Cognitive Impairments in Substance Use Patients Treated with Methadone

Document Type : Original Article

Authors

Kavosh Cognitive Behavior Sciences and Addiction Research Center, Department of Psychiatry, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran

10.34172/ahj.1693

Abstract

Introduction: Substance abuse remains a critical global challenge with social, economic, and health impacts. Cognitive impairments are recognized as significant risk factors for relapse and poor treatment outcomes in individuals undergoing substance abuse treatment. This study investigated the prevalence of cognitive impairments and associated factors among patients receiving methadone maintenance therapy (MMT).
Methods: A cross-sectional analytical study was conducted among 370 patients receiving MMT at substance abuse treatment centers in Rasht in 2022. Participants were selected through a two-stage cluster sampling method after obtaining informed consent. Data were collected using demographic questionnaires, the Depression, Anxiety, and Stress Scale-21 (DASS-21), and the Montreal Cognitive Assessment (MoCA). Statistical analyses, including standard deviation, Spearman’s correlation, and the Kruskal-Wallis test, were conducted using SPSS version 21 (P = 0.0001).
Results: Cognitive impairments were observed in 11.1% of participants, with an average age of 49.58 ± 14.40 years. Male participants scored significantly higher on the verbal fluency (P = 0.004) and delayed recall (P = 0.030) subscales. Employed or retired patients demonstrated better cognitive performance compared to their unemployed counterparts (P = 0.0001). Cognitive scores were inversely correlated with age (P = 0.0001) and positively correlated with education level (P = 0.0001). Longer primary substance use duration, higher methadone doses, and longer treatment durations were inversely associated with cognitive performance (P = 0.0001). Stress, depression, and anxiety scores were inversely correlated with MoCA scores (P = 0.0001).
Conclusion: Cognitive impairments were identified in 11.1% of participants. Longer durations of primary substance use, higher methadone maintenance doses, and extended treatment durations were significantly associated with poorer cognitive performance.

Highlights

Mohammad Hassan Novin (GoogleScholar)(Pubmed)

