There has been emerging evidence that amphetamine use is linked to serious long-term health effects, including depression, anxiety, psychosis and memory disturbance.
A pilot study was developed in Perth to determine if amphetamine users had brain abnormalities that neither they nor their doctors treating them suspected. People who presented to the Royal Perth Hospital Emergency Department with amphetamine-related symptoms were eligible to be recruited for the study. Brain abnormalities were detected using Magnetic Resonance Imaging (MRI), and is defined when the brain has been injured by drug use resulting in an abnormality in the brain.
Thirty-eight patients were enrolled in the study, of which 30 had MRI scans. Of the patients enrolled in the study:
- 21 reported problems with their mood;
- 19 reported problems with their concentration;
- 15 reported problems with their general health;
- 14 reported problems with their memory;
- 14 reported a history of depression;
- 9 reported having been admitted to a psychiatric ward;
- 7 reported a history of psychosis; and
- 6 patients had been prisoners in jail.
The results from this pilot study showed that one in five cases had an occult brain lesion or brain scarring. The most common MRI abnormality seen was an unidentified bright object (UBO), of which were mostly found in the frontal region of the brain. This finding is consistent with other reports of frontal abnormalities in methamphetamine users.
Although the study recruited cases on the basis of amphetamine-related presentations, all those involved in the study had also been using a variety of other drugs such as ecstasy, cannabis, speed and alcohol. Due to this, it is difficult to ascribe causation to a specific drug as many were poly-drug users, using whatever they could access.
There has been emerging evidence that drugs that have stimulant effects such as amphetamines have shown similar patterns of results to this study. There is evidence emerging to suggest that these types of drugs cause problems for the brain, especially with memory, judgment, thinking and mood being affected. The findings from this study support the possibility of amphetamine use being a risk for cognitive decline and perhaps an increased risk of stroke.
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A word from the Project leader, Professor Daniel Fatovich, Professor or Emergency Medicine, University of Western Australia and Royal Perth Hospital:
The editorial by Wallin and Fladby highlights the clinical importance of white matter hyperintensities on magnetic resonance imaging as a marker of small vessel disease in elderly people. Prevalence ranges from 11-21% at age 64 to 94% at age 82, but is around 0.5% in young people. We recently reported the presence of white matter hyperintensities in a prospectively identified cohort of young people (mean age 27 years) attending our emergency department in relation to amphetamine use (methamphetamine, amphetamine, and ecstasy). Four of 23 serious amphetamine users had these lesions on magnetic resonance imaging (17%), most commonly in the frontal lobes.
Such lesions, and other neuroimaging abnormalities, have been reported in abstinent amphetamine users and in cocaine users. These findings are consistent with the known effects of these stimulant drugs to cause vasospasm. Although the long term effects of these lesions in young drug users is unknown, reported cognitive effects in amphetamine users could be related to small vessel disease. Longitudinal studies are needed to test this hypothesis.
*taken from BMJ 2010;341:c5636