A Systematic Review and Meta-Analysis of Cognitive Performance among People with Chronic Use of Opioids for Chronic Non-Cancer Pain

Pain Medicine ◽  
2021 ◽  
Author(s):  
Jane Akhurst ◽  
Monica Lovell ◽  
Amy Peacock ◽  
Raimondo Bruno
Keyword(s):  
Working Memory ◽  
Cancer Pain ◽  
Cognitive Performance ◽  
Case Control ◽  
Small Sample ◽  
Effect Sizes ◽  
Attention And Memory ◽  
Small Magnitude ◽  
Meta Analyses

Abstract Objective Opioids, often prescribed for chronic non-cancer pain, may adversely affect cognition. Research has not been synthesised in recent years, during which time academic interest has increased. This study presents meta-analyses on cognitive performance in people taking opioids for CNCP. Methods We ran systematic literature searches in EMBASE, Medline, and PsycINFO. Eligible studies included people taking opioids for CNCP and an opioid-free group (i.e., case-control) or session (e.g., pre-post), and objective cognitive assessments. Using random-effects meta-analyses, we computed pooled effect sizes for differential task performance for each study design across five domains (motor performance, attention, working memory, executive functions, memory). Results Seventeen studies were included. Case-control studies covered 3 control types (healthy, CNCP, taper-off). Pre-post studies were grouped into 5 follow-ups (4–6 and 6–9 weeks; 3, 6, and 12 months). Effect sizes ranged from 0.02–0.62. Cases showed small magnitude impairments in attention and memory compared with healthy controls. Although limited by small sample sizes, there was no clear evidence of impairment in cases compared with opioid-free controls with CNCP. Cases showed some cognitive improvements from opioid-free baseline to follow-up. Effects were strongest for attention and working memory, and were apparent from 4 weeks to 6 months follow-up. Other effects were small and non-significant. Conclusions Opioid therapy for CNCP did not worsen cognitive performance and improved it for some domains. People who take opioids for CNCP may evidence deficits in attention and memory, but this is unlikely to translate to global impairment and likely relates to pain more so than opioids.

scholarly journals Influence of Pilot and Small Trials in Meta-Analyses of Behavioral Interventions: A Meta-epidemiological Study

2020 ◽  
Author(s):  
Michael W. Beets ◽  
R. Glenn Weaver ◽  
John P.A. Ioannidis ◽  
Alexis Jones ◽  
Lauren von Klinggraeff ◽  
...  
Keyword(s):  
Sample Size ◽  
Behavioral Interventions ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Feasibility Studies ◽  
Small Sample ◽  
Effect Sizes ◽  
Absolute Difference ◽  
Meta Analyses ◽  
The Impact

Abstract Background: Pilot/feasibility or studies with small sample sizes may be associated with inflated effects. This study explores the vibration of effect sizes (VoE) in meta-analyses when considering different inclusion criteria based upon sample size or pilot/feasibility status. Methods: Searches were conducted for meta-analyses of behavioral interventions on topics related to the prevention/treatment of childhood obesity from 01-2016 to 10-2019. The computed summary effect sizes (ES) were extracted from each meta-analysis. Individual studies included in the meta-analyses were classified into one of the following four categories: self-identified pilot/feasibility studies or based upon sample size (N≤100, N>100, and N>370 the upper 75th of sample size). The VoE was defined as the absolute difference (ABS) between the re-estimations of summary ES restricted to study classifications compared to the originally reported summary ES. Concordance (kappa) of statistical significance between summary ES was assessed. Fixed and random effects models and meta-regressions were estimated. Three case studies are presented to illustrate the impact of including pilot/feasibility and N≤100 studies on the estimated summary ES.Results: A total of 1,602 effect sizes, representing 145 reported summary ES, were extracted from 48 meta-analyses containing 603 unique studies (avg. 22 avg. meta-analysis, range 2-108) and included 227,217 participants. Pilot/feasibility and N≤100 studies comprised 22% (0-58%) and 21% (0-83%) of studies. Meta-regression indicated the ABS between the re-estimated and original summary ES where summary ES were comprised of ≥40% of N≤100 studies was 0.29. The ABS ES was 0.46 when summary ES comprised of >80% of both pilot/feasibility and N≤100 studies. Where ≤40% of the studies comprising a summary ES had N>370, the ABS ES ranged from 0.20-0.30. Concordance was low when removing both pilot/feasibility and N≤100 studies (kappa=0.53) and restricting analyses only to the largest studies (N>370, kappa=0.35), with 20% and 26% of the originally reported statistically significant ES rendered non-significant. Reanalysis of the three case study meta-analyses resulted in the re-estimated ES rendered either non-significant or half of the originally reported ES. Conclusions: When meta-analyses of behavioral interventions include a substantial proportion of both pilot/feasibility and N≤100 studies, summary ES can be affected markedly and should be interpreted with caution.

