Depression and cognitive functioning in alcoholism

Effects of age, gender, and education on task performance and prefrontal cortex processing during emotional and non-emotional verbal fluency tests

The emotional semantic fluency test (SFT) is an emerging verbal fluency test that requires controlled access to emotional lexical information. Currently, how demographic variables influence neurocognitive processing during this test remains elusive. The present study compared the effects of age, gender, and education on task performance and prefrontal cortex (PFC) processing during the non-emotional and emotional SFTs. One-hundred and thirty-three Cantonese-speaking adults aged 18-79 performed the non-emotional and emotional SFTs while their PFC activation was measured using functional near-infrared spectroscopy. Results showed that more education predicted better non-emotional SFT performance, whereas younger age, being female, and more education predicted better emotional SFT performance. Only age significantly affected PFC activation during the SFTs, and the effect was comparable between the two SFTs. Thus, compared with its non-emotional analog, the emotional SFT is influenced by overlapping yet distinct demographic variables. There is a similar age-related reorganization of PFC function across SFT performances.

Patients with Schizophrenia Showed Worse Cognitive Performance than Bipolar and Major Depressive Disorder in a Sample with Comorbid Substance Use Disorders

Comorbidity of substance use disorders (SUD) and severe mental illness (SMI) is highly frequent in patients, the most common diagnoses being schizophrenia (SZ), bipolar disorder (BD) and major depressive disorder (MDD). Since comorbidity has its own clinical features, and neurocognitive functioning is not always similar to psychiatric symptoms the present study explores the cognitive performance of patients with dual disorders. A neuropsychological battery of tests was used to assess 120 under treatment male patients, 40 for each group considered (SZ + SUD, BD + SUD and MDD + SUD) who were mainly polyconsumers. Significant differences (with premorbid IQ as a covariate) were found among the groups, with SZ + SUD having a worse performance in attention, verbal learning, short term memory and recognition. The consideration of a global Z score for performance evidenced an impaired neurocognitive pattern for SZ + SUD compared with BD + SUD and MDD + SUD. According to norms, all patients showed difficulties in verbal learning, short-term memory and recognition. Our research indicated that the neurocognitive functioning of dual disorder patients was influenced by the comorbid SMI, with SZ + SUD presenting major difficulties. Future studies should thoroughly explore the role of such difficulties as indicators or endophenotypes for dual schizophrenia disorders, and their usefulness for prevention and treatment.

Kognitive Beeinträchtigungen alkoholabhängiger Patient_innen im Abstinenzverlauf und die Relevanz depressiver Komorbidität

Zusammenfassung: Hintergrund: Mit dieser Studie wird der Frage nachgegangen, inwieweit sich kognitive Beeinträchtigungen alkoholabhängiger Patient_innen in Abhängigkeit von Abstinenz und Depressivität im Behandlungsverlauf verbessern. Methode: Alkoholabhängige Patient_innen mit ( n = 22) und ohne Depression ( n = 58) wurden neuropsychologisch und hinsichtlich der Depressivität zu drei Zeitpunkten untersucht (nach Entzug und 6 Wochen bzw. 6 Monate später). 33 gesunde Kontrollproband_innen wurden zusätzlich zum ersten Zeitpunkt untersucht. Ergebnisse: Alkoholabhängige Patient_innen zeigten verglichen mit gesunden Kontrollpersonen eine verminderte Leistung im schlussfolgernden Denken. Im Behandlungsverlauf zeigte sich eine trendweise günstigere Entwicklung für abstinente verglichen mit rückfälligen Patient_innen und eine größere Depressivität war mit schwächeren Leistungen assoziiert. Diskussion: Alkoholabhängige Patient_innen leiden an kognitiven Defiziten, die sich z. T. im weiteren Behandlungsverlauf zu verbessern scheinen, v. a. bei Abstinenz.

Cognitive impairment in the co-occurrence of alcohol dependence and major depression: neuropsychological assessment and event-related potentials analyses

To evaluate the putative detrimental effect of Major Depressive Disorder (MDD) on the cognitive impairment associated with Alcohol Dependence (AD), we contrasted the neuropsychological profile and behavioral responses of AD subjects, MDD individuals, and in those with a co-occurring AD-MDD diagnosis (DD). Patients and healthy subjects completed a comprehensive neuropsychological battery and were recorded for P200, P300, and N450 event-related potentials during memory and Stroop tasks. AD subjects exhibited a generalized detrimental neuropsychological performance; in contrast, in MDD individuals, impairment was limited to discrete domains. Notably, the deficits were distinctive in DD cases. A P200 increased amplitude in MDD, a decrease in P300 amplitude in AD, and increased latency of P300 in DD patients were the overt electrophysiological abnormalities identified. Dual patients also exhibited a distinct pattern of behavioral responses, particularly apparent during high-demand cognitive tasks. Specific ERP adjustments were associated with the short-term fluoxetine treatment in DD and MDD subjects; the SSRI also improved altered baseline performance in learning and cognitive flexibility in DD subjects. In conclusion, the neuropsychological and behavioral alterations detected in the co-occurrence of AD-MDD did not seem to be merely the sum of the negative contributions of the independent disorders.

