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Kalapatapu RK, Lewis DF, Vinogradov S, Batki SL, Winhusen T. Relationship of age to impulsivity and decision making: a baseline secondary analysis of a behavioral treatment study in stimulant use disorders. J Addict Dis 2013; 32:206-16. [PMID: 23815427 DOI: 10.1080/10550887.2013.795471] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Because stimulant use disorders remain prevalent across the lifespan, cognition is an important area of clinical care and research focus among aging adults with stimulant use disorders. This secondary analysis of a National Institute on Drug Abuse Clinical Trials Network study suggests that decision making, verbal learning/memory, executive function, and set shifting are important cognitive domains to screen clinically and treat in aging adults with stimulant use disorders. Some suggestions are made on how clinical treatment providers can practically use these results. An important direction for future research is the development of cognitively remediating treatments for impaired cognitive domains in aging adults with stimulant use disorders.
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Affiliation(s)
- Raj K Kalapatapu
- Department of Psychiatry, University of California, San Francisco, CA, USA.
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102
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de Guise E, Alturki AY, LeBlanc J, Champoux MC, Couturier C, Lamoureux J, Desjardins M, Marcoux J, Maleki M, Feyz M. The Montreal Cognitive Assessment in Persons with Traumatic Brain Injury. APPLIED NEUROPSYCHOLOGY-ADULT 2013; 21:128-35. [DOI: 10.1080/09084282.2013.778260] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Elaine de Guise
- a Traumatic Brain Injury Program and Neurosurgery Department , McGill University Health Centre-Montreal General Hospital, Montreal , Quebec , Canada
| | - Abdulrahman Yaqub Alturki
- b Neurosurgery Department , McGill University Health Centre-Montreal General Hospital , Montreal , Quebec , Canada
- c Neurology and Neurosurgery , The National Neuroscience Institute , Riyadh , Saudi Arabia
| | - Joanne LeBlanc
- d Traumatic Brain Injury Program, McGill University Health Centre-Montreal General Hospital , Montreal , Quebec , Canada
| | - Marie-Claude Champoux
- d Traumatic Brain Injury Program, McGill University Health Centre-Montreal General Hospital , Montreal , Quebec , Canada
| | - Céline Couturier
- d Traumatic Brain Injury Program, McGill University Health Centre-Montreal General Hospital , Montreal , Quebec , Canada
| | - Julie Lamoureux
- e Social and Preventive Medicine Department , University of Montreal , Montreal , Quebec , Canada
| | - Monique Desjardins
- f Psychiatry Department , McGill University Health Centre-Montreal General Hospital , Montreal , Quebec , Canada
| | - Judith Marcoux
- b Neurosurgery Department , McGill University Health Centre-Montreal General Hospital , Montreal , Quebec , Canada
| | - Mohammed Maleki
- b Neurosurgery Department , McGill University Health Centre-Montreal General Hospital , Montreal , Quebec , Canada
| | - Mitra Feyz
- d Traumatic Brain Injury Program, McGill University Health Centre-Montreal General Hospital , Montreal , Quebec , Canada
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103
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Battistella G, Fornari E, Thomas A, Mall JF, Chtioui H, Appenzeller M, Annoni JM, Favrat B, Maeder P, Giroud C. Weed or wheel! FMRI, behavioural, and toxicological investigations of how cannabis smoking affects skills necessary for driving. PLoS One 2013; 8:e52545. [PMID: 23300977 PMCID: PMC3534702 DOI: 10.1371/journal.pone.0052545] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 11/20/2012] [Indexed: 11/19/2022] Open
Abstract
Marijuana is the most widely used illicit drug, however its effects on cognitive functions underlying safe driving remain mostly unexplored. Our goal was to evaluate the impact of cannabis on the driving ability of occasional smokers, by investigating changes in the brain network involved in a tracking task. The subject characteristics, the percentage of Δ(9)-Tetrahydrocannabinol in the joint, and the inhaled dose were in accordance with real-life conditions. Thirty-one male volunteers were enrolled in this study that includes clinical and toxicological aspects together with functional magnetic resonance imaging of the brain and measurements of psychomotor skills. The fMRI paradigm was based on a visuo-motor tracking task, alternating active tracking blocks with passive tracking viewing and rest condition. We show that cannabis smoking, even at low Δ(9)-Tetrahydrocannabinol blood concentrations, decreases psychomotor skills and alters the activity of the brain networks