Assessment of Cognitive Functioning Using the Mini Mental State Examination in Men with Alcohol and Crack Cocaine Use Disorder

Overview

Journal Trends Psychiatry Psychother

Specialty Psychiatry

Date 2023 Mar 8

PMID 36889679

Authors

Jaqueline B Schuch

Natalia Becker

Francisco Diego Rabelo-da-Ponte

Felipe Ornell

Hellen J M Freitas

Fernando P Rebelatto

Anne O Sordi

Flavio Pechansky

Lisia von Diemen

Felix H P Kessler

Affiliations

Soon will be listed here.

Abstract

Introduction: Consumption of substances has been associated with cognitive impairment. The Mini Mental State Examination (MMSE) is an easy-to-apply screening tool used to assess cognitive functions.

Objectives: To evaluate the cognitive performance of individuals with alcohol (AUD) and/or crack cocaine use disorder (CUD) and polysubstance use using the MMSE and to investigate the impact of substance use profile and the moderation effect of educational level on MMSE performance.

Methods: Cross-sectional study with 508 adult male inpatients diagnosed with substance use disorders (245 with AUD, 85 with CUD, and 178 with polysubstance use). Cognitive performance was assessed using the MMSE scale (total and composite scores).

Results: Individuals with AUD had worse total MMSE scores and scored worse for all three MMSE components compared to individuals with polysubstance use (p < 0.001, oral/written language comprehension, p < 0.001, attention/memory, and p = 0.007, motor functions). MMSE scores were positively correlated with educational level (p < 0.017), but were not associated with age, recent drug use, or years of drug use. Educational level moderated the impact of substance use on MMSE performance, especially total score and composite language comprehension score. Individuals with a low educational level (≤ 8 years) had worse performance than those with a high educational level (≥ 9 years), mainly in individuals with AUD (p < 0.001).

Discussion: Individuals with a low educational level and alcohol use are more prone to present cognitive impairment than crack cocaine users, especially involving language aspects. Better-preserved cognitive function could impact treatment adherence and might guide the decision of therapeutic strategies.

Citing Articles

Impact of alcohol use disorder on cognition in correlation with aging: a community-based retrospective cohort study.

Essa H, Ali H, Min P, Ali D, Lowe V, Petersen R Alcohol Alcohol. 2024; 60(1).

PMID: 39602567 PMC: 11601986. DOI: 10.1093/alcalc/agae080.

References

Copersino M, Fals-Stewart W, Fitzmaurice G, Schretlen D, Sokoloff J, Weiss R . Rapid cognitive screening of patients with substance use disorders. Exp Clin Psychopharmacol. 2009; 17(5):337-44. PMC: 3144764. DOI: 10.1037/a0017260. View

Volkow N, Michaelides M, Baler R . The Neuroscience of Drug Reward and Addiction. Physiol Rev. 2019; 99(4):2115-2140. PMC: 6890985. DOI: 10.1152/physrev.00014.2018. View

Czermainski F, Willhelm A, Santos A, Pacheco Pachado M, de Almeida R . Assessment of inhibitory control in crack and/or cocaine users: a systematic review. Trends Psychiatry Psychother. 2017; 39(3):216-225. DOI: 10.1590/2237-6089-2016-0043. View

Fernandez-Serrano M, Perez-Garcia M, Rio-Valle J, Verdejo-Garcia A . Neuropsychological consequences of alcohol and drug abuse on different components of executive functions. J Psychopharmacol. 2009; 24(9):1317-32. DOI: 10.1177/0269881109349841. View

Kessler F, Cacciola J, Alterman A, Faller S, Souza-Formigoni M, Cruz M . Psychometric properties of the sixth version of the Addiction Severity Index (ASI-6) in Brazil. Braz J Psychiatry. 2012; 34(1):24-33. DOI: 10.1590/s1516-44462012000100006. View

Ray L, Meredith L, Kiluk B, Walthers J, Carroll K, Magill M . Combined Pharmacotherapy and Cognitive Behavioral Therapy for Adults With Alcohol or Substance Use Disorders: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020; 3(6):e208279. PMC: 7305524. DOI: 10.1001/jamanetworkopen.2020.8279. View

