Is the Mini-Mental State Examination (MMSE) useful for eligibility screening of research participants with substance use disorder?
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Abstract
Introduction: the MMSE is used for eligibility screening of potential research participants diagnosed with substance use disorder (SUD), as abilities needed to provide a valid informed consent or accurate information could be impaired in these clinical populations. Knowledge about the capacity of the MMSE to detect impairment in these abilities or at least to assess impact of SUD on its total score, however, is rather diffuse. This has important ethical and methodological implications.
Objective: to analyze effects of SUD only, main substances of abuse, age of onset of substance use, recent substance use, and psychiatric comorbidity upon MMSE outcome. The overall purpose of the study was to assess the utility of the MMSE for eligibility screening of potential research participants with SUD.
Method: individuals were recruited from residential facilities for substance use treatment. A demographic questionnaire, MMSE and Mini International Neuropsychiatric Interview were used.
Results: A total of 601 participants were gathered for main analysis. Controlling for education, no differences in MMSE score were detected within main substances of abuse (F=1.25[4,529], p=.28), nor between SUD only versus SUD with psychiatric comorbidity (F=.58[1,597], p=.44). Effects of age of onset and recent use of specific substances upon MMSE score were also absent.
Discussion and conclusions: If there is some cognitive impairment in this clinical population, it may not be pertinently assessed by the MMSE, thus casting doubt on its pertinence for eligibility screening.
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References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Publishing
Bearden, C. E., & Freimer, N. B. (2006). Endophenotypes for psychiatric disorders: ready for primetime? Trends in Genetics, 22(6), 306-313. doi: 10.1016/j.tig.2006.04.004
Carter, A., & Hall, W. (2008). Informed consent to opioid maintenance treatment: Recommended ethical guidelines. International Journal of Drug Policy, 19(1), 79-89. doi: 10:1016/j.drugpo.2007.09.007
Conner, K. R., Houston, R. J., Swogger, M. T., Conwell, Y., You, S., He, H., … Duberstein, P. R. (2012). Stressful life events and suicidal behavior in adults with alcohol use disorders: role of event severity, timing and type. Drug and Alcohol Dependence, 120(1-3), 155-161. doi: 10.1016/j.drugalcdep.2011.07.013
Copersino, M. L., Fitzmaurice, G., Sokoloff, J., Fals-Stewart, W., Schretlen, D. J., & Weiss, R. D. (2009). Rapid cognitive screening of patients with substance use disorders. Experimental and Clinical Psychopharmology, 17(5), 337-344. doi: 10.1037/a0017260
Goldstein, T. Z., & Volkow, N. D. (2011). Dysfunction of the prefrontal cortex in Baddiction: neuroimaging findings and clinical implications. Nature Reviews Neuroscience, 12(11), 652-669. doi: 10.1038/nrn3119
Jeste, D. V., Palmer, B. W., Appelbaum, P. S., Golshan, S., Glorioso, D., Dunn, L. B., … Kraemer, H. C. (2007). A new brief instrument for assessing decisional capacity for clinical research. Archives of General Psychiatry, 64(8), 966-974. doi: 10.1001/archpsyc.64.8.966
Marín-Navarrete, R., Medina-Mora, M. E., Horigian, V. E., Salloum, I., Villalobos- Gallegos, L., & Fernandez-Mondragón. (in press). Co-occurring disorders: A challenge for community-based residential care facilities for substance use.
Pachet, A., Astner, K., & Brown, L. (2010). Clinical utility of the Mini-Mental Status Examination when assessing decision-making capacity. Journal of Geriatric Psychiatry and Neurology, 23(1), 3-8. doi: 10.1177/0891988709342727
Palmer, B. W., & Savla, G. N. (2007). The association of specific neuropsychological deficits with capacity to consent to research or treatment. Journal of the International Neuropsychological Society, 13(6), 1047-1059. doi: 10.10170S1355617707071299
Robbins, T. W., Gillan, C. M., Smith, D. G., de Wit, S., & Ersche, K. D. (2012). Neurocognitive endophenotypes of impulsivity and compulsivity: towards dimensional psychiatry. Trends in Cognitive Science, 16(1), 81-91. doi: 10.1016/j.tics.2011.11.009
Saitz, R., Cheng, D. M., Winter, M., Kim, T. W., Meli, S. M., Allensworth-Davies, D., … Samet, J. H. (2013). Chronic care management for dependence on alcohol and other drugs. The AHEAD randomized trial. Journal of the American Medical Association, 310(11), 1156-1167. doi: 10.1001/jama.2013.277609
Saitz, R., Palfai, T. P., Cheng, D. M., Horton, N. J., Freedner, N., Dukes, K., … Samet, J. H. (2007). Brief intervention for medical inpatients with unhealthy alcohol use. A randomized, controlled trial. Annals of Internal Medicine, 146(3), 167-176. doi: 10.7326/0003-4819-147-8-200710160-00017
Sheehan, D., Lecrubier, Y., Sheehan, K., Amorim, P., Janavs, J., Weiller, E., … Dunbar, G. C. (1998). The Mini International Neuropsychiatric Interview (MINI): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical of Psychiatry, 59(20), 22-33.
Smith, K. L., Horton, N. J., Saitz, R., & Samet, J. H. (2006). The use of the mini-mental state examination in recruitment for substance abuse research studies. Drug and Alcohol Dependence, 82(3), 231-237. doi: 10.1016/j.drugalcdep.2005.09.012
Tombaugh, T. N., & McIntyre, N. J. (1992). The mini-mental state examination: a comprehensive review. Journal of the American Geriatrics Society, 40(9), 922-935. doi: 10.1111/j.1532-5415.1992.tb01992.x
Verdejo-García, A., & Pérez-García, M. (2008). Substance abusers’ self-awareness of the neurobehavioral consequences of addiction. Psychiatry Research, 158(2), 172-180. doi: 10.1016/j.psychres.2006.08.001
Williams, E. C., Palfai, T., Cheng, D. M., Samet, J., Bradley, K. A., Koepsell, T. D., … Saitz, R. (2010). Physical health and drinking among medical inpatients with unhealthy alcohol use: A prospective study. Alcoholism: Clinical Experimental Research, 34(7), 1257-1265. doi: 10.1111/j.1530-0277.2010.01203.x
Yücel, M., Lubman, D. I., Solowij, N., & Brewer, W. J. (2007). Understanding drug addiction: a neuropsychological perspective. Australian and New Zealand Journal of Psychiatry, 41(2), 957-968. doi: 10.1080/00048670701689444
Yücel, M., Takagi, M., Walterfang, M., & Lubman, D. I. (2008). Toluene misuse and long- term harms: A systematic review of the neuropsychological and neuroimaging literature. Neuroscience and Biobehavioral Reviews, 32(5), 910-926. doi: 10.1016/j.neubiorev.2008.01.006