower total- and memory domain score than those using cannabis. Patients using opioids scored lower on visuospatial abilities than those using cannabis or stimulants. Younger patients scored higher than older patients. No effect was found for the other investigated characteristics. DISCUSSION AND CONCLUSIONS Given the high prevalence of cognitive impairments, standard screening at an early stage of treatment is important to determine the course of treatment and maximise treatment outcome. Caution is needed in interpreting results about opioids due to an underrepresentation of this patient group, and more research is needed on the effect of age on Montreal Cognitive Assessment performance.
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Affiliation(s)
- Carolien J W H Bruijnen
- Centre of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands.,Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Boukje A G Dijkstra
- Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University, Nijmegen, The Netherlands.,Novadic-Kentron, Addiction Care Centre, Vught, The Netherlands
| | - Serge J W Walvoort
- Centre of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands.,Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University, Nijmegen, The Netherlands
| | - Wiebren Markus
- Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University, Nijmegen, The Netherlands.,IrisZorg, Centre for Addiction Treatment, Arnhem, The Netherlands
| | - Joanne E L VanDerNagel
- Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University, Nijmegen, The Netherlands.,Tactus, Centre for Addiction and Intellectual Disability, Deventer, The Netherlands.,Aveleijn, Borne, The Netherlands
| | - Roy P C Kessels
- Centre of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands.,Department of Medical Psychology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Cornelis A J DE Jong
- Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University, Nijmegen, The Netherlands.,Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
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The Montreal Cognitive Assessment as a predictor of dropout from residential substance use disorder treatment. Heliyon 2019; 5:e01282. [PMID: 31025003 PMCID: PMC6476942 DOI: 10.1016/j.heliyon.2019.e01282] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 01/18/2019] [Accepted: 02/25/2019] [Indexed: 11/24/2022] Open
Abstract
Background Cognitive function is a challenge for many SUD patients, and residential SUD treatment is cognitively demanding. Treatment retention is a predictor for success in SUD treatment, and the literature links low cognitive function to increased dropout rates. In our study we investigate cognitive function and dropout in a residential SUD treatment setting, also accounting for psychological distress. Methods We screened a cohort (N = 142) of inpatients for cognitive function (MoCA®) and psychological distress (SCL-10) and calculated the relative risk for dropping out if over versus under the respective cut-off values (<26 and >1.85), and sex, and age-group (<23 years). We also employed a logistic regression with dropout as outcome and MoCA- and SCL-10 scores, and age and days before testing as input. Results Dropout risk was higher (RR = 1.70) if scoring below MoCA cut-off, and for those younger than 23 years (RR = 2.36). The other variables did not influence dropout risk. MoCA raw scores, age, and SCL-10 were associated with dropout (p < .05); with lower symptoms of psychological distress predicting increased dropout. The interaction between MoCA and SCL-10 scores was not significant (p = .26). Conclusions SUD patients should routinely be screened for cognitive impairment, as it predicts dropout. Screenings should be ensued by appropriate adaptations to treatment and further assessment. The MoCA is a useful screening tool for this, independent of psychological distress. Future studies should replicate our findings, investigate specific interventions, and establish SUD population norms for the MoCA.
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Berry J, Jacomb I, Lunn J, Sedwell A, Shakeshaft A, Kelly PJ, Sarrami P, James M, Russell S, Nardo T, Barker D, Holmes J. A stepped wedge cluster randomised trial of a cognitive remediation intervention in alcohol and other drug (AOD) residential treatment services. BMC Psychiatry 2019; 19:70. [PMID: 30760250 PMCID: PMC6372999 DOI: 10.1186/s12888-019-2044-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 01/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Executive functioning impairment is common in substance use disorder and is a major risk factor for poor treatment outcomes, including treatment drop-out and relapse. Cognitive remediation interventions seek to improve executive functioning and offer a promising approach to increase the efficacy of alcohol and other drug (AOD) treatments and improve long-term therapeutic outcomes. This protocol describes a study funded by the NSW Agency for Clinical Innovation that assesses the effectiveness of delivering a six-week group-based intervention of cognitive remediation in an ecologically valid sample of people attending residential AOD treatment services. We primarily aim to investigate whether cognitive remediation will be effective in improving executive functioning and treatment retention rates. We will also evaluate if cognitive remediation may reduce long-term AOD use and rates of health service utilisation, as well as improve personal goal attainment, quality of life, and client satisfaction with treatment. In addition, the study will involve an economic analysis of the cost of delivering cognitive remediation. METHODS/DESIGN The study uses a stepped wedge cluster randomised design, where randomisation will occur at the cluster level. Participants will be recruited from ten residential AOD treatment services provided by the non-government sector. The intervention will be delivered in 12 one-hour group-based sessions over a period of six weeks. All participants who are expected to receive treatment for the duration of the six-week intervention will be asked to participate in the study. The clusters of participants who are randomly assigned to the treatment condition will complete cognitive remediation in addition to treatment as usual (TAU). Primary and secondary outcome assessments will be conducted at pre-cognitive remediation/TAU phase, post-cognitive remediation/TAU phase, two-month follow-up, four-month follow-up, six-month follow-up, and eight-month follow-up intervals. DISCUSSION This study will provide comprehensive data on the effect of delivering a cognitive remediation intervention within residential AOD treatment services. If shown to be effective, cognitive remediation may be incorporated as an adjunctive intervention in current treatment programs. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Register (ANZCTR): ACTRN12618001190291 . Prospectively registered 17th July 2018.
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Affiliation(s)
- Jamie Berry
- Macquarie University, Balaclava Road, North Ryde, NSW 2109 Australia
- Advanced Neuropsychological Treatment Services, PO Box 4070, Strathfield South, NSW 2136 Australia
| | - Isabella Jacomb
- Macquarie University, Balaclava Road, North Ryde, NSW 2109 Australia
| | - Jo Lunn
- We Help Ourselves, PO Box 1779, Rozelle, NSW 2039 Australia
| | - Antoinette Sedwell
- Agency for Clinical Innovation, Level 4, 67 Albert Ave, Chatswood, NSW 2067 Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052 Australia
| | - Peter J Kelly
- Illawarra Health and Medical Research Institute and the School of Psychology, Faculty of Social Sciences, University of Wollongong, Building 41, Room 128, Wollongong, NSW 2522 Australia
| | - Pooria Sarrami
- Agency for Clinical Innovation, Level 4, 67 Albert Ave, Chatswood, NSW 2067 Australia
- South Western Sydney Clinical School, University of New South Wales, Goulburn St, Liverpool, NSW 2170 Australia
| | - Megan James
- Agency for Clinical Innovation, Level 4, 67 Albert Ave, Chatswood, NSW 2067 Australia
| | - Skye Russell
- Agency for Clinical Innovation, Level 4, 67 Albert Ave, Chatswood, NSW 2067 Australia
| | - Talia Nardo
- Macquarie University, Balaclava Road, North Ryde, NSW 2109 Australia
| | - Daniel Barker
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Jennifer Holmes
- Ministry of Health NSW, 73 Miller St, North Sydney, NSW 2060 Australia
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Hagen E, Sømhovd M, Hesse M, Arnevik EA, Erga AH. Measuring cognitive impairment in young adults with polysubstance use disorder with MoCA or BRIEF-A – The significance of psychiatric symptoms. J Subst Abuse Treat 2019; 97:21-27. [DOI: 10.1016/j.jsat.2018.11.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/21/2018] [Accepted: 11/21/2018] [Indexed: 11/25/2022]
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Verdejo-Garcia A, Lorenzetti V, Manning V, Piercy H, Bruno R, Hester R, Pennington D, Tolomeo S, Arunogiri S, Bates ME, Bowden-Jones H, Campanella S, Daughters SB, Kouimtsidis C, Lubman DI, Meyerhoff DJ, Ralph A, Rezapour T, Tavakoli H, Zare-Bidoky M, Zilverstand A, Steele D, Moeller SJ, Paulus M, Baldacchino A, Ekhtiari H. A Roadmap for Integrating Neuroscience Into Addiction Treatment: A Consensus of the Neuroscience Interest Group of the International Society of Addiction Medicine. Front Psychiatry 2019; 10:877. [PMID: 31920740 PMCID: PMC6935942 DOI: 10.3389/fpsyt.2019.00877] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 11/06/2019] [Indexed: 01/01/2023] Open
Abstract
Although there is general consensus that altered brain structure and function underpins addictive disorders, clinicians working in addiction treatment rarely incorporate neuroscience-informed approaches into their practice. We recently launched the Neuroscience Interest Group within the International Society of Addiction Medicine (ISAM-NIG) to promote initiatives to bridge this gap. This article summarizes the ISAM-NIG key priorities and strategies to achieve implementation of addiction neuroscience knowledge and tools for the assessment and treatment of substance use disorders. We cover two assessment areas: cognitive assessment and neuroimaging, and two interventional areas: cognitive training/remediation and neuromodulation, where we identify key challenges and proposed solutions. We reason that incorporating cognitive assessment into clinical settings requires the identification of constructs that predict meaningful clinical outcomes. Other requirements are the development of measures that are easily-administered, reliable, and ecologically-valid. Translation of neuroimaging techniques requires the development of diagnostic and prognostic biomarkers and testing the cost-effectiveness of these biomarkers in individualized prediction algorithms for relapse prevention and treatment selection. Integration of cognitive assessments with neuroimaging can provide multilevel targets including neural, cognitive, and behavioral outcomes for neuroscience-informed interventions. Application of neuroscience-informed interventions including cognitive training/remediation and neuromodulation requires clear pathways to design treatments based on multilevel targets, additional evidence from randomized trials and subsequent clinical implementation, including evaluation of cost-effectiveness. We propose to address these challenges by promoting international collaboration between researchers and clinicians, developing harmonized protocols and data management systems, and prioritizing multi-site research that focuses on improving clinical outcomes.
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Affiliation(s)
- Antonio Verdejo-Garcia
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Valentina Lorenzetti
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Canberra, ACT, Australia
| | - Victoria Manning
- Eastern Health Clinical School Turning Point, Eastern Health, Richmond, VIC, Australia.,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Hugh Piercy
- Eastern Health Clinical School Turning Point, Eastern Health, Richmond, VIC, Australia.,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Raimondo Bruno
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Rob Hester
- School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - David Pennington
- San Francisco Veterans Affairs Health Care System (SFVAHCS), San Francisco, CA, United States.,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Serenella Tolomeo
- School of Medicine, University of St Andrews, Medical and Biological Science Building, North Haugh, St Andrews, United Kingdom.,Department of Psychology, National University of Singapore, Singapore, Singapore
| | - Shalini Arunogiri
- Eastern Health Clinical School Turning Point, Eastern Health, Richmond, VIC, Australia.,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Marsha E Bates
- Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ, United States
| | | | - Salvatore Campanella
- Laboratoire de Psychologie Médicale et d'Addictologie, ULB Neuroscience Institute (UNI), CHU Brugmann-Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Stacey B Daughters
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Christos Kouimtsidis
- Department of Psychiatry, Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, United Kingdom
| | - Dan I Lubman
- Eastern Health Clinical School Turning Point, Eastern Health, Richmond, VIC, Australia
| | - Dieter J Meyerhoff
- DVA Medical Center and Department of Radiology and Biomedical Imaging, University of California San Francisco, School of Medicine, San Francisco, CA, United States
| | - Annaketurah Ralph
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
| | - Tara Rezapour
- Department of Cognitive Psychology, Institute for Cognitive Sciences Studies, Tehran, Iran
| | - Hosna Tavakoli
- Department of Cognitive Psychology, Institute for Cognitive Sciences Studies, Tehran, Iran.,Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehran Zare-Bidoky
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran.,School of Medicine, Shahid-Sadoughi University of Medical Sciences, Yazd, Iran
| | - Anna Zilverstand
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States
| | - Douglas Steele
- Medical School, University of Dundee, Ninewells Hospital, Scotland, United Kingdom
| | - Scott J Moeller
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
| | - Martin Paulus
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, OK, United States
| | - Alex Baldacchino
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Hamed Ekhtiari
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, OK, United States
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Chalhoub NE, Luggen ME. Screening for cognitive dysfunction in systemic lupus erythematosus: the Montreal Cognitive Assessment Questionnaire and the Informant Questionnaire on Cognitive Decline in the Elderly. Lupus 2018; 28:51-58. [PMID: 30482092 DOI: 10.1177/0961203318815299] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cognitive dysfunction (CD) is among the most common neuropsychiatric manifestations of systemic lupus erythematosus (SLE). Traditional neuropsychological testing and the Automated Neuropsychologic Assessment Metrics (ANAM) have been used to assess CD but neither is an ideal screening test. The Montreal Cognitive Assessment Questionnaire (MoCA) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) are brief and inexpensive tests. This study evaluated the MoCA and IQCODE as screening tools. METHODS SLE patients fulfilling American College of Rheumatology (ACR) classification criteria were evaluated using the ANAM as the reference standard. The performance characteristics of the MoCA and IQCODE were assessed in comparison with normal controls (NCs) and rheumatoid arthritis (RA) patients. Four different definitions of CD were utilized. RESULTS In total, 78 patients were evaluated. MoCA and ANAM scores were significantly correlated ( r = 0.51, p < 0.001). At the optimal cutoff, the sensitivity of the MoCA was ≥ 90% (depending on definition of CD) vs RA patients and ≥83% vs NCs. ANAM and IQCODE scores did not correlate ( p = 0.8152). IQCODE sensitivities were low for both RA patients and NCs regardless of definition and cutoff used. CONCLUSION The MoCA appears to be a promising and practical screening tool for identification of patients with SLE at risk for CD.
