Using the Trail Making test to screen for cognitive impairment in a drug abuse treatment sample

Heroin use and neuropsychological impairments: comparison of intravenous and inhalational use

BACKGROUND AND OBJECTIVES

Injection and inhalational heroin use are associated with different levels of brain exposure to heroin and its metabolites and differences in the severity of dependence, which might lead to differential impacts on neuropsychological functions. We examined the difference and the magnitude of difference in the neuropsychological functions between inhalational and injection heroin-dependent subjects and also compared them with healthy controls.

METHODS

The study sample comprised three groups: 73 subjects with injection heroin dependence, 74 with inhalational heroin dependence, and 75 healthy controls (HC). We excluded patients with HIV, head injury, epilepsy, and severe mental illness. Neuropsychological assessments were done by Standard Progressive Matrices, Wisconsin Card Sorting Test (WCST), Iowa Gambling Task, Trail-Making Tests A and B (TMT), and Verbal and Visual Memory 1 and 2 Backtests (NBT). We estimated independent effects of the groups on various neuropsychological test parameters, adjusted for age and duration of dependence.

RESULTS

In the WCST, the inhalational heroin-dependent group took more trials to complete the first category and had higher scores in the failure to maintain set than controls. The intravenous group had higher total errors than controls in verbal working memory tests and Visual Working Memory 2 Backtest. This group scored higher commission errors in the Verbal 2 Backtest than the controls. The two groups of heroin users differed in failure to maintain set and Verbal Working Memory 2 Backtests. The effect sizes of the group differences were modest.

CONCLUSION AND SCIENTIFIC SIGNIFICANCE

Either route of heroin use is associated with cognitive impairments; inhalational and injection use involve different cognitive domains.

Drug Trend Study in Mexican Population: Consumption and Cognitive Dysfunction Correlates

Introduction: Drug abuse screening tests (DAST) are a useful tool in decision making regarding the planning and implementation of drug-related public health policies. In addition, they constitute a rapid way to obtain data on the effects of drug consumption in specific populations.Objective: To describe the correlation between drug abuse (per type of drug) and cognitive dysfunction prevalence based on the information reported in a DAST.Materials and methods: A DAST was administered to 1299 individuals from 5 cities in Baja California, Mexico. In addition, an internal consistency reliability test was conducted to determine the internal consistency level of the instrument.Results: Several correlations between the consumption of different drugs were found. The main associations were found between methamphetamine and marijuana consumption. In addition, a positive correlation between the age at first drug use and cognitive impairment was found.Conclusions: DAST are brief administration instruments that allow obtaining data on drug abuse and drug addiction patterns. In addition, they can be used to identify the interaction between the consumption patterns of different drugs and the possible association between age at first drug use and cognitive dysfunction.

The impact of early-onset cannabis use on functional brain correlates of working memory

Cannabis is the most commonly used illicit drug. Prevalence rates are particularly high among adolescents. Neuropsychological studies have identified cannabis-associated memory deficits, particularly linked to an early onset of use. However, it remains unclear, whether the age of onset accounts for altered cortical activation patterns usually observed in cannabis users. Functional magnetic resonance imaging was used to examine cortical activation during verbal working memory challenge in (1) early-onset (onset before the age of sixteen; n=26) and (2) late-onset cannabis users (age at onset at least sixteen; n=17). Early-onset users showed increased activation in the left superior parietal lobe. Correlational analyses confirmed the association between an earlier start of use and increased activity. Contrariwise neither cumulative dose, frequency nor time since last use was significantly associated with cortical activity. Our findings suggest that an early start of cannabis use is associated with increased cortical activation in adult cannabis users, possibly reflecting suboptimal cortical efficiency during cognitive challenge. The maturing brain might be more vulnerable to the harmful effects of cannabis use. However, due to a lack of a non-using control group we cannot exclude alternative interpretations.

Predictors of decision-making on the Iowa Gambling Task: independent effects of lifetime history of substance use disorders and performance on the Trail Making Test

Poor decision-making and executive function deficits are frequently observed in individuals with substance use disorders (SUDs), and executive deficits may contribute to poor decision-making in this population. This study examined the influence of lifetime history of an alcohol, cocaine, heroin, or polysubstance use disorder on decision-making as measured by the Iowa Gambling Task (IGT) after controlling for executive ability, demographic characteristics, and current substance use. Participants (131 with lifetime history of SUD and 37 controls) completed the IGT and two neuropsychological tests: the Trail Making Test and the Controlled Oral Word Association Test. Control participants performed significantly better than those with a lifetime SUD history on the IGT, but performance on the neuropsychological tests was comparable for the two groups. A lifetime SUD diagnosis was associated with performance on the IGT after controlling for covariates, and Trail Making Test performance was associated with IGT performance in both SUD and control participants.

The trail making test in India

The trail making test (TMT) is a short and convenient estimate of cognitive functions, principally attention and working memory. Like most neuropsychological tests, it is derived from and primarily applicable to English-speaking individuals. Norms for other ethnic minorities may differ significantly. The application of majority or mixed norms to specific ethnic subcultures may introduce systematic bias. To examine the impact of an English test on primarily nonEnglish-speaking individuals, outpatients attending the dermatology department of a large Indian hospital (n = 120) were asked to complete the English version of the TMT. The time taken to complete the TRAILS was unexpectedly long, although all the subjects scored within normal limits on the modified mini mental status examination and a test for general knowledge. Possible reasons for the delayed completion times are discussed below.

Interpreting the Trail Making Test Following Traumatic Brain Injury: Comparison of Traditional Time Scores and Derived Indices

The purpose of this study was to examine the clinical application of traditional time scores and various derived indices from the Trail Making Test (TMT) in a sample of 571 patients with acute traumatic brain injury (TBI). Participants were classified into four injury severity groups. A clear linear relation between injury severity and TMT performance was demonstrated, with the more severely brain injured patients performing more poorly on most measures. Hierarchical logistic regression analysis of TMT time scores across binary extreme groups based on injury severity resulted in high classification rates for patients with very mild TBI (93.0% correctly classified) and low classification rates for patients with moderate to severe TBI (50.0% correctly classified). However, TMT derived indices did not provide a unique contribution to test interpretation beyond what is already available from Part A and B separately.