Elsevier

Biological Psychiatry

Volume 79, Issue 7, 1 April 2016, Pages 557-567
Biological Psychiatry

Review
Acute and Chronic Effects of Cannabinoids on Human Cognition—A Systematic Review

https://doi.org/10.1016/j.biopsych.2015.12.002Get rights and content

Abstract

Cannabis use has been associated with impaired cognition during acute intoxication as well as in the unintoxicated state in long-term users. However, the evidence has been mixed and contested, and no systematic reviews of the literature on neuropsychological task-based measures of cognition have been conducted in an attempt to synthesize the findings. We systematically review the empirical research published in the past decade (from January 2004 to February 2015) on acute and chronic effects of cannabis and cannabinoids and on persistence or recovery after abstinence. We summarize the findings into the major categories of the cognitive domains investigated, considering sample characteristics and associations with various cannabis use parameters. Verbal learning and memory and attention are most consistently impaired by acute and chronic exposure to cannabis. Psychomotor function is most affected during acute intoxication, with some evidence for persistence in chronic users and after cessation of use. Impaired verbal memory, attention, and some executive functions may persist after prolonged abstinence, but persistence or recovery across all cognitive domains remains underresearched. Associations between poorer performance and a range of cannabis use parameters, including a younger age of onset, are frequently reported. Little further evidence has emerged for the development of tolerance to the acutely impairing effects of cannabis. Evidence for potential protection from harmful effects by cannabidiol continues to increase but is not definitive. In light of increasing trends toward legalization of cannabis, the knowledge gained from this body of research needs to be incorporated into strategies to minimize harm.

Section snippets

Method

This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (Figure 1) (33). The search strategy and data extraction are detailed in Supplement 1, and selection criteria, resulting in 105 studies included for review, are provided in the legend of Figure 1. From each study, we extracted participant demographics (age, sex, IQ), cannabis use metrics (e.g., age of onset and duration, frequency, and quantity of use), period of

Results

We provide a summary appraisal of findings organized by primary cognitive domain in order of evidential strength from most to least consistently impaired. A more detailed account of findings from all studies is provided in Supplement 1, and detailed data extracted from each article are tabulated in Table S1 in Supplement 2. Within each cognitive domain, we address first acute administration studies, then studies of chronic exposure to cannabis, followed briefly by abstinence studies. Further

Discussion

In general, the literature on the cognitive effects of cannabis exposure continues to be plagued with complexity in terms of heterogeneity of both the extent of cannabis exposure in the samples assessed and the means of assessing cognitive function (18, 19, 20, 21). The nature of the samples recruited and the way in which prior exposure to cannabis is quantified affect interpretation of findings for acute and chronic effects. In studies of chronic users, associations with frequency of use are

Conclusions

Further significant evidence has emerged supporting the finding that acute and chronic exposure to cannabinoids impairs cognition, especially in the domains of verbal learning, memory, and attention (Table 2). Mixed evidence across the range of other cognitive domains is likely due to ongoing heterogeneity in the cognitive tests employed, prior cannabis use histories, and the assessment of cannabis use metrics as well as the neurodevelopmental stage at both onset and cessation of cannabis use.

Acknowledgments and Disclosures

This work was supported by the Australian Research Council Future Fellowship Grant No. FT110100752 (to NS) and National Health and Medical Research Council Project Grant No. 1007593 (to NS) and Senior Research Fellowship Grant No. 1021973 (to MY).

We thank Madeleine Godber for assistance with literature searches and document retrieval.

The authors report no biomedical financial interests or potential conflicts of interest.

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    SJB, HHvH, and NS contributed equally to this work.

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