scholarly journals Individual variation in cognitive performance: developmental and evolutionary perspectives

2012 ◽  
Vol 367 (1603) ◽  
pp. 2773-2783 ◽  
Author(s):  
Alex Thornton ◽  
Dieter Lukas
Keyword(s):  
Cognitive Performance ◽  
Individual Variation ◽  
Animal Cognition ◽  
Individual Performance ◽  
Small Sample ◽  
Cognitive Capacity ◽  
Single Individual ◽  
High Performing ◽  
Cognitive Traits ◽  
Meta Analyses

Animal cognition experiments frequently reveal striking individual variation but rarely consider its causes and largely ignore its potential consequences. Studies often focus on a subset of high-performing subjects, sometimes viewing evidence from a single individual as sufficient to demonstrate the cognitive capacity of a species. We argue that the emphasis on demonstrating species-level cognitive capacities detracts from the value of individual variation in understanding cognitive development and evolution. We consider developmental and evolutionary interpretations of individual variation and use meta-analyses of data from published studies to examine predictors of individual performance. We show that reliance on small sample sizes precludes robust conclusions about individual abilities as well as inter- and intraspecific differences. We advocate standardization of experimental protocols and pooling of data between laboratories to improve statistical rigour. Our analyses show that cognitive performance is influenced by age, sex, rearing conditions and previous experience. These effects limit the validity of comparative analyses unless developmental histories are taken into account, and complicate attempts to understand how cognitive traits are expressed and selected under natural conditions. Further understanding of cognitive evolution requires efforts to elucidate the heritability of cognitive traits and establish whether elevated cognitive performance confers fitness advantages in nature.

scholarly journals Working Memory Training and Cortical Arousal in Healthy Older Adults: A Resting-State EEG Pilot Study

2021 ◽  
Vol 13 ◽  
Author(s):  
Chiara Spironelli ◽  
Erika Borella
Keyword(s):  
Older Adults ◽  
Working Memory ◽  
Pilot Study ◽  
Resting State ◽  
Training Group ◽  
Effect Sizes ◽  
Intrusion Errors ◽  
High Beta

The current pilot study aimed to test the gains of working memory (WM) training, both at the short- and long-term, at a behavioral level, and by examining the electrophysiological changes induced by training in resting-state EEG activity among older adults. The study group included 24 older adults (from 64 to 75 years old) who were randomly assigned to a training group (TG) or an active control group (ACG) in a double-blind, repeated-measures experimental design in which open eyes, resting-state EEG recording, followed by a WM task, i.e., the Categorization Working Memory Span (CWMS) task, were collected before and after training, as well as at a 6-month follow-up session. At the behavioral level, medium to large Cohen's d effect sizes was found for the TG in immediate and long-term gains in the WM criterion task, as compared with small gains for the ACG. Regarding intrusion errors committed in the CWMS, an index of inhibitory control representing a transfer effect, results showed that medium to large effect sizes for immediate and long-term gains emerged for the TG, as compared to small effect sizes for the ACG. Spontaneous high-beta/alpha ratio analyses in four regions of interest (ROIs) revealed no pre-training group differences. Significantly greater TG anterior rates, particularly in the left ROI, were found after training, with frontal oscillatory responses being correlated with better post-training CWMS performance in only the TG. The follow-up analysis showed similar results, with greater anterior left high-beta/alpha rates among TG participants. Follow-up frontal high-beta/alpha rates in the right ROI were correlated with lower CWMS follow-up intrusion errors in only the TG. The present findings are further evidence of the efficacy of WM training in enhancing the cognitive functioning of older adults and their frontal oscillatory activity. Overall, these results suggested that WM training also can be a promising approach toward fostering the so-called functional cortical plasticity in aging.

