Neuropsychological comparisons of cocaine versus methamphetamine users: A research synthesis and meta-analysis

Figures & data

Figure 1. Flow chart of citations through searching, sorting, and consensus.

Table 1. Demographic and clinical characteristics of included cocaine studies.

Study	Cocaine Users (n)	Age	Education	Control (n)	Age	Education	Use	Abstinence	Domains Extracted
Abi-Saab (30)	93	34.8	12.2	16	32.1	14.6	12.3	Acute	CMS, EF, IL, MMS, PMS, VF, VRM, VWM
Adinoff (31)	13	41.2	–	15	35.0	–	–	21	EF
Albein-Urios (32)	24	33.2	9.6	20	28.6	10.6	4.42	14	A, EF, IQ, VWM
Albein-Urios (33)	36	32.0	10.3	34	30.5	10.5	4.36	70	APS, EF, IQ, VWM
Balconi (34)	34	54.8	13.2	39	56.4	13.9	12.3	15	EF
Beatty (35)	23	34.0	13.7	22	35.5	14.0	7.10	21	EF, IL, IQ, PMS, VM, VRM, VWM
Berry (36)	16	34.5	14.0	21	33.2	14.1	–	14	A, EF IL, IQ, PMS, VF, VSP,
Bolla (37)	30	33.5	12.0	21	33.9	12.6	6.70	30	CMS, EF, IL, IQ, MMS, PMS, VF, VRM, VM, VSP
Browndyke (38)	37	35.5	12.3	13	30.5	14.0	12.4	14	A, CMS, MMS
Cheney (39)	16	37.4	12.3	16	38.0	12.9	8.06	35	A, IQ, VM, VRM, VSP
Cunha (40)	15	25.6	10.5	15	26.6	11.2	7.80	15	EF, IQ, L
Cunha (41)	58	31.2	11.7	32	26.7	10.7	10.7	12	A, APS, EF, IQ, L
De Oliveira (42)	20	25.9	10.9	18	24.2	11.5	2.90	180	A, EF, IL, L, PMS, VF, VRM, VWM
Di Sclafani (43)	19	39.2	12.8	19	35.3	15.3	12.3	72	A, EF, VSP
Di Sclafani (44)	20	40.0	13.0	29	37.0	15.0	14.0	42	A, CMS, PMS, VF, VSP
Elman (45)	27	37.8	12.8	33	31.1	15.7	15.1	Acute	VSP
Ersche (5)	27	32.3	–	12	35.1	–	8.70	Acute	EF, IQ
Fernandez-Serrano (46)	42	28.9	11.8	65	30.1	17.0	4.13	239	EF
Gillen (47)	19	34.3	13.6	16	30.9	14.4	6.30	Acute	A, EF, IL, L, PMS, VF, VM, VRM, VSP, VWM,
Goldstein (48)	30	42.6	12.6	42	40.9	13.6	18.7	Acute	IQ, L
Hanlon (49)	24	37.0	–	25	36.2	–	10.2	243	EF, IQ
Hoff (50)	38	34.3	13.2	54	32.1	15.4	7.30	24	EF, IL, IQ, L, MMS, PMS, VF, VM, VRM
Kalapatapu (51)	20	56.8	13.5	20	55.4	14.7	–	–	A, EF, IQ, PMS, VWM
Kelley (52)	12	36.5	13.1	12	33.1	16.4	–	Acute	APS, EF, IQ, L, VF, VM, VRM, VSP
