Register      Login
Brain Impairment Brain Impairment Society
Journal of the Australasian Society for the Study of Brain Impairment
Shopping Cart: ( empty )
You are here: Home > Journals > IB > IB23007
RESEARCH ARTICLE (Open Access)
Contents Vol 24(1)

Predictors of cognitive functioning in presentations to a community-based specialist addiction neuropsychology service

James R. Gooden https://orcid.org/0000-0001-6835-9528 A B C D * , Catherine A. Cox A , Vanessa Petersen https://orcid.org/0000-0003-1594-2845 A , Ashlee Curtis https://orcid.org/0000-0001-9182-2840 E , Paul G. Sanfilippo A , Victoria Manning https://orcid.org/0000-0003-3908-5980 A D , Georgia L. Bolt https://orcid.org/0000-0001-5065-3841 A and Dan I. Lubman https://orcid.org/0000-0002-6747-1937 A D
+ Author Affiliations
- Author Affiliations

A Turning Point, Eastern Health, Richmond, VIC, Australia

B The National Centre for Clinical Research on Emerging Drugs (NCCRED), University of New South Wales, Sydney, NSW, Australia

C National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia

D Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia

E Centre for Drug Use, Addiction, and Anti-Social Behaviour Research, School of Psychology, Deakin University, Geelong, VIC, Australia

* Correspondence to: jamesg@turningpoint.org.au

Brain Impairment 24(1) 54-68 https://doi.org/10.1017/BrImp.2021.38
Submitted: 13 April 2021  Accepted: 22 December 2021  Published: 14 February 2022

© The Author(s), 2022. Published by Cambridge University Press on behalf of Australasian Society for the Study of Brain Impairment. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Neuropsychology, addiction, acquired brain injury, drugs and alcohol, cognition.

References

Abad F. J., Sorrel M. A., Román F. J., Colom R. (2016) The relationships between WAIS-IV factor index scores and educational level: A bifactor model approach. Psychological Assessment 28(8), 987-1000.
| Crossref | Google Scholar |

Australian Bureau of Statistics. (2017). Drug induced deaths in Australia: A changing story. Canberra: Australian Bureau of Statistics.

Bachi K., Sierra S., Volkow N. D., Goldstein R. Z., Alia-Klein N. (2017) Is biological aging accelerated in drug addiction? Current Opinion in Behavioral Sciences 13, 34-39.
| Crossref | Google Scholar |

Barreira D. P., Marinho R. T., Bicho M., Fialho R., Ouakinin S. R. S. (2019) Psychosocial and neurocognitive factors associated with hepatitis C – Implications for future health and wellbeing. [Mini review]. Frontiers in Psychology 9, 2666.
| Crossref | Google Scholar |

Basterfield C., Hester R., Bowden S. C. (2019) A meta-analysis of the relationship between abstinence and neuropsychological functioning in methamphetamine use disorder. Neuropsychology 33(5), 739-753.
| Crossref | Google Scholar |

Bates M. E., Buckman J. F., Nguyen T. T. (2013) A role for cognitive rehabilitation in increasing the effectiveness of treatment for alcohol use disorders. Neuropsychology Review 23(1), 27-47.
| Crossref | Google Scholar |

Beitchman J. H., Wilson B., Douglas L., Young A., Adlaf E. (2001) Substance use disorders in young adults with and without LD: Predictive and concurrent relationships. Journal of Learning Disabilities 34(4), 317-332.
| Crossref | Google Scholar |

Birtel M. D., Wood L., Kempa N. J. (2017) Stigma and social support in substance abuse: Implications for mental health and well-being. Psychiatry Research 252, 1-8.
| Crossref | Google Scholar |

Bruijnen C. J. W. H., Dijkstra B. A. G., Walvoort S. J. W., Markus W., VanDerNagel J. E. L., Kessels R. P. C., De Jong C. A. J. (2019) Prevalence of cognitive impairment in patients with substance use disorder. Drug and Alcohol Review 38(4), 435-442.
| Crossref | Google Scholar |

Carroll A., Houghton S., Bourgeois A. (2014) Self-reported substance use among high school students with and without learning difficulties. Australian Journal of Learning Difficulties 19(1), 47-59.
| Crossref | Google Scholar |

Cohen B. E., Neylan T. C., Yaffe K., Samuelson K. W., Li Y., Barnes D. E. (2013) Posttraumatic stress disorder and cognitive function: Findings from the mind your heart study. The Journal of Clinical Psychiatry 74(11), 1063-1070.
| Crossref | Google Scholar |

Crowe S. F., Cammisuli D. M., Stranks E. K. (2019) Widespread cognitive deficits in alcoholism persistent following prolonged abstinence: An updated meta-analysis of studies that used standardised neuropsychological assessment tools. Archives of Clinical Neuropsychology 35(1), 31-45.
| Crossref | Google Scholar |

