Helene Bergly Tone, Julius Sømhovd Mikael
a Research and Development , The Tyrili Foundation , Oslo , Norway.
b Department of Psychology , Technical University of Denmark, University of Copenhagen , Copenhagen , Denmark.
J Dual Diagn. 2018 Oct-Dec;14(4):228-236. doi: 10.1080/15504263.2018.1496305. Epub 2018 Sep 5.
Attention-deficit/hyperactivity disorder (ADHD) frequently co-occurs with substance use disorders and has some overlapping symptoms with mild cognitive impairment, including executive functions. We wanted to investigate whether patients with ADHD have an excess risk of mild cognitive impairment-like symptoms, as defined by the Montreal Cognitive Assessment (MoCA). Second, we assessed the impact of ADHD medication on the dichotomized MoCA for patients with ADHD.
The participants in this study were 129 inpatients at seven treatment clinics in Norway. All were screened with the MoCA. We calculated relative risk estimates (RR) for scoring in the mild cognitive impairment range (< 26) for those having ADHD. Finally, we calculated the RR for the patients within the ADHD group who were taking medication.
Of the 129 participants included in the analyses, 38 (29.5%) scored below the MoCA threshold (< 26), and 24 (18.6%) had ADHD that was diagnosed before or during the inpatient treatment. Of the 105 participants without ADHD, 31 (29.5%) scored below the threshold. Seven (29.2%) of those with ADHD scored below the threshold. The risk of scoring in the mild cognitive impairment range for those with and without ADHD was equal (RR = 0.98). Of the 24 patients with ADHD, 9 (37.5%) were taking medication at the time of testing. One of the patients taking medication scored below the threshold compared to six of those not taking medication. This suggests a 72% lower risk of mild cognitive impairment-like symptoms when taking medication (RR = 0.28); however, the effect was not significant.
We revealed no excess risk of mild cognitive impairment-like symptoms for the ADHD group. However, within the ADHD group, there was a possible lower risk of mild cognitive impairment-like symptoms for patients taking medication. These results suggest that there may be a confounding overlap of symptoms between ADHD and cognitive function screens that necessitates adequate assessment and treatment of ADHD before screening or measuring cognitive function.
注意力缺陷多动障碍（ADHD）常与物质使用障碍同时出现，且与轻度认知障碍有一些重叠症状，包括执行功能。我们想调查ADHD患者是否存在如蒙特利尔认知评估（MoCA）所定义的轻度认知障碍样症状的额外风险。其次，我们评估了ADHD药物对ADHD患者二分法MoCA评分的影响。
本研究的参与者为挪威七家治疗诊所的129名住院患者。所有人都接受了MoCA筛查。我们计算了患有ADHD的患者在轻度认知障碍范围（<26分）内得分的相对风险估计值（RR）。最后，我们计算了ADHD组中正在服药的患者的RR。
在纳入分析的129名参与者中，38人（29.5%）得分低于MoCA阈值（<26分），24人（18.6%）在住院治疗前或治疗期间被诊断患有ADHD。在105名没有ADHD的参与者中，31人（29.5%）得分低于阈值。7名（29.2%）患有ADHDHD患者得分低于阈值。患有和未患有ADHD的患者在轻度认知障碍范围内得分的风险相等（RR = 0.98）。在24名患有ADHD的患者中，9人（37.5%）在测试时正在服药。服药的患者中有1人得分低于阈值，未服药的患者中有6人得分低于阈值。这表明服药时出现轻度认知障碍样症状的风险降低了72%（RR = 0.28）；然而，该效果并不显著。
我们发现ADHD组不存在轻度认知障碍样症状的额外风险。然而，在ADHD组中，服药患者出现轻度认知障碍样症状的风险可能较低。这些结果表明，ADHD与认知功能筛查之间可能存在症状的混淆重叠，这使得在筛查或测量认知功能之前有必要对ADHD进行充分的评估和治疗。
