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Gautron MA, Clergue-Duval V, Chantre J, Lejoyeux M, Geoffroy PA. Predictive factors of cognitive impairment in alcohol use disorder inpatients. Addict Behav 2024; 158:108132. [PMID: 39146925 DOI: 10.1016/j.addbeh.2024.108132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 07/03/2024] [Accepted: 08/12/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Cognitive impairments are common in patients with AUD and worsen the prognosis of addiction management. There are no clear guidelines for screening cognitive impairments in hospitalized patients with AUD. METHODS Fifty-seven patients with an AUD history who were admitted to an acute hospital and assessed by the addiction care team were included. Those patients were screened for cognitive impairments using the Montreal Cognitive Assessment (MoCA) test. We collected clinical information regarding addiction history, comorbidities, and current treatments. Chi-square tests, t-tests, and Mann-Whitney tests were performed to determine factors associated with a pathological MoCA score (<26). RESULTS A pathological MoCA score was positively associated with spatial-temporal disorientation, difficulty in recalling addiction history, patient underreporting of AUD and a date of last alcohol consumption lower than 11 days ago, and negatively associated with a reason for hospitalization due to alcohol-related health issues. No medication was associated with cognitive impairments. CONCLUSIONS Clinical elements from assessment by the addiction care team allow for relevant indication for screening cognitive impairments.
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Affiliation(s)
- Marie-Astrid Gautron
- Unité de Traitement Ambulatoire des Maladies Addictives, Département d'Addictologie et de Psychiatrie, Hôpital Beaujon, APHP GHU Nord, 100 bd du général Leclerc, 92110 Clichy, France; ResAlCog (Réseau pour la prise en charge des troubles cognitifs liés à l'alcool), 51 bis Rue des Epinettes, 75017 Paris, France.
| | - Virgile Clergue-Duval
- ResAlCog (Réseau pour la prise en charge des troubles cognitifs liés à l'alcool), 51 bis Rue des Epinettes, 75017 Paris, France; Département de Psychiatrie et de Médecine Addictologique, Site Lariboisière Fernand-Widal, APHP GHU Nord, 200 rue du faubourg Saint-Denis, 75010 Paris, France; UFR de Médecine, Université Paris Cité, 85 boulevard Saint-Germain, 75006 Paris, France; UMRS-1144 Optimisation thérapeutique en neuropsychopharmacologie, Inserm, Université Paris Cité, 4 avenue de l'Observatoire, 75006 Paris, France; FHU Network of Research in Substance Use Disorders (NOR-SUD), 4 avenue de l'Observatoire, 75006 Paris , France
| | - Janice Chantre
- Unité de Traitement Ambulatoire des Maladies Addictives, Département d'Addictologie et de Psychiatrie, Hôpital Beaujon, APHP GHU Nord, 100 bd du général Leclerc, 92110 Clichy, France; ResAlCog (Réseau pour la prise en charge des troubles cognitifs liés à l'alcool), 51 bis Rue des Epinettes, 75017 Paris, France; Département de psychiatrie et d'addictologie, AP-HP, DMU Neurosciences, Hôpital Bichat - Claude Bernard, APHP GHU Nord, 46 rue Henri Huchard, 75018 Paris, France
| | - Michel Lejoyeux
- UFR de Médecine, Université Paris Cité, 85 boulevard Saint-Germain, 75006 Paris, France; Département de psychiatrie et d'addictologie, AP-HP, DMU Neurosciences, Hôpital Bichat - Claude Bernard, APHP GHU Nord, 46 rue Henri Huchard, 75018 Paris, France; 22ème secteur de psychiatrie parisienne GHU Paris - Psychiatry & Neurosciences, 1 rue Cabanis, 75014 Paris, France
| | - Pierre A Geoffroy
- UFR de Médecine, Université Paris Cité, 85 boulevard Saint-Germain, 75006 Paris, France; Département de psychiatrie et d'addictologie, AP-HP, DMU Neurosciences, Hôpital Bichat - Claude Bernard, APHP GHU Nord, 46 rue Henri Huchard, 75018 Paris, France; Centre ChronoS, GHU Paris - Psychiatry & Neurosciences, 1 rue Cabanis, 75014 Paris, France; CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, Strasbourg, France
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2
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Høiland K, Arnevik EKA, Diep LM, Mathisen T, Witkiewitz K, Egeland J. Impaired or not impaired: The accuracy of the Montreal Cognitive Assessment in detecting cognitive impairment among patients with alcohol use disorder. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024. [PMID: 39245727 DOI: 10.1111/acer.15437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 08/09/2024] [Accepted: 08/19/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Cognitive impairments are common in alcohol use disorder (AUD), but only a few studies have investigated the accuracy of the Montreal Cognitive Assessment (MoCA) in this population. We examined the accuracy and precision of the MoCA in detecting cognitive impairment in a sample of patients with AUD. In addition, we investigated whether the MoCA predicts premature discontinuation from treatment. METHOD A sample of 126 persons with AUD undergoing treatment in specialist health services were administered the MoCA and a battery of 12 neuropsychological tests. Five cognitive domains were derived from the reference tests. A composite total score from these tests was used as a reference criterion for determining correct and incorrect classifications for the MoCA. We analyzed the optimal cut-off score for the MoCA and the accuracy and agreement of classification between the MoCA and the reference tests. RESULTS Receiver operating characteristic (ROC) curve analyzes yielded an area under the curve (AUC) of 0.77 (95% CI [0.67, 0.87]). Applying 25 as the cut-off, MoCA sensitivity was 0.77 and specificity 0.62. The PPV was 0.53. The NPV was 0.84. Using a cut-off score of 24 yielded a lower sensitivity 0.60, but specificity was significantly better i.e., 0.79. PPV was 0.68. The NPV was 0.82. Kappa agreement between MoCA and the reference tests was fair to moderate, 0.38 for the cut-off of 25, and 0.44 for the cut-off of 24. MoCA did not predict discontinuation from treatment. CONCLUSIONS Our findings indicate limitations in the classification accuracy of the MoCA in predicting cognitive impairment in AUD. Achieving the right balance between accurately identifying impaired cases without including too many false positives can be challenging. Further, MoCA does not predict discontinuation from treatment. Overall, the results do not support MoCA as a time-efficient screening instrument.