Crowe S. F., Stranks E. K. (2018) The residual medium and long-term cognitive effects of benzodiazepine use: An updated meta-analysis. Archives of Clinical Neuropsychology 33(7), 901-911.
| Crossref | Google Scholar |

Foulds J. A., Manning V., Garfield J. B. B., Allsop S. J., Lam T., Arunogiri S., Lubman D. I. (2018) Prescribed sedative and other psychotropic medication use among clients attending alcohol and other drug treatment. Drug and Alcohol Review 37(6), 738-742.
| Crossref | Google Scholar |

Goodall J., Fisher C., Hetrick S., Phillips L., Parrish E. M., Allott K. (2018) Neurocognitive functioning in depressed young people: A systematic review and meta-analysis. Neuropsychology Review 28(2), 216-231.
| Crossref | Google Scholar |

Gooden J. R., Cox C. A., Petersen V., Curtis A., Manning V., Lubman D. I. (2021) Characterisation of presentations to a community-based specialist addiction neuropsychology service: Cognitive profiles, diagnoses and comorbidities. Drug and Alcohol Review 40(1), 83-92.
| Crossref | Google Scholar |

Gould F., Clarke J., Heim C., Harvey P. D., Majer M., Nemeroff C. B. (2012) The effects of child abuse and neglect on cognitive functioning in adulthood. Journal of Psychiatric Research 46(4), 500-506.
| Crossref | Google Scholar |

Herlitz A., Nilsson L.-G., Bäckman L. (1997) Gender differences in episodic memory. Memory & Cognition 25(6), 801-811.
| Crossref | Google Scholar |

Hoban B., Gisev N., Nielsen S., Larance B., Bruno R., & Degenhardt L. (2015). Investigating correlates of sedative load among people with chronic non-cancer pain and the association with drowsiness and ambulance use. In: 2015 NDARC Annual Research Symposium.

IBM Corp. (2020). IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY: IBM Corp.

Jakobsen J. C., Gluud C., Wetterslev J., Winkel P. (2017) When and how should multiple imputation be used for handling missing data in randomised clinical trials – A practical guide with flowcharts. BMC Medical Research Methodology 17(1), 162.
| Crossref | Google Scholar |

Kramer J. H., Yaffe K., Lengenfelder J., Delis D. C. (2003) Age and gender interactions on verbal memory performance. Journal of the International Neuropsychological Society 9(1), 97-102.
| Crossref | Google Scholar |

Lesak M. D., Howieson D. B., Bigler E. D., & Tranel D. (2012). Neuropsychological assessment (5th ed.). New York, NY: Oxford University Press.

Linjakumpu T., Hartikainen S., Klaukka T., Koponen H., Kivelä S. L., Isoaho R. (2003) A model to classify the sedative load of drugs. International Journal of Geriatric Psychiatry 18(6), 542-544.
| Google Scholar |

Linjakumpu T. A., Hartikainen S. A., Klaukka T. J., Koponen H. J., Hakko H. H., Viilo K. M., Isoaho R. E. (2004) Sedative drug use in the home-dwelling elderly. Annals of Pharmacotherapy 38(12), 2017-2022.
| Crossref | Google Scholar |

Liu Y., Williamson V., Setlow B., Cottler L. B., Knackstedt L. A. (2018) The importance of considering polysubstance use: Lessons from cocaine research. Drug and Alcohol Dependence 192, 16-28.
| Crossref | Google Scholar |

Livingston G., Huntley J., Sommerlad A., Ames D., Ballard C., Banerjee S., Mukadam N. (2020) Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet 396(10248), 413-446.
| Crossref | Google Scholar |

Lovibond S. H., & Lovibond P. F. (1995). Manual for the depression anxiety stress scales (2nd ed.). Sydney: Psychology Foundation.

Lubman D. I., Garfield J. B. B., Manning V., Berends L., Best D., Mugavin J. M., Allsop S. (2016) Characteristics of individuals presenting to treatment for primary alcohol problems versus other drug problems in the Australian patient pathways study. BMC Psychiatry 16(1), 250.
| Crossref | Google Scholar |

Mann K., Günther A., Stetter F., Ackermann K. (1999) Rapid recovery from cognitive deficits in abstinent alcoholics: A controlled test-retest study. Alcohol and Alcoholism 34(4), 567-574.
| Crossref | Google Scholar |

Manning V., Garfield J. B., Best D., Berends L., Room R., Mugavin J., Lubman D. I. (2017) Substance use outcomes following treatment: Findings from the Australian Patient Pathways Study. Australian & New Zealand Journal of Psychiatry 51(2), 177-189.
| Crossref | Google Scholar |

Meyers J. E., & Meyers K. R. (1995). The meyers scoring system for the rey complex figure and the recognition trial: Professional manual. Odessa, FL: Psychological Assessment Resources.

