A multicenter study to validate the Brief Cognitive Status Examination as a screening tool for the detection of cognitive impairment in a substance use disorder population over 45 years of age in a Spanish population.

To date, there has not been a time-efficient and resource-conscious way to identify cognitive impairment in patients with substance use disorders (SUDs). In this study, we assessed the validity, accuracy, and clinical utility of a brief (10-min) screening instrument, the Montreal Cognitive Assessment (MoCA), in identifying cognitive impairment among patients with SUDs. The Neuropsychological Assessment Battery-Screening Module, a 45-min battery with known sensitivity to the mild to moderate deficits observed in patients with SUDs, was used as the reference criterion for determining agreement, rates of correct and incorrect decision classifications, and criterion-related validity for the MoCA. Classification accuracy of the MoCA, based on receiver operating characteristic (ROC) analysis, was strong, with an area under the ROC curve of 0.86, 95% confidence interval [0.75, 0.97]. The MoCA also showed acceptable sensitivity (83.3%) and specificity (72.9%) for the identification of cognitive impairment. Using a cutoff of 25 on the MoCA, the overall agreement was 75.0%; chance-corrected agreement (kappa) was 41.9%. These findings indicate that the MoCA provides a time-efficient and resource-conscious way to identify patients with SUDs and neuropsychological impairment, thus addressing a critical need in the addiction treatment research community.

Posttraumatic stress disorder (PTSD) is frequently comorbid with substance use disorder (SUD) in individuals seeking treatment for substance use. Further, SUD and PTSD are individually associated with cognitive impairment (CI) and poor treatment outcomes. Despite the frequent use of the Montreal Cognitive Assessment (MoCA) as a screening tool for CI, the validity of the MoCA has not been established in individuals with comorbid SUD-PTSD. We assessed the criterion validity of the MoCA in 128 participants seeking inpatient medically-assisted detoxification using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) as a reference for CI. The correlation between the RBANS and MoCA was weaker in those with SUD-PTSD (r = .32) relative to SUD alone (r = .56). Receiver operating characteristic (ROC) curves demonstrated that the MoCA had moderate-to-high ability to discriminate CI in individuals with SUD alone, with an area under the ROC curve of .82 (95% CI .69–.92) and optimal cutoff score of ≤23. However, in individuals with comorbid SUD-PTSD, the ROC analysis was not significant. Results suggest that PTSD, when comorbid with SUD, reduces the criterion-related validity of the MoCA. We recommend exercising caution when classifying CI in individuals with SUD-PTSD using the MoCA and suggest reducing the cutoff score to ≤23 in order to limit the rate of false-positive CI diagnoses in SUD-PTSD populations.

The objective of this study was to determine the test–retest reliability; construct and criterion validity; and test operating characteristics of a newly developed cognitive impairment risk factor screening instrument, the Alcohol and Drug Cognitive Enhancement (ACE) Screening Tool. Participants in the validation study were 129 adults with substance use disorder (SUD) enrolled in residential SUD treatment services and 209 normal controls. Test and retest data were available for 36 participants with SUD and 40 normal control individuals on the ACE Screening Tool. Test–retest reliability was excellent (ICC = 0.97). The ACE Screening Tool was significantly correlated with the Montreal Cognitive Assessment (MoCA), Behavior Rating Inventory of Executive Functioning—Adult Version (BRIEF-A), Test of Premorbid Functioning (TOPF) and Five Point Test, establishing construct validity. Criterion validity was established using a ternary severity variable constructed using results obtained on the MoCA and BRIEF-A. Test operating characteristics analysis showed 93% sensitivity, 46% specificity, 33% positive predictive power, and 96% negative predictive power using a cut-score of >3. Those high levels of sensitivity and negative predictive power indicated that the tool would likely detect cognitive impairment when present and should therefore be considered suitable as an initial screening tool for cognitive impairment in individuals attending SUD services.

