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There are enough pieces of psychological
research, which shows the connection of neuropsychological deficits with chronic
cannabis uses. However, it is also being observed that cannabis is more
neurotoxic for the chronic users who have started it much earlier before the
age of 15 compared to the chronic users who have started it in later stages.
The literature review also suggested that adolescent brains are found to be
exposed to these toxic effects which, has negative impact on their memory
skills and behaviour compared to non-users.  Cognitive performance impaired patients find
it difficult to process the complex information and as the lifetime intake of
cannabis gets increases, the performance goes slower. The possible reason for
this Cognitive performance impairment is that during the early age when the
brain is maturing biologically, the cannabis use would affect the body development
and as a result the users will have smaller brain size and would be physically
small in height and would have less weight.

To experiment this, Fontes et al. (2011)
recruited (n=148) participants, out of which, 104 were chronic cannabis users.
This group was further divided into two groups, one group consist the users
(n1=55) who started using it before the age of 15 and the other group had the
users (n2=49) who started it after the age of 15. Both cohorts were considered
as the cases here. Remaining (n3=44) participants were in the control group.
The inclusion criteria for the cases were the chronic cannabis users between
the age of 18 to 55 irrespective of gender.  Whereas the exclusion requirement involved the
history of DSM-IV Axis I disorder,
current users of cannabis and the history of head trauma, intellectual
infirmity and with IQ less than 80. The control group participant inclusion characteristics
were the participants between the age of 18 and 55, who had never used
psychoactive substances, especially cannabis in last 3 months or never been exposed
more than 5 times in their life, no history of head trauma as well as negative
diagnosis of DSM-IV Axis I

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After obtaining necessary IRB approvals
and getting the ethics informed consent from participants, a battery of tests
including Composite International Diagnostic interviews were done to obtain the
demographic details, the Time Line Follow Back (TLFB) calendar test was done to
determine the use and dependency on cannabis. Afterwards, few more tests were conducted
to assess the control of the cognitive process, FAB- Frontal Assessment
Battery, IQ (WAIS-R test), to verify the capacity of understanding general
ideas, Wisconsin Card sort Test version 64, and Stroop test Victoria version. These
tests helped in arbitrating the scores related to cognitive performance indicators
like automatic reading response, effortful colour naming, planning, IQ, conceptualisation,
preservation, ability to learn, ability to verbally express themselves etc.

Collected data were analysed using the
Student’s t-test, Mann-Whitney U-test and ANOVA with the alpha level set to p<0.05 (two-tailed).  The early onset group started consuming cannabis at the mean age of 13.9 with s.d. of 1.5 whereas the late onset group started consuming it at the age of 18.4 with s.d. of 2.8. There was no significant difference in IQ, Vocabulary and block design results amongst the early onset case group, late-onset case group, and control group (with p-value >.05). However early-onset group performed significantly poor
compared to late-onset and control group on the WCST test, FAB and Stroop test
with p=value 0.008 and p=0.006 respectively which was less than .05.

To conclude, it was found that there is a
significant difference between cognitive performances of brain amongst the
early-onset group of cannabis users in comparison to the late-onset group of
cannabis users or for that matter with the control group. The performance was
poor for the early onset of the group in contrast to the late onset of group
and control group both. Moreover, no significant difference was found in
cognitive performance between the late onset group and control group whereas it
was there with early onset of the group. So, our hypothesis about cannabis uses
adversely impacts the cognitive functions if started early found to be true. The
limitations of the study that the number of male participants for late onset
and early onset of the groups were predominantly composed in compare with the control
group which, both male and female participants were equal. As, the case groups
were dominated by the male participants, so gender-based evaluation of the data
could not be generated. Apart from that, all the participants were chronic
cannabis users so the effect of cannabis, on the population who had started it
recently and are also the early starter, could not be examined and it could be
a potential subject for further research.

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