Academic journal article Indian Journal of Psychiatry

Brief Screening for Cognitive Impairment in Addictive Disorders

Academic journal article Indian Journal of Psychiatry

Brief Screening for Cognitive Impairment in Addictive Disorders

Article excerpt

Byline: Arun. Gupta, Pratima. Murthy, Shobini. Rao

Chronic use of mind altering substances can lead to a wide variety of neuropsychological deficits, affecting the domains of attention, learning, memory, reasoning. Executive functions such as working memory, cognitive flexibility and inhibitory control may specifically be impaired. These deficits can impact engagement in effective psychosocial interventions. Mild to moderate cognitive dysfunction may not be picked up in routine clinical examination or through commonly used tests like the mini-mental state examination (MMSE). Detailed neuropsychological tests, although extremely valuable, are time and human-resource intensive and are not readily available to the clinician. This study attempted to devise a brief cognitive screen (BCS- AUD) for alcohol use disorders. Ninety subjects who fulfilled ICD-10 criteria for alcohol use disorders were assessed on the MMSE and selective tests from the NIMHANS neuropsychological battery. While 79 (87.78%) of patients had adequate scores on the MMSE (>25), cognitive deficits were noted with relatively high frequency on finger tapping (92.22-93.33%), auditory verbal learning test delayed recall AVLTDR (37-63%) and Tower of London 5 move subtest (42%). Statistically significant associations were found between MMSE and Digit symbol total time (0.05), Finger tapping right hand (0.01), Tower of London total number of problems solved with minimum moves (TNPSMM) (0.05), Verbal working memory two back hits (VM2BKHIT) (0.01), AVLTDR (0.01), and complex figure test-copy (0.01). Principal component analysis helped to identify three tests that merited inclusion in the BCS-AUD, namely Finger Tapping Test, Verbal Working Memory N Back Test and Auditory Verbal Test (AVLT). The utility of the BCS-AUD in identifying cognitive dysfunction in other substance use disorders needs to be examined. Patients rating positive on the cognitive screener would require in-depth evaluation, monitoring and remediation.

Introduction

In 1901, Bonhoeffer demonstrated memory dysfunction in cases of delirium tremens.[1] Since then, there have been a series of studies examining cognitive dysfunction in alcoholism, ranging from evaluating intelligence quotients (IQ)[2] to evaluating more subtle derangement of cognitive functioning.[3],[4],[5] Alcohol tends to affect elective mental capacities, rather than having a diffuse impact on mental function.

The brain regions and neural processes underlying addiction overlap extensively with those that support cognitive functioning, including learning, memory and reasoning.[6]

Cognitive deficits associated with alcohol use

A large number of neuropsychological deficits are associated with chronic alcohol use. Investigations in alcohol dependent individuals indicates diffuse deficits involving the areas of attention, delayed response ability, psychomotor functioning, ideational fluency, abstraction, problem solving, visuo-spatial functions, visual integration, verbal and visual learning and memory functions.[7] Specific deficits in coding and retrieval were found in male alcohol dependent patients as compared to social drinkers.[8] In a group of 30 patients with alcohol dependence who underwent a detailed neuropsychological assessment at the Centre for Addiction Medicine at NIMHANS, a range of deficits were found in response inhibition (55.9%), conceptual responses on the Wisconsin Card Sorting Test (50%), phonemic fluency and visual working memory (29.4%), visual and verbal 1 back task and failure to maintain set (26.5%) conceptual level responses and visual 1 back hits (23.5%), animal fluency and on verbal 2 back errors (20.6%).[9]

Cognitive deficits associated with other substance use

Cognitive deficits have also been shown to be present in other chronic drug use, including deficits in cognitive flexibility in cocaine[10] and opioid users[11], deficits in attention and impulse control in amphetamine users[12], deficits in cognitive flexibility and attention in cannabis users and deficits in working memory and declarative learning in tobacco smokers. …

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