scholarly journals Working Memory Training Revisited: A Multi-Level Meta-Analysis of N-back Training Studies

2018 ◽  
Author(s):  
Anna Soveri ◽  
Jan Antfolk ◽  
Linda C. Karlsson ◽  
Benny Salo ◽  
Matti Laine
Keyword(s):  
Working Memory ◽  
Cognitive Control ◽  
Fluid Intelligence ◽  
Meta Analysis ◽  
Effect Sizes ◽  
Substantial Part ◽  
Training Dose ◽  
Multi Level ◽  
Training Studies ◽  
Meta Analyses

The efficacy of working memory (WM) training has been a controversial and hotly debated issue during the last years, and despite a large number of training studies and several meta-analyses, the matter has not yet been solved. We conducted a multi-level meta-analysis on the cognitive transfer effects in healthy adults who have been administered WM updating training with n-back tasks, the most common experimental WM training paradigm. Thanks to this methodological approach that has not been employed in previous meta-analyses in this field, we were able to include effect sizes from all relevant tasks used in the original studies. Altogether 203 effect sizes were derived from 33 published randomized controlled trials. In contrast to earlier meta-analyses, we separated task-specific transfer (here untrained n-back tasks) from other WM transfer tasks. Two additional cognitive domains of transfer that we analyzed consisted of fluid intelligence (Gf) and cognitive control tasks. A medium-sized transfer effect was observed to untrained n-back tasks. For other WM tasks, Gf, and cognitive control, the effect sizes were of similar size and very small. Moderator analyses showed no effects of age, training dose, training type (single vs. dual), or WM and Gf transfer task contents (verbal vs. visuospatial). We conclude that a substantial part of transfer following WM updating training with n-back is task-specific and discuss the implications of the results to WM training research.

scholarly journals Feasibility of Present-Centered Therapy for Prolonged Grief Disorder: Results of a Pilot Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Anna Vogel ◽  
Hannah Comtesse ◽  
Agnes Nocon ◽  
Anette Kersting ◽  
Winfried Rief ◽  
...  
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Psychological Distress ◽  
Posttraumatic Stress ◽  
Symptom Severity ◽  
Stress Disorder ◽  
Effect Sizes ◽  
Prolonged Grief ◽  
General Psychological Distress ◽  
Meta Analyses

Present-centered therapy (PCT) was originally developed as a strong comparator for the non-specific effects of psychotherapy in the treatment of posttraumatic stress disorder. PCT qualifies as a not strictly supportive treatment as it is structured and homework is assigned between sessions. It does not focus on cognitive restructuring or exposure. A growing body of literature supports its beneficial effects. For example, it demonstrated only slightly inferior effect sizes and lower dropout rates compared to that of trauma-focused cognitive behavioral therapy in several trials with patients suffering from posttraumatic stress disorder. The current study is the first to evaluate the feasibility and the treatment effects of PCT in adults with prolonged grief disorder (PGD). Meta-analyses on psychotherapy for PGD have yielded moderate effect sizes. N = 20 individuals suffering from PGD were treated with PCT by novice therapists as part of a preparation phase for an upcoming RCT in an outpatient setting. Treatment consisted of 20–24 sessions á 50 min. All outcomes were assessed before treatment, at post-treatment, and at the 3-month follow-up. The primary outcome, PGD symptom severity, was assessed using the Interview for Prolonged Grief-13. Secondary outcomes were self-reported PGD severity, depression, general psychological distress, and somatic symptom severity. Furthermore, therapists evaluated their experiences with their first PCT patient and the treatment manual. In intent-to-treat analyses of all patients we found a significant decrease in interview-based PGD symptom severity at post-treatment (d = 1.26). Decreases were maintained up to the 3-month follow-up assessment (d = 1.25). There were also significant decreases in self-reported PGD symptoms, depression, and general psychological distress. No changes were observed for somatic symptoms. The completion rate was 85%. Therapists deemed PCT to be a learnable treatment program that can be adapted to the patient's individual needs. The preliminary results of PCT as a treatment for PGD demonstrate large effects and indicate good feasibility in outpatient settings. The treatment effects were larger than those reported in meta-analyses. Thus, PCT is a promising treatment for PGD. Possible future research directions are discussed.