While there is broad recognition of the high societal costs of substance use disorders (SUD), treatment rates are low. We examined whether, in the United States, participants with substance or alcohol use disorder would report a greater willingness to enter SUD treatment located in a primary care setting (primary care) or more commonly found specialty care setting in the United States (usual care). Randomized survey-embedded experiment. US web-based research panel in which participants were randomized to read one-paragraph vignettes describing treatment in usual care (specialty drug or alcohol treatment center), primary care or collaborative care within a primary care setting. A total of 42451 panelists aged 18+ were screened for substance or alcohol use disorder using validated diagnostic criteria. Participants included 344 with a substance use disorder and 634 with an alcohol use disorder not in treatment with no prior treatment history. Willingness to enter treatment across vignettes by condition. Among participants with a substance use disorder, 24.6% of those randomized to usual care reported being willing to enter drug treatment compared with 37.2% for primary care [12.6 percentage point difference; 95% confidence interval (CI)=0.8, 24.4) and 34.0% for collaborative care (9.4 percentage point difference; 95% CI=-2.0, 20.8). Among participants with an alcohol use disorder, 17.6% of those randomized to usual care reported being willing to enter alcohol treatment compared with 20.3% for primary care (2.6 percentage point difference; 95% CI=-4.9, 10.1) and 20.8% for collaborative care (3.1 percentage point difference; 95% CI=-4.3, 10.6). The most common reason for not being willing to enter drug (63%) and alcohol (78%) treatment was the belief that treatment was not needed. In the United States, people diagnosed with substance or alcohol use disorders appear to be more willing to enter treatment in a primary care setting than in a specialty drug treatment center. Expanding availability of primary care-based substance use disorder treatment could increase treatment rates in the United States.

SS3.03: Cognitive screening for dementia: crossing four essential borders

Cognitive impairment is common in individuals with substance use disorders (SUDs), yet no evidence-based guidelines exist regarding the most appropriate screening measure for use in this population. This systematic review aimed to (1) describe different cognitive screening measures used in adults with SUDs, (2) identify substance use populations and contexts these tools are utilised in, (3) review diagnostic accuracy of these screening measures versus an accepted objective reference standard, and (4) evaluate methodology of included studies for risk of bias. Online databases (PsycINFO, MEDLINE, Embase, and CINAHL) were searched for relevant studies according to pre-determined criteria, and risk of bias and applicability was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). At each review phase, dual screening, extraction, and quality ratings were performed. Fourteen studies met inclusion, identifying 10 unique cognitive screening tools. The Montreal Cognitive Assessment (MoCA) was the most common, and two novel screening tools (Brief Evaluation of Alcohol-Related Neuropsychological Impairments [BEARNI] and Brief Executive Function Assessment Tool [BEAT]) were specifically developed for use within SUD populations. Twelve studies reported on classification accuracy and relevant psychometric parameters (e.g., sensitivity and specificity). While several tools yielded acceptable to outstanding classification accuracy, there was poor adherence to the Standards for Reporting Diagnostic Accuracy Studies (STARD) across all studies, with high or unclear risk of methodological bias. While some screening tools exhibit promise for use within SUD populations, further evaluation with stronger methodological design and reporting is required. Clinical recommendations and future directions for research are discussed.

Substance use disorder (SUD) is frequently associated with cognitive impairment that negatively affects treatment adherence and clinical outcomes. Neuropsychological assessments provide detailed information but are often impractical in clinical settings, underscoring the value of brief but sensitive tools such as the Montreal Cognitive Assessment (MoCA). This study aimed to evaluate the utility of MoCA in detecting cognitive impairment in SUD, examining cognitive recovery following sustained abstinence, exploring gender differences in cognitive progression and determining whether baseline cognitive performance predicts treatment dropout. Ninety-five SUD patients and 57 healthy controls completed MoCA at baseline and were reassessed after 6 months. At baseline, 72.60% of individuals demonstrated cognitive impairment compared with controls, with deficits evident in both global cognition and visuospatial/executive, attention, memory and language domains. Following 6 months of abstinence, deterioration rates decreased to 50%, indicating substantial but not complete recovery, because the improvement in overall cognition was moderate. Male patients showed significantly greater cognitive gains than female patients, particularly in visuospatial/executive and digit span performance. Patients impaired at baseline reported more severe alcohol use and earlier onset of cannabis use disorder. Patients with cocaine use disorder showed the poorest recovery and the highest rate of treatment dropout. Lower baseline language and fluency scores were strongly associated with treatment discontinuation. Language deficits, together with cocaine use disorder, predicted 69% of dropout cases. Findings indicate MoCA as a practical screening tool for early detection of cognitive impairment, longitudinal monitoring and personalised treatment planning in SUD.