Kjome (53)	66	36.7	–	20	33.9	–	–	–	EF
Lane (54)	18	39.2	12.6	15	34.0	16.0	14.6	–	EF
Lane (55)	15	38.4	13.1	18	35.2	15.4	16.1	–	EF
Liu (57)	37	40.5	12.9	32	32.9	13.3	13.6	Acute	A, EF
Madoz-Gurpide (58)	24	35.9	–	27	33.4	–	–	Acute	A, EF, VWM
Meade (59)	53	45.8	12.0	32	44.7	13.8	17.9	–	A, CMS, EF, IL, IQ, L, PMS, VF, VM, VRM, VWM
Mittenberg (60)	16	29.3	14.1	16	29.4	14.6	5.00	20	IQ, L, VRM, VSP
Moeller (61)	30	36.5	–	25	29.6	–	–	Acute	EF
Moeller (62)	18	33.1	–	18	30.3	–	9.70	Acute	A, EF
Moeller (63)	16	48.0	13.0	23	42.7	13.9	18.3	Acute	IL, IQ, VRM
O’Malley (64)	20	27.7	13.3	40	27.6	13.2	4.15	23	EF, IL, IQ, L, PMS, VRM, VM, VSP
Patzelt (65)	45	41.0	12.9	41	40.0	14.5	14.7	Acute	EF
Ranlett (66)	20	36.3	13.2	18	36.3	13.8	13.0	34	A, IQ, VRM
Ray Li, 2006	18	39.1	11.8	41	34.1	12.9	10.9	14	EF
Robinson (67)	30	28.7	13.0	30	29.0	13.0	4.10	146	A, CMS, IL, IQ, MMS, PMS, VSP, VWM
Rosselli (68)	61	26.1	10.4	63	25.6	10.5	10.2	78	EF, IL, IQ, L, PMS, VF, VM, VRM, VSP, VWM
Rosselli (69)	42	34.1	11.4	17	34.5	12.2	16.0	60	A, EF, L, PMS, VF, VM, VRM, VSP, VWM
Selby (70)	60	33.1	11.2	138	33.9	11.4	12.5	1075	CMS, EF, IQ, PMS, VF, VM, VRM, VSP
Simon (6)	40	38.0	12.9	40	35.0	13.7	–	Acute	APS, EF, IL, IQ, PMS, VF, VM, VRM, VWM
Smelson (71)	35	36.1	–	17	40.0	–	–	Acute	CMS, EF, IL, PMS, VWM
Stout (72)	12	36.9	–	14	30.0	–	–	–	EF, IQ
Tucker (73)	60	35.3	12.3	13	33.5	13.0	11.9	Acute	A, CMS, EF, IL, MMS, PMS, VRM, VWM
Vadhan (75)	22	39.3	12.4	21	38.9	13.3	21.0	Acute	APS, EF
Vadhan (74)	22	40.3	13.1	24	36.9	15.4	20.5	Acute	EF, IQ
van der Plas (14)	38	34.5	11.4	36	28.9	16.2	10.1	14	EF, VWM
van Gorp (76)	37	39.2	13.2	27	38.2	14.1	0.71	Acute	VM
Verdejo-Garcia (77)	12	36.8	13.3	14	30.9	13.6	8.50	Acute	EF, IQ
Vonmoos (78)	30	32.5	10.0	68	30.3	10.7	9.40	21	A, EF, IQ, VRM, WVM
Woicik (79)	21	40.9	12.5	64	38.7	13.6	18.5	15	CMS, EF, IL, IQ, L, MMS, PMS, VF, VRM, VWM
Woicik (80)	107	43.3	12.9	107	38.1	13.3	–	Acute	EF, IQ
Total	1,718	36.5	12.2	1,668	34.3	13.4	11.0	132.9