scholarly journals White matter hyperintensities associated with small vessel disease impair social cognition beside attention and memory

2017 ◽  
Vol 38 (6) ◽  
pp. 996-1009 ◽  
Author(s):  
Jana Kynast ◽  
Leonie Lampe ◽  
Tobias Luck ◽  
Stefan Frisch ◽  
Katrin Arelin ◽  
...  
Keyword(s):  
Social Cognition ◽  
White Matter ◽  
Cognitive Decline ◽  
Cognitive Performance ◽  
White Matter Hyperintensities ◽  
Community Dwelling ◽  
Effect Sizes ◽  
Attention And Memory ◽  
Age Related ◽  
The Impact

Age-related white matter hyperintensities (WMH) are a manifestation of white matter damage seen on magnetic resonance imaging (MRI). They are related to vascular risk factors and cognitive impairment. This study investigated the cognitive profile at different stages of WMH in a large community-dwelling sample; 849 subjects aged 21 to 79 years were classified on the 4-stage Fazekas scale according to hyperintense lesions seen on individual T2-weighted fluid-attenuated inversion recovery MRI scans. The evaluation of cognitive functioning included seven domains of cognitive performance and five domains of subjective impairment, as proposed by the DSM-5. For the first time, the impact of age-related WMH on Theory of Mind was investigated. Differences between Fazekas groups were analyzed non-parametrically and effect sizes were computed. Effect sizes revealed a slight overall cognitive decline in Fazekas groups 1 and 2 relative to healthy subjects. Fazekas group 3 presented substantial decline in social cognition, attention and memory, although characterized by a high inter-individual variability. WMH groups reported subjective cognitive decline. We demonstrate that extensive WMH are associated with specific impairment in attention, memory, social cognition, and subjective cognitive performance. The detailed neuropsychological characterization of WMH offers new therapeutic possibilities for those affected by vascular cognitive decline.

scholarly journals Current Evidence and Limitation of Biomarkers for Detecting Sepsis and Systemic Infection

Biomedicines ◽  
2020 ◽  
Vol 8 (11) ◽  
pp. 494
Author(s):  
Shang-Kai Hung ◽  
Hao-Min Lan ◽  
Shih-Tsung Han ◽  
Chin-Chieh Wu ◽  
Kuan-Fu Chen
Keyword(s):  
Study Design ◽  
Systemic Infection ◽  
Sampling Strategy ◽  
Case Control ◽  
Small Sample ◽  
Current Evidence ◽  
Synthesis Methods ◽  
Control Analysis ◽  
Small Sample Sizes ◽  
Meta Analyses

Sepsis was recently redefined as a life-threatening disease involving organ dysfunction caused by a dysregulated host response to infection. Biomarkers play an important role in early detection, diagnosis, and prognostication. We reviewed six promising biomarkers for detecting sepsis and systemic infection, including C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), CD64, presepsin, and sTREM-1. Among the recent studies, we found the following risks of bias: only a few studies adopted the random or consecutive sampling strategy; extensive case-control analysis, which worsened the over-estimated performance; most of the studies used post hoc cutoff values; and heterogeneity with respect to the inclusion criteria, small sample sizes, and different quantitative synthesis methods applied in meta-analyses. We recommend that CD64 and presepsin should be considered as the most promising biomarkers for diagnosing sepsis. Future studies should enroll a larger sample size with a cohort rather than a case-control study design. A random or consecutive study design with a pre-specified laboratory threshold, consistent sampling timing, and an updated definition of sepsis will also increase the reliability of the studies. Further investigations of appropriate specimens, testing assays, and cutoff levels for specific biomarkers are also warranted.