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Affiliation(s)
- N E Chalhoub
- Division of Immunology, Allergy, and Rheumatology, University of Cincinnati College of Medicine, Cincinnati, USA
| | - M E Luggen
- Division of Immunology, Allergy, and Rheumatology, University of Cincinnati College of Medicine, Cincinnati, USA
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Frenette LC, Tinawi S, Correa JA, Alturki AY, LeBlanc J, Feyz M, de Guise E. Early detection of cognitive impairments with the Montreal Cognitive Assessment in patients with uncomplicated and complicated mild traumatic brain injury. Brain Inj 2018; 33:1-9. [PMID: 30388898 DOI: 10.1080/02699052.2018.1542506] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 08/23/2018] [Accepted: 10/26/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The Montreal Cognitive Assessement (MoCA) is a brief and standardized cognitive screening tool that has been used with several clinical populations. The aim of this study was to screen the early cognitive status of patients following mild traumatic brain injury (mTBI) with the MoCA. METHODS The MoCA was administered within the first 2 weeks post-injury to 42 patients with uncomplicated mTBI, 92 patients with complicated mTBI and 50 healthy controls. RESULTS Patients with complicated mTBI had a significantly lower performance (more impairments) on the total score of the MoCA than both the group with uncomplicated mTBI and the control group. Also, the group with uncomplicated mTBI had a significantly lower performance than controls. Moreover, age, education and TBI severity had a significant effect on the MoCA total score where younger, more educated and patients with less severe (higher GCS score) mTBI performed significantly better. CONCLUSIONS The MoCA may be clinically useful to acutely screen cognition following mTBI.
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Affiliation(s)
- L C Frenette
- a Department of Psychology , Université de Montréal , Montréal , Canada
- b Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR) , Montréal , Canada
| | - S Tinawi
- c Traumatic Brain Injury Program-McGill University Health Center , Montréal , Canada
| | - J A Correa
- d Department of Mathematics and Statistics , McGill University , Montréal , Canada
| | - A Y Alturki
- e Department of Neurology and neurosurgery , McGill University , Montréal , Canada
- f Department of Neurosurgery , The National Neuroscience Institute , Riyadh , Saudi Arabia
| | - J LeBlanc
- c Traumatic Brain Injury Program-McGill University Health Center , Montréal , Canada
| | - M Feyz
- c Traumatic Brain Injury Program-McGill University Health Center , Montréal , Canada
| | - E de Guise
- a Department of Psychology , Université de Montréal , Montréal , Canada
- b Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR) , Montréal , Canada
- g Research Institute-McGill University Health Center , Montréal , Canada
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Aharonovich E, Hasin DS, Nunes EV, Stohl M, Cannizzaro D, Sarvet A, Bolla K, Carroll KM, Genece KG. Modified cognitive behavioral therapy (M-CBT) for cocaine dependence: Development of treatment for cognitively impaired users and results from a Stage 1 trial. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2018; 32:800-811. [PMID: 30346186 DOI: 10.1037/adb0000398] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Cognitive impairments are associated with poor outcomes when treating cocaine dependent patients, but behavioral interventions to mitigate this impact have not been developed. In this Stage 1A/1B treatment development study, several compensatory strategies (e.g., content repetition, daily logs, diaries, visual presentation) were combined to create a modified cognitive behavioral therapy (M-CBT) for treating cocaine dependence. Initially, a select group of therapists, neuropsychology experts, and patients were asked to provide input on early drafts of the treatment manual and companion patient workbook. After an uncontrolled small trial (N = 15) and two rounds of manual development (Stage 1A), a pilot randomized clinical trial (N = 102) of cocaine dependent outpatients with and without cognitive impairments was conducted (Stage 1B). Participants were randomized to M-CBT (N = 52) or CBT (N = 50). Both treatments were individually delivered over 12 weeks with assessments conducted at baseline, end-of-treatment, and 3-month follow-up. The primary outcome was frequency of cocaine use, measured by number of days used in the prior 7 days. Participants in the two treatment groups did not differ significantly on drug use reduction or retention in treatment. However, among participants who completed at least 9 weeks of treatment, those in M-CBT showed a trend toward greater reduction in cocaine use compared to those in the CBT group. M-CBT is feasible for impaired and nonimpaired cocaine dependent participants. However, M-CBT treatment did not show significant superiority over standard CBT in the present sample. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | | | - Karen Bolla
- Department of Neurology, Bayview Medical Center, Johns Hopkins University
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Helene Bergly T, Julius Sømhovd M. The Relation Between ADHD Medication and Mild Cognitive Impairment, as Assessed by the Montreal Cognitive Assessment (MoCA), in Patients Entering Substance Use Disorder Inpatient Treatment. J Dual Diagn 2018; 14:228-236. [PMID: 30183548 DOI: 10.1080/15504263.2018.1496305] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Attention-deficit/hyperactivity disorder (ADHD) frequently co-occurs with substance use disorders and has some overlapping symptoms with mild cognitive impairment, including executive functions. We wanted to investigate whether patients with ADHD have an excess risk of mild cognitive impairment-like symptoms, as defined by the Montreal Cognitive Assessment (MoCA). Second, we assessed the impact of ADHD medication on the dichotomized MoCA for patients with ADHD. METHODS The participants in this study were 129 inpatients at seven treatment clinics in Norway. All were screened with the MoCA. We calculated relative risk estimates (RR) for scoring in the mild cognitive impairment range (< 26) for those having ADHD. Finally, we calculated the RR for the patients within the ADHD group who were taking medication. RESULTS Of the 129 participants included in the analyses, 38 (29.5%) scored below the MoCA threshold (< 26), and 24 (18.6%) had ADHD that was diagnosed before or during the inpatient treatment. Of the 105 participants without ADHD, 31 (29.5%) scored below the threshold. Seven (29.2%) of those with ADHD scored below the threshold. The risk of scoring in the mild cognitive impairment range for those with and without ADHD was equal (RR = 0.98). Of the 24 patients with ADHD, 9 (37.5%) were taking medication at the time of testing. One of the patients taking medication scored below the threshold compared to six of those not taking medication. This suggests a 72% lower risk of mild cognitive impairment-like symptoms when taking medication (RR = 0.28); however, the effect was not significant. CONCLUSIONS We revealed no excess risk of mild cognitive impairment-like symptoms for the ADHD group. However, within the ADHD group, there was a possible lower risk of mild cognitive impairment-like symptoms for patients taking medication. These results suggest that there may be a confounding overlap of symptoms between ADHD and cognitive function screens that necessitates adequate assessment and treatment of ADHD before screening or measuring cognitive function.
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Affiliation(s)
| | - Mikael Julius Sømhovd
- a Research and Development , The Tyrili Foundation , Oslo , Norway.,b Department of Psychology , Technical University of Denmark, University of Copenhagen , Copenhagen , Denmark
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Mukherjee T, Sakthivel R, Fong HY, McStea M, Chong ML, Omar SF, Chin AV, Kamaruzzaman S, Kamarulzaman A, Rajasuriar R, Cysique LA. Utility of Using the Montreal Cognitive Assessment (MoCA) as a Screening Tool for HIV-Associated Neurocognitive Disorders (HAND) In Multi-Ethnic Malaysia. AIDS Behav 2018; 22:3226-3233. [PMID: 29508103 PMCID: PMC6123290 DOI: 10.1007/s10461-018-2073-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study determines the optimal cut-off scores for the Montreal Cognitive Assessment (MoCA) to detect HIV-associated neurocognitive disorders (HAND) in a multi-ethnic Malaysian HIV-positive cohort by developing demographically corrected normative standards among 283 HIV-negative community-based controls with overlapping demographic characteristics. The norms (corrected for age, sex, education, ethnicity) were applied to 342 HIV-positive virally suppressed individuals on cART. Impairment rates were classified using the Global Deficit Score (GDS ≥ .5) method. The MoCA was also scored according to the recommended cut-off of ≤ 26, and functional decline was applied to both impairment definitions to classify HAND per the Frascati criteria. The ≤ 26 cut-off considerably overestimated cognitive impairment in both samples (59.4% HIV-negative; 69.3% HIV-positive). In contrast, corrected scores yielded impairment rates consistent with what has been reported internationally in virally suppressed cohorts (23.4% with 83.3% mild impairment, 16.7% moderate impairment). A supplemental file allowing the computation of corrected MoCA scores and impairment status is included.
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Affiliation(s)
- Trena Mukherjee
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Rishanantini Sakthivel
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, Kuala Lumpur, Malaysia
| | - Ho Yen Fong
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, Kuala Lumpur, Malaysia
| | - Megan McStea
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, Kuala Lumpur, Malaysia
| | - Meng Li Chong
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, Kuala Lumpur, Malaysia
| | - Sharifah Faridah Omar
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ai Vyrn Chin
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Adeeba Kamarulzaman
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Reena Rajasuriar
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, Kuala Lumpur, Malaysia.
- Department of Pharmacy, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia.
| | - Lucette A Cysique
- Neuroscience Research Australia, School of Medical Sciences, Faculty of Medicine, The University of New South Wales, Sydney, NSW, Australia
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Yang Z, Abdul Rashid NA, Quek YF, Lam M, See YM, Maniam Y, Dauwels J, Tan BL, Lee J. Montreal Cognitive Assessment as a screening instrument for cognitive impairments in schizophrenia. Schizophr Res 2018; 199:58-63. [PMID: 29549976 DOI: 10.1016/j.schres.2018.03.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cognitive impairment is one of the core features of schizophrenia. For its evaluation, current clinical practice relies on detailed neuropsychological batteries which require trained testers and considerable amount of time to administer. Therefore, a brief and reliable screening tool for identification of overall cognitive impairment prior to a detailed comprehensive neurocognitive assessment is needed in a busy clinical setting. This study evaluates the clinical utility of the Montreal Cognitive Assessment (MoCA) in detecting cognitive impairments in schizophrenia and its relationship with functional outcome and demographic characters. METHODS The MoCA, the Brief Assessment of Cognition in Schizophrenia (BACS), and the Brief UCSD Performance-based Skills Assessment (UPSA-B) were administered to 64 patients with schizophrenia. Mild and severe cognitive impairments were defined as BACS Z-score (calculated with the age and gender adjustments using previously published local norm data) of one or two standard deviations below the mean, respectively. RESULTS The results showed that the MoCA was significantly correlated with BACS (r=.61, p<.001) and sensitive to detect both mild (AUC=0.82, p<.001) and severe (AUC=0.81, p<.001) cognitive impairments in schizophrenia. The MoCA was significantly correlated with UPSA-B score (r=.51, p<.001), and accounted for significant additional variance in UPSA-B score beyond the BACS. CONCLUSION These findings indicate that MoCA is a useful bedside cognitive screening instrument for people with schizophrenia.
