Reliability of the WAIS-III subtests, indexes, and IQs in individuals with substance abuse disorders

Cognitive Profiles of Adolescent Inpatients with Substance Use Disorder

The prevalence of substance abuse is high during adolescence, and several studies have linked the use of alcohol and cannabis in adolescence to different cognitive impairments. To investigate whether specific cognitive deficits can be observed in adolescents with substance use disorder (SUD), we compared the cognitive profiles of inpatient adolescents diagnosed with SUD to a control group matched for sex, age and educational status. The inpatient adolescents received diagnoses of cannabis use disorder, alcohol use disorder or both. We compared the WISC-V profiles of 22 inpatients (45.5% female, M_age: 14.5; SD: 0.8) and the WAIS-IV profiles of 27 inpatients (44.4% female, M_age: 17.1; SD: 0.9) to 49 matched control participants with no diagnosed SUD. At the time of testing, participants were hospitalized for treatment of their SUD and were abstinent for a period of at least 6 weeks. To gain greater power, we jointly analyzed the Verbal Comprehension Index, Working Memory Index, Processing Speed Index and Full Scale IQ as assessed by WISC-V and WAIS-IV. The clinical group performed significantly worse than the control group on all the above indices. When only the group of inpatients was observed, in a model with the factors sex, educational status, presence of a comorbid diagnosis of depression and the number of comorbid diagnoses, only the factor educational status was significantly associated with the Full Scale IQ, whereas the factors sex and a comorbid diagnosis of depression in this group were associated with the Processing Speed Index. The results show that adolescents diagnosed with SUD (cannabis and/or alcohol) display broad cognitive impairments after 6 weeks of abstinence. Future research is required to further explore the role of comorbid diagnoses.

A pilot study on the adequacy of the TOMM in detecting invalid performance in patients with substance use disorders

Objective: The validity of neuropsychological test performance has scarcely been studied in patients with substance use disorders (SUD), despite the possibility that some SUD individuals may distort their performance for compensation seeking (e.g., work leave, permanent or total disability, or the designation of services such as sheltered housing). Thus, the aim of the present study is to determine: (i) the possible utility of the Test of Memory Malingering (TOMM) in detecting invalid test results among SUD patients, and (ii) the percentage of individuals that underperform the TOMM among SUD patients seeking compensation.Method: Seventy-seven patients (59 men and 18 women) with SUD in outpatient treatment with an age range between 20 and 59 years were divided into two groups: SUD patients without compensation seeking (n = 41), and SUD patients with compensation seeking (n = 36). Participants performed a neuropsychological assessment with measures of processing speed, working memory, inhibition, verbal memory, cognitive flexibility, and decision-making, that also included the TOMM.Results: Our results demonstrate that there were no significant differences on TOMM performance between the two groups. Only one participant underperformed the TOMM (1.3% of the sample). Results showed cognitive impairment in the sample, but no differences between the groups on the different neuropsychological measures.Conclusions: This constitutes the first study to explore the capacity of a forced-choice test to detect invalid test results in an SUD population. There was a high performance on the TOMM among the SUD participants of our study despite their cognitive impairment, indicating adequate effort in their neuropsychological test performance. Further, these findings suggest that the probability of showing invalid neuropsychological performance among SUD compensation seeking patients is much lower than what has been found in other populations, such as in mild brain injury patients.

Cognitive deficits in problematic drinkers with and without mild to borderline intellectual disability

We examined cognitive deficits in problematic drinkers with and without mild to borderline intellectual disability (MBID). Problematic drinkers were expected to show a significantly lower estimated performance IQ (PIQ), but not a lower estimated verbal IQ (VIQ), compared to light drinkers. Participants ( N = 474) were divided into four groups based on IQ and severity of alcohol use-related problems. IQ was estimated using (a short form of) the Wechsler Adult Intelligence Scale third edition. Severity of alcohol use-related problems was assessed using the Alcohol Use Disorder Identification Test. Overall, there were no significant differences between light and problematic drinkers on estimated VIQ. Within the group without MBID, estimated PIQ was significantly lower. Estimated PIQ was not lower in problematic drinkers with MBID compared to light drinkers with MBID. The results are indicative of cognitive deficits in problematic drinkers without MBID. Screening for cognitive deficits with additional instruments is advised.

