Cognitive Impairment in Patients Clinically Recovered From Central Nervous System Depressant Drug Overdose

Abstract

Central nervous system depressant drugs (CNS-Ds) are known to impair cognitive functions. Overdose of these drugs is common, and most of the hospital-treated patients are discharged within 24 to 48 hours. No previous studies have examined whether they have residual impairment at the time of discharge. Our aim was to evaluate whether patients with CNS-D overdose are impaired in cognitive domains important in daily activities at that time. We compared visuomotor skills (Trail-Making Test A and Choice Reaction Time), executive functions (viz attentional set-shifting: Trail-Making Test B; and planning: Stockings of Cambridge Task from the Cambridge Neuropsychological Test Automated Battery), working memory (Letter-Number Sequencing), and impulsivity and decision making (Cambridge Neuropsychological Test Automated Battery Information Sampling) in 107 patients with CNS-D overdose (benzodiazepines, opioids, or antipsychotics) with a control group of 68 with non-CNS-D overdose (acetaminophen, selective serotonin reuptake inhibitors, and serotonin noradrenaline reuptake inhibitors) on discharge from hospital. Outcome measures were adjusted for demographic and clinical covariates in multivariate regression models. Compared with the controls, patients in the CNS-D group were significantly impaired in all domains: they had prolonged Trail-Making completion times and reaction times, poorer working memory and planning and were more impulsive in decision making. Their Stockings of Cambridge Task performance was comparable to that of the control group for simple problems but worsened with increasing task complexity. The results show that patients with CNS-D overdose could be impaired in multiple cognitive domains underlying everyday functioning even at the time they are deemed medically fit to be discharged. Such impairments could adversely affect social and professional lives of this relatively young population during the immediate postdischarge period.

Cognitive toxicity: from pesticides to pharmaceuticals

“…Our results showed that the CNS-Depressant Group was impaired in all tests in all three 66 domains . After adjusting for confounding factors CNS-Depressant Group was found to be impaired in visual attention and visuomotor skills, executive functions and working memory.…”

“…The aim of our first study was to determine whether patients with CNS-depressant overdose are cognitively impaired at the time they are clinically deemed fit to be discharged [66][67][68] from hospital .…”

Patient emergency assessment following deliberate self-poisoning with benzodiazepines: Can cognitive markers predict recall of the psychiatric interview? A pilot study

“…Additionally, those experimental results have been confirmed by a clinical study in which patients with CNS depressant drug overdose, especially with BZDs, may be impaired in multiple cognitive functions, especially impaired planning and working memory. Those impairments are under-recognized, and may persist even when patients are considered medically fit for discharge (Dassanayake et al, 2012). Indeed, several studies conducted in this population of BZD self-poisoning patients showed how these or those cognitive impairments, especially anterograde amnesia, can have problematic clinical consequences, because almost half of the patients were unable to recognize the psychiatric resident they had spoken to the day before (Verwey et al, 2010).…”

Impulsividad en varones con prescripción de benzodiacepinas y metadona en prisión

“…Asimismo, algunos estudios en consumidores de esta sustancia han encontrado alteraciones en la impulsividad indicando comportamientos desinhibidos (Michel y Lang, 2003), toma de decisiones impulsivas (Dassanayake et al, 2012;Lane, Tcheremissine, Lieving, Nouvion, y Cherek, 2005), y déficits en la inhibición de respuesta (Acheson, Reynolds, Richards, y de Wit, 2006). Distintos modelos teóricos sobre adicción han señala-do la impulsividad como un marcador de vulnerabilidad de gran relevancia en la explicación de los procesos adictivos, tanto para explicar el inicio como el mantenimiento del consumo de drogas (Adan, 2002, Arce y Santisteban, 2006Cano-Cervantes, Araque-Serrano, y Cándido-Ortiz, 2011;Cortés-Tomás, Giménez-Costa, Motos-Sellés, y Cadaveira-Mahía, 2014;Gullo, Loxton, y Dawe, 2014;Navas, Torres, Cándido, y Perales, 2014;Pattij y De Vries, 2013).…”