238623 Decreased Cognitive Performance in Illicit Drug Use in an Urban African-American Population

Tuesday, November 1, 2011

Pammie Gabrielle Renee Crawford, MPhil, SM , International Health, Health Systems Division/Department of Health Information Systems, Johns Hopkins University Bloomberg School of Public Health/Johns Hopkins University School of Medicine, Baltimore, MD
Xiaoqiang Xu, MS , Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
Amy B. Wisniewski, PhD , Department of Biology, Drake University, Des Moines, IA
Todd T. Brown, MD, PhD , Division of Endocrinology and Metabolism, Johns Hopkins School of Medicine, Baltimore, MD
Joseph Cofrancesco Jr., MD, MPH , Department of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD
Ola Selnes, PhD , Department of Neurology, The Johns Hopkins Hospital, Baltimore, MD
Adrian S. Dobs, MD, MHS , Division of Endocrinology and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, MD
Introduction Illicit drug use (IDU) is a major public health problem requiring interventions to prevent, treat, and minimize recidivism. Cognitive function abnormalities may impair decision-making/higher executive function and contribute to IDU. We sought to better understand the contribution of cognitive performance to drug abuse. Participants were 217 urban, low socioeconomic residents in/around Baltimore City, Maryland grouped as: Non-IDU; Occasional IDU (drug use < 3x/week) and Heavy IDU (≥3 times/week/or methadone maintenance).

Methods Consented participants took standardized cognitive function tests on executive function/motor skills, verbal/visual memory. Cognitive functions were compared across three groups using general linear models and adjusted by age and gender. Pair-wise comparisons were performed for those showing a significant result (p<0.05).

Results Significant differences were found in eight cognitive test cross-group comparisons, particularly between Non-IDU and Heavy IDU/methadone maintenance: verbal memory recognition (p<0.001) and working memory (p<0.025), and motor memory (p<0.010). Differences between Non-IDU and Heavy-IDU/methadone maintenance were greater than between Occasional-IDU and Heavy-IDU/methadone maintenance-supporting the hypothesis that cognitive functioning worsens with increased IDU intensity and duration.

Conclusion IDU was associated with lower cognitive performance compared to Non-IDU of similar socioeconomic backgrounds. This information is useful in planning/designing health/social programs for IDU. Besides poorer health outcomes, former/current IDU often experience cognitive deficits affecting decision-making and higher executive functioning. Such deficits can further impair overall health/life quality, especially when IDU navigate social services/programs to receive important assistance. Our findings can broadly impact health policy/program designs: IDU require a full range of support services to ensure good health/quality of life.

Learning Areas:
Planning of health education strategies, interventions, and programs
Provision of health care to the public
Public health or related research

Learning Objectives:
Demonstrate IDU is associated with diminished cognitive abilities Explain how cognition dysfunction directly vary with intensity of IDU Describe how current policy/programming supporting IDU fail to recognize cognitively-impaired IDU needs Discuss how public health policy writers, health program designers and health providers can improve IDU health/social services Design plans for improving IDU health and social services

Keywords: Drug Abuse, Urban Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a PhD student in Public Health working with the research team on this project.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.