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Affiliation(s)
| | - Espen Kristian Ajo Arnevik
- Section for Clinical Addiction Research, Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Lien My Diep
- Oslo Center for Biostatistics and Epidemiology (OCBE), University of Oslo, Oslo, Norway
| | | | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Albuquerque, New Mexico, USA
| | - Jens Egeland
- Vestfold Hospital Trust, Tønsberg, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
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3
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Lefebvre-Durel C, Morel A, Dereux A, Etain B, Clergue Duval V, Vorspan F. Reduction of Psychosis Proneness in a Daycare Hospital Program for Patients with Severe Alcohol Use Disorder. J Dual Diagn 2024:1-7. [PMID: 39072559 DOI: 10.1080/15504263.2024.2378874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
OBJECTIVES Anxiety and depressive symptoms, as well as cognitive dysfunctions, improve with abstinence in individuals with alcohol use disorders (AUD), but less is known about psychotic features. The objective of this study was to evaluate the psychosis proneness in a sample of individuals with severe AUD and potential changes after alcohol withdrawal. METHOD An observational study was conducted, assessing prospectively Peter's Delusional Inventory scale (PDI); anxiety and depression symptoms by MADRS and cognitive functioning by the MoCA at entry in daycare hospital (D0) and after 30 days (D30). Individuals with schizophrenia, chronic delusional disorder and bipolar disorder were excluded. Wilcoxon tests were used to evaluate the evolution between D0 and D30, and linear regressions were conducted to test the association between delta PDI and the variables that could be potential confounders. RESULTS Forty individuals (72% males) with a mean age of 50 ± 9 years old and AUD evolved for 15 ± 11 years were included. After one month, PDI score decreased significantly (p = .001), and several biological and clinical parameters improved significantly with abstinence or consumption reduction: GGT (p = .003), MoCA (p < .001), MADRS (p = .047). CONCLUSION We observed a decrease in delusional thinking along abstinence and/or consumption reduction. To our knowledge, this is the first research to study psychosis proneness evolution in patients with severe AUD. Replications are required in independent samples with larger sample size.
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Affiliation(s)
- Camille Lefebvre-Durel
- Département de psychiatrie et de médecine addictologique, Hôpital Lariboisière-Fernand Widal, GHU NORD, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Alix Morel
- Département de psychiatrie et de médecine addictologique, Hôpital Lariboisière-Fernand Widal, GHU NORD, Assistance Publique - Hôpitaux de Paris, Paris, France
- Université Paris Cité, Inserm UMRS1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France
- UFR Médecine, Université de Paris, Paris, France
| | - Alexandra Dereux
- Département de psychiatrie et de médecine addictologique, Hôpital Lariboisière-Fernand Widal, GHU NORD, Assistance Publique - Hôpitaux de Paris, Paris, France
- Université Paris Cité, Inserm UMRS1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France
- FHU NOR-SUD, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Bruno Etain
- Département de psychiatrie et de médecine addictologique, Hôpital Lariboisière-Fernand Widal, GHU NORD, Assistance Publique - Hôpitaux de Paris, Paris, France
- Université Paris Cité, Inserm UMRS1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France
- UFR Médecine, Université de Paris, Paris, France
| | - Virgile Clergue Duval
- Département de psychiatrie et de médecine addictologique, Hôpital Lariboisière-Fernand Widal, GHU NORD, Assistance Publique - Hôpitaux de Paris, Paris, France
- Université Paris Cité, Inserm UMRS1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France
- UFR Médecine, Université de Paris, Paris, France
- FHU NOR-SUD, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Florence Vorspan
- Département de psychiatrie et de médecine addictologique, Hôpital Lariboisière-Fernand Widal, GHU NORD, Assistance Publique - Hôpitaux de Paris, Paris, France
- Université Paris Cité, Inserm UMRS1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France
- UFR Médecine, Université de Paris, Paris, France
- FHU NOR-SUD, Assistance Publique - Hôpitaux de Paris, Paris, France
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4
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Fitzpatrick-Schmidt T, Oral E, Welsh DA, Molina PE, Ferguson TF, Edwards S. Moderate-to-severe cognitive impairment is associated with both recent and chronic alcohol misuse in people with HIV: The New Orleans alcohol use in HIV (NOAH) study. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:1405-1416. [PMID: 38825691 DOI: 10.1111/acer.15378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 04/21/2024] [Accepted: 05/06/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) profoundly impacts the nervous system, leading to neurological deficits including HIV-associated neurocognitive disorder (HAND). HAND represents the most common neurological comorbidity among people with HIV (PWH), and alcohol use may exacerbate cognitive deficits, especially in vulnerable populations. This study investigated relationships between alcohol use and cognition in an underserved cohort of PWH, on the hypothesis that alcohol misuse exacerbates cognitive deficits. METHODS Data collected from participants (n = 259; 66.7% male; mean age 52 ± 10 years) enrolled in the New Orleans Alcohol Use in HIV (NOAH) study were utilized for cross-sectional analysis. