Cognition and Depression in American Indian Elders with Prescribed Opioid Use: Data from the Strong Heart Study

American Indian communities experience significant health care disparities, resulting in an increased risk of multiple chronic conditions, including cardiovascular disease, diabetes, and stroke. The rate of prescribed opioids in the long-term treatment of chronic conditions is also increased in this population. Tribal communities have an increased morbidity due to conditions, such as clinically significant depression, which have profound effects on cognitive function and quality of life. Changes in neurocognition with acute opioid use are well documented and range from decreased attention to delayed psychomotor speed. However, literature on prolonged opioid use and long-term effects on neurocognition are scarce, especially for qualifying an increased risk in American Indian elders with prolonged use of prescribed opioids. Our study aimed to determine whether poorer cognitive function, depressive symptoms, and quality of life are associated with prescribed opioid use, with the goal of identifying high-risk groups for targeted prevention and intervention.

Our study used data from the ancillary neurology cohort Cerebrovascular Disease and its Consequences in American Indians (CDCAI) Study of the parent cohort of the Strong Heart Study (SHS), collected from N = 818 participants aged 64-95 years, over two examinations visits in 2010-2019. An expert panel in neurology, psychology, and epidemiology adjudicated cognitive status by consensus review of cognitive tests over two visits. Cognitive test results from visit 2 were used for longitudinal analysis. Sex, age, education, smoking/alcohol use, and comorbidities were self-reported. Depression (CES-D score), quality of life (SF36 scale), and cognitive score were assessed for associations by linear regression models. All analyses were conducted using the Stata v18.

The CDCAI data indicated an opioid prescription rate of 12% (n = 96) in a cohort of 818 participants. Using adjusted and unadjusted models, there was no significant difference in neurocognitive measures between the prescribed opioid group and the non-prescribed opioid group (n = 722). An association was confirmed between opioid use and depressive symptoms (using the SF36 quality of life score), with an estimated total effect beta coefficient of - 14.5 (95% confidence interval: - 17.1, - 11.8; P < 0.001), direct effect beta coefficient - 14.9 (95% CI: - 18.6, - 11.3; P < 0.001), and indirect effect beta 0.5 (95% CI: - 1.3, 2.3; P = 0.596).

Existing data do not provide a clear association between changes in neurocognition and prescribed opioids use in American Indian elders. However, the results did support known associations between the use of prescribed opioids, QOL, and depression in this population. Additional studies are needed to further delineate whether long-term opioid use affects neurocognition, especially in populations with increased rates of healthcare disparities, prescribed opioid use, and depression.