involved in cognition. The relative decrease of Blood Oxygen Level Dependent response (BOLD) after cannabis smoking in the anterior insula, dorsomedial thalamus, and striatum compared to placebo smoking suggests an alteration of the network involved in saliency detection. In addition, the decrease of BOLD response in the right superior parietal cortex and in the dorsolateral prefrontal cortex indicates the involvement of the Control Executive network known to operate once the saliencies are identified. Furthermore, cannabis increases activity in the rostral anterior cingulate cortex and ventromedial prefrontal cortices, suggesting an increase in self-oriented mental activity. Subjects are more attracted by intrapersonal stimuli ("self") and fail to attend to task performance, leading to an insufficient allocation of task-oriented resources and to sub-optimal performance. These effects correlate with the subjective feeling of confusion rather than with the blood level of Δ(9)-Tetrahydrocannabinol. These findings bolster the zero-tolerance policy adopted in several countries that prohibits the presence of any amount of drugs in blood while driving.
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Affiliation(s)
- Giovanni Battistella
- Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), and University of Lausanne, Lausanne, Switzerland
| | - Eleonora Fornari
- Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), and University of Lausanne, Lausanne, Switzerland
- CIBM (Centre d’Imagerie Biomédicale), Centre Hospitalier Universitaire Vaudois (CHUV) unit, Lausanne, Switzerland
| | - Aurélien Thomas
- CURML (University Center of Legal Medicine), UTCF (Forensic Toxicology and Chemistry Unit), Geneva, Switzerland
| | - Jean-Frédéric Mall
- Department of Psychiatry, SUPAA (Service Universitaire de Psychiatrie de l’Age Avancé), Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Haithem Chtioui
- Department of Clinical Pharmacology and Toxicology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Monique Appenzeller
- Department of Clinical Pharmacology and Toxicology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Jean-Marie Annoni
- Neurology Unit, Department of Medicine, University of Fribourg, Fribourg, Switzerland
| | - Bernard Favrat
- CURML (University Center of Legal Medicine), UMPT (Unit of Psychology and Traffic Medicine), Lausanne and Geneva, Switzerland
| | - Philippe Maeder
- Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), and University of Lausanne, Lausanne, Switzerland
- * E-mail:
| | - Christian Giroud
- CURML (University Center of Legal Medicine), UTCF (Forensic Toxicology and Chemistry Unit), Lausanne, Switzerland
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104
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Likhitsathian S, Saengcharnchai P, Uttawichai K, Yingwiwattanapong J, Wittayanookulluk A, Srisurapanont M. Cognitive changes in topiramate-treated patients with alcoholism: a 12-week prospective study in patients recently detoxified. Psychiatry Clin Neurosci 2012; 66:235-41. [PMID: 22443246 DOI: 10.1111/j.1440-1819.2012.02326.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS The aim of this study was to determine the 12-week cognitive changes in topiramate-treated patients recently detoxified from alcohol. METHODS Participants were inpatients with DSM-IV alcohol dependence. All of them were discharged within 14 days after the initiation of topiramate treatment. The topiramate dose range was 50-300 mg/day. The Montreal Cognitive Assessment (MoCA) was used on day 0, day 29, day 57, and day 85. Differences of the MoCA total and seven subtest scores among four time-points were compared. RESULTS Thirty-eight participants (36 men and two women) had a mean ± SD age of 43.1 ± 8.6 years old. At enrollment, they were abstinent for a mean ± SD of 11.5 ± 5.3 days. Five, one, and three patients dropped out of the study on day 29, day 57, and day 85, respectively. On day 85, the mean ± SD dose of topiramate was 253.1 ± 60.8 mg/day. Alcohol consumption decreased drastically during follow up. At each time-point, 75%-80% of the participants were continuous abstainers. The mean ± SD MoCA total, language subtest, and delayed recall subtest scores increased significantly from day 0 to day 85, from 22.0 ± 4.7 to 24.7 ± 3.4 (P < 0.01), from 1.1 ± 1.0 to 1.3 ± 1.0 (P = 0.03), and from 2.7 ± 1.7 to 4.1 ± 1.0 (P < 0.01), respectively. CONCLUSION Topiramate-treated patients recently detoxified from alcohol usually have an improvement of their cognitive function, especially in the language and delayed recall domains. This phenomenon may be caused by the greater influence of cognitive recovery associated with decreased drinking as compared with topiramate-induced cognitive impairment.