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), and alcohol use was comprehensively measured using four metrics: the Alcohol Use Disorders Identification Test (AUDIT), 30-day timeline follow back (TLFB), lifetime drinking history, and phosphatidylethanol (PEth) levels. RESULTS The average MoCA score among participants was 20.7 ± 4.5, with 86.5% demonstrating cognitive impairment (MoCA < 26). Individuals with MoCA scores below 18 (moderately or severely cognitively impaired) had a higher frequency of recent severe alcohol misuse and greater lifetime alcohol consumption. Participants at increased risk for AUD (AUDIT ≥ 16) also had worse global cognition and memory task performance than those with lower AUDIT scores; this was particularly true among those aged 50 and older. Analysis of the MoCA sub-score data indicated that participants with increased AUD risk had impairments in the cognitive domains of language and memory. CONCLUSIONS Our findings demonstrate a high prevalence of cognitive impairment in the NOAH cohort and suggest that alcohol misuse contributes to global cognitive deficits in PWH, especially among individuals aged 50 and older. Further exploration of the impact of alcohol use on specific cognitive domains, including memory and language, should incorporate additional cognitive tasks. These findings highlight the importance of considering alcohol use and AUD risk as significant factors that may exacerbate cognitive deficits in vulnerable populations, including older PWH.
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Affiliation(s)
- Taylor Fitzpatrick-Schmidt
- Comprehensive Alcohol-HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Department of Physiology, School of Medicine, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Alcohol & Drug Abuse Center of Excellence, LSU Health Sciences Center, New Orleans, Louisiana, USA
| | - Evrim Oral
- Comprehensive Alcohol-HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Biostatistics, School of Public Health, LSU Health Sciences Center, New Orleans, Louisiana, USA
| | - David A Welsh
- Comprehensive Alcohol-HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Alcohol & Drug Abuse Center of Excellence, LSU Health Sciences Center, New Orleans, Louisiana, USA
| | - Patricia E Molina
- Comprehensive Alcohol-HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Department of Physiology, School of Medicine, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Alcohol & Drug Abuse Center of Excellence, LSU Health Sciences Center, New Orleans, Louisiana, USA
| | - Tekeda F Ferguson
- Comprehensive Alcohol-HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Department of Physiology, School of Medicine, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Alcohol & Drug Abuse Center of Excellence, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Epidemiology, School of Public Health, LSU Health Sciences Center, New Orleans, Louisiana, USA
| | - Scott Edwards
- Comprehensive Alcohol-HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Department of Physiology, School of Medicine, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Alcohol & Drug Abuse Center of Excellence, LSU Health Sciences Center, New Orleans, Louisiana, USA
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5
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Teixeira J, Pinheiro M, Pereira GÁ, Nogueira P, Guerreiro M, Castanho M, do Couto FS. Predicting alcohol relapse post-detoxification: The role of cognitive impairments in alcohol use disorder patients. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:918-927. [PMID: 38494444 DOI: 10.1111/acer.15302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/21/2024] [Accepted: 02/29/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Studies on early abstinence suggest that cognitive function is significantly reduced in the first year of abstinence, which raises the question of whether it is relevant to early relapse in patients with substance use disorders. This study investigates the extent to which impairments in executive function and memory predict alcohol relapse in patients with alcohol use disorder (AUD). Understanding these relationships is crucial for improving therapeutic approaches to prevent relapse in patients with AUD. METHODS We selected 116 adult patients (79 male and 37 female) diagnosed with AUD based on DSM-5 criteria, all of whom were undergoing alcohol detoxification treatment. A comprehensive array of neuropsychological tests was administered to assess global cognition, memory, and executive functions. Patients' alcohol use was monitored monthly during a 6-month follow-up period. Logistic regression and Cox regression were used to explore the relationship between cognitive function and the likelihood of alcohol relapse. RESULTS Impairments in global cognition, semantic and phonemic fluency, cognitive flexibility, and learning ability during detoxification were significant predictors of relapse in AUD patients, showing similar predictive values at both 3 and 6 months post-treatment. An abnormal Montreal Cognitive Assessment (MoCA) score increased the risk of relapse by 123% (HR: 2.227), and impairments in both semantic and phonemic fluency each increased the risk by 142% (HR: 2.423). Additionally, abnormal performance on the MoCA, Trail Making Test Part B (TMT-B), and California Verbal Learning Test (CVLT) was associated with a higher number of drinking days at 3 months (IRR: 3.764; IRR: 2.237; IRR: 2.738, respectively) and abnormal MoCA and TMT-B scores at 6 months (IRR: 2.451; IRR: 1.859, respectively). CONCLUSIONS The MoCA test is a valuable tool for predicting relapse risk in AUD patients undergoing detoxification treatment, with similar predictive value for relapse at 3 or 6 months. Learning ability needs to be assessed and their impairments considered in the treatment of AUD patients. Future research should explore strategies for managing patients with impairments in memory and learning ability to enhance treatment effectiveness and prevent relapse.