Background and aimToxic oligomeric α-synuclein (αS; O-αS) has been suggested to play a central role in the pathogenesis of Lewy body diseases such as Parkinson’s disease (PD). Cerebrospinal fluid (CSF) levels of αS, O-αS, total and phosphorylated tau, and amyloid β 1–42 (Aβ1–42) are thought to reflect the pathophysiology or clinical symptoms in PD. In this study, we examined correlations of the CSF levels of these proteins with the clinical symptoms, and with each other in drug-naïve patients with PD.MethodsTwenty-seven drug-naïve patients with PD were included. Motor and cognitive functions were assessed using the Unified Parkinson’s Disease Rating Scale (UPDRS), Montreal Cognitive Assessment (MoCA), and Neurobehavioral Cognitive Status Examination (COGNISTAT). CSF levels of total αS, O-αS, Aβ1–42, total tau and tau phosphorylated at threonine 181 (P-tau181p) were measured. CSF levels of these proteins were compared with clinical assessments from the UPDRS, MoCA and COGNISTAT using Spearman correlation analysis. Spearman correlation coefficients among CSF protein levels were also evaluated.ResultsCSF levels of αS were negatively correlated with UPDRS part III (motor score) (p < 0.05) and bradykinesia (p < 0.01), and positively correlated with COGNISTAT subtest of judgement (p < 0.01) and CSF levels of Aβ1–42 (p < 0.001), total tau (p < 0.001) and P-tau181p (p < 0.01). Lower CSF levels of Aβ1–42, total tau and P-tau181p were significantly related to worsening of some motor and/or cognitive functions. The CSF level of O-αS showed no correlation with any motor and cognitive assessments or with CSF levels of the other proteins.ConclusionCSF levels of αS are correlated with some clinical symptoms and CSF levels of other pathogenic proteins in drug-naïve PD patients. These correlations suggest a central role for interaction and aggregation of αS with Aβ1–42, tau, and phosphorylated tau in the pathogenesis of PD. Although O-αS has been shown to have neurotoxic effects, CSF levels do not reflect clinical symptoms or levels of other proteins in cross-sectional assessment.

Substance use disorder (SUD) among women of reproductive age is a complex public health problem affecting a diverse spectrum of women and their families, with potential consequences across generations. The goals of this study were 1) to describe and compare the prevalence of patterns of injury requiring emergency department (ED) visits among SUD-positive and SUD-negative women and 2) among SUD-positive women, to investigate the association of specific categories of injury with type of substance used. This study was a secondary analysis of a large, multisource health care utilization data set developed to analyze SUD prevalence, and health and substance abuse treatment outcomes, for women of reproductive age in Massachusetts, 2002 through 2008. Sources for this linked data set included diagnostic codes for ED, inpatient, and outpatient stay discharges; SUD facility treatment records; and vital records for women and for their neonates. Injury data (ICD-9-CM E-codes) were available for 127,227 SUD-positive women. Almost two-thirds of SUD-positive women had any type of injury, compared to 44.8% of SUD-negative women. The mean (±SD) number of events also differed (2.27 ± 4.1 for SUD-positive women vs. 0.73 ± 1.3 for SUD-negative women, p < 0.0001). For four specific injury types, the proportion injured was almost double for SUD-positive women (49.3% vs 23.4%), and the mean (±SD) number of events was more than double (0.72 ± 0.9 vs. 0.26 ± 0.5, p < 0.0001). The numbers and proportions of motor vehicle incidents and falls were significantly higher in SUD-positive women (22.5% vs. 12.5% and 26.6% vs. 11.0%, respectively), but the greatest differences were in self-inflicted injury (11.5% vs. 0.8%; mean ± SD events = 0.19 ± 0.9 vs. 0.009 ± 0.2, p < 0.0001) and purposefully inflicted injury (11.5% vs 1.9%, mean ± SD events = 0.18 ± 0.1 vs. 0.02 ± 0.2, p < 0.0001). In each of the injury categories that we examined, injury rates among SUD-positive women were lowest for alcohol disorders only and highest for alcohol and drug disorders combined. Among 33,600 women identified as using opioids, 2,132 (6.3%) presented to the ED with overdose. Multiple overdose visits were common (mean ± SD = 3.67 ± 6.70 visits). After adjustment for sociodemographic characteristics, psychiatric history, and complex/chronic illness, SUD remained a significant risk factor for all types of injury, but for the suicide/self-inflicted injury category, psychiatric history was by far the stronger predictor. The presence of SUD increases the likelihood that women in the 15- to 49-year age group will present to the ED with injury. Conversely, women with injury may be more likely to be involved in alcohol abuse or other substance use. The high rates of injury that we identified among women with SUD suggest the utility of including a brief, validated screen for substance use as part of an ED injury treatment protocol and referring injured women for assessment and/or treatment when scores indicate the likelihood of SUD.

