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Developing a cognitive dysfunction risk score for use with opioid-dependent persons in drug treatment
Michael M Copenhaver1, Victoria Sanborn2, Roman Shrestha1
1Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA; Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA.
Drug and Alcohol Dependence
|April 30, 2021
Summary
A new Cognitive Dysfunction Risk Score (CDRS) effectively identifies patients with opioid use disorder (OUD) who may have cognitive challenges, aiding treatment engagement. This brief tool requires minimal resources for screening in clinical settings.
Area of Science:
- Neuroscience
- Addiction Medicine
- Clinical Psychology
Background:
- Cognitive dysfunction is prevalent among individuals undergoing medication for opioid use disorder (MOUD).
- This cognitive impairment can significantly impede engagement with addiction-related services and treatment outcomes.
- There is a critical need for brief, accurate screening tools for cognitive dysfunction in resource-limited MOUD settings.
Purpose of the Study:
- To develop and validate a brief predictive risk score for cognitive dysfunction tailored to patients in drug treatment programs.
- To identify key demographic, clinical, and self-report factors associated with mild cognitive impairment (MCI) in this population.
Main Methods:
- A cohort of 173 patients receiving methadone for MOUD were assessed for MCI using the NIH Toolbox.
- Predictors of MCI were identified using demographic data, medical chart review, and the Brief Inventory of Neuro-Cognitive Impairment (BINI) in one subsample.
- Logistic regression and Receiver Operating Curve (ROC) analyses were employed for cross-validation and to determine an optimal cut-off score for the Cognitive Dysfunction Risk Score (CDRS).
Main Results:
- The developed CDRS incorporates age (50+), non-White ethnicity, education level, history of head injury, overdose, psychiatric diagnosis, polysubstance use, and specific BINI items.
- The CDRS demonstrated acceptable discrimination for MCI, with a ROC curve area of 70.6%.
- The score correctly identified 78% of MCI cases, showing a sensitivity of 87.5% and specificity of 55.6%.
Conclusions:
- The CDRS is a valuable tool for efficiently identifying patients with opioid use disorder who exhibit cognitive challenges that may impact treatment.
- Its ease of use, requiring minimal training and resources, makes it suitable for resource-limited clinical settings.
- Further validation in diverse clinical settings is recommended to broaden its applicability.
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