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Affiliation(s)
- Joana Teixeira
- Unidade de Alcoologia e Novas Dependências, Centro Hospitalar Psiquiátrico de Lisboa, Lisbon, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | | | - Gabriela Álvares Pereira
- Unidade de Neuropsicologia, Centro Hospitalar Psiquiátrico de Lisboa, Lisbon, Portugal
- Faculty of Human Sciences, Católica Research Centre for Psychological, Family and Social Wellbeing (CRC-W), Universidade Católica Portuguesa, Lisbon, Portugal
| | - Paulo Nogueira
- NOVA National School of Public Health, Public Health Research Center, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
- Instituto de Saúde Ambiental, Faculdade de Medicina Universidade de Lisboa, Lisbon, Portugal
- Laboratório para a Sustentabilidade do Uso da Terra e dos Serviços dos Ecossistemas - TERRA, Lisbon, Portugal
- CIDNUR - Centro de Investigação, Inovação e Desenvolvimento em Enfermagem de Lisboa, Escola Superior de Enfermagem de Lisboa, Lisbon, Portugal
| | | | - Miguel Castanho
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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Deng M, Wang G, Gao X, Wang Y, Ni Y, Chen Y, Xu J, Jiang W. The nonlinear association between HbA1c and cognitive impairment in patients with alcohol use disorder. J Addict Dis 2024; 42:5-13. [PMID: 36094304 DOI: 10.1080/10550887.2022.2120791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Background: Extensive research has indicated that higher levels of glycated hemoglobin (HbA1c) are associated with poor cognitive performance regardless of the presence of diabetes. To our knowledge, the association between HbA1c levels and cognitive decline in patients with alcohol use disorder is not well understood. This study aimed to investigate whether HbA1c was associated with cognitive impairment in patients with alcohol use disorder. Methods: Patients admitted to the Psychiatry Department of the Third Hospital of Quzhou with a confirmed diagnosis of alcohol-related cognitive impairment were recruited between January 2019 and February 2022. Their HbA1c levels were measured, and they completed the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) after at least one week of monitored abstinence from alcohol. Univariate linear regression, multivariate linear regression and generalized additive models (GAMs) were used to investigate the association of HbA1c with MMSE and MoCA scores. Results: In total, 227 patients were included. Univariate and multivariate regression analyses suggested that HbA1c was negatively associated with MMSE and MoCA scores after adjustment for potential confounders (P < 0.05). The GAM analysis revealed that the relationships between the HbA1c level and the MMSE and MoCA scores were bell-shaped. The inflection points were 5.3% and 5.2% for the MMSE and MoCA respectively. Conclusion: The results of this study suggest that HbA1c levels are significantly related to cognitive impairment in patients with alcohol use disorder. Future studies are required to determine the effects of optimal glucose control in people with alcohol use disorder.
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Affiliation(s)
- Mengling Deng
- Graduate School, Zhejiang Chinese Medical University, Hangzhou, China
- Department of Psychiatry, The Third Hospital of Quzhou, Quzhou, China
| | - Guomin Wang
- Department of Psychiatry, The Third Hospital of Quzhou, Quzhou, China
| | - Xiaofeng Gao
- Department of Psychiatry, The Third Hospital of Quzhou, Quzhou, China
| | - Yan Wang
- Department of Psychiatry, The Third Hospital of Quzhou, Quzhou, China
| | - Yanfei Ni
- Department of Psychiatry, The Third Hospital of Quzhou, Quzhou, China
| | - Yunyu Chen
- Department of Psychiatry, The Third Hospital of Quzhou, Quzhou, China
| | - Jiating Xu
- Department of Psychiatry, The Third Hospital of Quzhou, Quzhou, China
| | - Weifeng Jiang
- College of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, China
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7
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Crosnier Leconte G, Clergue-Duval V, Bloch V, Barre T, Amami J, Bellivier F, Questel F, Vorspan F, Icick R. Prevalence of benzodiazepine use disorder during hospitalization for alcohol detoxification. Fundam Clin Pharmacol 2023. [PMID: 36878490 DOI: 10.1111/fcp.12888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 01/07/2023] [Accepted: 02/21/2023] [Indexed: 03/08/2023]
Abstract
Benzodiazepines (BZDs) are the first-line treatment of alcohol withdrawal. Comorbidity between benzodiazepine use disorder (BUD) and alcohol use disorders (AUD) is common. However, the risk factors are poorly characterized due to the paucity of available BUD screening tools. The present study aimed to rectify this by conducting an observational screening investigation for BUD in patients hospitalized for alcohol detoxification in a specialized unit. During a face-to-face interview, a short BUD screening tool, Echelle Cognitive d'Attachement aux benzodiazépines (ECAB), was administered to record recent patterns of BZD use, thereby allowing categorization of AUD patients as follows: non-BZD users, BZD users without BUD, and BUD (ECAB ≥6). Clinical and sociodemographic risk factors were identified and recorded during clinical assessment and were analyzed using nonparametric bivariate tests and multinomial regression for association with BUD, with p < 0.05 for significance. Of the 150 AUD patients, 23 (15%) had comorbid BUD. Several variables were associated with ECAB score, with their independence being verified using multinomial regression, with lower risk of BUD versus BZD use, when the initial prescriber was an addiction specialist compared with a psychiatrist or a general practitioner [odds ratio (OR) = 0.12, 95% confidence interval (CI) = 0.14-0.75]. A higher risk of BZD use versus no use was evident when comorbid psychiatric disorders were present (OR = 9.2, 95%CI = 1.3-65). Our findings raise clinicians' awareness that in patients hospitalized for alcohol detoxification, BUD is highly prevalent but not specifically related to psychiatric disorders. BUD can be effectively screened by utilization of the ECAB.