Note. n = sample size; Use = total duration of use in years; Abstinence = abstinence in days, Acute = toxicology was positive on the day of testing, or last use was one week prior to testing. All total averages are weighted by sample size. A = Attention; APS = Auditory Processing Speed; CMS = Coordinated Motor Speed; EF = Executive Functioning; IL = Incidental Learning; IQ = Intelligence Quotient; L = Language; MMS = Manual Motor Speed; PMS = Psychomotor Speed; VF = Verbal Fluency; VM = Visual Memory; VRM = Verbal Memory; VSP = Visuospatial Processing; VWM = Verbal Working Memory.

Table 2. Demographic and clinical characteristics of the included methamphetamine studies.

Study	Meth Users (n)	Age	Education	Control (n)	Age	Education	Use	Abstinence	Domains extracted
Ahn (81)	38	22.7	12.5	48	24.7	13.8	3.20	90	EF, IQ
Al-Zahrani (82)	56	33.3	–	100	31.2	–	–	–	APS, EF, IL, PMS, VF
Boileau (83)	16	27.8	12.1	14	29.7	15.5	5.10	19	CMS, EF, IQ, PMS, VWM
Bousman (84)	50	36.0	13.0	49	37.0	13.0	10.0	125	EF, IQ
Carter (85)	23	33.7	–	21	36.2	–	–	–	EF
Chang (86)	20	33.1	12.8	13	30.9	14.4	9.83	120	APS, CMS, EF, IL, PMS, VRM
Cherner (87)	54	36.3	12.6	46	35.1	12.2	12.0	129	A, CMS, EF, IL, IQ, PMS, VF, VM, VRM, VWM
Chung (88)	23	36.0	–	20	33.3	–	6.24	729	EF
Dean (89)	24	35.9	12.9	17	31.1	14.5	10.1	11	APS, CMS, EF, IL, MMS, VWM
Ersche (90)	25	37.0	–	27	35.1	–	16.9	Acute	EF, VM, VSP
Ersche (5)	30	37.4	–	13	35.1	–	15.8	Acute	EF, IQ
Gonzalez (92)	26	39.3	12.1	41	34.6	12.9	12.1	135	A, CMS, EF, IQ, L, VF, VM, VRM, VWM
Gonzalez (91)	16	35.4	11.7	19	31.1	14.9	16.7	29.9	EF, IQ
Han (93)	37	35.1	10.2	40	34.4	13.0	11.3	28	EF
Hekmat (94)	52	28.3	–	130	30.1	–	–	16	APS, EF, IL, PMS
Henry (96)	12	27.5	11.7	12	28.2	12.7	3.90	177	EF, IQ, VF, VRM
Henry (95)	16	36.7	13.6	18	36.1	13.9	10.3	290	EF, IQ
Hoffman (97)	41	37.8	12.3	41	35.1	13.5	2.55	196	APS, CMS, EF, IQ, PMS, VM, VRM, VSP
Hosak (98)	43	25.3	11.4	52	38.7	13.3	6.20	30	EF
Johanson (99)	16	32.0	–	18	31.0	–	10.3	90	A, CMS, EF, IL, L, MMS, PMS, VF, VRM
Kalechstein (101)	27	35.4	12.6	18	32.7	13.2	–	Acute	APS, EF, IL, IQ, PMS, VF, VM, VRM, VSP, VWM
Kalechstein (100)	25	34.8	12.7	19	32.5	13.7	–	Acute	EF, IQ
Kim (102)	29	36.6	10.7	20	33.2	15.1	5.35	600	EF
Kim (104)	24	37.7	10.5	21	39.1	12.4	13.6	20	EF
Kim (103)	28	40.2	14.3	27	38.9	14.8	13.9	19	EF
Marquine (105)	25	38	12.0	47	38.4	14.0	4.38	31	IQ
McCann (106)	22	33.4	13.0	17	34.7	14.5	8.44	867	APS, IQ, L, MMS, VRM
Mcketin (107)	15	22.0	–	9	22.0	–	–	–	A, IQ, L, VRM
Moon (108)	17	–	–	18	–	–	12.8	653	VM, VRM, VSP
Rapeli (109)	12	26.8	10.9	12	28.2	13.8	9.30	1206	A, APS, EF, IQ, VRM, VWM
Rendell (110)	20	27.5	11.6	20	28.2	12.6	3.85	177	A, EF, IQ, VF, VRM, VWM
Rogers (111)	18	35.5	–	26	37.4	–	13.4	Acute	EF, IQ
Segala (112)	78	23.6	12.9	102	25.2	13.3	3.60	817	A, EF, IQ
Sim (113)	41	31.9	13.2	39	29.6	13.3	–	Acute	EF, IQ, PMS
Simon (115)	65	32.0	12.4	65	31.0	12.8	11.2	Acute	APS, EF, IL, IQ, PMS, VF, VM, VRM, VWM
Simon (6)	40	32.0	12.5	40	30.0	13.0	–	Acute	APS, EF, IL, IQ, PMS, VF, VM, VRM, VWM
Simon (114)	25	33.9	12.7	24	33.3	15.1	7.63	Acute	APS, EF, IQ, PMS, VF, VM, VRM, VWM
van der Plas (14)	38	30.7	11.7	36	28.9	16.2	7.80	15	EF
Van Wyk (116)	17	–	–	18	–	–	–	30	A, VM
Wang (117)	26	27.3	9.23	39	30.0	9.77	2.31	14	EF
Woods (118)	87	37.8	12.5	71	36.1	12.7	12.6	120	EF, IQ, VRM
Total	1,297	32.9	12.2	1,427	32.3	13.4	9.0	223.5