Nunes P, Kipp B, Reitz N, Savage L . Aging with alcohol-related brain damage: Critical brain circuits associated with cognitive dysfunction. Int Rev Neurobiol. 2019; 148:101-168. PMC: 7372724. DOI: 10.1016/bs.irn.2019.09.002. View

Requena-Ocana N, Araos P, Flores M, Garcia-Marchena N, Silva-Pena D, Aranda J . Evaluation of neurotrophic factors and education level as predictors of cognitive decline in alcohol use disorder. Sci Rep. 2021; 11(1):15583. PMC: 8328971. DOI: 10.1038/s41598-021-95131-2. View

Nagaratnam J, Sharmin S, Diker A, Lim W, Maier A . Trajectories of Mini-Mental State Examination Scores over the Lifespan in General Populations: A Systematic Review and Meta-Regression Analysis. Clin Gerontol. 2020; 45(3):467-476. DOI: 10.1080/07317115.2020.1756021. View

10.

Folstein M, Folstein S, McHugh P . "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12(3):189-98. DOI: 10.1016/0022-3956(75)90026-6. View

11.

de Melo D, Barbosa A . [Use of the Mini-Mental State Examination in research on the elderly in Brazil: a systematic review]. Cien Saude Colet. 2015; 20(12):3865-76. DOI: 10.1590/1413-812320152012.06032015. View

12.

Bruijnen C, Dijkstra B, Walvoort S, Markus W, VanDerNagel J, Kessels R . Prevalence of cognitive impairment in patients with substance use disorder. Drug Alcohol Rev. 2019; 38(4):435-442. PMC: 6593747. DOI: 10.1111/dar.12922. View

13.

Smith K, Horton N, Saitz R, Samet J . The use of the mini-mental state examination in recruitment for substance abuse research studies. Drug Alcohol Depend. 2005; 82(3):231-7. DOI: 10.1016/j.drugalcdep.2005.09.012. View

14.

McKowen J, Isenberg B, Carrellas N, Zulauf C, Ward N, Fried R . Neuropsychological changes in patients with substance use disorder after completion of a one month intensive outpatient treatment program. Am J Addict. 2018; 27(8):632-638. PMC: 11006117. DOI: 10.1111/ajad.12824. View

15.

Kochhann R, Varela J, Lisboa C, Chaves M . The Mini Mental State Examination: Review of cutoff points adjusted for schooling in a large Southern Brazilian sample. Dement Neuropsychol. 2017; 4(1):35-41. PMC: 5619528. DOI: 10.1590/S1980-57642010DN40100006. View

16.

Seblova D, Berggren R, Lovden M . Education and age-related decline in cognitive performance: Systematic review and meta-analysis of longitudinal cohort studies. Ageing Res Rev. 2019; 58:101005. DOI: 10.1016/j.arr.2019.101005. View

17.

Verdejo-Garcia A, Bechara A, Recknor E, Perez-Garcia M . Executive dysfunction in substance dependent individuals during drug use and abstinence: an examination of the behavioral, cognitive and emotional correlates of addiction. J Int Neuropsychol Soc. 2006; 12(3):405-15. DOI: 10.1017/s1355617706060486. View

18.

Bracht T, Soravia L, Moggi F, Stein M, Grieder M, Federspiel A . The role of the orbitofrontal cortex and the nucleus accumbens for craving in alcohol use disorder. Transl Psychiatry. 2021; 11(1):267. PMC: 8097061. DOI: 10.1038/s41398-021-01384-w. View

19.

Ridley N, Batchelor J, Draper B, Demirkol A, Lintzeris N, Withall A . Cognitive screening in substance users: Diagnostic accuracies of the Mini-Mental State Examination, Addenbrooke's Cognitive Examination-Revised, and Montreal Cognitive Assessment. J Clin Exp Neuropsychol. 2017; 40(2):107-122. DOI: 10.1080/13803395.2017.1316970. View

20.

Crowe S, Cammisuli D, Stranks E . Widespread Cognitive Deficits in Alcoholism Persistent Following Prolonged Abstinence: An Updated Meta-analysis of Studies That Used Standardised Neuropsychological Assessment Tools. Arch Clin Neuropsychol. 2019; 35(1):31-45. DOI: 10.1093/arclin/acy106. View