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Affiliation(s)
- Zixu Yang
- Research Division, Institute of Mental Health, Singapore, Singapore.
| | | | - Yue Feng Quek
- School of Psychology, University of Wollongong, Wollongong, Australia
| | - Max Lam
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Yuen Mei See
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Yogeswary Maniam
- Department of Early Psychosis Intervention, Institute of Mental Health, Singapore, Singapore
| | - Justin Dauwels
- School of Electrical & Electronic Engineering, Nanyang Technological University, Singapore, Singapore
| | - Bhing Leet Tan
- Health & Social Sciences, Singapore Institute of Technology, Singapore, Singapore; Department of Occupational Therapy, Institute of Mental Health, Singapore, Singapore
| | - Jimmy Lee
- Research Division, Institute of Mental Health, Singapore, Singapore; Department of Psychosis, Institute of Mental Health, Singapore, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Gautron MA, Questel F, Lejoyeux M, Bellivier F, Vorspan F. Nutritional Status During Inpatient Alcohol Detoxification. Alcohol Alcohol 2018; 53:64-70. [PMID: 29136089 DOI: 10.1093/alcalc/agx086] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 10/12/2017] [Indexed: 12/15/2022] Open
Abstract
Aims As low rates of thiamine are thought to be implicated in alcohol-related cognitive disorders, we wanted to assess patients with alcohol use disorders (AUD) during detoxification for their nutritional status and test if vitamins blood levels were associated with a surrogate of cognitive impairment. Methods We performed a retrospective chart review of medical records of 94 consecutive patients hospitalized for alcohol detoxification in a specialized addiction medicine department. Nutritional status was assessed with Body Mass Index (BMI). Vitamins blood levels were available for 80 patients, but thiamine only for 52 patients. The Montreal Cognitive Assessment (MoCA) score was used to screen for cognitive impairment at Day 10 of entry and was available in 59 patients. A binary logistic regression was performed to identify factors associated with MoCA scores below the threshold (26 points). Results The mean BMI was 23.28 ± 3.78 kg/m2 and 8.79% of weighted patients qualified for malnutrition. The mean MoCA score was 22.75 ± 4.88 points, and 66% of tested patients were below the threshold of suspected cognitive impairment. No low blood thiamine level was found. In multivariate analysis, BMI, but not vitamins blood rates, was significantly associated with a pathological MoCA screening test. Conclusion Clinical examination is more sensitive than biomarkers to determine malnourished AUD patients who are at-risk for cognitive impairment. Malnourished patients with AUD should receive a full neuropsychological testing. Summary This retrospective chart review study screened for cognitive disorders during alcohol inpatient detoxification with the MoCA test. Body mass index, but not vitamins blood rates, was associated with a pathological MoCA. Clinical examination is more sensitive than biomarkers to determine malnourished AUD patients who are at-risk for cognitive impairment.
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Affiliation(s)
- Marie-Astrid Gautron
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, AP-HP, 200 rue du Faubourg Saint Denis, 75475 Paris Cedex 10, France.,Département de Psychiatrie et d'Addictologie, Hôpital Bichat, AP-HP, 46 rue Henri Huchard 75877 Paris Cedex 18, France
| | - Frank Questel
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, AP-HP, 200 rue du Faubourg Saint Denis, 75475 Paris Cedex 10, France
| | - Michel Lejoyeux
- Faculté de Médecine Paris Diderot, 16 rue Huchard, 75018 Paris, France.,Département de Psychiatrie et d'Addictologie, Hôpital Bichat, AP-HP, 46 rue Henri Huchard 75877 Paris Cedex 18, France
| | - Frank Bellivier
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, AP-HP, 200 rue du Faubourg Saint Denis, 75475 Paris Cedex 10, France.,Faculté de Médecine Paris Diderot, 16 rue Huchard, 75018 Paris, France.,Frank Bellivier and Florence Vorspan: 4. Inserm Umr-s 1144, 4 avenue de l'Observatoire, 75006 Paris, France
| | - Florence Vorspan
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, AP-HP, 200 rue du Faubourg Saint Denis, 75475 Paris Cedex 10, France.,Faculté de Médecine Paris Diderot, 16 rue Huchard, 75018 Paris, France.,Frank Bellivier and Florence Vorspan: 4. Inserm Umr-s 1144, 4 avenue de l'Observatoire, 75006 Paris, France
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Bruijnen CJWH, Jansen M, Dijkstra BAG, Walvoort SJW, Lugtmeijer S, Markus W, De Jong CAJ, Kessels RPC. The Montreal Cognitive Assessment (MoCA) as a cognitive screen in addiction health care: A validation study for clinical practice. JOURNAL OF SUBSTANCE USE 2018. [DOI: 10.1080/14659891.2018.1497102] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Carolien J. W. H. Bruijnen
- Center of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University Nijmegen, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - Mandy Jansen
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - Boukje A. G. Dijkstra
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University Nijmegen, Nijmegen, The Netherlands
- Novadic-Kentron, Addiction Care Center, Vught, The Netherlands
| | - Serge J. W. Walvoort
- Center of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Selma Lugtmeijer
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
- Amsterdam Brain and Cognition (ABC) Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Wiebren Markus
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University Nijmegen, Nijmegen, The Netherlands
- IrisZorg, Center for Addiction Treatment, Arnhem, The Netherlands
| | - Cor A. J. De Jong
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Roy P. C. Kessels
- Center of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
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Viswam A, Nagarajan P, Kuppili PP, Bharadwaj B. Cognitive Functions among Recently Detoxified Patients with Alcohol Dependence and Their Association with Motivational State to Quit. Indian J Psychol Med 2018; 40:310-314. [PMID: 30093740 PMCID: PMC6065129 DOI: 10.4103/ijpsym.ijpsym_72_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
CONTEXT Cognitive impairments are common among patients with alcohol dependence. It may involve frontal executive dysfunction, global cognitive impairments, or both. Motivation to quit alcohol involves recognition of alcohol use as a problem. This ability may be construed as a cognitive symptom. AIMS The aim is to study the frequency of cognitive dysfunction among patients with alcohol dependence and to study the association between cognitive dysfunction and the motivation to quit alcohol. MATERIALS AND METHODS Fifty-six adult males with alcohol dependence (International Classification of Diseases-10) who had completed a course of detoxification and who did not have active withdrawal symptoms or acute medical illnesses were recruited for this study. Their cognitive functions were tested using the Montreal Cognitive Assessment (MoCA) and Frontal Assessment Battery (FAB). Their motivation levels were assessed using the Stages of Change Readiness and Treatment Eagerness Scale. Clinical details were collected using a semi-structured pro forma. RESULTS Global cognitive impairment (MoCA < 26) was seen in 81% and frontal executive dysfunction (FAB < 12) in 16% of patients. Higher MoCA and FAB scores correlated with better education, while lower FAB scores correlated with higher age. The 14 patients (25%) with good motivation did not differ in age, education, years of dependence, or MoCA or FAB scores from poorly motivated patients. FAB scores, but not MoCA, were associated with poor motivation. All nine patients with FAB < 12 were poorly motivated to quit alcohol; likelihood score = 5.731, P = 0.017. CONCLUSIONS Four-fifths of patients with alcohol dependence had global cognitive impairments after the detoxification period. One-sixth had frontal executive dysfunction. Cognitive functions were not significantly correlated with the duration of dependence. Presence of frontal executive dysfunction was associated with almost six times likelihood that the patient will be poorly motivated to quit alcohol.
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Affiliation(s)
- Athira Viswam
- Department of Psychiatric Nursing, College of Nursing, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Padmavathi Nagarajan
- Department of Psychiatric Nursing, College of Nursing, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Pooja Patnaik Kuppili
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Balaji Bharadwaj
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Ram D, George M, Gowdappa B. Correlation of cognitive functions with emotional dysregulation in alcohol dependence: A preliminary study. Indian J Psychiatry 2018; 60:307-311. [PMID: 30405256 PMCID: PMC6201679 DOI: 10.4103/psychiatry.indianjpsychiatry_183_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
CONTEXT AND AIMS Dysfunction of cognition and emotion is known in alcohol dependence; however, their relationship in alcohol dependence is unknown. Thus, this study aimed to know the level of emotional dysregulation and cognitive functions and their correlation in patients with alcohol dependence. MATERIALS AND METHODS In this hospital-based cross-sectional study, 120 patients with alcohol dependence were consecutively recruited and assessed with sociodemographic and clinical pro forma, Montreal Cognitive Assessment (MoCA), and Difficulty in Emotional Regulation Scale-Short Form (DERS-SF). STATISTICAL ANALYSIS Descriptive statistical, Kruskal-Wallis H, and regression analysis. RESULTS Results revealed a mild level of cognitive impairment (mean MoCA score = 0 23.76) and high levels of emotional dysregulation (mean DERS-SF score = 0 26.90). On linear regression analysis (R 2 = 0.266, df = 0 1, F = 0 42.782, P =0.000), the score on MoCA had statistically significant negative association with score on DERS-SF (P = 0.001). CONCLUSIONS Cognitive impairment and emotional dysregulation are inversely related in patients with alcohol dependence. Improving the dysfunction may improve the outcome of alcohol dependence.
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Affiliation(s)
- Dushad Ram
- Department of Psychiatry, JSS Medical College and Hospital, Mysore, Karnataka, India
| | - Manju George
- Department of Psychiatry, JSS Medical College and Hospital, Mysore, Karnataka, India
| | - Basawanna Gowdappa
- Department of Medicine, JSS Medical College and Hospital, Mysore, Karnataka, India
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Pelletier S, Alarcon R, Ewert V, Forest M, Nalpas B, Perney P. Comparison of the MoCA and BEARNI tests for detection of cognitive impairment in in-patients with alcohol use disorders. Drug Alcohol Depend 2018; 187:249-253. [PMID: 29684893 DOI: 10.1016/j.drugalcdep.2018.02.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/19/2018] [Accepted: 02/25/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Screening of cognitive impairment is a major challenge in alcoholics seeking treatment, since cognitive dysfunction may impair the overall efficacy of rehabilitation programs and consequently increase relapse rate. We compared the performance of two screening tools: the MoCA (Montreal Cognitive Assessment), which is widely used in patients with neurological diseases and already used in patients with alcohol use disorder (AUD), and the BEARNI (Brief Evaluation of Alcohol-Related Neuropsychological Impairments), a recent test specifically developed for the alcoholic population. METHODS We compared the sensitivity and specificity of the MoCA and the BEARNI in a sample of AUD patients with and without cognitive impairment assessed by a battery of neuropsychological tests. RESULTS Ninety patients were included. There were 67 men and 23 women aged 48.9 ± 9.6 years. According to the neuropsychological tests, 51.1% of patients had no cognitive impairment, while it was mild or moderate to severe in 31.1 and 17.8%, respectively. The BEARNI sensitivity was extremely high (1.0), since all patients with cognitive impairment were identified, but its specificity was very low (0.04). The MoCA had a lower sensitivity (0.79) than the BEARNI, but its specificity was significantly better (0.65). A detailed analysis of the BEARNI scores showed a discrepancy between the qualitative and quantitative interpretation of the test which could, at least in part, explain its low specificity. CONCLUSION Both the MoCA and the BEARNI are screening tools which identified alcoholic patients with cognitive impairment. However, in routine use, the MoCA appeared to be more appropriate given the low specificity of the BEARNI.