Keywords


  1. Galanter M. Innovations: alcohol & drug abuse: spirituality in alcoholics anonymous: a valuable adjunct to psychiatric services. Psychiatr Serv 2006;57(3):307-9. doi:10.1176/appi. ps.57.3.307
  2. Ungar AK, Konova AB, Patel A, Goldstein RZ, Hurd YL. Substance use and addictive disorders. In: Simon AB, New AS, Goodman WK, eds. Mount Sinai Expert Guides. John Wiley & Sons; 2016. p. 138-51. doi:10.1002/9781118654231.ch16
  3. Heidari Pahlavian A, Mahjub H, Rahimi A. Mental disorders in substance dependent individuals as compared to non-substance dependent people in Hamadan, Iran. Avicenna J Clin Med 2011;18(3):22-8.
  4. Manning V, Bolt G. Cognitive assessment, management, and training in addiction treatment. In: Patel VB, Preedy VR, eds. Handbook of Substance Misuse and Addictions: From Biology to Public Health. Cham: Springer International Publishing; 2022. p. 93-121. doi:10.1007/978-3-030-92392-1_6
  5. Moreno-López L, Stamatakis EA, Fernández-Serrano MJ, Gómez-Río M, Rodríguez-Fernández A, Pérez-García M, et al. Neural correlates of hot and cold executive functions in polysubstance addiction: association between neuropsychological performance and resting brain metabolism  as measured by positron emission tomography. Psychiatry Res 2012;203(2-3):214-21. doi:10.1016/j.pscychresns.2012.01.006 
  6. Li M, Tian J, Zhang R, Qiu Y, Wen X, Ma X, et al. Abnormal cortical thickness in heroin-dependent individuals. Neuroimage 2014;88:295-307. doi:10.1016/j.neuroimage.2013.10.021 
  7. Stewart JL, May AC, Aupperle RL, Bodurka J. Forging neuroimaging targets for recovery in opioid use disorder. Front Psychiatry 2019;10:117. doi:10.3389/fpsyt.2019.00117 
  8. Ersche KD, Sahakian BJ. The neuropsychology of amphetamine and opiate dependence: implications for treatment. Neuropsychol Rev 2007;17(3):317-36. doi:10.1007/s11065- 007-9033-y 
  9. Rapeli P, Fabritius C, Kalska H, Alho H. Memory function in opioid-dependent patients treated with methadone or buprenorphine along with benzodiazepine: longitudinal change in comparison to healthy individuals. Subst Abuse Treat Prev Policy 2009;4:6. doi:10.1186/1747-597x-4-6 
  10. Ross S, Peselow E. The neurobiology of addictive disorders. Clin Neuropharmacol 2009;32(5):269-76. doi:10.1097/ wnf.0b013e3181a9163c 
  11. Chen J, Li Y, Wang S, Li W, Liu Y, Jin L, et al. Methadone maintenance treatment alters couplings of default mode and salience networks in individuals with heroin use disorder: a longitudinal self-controlled resting-state fMRI study. Front Psychiatry 2023;14:1132407. doi:10.3389/fpsyt.2023.1132407 
  12. Gunstad J, Cohen RA, Paul RH, Gordon E. Dissociation of the component processes of attention in healthy adults. Arch Clin Neuropsychol 2006;21(7):645-50. doi:10.1016/j. acn.2006.05.009 
  13. Darke S, Sims J, McDonald S, Wickes W. Cognitive impairment among methadone maintenance patients. Addiction 2000;95(5):687-95. doi:10.1046/j.1360-0443.2000.9556874.x 
  14. Ornstein TJ, Iddon JL, Baldacchino AM, Sahakian BJ, London M, Everitt BJ, et al. Profiles of cognitive dysfunction in chronic amphetamine and heroin abusers. Neuropsychopharmacology 2000;23(2):113-26. doi:10.1016/s0893-133x(00)00097-x 
  15. Luo YX, Xue YX, Shen HW, Lu L. Role of amygdala in drug memory. Neurobiol Learn Mem 2013;105:159-73. doi:10.1016/j.nlm.2013.06.017 
  16. Parsegian A, Glen WB Jr, Lavin A, See RE. Methamphetamine self-administration produces attentional set-shifting deficits and alters prefrontal cortical neurophysiology in rats. Biol Psychiatry 2011;69(3):253-9. doi:10.1016/j.biopsych.2010.09.003 
  17. Redžepagić Š, Ladas AI. Prospective memory, sustained attention and response inhibition in poly-substance users stable on methadone maintenance treatment. Subst Use Misuse 2023;58(3):397-405. doi:10.1080/10826084.2023.2165410 
  18. Barahmand U, Tavakolian E, Khazaee A, Mohammadi K. Hot and cold executive functions in pure opioid users undergoing methadone maintenance treatment: effects of methadone dose, treatment duration, and time between last methadone administration and testing. Niger J Clin Pract 2016;19(5):603- 10. doi:10.4103/1119-3077.188695 
  19. Verdejo-Garcia A, Garcia-Fernandez G, Dom G. Cognition and addiction Dialogues Clin Neurosci 2019;21(3):281-90. doi:10.31887/DCNS.2019.21.3/gdom 
  20. Rapeli P, Fabritius C, Alho H, Salaspuro M, Wahlbeck K, Kalska H. Methadone vs. buprenorphine/naloxone during early opioid substitution treatment: a naturalistic comparison of cognitive performance relative to healthy controls. BMC Clin Pharmacol 2007;7:5. doi:10.1186/1472-6904-7-5