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Affiliation(s)
- Surinporn Likhitsathian
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University Chiang Mai Drug Dependence Treatment Center, Chiang Mai, Thailand
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105
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Copersino ML, Schretlen DJ, Fitzmaurice GM, Lukas SE, Faberman J, Sokoloff J, Weiss RD. Effects of cognitive impairment on substance abuse treatment attendance: predictive validation of a brief cognitive screening measure. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2012; 38:246-50. [PMID: 22443860 DOI: 10.3109/00952990.2012.670866] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Neuropsychological impairment among patients with substance use disorders (SUDs) contributes to poorer treatment processes and outcomes. However, neuropsychological assessment is typically not an aspect of patient evaluation in SUD treatment programs because it is prohibitively time and resource consuming. In a previous study, we examined the concurrent validity, classification accuracy, and clinical utility of a brief screening measure, the Montreal Cognitive Assessment (MoCA), in identifying cognitive impairment among SUD patients. To provide further evidence of criterion-related validity, MoCA classification should optimally predict a clinically relevant behavior or outcome among SUD patients. The purpose of this study was to examine the validity of the MoCA in predicting treatment attendance. METHODS We compared previously collected clinical assessment data on 60 SUD patients receiving treatment in a program of short duration and high intensity to attendance data obtained via medical chart review. RESULTS Though the proportion of therapy sessions attended did not differ between groups, cognitively impaired subjects were significantly less likely than unimpaired subjects to attend all of their group therapy sessions. CONCLUSION These results complement our previous findings by providing further evidence of criterion-related validity of the MoCA in predicting a clinically relevant behavior (i.e., perfect attendance) among SUD patients. SCIENTIFIC SIGNIFICANCE The capacity of the MoCA to predict a clinically relevant behavior provides support for its validity as a brief cognitive screening measure.
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Affiliation(s)
- Marc L Copersino
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, MA, USA.
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Paul R, Lane EM, Tate DF, Heaps J, Romo DM, Akbudak E, Niehoff J, Conturo TE. Neuroimaging signatures and cognitive correlates of the montreal cognitive assessment screen in a nonclinical elderly sample. Arch Clin Neuropsychol 2011; 26:454-60. [PMID: 21642663 PMCID: PMC3142949 DOI: 10.1093/arclin/acr017] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2011] [Indexed: 11/12/2022] Open
Abstract
The Montreal Cognitive Assessment (MoCA) screen was developed as a brief instrument to identify mild cognitive impairment and dementia among older individuals. To date, limited information is available regarding the neuroimaging signatures associated with performance on the scale, or the relationship between the MoCA and more comprehensive cognitive screening measures. The present study examined performances on the MoCA among 111 non-clinical older adults (ages 51-85) enrolled in a prospective study of cognitive aging. Participants were administered the MoCA, Mini-Mental State Exam (MMSE), and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). A subset of participants (N = 69) underwent structural 3 T magnetic resonance imaging (MRI) to define the volumes of total frontal gray matter, total hippocampus, T2-weighted subcortical hyperintensities (SH), and total brain volume. The results revealed significant correlations between the total score on the MoCA and total score on the RBANS and MMSE, though the strength of the correlations was more robust between the MoCA and the RBANS. Modest correlations between individual subscales of the MoCA and neuroimaging variables were evident, but no patterns of shared variance emerged between the MoCA total score and neuroimaging indices. In contrast, total brain volume correlated significantly with total score on the RBANS. These results suggest that additional studies are needed to define the significance of MoCA scores relative to brain integrity among an older population.
