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Cannabis use before age 15 and subsequent executive functioning

  • Maria Alice Fontes (a1), Karen I. Bolla (a2), Paulo Jannuzzi Cunha (a3), Priscila Previato Almeida (a1), Flávia Jungerman (a4), Ronaldo Ramos Laranjeira (a4), Rodrigo A. Bressan (a5) and Acioly L. T. Lacerda (a6)...
Abstract
Background

Many studies have suggested that adolescence is a period of particular vulnerability to neurocognitive effects associated with substance misuse. However, few large studies have measured differences in cognitive performance between chronic cannabis users who started in early adolescence (before age 15) with those who started later.

Aims

To examine the executive functioning of individuals who started chronic cannabis use before age 15 compared with those who started chronic cannabis use after 15 and controls.

Method

We evaluated the performance of 104 chronic cannabis users (49 early-onset users and 55 late-onset users) and 44 controls who undertook neuropsychological tasks, with a focus on executive functioning. Comparisons involving neuropsychological measures were performed using generalised linear model analysis of variance (ANOVA).

Results

The early-onset group showed significantly poorer performance compared with the controls and the late-onset group on tasks assessing sustained attention, impulse control and executive functioning.

Conclusions

Early-onset chronic cannabis users exhibited poorer cognitive performance than controls and late-onset users in executive functioning. Chronic cannabis use, when started before age 15, may have more deleterious effects on neurocognitive functioning.

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Copyright
Corresponding author
Maria Alice Fontes, Rua Dr José Gustavo Busch, 155–121B Morumbi, São Paulo SP Brazil, ZIP 05705-190. Email: m.alice@plenamente.com.br
Footnotes
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Declaration of interest

None.

Footnotes
References
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Cannabis use before age 15 and subsequent executive functioning

  • Maria Alice Fontes (a1), Karen I. Bolla (a2), Paulo Jannuzzi Cunha (a3), Priscila Previato Almeida (a1), Flávia Jungerman (a4), Ronaldo Ramos Laranjeira (a4), Rodrigo A. Bressan (a5) and Acioly L. T. Lacerda (a6)...
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eLetters

A call for more care when conducting neuropsychological studies in cannabis users

[Editor's note: This eLetter was originally published 24 August 2011 but was re-uploaded to the site in 2015 due to a technical error]

First of all, it is very important to acknowledge that all chronic cannabis users were seeking treatment and that the study used as inclusion criteria the fact that users presented cannabis misuse or dependence. These factors clearly introduce a bias in the study, since this population of users is very probably already presenting some kind of problems derived from their use of cannabis. The results of the study could possibly be different if the chronic users were not seeking treatment.

Second, abstinence was encouraged, but not required. Moreover, although the authors declared that they did urine analyses in all participants, they did not report the results of these analyses in any part of the article. Although the authors recognize that some of the results could be explained by “substance residues or withdrawal symptoms”, the authors explained that this effect was “minimized” because the cannabis groups were matched in several cannabis parameters. This means that it is possible that some of the participants were under the acute effects of cannabis while doing the tests. Furthermore, urine tests were performed only to detect cannabinoid-related substances. This means that some of the participants may be consumers of other substances that could also produce an effect on the neuropsychological tests and, more seriously, that some participants were under the effects of different kinds of drugs while doing the tests.



Third, the authors present, basically, the following results: the early-onset group performed worse on the WCST and on the Stroop test compared with controls, and their performance on the FAB was poorer in comparison with both the late-onset and the control group. The fact that cannabis users may perform worse than non-users is not any news, so the worse performance of the early-onset group when compared with the controls does not really bring any scientific novelty. So, the most (and probably only) relevant finding would be the worse performance of the early- versus late-onset cannabis users. Nevertheless, as the authors recognize, it is not possible to establish whether the results are the consequences of cannabis use or not.

Fourth, comparisons involving late-onset and control groups were non-significant. Although, as the authors suggest, different neural networks and stages in brain development may explain this result, it is also possible that early-onset cannabis users present different bio-psycho-social components that may predispose these individuals to perform worse in executive functions. Also, this result also suggests that cannabis may not be exceptionally harmful to cognition.

Fifth, the authors excluded participants only with current history of other DSM-IV Axis I disorders. It is well know that many people who seek treatment for drug-related problems present DSM-IV Axis II disorders, so the authors should have acknowledged this limitation, since this fact may, at least theoretically, influence the neuropsychological tests.

Finally, in any part of the paper the authors informed if the deficits are clinically relevant or are in the normal range.

In conclusion, although there is the real possibility that early-onset chronic cannabis use may produce neuropsychological deficits, the limitations of the study just discussed suggest that more research is needed before a definitive conclusion can be made.

... More

Conflict of interest: None Declared

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A call for more care when conducting neuropsychological studies in cannabis users

Rafael G. dos Santos, PhD candidate in Pharmacology
24 August 2011

First of all, it is very important to acknowledge that all chronic cannabis users were seeking treatment and that the study used as inclusioncriteria the fact that users presented cannabis misuse or dependence. These factors clearly introduce a bias in the study, since this populationof users is very probably already presenting some kind of problems derivedfrom their use of cannabis. The results of the study could possibly be different if the chronic users were not seeking treatment.

Second, abstinence was encouraged, but not required. Moreover, although the authors declared that they did urine analyses in all participants, they did not report the results of these analyses in any part of the article. Although the authors recognize that some of the results could be explained by "substance residues or withdrawal symptoms",the authors explained that this effect was "minimized" because the cannabis groups were matched in several cannabis parameters. This means that it is possible that some of the participants were under the acute effects of cannabis while doing the tests. Furthermore, urine tests were performed only to detect cannabinoid-related substances. This means that some of the participants may be consumers of other substances that could also produce an effect on the neuropsychological tests and, more seriously, that some participants were under the effects of different kinds of drugs while doing the tests.

Third, the authors present, basically, the following results: the early-onset group performed worse on the WCST and on the Stroop test compared with controls, and their performance on the FAB was poorer in comparison with both the late-onset and the control group. The fact that cannabis users may perform worse than non-users is not any news, so the worse performance of the early-onset group when compared with the controlsdoes not really bring any scientific novelty. So, the most (and probably only) relevant finding would be the worse performance of the early- versuslate-onset cannabis users. Nevertheless, as the authors recognize, it is not possible to establish whether the results are the consequences of cannabis use or not.

Fourth, comparisons involving late-onset and control groups were non-significant. Although, as the authors suggest, different neural networks and stages in brain development may explain this result, it is also possible that early-onset cannabis users present different bio-psycho-social components that may predispose these individuals to perform worse in executive functions. Also, this result also suggests that cannabis may not be exceptionally harmful to cognition.

Fifth, the authors excluded participants only with current history ofother DSM-IV Axis I disorders. It is well know that many people who seek treatment for drug-related problems present DSM-IV Axis II disorders, so the authors should have acknowledged this limitation, since this fact may,at least theoretically, influence the neuropsychological tests.

Finally, in any part of the paper the authors informed if the deficits are clinically relevant or are in the normal range.

In conclusion, although there is the real possibility that early-onset chronic cannabis use may produce neuropsychological deficits, the limitations of the study just discussed suggest that more research is needed before a definitive conclusion can be made.

... More

Conflict of interest: None declared

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