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Affiliation(s)
- Gilles Crosnier Leconte
- Assistance Publique-Hôpitaux de Paris, GHU APHP. Nord DMU Neurosciences, Paris, France.,Université de Paris Cité, INSERM UMR-S 1144, Paris, France.,FHU NOR-SUD Network of Research in Substance Use Disorders, Paris, France
| | - Virgile Clergue-Duval
- Assistance Publique-Hôpitaux de Paris, GHU APHP. Nord DMU Neurosciences, Paris, France.,Université de Paris Cité, INSERM UMR-S 1144, Paris, France.,FHU NOR-SUD Network of Research in Substance Use Disorders, Paris, France
| | - Vanessa Bloch
- Université de Paris Cité, INSERM UMR-S 1144, Paris, France.,FHU NOR-SUD Network of Research in Substance Use Disorders, Paris, France.,Assistance Publique-Hôpitaux de Paris, GHU APHP. Nord, DMU Pharmacie Hospitalière, DMU Biologie-Génétique-PUI, Paris, France
| | - Thomas Barre
- Assistance Publique-Hôpitaux de Paris, GHU APHP. Nord DMU Neurosciences, Paris, France
| | - Jihed Amami
- Assistance Publique-Hôpitaux de Paris, GHU APHP. Nord DMU Neurosciences, Paris, France
| | - Frank Bellivier
- Assistance Publique-Hôpitaux de Paris, GHU APHP. Nord DMU Neurosciences, Paris, France.,Université de Paris Cité, INSERM UMR-S 1144, Paris, France.,FHU NOR-SUD Network of Research in Substance Use Disorders, Paris, France
| | - Frank Questel
- Assistance Publique-Hôpitaux de Paris, GHU APHP. Nord DMU Neurosciences, Paris, France.,Université de Paris Cité, INSERM UMR-S 1144, Paris, France.,FHU NOR-SUD Network of Research in Substance Use Disorders, Paris, France
| | - Florence Vorspan
- Assistance Publique-Hôpitaux de Paris, GHU APHP. Nord DMU Neurosciences, Paris, France.,Université de Paris Cité, INSERM UMR-S 1144, Paris, France.,FHU NOR-SUD Network of Research in Substance Use Disorders, Paris, France
| | - Romain Icick
- Assistance Publique-Hôpitaux de Paris, GHU APHP. Nord DMU Neurosciences, Paris, France.,Université de Paris Cité, INSERM UMR-S 1144, Paris, France.,FHU NOR-SUD Network of Research in Substance Use Disorders, Paris, France
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8
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Jones L, Owens L, Thompson A, Gilmore I, Richardson P. Informing the development of diagnostic criteria for differential diagnosis of alcohol-related cognitive impairment (ARCI) among heavy drinkers: A systematic scoping review. PLoS One 2023; 18:e0280749. [PMID: 36753517 PMCID: PMC9907814 DOI: 10.1371/journal.pone.0280749] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 01/08/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Early detection and diagnosis of alcohol-related cognitive impairment (ARCI) among heavy drinkers is crucial to facilitating appropriate referral and treatment. However, there is lack of consensus in defining diagnostic criteria for ARCI. Uncertainty in attributing a diagnosis of suspected ARCI commonly arises in clinical practice and opportunities to intervene are missed. A systematic scoping review approach was taken to (i) summarise evidence relating to screening or diagnostic criteria used in clinical studies to detect ARCI; and (ii) to determine the extent of the research available about cognitive assessment tools used in 'point-of-care' screening or assessment of patients with suspected non-Korsakoff Syndrome forms of ARCI. METHODS We searched Medline, PsycINFO, Cinahl and the Web of Science, screened reference lists and carried out forward and backwards citation searching to identify clinical studies about screening, diagnosis or assessment of patients with suspected ARCI. RESULTS In total, only 7 studies met our primary objective and reported on modifications to existing definitions or diagnostic criteria for ARCI. These studies revealed a lack of coordinated research and progress towards the development and standardisation of diagnostic criteria for ARCI. Cognitive screening tools are commonly used in practice to support a diagnosis of ARCI, and as a secondary objective we included an additional 12 studies, which covered a range of settings and patient populations relevant to screening, diagnosis or assessment in acute, secondary or community 'point-of-care' settings. Across two studies with a defined ARCI patient sample and a further four studies with an alcohol use disorder patient sample, the accuracy, validity and/or reliability of seven different cognitive assessment tools were examined. The remaining seven studies reported descriptive findings, demonstrating the lack of evidence available to draw conclusions about which tools are most appropriate for screening patients with suspected ARCI. CONCLUSION This review confirms the scarcity of evidence available on the screening, diagnosis or assessment of patients with suspected ARCI. The lack of evidence is an important barrier to the development of clear guidelines for diagnosing ARCI, which would ultimately improve the real-world management and treatment of patients with ARCI.