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Affiliation(s)
- Robert Paul
- Department of Psychology, University of Missouri-St Louis, Behavioral Neuroscience, St Louis, MO 63121, USA.
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107
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Damian AM, Jacobson SA, Hentz JG, Belden CM, Shill HA, Sabbagh MN, Caviness JN, Adler CH. The Montreal Cognitive Assessment and the mini-mental state examination as screening instruments for cognitive impairment: item analyses and threshold scores. Dement Geriatr Cogn Disord 2011; 31:126-31. [PMID: 21282950 DOI: 10.1159/000323867] [Citation(s) in RCA: 155] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/26/2010] [Indexed: 11/19/2022] Open
Abstract
AIMS To perform an item analysis of the Montreal Cognitive Assessment (MoCA) versus the Mini-Mental State Examination (MMSE) in the prediction of cognitive impairment, and to examine the characteristics of different MoCA threshold scores. METHODS 135 subjects enrolled in a longitudinal clinicopathologic study were administered the MoCA by a single physician and the MMSE by a trained research assistant. Subjects were classified as cognitively impaired or cognitively normal based on independent neuropsychological testing. RESULTS 89 subjects were found to be cognitively normal, and 46 cognitively impaired (20 with dementia, 26 with mild cognitive impairment). The MoCA was superior in both sensitivity and specificity to the MMSE, although not all MoCA tasks were of equal predictive value. A MoCA threshold score of 26 had a sensitivity of 98% and a specificity of 52% in this population. In a population with a 20% prevalence of cognitive impairment, a threshold of 24 was optimal (negative predictive value 96%, positive predictive value 47%). CONCLUSION This analysis suggests the potential for creating an abbreviated MoCA. For screening in primary care, the MoCA threshold of 26 appears optimal. For testing in a memory disorders clinic, a lower threshold has better predictive value.
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Affiliation(s)
- Anne M Damian
- University of Arizona College of Medicine Phoenix Campus, Phoenix, AZ, USA
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108
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Adhikari T, Piatti A, Luggen M. Cognitive dysfunction in SLE: development of a screening tool. Lupus 2011; 20:1142-6. [PMID: 21676920 DOI: 10.1177/0961203311405374] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cognitive dysfunction (CD) is among the most common neuropsychiatric manifestations of systemic lupus erythematosus (SLE). There are two methods which have been used to detect CD in patients with SLE: traditional neuropsychological tests (NPT) and the Automated Neuropsychological Assessment Metrics (ANAM). Both are time-consuming and neither is readily available for screening purposes. PURPOSE The aim of our study was to evaluate the Montreal Cognitive Assessment (MoCA) test as a screening tool for detection of CD in SLE. Methods. SLE patients fulfilling ACR criteria were administered the ANAM, a computerized test battery which measures various cognitive domains and the MoCA, a one-page, performance-based screening test designed to detect mild cognitive impairment in the elderly. With the ANAM as the gold standard, the performance characteristics of the MoCA were assessed. RESULTS In total, 44 patients were evaluated. Of these, 11 (25%) were identified by the ANAM as being impaired in comparison with 13 (29.5%) by the MoCA. The scores were significantly correlated (r = 0.57, p < 0.001). Using the standard cutoff of 26, the sensitivity of MoCA was 83% and specificity 73%. CONCLUSION The MoCA appears to be a promising screening tool for the detection of CD in SLE both for epidemiologic studies and for routine clinical care.
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Affiliation(s)
- T Adhikari
- Division of Immunology, Allergy, and Rheumatology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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