  21. Arezoomandan M, Zhiani R, Mehrzad J, Motavalizadehkakhky A, Eshrati S, Arezoomandan R. Inflammatory, oxidative stress and cognitive functions in patients under maintenance treatment with methadone or buprenorphine and healthy subjects. J Clin Neurosci 2022;101:57-62. doi:10.1016/j.jocn.2022.04.018 
  22. Sadeghamal Nikraftar N, Fayaz Feyzi Y, Ramzani F, Nikbakht- Zadeh M, Amini M, Arezoomandan M, et al. Comparison of psychological symptoms and cognitive functions in patients under maintenance treatment with methadone or buprenorphine, current opioid users and healthy subjects. Asian J Psychiatr 2021;58:102603. doi:10.1016/j.ajp.2021.102603 
  23. Pedrero-Pérez EJ. Methadone dosage and its relationship to quality of life, satisfaction, psychopathology, cognitive performance and additional consumption of non-prescribed drugs. Adicciones 2016;29(1):37-54. doi:10.20882/ adicciones.831 
  24. Abdolkarimi M, Sarrafi M, Nejad Torshabi M, Khodadadi H, Zareipour M. Stress, anxiety and depression and related factors in secondary school girls in Rafsanjan in 98. J Pediatr Nurs 2021;7(3):69-75. 
  25. Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005;53(4):695-9. doi:10.1111/ j.1532-5415.2005.53221.x 
  26. Rosca EC, Albarqouni L, Simu M. Montreal Cognitive Assessment (MoCA) for HIV-associated neurocognitive disorders. Neuropsychol Rev 2019;29(3):313-27. doi:10.1007/ s11065-019-09412-9 
  27. Pedraza OL, Salazar AM, Sierra FA, Soler D, Castro J, Castillo P, et al. Reliability, criterion and discriminant validity of the Montreal Cognitive Assessment Test (MoCA) in a group of adults from Bogotá. Acta Med Colomb 2016;41(4):221-8. doi:10.36104/amc.2016.693 
  28. Emsaki G, Molavi H, Chitsaz A, Movahed Abtahi M, Asgari K. Psychometric properties of the Montreal Cognitive Assessment (MoCA) in Parkinson’s disease patients in Isfahan. J Isfahan Med Sch 2011;29(158):1606-15. 
  29. Jadenur SS, Saroja AO, Kari A, Angolkar M. Prevalence of cognitive impairment among people aged ≥ 50 years in rural population of Belagavi Taluka–a community based cross sectional study. Clin Epidemiol Glob Health 2022;13:100940. doi:10.1016/j.cegh.2021.100940 
  30. Pais R, Ruano L, Carvalho OP, Barros H. Global cognitive impairment prevalence and incidence in community dwelling older adults-a systematic review. Geriatrics (Basel) 2020;5(4):84. doi:10.3390/geriatrics5040084 
  31. Bruijnen CJ, Dijkstra BA, Walvoort SJ, Markus W, VanDerNagel JE, Kessels RP, et al. Prevalence of cognitive impairment in patients with substance use disorder. Drug Alcohol Rev 2019;38(4):435-42. doi:10.1111/dar.12922
  32. Allan J, Kemp M, Golden A. The prevalence of cognitive impairment in a rural in-patient substance misuse treatment programme. Ment Health Subst Use 2012;5(4):303-13. doi:10 .1080/17523281.2012.711767
  33. Yang W, Luo X, Bi K, Li Y, Fan X, Liu X, et al. Cognitive and psychological status of methadone maintenance treatment patients in Yunnan province and its influencing factors. Res Sq [Preprint]. February 14, 2024. Available from: https://www. researchsquare.com/article/rs-3937078/v1.
  34. Overton M, Pihlsgård M, Elmståhl S. Prevalence and incidence of mild cognitive impairment across subtypes, age, and sex. Dement Geriatr Cogn Disord 2019;47(4-6):219-32. doi:10.1159/000499763
  35. Levine DA, Gross AL, Briceño EM, Tilton N, Giordani BJ, Sussman JB, et al. Sex differences in cognitive decline among US adults. JAMA Netw Open 2021;4(2): e210169. doi:10.1001/ jamanetworkopen.2021.0169
  36. Pask S, Dell’Olio M, Murtagh FE, Boland JW. The effects of opioids on cognition in older adults with cancer and chronic noncancer pain: a systematic review. J Pain Symptom Manage 2020;59(4):871-93.e1. doi:10.1016/j. jpainsymman.2019.10.022
  37. Wong JS, Nikoo M, Kianpoor K, Gholami A, Jazani M, Mohammadian F, et al. The effects of opium tincture and methadone on the cognitive function of patients with opioid use disorder. Pers Individ Dif 2021;169:110091. doi:10.1016/j. paid.2020.110091
  38. Novin MH, Eftekhar-Ardebili H, Batebi A, Mohtasham Amiri Z, Bazarganian Langeroodi N. Prevalence of depression and its affecting factors in patients referred to substance abuse treatment centers in Guilan province, Iran, during year 2013. Iran J Psychiatry Behav Sci 2018;12(4): e58779. doi:10.5812/ ijpbs.58779
  39. Ahmadi J, Farrashbandi H, Majdi B, Mahdavi S, Babaee MA, Menzies P, et al. Prevalence of mood and anxiety disorders in a sample of Iranian outpatient opioid addicts. Ger J Psychiatry 2005;8(1):5-7.
  40. Ma L. Depression, anxiety, and apathy in mild cognitive impairment: current perspectives. Front Aging Neurosci 2020;12:9. doi:10.3389/fnagi.2020.00009