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Affiliation(s)
- Lisa Jones
- Liverpool Centre for Alcohol Research, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
- Public Health Institute, Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
- * E-mail:
| | - Lynn Owens
- Liverpool Centre for Alcohol Research, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
- Department of Gastroenterology and Hepatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Andrew Thompson
- Liverpool Centre for Alcohol Research, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Ian Gilmore
- Liverpool Centre for Alcohol Research, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Paul Richardson
- Liverpool Centre for Alcohol Research, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
- Department of Gastroenterology and Hepatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
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9
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Screening Tools for Cognitive Impairment in Adults with Substance Use Disorders: A Systematic Review. J Int Neuropsychol Soc 2022; 28:756-779. [PMID: 34433502 DOI: 10.1017/s135561772100103x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Cognitive impairment is common in individuals with substance use disorders (SUDs), yet no evidence-based guidelines exist regarding the most appropriate screening measure for use in this population. This systematic review aimed to (1) describe different cognitive screening measures used in adults with SUDs, (2) identify substance use populations and contexts these tools are utilised in, (3) review diagnostic accuracy of these screening measures versus an accepted objective reference standard, and (4) evaluate methodology of included studies for risk of bias. METHODS Online databases (PsycINFO, MEDLINE, Embase, and CINAHL) were searched for relevant studies according to pre-determined criteria, and risk of bias and applicability was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). At each review phase, dual screening, extraction, and quality ratings were performed. RESULTS Fourteen studies met inclusion, identifying 10 unique cognitive screening tools. The Montreal Cognitive Assessment (MoCA) was the most common, and two novel screening tools (Brief Evaluation of Alcohol-Related Neuropsychological Impairments [BEARNI] and Brief Executive Function Assessment Tool [BEAT]) were specifically developed for use within SUD populations. Twelve studies reported on classification accuracy and relevant psychometric parameters (e.g., sensitivity and specificity). While several tools yielded acceptable to outstanding classification accuracy, there was poor adherence to the Standards for Reporting Diagnostic Accuracy Studies (STARD) across all studies, with high or unclear risk of methodological bias. CONCLUSIONS While some screening tools exhibit promise for use within SUD populations, further evaluation with stronger methodological design and reporting is required. Clinical recommendations and future directions for research are discussed.
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10
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Feng Z, Wu Q, Wu L, Zeng T, Yuan J, Wang X, Kang C, Yang J. Effect of High-Frequency Repetitive Transcranial Magnetic Stimulation on Visual Selective Attention in Male Patients With Alcohol Use Disorder After the Acute Withdrawal. Front Psychiatry 2022; 13:869014. [PMID: 35573341 PMCID: PMC9098796 DOI: 10.3389/fpsyt.2022.869014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/25/2022] [Indexed: 11/20/2022] Open
Abstract
Objective To investigate the effect of high-frequency repetitive transcranial magnetic stimulation (rTMS) on attention cue reactivity in male patients with alcohol use disorder (AUD) after acute withdrawal. Methods A total of 90 male patients with AUD who were hospitalized were enrolled and divided into study and waiting groups by a random number table. During the study, 18 patients dropped out. After the alcohol withdrawal symptoms were eliminated, the study group received high-frequency rTMS at 10 Hz for 14 consecutive days, and the waiting group was administrated by sham rTMS. All subjects were evaluated for attention cue reactivity, impulsiveness, cognitive function by oddball paradigm, Barratt Impulsiveness Scale version II (BIS-II), and the Montreal Cognitive Assessment (MoCA) at baseline and after true or sham rTMS. Results 1. There was no significant difference between the study and the waiting groups regarding the drinking level, cognition level, and demographic data at baseline. 2. In the oddball paradigm, both for alcohol-related and non-alcohol-related cues, the response times were significantly shorter in the study group after rTMS treatment than in the waiting-for-treatment group, either between the two groups or within the study group. There was no significant difference in the accuracy rate for alcohol-related and non-alcohol-related cues between the two groups or within the study group after rTMS intervention. 3. The total score of MoCA was significantly increased, and the total score of BIS-II was significantly decreased in the study group after rTMS treatment, either between the two groups or within the study group. Conclusion The results suggested that high-frequency rTMS could improve the attention bias of alcohol-related cues and impulsivity for patients with AUD.