Note. n = sample size; Use = total duration of use in years; Abstinence = abstinence in days, Acute = toxicology was positive on the day of testing, or last use was one week prior to testing. All total averages are weighted by sample size. A = Attention; APS = Auditory Processing Speed; CMS = Coordinated Motor Speed; EF = Executive Functioning; IL = Incidental Learning; IQ = Intelligence Quotient; L = Language, MMS = Manual Motor Speed; PMS = Psychomotor Speed; VF = Verbal Fluency; VM = Visual Memory; VRM = Verbal Memory; VSP = Visuospatial Processing; VWM = Verbal Working Memory.

Table 3. Breakdown of the measures included for each construct assessed.

Construct	Variable	Measure
Perseveration	Perseverative Errors or Responses	WCST
Inhibition	Time/Number Correct	Stroop; C-WIT
Mental Flexibility	Time	TMT-B
Decision Making	Net Score/Advantageous/Disadvantageous Choices	IGT; Decision Making Task
Verbal Working Memory	Number Correct	DS-B/T; Arithmetic; N-LS
Coordinated Motor Speed	Time	Grooved Pegboard
Manual Motor Speed	Time	Finger Tapping Test
Psychomotor Speed	Time	TMT-A
Incidental Learning	Number Correct	Digit Symbol
Verbal Fluency	Total Number	COWAT
Non-Contextual Verbal Memory	Delayed Memory	CVLT; HVLT; RAVLT; KAVLT
Contextual Verbal Memory	Delayed Memory	LM; BST
Auditory Processing Speed	Time/Number Correct	Color Naming, Word Reading
Attention	Total Correct	Digit Span Forward; PASAT
Visual Memory	Delayed Memory	BVMT; Rey-O; VR; DRMT; PRM; K-CFT

Note. WCST = Wisconsin Card Sorting Test; C-WIT = Color Word Interference Test; TMT-B = Trail Making Test part B; IGT = Iowa Gambling Test; DS-B/T = Digit Span Backward/Total; N-LS = Number-Letter Sequencing; TMT-A = Trail Making Test part A; COWAT = Controlled Oral Word Association Test; CVLT = California Verbal Learning Test; HVLT = Hopkins Verbal Learning Test; RAVLT = Rey Auditory Verbal Learning Test; KAVLT = Korean Auditory Verbal Learning Test; LM = Logical Memory; BSMT = Babcock Story Memory Test; PASAT = Paced Auditory Serial Attention Test; Delayed Pattern Recognition Memory; Rey-O = Rey–Osterrieth Complex Figure Test; VR = Visual Reproduction; BVMT = Brief Visuospatial Memory Test; RMT = Repeated Memory Test; Korean-Complex Figure Test.

Table 4. Effect size estimates and subgroup analyses comparing cocaine and methamphetamine users.