Ponsford J., Sloan S., & Snow P. (2013). Traumatic brain injury: Rehabilitation for everyday adaptive living (2nd ed.). New York, NY: Psychology Press.

Reitan R., & Wolfson D. (1988). The Halstead-Reitan neuropsychological test battery. Tuscan, AZ: Neuropsychology Press.

Robinson O., Vytal K., Cornwell B., Grillon C. (2013) The impact of anxiety upon cognition: Perspectives from human threat of shock studies [Review]. Frontiers in Human Neuroscience 7(203),.
| Crossref | Google Scholar |

Rock P. L., Roiser J. P., Riedel W. J., Blackwell A. D. (2014) Cognitive impairment in depression: A systematic review and meta-analysis. Psychological Medicine 44(10), 2029-2040.
| Crossref | Google Scholar |

Room R. (2005) Stigma, social inequality and alcohol and drug use. Drug and Alcohol Review 24(2), 143-155.
| Crossref | Google Scholar |

Schmidt T. P., Pennington D. L., Cardoos S. L., Durazzo T. C., Meyerhoff D. J. (2017) Neurocognition and inhibitory control in polysubstance use disorders: Comparison with alcohol use disorders and changes with abstinence. Journal of Clinical and Experimental Neuropsychology 39(1), 22-34.
| Crossref | Google Scholar |

Schomerus G., Lucht M., Holzinger A., Matschinger H., Carta M. G., Angermeyer M. C. (2010) The stigma of alcohol dependence compared with other mental disorders: A review of population studies. Alcohol and Alcoholism 46(2), 105-112.
| Crossref | Google Scholar |

Schulte M. H. J., Cousijn J., den Uyl T. E., Goudriaan A. E., van den Brink W., Veltman D. J., Wiers R. W. (2014) Recovery of neurocognitive functions following sustained abstinence after substance dependence and implications for treatment. Clinical Psychology Review 34(7), 531-550.
| Crossref | Google Scholar |

Severtson S. G., Hedden S. L., Martins S. S., Latimer W. W. (2012) Patterns of cognitive impairments among heroin and cocaine users: The association with self-reported learning disabilities and infectious disease. Journal of Learning Disabilities 45(2), 139-150.
| Crossref | Google Scholar |

StataCorp. (2019). Stata statistical software: Release 16. College Station, TX: StataCorp LLC.

Strauss E., Sherman E. M., & Spreen O. (2006). A compendium of neuropsychological tests: Administration, norms, and commentary (3rd ed.). New York, NY: Oxford University Press.

Sun E. C., Dixit A., Humphreys K., Darnall B. D., Baker L. C., Mackey S. (2017) Association between concurrent use of prescription opioids and benzodiazepines and overdose: Retrospective analysis. BMJ 356, j760.
| Crossref | Google Scholar |

Tannenbaum C., Paquette A., Hilmer S., Holroyd-Leduc J., Carnahan R. (2012) A systematic review of amnestic and non-amnestic mild cognitive impairment induced by anticholinergic, antihistamine, GABAergic and opioid drugs. Drugs Aging 29(8), 639-658.
| Crossref | Google Scholar |

Tombaugh T. N. (2004) Trail Making Test A and B: Normative data stratified by age and education. Archives of Clinical Neuropsychology 19(2), 203-214.
| Crossref | Google Scholar |

Troyer A. K., Leach L., Strauss E. (2006) Aging and response inhibition: Normative data for the Victoria Stroop Test. Neuropsychology, Development, and Cognition. Section B, Aging, Neuropsychology and Cognition 13(1), 20-35.
| Crossref | Google Scholar |

van Boekel L. C., Brouwers E. P. M., van Weeghel J., Garretsen H. F. L. (2013) Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: Systematic review. Drug and Alcohol Dependence 131(1), 23-35.
| Crossref | Google Scholar |

Wechsler D. (2008a). WAIS-IV administration and scoring manual. Sydney: Pearson.

Wechsler D. (2008b). WMS-IV administration and scoring manual. Sydney: Pearson.

Wilens T. E., Martelon M., Joshi G., Bateman C., Fried R., Petty C., Biederman J. (2011) Does ADHD predict substance-use disorders? A 10-year follow-up study of young adults with ADHD. Journal of the American Academy of Child & Adolescent Psychiatry 50(6), 543-553.
| Crossref | Google Scholar |

Yarlott L., Heald E., Forton D. (2017) Hepatitis C virus infection, and neurological and psychiatric disorders – A review. Journal of Advanced Research 8(2), 139-148.
| Crossref | Google Scholar |

Yücel M., Lubman D. I., Solowij N., Brewer W. J. (2007) Understanding drug addiction: A neuropsychological perspective. Australian & New Zealand Journal of Psychiatry 41(12), 957-968.
| Crossref | Google Scholar |