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. 2025 Oct 10;15(1):35558.
doi: 10.1038/s41598-025-20028-3.

Temporal changes in cognitive functions and associated factors among stimulant users: a 12-month, prospective study

Albert Kar Kin Chung  1 , Cheuk Yin Tse  2 , Y Doug Dong  2 , Sau Wan Tang  2 , Johnson Kai Chun Law  2 , Edward Tin Kei Leung  2 , Tommy Tsang Cheung  3
Affiliations

Temporal changes in cognitive functions and associated factors among stimulant users: a 12-month, prospective study

Albert Kar Kin Chung et al. Sci Rep. .

Abstract

Cognitive impairments are commonly observed in individuals who use stimulants, yet few studies have tracked these individuals longitudinally. This prospective, 12-month longitudinal study investigated changes in cognitive functioning among active stimulant users and explored the associated factors. Adults with recent stimulant use were recruited from substance misuse treatment clinics and the community. Their demographics, history of drug use, and stimulant use disorder severity were assessed with structured clinical interviews. Global cognitive function and frontal executive function were measured every three months using the Montreal Cognitive Assessment (MoCA) and the Frontal Assessment Battery (FAB) over one year. Linear mixed-effects models evaluated temporal trajectories and associated factors related to the Changes in cognitive functions. Among 76 analysed participants, their frequency of stimulant uses were active and stable over 12 months. The MoCA scores averaged below the clinical cut-off at baseline, although no further persistent decline was observed. In contrast, FAB scores presented no systematic temporal changes. Being female and being of older ages were found to be associated with lower MoCA and FAB. None of severity, education, recent stimulant use, and lifetime duration of use, were found to be associated with cognition. While stimulant users exhibited some modest cognitive declines at baseline, no further substantial cognitive deterioration was observed over the one-year study period. Cognitive outcomes were more strongly associated with demographic factors than SUD severity or stimulant use patterns. These findings highlight the need for more sensitive tools to detect subtle cognitive changes associated with stimulant uses.

Keywords: Cognitive function; FAB; Longitudinal study; MoCA; Stimulant use; Substance use disorder.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethics statement: The study was approved by the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (HKU/HA HKW IRB reference number: UW 19–616). The study was conducted in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and institutional requirements. All participants provided written informed consent.

Figures

Fig. 1
Fig. 1
Temporal trajectories of DSM-5 severity, frequency of drug use, and cognitive functioning over the 1-year study period. Errorbars denote 95%CI. Note. CI: Confidence Interval; DSM-5: Diagnostic and Statistical Manual of Mental Disorders, 5th edition; FAB: Frontal Assessment Battery; FREQ: Frequency of use in the past three months; SUD: Stimulant User Disorder; MoCA: Montreal Cognitive Assessment.
Fig. 2
Fig. 2
Temporal trajectories of outcome measures stratified by DSM-5 severity over the 1-year study period. Errorbars denote 95%CI. Note. CI: Confidence Interval; FAB: Frontal Assessment Battery; FREQ: Frequency of use in the past three months; MoCA: Montreal Cognitive Assessment.
Fig. 3
Fig. 3
Differences in cognitive functioning stratified by gender and age. Errorbars denote 95%CI. Note. CI: Confidence Interval; FAB: Frontal Assessment Battery; FREQ: Frequency of use in the past three months; MoCA: Montreal Cognitive Assessment.
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