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Affiliation(s)
- Stéphanie Pelletier
- Service Addictologie, Hôpital du Grau du Roi, CHU Caremeau, Place du Pr R. Debré, 30029 Nîmes, France; Inserm U1018, Hôpital Paul Brousse, 16 avenue Paul Vaillant-Couturier, 94807 Villejuif, France.
| | - Régis Alarcon
- Service Addictologie, Hôpital du Grau du Roi, CHU Caremeau, Place du Pr R. Debré, 30029 Nîmes, France.
| | - Valérie Ewert
- Service Addictologie, Hôpital du Grau du Roi, CHU Caremeau, Place du Pr R. Debré, 30029 Nîmes, France.
| | - Margot Forest
- Service Addictologie, Hôpital du Grau du Roi, CHU Caremeau, Place du Pr R. Debré, 30029 Nîmes, France.
| | - Bertrand Nalpas
- Service Addictologie, Hôpital du Grau du Roi, CHU Caremeau, Place du Pr R. Debré, 30029 Nîmes, France; Département d'Information Scientifique et de Communication, Inserm, 101 rue de Tolbiac, 75013 Paris, France.
| | - Pascal Perney
- Service Addictologie, Hôpital du Grau du Roi, CHU Caremeau, Place du Pr R. Debré, 30029 Nîmes, France; Département d'Information Scientifique et de Communication, Inserm, 101 rue de Tolbiac, 75013 Paris, France.
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Andrianopoulos V, Vogiatzis I, Gloeckl R, Bals R, Koczulla RA, Kenn K. Cerebral oxygen availability during exercise in COPD patients with cognitive impairment. Respir Physiol Neurobiol 2018; 254:64-72. [PMID: 29729396 DOI: 10.1016/j.resp.2018.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/30/2018] [Accepted: 05/01/2018] [Indexed: 02/07/2023]
Abstract
Insufficient cerebral blood flow regulation to meet increasing metabolic demand during physical exertion could be associated with cognitive impairment. We compared cerebral oxygen availability during exercise in cognitively impaired (CI) to cognitively normal (CN) COPD patients. Fifty-two patients (FEV1: 51 ± 16%) were classified as CN or CI according to the Montreal Cognitive Assessment. Patients performed cycle-ergometry at 75% peak capacity with continuous measurement of Near-Infrared Spectroscopy frontal-cortex Tissue oxygen Saturation Index (TSI), cerebral haemoglobin indices (oxy/deoxy/total- Hb), transcutaneous carbon-dioxide partial pressure (TcPCO2), and arterial oxygen saturation (SpO2). Twenty-one patients (40%) presented evidences of CI. During exercise, CN and CI patients exhibited mild to moderate SpO2decline (nadir[Δ]≥ -3 ± 2% and -5 ± 3%, respectively) but preserved baseline frontal-cortex TSI levels, whilst presenting small TcPCO2 perturbations and increased cerebral total-Hb (post [Δ]≥ 2.0 ± 3 μM sec-1). CI patients preserve the capacity to adequately maintain cerebral oxygen availability during submaximal exercise. Therefore, rehabilitative exercise training in CI patients with COPD exhibiting mild to moderate exercise-induced SpO2 decline does not appear to lead to reduced cerebral oxygen availability.
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Affiliation(s)
- Vasileios Andrianopoulos
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany.
| | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University Newcastle, United Kingdom; Faculty of Physical Education and Sports Sciences, National and Kapodistrian University of Athens, Greece.
| | - Rainer Gloeckl
- Department of Respiratory Medicine & Exercise Therapy, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany; Department for Prevention and Sports Medicine, Klinikum Rechts der Isar, Technical University Munich (TUM), Munich, Germany.
| | - Robert Bals
- Department of Internal Medicine V - Pulmonology, Allergology and Critical Care Medicine, Saarland University, Homburg, Germany.
| | - Rembert A Koczulla
- Department of Respiratory Medicine & Exercise Therapy, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany; Department of Pulmonary Rehabilitation, Philipps University Marburg, Marburg, Germany; German Center of Lung Research (DZL), Giessen-Marburg, Germany.
| | - Klaus Kenn
- Department of Respiratory Medicine & Exercise Therapy, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany; Department of Pulmonary Rehabilitation, Philipps University Marburg, Marburg, Germany; German Center of Lung Research (DZL), Giessen-Marburg, Germany.
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van Duijvenbode N, Didden R, VanDerNagel JE, Korzilius HP, Engels RC. Cognitive deficits in problematic drinkers with and without mild to borderline intellectual disability. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2018; 22:5-17. [PMID: 27555557 DOI: 10.1177/1744629516664840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We examined cognitive deficits in problematic drinkers with and without mild to borderline intellectual disability (MBID). Problematic drinkers were expected to show a significantly lower estimated performance IQ (PIQ), but not a lower estimated verbal IQ (VIQ), compared to light drinkers. Participants ( N = 474) were divided into four groups based on IQ and severity of alcohol use-related problems. IQ was estimated using (a short form of) the Wechsler Adult Intelligence Scale third edition. Severity of alcohol use-related problems was assessed using the Alcohol Use Disorder Identification Test. Overall, there were no significant differences between light and problematic drinkers on estimated VIQ. Within the group without MBID, estimated PIQ was significantly lower. Estimated PIQ was not lower in problematic drinkers with MBID compared to light drinkers with MBID. The results are indicative of cognitive deficits in problematic drinkers without MBID. Screening for cognitive deficits with additional instruments is advised.
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Affiliation(s)
| | - Robert Didden
- Radboud University, the Netherlands; Trajectum, the Netherlands
| | - Joanne El VanDerNagel
- Aveleijn, the Netherlands; Radboud University, the Netherlands; Tactus, the Netherlands
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Abstract
Chronic use of mind altering substances can lead to a wide variety of neuropsychological deficits, affecting the domains of attention, learning, memory, reasoning. Executive functions such as working memory, cognitive flexibility and inhibitory control may specifically be impaired. These deficits can impact engagement in effective psychosocial interventions. Mild to moderate cognitive dysfunction may not be picked up in routine clinical examination or through commonly used tests like the mini-mental state examination (MMSE). Detailed neuropsychological tests, although extremely valuable, are time and human-resource intensive and are not readily available to the clinician. This study attempted to devise a brief cognitive screen (BCS- AUD) for alcohol use disorders. Ninety subjects who fulfilled ICD-10 criteria for alcohol use disorders were assessed on the MMSE and selective tests from the NIMHANS neuropsychological battery. While 79 (87.78%) of patients had adequate scores on the MMSE (>25), cognitive deficits were noted with relatively high frequency on finger tapping (92.22-93.33%), auditory verbal learning test delayed recall AVLTDR (37-63%) and Tower of London 5 move subtest (42%). Statistically significant associations were found between MMSE and Digit symbol total time (0.05), Finger tapping right hand (0.01), Tower of London total number of problems solved with minimum moves (TNPSMM) (0.05), Verbal working memory two back hits (VM2BKHIT) (0.01), AVLTDR (0.01), and complex figure test-copy (0.01). Principal component analysis helped to identify three tests that merited inclusion in the BCS-AUD, namely Finger Tapping Test, Verbal Working Memory N Back Test and Auditory Verbal Test (AVLT). The utility of the BCS-AUD in identifying cognitive dysfunction in other substance use disorders needs to be examined. Patients rating positive on the cognitive screener would require in-depth evaluation, monitoring and remediation.
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Affiliation(s)
- Arun Gupta
- Flinders Medical Centre, Bedford Park SA 5042, Australia
| | | | - Shobini Rao
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
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73
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Braatveit KJ, Torsheim T, Hove O. Intellectual Functioning in In-Patients with Substance Use Disorders: Preliminary Results from a Clinical Mediation Study of Factors Contributing to IQ Variance. Eur Addict Res 2018; 24:19-27. [PMID: 29393174 DOI: 10.1159/000486620] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 12/29/2017] [Indexed: 11/19/2022]
Abstract
AIMS To investigate the direct effect of different childhood difficulties on adult intelligence coefficient (IQ) and their possible indirect effect through the mediating pathways of education and severity substance use. PARTICIPANTS Ninety in-patients aged 19-64. The participants had abstained from substance use for at least 6 weeks and had different substance use profiles. MEASUREMENTS Substance use disorder (SUD) and psychiatric illnesses were diagnosed according to the International Classification of Diseases 10th edition criteria. IQ was measured with the Wechsler Adult Intelligence Scale, 4th edition. Childhood difficulties, severity of substance use and level of education were assessed through a self-report questionnaire. FINDINGS Mean full scale IQ for the studied population was 87.3. Learning and attention deficit/hyperactivity difficulties in childhood were directly related to adult IQ. Education had a mediating effect between childhood learning difficulties/conduct problems and the verbal comprehension index. There was no significant difference in IQ due to the specific substance used or severity of substance use. CONCLUSION IQ variance in in-treatment individuals with SUD was related to childhood functioning alone or through the mediator of education. Substance-related factors did not contribute to IQ variance. The results fit a normal theory of IQ development with commonly known risk factors and no disturbing effect of substance use.
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Affiliation(s)
| | - Torbjørn Torsheim
- Department of Psychosocial Science, University of Bergen, Faculty of Psychology, Bergen, Norway
| | - Oddbjørn Hove
- Department of Research and Innovation, Helse Fonna HF, Haugesund, Norway
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74
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Siu AMH, Ko FSL, Mak SK. Outcome Evaluation of a Short-Term Hospitalization and Community Support Program for People Who Abuse Ketamine. Front Psychiatry 2018; 9:313. [PMID: 30065669 PMCID: PMC6057144 DOI: 10.3389/fpsyt.2018.00313] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/25/2018] [Indexed: 11/22/2022] Open
Abstract
Ketamine is a popular recreational drug among young people in Hong Kong. Long-term abuse of ketamine can lead to acute urological and medical issues, which often require immediate care at emergency rooms. Many patients require short-term hospitalization for medical management. This opens a brief time window, within which mental health professionals could engage young people who abuses ketamine in psychosocial, functional, and lifestyle interventions. The Crisis Accommodation Program (CAP) is a short-term hospitalization and community support program that addresses the health care needs of young people who abuse ketamine. During short-term hospitalization, the patient participates in a range of cognitive and psychosocial assessments, motivational interviewing, emotions management, and lifestyle re-design interventions. Upon discharge, social work professionals of non-government agencies continue to work with the patients on their action plans in the community. This evaluation study uses a quasi-experimental non-equivalent group design, in which the outcomes of the treatment group (n = 84) are compared with a comparison group (n = 34) who have a history of ketamine abuse but who have not joined the treatment program. The results confirm that the treatment group showed significant increases in motivation for treatment, reduction in drug use, improvement in cognitive screening tests, healthy lifestyle scores, and self-efficacy in avoidance of drugs over 13 weeks. When compared with the comparison group, the treatment group had significant decreases in anxiety and treatment needs and had moved from pre-contemplation to the contemplation or preparation stage. However, there were no significant changes in outcome measures covering lifestyle or self-efficacy in drug avoidance. Overall, the CAP is effective in reducing drug use, anxiety, and helping patients to move from pre-contemplation to the contemplation or preparation stage of change. The study results suggest that health care professionals can successfully engage young people who abuse ketamine to participate in a package of psychosocial interventions, motivational interviewing, and lifestyle re-design during their hospital stay for management of urological problems. The CAP also highlights the importance of collaboration between hospitals and community social services in the management of addiction.
