title: Executive cognitive dysfunction and ADHD in cocaine dependence: searching for a common cognitive endophenotype for addictive disorders.
abstract: BACKGROUND
  Cocaine-dependent individuals (CDI) present executive cognitive function (ECF) deficits, but the impact of psychiatric comorbidities such as Attention-Deficit Hyperactivity Disorder (ADHD) on neuropsychological functioning is still poorly understood. The aim of this study was to investigate if CDI with ADHD (CDI + ADHD) would have a distinct pattern of executive functioning when compared with CDI without ADHD (CDI).
  
  
  METHODS
  We evaluated 101 adults, including 69 cocaine-dependent subjects (divided in CDI and CDI + ADHD) and 32 controls. ECF domains were assessed with Digits Forward (DF), Digits Backward (DB), Stroop Color Word Test (SCWT), the Wisconsin Card Sorting Test (WCST), and the Frontal Assessment Battery (FAB). DSM-IV criteria for ADHD were used for diagnosis and previous ADHD symptoms (in the childhood) were retrospectively assessed by the Wender-Utah Rating Scale (WURS).
  
  
  RESULTS
  There were no significant differences between CDI + ADHD, CDI, and controls in estimated intellectual quotient (IQ), socioeconomic background, education (in years), and pre-morbid IQ (p > 0.05). SCWT and WCST scores did not differ across groups (p > 0.05). Nevertheless, CDI and CDI + ADHD performed more poorly than controls in total score of the FAB (p < 0.05). Also, CDI + ADHD did worse than CDI on DF (F = 4.756, p = 0.011), DB (F = 8.037, p = 0.001), Conceptualization/FAB (F = 4.635, p = 0.012), and Mental flexibility/FAB (F = 3.678, p = 0.029). We did not find correlations between cocaine-use variables and neuropsychological functioning, but previous ADHD symptoms assessed by WURS were negatively associated with DF (p = 0.016) and with the total score of the FAB (p = 0.017).
  
  
  CONCLUSIONS
  CDI + ADHD presented more pronounced executive alterations than CDI and CDI exhibited poorer cognitive functioning than controls. Pre-existing ADHD symptoms may have a significant negative impact on executive dysfunction in CDI. It remains to be investigated by future studies if symptoms such as impulsivity or a pre-existing ECF dysfunction could represent underlying cognitive endophenotypes that would substantially increase the risk for acquiring addictive disorders.
authors.affiliation: Laboratory of Psychiatric Neuroimaging (LIM-21), Department of Psychiatry, Faculty of Medicine, University of São Paulo (USP) , São Paulo, SP , Brazil ; Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), USP , São Paulo, SP , Brazil ; Interdisciplinary Group of Studies on Alcohol and Drugs (GREA), Faculty of Medicine, USP , São Paulo, SP , Brazil ; Equilibrium Program, Department of Psychiatry, Faculty of Medicine, USP , São Paulo, SP , Brazil.
authors.forename: Paulo Jannuzzi
authors.initials: PJ
authors.lastname: Cunha
authors.forename: Priscila Dib
authors.initials: PD
authors.lastname: Gonçalves
authors.forename: Mariella
authors.initials: M
authors.lastname: Ometto
authors.forename: Bernardo
authors.initials: B
authors.lastname: Dos Santos
authors.forename: Sergio
authors.initials: S
authors.lastname: Nicastri
authors.forename: Geraldo F
authors.initials: GF
authors.lastname: Busatto
authors.forename: Arthur Guerra
authors.initials: AG
authors.lastname: de Andrade
keywords: ADHD; addiction; cocaine; executive dysfunction; impulsivity; prefrontal cortex