Executive dysfunction in chronic cocaine users: an exploratory study

INTRODUCTION

Chronic cocaine use is associated with some executive deficits. We assessed executive functions using ecologically valid tests in chronic cocaine users.

OBJECTIVES

To investigate the relationship between executive deficits and three measures of severity of cocaine use: years of use, quantity used, and frequency of use.

METHODS

Twenty-four cocaine users were compared with twenty-seven community controls. We used Student's t-test and Chi-squared to compare means and categorical variables, respectively. Linear regression analyses for the adjusted comparative analysis between cases and controls, and severity of cocaine use among cocaine users were performed.

RESULTS

Chronic cocaine users performed worse on measures of attention and working memory (Forward and Backward Digit Span, p<.001), set-shifting abilities (difference score between the Trail Making B and A, TMB-A, p=.006), cognitive test of mental flexibility and response inhibition (Rule Shift Cards) (p<.001), and prefrontal functioning (Wisconsin Card Sorting Test, WCST, p=.023) than controls. Years of cocaine use were associated with deficits in the Backward Digit Span (p=.041; CI 95%: -.760 to -.002), the TMB-A (p=.026; CI 95%: .687 to 9.761), the Zoo Map (p=.034; CI 95%: -.480 to -.021), and the Rule Shift Cards (p=.006; CI 95%: -.836 to -.164), among others. Quantity of cocaine use was associated with executive deficits measured by the Forward Digit Span (p=.007; CI 95%: -.727 to -.133), the TMB-A (p=.021; CI 95%: 5.304-57.945), and the number of perseverative errors in the WSCT (p=.002; CI 95%: -10.654 to -2.800). Frequency of cocaine was associated with deficits in the Backward Digit Span (p=.042; CI 95%: -1.548 to -.030).

CONCLUSIONS

Chronic use of cocaine is associated with executive deficits, which may influence patients' functionality, prognosis, and therapeutic failure.

Deterioration of intelligence in methamphetamine-induced psychosis: comparison with alcohol dependence on WAIS-III

AIMS

Long-term use of methamphetamine could induce psychosis, but consequences with regards to intelligence have seldom been investigated. Long-term use of alcohol could also result in intellectual deterioration.

METHODS

The IQ of 34 methamphetamine-induced psychosis (MIP) patients (age, 28.7 +/- 6.1 years) and 34 alcohol-dependent (AD) patients (age, 40.7 +/- 7.3 years) was compared using the Chinese version of the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III).

RESULTS

The average full-scale IQ, verbal IQ, performance IQ, verbal comprehension index, working memory index, perceptual organization index, and processing speed index was 82.3 +/- 10.8, 84.3 +/- 11.9, 81.9 +/- 12.1, 85.5 +/- 11.9, 84.7 +/- 12.5, 85.4 +/- 13.6, and 78.5 +/- 12.7 in MIP patients and 90.5 +/- 12.0, 95.2 +/- 11.3, 86.0 +/- 13.7, 95.5 +/- 11.0, 87.1 +/- 14.5, 96.2 +/- 13.1, and 84.5 +/- 15.0 in AD patients, respectively. There were six MIP patients (17.6%) whose full-scale IQ was <70 and 13 (38.2%) whose full-scale IQ was <85 and >70, while one AD patient had a full-scale IQ <70 (2.9%) and 10 (22%) had full-scale IQ <85 and >70.

CONCLUSIONS

Long-term use of methamphetamine can result not only in psychosis, but also in mentality deterioration. Intelligence deterioration is more severe in clinical MIP patients than AD patients. Assessment of the mentality of MIP patients is suggested to help with the implementation of rehabilitative programs for these patients.

Sustained attention in patients receiving and abstinent following methadone maintenance treatment for opiate dependence: performance and neuroimaging results

OBJECTIVE

Impairments in the function of attention exacerbate the course of opiate dependence and may play a role in the relapsing nature of the disorder. This study used clinical measures and positron emission tomography (PET) to assess the functioning of sustained attention in subjects with a history of opiate dependence.

