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Gooden JR, Cox CA, Petersen V, Curtis A, Sanfilippo PG, Manning V, Bolt GL, Lubman DI. Predictors of cognitive functioning in presentations to a community-based specialist addiction neuropsychology service. BRAIN IMPAIR 2023; 24:54-68. [PMID: 38167583 DOI: 10.1017/brimp.2021.38] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Cognitive impairment is common in individuals presenting to alcohol and other drug (AOD) settings and the presence of biopsychosocial complexity and health inequities can complicate the experience of symptoms and access to treatment services. A challenge for neuropsychologists in these settings is to evaluate the likely individual contribution of these factors to cognition when providing an opinion regarding diagnoses such as acquired brain injury (ABI). This study therefore aimed to identify predictors of cognitive functioning in AOD clients attending for neuropsychological assessment. METHODS Clinical data from 200 clients with AOD histories who attended for assessment between 2014 and 2018 were analysed and a series of multiple regressions were conducted to explore predictors of cognitive impairment including demographic, diagnostic, substance use, medication, and mental health variables. RESULTS Regression modelling identified age, gender, years of education, age of first use, days of abstinence, sedative load, emotional distress and diagnoses of ABI and developmental disorders as contributing to aspects of neuropsychological functioning. Significant models were obtained for verbal intellectual functioning (Adj R2 = 0.19), nonverbal intellectual functioning (Adj R2 = 0.10), information processing speed (Adj R2 = 0.20), working memory (Adj R2 = 0.05), verbal recall (Adj R2 = 0.08), visual recall (Adj R2 = 0.22), divided attention (Adj R2 = 0.14), and cognitive inhibition (Adj R2 = 0.07). CONCLUSIONS These findings highlight the importance of careful provision of diagnoses in clients with AOD histories who have high levels of unmet clinical needs. They demonstrate the interaction of premorbid and potentially modifiable comorbid factors such as emotional distress and prescription medication on cognition. Ensuring that modifiable risk factors for cognitive impairment are managed may reduce experiences of cognitive impairment and improve diagnostic clarity.
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Affiliation(s)
- James R Gooden
- Turning Point, Eastern Health, Richmond, VIC, Australia
- The National Centre for Clinical Research on Emerging Drugs (NCCRED), University of New South Wales, Sydney, NSW, Australia
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia
| | | | | | - Ashlee Curtis
- Centre for Drug Use, Addiction, and Anti-Social Behaviour Research, School of Psychology, Deakin University, Geelong, VIC, Australia
| | | | - Victoria Manning
- Turning Point, Eastern Health, Richmond, VIC, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia
| | | | - Dan I Lubman
- Turning Point, Eastern Health, Richmond, VIC, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia
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Shirley K, O’Neil M, Boyd S, Loftis JM. Differences in rates of impairment in adults who use methamphetamine using two sets of demographically corrected norms. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-9. [PMID: 36668907 PMCID: PMC10356906 DOI: 10.1080/23279095.2022.2164197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Neuropsychologists can expect to meet with increasing rates of patients who use methamphetamine (MA), as MA use is on the rise, often comorbid with other substance use disorders, and frequently accompanied by changes in cognitive functioning. To detect impairment, neuropsychologists must apply the appropriate normative data according to important demographic factors such as age, sex, and education. This study involved 241 adults with and without MA dependence who were administered the Neuropsychological Assessment Battery. Given the high rates of polysubstance use among adults who use MA, we included adults with mono-dependence and poly-dependence on MA and at least one other substance. We compared the rates of adults with and without previous MA dependence classified as impaired on neurocognitive testing when using norms corrected for age, education, and sex versus norms corrected only for age. Norms corrected for age, education, and sex resulted in less frequent identification of impairment compared to norms corrected only for age, but both sets of norms appeared sufficient and similar enough to warrant their use with this population. It may be appropriate to explore the possible implications of discrepancies between education-corrected and non-education corrected sets of scores when assessing impairment in individuals who use MA.
