Harmen Beurmanjer

50 Chapter 4 Abstract Background: The recreational use of Gamma-hydroxybutyrate(GHB) is associated with frequent overdoses, coma and the risk of developing GHB use disorder(GUD). Several studies suggest negative effects of GHB use or related comas on cognition. Since relapse rates are high in GUD, and cognitive impairment has been associated with relapse in other substance use disorders, we aim to investigate the 1) prevalence of cognitive impairment before and after detoxification, 2) relationship between GHB use, comas and cognitive impairment, and 3) association between cognitive impairment and relapse after detoxification in GUD patients. Methods: In this prospective cohort study a consecutive series of patients with GUD (n=137) admitted for detoxification were recruited at six addiction care facilities in the Netherlands. The Montreal Cognitive Assessment (MoCA) was used to screen for cognitive impairments before and after detoxification. Follow-up duration for the assessment of relapse in GHB use was three months. Results: A substantial number of patients with GUD screened positive for cognitive impairment before (56.3%) and after (30.6%) detoxification. Most patients showed impairment on the memory domain (58.8%). Cognitive impairment was not related to the severity of GUD or number of GHB-induced comas. Regression analysis showed that only the memory score predicted relapse. Discussion: Cognitive impairment seems highly prevalent among patients with GUD, possibly related to the risk of relapse. The absence of a relationship between the severity of GUD, level of GHB use, the number of GHB-induced comas and cognitive impairment suggest that other factors may also contribute to the observed cognitive impairment.