		Effect size estimates					Test of heterogeneity			Subgroup analyses
Construct	k	g (SE)	95% CI	Z	P	I^2	Τ^2	Q	p	Q	df	p
Perseveration										1.853	1	0.173
Cocaine	12	.396(.090)	.220 to .571	4.413	.000	37.024	.034	17.467	.095
Methamphetamine	14	.557(.078)	.404 to .711	7.130	.000	32.223	.027	19.181	.118
Inhibition										3.187	1	.074
Cocaine	13	.330(.091)	.150 to .509	3.606	.000	44.108	.046	21.470	.044
Methamphetamine	9	.551(.084)	.387 to .716	6.567	.000	.000	.000	6.557	.585
Mental Flexibility										1.661	1	.197
Cocaine	18	.498(.083)	.335 to .662	5.984	.000	45.428	.054	31.152	.019
Methamphetamine	13	.360(.068)	.227 to .493	5.299	.000	0.000	.000	6.797	.871
Decision Making										.679	1	.411
Cocaine	9	.743(.118)	.512 to .973	6.310	.000	19.593	.024	9.949	.269
Methamphetamine	7	.562(186)	.197 to .926	3.016	.003	71.337	.163	20.933	.002
Verbal Working Memory										7.736	1	.005*
Cocaine	16	.650(.117)	.421 to .879	5.567	.000	68.642	.146	47.835	.000
Methamphetamine	10	.226(.098)	.033 to .418	2.297	.022	28.729	.027	12.628	.180
Coordinated Motor Speed										.229	1	.632
Cocaine	10	.474(.139)	.201 to .747	3.399	.001	69.069	.128	29.097	.001
Methamphetamine	6	.392(.100)	.195 to .588	3.898	.000	.000	.000	2.233	.818
Manual Motor Speed										2.160	1	.142
Cocaine	7	.147(.093)	−.034 to .329	1.592	.111	.000	.000	4.614	.594
Methamphetamine	3	.436(.173)	.097 to .775	2.519	.012	.000	.000	.074	.964
Psychomotor Speed										.011	1	.915
Cocaine	18	.348(.081)	.189 to .507	4.293	.000	43.734	.050	30.214	.025
Methamphetamine	10	.360(.078)	.208 to .513	4.630	.000	.000	.000	5.187	.818
Incidental Learning										.649	1	.420
Cocaine	12	.578(.097)	.387 to .768	5.938	.000	34.704	.038	16.846	.113
Methamphetamine	4	.696(.110)	.480 to .913	6.305	.000	.000	.000	2.691	.442
Verbal Fluency										.428	1	.513
Cocaine	14	.184(.091)	.006 to .363	2.023	.043	43.651	.048	23.071	.041
Methamphetamine	10	.289(.131)	.032 to .546	2.201	.028	63.834	.104	24.885	.003
Non-Contextual Del. Ver. Memory										.123	1	.726
Cocaine	13	.485(.125)	.240 to .730	3.875	.000	60.077	.119	30.058	.003
Methamphetamine	14	.535(.067)	.403 to .667	7.927	.000	.000	.000	7.418	.879
Contextual Del. Ver. Memory										4.565	1	.033*
Cocaine	7	.305(.129)	.051 to .558	2.356	.018	52.008	.058	12.502	.052
Methamphetamine	4	.726(.149)	.434 to 1.017	4.884	.000	.000	.000	1.413	.703
Auditory Processing Speed										.070	1	.791
Cocaine	5	.258(.130)	.002 to .514	1.976	.048	30.340	.026	5.742	.219
Methamphetamine	11	.219(.067)	.088 to .350	3.274	.001	.000	.000	8.867	.545
Attention										1.199	1	.273
Cocaine	10	.615(.172)	.278 to .951	3.582	.000	70.470	.204	30.478	.000
Methamphetamine	4	.347(.175)	.004 to .689	1.984	.047	36.850	.045	4.751	.191
Delayed Visual Memory										4.622	1	.032*
Cocaine	13	.302(.072)	.162 to .442	4.220	.000	12.786	.008	13.759	.316
Methamphetamine	9	.550(.091)	.373 to .728	6.078	.000	18.766	.014	9.848	.276

Note: k = number of comparisons in the analysis; g = Hedges’ g effect size; SE = Standard error for Hedges’ g; CI = confidence interval; z = z-score; p = level of significance; df = degrees of freedom; I² = amount of heterogeneity as a percentage of total variance; Τ² = estimate the variance of the true effect size; Q = Q-statistic utilized to measure heterogeneity.

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