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Affiliation(s)
- Andrew M H Siu
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Flora S L Ko
- North District Hospital, Hospital Authority of Hong Kong, Hong Kong, Hong Kong
| | - S K Mak
- North District Hospital, Hospital Authority of Hong Kong, Hong Kong, Hong Kong
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75
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Ewert V, Pelletier S, Alarcon R, Nalpas B, Donnadieu-Rigole H, Trouillet R, Perney P. Determination of MoCA Cutoff Score in Patients with Alcohol Use Disorders. Alcohol Clin Exp Res 2017; 42:403-412. [DOI: 10.1111/acer.13547] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 11/01/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Valérie Ewert
- Service Addictologie; Hôpital du Grau du Roi; CHU Caremeau; Nîmes France
| | - Stéphanie Pelletier
- Service Addictologie; Hôpital du Grau du Roi; CHU Caremeau; Nîmes France
- Inserm U1018; Paris France
| | - Régis Alarcon
- Service Addictologie; Hôpital du Grau du Roi; CHU Caremeau; Nîmes France
| | - Bertrand Nalpas
- Service Addictologie; Hôpital du Grau du Roi; CHU Caremeau; Nîmes France
- Département d'Information Scientifique et de Communication (DISC); Inserm; Paris France
| | - Hélène Donnadieu-Rigole
- Service Addictologie; Hôpital Saint-Eloi; CHU Montpellier; Montpellier France
- Inserm, U1183, IRMB; Hôpital Saint-Eloi; CHU Montpellier; Montpellier France
| | | | - Pascal Perney
- Service Addictologie; Hôpital du Grau du Roi; CHU Caremeau; Nîmes France
- Inserm U1018; Paris France
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76
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Wu C, Dagg P, Molgat C. Measuring stability of cognitive impairment in inpatients with schizophrenia with alternate forms of the Montreal Cognitive Assessment during acute hospitalization. Psychiatry Res 2017; 258:299-304. [PMID: 28886902 DOI: 10.1016/j.psychres.2017.08.065] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 07/12/2017] [Accepted: 08/23/2017] [Indexed: 10/19/2022]
Abstract
Cognitive impairment is a core feature of schizophrenia. Measuring the stability of cognitive impairment is important for further understanding of this disorder. The Montreal Cognitive Assessment (MoCA) has been demonstrated to be a brief and effective screening tool in detecting cognitive impairment in patients with schizophrenia. It has alternative versions designed for longitudinal settings. The current study retrospectively analyzed the total and subscores of two versions of the MoCA, administered to a group of inpatients with severe schizophrenia at admission and discharge, to measure their cognitive stability during hospitalization. The results revealed that the test-retest reliability coefficient of the MoCA had good reliability, suggesting the two alternative versions of the MoCA are reliable measurements for assessing cognitive impairment repeatedly in patients with schizophrenia. The paired-samples t-test showed that the overall cognitive impairment of patients measured by two forms of the MoCA remained stable during acute hospital stay and across symptom changes. Furthermore, the results showed that patients' cognitive stability was not related to their symptom/illness severity improvement, age, education, or length of stay.
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Affiliation(s)
- Caili Wu
- Hillside Psychiatric Centre, Interior Health, Kamloops, BC, Canada V2C 2T1.
| | - Paul Dagg
- Hillside Psychiatric Centre, Interior Health, Kamloops, BC, Canada V2C 2T1; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada V6T 1Z4
| | - Carmen Molgat
- Hillside Psychiatric Centre, Interior Health, Kamloops, BC, Canada V2C 2T1; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada V6T 1Z4
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77
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Mahoney JJ, Kalechstein AD, Newton TF, De La Garza R. The limited impact that cocaine use patterns have on neurocognitive functioning in individuals with cocaine use disorder. J Psychopharmacol 2017; 31:989-995. [PMID: 28695777 DOI: 10.1177/0269881117715606] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
It is well-documented in the literature that cocaine use is associated with neurocognitive impairment. The manner in which patterns of cocaine use, such as years of use, recent use over the past month, and daily amount of cocaine use, moderate neurocognition has been studied in a relatively piecemeal manner. Hence, the purpose of the study was to evaluate whether cocaine use patterns modulate neurocognition in individuals with cocaine use disorder. Cocaine users who were cocaine-negative ( n=125) were divided into tertiles based on cocaine use patterns and the performances of the highest and lowest groups were compared on the following cognitive measures: Continuous Performance Task-II, n-back, and Hopkins Verbal Learning Task-Revised. Participants with cocaine use disorder who used for more years (25.2±0.6 versus 10.1±0.6 years; mean±standard error of the mean) and who had more recent cocaine use over the past month (26.3±0.5 versus 6.0±0.6 days) did not differ significantly on any of the neurocognitive variables when compared to those with use patterns of shorter duration and less frequency (all p's >0.05). Lastly, participants reporting the greatest amount daily cocaine use (1.8±0.0 g) demonstrated better performance on an auditory working memory task when compared to those with the lowest daily use (0.7±0.0 g; p=0.04). While one might expect that individuals who used greater amounts of cocaine over longer periods of time would demonstrate relatively poorer performance on measures of neurocognition, particularly in the initial phase of abstinence, our findings did not confirm this. While speculative, a potential explanation for these findings is that after an individual uses cocaine for a certain number of years, or uses a specific amount over time, then the deleterious effects of cocaine on neurocognition stabilizes, and increased duration of cocaine use does not further exacerbate those impairments.
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Affiliation(s)
- James J Mahoney
- 1 Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, USA
| | - Ari D Kalechstein
- 2 Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, USA
| | - Thomas F Newton
- 2 Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, USA
| | - Richard De La Garza
- 2 Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, USA
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78
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Ridley N, Batchelor J, Draper B, Demirkol A, Lintzeris N, Withall A. Cognitive screening in substance users: Diagnostic accuracies of the Mini-Mental State Examination, Addenbrooke's Cognitive Examination-Revised, and Montreal Cognitive Assessment. J Clin Exp Neuropsychol 2017; 40:107-122. [PMID: 28436744 DOI: 10.1080/13803395.2017.1316970] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Despite the considerable prevalence of cognitive impairment in substance-using populations, there has been little investigation of the utility of cognitive screening measures within this context. In the present study the accuracy of three cognitive screening measures in this population was examined-the Mini-Mental State Examination (MMSE), the Addenbrooke's Cognitive Examination-Revised (ACE-R), and the Montreal Cognitive Assessment (MoCA). METHOD A sample of 30 treatment-seeking substance users and 20 healthy individuals living in the community were administered the screening measures and a neuropsychological battery (NPB). Agreement of classification of cognitive impairment by the screening measures and NPB was examined. RESULTS Results indicated that the ACE-R and MoCA had good discriminative ability in detection of cognitive impairment, with areas under the receiver-operating characteristic (ROC) curve of .85 (95% confidence interval, CI [.75. .94] and .84 (95% CI [.71, .93]) respectively. The MMSE had fair discriminative ability (.78, 95% CI [.65, .93]). The optimal cut-score for the ACE-R was 93 (impairment = score of 92 or less), at which it correctly classified 89% of individuals as cognitively impaired or intact, while the optimal cut-score for the MoCA was <26 or <27 depending on preference for either specificity or sensitivity. The optimal cut-score for the MMSE was <29; however, this had low sensitivity despite good specificity. CONCLUSIONS These findings suggest that the MoCA and ACE-R are both valid and time-efficient screening tools to detect cognitive impairment in the context of substance use.
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Affiliation(s)
- Nicole Ridley
- a Drug and Alcohol Services , South Eastern Sydney Local Health District , Sydney , NSW , Australia
| | - Jennifer Batchelor
- b Department of Psychology , Macquarie University , North Ryde , NSW , Australia
| | - Brian Draper
- c School of Psychiatry, Faculty of Medicine , UNSW Australia , NSW , Sydney , Australia.,d Academic Department for Old Age Psychiatry , Prince of Wales Hospital , Randwick , NSW , Australia
| | - Apo Demirkol
- a Drug and Alcohol Services , South Eastern Sydney Local Health District , Sydney , NSW , Australia.,e School of Public Health & Community Medicine, Faculty of Medicine , UNSW Australia , Sydney , NSW , Australia
| | - Nicholas Lintzeris
- a Drug and Alcohol Services , South Eastern Sydney Local Health District , Sydney , NSW , Australia.,f Discipline of Addiction Medicine, Central Clinical School , Sydney Medical School, The University of Sydney , Sydney , NSW , Australia
| | - Adrienne Withall
- e School of Public Health & Community Medicine, Faculty of Medicine , UNSW Australia , Sydney , NSW , Australia
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79
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García AM, Bocanegra Y, Herrera E, Pino M, Muñoz E, Sedeño L, Ibáñez A. Action-semantic and syntactic deficits in subjects at risk for Huntington's disease. J Neuropsychol 2017; 12:389-408. [PMID: 28296213 DOI: 10.1111/jnp.12120] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/23/2017] [Indexed: 12/21/2022]
Abstract
Frontostriatal networks play critical roles in grounding action semantics and syntactic skills. Indeed, their atrophy distinctively disrupts both domains, as observed in patients with Huntington's disease (HD) and Parkinson's disease, even during early disease stages. However, frontostriatal degeneration in these conditions may begin up to 15 years before the onset of clinical symptoms, opening avenues for pre-clinical detection via sensitive tasks. Such a mission is particularly critical in HD, given that patients' children have 50% chances of inheriting the disease. Against this background, we assessed whether deficits in the above-mentioned domains emerge in subjects at risk to develop HD. We administered tasks tapping action semantics, object semantics, and two forms of syntactic processing to 18 patients with HD, 19 asymptomatic first-degree relatives, and sociodemographically matched controls for each group. The patients evinced significant deficits in all tasks, but only those in the two target domains were independent of overall cognitive state. More crucially, relative to controls, the asymptomatic relatives were selectively impaired in action semantics and in the more complex syntactic task, with both patterns emerging irrespective of the subjects' overall cognitive state. Our findings highlight the relevance of these dysfunctions as potential prodromal biomarkers of HD. Moreover, they offer theoretical insights into the differential contributions of frontostriatal hubs to both domains while paving the way for innovations in diagnostic procedures.
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Affiliation(s)
- Adolfo M García
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.,Faculty of Education, National University of Cuyo (UNCuyo), Mendoza, Argentina
| | - Yamile Bocanegra
- Neuroscience Group, Faculty of Medicine, University of Antioquia (UDEA), Medellín, Colombia.,Group of Neuropsychology and Conduct (GRUNECO), Faculty of Medicine, University of Antioquia (UDEA), Medellín, Colombia
| | - Eduar Herrera
- Psychological Studies Department, Icesi University, Cali, Colombia
| | - Mariana Pino
- Autonomous University of the Caribbean, Barranquilla, Colombia
| | - Edinson Muñoz
- Departamento de Lingüística y Literatura, Facultad de Humanidades, Universidad de Santiago de Chile, Chile
| | - Lucas Sedeño
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Agustín Ibáñez
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.,Autonomous University of the Caribbean, Barranquilla, Colombia.,Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibáñez, Santiago de Chile, Chile.,Centre of Excellence in Cognition and its Disorders, Australian Research Council (ACR), Sydney, New South Wales, Australia
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80
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Wang TY, Fan TT, Bao YP, Li XD, Liang CM, Wang RJ, Ma J, Han Y, Meng SQ, Wu P, Shi J, Lu L. Pattern and related factors of cognitive impairment among chronic methamphetamine users. Am J Addict 2017; 26:145-151. [PMID: 28177556 DOI: 10.1111/ajad.12505] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 01/15/2017] [Accepted: 01/21/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Methamphetamine (MA) use is increasingly prevalent in East and Southeast Asia and commonly associated with cognitive impairment. The present study estimated the characteristics of cognitive impairment and explored the associated potential factors among chronic MA users. METHODS The data were from the baseline visit of a longitudinal study among synthetic drug users. The baseline survey was conducted in detoxification and rehabilitation centers in Guangdong province, China, from September to December in 2013. A total of 528 participants were included in our analysis. Cognitive impairment was measured by the Montreal Cognitive Assessment (MoCA). Logistic regression was performed to explore the risk factors associated with cognitive impairment. RESULTS Approximately 69.89% of the study participants exhibited cognitive impairment according to MoCA scores. Multiple logistic regression analyses indicated that older age (≥30 years old), a longer duration of MA use (>24 months), and a higher frequency of MA use (everyday) were associated with cognitive impairment, with adjusted odds ratios (ORs) of 1.58 (95% confidence interval [CI]: 1.07-2.34), 1.53 (95%CI: 1.01-2.31), and 1.55 (95%CI: 1.05-2.30), respectively. Methamphetamine users that had a higher level of education had a lower risk of cognitive impairment(OR = .59; 95%CI: .38-.93). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Cognitive impairment occurred frequently among chronic MA users. The causal relationship between cognitive impairment and MA use needs to be ascertained in longitudinal studies in future work. Our study provides evidence for the development of intervention strategies for the prevention of MA use and associated cognitive impairment. (Am J Addict 2017;26:145-151).