scholarly journals A Combination of Ice Ingestion and Head Cooling Enhances Cognitive Performance during Endurance Exercise in the Heat

2021 ◽  
pp. 23-32
Author(s):  
Nur Shakila Mazalan ◽  
Grant Justin Landers ◽  
Karen Elizabeth Wallman ◽  
Ullrich Ecker
Keyword(s):  
Working Memory ◽  
Cognitive Performance ◽  
Thermal Sensation ◽  
Core Body Temperature ◽  
Effect Sizes ◽  
Operation Span ◽  
Head Cooling ◽  
Core Body ◽  
Crushed Ice ◽  
Healthy Males

his study assessed the effectiveness of head cooling during exercise in the heat on cognitive performance, either alone or with ice ingestion. Ten healthy males, non-acclimatized to heat, ran (70% V̇O2peak) for 2×30 min in heat (35 ± 0.9°C, 68.2 ± 6.9% RH). Participants completed 3 trials: 10 min of head cooling during exercise (HC); precooling with crushed ice (7gikg-1) and head cooling during exercise (MIX); or no-cooling/control (CON). Working memory was assessed using the automated operation span task (OSPAN) and serial seven test (S7). Following MIX, S7 scores were improved compared to CON (12 ± 9.5, p = 0.004, d = 1.42, 0.34-2.28) and HC (4 ± 5.5, p = 0.048, d = 0.45, -0.47 to 1.3) during exercise. Moderate to large effect sizes were recorded for S7 and OSPAN following MIX and HC compared to CON, suggesting a tendency for improved cognitive performance during exercise in heat. Following precooling (MIX), core body temperature (Tc) and forehead temperature (Th) were lower compared to baseline (-0.75 ± 0.37°C, p < 0.001; -0.31 ± 0.29°C, p = 0.008, respectively) but not in HC or CON (p > 0.05). Thermal sensation (TS) was lower in MIX and HC compared to CON during exercise (p < 0.05). The reduction in Tc, Th and TS with MIX may have attenuated the effect of heat and subsequently improved working memory during exercise in heat.

scholarly journals Association between subjective tinnitus and cognitive performance: protocol for systematic review and meta-analysis

BMJ Open ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. e023700 ◽  
Author(s):  
Nathan A Clarke ◽  
Michael A Akeroyd ◽  
Helen Henshaw ◽  
Derek J Hoare
Keyword(s):  
Systematic Review ◽  
Cognitive Performance ◽  
Ethical Issues ◽  
Meta Analysis ◽  
Attention And Memory ◽  
Subjective Tinnitus ◽  
Adult Participants ◽  
Registration Number ◽  
Meta Analyses ◽  
Study Designs

IntroductionSubjective tinnitus is very common and has a number of comorbid associations including depression, sleep disturbance and concentration difficulties. Concentration difficulties may be observable in people with tinnitus through poorer behavioural performance in tasks thought to measure specific cognitive domains such as attention and memory (ie, cognitive performance). Several reviews have discussed the association between tinnitus and cognition; however, none to date have investigated the association between tinnitus and cognitive performance through meta-analysis with reference to an established theoretical taxonomy. Furthermore, there has been little overlap between sets of studies that have been included in previous reviews, potentially contributing to the typically mixed findings that are reported.Methods and analysisThis systematic review aims to comprehensively review the literature using an established theoretical taxonomy and quantitatively synthesise relevant data to determine associations between subjective tinnitus and cognitive performance. Methods are reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. All study designs will be eligible for inclusion with no date restrictions on searches. Studies eligible for inclusion must contain adult participants (≥18 years) with subjective tinnitus and a behavioural measure of cognitive performance. Meta-analysis will be reported via correlation for the association between tinnitus and cognitive performance.Ethics and disseminationNo ethical issues are foreseen. Findings will be reported in a student thesis, at national and international , ear, nose and throat/audiology conferences and by peer-reviewed publication.PROSPERO registration numberCRD42018085528.

Sign in / Sign up

Export Citation Format

Share Document