Kan tester forutsi risiko for drop-out?

Svekkede kognitive evner og lav alder øker risiko for drop-out fra behandling. I en ny artikkel anbefaler forfatterne at ruspasienter screenes rutinemessig med MoCA og at behandlingen tilpasses pasientens kognitive nivå.

The Montreal Cognitive Assessment as a predictor of dropout from residential substance use disorder treatment

 Forfattere: Mikael Sømhovd, Egon Hagen, Tone Bergly, Espen Ajo Arnevik

Publisert i: Heliyon 5 (2019) e01282. doi: 10.1016/j.heliyon.2019.e01282

 

Abstract

Background:

Cognitive function is a challenge for many SUD patients, and

residential SUD treatment is cognitively demanding. Treatment retention is a predictor for success in SUD treatment, and the literature links low cognitive function to increased dropout rates. In our study we investigate cognitive function and dropout in a residential SUD treatment setting, also accounting for psychological distress.

Methods:

We screened a cohort (N ¼ 142) of inpatients for cognitive function

(MoCA_) and psychological distress (SCL-10) and calculated the relative risk for dropping out if over versus under the respective cut-off values (<26 and>1.85), and sex, and age-group (<23 years). We also employed a logistic regression with dropout as outcome and MoCA- and SCL-10 scores, and age and days before testing as input.

Results:

Dropout risk was higher (RR ¼ 1.70) if scoring below MoCA cut-off, and

for those younger than 23 years (RR ¼ 2.36). The other variables did not influence dropout risk. MoCA raw scores, age, and SCL-10 were associated with dropout (p < .05); with lower symptoms of psychological distress predicting increased dropout. The interaction between MoCA and SCL-10 scores was not significant (p ¼ .26).

Conclusions:

SUD patients should routinely be screened for cognitive impairment,

as it predicts dropout. Screenings should be ensued by appropriate adaptations to treatment and further assessment. The MoCA is a useful screening tool for this, independent of psychological distress. Future studies should replicate our findings, investigate specific interventions, and establish SUD population norms for the MoCA.