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Affiliation(s)
- Kate Shirley
- Research & Development Service, VA Portland Health Care System, Portland, OR, USA
- Department of Psychiatry, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Maya O’Neil
- Research & Development Service, VA Portland Health Care System, Portland, OR, USA
- Department of Psychiatry, School of Medicine, Oregon Health & Science University, Portland, OR, USA
- Mental Health & Clinical Neurosciences Division, VA Portland Health Care System, Portland, OR, USA
| | - Stephen Boyd
- Department of Anesthesiology and Perioperative Medicine, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Jennifer M. Loftis
- Research & Development Service, VA Portland Health Care System, Portland, OR, USA
- Department of Psychiatry, School of Medicine, Oregon Health & Science University, Portland, OR, USA
- Department of Behavioral Neuroscience, School of Medicine, Oregon Health & Science University, Portland, OR, USA
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Gooden JR, Petersen V, Bolt GL, Curtis A, Manning V, Cox CA, Lubman DI, Arunogiri S. Maybe It's Not the Meth: Considering Biopsychosocial Contributors to Cognitive Impairment in Methamphetamine Polydrug Use. Front Psychiatry 2022; 13:795400. [PMID: 35237189 PMCID: PMC8882579 DOI: 10.3389/fpsyt.2022.795400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/19/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE In considering the cognitive harms of methamphetamine (MA) use, there is currently a limited appreciation of the profile of pre-existing, comorbid, or modifiable risk factors for cognitive impairment in individuals with MA-polydrug use who present to clinical services. This is in contrast to the well-recognized evidence in alcohol use groups. The aim of this study was to investigate the biopsychosocial and neuropsychological profiles of MA-polysubstance using individuals reporting cognitive impairment in comparison to an alcohol-using group. METHODS A retrospective file audit was undertaken of individuals who presented for assessment to a specialist addiction neuropsychology service and reported either more than 1 year of heavy MA use as part of a polydrug use history (n = 40) or having only used alcohol (n = 27). Clinical histories including demographic, medical, mental health, substance use, and neuropsychological assessment results were extracted from medical records. Between group comparisons were conducted to explore differences in the MA-polydrug vs. the alcohol group. RESULTS Individuals in the MA-polydrug group were significantly younger, commenced substance use at an earlier age, were more likely to have an offending history, and experienced an overdose than those in the alcohol group. No differences in comorbid neurodevelopmental, psychiatric or acquired brain injury diagnoses were observed between groups. For neuropsychological functioning, significant group differences were observed in overall IQ, semantic verbal fluency, and psychomotor tracking, where individuals in the alcohol group performed significantly worse. CONCLUSIONS Neuropsychological profiles were largely equivalent between groups across cognitive domains, with minor differences in favor of the MA-polydrug group. Relative to the general population, cognitive functioning was reduced for both groups across a range of domains. High rates of comorbid mental health concerns were common across both groups, however, individuals in the MA-polydrug group presented with a higher risk of overall harm from substance use at a significantly younger age which is a unique concern for this group. These findings highlight the importance of considering the biopsychosocial factors, such as age of first use, emotional distress, indirect substance related harms including overdose and blood born virus infection that may be relevant to experiences of cognitive difficulty in MA-polydrug users.
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Affiliation(s)
- James R. Gooden
- Turning Point, Eastern Health, Richmond, VIC, Australia
- The National Centre for Clinical Research on Emerging Drugs, University of New South Wales, Sydney, NSW, Australia
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia
| | | | | | - Ashlee Curtis
- Centre for Drug Use, Addictive and Anti-Social Behaviour Research, School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Victoria Manning
- Turning Point, Eastern Health, Richmond, VIC, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia
| | | | - Dan I. Lubman
- Turning Point, Eastern Health, Richmond, VIC, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia
| | - Shalini Arunogiri
- Turning Point, Eastern Health, Richmond, VIC, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia
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Sullivan A, Ridley N, Monds LA, Logge W, Hurzeler T, Morley KC. Assessing the validity of the Wechsler Adult Intelligence Scale (WAIS-IV) in predicting completion in a long-term residential rehabilitation for substance use problems. APPLIED NEUROPSYCHOLOGY-ADULT 2021:1-6. [PMID: 34455866 DOI: 10.1080/23279095.2021.1967954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND We aimed to examine the predictive validity of the Weschler Adult Intelligence Scale (WAIS-IV) in predicting treatment completion, over and above educational status. METHODS One hundred and ninety-six (N = 196) individuals from the Odyssey House Residential Rehabilitation Program, NSW, Australia between 2010 and 2016 were administered a structured interview including substance use disorders and the Verbal Comprehension (VCI), Perceptual Reasoning (PRI), Working Memory (WMI), and Processing Speed (PSI) domains of the WAIS-IV. RESULTS There were significant differences between our clinical sample and the population norm with respect to the proportion below the mean for PSI (z = 12.27, p < .001), VCI (z = 2.33, p < .02) but not for WMI (z = 1.67, p < .10) or PRI (z = -1.76, p < .08). The WAIS-IV subscales did not significantly predict treatment completion (p's > .16) over and above educational status (p < .01). CONCLUSIONS Our findings suggest that in clients in drug and alcohol rehabilitation settings a combination of skills may be impacted including Verbal Comprehension and Processing Speed. Moreover, our findings also suggest that WAIS-IV subscales do not predict treatment completion in a drug and alcohol residential setting, over and above a brief assessment of educational status.
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Affiliation(s)
| | - Nicole Ridley
- The Langton Centre, South Eastern Local Health District, Sydney, Australia
| | - Lauren A Monds
- Specialty of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Northern Sydney Local Health District, Drug and Alcohol Services, Sydney, Australia
| | - Warren Logge
- Specialty of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney, Australia
| | - Tristan Hurzeler
- Specialty of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney, Australia
| | - Kirsten C Morley
- Specialty of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney, Australia
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