METHODS

A test of auditory sustained attention was administered to 10 subjects receiving methadone maintenance treatment, 13 formerly opiate-dependent subjects in protracted abstinence, and 14 healthy Comparison subjects. Simultaneous measurement of regional glucose metabolism was made by [(18)F] flourodeoxyglucose PET. Subjects groups were compared on the measures of sustained attention and regional cerebral glucose metabolism.

RESULTS

Healthy Comparison subjects scored significantly better than either methadone-maintained or abstinent former opiate addicts on measures of sustained attention. Formerly opiate-dependent subjects in protracted abstinence scored better than methadone-maintained subjects on sustained attention. Methadone-maintained subjects demonstrated a relative reduction in regional cerebral glucose metabolism in the right supramarginal gyrus, and the thalamus bilaterally. The Comparison subjects without a history of opiate dependence demonstrated a relative increase in regional cerebral glucose metabolism in the right anterior cingulate gyrus, the right medial superior frontal gyrus and the thalamus bilaterally.

CONCLUSIONS

Subjects with a history of opiate dependence have impairments in the functioning of sustained attention, and abnormalities in brain regions identified as important in attention processing. Impairments in attention performance persist in subjects who enjoy prolonged abstinence from opiates.

WAIS-III index score profiles in the Canadian standardization sample

Representative index score profiles were examined in the Canadian standardization sample of the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III). The identification of profile patterns was based on the methodology proposed by Lange, Iverson, Senior, and Chelune (2002) that aims to maximize the influence of profile shape and minimize the influence of profile magnitude on the cluster solution. A two-step cluster analysis procedure was used (i.e., hierarchical and k-means analyses). Cluster analysis of the four index scores (i.e., Verbal Comprehension [VCI], Perceptual Organization [POI], Working Memory [WMI], Processing Speed [PSI]) identified six profiles in this sample. Profiles were differentiated by pattern of performance and were primarily characterized as (a) high VCI/POI, low WMI/PSI, (b) low VCI/POI, high WMI/PSI, (c) high PSI, (d) low PSI, (e) high VCI/WMI, low POI/PSI, and (f) low VCI, high POI. These profiles are potentially useful for determining whether a patient's WAIS-III performance is unusual in a normal population.

Cross-cultural effects on IQ test performance: a review and preliminary normative indications on WAIS-III test performance

This article presents a review of cross-cultural influences on Wechsler IQ tests, together with a preliminary investigation into WAIS-III test performance (English administration) for a southern African sample (age range 19-30) stratified for white English first language and black African first language, level and quality of education. ('African language' is the term used to denote the indigenous languages of black populations in southern Africa). A two-way ANOVA revealed highly significant effects for both level and quality of education within the black African first language group. Scores for the white English and black African first language groups with advantaged education were comparable with the US standardization, whereas scores for black African first language participants with disadvantaged education were significantly lower than this. Thus indications from this research are that normative studies should take account of the influential variable of quality of education, in addition to level of education. Alternatively faulty conclusions may be drawn about the effects of ethnicity, with the potential for neuropsychological misdiagnosis.

Reliabilities of the WAIS–III for Discrepancy Scores: Generalization to a Clinical Sample

Internal consistency reliabilities for WAIS–III IQ, Index, and subtest discrepancy scores are provided for 100 men in a treatment program for substance abuse disorders. There were 63 Euro-Americans and 37 African Americans. Means for age, education, and Full Scale IQ were 46.1 yr. ( SD = 8.8), 12.7 yr. ( SD = 1.5), and 93.8 ( SD = 14.0), respectively. Reliabilities ranged from .34 to .86. Compared with the WAIS–III standardization sample, discrepancy score reliability coefficients differed only for the Verbal Comprehension Index vs Perceptual Organization Index contrast, which was higher in the patient sample. Interpretation of discrepancy scores for the WAIS–III appears to be useful in a clinical sample with substance abuse as in a purportedly normal sample.