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Affiliation(s)
- Zuxing Feng
- Department of Psychiatry, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Qiao Wu
- Department of Psychiatry, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Li Wu
- Department of Substance use Disorders, the Psychiatry Hospital of Yunnan, Kunming, China
| | - Tingting Zeng
- Department of Psychiatry, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jing Yuan
- Department of Psychiatry, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xin Wang
- Department of Psychiatry, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Chuanyuan Kang
- Department of Psychosomatic Medicine, Tongji University School of Medicine, Shanghai East Hospital, Shanghai, China
| | - Jianzhong Yang
- Department of Psychiatry, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
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11
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Fatkin T, Moore SK, Okst K, Creedon TB, Samawi F, Fredericksen AK, Roll D, Oxnard A, Lê Cook B, Schuman-Olivier Z. Feasibility and acceptability of mindful recovery opioid use care continuum (M-ROCC): A concurrent mixed methods study. J Subst Abuse Treat 2021; 130:108415. [PMID: 34118705 PMCID: PMC8478704 DOI: 10.1016/j.jsat.2021.108415] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 11/19/2022]
Abstract
As opioid overdose deaths increase, buprenorphine/naloxone (B/N) treatment is expanding, yet almost half of patients are not retained in B/N treatment. Mindfulness-based interventions (MBIs) designed to promote non-judgmental awareness of present moment experience may be complementary to B/N treatment and offer the potential to enhance retention by reducing substance use and addressing comorbid symptoms. In this pilot study, we examined the feasibility and acceptability of the Mindful Recovery OUD Care Continuum (M-ROCC), a trauma-informed, motivationally sensitive, 24-week MBI. Participants (N = 18) were adults with Opioid Use Disorder prescribed B/N. The study team conducted assessments of satisfaction, mindfulness levels, and home practice, as well as qualitative interviews at 4 and 24-weeks. M-ROCC was feasible in a sample with high rates of childhood trauma and comorbid psychiatric diagnoses with 89% of participants retained at 4-weeks and 72% at 24-weeks. Positive qualitative interview responses and a high rate of participants willing to refer a friend (100%) demonstrates program acceptability. Participant mindfulness increased from baseline to 24-weeks (β = 0.24, p = 0.001, d = 0.51), and increases were correlated with informal mindfulness practice frequency (r = 0.7, p < 0.01). Although limited by small sample size, this pilot study highlights the feasibility and acceptability of integrating MBIs into standard primary care Office-Based Opioid Treatment (OBOT) among a population with substantial trauma history.
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Affiliation(s)
- Thomas Fatkin
- Cambridge Health Alliance, Cambridge, MA, United States of America.
| | - Sarah K Moore
- Geisel School of Medicine at Dartmouth College, Hanover, NH, United States of America.
| | - Kayley Okst
- Cambridge Health Alliance, Cambridge, MA, United States of America.
| | - Timothy B Creedon
- Harvard Medical School, Boston, MA, United States of America; Cambridge Health Alliance, Cambridge, MA, United States of America.
| | - Farah Samawi
- Cambridge Health Alliance, Cambridge, MA, United States of America.
| | | | - David Roll
- Harvard Medical School, Boston, MA, United States of America; Cambridge Health Alliance, Cambridge, MA, United States of America.
| | - Alexandra Oxnard
- Harvard Medical School, Boston, MA, United States of America; Cambridge Health Alliance, Cambridge, MA, United States of America.
| | - Benjamin Lê Cook
- Harvard Medical School, Boston, MA, United States of America; Cambridge Health Alliance, Cambridge, MA, United States of America.
| | - Zev Schuman-Olivier
- Harvard Medical School, Boston, MA, United States of America; Cambridge Health Alliance, Cambridge, MA, United States of America; Geisel School of Medicine at Dartmouth College, Hanover, NH, United States of America.
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12
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Bruijnen CJWH, Walvoort SJW, Dijkstra BAG, de Jong CAJ, Kessels RPC. The Course of Cognitive Performance during Inpatient Treatment in Patients with Alcohol Use Disorder with No, Mild or Major Neurocognitive Disorders. Alcohol Alcohol 2021; 56:89-100. [PMID: 33089302 PMCID: PMC7768622 DOI: 10.1093/alcalc/agaa100] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 11/25/2022] Open
Abstract
Aims In patients with a history of chronic alcohol abuse, neurocognitive disorders (NCD) are not uncommon. The current study aimed to explore the course of cognitive performance, as measured by the Montreal Cognitive Assessment (MoCA), and everyday cognitive functioning, as measured by the Patient Competency Rating Scale (PCRS), in a large group of patients with alcohol use disorder (AUD) admitted to the Center of Excellence for Korsakov and Alcohol-related Cognitive Impairments. Methods A multiple time-series design was used, in which the MoCA was administered at three time points of assessment, and the PCRS was completed by both the patient and a clinician at two time points, all during clinical treatment. Results A total of 524 patients were included, 71 of whom were diagnosed with AUD only, 284 with AUD and mild NCD (ARCI) and 169 with AUD, major NCD and fulfilling criteria for Korsakoff’s syndrome (KS). Conclusions Cognitive performance improved for all three groups during treatment, sustained abstinence and recovery from AUD. A low memory performance on the MoCA without improvement over time was predictive for KS, while improvement on this domain did not differentiate between AUD and ARCI. Changes in overall cognitive performance and orientation in patients with KS were positively related to changes in everyday cognitive functioning.