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Affiliation(s)
- Tong-Yu Wang
- Institute of Mental Health, National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health and Peking University Sixth Hospital, Peking University, Beijing, 100191, China.,National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, 100191, China.,School of Public Health, Peking University, Beijing, 100191, China
| | - Teng-Teng Fan
- Institute of Mental Health, National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health and Peking University Sixth Hospital, Peking University, Beijing, 100191, China
| | - Yan-Ping Bao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, 100191, China
| | - Xiao-Dong Li
- Zhuhai Jinding Vocabulary Rehabilitation Hospital, Zhuhai, Guangdong, 519085, China
| | - Chun-Mei Liang
- Zhuhai Jinding Vocabulary Rehabilitation Hospital, Zhuhai, Guangdong, 519085, China
| | - Ru-Jia Wang
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, 100191, China.,School of Public Health, Peking University, Beijing, 100191, China
| | - Jun Ma
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, 100191, China.,School of Public Health, Peking University, Beijing, 100191, China
| | - Ying Han
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, 100191, China
| | - Shi-Qiu Meng
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, 100191, China
| | - Ping Wu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, 100191, China
| | - Jie Shi
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, 100191, China
| | - Lin Lu
- Institute of Mental Health, National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health and Peking University Sixth Hospital, Peking University, Beijing, 100191, China.,National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, 100191, China.,Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, 100191, China
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81
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Fazeli PL, Casaletto KB, Paolillo E, Moore RC, Moore DJ, the HNRP Group. Screening for neurocognitive impairment in HIV-positive adults aged 50 years and older: Montreal Cognitive Assessment relates to self-reported and clinician-rated everyday functioning. J Clin Exp Neuropsychol 2017; 39:842-853. [DOI: 10.1080/13803395.2016.1273319] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- P. L. Fazeli
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - K. B. Casaletto
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - E. Paolillo
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - R. C. Moore
- Department of Psychiatry, University of California, San Diego, CA, USA
- Stein Institute for Research on Aging, University of California, San Diego, CA, USA
- Veterans Administration San Diego Health Care System, San Diego, CA, USA
| | - D. J. Moore
- Department of Psychiatry, University of California, San Diego, CA, USA
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Hayes V, Demirkol A, Ridley N, Withall A, Draper B. Alcohol-related cognitive impairment: current trends and future perspectives. Neurodegener Dis Manag 2016; 6:509-523. [DOI: 10.2217/nmt-2016-0030] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Excessive alcohol use is associated with a wide range of physical, psychological and social consequences, and is responsible for a significant proportion of the burden of disease globally. An area which has received increasing interest is alcohol-related brain damage, not just because of the cost to the individual and society through resource utilization, but also because of the potential for prevention and reversibility. This paper aims to review the current literature on this subject and seeks to explore issues around diagnosis and treatment of alcohol-related brain damage.
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Affiliation(s)
- Victoria Hayes
- Drug & Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia
- School of Public Health & Community Medicine, Faculty of Medicine, UNSW, Sydney, Australia
| | - Apo Demirkol
- Drug & Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia
- School of Public Health & Community Medicine, Faculty of Medicine, UNSW, Sydney, Australia
| | - Nicole Ridley
- Drug & Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia
| | - Adrienne Withall
- School of Public Health & Community Medicine, Faculty of Medicine, UNSW, Sydney, Australia
| | - Brian Draper
- School of Psychiatry, UNSW, Sydney, Australia
- Academic Department of Old Age Psychiatry, Prince of Wales Hospital, Randwick, Australia
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83
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Walvoort SJW, van der Heijden PT, Wester AJ, Kessels RPC, Egger JIM. Self-awareness of cognitive dysfunction: Self-reported complaints and cognitive performance in patients with alcohol-induced mild or major neurocognitive disorder. Psychiatry Res 2016; 245:291-296. [PMID: 27567191 DOI: 10.1016/j.psychres.2016.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 07/27/2016] [Accepted: 08/03/2016] [Indexed: 12/19/2022]
Abstract
Patients with Korsakoff's syndrome (KS) typically have difficulties in recognizing the impact of their alcohol-related cognitive deficits on daily-life functioning. In this study, mean scores on self-reported complaints (measured with Minnesota Multiphasic Personality Inventory-2-Restructured Form; MMPI-2-RF) and cognitive performance (measured with the Wechsler Adult Intelligence Scale-Third edition; WAIS-III; and the California Verbal Learning Test; CVLT) are compared between two matched patient groups with severe (KS) and mild alcohol-related cognitive disorders or non KS (NKS). KS patients demonstrate significantly lower scores on the WAIS-III indices and on the CVLT than the matched NKS group, and significantly higher scores on MMPI-2-RF validity scales that indicate denial of psychological complaints. Both groups are in the normal range on MMPI-2-RF Cognitive Complaints (COG) and Neurological Complaints (NUC) scales compared with the normative sample. Finally, self-reported complaints and cognitive performance are not correlated significantly in both groups. Despite their alcohol-related cognitive impairments, both groups report no cognitive complaints at all indicating self-awareness impairment. In addition to KS patients, also NKS patients are at risk that their apparently "without cognitive complaints" appearance on self-report questionnaires can be easily overlooked. These findings may have important clinical implications for diagnostic and treatment purposes.
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Affiliation(s)
- Serge J W Walvoort
- Centre of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands; Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.
| | - Paul T van der Heijden
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands; Reinier van Arkel Mental Health Institute, 's-Hertogenbosch, The Netherlands
| | - Arie J Wester
- Centre of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands
| | - Roy P C Kessels
- Centre of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands; Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jos I M Egger
- Centre of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands; Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands; Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands
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Kiluk BD, Buck MB, Devore KA, Babuscio TA, Nich C, Carroll KM. Performance-Based Contingency Management in Cognitive Remediation Training: A Pilot Study. J Subst Abuse Treat 2016; 72:80-88. [PMID: 27590364 DOI: 10.1016/j.jsat.2016.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 07/12/2016] [Accepted: 08/04/2016] [Indexed: 01/13/2023]
Abstract
Impairments in attention, working memory, and executive function are common among substance users and may adversely affect SUD treatment outcomes. The ability of cognitive remediation (CR) interventions to improve these deficits is hindered in part because levels of engagement in CR training may be inadequate to achieve benefit. This pilot study aimed to increase CR engagement and improve outcome by implementing contingency management (CM) procedures that reinforce performance improvements on CR tasks. Participants were forty individuals (50% male; 65% African American) in an outpatient substance use treatment facility with mild cognitive impairment who had ≥30-days of abstinence from alcohol and drugs. They were randomized to standard (CR-S; n=21) or CM-enhanced (CR-CM; n=19) cognitive remediation training. CR consisted of 1-hour sessions, three times per week for four weeks (12 sessions). A neuropsychological assessment battery was administered prior to and after the four-week intervention. Both groups had high rates of CR session attendance (mean CR-S=11.7, CR-CM=10.9 sessions). Performance on 8 of the 9 CR tasks significantly improved over time for both conditions, with the CR-CM condition demonstrating greater improvement on a CR Sequenced Recall task [F(1,37)=5.81, p<.05]. Significant improvement was also evident on 4 of 9 neuropsychological assessment measures, with the CR-CM condition showing differential improvement on the Trail Making Test - Part B [F (1,37)=5.34, p<.05]. These findings support the feasibility of using CM procedures to enhance substance users' engagement with CR training and suggest the potential value of more research in this area.
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Affiliation(s)
- Brian D Kiluk
- Yale University School of Medicine, One Long Wharf Drive, New Haven, CT 06511, USA.
| | - Matthew B Buck
- Yale University School of Medicine, One Long Wharf Drive, New Haven, CT 06511, USA
| | - Kathleen A Devore
- Yale University School of Medicine, One Long Wharf Drive, New Haven, CT 06511, USA
| | - Theresa A Babuscio
- Yale University School of Medicine, One Long Wharf Drive, New Haven, CT 06511, USA
| | - Charla Nich
- Yale University School of Medicine, One Long Wharf Drive, New Haven, CT 06511, USA
| | - Kathleen M Carroll
- Yale University School of Medicine, One Long Wharf Drive, New Haven, CT 06511, USA
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85
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Assessment of Executive Function in Patients With Substance Use Disorder: A Comparison of Inventory- and Performance-Based Assessment. J Subst Abuse Treat 2016; 66:1-8. [DOI: 10.1016/j.jsat.2016.02.010] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 02/15/2016] [Accepted: 02/28/2016] [Indexed: 11/23/2022]
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86
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Marceau EM, Lunn J, Berry J, Kelly PJ, Solowij N. The Montreal Cognitive Assessment (MoCA) is Sensitive to Head Injury and Cognitive Impairment in a Residential Alcohol and Other Drug Therapeutic Community. J Subst Abuse Treat 2016; 66:30-6. [DOI: 10.1016/j.jsat.2016.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 02/22/2016] [Accepted: 03/18/2016] [Indexed: 10/22/2022]
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87
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Sachdeva A, Chandra M, Choudhary M, Dayal P, Anand KS. Alcohol-Related Dementia and Neurocognitive Impairment: A Review Study. INTERNATIONAL JOURNAL OF HIGH RISK BEHAVIORS & ADDICTION 2016; 5:e27976. [PMID: 27818965 PMCID: PMC5086415 DOI: 10.5812/ijhrba.27976] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 06/01/2015] [Accepted: 07/05/2015] [Indexed: 12/02/2022]
Abstract
Context Alcohol consumption has escalated rapidly in many countries over the past decade. Evidence suggests a correlation between alcohol use and cognitive decline. We have systematically reviewed the concept and controversies, epidemiology, nosology, neuropathology and neurobiology, neuropsychology and management updates of alcohol-related dementia (ARD) in this paper. Evidence Acquisition We retrieved papers for this review by searching the PubMed database for terms “alcohol and dementia”, “alcohol and cognitive impairment”, and “alcohol and wernicke-korsakoff” mentioned in the title of the published papers. A total of 131 studies showed up. Appropriate studies were shortlisted and included (n = 72). Cross-references if relevant were considered from the selected studies. Eligible articles were fully read by the authors and the results were compiled. Results The prolonged and excessive use of alcohol may lead to structural and functional brain damage, leading to ARD. The cognitive deficits are most frequently observed in domains of visuospatial functions, memory and executive tasks, with a potential of partial recovery if abstinence is maintained. However, there are doubts regarding the etiopathogenesis, nosological status, prevalence and diagnostic criteria for ARD, due to difficulty in assessment and various confounding factors. Conclusions With growing cohort of young and middle-aged people, there is a probable risk of upsurge of ARD. Presently, there are dilemmas over the diagnosis of independent ARD. Thus, there is a need to develop evidence-based guidelines for diagnosis and management of ARD through further systematic studies.
