Review
Cognitive consequences of cannabis use: Comparison with abuse of stimulants and heroin with regard to attention, memory and executive functions

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Abstract

This review aims to compare cognitive consequence between cannabis, and stimulants and heroin with regards to attention, memory and executive functions. The available studies using brain imaging techniques and neuropsychological tests show that acutely, all drugs create a disharmony in the neuropsychological network, causing a decrease of activity in areas responsible for short-term memory and attention, with the possible exception of heroin. Cannabis induces loss of internal control and cognitive impairment, especially of attention and memory, for the duration of intoxication. Heavy cannabis use is associated with reduced function of the attentional/executive system, as exhibited by decreased mental flexibility, increased perserveration, and reduced learning, to shift and/or sustain attention. Recent investigations on amphetamine/methamphetamine have documented deficits in learning, delayed recall, processing speed, and working memory. MDMA users exhibit difficulties in coding information into long-term memory, display impaired verbal learning, are more easily distracted, and are less efficient at focusing attention on complex tasks. The degree of executive impairment increases with the severity of use, and the impairments are relatively lasting over time. Chronic cocaine users display impaired attention, learning, memory, reaction time and cognitive flexibility. Heroin addiction may have a negative effect on impulse control, and selective processing.

Introduction

Clinical observations, conventional wisdom, and well-reasoned theoretical mechanisms, suggest that the acute and chronic use of psychoactive substances would impair cognitive functioning of individuals. Could this impairment be a specific effect with regard to specific drugs of abuse or is it a general impact on the brain? This review compares findings from other drugs of abuse according to how cannabis impairs human cognition, with regard to attention, memory and executive functions. The executive functions are a group of superior abilities of organization and integration that have been neuroanatomically associated with different neural interaction pathways involving the prefrontal cortex (Roberts et al., 1998). These include anticipating and establishing goals, designing plans and programs, self-regulation and monitoring of tasks, and effective execution and feedback (Lezak, 1995).

To reduce the scope of this review the focus will be on the abuse of amphetamine and methamphetamine, MDMA or similar synthetic amphetamine derivates, cocaine, and heroin.

Recent studies of the acute and chronic effects of specific drugs of abuse on human cognition have shown a cluster of cognitive, behavioural or physiological symptoms. Hall et al. (1999) compared the health effects of cannabis to other drugs by using the same standards that have been used to appraise the health effects of other drugs. The analysis, which was undertaken at the request of the WHO Committee on the health, proved difficult. The analysis was hindered by a dearth of epidemiological studies of consequences of cannabis use that would permit quantitative comparisons.

Other attempts to investigate this area have been made by Rogers and Robbins (2001) and Vik et al. (2004), and Verdejo-Garcia et al. (2005). Rogers and Robbins (2001) reviewed the neurocognitive deficits associated with chronic drug misuse and concluded that chronic and heavy use of cannabis may be associated with quite subtle changes in cognitive, particularly attentional function, but whether such changes are permanent remains unclear, that chronic amphetamine abuse is associated with altered functioning of the circuitry, involving the ventral prefrontal cortex (PFC) that mediates decision-making. This is consistent with earlier results indicating that prolonged stimulant use (cocaine) is associated with altered metabolism in the orbital cortex (Volkow et al., 1993). It is also consistent with the finding of high densities of the cannabinoid receptor in the cerebral cortex and hippocampus (Herkenham et al., 1990), hypothesising that cannabinoids are involved in attentional and memory processes. Vik et al. (2004) conclude that acute intoxication and immediate and protracted withdrawal produce transient alterations of cognitions that can persist for weeks to months. Some subtle residual effects remain for up to 1 year for certain drugs. Evidence of irreversible effects is less clear. In comparison with cannabis and stimulants, there has been substantially less research into neuropsychological deficits in chronic abusers of opiates. Verdejo-Garcia et al. (2005) analyzed the relationship between severity of consumption of different drugs and neuropsychological performance on tasks sensitive to impairment in the executive subprocesses of working memory, response inhibition, cognitive flexibility, and abstract reasoning. The results showed a differential impact of severity of MDMA abuse on working memory and abstract reasoning indices, of cocaine severity on an inhibitory control index and of cannabis on a cognitive flexibility index.

Most of the neurotransmitters affected by drugs of abuse exert their effects through relatively diffuse patterns of innervations across the whole of the forebrain and wider cortical areas. It is therefore unsurprising that there have been relatively few, if any, convincing demonstrations of differences in neurocognitive performance between abusers of different drugs of abuse.

Section snippets

Cannabis

Qualitative analyses of the cognitive consequences of cannabis use made by Hall et al. (1999) conclude, focusing on: acute effects that, cannabis induces loss of internal control and cognitive impairment, especially of attention and memory, for the duration of intoxication. Further, according to Hall et al. (1999), the major health and psychological effects of chronic heavy cannabis use, especially daily use over many years, remain uncertain. On the available evidence, the major probable

Amphetamine and methamphetamine

Neuroimaging studies have demonstrated that methamphetamine user exhibits various abnormalities in brain function relative to healthy controls. These include alterations in frontal, temporal, and subcortical brain metabolism (Gouzoulis-Mayfrank et al., 1999, Iyo et al., 1997, Volkow et al., 2001a), changes in brain metabolites suggestive of neuronal injury in the basal ganglia and frontal cortex (Ernst et al., 2000), and decreased density of dopaminergic neurons in the caudate and putamen (

Discussion

Searching PubMed (January 2005) for attention and memory gives the following top five in the abuse perspective; cannabis, cocaine, ecstasy, methamphetamine, heroin. The order probably well illustrates the prevalence of the drugs. When executive functioning was added to the search, only 10 studies for all the above mentioned drugs together were found. This indicates paucity in studies assessing drug abuser and executive functioning. The brain imaging studies contain the same technique but have

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