Substance use disorders (SUDs) are frequently associated with cognitive impairment, but the specific clinical and sociodemographic factors that contribute to these deficits remain insufficiently characterized. This study aimed to examine cognitive performance in a sample of treatment-seeking patients with SUDs and to identify predictors of impairment. Eighty abstinent outpatients were consecutively recruited and underwent clinical and neuropsychological evaluation. Cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA), which evaluate attention, executive function, memory, language, visuoconstructional skills and orientation and the Complutense Verbal Learning Test (Test de Aprendizaje Verbal España-Complutense; TAVEC) to measure learning and memory. Overall, patients showed deterioration in several cognitive domains. Educational attainment and the duration of problematic substance use emerged as the strongest predictors of performance, particularly in attention, identification, and language. Age and abstinence length were also associated with selected domains, highlighting their role in the trajectory of cognitive recovery. Exploratory analyses suggested that the primary substance reported (alcohol or cocaine) may influence memory outcomes, although interpretation is limited by the high prevalence of polysubstance use. These findings emphasize the relevance of considering educational background, clinical history, and abstinence when assessing cognitive function in SUD populations, and suggest that strengthening cognitive reserve could mitigate neuropsychological deficits and improve treatment outcomes.

This practice parameter describes the assessment and treatment of children and adolescents with substance use disorders and is based on scientific evidence and clinical consensus regarding diagnosis and effective treatment as well as on the current state of clinical practice. This parameter considers risk factors for substance use and related problems, normative use of substances by adolescents, the comorbidity of substance use disorders with other psychiatric disorders, and treatment settings and modalities. (Reprinted with permission from the Journal of the American Academy of Child and Adolescent Psychiatry 2005; 44(6):609–621)

Registered Nurses’ Awareness of Workplace Signs, Actions, and Interventions for Nurses With Substance Use Disorder

Substance use and substance use disorders in recently deployed and never deployed soldiers

I Have to Pay to Use the Montreal Cognitive Assessment: What Should I Do?

The Edinburgh Cognitive and Behavioural ALS Screen (ECAS) has recently been developed as a fast and easy cognitive screening tool specifically designed for patients with motor impairments in routine clinical use. The German/Swiss-German version of the ECAS was validated in a German-Swiss consortium. One hundred and thirty-six non-demented ALS patients and 160 healthy controls were included in the study. In addition, the Frontal Assessment Battery (FAB), Montreal Cognitive Assessment (MoCA) and Consortium to Establish a Registry for Alzheimer's Disease plus Scale (CERAD plus) were administered to subgroups of patients. Results showed that administration of ECAS was fast (mean 24 min). Similar to the population in the UK version, ALS patients performed significantly worse in the ALS-specific functions (p < 0.001), specifically in the domain of language (p < 0.001), verbal fluency (p = 0.005) and executive functions (p = 0.02), but not for the non-ALS-specific functions. Carers reported behavioural abnormalities in about 30% and psychotic symptoms in 6% of the patients. Compared to ECAS, FAB, MoCA and CERAD were more generic and performance was not adjusted to motor speed. We conclude that the German/Swiss-German version of the ECAS is a fast and easy to administer cognitive screening instrument sensitive for ALS-specific dysfunctions and behaviour change.