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Affiliation(s)
- Ankur Sachdeva
- Department of Psychiatry, ESIC Medical College and Hospital, Maharishi Dayanand University, Haryana, India
- Corresponding author: Ankur Sachdeva, Department of Psychiatry, ESIC Medical College and Hospital, Maharishi Dayanand University, Haryana, India. Tel: +91-1126593236; +91-9899528355, Fax: +91-1292413032, E-mail:
| | - Mina Chandra
- Department of Psychiatry and Drug De-addiction, Post Graduate Institute of Medical Education and Research (PGIMER), Dr Ram Manohar Lohia Hospital, Guru Gobind Singh Indraprastha University, New Delhi, India
| | - Mona Choudhary
- Department of Psychiatry and Drug De-addiction, Post Graduate Institute of Medical Education and Research (PGIMER), Dr Ram Manohar Lohia Hospital, Guru Gobind Singh Indraprastha University, New Delhi, India
| | - Prabhoo Dayal
- National Drug Dependence Treatment Centre (WHO Collaborating Centre), All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Kuljeet Singh Anand
- Department of Neurology, Post Graduate Institute of Medical Education and Research (PGIMER), Dr Ram Manohar Lohia Hospital, Guru Gobind Singh Indraprastha University, New Delhi, India
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88
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Cabé N, Laniepce A, Ritz L, Lannuzel C, Boudehent C, Vabret F, Eustache F, Beaunieux H, Pitel AL. Troubles cognitifs dans l’alcoolodépendance : intérêt du dépistage dans l’optimisation des prises en charge. Encephale 2016; 42:74-81. [DOI: 10.1016/j.encep.2015.12.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 12/08/2015] [Indexed: 02/08/2023]
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89
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Coen RF, Robertson DA, Kenny RA, King-Kallimanis BL. Strengths and Limitations of the MoCA for Assessing Cognitive Functioning: Findings From a Large Representative Sample of Irish Older Adults. J Geriatr Psychiatry Neurol 2016; 29:18-24. [PMID: 26251108 DOI: 10.1177/0891988715598236] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 05/19/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Montreal Cognitive Assessment (MoCA) is a very widely used test for mild cognitive impairment. Differing recommendations have been made regarding its utility in providing a profile of performance across several cognitive domains. OBJECTIVES To examine the factor structure of the MoCA in a nationally representative population study of older Irish adults and evaluate its utility in providing domain-specific information. METHODS A cross-sectional analysis of wave 1 data from the Irish Longitudinal Study on Ageing was undertaken. Data from a subset of 2342 participants assessed using the MoCA were analyzed using both confirmatory factor analytic (CFA) and exploratory factor analytic (EFA) methods. RESULTS Mean age was 72.64 (range 65 to 98), 53% female. The CFA provided evidence of adequate overall model fit for a previously proposed 6-factor model. In contrast, EFA yielded a 3-factor solution and test items cross-loaded onto a number of factors with no clear pattern of underlying cognitive domains. Using EFA to explore the 6-factor model yielded good fit, but again test items cross-loaded onto a number of factors with no clear pattern evident. CONCLUSION Lack of concordance between the CFA and EFA findings demonstrates that the correspondence between individual tests and their assumed cognitive domains is not robust, reflecting at least in part a current lack of consensus on how core cognitive constructs are defined and on what subcomponents can be subsumed under different cognitive domains. The MoCA should not be viewed as a substitute for more in-depth neuropsychological assessment when domain-specific information is required.
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Affiliation(s)
- Robert F Coen
- Mercer's Institute for Research on Ageing, St James's Hospital, Dublin, Ireland
| | - Deirdre A Robertson
- TILDA (The Irish Longitudinal Study on Ageing), Lincoln Gate, Trinity College Dublin, Dublin, Ireland
| | - Rose Anne Kenny
- TILDA (The Irish Longitudinal Study on Ageing), Lincoln Gate, Trinity College Dublin, Dublin, Ireland
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90
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Ritz L, Lannuzel C, Boudehent C, Vabret F, Bordas N, Segobin S, Eustache F, Pitel AL, Beaunieux H. Validation of a Brief Screening Tool for Alcohol-Related Neuropsychological Impairments. Alcohol Clin Exp Res 2015; 39:2249-60. [DOI: 10.1111/acer.12888] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 08/25/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Ludivine Ritz
- U1077; INSERM; Caen France
- UMR-S1077; Université de Caen Basse-Normandie; Caen France
- UMR-S1077; Ecole Pratique des Hautes Etudes; Caen France
- U1077; Centre Hospitalier Universitaire; Caen France
| | - Coralie Lannuzel
- U1077; INSERM; Caen France
- UMR-S1077; Université de Caen Basse-Normandie; Caen France
- UMR-S1077; Ecole Pratique des Hautes Etudes; Caen France
- U1077; Centre Hospitalier Universitaire; Caen France
| | - Céline Boudehent
- U1077; INSERM; Caen France
- UMR-S1077; Université de Caen Basse-Normandie; Caen France
- UMR-S1077; Ecole Pratique des Hautes Etudes; Caen France
- U1077; Centre Hospitalier Universitaire; Caen France
- Service d'addictologie; Centre Hospitalier Universitaire; Caen France
| | - François Vabret
- U1077; INSERM; Caen France
- UMR-S1077; Université de Caen Basse-Normandie; Caen France
- UMR-S1077; Ecole Pratique des Hautes Etudes; Caen France
- U1077; Centre Hospitalier Universitaire; Caen France
- Service d'addictologie; Centre Hospitalier Universitaire; Caen France
| | - Nadège Bordas
- Centre Hospitalier Universitaire Paul Brousse; Villejuif France
| | - Shailendra Segobin
- U1077; INSERM; Caen France
- UMR-S1077; Université de Caen Basse-Normandie; Caen France
- UMR-S1077; Ecole Pratique des Hautes Etudes; Caen France
- U1077; Centre Hospitalier Universitaire; Caen France
| | - Francis Eustache
- U1077; INSERM; Caen France
- UMR-S1077; Université de Caen Basse-Normandie; Caen France
- UMR-S1077; Ecole Pratique des Hautes Etudes; Caen France
- U1077; Centre Hospitalier Universitaire; Caen France
| | - Anne-Lise Pitel
- U1077; INSERM; Caen France
- UMR-S1077; Université de Caen Basse-Normandie; Caen France
- UMR-S1077; Ecole Pratique des Hautes Etudes; Caen France
- U1077; Centre Hospitalier Universitaire; Caen France
| | - Hélène Beaunieux
- U1077; INSERM; Caen France
- UMR-S1077; Université de Caen Basse-Normandie; Caen France
- UMR-S1077; Ecole Pratique des Hautes Etudes; Caen France
- U1077; Centre Hospitalier Universitaire; Caen France
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91
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Alarcon R, Nalpas B, Pelletier S, Perney P. MoCA as a Screening Tool of Neuropsychological Deficits in Alcohol-Dependent Patients. Alcohol Clin Exp Res 2015; 39:1042-8. [DOI: 10.1111/acer.12734] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 03/20/2015] [Indexed: 01/06/2023]
Affiliation(s)
- Régis Alarcon
- Service Addictologie; Hôpital du Grau du Roi; CHU Caremeau; Nîmes France
| | - Bertrand Nalpas
- Service Addictologie; Hôpital du Grau du Roi; CHU Caremeau; Nîmes France
- Département d'Information Scientifique et de Communication (DISC); Inserm; Paris France
| | | | - Pascal Perney
- Service Addictologie; Hôpital du Grau du Roi; CHU Caremeau; Nîmes France
- Université Montpellier I; Montpellier France
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92
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Goldsmith RS, Targino MC, Fanciullo GJ, Martin DW, Hartenbaum NP, White JM, Franklin P. Medical marijuana in the workplace: challenges and management options for occupational physicians. J Occup Environ Med 2015; 57:518-25. [PMID: 25951421 PMCID: PMC4410963 DOI: 10.1097/jom.0000000000000454] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although possession and use of marijuana is prohibited by federal law, legalization in four states (Alaska, Colorado, Oregon, and Washington) and allowance for palliation and therapy in 19 others may reposition the drug away from the fringes of society. This evolving legal environment, and growing scientific evidence of its effectiveness for select health conditions, requires assessment of the safety and appropriateness of marijuana within the American workforce. Although studies have suggested that marijuana may be used with reasonable safety in some controlled environments, there are potential consequences to its use that necessitate employer scrutiny and concern. Several drug characteristics must be considered, including Δ-tetrahydrocannabinol (Δ-THC, or THC) concentration, route of administration, dose and frequency, and pharmacokinetics, as well as the risks inherent to particular workplace environments.
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Affiliation(s)
- Robert S. Goldsmith
- From Novartis Pharmaceuticals Corporation (Dr Goldsmith), East Hanover; Johnson & Johnson (Dr Targino), New Brunswick, NJ; Department of Anesthesiology, Dartmouth-Hitchcock Medical Center (Dr. Fanciullo), Lebanon, NH; UnityPoint Health - St. Luke's, Occupational Medicine (Dr Martin), Sioux City, IA; Occumedix, Inc. (Dr Hartenbaum), Dresher, PA; Kaye Scholer LLP (Mr White), Washington, DC; and Bayer Corporation (Dr Franklin), Asbury, NJ
| | - Marcelo C. Targino
- From Novartis Pharmaceuticals Corporation (Dr Goldsmith), East Hanover; Johnson & Johnson (Dr Targino), New Brunswick, NJ; Department of Anesthesiology, Dartmouth-Hitchcock Medical Center (Dr. Fanciullo), Lebanon, NH; UnityPoint Health - St. Luke's, Occupational Medicine (Dr Martin), Sioux City, IA; Occumedix, Inc. (Dr Hartenbaum), Dresher, PA; Kaye Scholer LLP (Mr White), Washington, DC; and Bayer Corporation (Dr Franklin), Asbury, NJ
| | - Gilbert J. Fanciullo
- From Novartis Pharmaceuticals Corporation (Dr Goldsmith), East Hanover; Johnson & Johnson (Dr Targino), New Brunswick, NJ; Department of Anesthesiology, Dartmouth-Hitchcock Medical Center (Dr. Fanciullo), Lebanon, NH; UnityPoint Health - St. Luke's, Occupational Medicine (Dr Martin), Sioux City, IA; Occumedix, Inc. (Dr Hartenbaum), Dresher, PA; Kaye Scholer LLP (Mr White), Washington, DC; and Bayer Corporation (Dr Franklin), Asbury, NJ
| | - Douglas W. Martin
- From Novartis Pharmaceuticals Corporation (Dr Goldsmith), East Hanover; Johnson & Johnson (Dr Targino), New Brunswick, NJ; Department of Anesthesiology, Dartmouth-Hitchcock Medical Center (Dr. Fanciullo), Lebanon, NH; UnityPoint Health - St. Luke's, Occupational Medicine (Dr Martin), Sioux City, IA; Occumedix, Inc. (Dr Hartenbaum), Dresher, PA; Kaye Scholer LLP (Mr White), Washington, DC; and Bayer Corporation (Dr Franklin), Asbury, NJ
| | - Natalie P. Hartenbaum
- From Novartis Pharmaceuticals Corporation (Dr Goldsmith), East Hanover; Johnson & Johnson (Dr Targino), New Brunswick, NJ; Department of Anesthesiology, Dartmouth-Hitchcock Medical Center (Dr. Fanciullo), Lebanon, NH; UnityPoint Health - St. Luke's, Occupational Medicine (Dr Martin), Sioux City, IA; Occumedix, Inc. (Dr Hartenbaum), Dresher, PA; Kaye Scholer LLP (Mr White), Washington, DC; and Bayer Corporation (Dr Franklin), Asbury, NJ
| | - Jeremy M. White
- From Novartis Pharmaceuticals Corporation (Dr Goldsmith), East Hanover; Johnson & Johnson (Dr Targino), New Brunswick, NJ; Department of Anesthesiology, Dartmouth-Hitchcock Medical Center (Dr. Fanciullo), Lebanon, NH; UnityPoint Health - St. Luke's, Occupational Medicine (Dr Martin), Sioux City, IA; Occumedix, Inc. (Dr Hartenbaum), Dresher, PA; Kaye Scholer LLP (Mr White), Washington, DC; and Bayer Corporation (Dr Franklin), Asbury, NJ
| | - Phillip Franklin
- From Novartis Pharmaceuticals Corporation (Dr Goldsmith), East Hanover; Johnson & Johnson (Dr Targino), New Brunswick, NJ; Department of Anesthesiology, Dartmouth-Hitchcock Medical Center (Dr. Fanciullo), Lebanon, NH; UnityPoint Health - St. Luke's, Occupational Medicine (Dr Martin), Sioux City, IA; Occumedix, Inc. (Dr Hartenbaum), Dresher, PA; Kaye Scholer LLP (Mr White), Washington, DC; and Bayer Corporation (Dr Franklin), Asbury, NJ
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To WT, Vanheule S, Vanderplasschen W, Audenaert K, Vandevelde S. Screening for intellectual disability in persons with a substance abuse problem: Exploring the validity of the Hayes Ability Screening Index in a Dutch-speaking sample. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 36C:498-504. [PMID: 25462510 DOI: 10.1016/j.ridd.2014.10.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 10/25/2014] [Accepted: 10/29/2014] [Indexed: 06/04/2023]
Abstract
There is an increasing interest in screening instruments to detect intellectual disability (ID) in a quick and accurate way in mental health services as well as in the criminal justice system in order to provide appropriate support for people with undetected needs caused by ID. An instrument that has been proven to be useful in both settings is the Hayes Ability Screening Index (HASI). This study assessed the validity of the Dutch version of the HASI in persons with a substance abuse problem residing in mental health services, whether or not mandated to treatment by court order. The HASI was conducted along with the Wechsler Adult Intelligence Scale III as the criterion for validity to 90 participants. Additionally, the influence of psychiatric disorder and medication use on the HASI result was examined. A significant positive relationship was found between the two instruments, demonstrating convergent validity. Using a Receiver Operating Characteristic (ROC) curve analysis, the discriminative ability of the HASI with a cut-off score of 85 was found to be adequate, yielding in a good balance between sensitivity and specificity. The HASI was not distorted by the presence of the substance abuse problem or other psychiatric illnesses and medication did not influence the HASI scores in this study. These findings indicate that the HASI provides a time-efficient and resource-conscious way to detect ID in persons with a substance problem, thus addressing a critical need in mental health settings.
