Developing a cognitive dysfunction risk score for use with opioid-dependent persons in drug treatment

Drug Alcohol Depend. 2021 Jul 1:224:108726. doi: 10.1016/j.drugalcdep.2021.108726. Epub 2021 Apr 24.

Abstract

Background: Cognitive dysfunction is common in persons seeking medication for opioid use disorder (MOUD) and may hinder many addiction-related services. Brief but accurate screening measures are needed to efficiently assess cognitive dysfunction in these resource-limited settings. The study aimed to develop a brief predictive risk score tailored for use among patients in drug treatment.

Methods: The present study examined predictors of mild cognitive impairment (MCI), objectively assessed via the NIH Toolbox, among 173 patients receiving methadone as MOUD at an urban New England drug treatment facility. Predictors of MCI were identified in one subsample using demographic characteristics, medical chart data, and selected items from the Brief Inventory of Neuro-Cognitive Impairment (BINI). Predictors were cross-validated in a second subsample using logistic regression. Receiver operating curve (ROC) analyses determined an optimal cut-off score for detecting MCI.

Results: A cognitive dysfunction risk score (CDRS) was calculated from patient demographics (age 50+, non-White ethnicity, less than high school education), medical and substance use chart data (history of head injury, overdose, psychiatric diagnosis, past year polysubstance use), and selected self-report items (BINI). The CDRS discriminated acceptably well, with a ROC curve area of 70.6 %, and correctly identified 78 % of MCI cases (sensitivity = 87.5 %; specificity = 55.6 %).

Conclusions: The CDRS identified patients with cognitive challenges at a level likely to impede treatment engagement and/or key outcomes. The CDRS may assist in efficiently identifying patients with cognitive dysfunction while requiring minimal training and resources. Larger validation studies are needed in other clinical settings.

Keywords: Brief inventory for neurocognitive impairment; Cognitive dysfunction; Medication for opioid use disorder; Opioid-dependent; Risk score.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Analgesics, Opioid / adverse effects
  • Cognitive Dysfunction* / chemically induced
  • Cognitive Dysfunction* / diagnosis
  • Cognitive Dysfunction* / epidemiology
  • Humans
  • Mass Screening
  • Middle Aged
  • Neuropsychological Tests
  • Pharmaceutical Preparations*
  • ROC Curve
  • Risk Factors
  • Sensitivity and Specificity

Substances

  • Analgesics, Opioid
  • Pharmaceutical Preparations