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Affiliation(s)
- C J W H Bruijnen
- Center of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, Vincent van Gogh Institute for Psychiatry, 5800 Venray, The Netherlands.,Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University, 6500 Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6500 Nijmegen, The Netherlands
| | - S J W Walvoort
- Center of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, Vincent van Gogh Institute for Psychiatry, 5800 Venray, The Netherlands.,Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University, 6500 Nijmegen, The Netherlands
| | - B A G Dijkstra
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University, 6500 Nijmegen, The Netherlands.,Novadic-Kentron, Addiction Care Center, 5260 Vught, The Netherlands
| | - C A J de Jong
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University, 6500 Nijmegen, The Netherlands.,Behavioural Science Institute, Radboud University, 6500 Nijmegen, The Netherlands
| | - R P C Kessels
- Center of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, Vincent van Gogh Institute for Psychiatry, 5800 Venray, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6500 Nijmegen, The Netherlands.,Department of Medical Psychology, Radboud University Medical Center, 6500 Nijmegen, The Netherlands
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13
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Delonca D, Trouillet R, Alarcon R, Nalpas B, Perney P. Relationships between Attentional Bias and craving in Alcohol Use Disorder: Role of metacognitions. Addict Behav 2021; 117:106846. [PMID: 33548679 DOI: 10.1016/j.addbeh.2021.106846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/21/2021] [Accepted: 01/21/2021] [Indexed: 11/16/2022]
Abstract
Researchers have claimed that craving and Attentional Bias (AB) towards alcohol-related cues can be explained by a common incentive-salience mechanism. However, the exact relationship between AB and craving is a matter of debate. The aim of this study was to show that metacognitions moderate the effect of AB on craving. A sample of 38 alcohol abusers undergoing post-withdrawal treating in a hospital setting completed the visual Dot Probe Detection Task (DPDT), while both pre- and post-task measures of craving were recorded. Our results confirmed significant effects of both exposure to pictures of alcohol, and metacognitions, on craving; in particular, the interaction Metacognition * DPDT was significant. Although we initially confirmed a significant main effect of AB on craving, it became non-significant when adjusted for inter-subject variance, and metacognitions. The effect of the interaction AB * Metacognition on craving was not significant. Our findings support the hypothesis that craving and AB share variance, but the relationship appears to be spurious, and caused by confounding factors. We discuss these results with reference to the metacognitive model of addiction.
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Affiliation(s)
- Damien Delonca
- Laboratory Epsylon (EA4556), University of Paul Valéry Montpellier 3, Montpellier, France
| | - Raphaël Trouillet
- Laboratory Epsylon (EA4556), University of Paul Valéry Montpellier 3, Montpellier, France.
| | - Régis Alarcon
- Addictions Department, Hôpital du Grau du Roi, CHU Caremeau, Nîmes, France
| | - Bertrand Nalpas
- Addictions Department, Hôpital du Grau du Roi, CHU Caremeau, Nîmes, France; Department of Scientific Information and Communication (DISC), Inserm, Paris, France
| | - Pascal Perney
- Addictions Department, Hôpital du Grau du Roi, CHU Caremeau, Nîmes, France; Inserm U1018, Hôpital Paul Brousse, Villejuif, France
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Role of Patient Sex in Early Recovery from Alcohol-Related Cognitive Impairment: Women Penalized. J Clin Med 2019; 8:jcm8060790. [PMID: 31167412 PMCID: PMC6617550 DOI: 10.3390/jcm8060790] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/13/2019] [Accepted: 05/31/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The objective was to explore the role of patient sex in cognitive recovery and to identify predictive factors for non-recovery in alcohol use disorder (AUD). METHODS All patients with AUD admitted to a residential addictions treatment center were systematically assessed at admission and after 6 weeks of abstinence in a controlled environment. The inclusion criteria were that patients were admitted for AUD with baseline alcohol-related cognitive impairment (baseline total Montreal Cognitive Assessment (MoCA) score < 26) and reassessed at 6 weeks (n = 395). A logistic regression model was built to determine the influence of sex on recovery status (MoCA < or ≥ 26) taking into account the interaction effect of sex with alcohol consumption on cognitive function. RESULTS The mean age was 50.10 years (SD = 9.79), and 27.41% were women. At baseline, the mean MoCA scores were 21.36 (SD = 3.04). Participants who did not achieve recovery (59.3% of women vs 53.8% of men) had lower total MoCA scores at baseline. The 2 factors that was significantly and independently associated with non-recovery and with a non-zero coefficient was being a woman and initial MoCA score (respective adjusted odds ratios (AOR) = 1.5 and 0.96, p-values < 0.05). CONCLUSIONS These results could influence the time required in a controlled environment to maintain abstinence and the duration of in-care for women.
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15
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Psychiatric comorbidities associated with a positive screening using the Montreal Cognitive Assessment (MoCA) test in subjects with severe alcohol use disorder. Drug Alcohol Depend 2018; 191:266-269. [PMID: 30153608 DOI: 10.1016/j.drugalcdep.2018.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 07/03/2018] [Accepted: 07/09/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Patients with severe alcohol use disorder (SAUD) frequently show cognitive deficits that can be efficiently identified using screening tools such as the Montreal Cognitive Assessment (MoCA) test. These cognitive deficits, which reduce the efficacy of therapeutic interventions and may contribute to dropout and relapse, could be, however, partly due to a treatable other cause. Accordingly, this exploratory study examined whether psychiatric comorbid disorders can induce a positive MoCA screening among recently detoxified SAUD subjects. METHODS One hundred recently detoxified patients with SAUD were divided into two groups according to whether they presented cognitive deficits using the MoCA. Groups were compared for demographic data, SAUD severity, impulsivity, and psychiatric comorbidities. The significant parameters were then introduced in a logistic regression model to establish their relative contributions in a positive MoCA status in SAUD subjects. RESULTS Among the significant parameters revealed by the bivariable analyses, agoraphobia and current depressive episode were found to be significant predictors of the MoCA status in the multivariable comparisons. CONCLUSIONS A positive MoCA screening for cognitive impairments among post-detoxification SAUD patients could also be related to comorbid agoraphobia and depressive episode rather than to SAUD itself. A comprehensive psychiatric assessment must be performed in SAUD patients so that other potential causes of cognitive deficits, in particular with regard to mood and anxiety disorders, can be identified and treated.
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16
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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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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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