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Affiliation(s)
- Wing Ting To
- University College Ghent, Faculty of Education, Health and Social Work, Voskenslaan 362, 9000 Ghent, Belgium; Ghent University, Department of Special Education, Henri Dunantlaan 2, 9000 Ghent, Belgium.
| | - Stijn Vanheule
- Ghent University, Department of Psychoanalysis and Clinical Consulting, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Wouter Vanderplasschen
- Ghent University, Department of Special Education, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Kurt Audenaert
- Ghent University, Department of Psychiatry and Medical Psychology, De Pintelaan 185, 9000 Ghent, Belgium
| | - Stijn Vandevelde
- Ghent University, Department of Special Education, Henri Dunantlaan 2, 9000 Ghent, Belgium
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94
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Najolia GM, Dunning C, Smith L, Knopp P, Zolnikov B. Use of the Montreal Cognitive Assessment in Evaluations of Adjudicative Competency. JOURNAL OF FORENSIC PSYCHOLOGY PRACTICE 2014. [DOI: 10.1080/15228932.2014.954892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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95
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Wu C, Dagg P, Molgat C. A pilot study to measure cognitive impairment in patients with severe schizophrenia with the Montreal Cognitive Assessment (MoCA). Schizophr Res 2014; 158:151-5. [PMID: 25092174 DOI: 10.1016/j.schres.2014.07.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 06/30/2014] [Accepted: 07/03/2014] [Indexed: 11/18/2022]
Abstract
Cognitive impairment has been suggested to be a core feature of a schizophrenia diagnosis. Many comprehensive neuropsychological batteries and experimental procedures have been used to assess cognitive impairment in schizophrenia. A few brief performance-based cognitive assessments have been developed to fulfill the need of a more feasible cognitive assessment for schizophrenia in clinical settings. However, their usability is in question. The Montreal Cognitive Assessment (MoCA), a brief cognitive assessment tool, has been used widely in different clinical settings because of its high sensitivity and specificity for detecting cognitive impairments. This study assessed cognitive function in patients with schizophrenia by using the MoCA tool. The results showed that the MoCA was sensitive enough to detect cognitive impairment in patients with schizophrenia. It also provided normative data for the MoCA in schizophrenia patients. Furthermore, the results revealed that cognitive impairment measured by the MoCA was correlated with their education level, severity of illness, and negative symptoms. Lastly, the MoCA total score could be a significant predictor of patients' length of stay in the facility.
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Affiliation(s)
- Caili Wu
- Hillside Psychiatric Centre, Interior Health, Kamloops, BC V2C 2T1, Canada.
| | - Paul Dagg
- Hillside Psychiatric Centre, Interior Health, Kamloops, BC V2C 2T1, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Carmen Molgat
- Hillside Psychiatric Centre, Interior Health, Kamloops, BC V2C 2T1, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
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96
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Place C. Alcohol related brain damage – a case of neglect? ADVANCES IN DUAL DIAGNOSIS 2014. [DOI: 10.1108/add-02-2014-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to argue that alcohol-related brain damage (ARBD) is a neglected problem. ARBD is a term that has begun to be used over the past decade to describe prolonged cognitive impairment caused by alcohol use, including Wernicke's encephalopathy and Korsakoff syndrome, alcohol dementia and alcohol-related brain injury.
Design/methodology/approach
– The paper provides an overview of ARBD describing the research around its prevalence and prognosis. There is a consensus in the literature that there is little research and a lack of awareness of this condition. The author uses case studies from his own experience working with people with ARBD to describe the difficulties in accessing appropriate assessment and care for this group, and suggests that they are often excluded in a way that is familiar from the experience of the person with “dual diagnosis”.
Findings
– Recommendations are made including raising awareness, improving screening for cognitive impairment and developing specialist services.
Originality/value
– ARBD appears to have been neglected in the “dual diagnosis” world and this paper attempts to address this, and so should be of interest to a wide range of professionals working with substance use, mental health, homelessness and social work.
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97
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Cannizzaro DL, Elliott JC, Stohl M, Hasin DS, Aharonovich E. Neuropsychological Assessment Battery-Screening Module (S-NAB): performance in treatment-seeking cocaine users. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2014; 40:476-83. [PMID: 24949996 DOI: 10.3109/00952990.2014.916718] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED Abstract Background: Cocaine use is associated with cognitive impairments, which can have a negative effect on treatment retention and drug use. Thus, there is an increasing demand for a screening cognitive battery can be used by clinicians to detect such impairments in cocaine patients so that treatment can be adapted to patients' specific cognitive strengths and deficits. The Neuropsychological Assessment Battery-Screening Module (S-NAB) test for adults takes approximately 35-45 min to administer, and assesses attention, language, memory (verbal and visual), visual spatial reasoning, and executive functioning. OBJECTIVE The purpose of this descriptive study was to present S-NAB score results for a sample of treatment seeking adult cocaine users to determine its potential utility for detecting cognitive impairments in this population. METHODS In the present sample, 145 adult cocaine users participated in screening to enroll in an intervention to decrease cocaine use (59% male; 73.1% African American); screening included the S-NAB and self-report questionnaires. RESULTS A substantial proportion of the sample (44%) met criteria for impairment, i.e. composite scores of one or more standard deviations below the mean. Furthermore, memory scores were significantly lower than language and spatial scores (p < 0.007). CONCLUSIONS The impairments detected by the S-NAB were generally consistent with those previously observed in samples of cocaine users completing other batteries, as well in other substance abusing samples completing the S-NAB. This suggests that the S-NAB can be considered an additional appropriate battery, as an alternative to other existing batteries, for assessment of the cognitive functioning of adult cocaine users.
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98
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Kalapatapu RK, Delucchi KL, Lasher BA, Vinogradov S, Batki SL. Alcohol use biomarkers predicting cognitive performance: a secondary analysis in veterans with alcohol dependence and posttraumatic stress disorder. Mil Med 2014; 178:974-80. [PMID: 24005546 DOI: 10.7205/milmed-d-13-00097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE We conducted a secondary analysis of baseline data from a recently completed pharmacological pilot clinical trial among 30 veterans with alcohol dependence and posttraumatic stress disorder (PTSD). This trial included baseline measures of alcohol use biomarkers, both indirect (carbohydrate-deficient transferrin, GGT [γ-glutamyltransferase], mean corpuscular volume, AST [aspartate aminotransferase], alanine aminotransferase) and direct (ethyl glucuronide, ethyl sulfate), as well as neurocognitive measures (Trail Making Test parts A and B, Hopkins Verbal Learning Test-Revised, Balloon Analogue Risk Task, Delay Discounting Task). METHODS Two regression models were estimated and tested for each neurocognitive measure (dependent measure). The first model included the alcohol use biomarker alone as the predictor. The second model included the alcohol use biomarker along with the following 3 additional predictors: Beck Depression Inventory, Clinician-Administered PTSD Scale, and receiving medications. RESULTS In both models, the indirect biomarkers, such as GGT and AST, significantly predicted performance on the Hopkins Verbal Learning Test-Revised %Retention. GGT alone significantly predicted performance on the Trail Making Test part A. CONCLUSIONS Indirect alcohol use biomarkers may have a specific role in identifying those veterans with alcohol dependence and PTSD who have impaired cognitive performance. However, direct alcohol use biomarkers may not share such a role.
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Affiliation(s)
- Raj K Kalapatapu
- Department of Psychiatry, University of California, 401 Parnassus Avenue, San Francisco, CA 94143, USA
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Kalapatapu RK, Neylan TC, Regan MC, Cohen BE. Association of alcohol use biomarkers and cognitive performance in veterans with problematic alcohol use and posttraumatic stress disorder: data from the mind your heart study. J Addict Dis 2014; 33:67-76. [PMID: 24717141 PMCID: PMC4071132 DOI: 10.1080/10550887.2014.909701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The authors conducted a study of alcohol use biomarkers and cognitive performance among 85 veterans with problematic alcohol use and posttraumatic stress disorder (PTSD). All analyses were adjusted for demographics, depression, anxiety, and PTSD symptoms. Elevated levels of aspartate aminotransferase were associated with worse performance on the Trail Making Test Part A and Hopkins Verbal Learning Test. Two other biomarkers were not associated with any neurocognitive measures. Indirect alcohol use biomarkers (e.g., aspartate aminotransferase) may have a specific role in identifying veterans with problematic alcohol use and PTSD who show a change in psychomotor speed and immediate verbal memory performance.
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Affiliation(s)
- Raj K. Kalapatapu
- Department of Psychiatry, University of California, San Francisco, CA, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Thomas C. Neylan
- Department of Psychiatry, University of California, San Francisco, CA, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Mathilda C. Regan
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Beth E. Cohen
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Northern California Institute for Research and Education, San Francisco, CA, USA
- Department of Medicine, University of California, San Francisco, CA, USA
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Bernardin F, Maheut-Bosser A, Paille F. Cognitive impairments in alcohol-dependent subjects. Front Psychiatry 2014; 5:78. [PMID: 25076914 PMCID: PMC4099962 DOI: 10.3389/fpsyt.2014.00078] [Citation(s) in RCA: 143] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 06/23/2014] [Indexed: 01/19/2023] Open
Abstract
Chronic excessive alcohol consumption induces cognitive impairments mainly affecting executive functions, episodic memory, and visuospatial capacities related to multiple brain lesions. These cognitive impairments not only determine everyday management of these patients, but also impact on the efficacy of management and may compromise the abstinence prognosis. Maintenance of lasting abstinence is associated with cognitive recovery in these patients, but some impairments may persist and interfere with the good conduct and the efficacy of management. It therefore appears essential to clearly define neuropsychological management designed to identify and evaluate the type and severity of alcohol-related cognitive impairments. It is also essential to develop cognitive remediation therapy so that the patient can fully benefit from the management proposed in addiction medicine units.
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Affiliation(s)
- Florent Bernardin
- Service d'Addictologie, CHU Nancy , Vandoeuvre , France ; Faculté de Médecine, Université de Lorraine , Nancy , France
| | | | - François Paille
- Service d'Addictologie, CHU Nancy , Vandoeuvre , France ; Faculté de Médecine, Université de Lorraine , Nancy , France
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