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Dual diagnosis (DD) patients exhibited a distinctive pattern of cognitive impairments compared to single diagnosis subjects.

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The ERP alterations identified were not shared among affected groups.

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Dual patients exhibited idiosyncratic behavioral responses.

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Impaired executive functions in DD subjects improved with SSRI medication.

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Neuropsychological and behavioral alterations are not explained as the sum of negative contributions of individual diagnosis.

Higher-Order Language Dysfunctions in Individuals with Alcohol Use Disorder

Patients with alcohol use disorders (AUD) have difficulties with certain aspects of higher-order language functions (HOLF) but there is no data on a wide range of these functions in this group. Therefore, the aim of this study was to compare different aspects of HOLF in patients with AUD and healthy controls (HC). A total of 31 patients with AUD and 44 HC took part in the study. We assessed HOLF with the Right Hemisphere Language Battery (RHLB) and measured control variables: depression using the Patient Health Questionnaire (PHQ) as well as the speed of processing and executive functions with the Color Trails Test (CTT). Patients with AUD had lower results on nine RHLB tests. Moreover, AUD patients had higher scores on PHQ and longer reaction times on CTT. The differences in most RHLB results remained significant after co-varying the control variables. Patients with AUD have difficulties with making inferences from the text, understanding the meaning of individual words, metaphorical content, and prosody, which may impede the comprehension and production of discourse in which linguistic elements must be integrated with non-verbal cues and contextual information. These disturbances may impact various spheres of everyday life and negatively influence social, private, and professional functioning.

Visuoperceptive Impairments in Severe Alcohol Use Disorder: A Critical Review of Behavioral Studies

The present literature review is aimed at offering a comprehensive and critical view of behavioral data collected during the past seventy years concerning visuoperception in severe alcohol use disorders (AUD). To pave the way for a renewal of research and clinical approaches in this very little understood field, this paper (1) provides a critical review of previous behavioral studies exploring visuoperceptive processing in severe AUD, (2) identifies the alcohol-related parameters and demographic factors that influence the deficits, and (3) addresses the limitations of this literature and their implications for current clinical strategies. By doing so, this review highlights the presence of visuoperceptive deficits but also shows how the lack of in-depth studies exploring the visual system in this clinical population results in the current absence of integration of these deficits in the dominant models of vision. Given the predominance of vision in everyday life, we stress the need to better delineate the extent, the specificity, and the actual implications of the deficits for severe AUD.

Functional and Structural Alteration of Default Mode, Executive Control, and Salience Networks in Alcohol Use Disorder

Alcohol use disorder (AUD) has been related to aberrant functional connectivity (FC) in the salience network (SN), executive control network (ECN), and default mode network (DMN). However, there is a lack of comprehensive and simultaneous examination of these networks in patients with AUD and of their relation to potential anatomical changes. We aimed to comprehensively examine the alteration in FC in the three networks in AUD patients, and the correlation of the alteration with anatomical/structural changes (volume) in the neural areas implicated in these networks, by applying voxel-based morphometry (VBM) and region of interest-to-region of interest connectivity analysis simultaneously. In all, 22 patients with AUD and 22 healthy adults participated in the study and underwent T1 magnetic resonance imaging. Patients with AUD showed increased FCs within the DMN and SN networks, especially in terms of connectivity of the frontal areas and bilateral hippocampi. They also showed decreased FCs in the ECN. In addition, there was significant volume reduction in these areas (frontal areas and hippocampus). The increased FCs within the frontal areas or bilateral hippocampi showed a negative correlation with gray matter volume of these areas in AUD patients. Our findings add to the empirical evidence that the frontal lobe and hippocampi are critical areas that are vulnerable to functional and structural changes due to AUD.

Neuropsychological performance in patients with substance use disorder with and without mood disorders

Background: Mood disorders commonly co-occur in patients with substance use disorders (SUD). This combination may increase the risk of pathological effects and impair cognitive functioning.Aim: The aim of the study was to examine the effects of mood and substance use disorders on specific neuropsychological measures.Methods: The participants comprised 164 hospitalised patients, 88 with (SUD + MD) and 76 (SUD-MD) without mood disorders, ranging in age from 19 to 65 years. Their diagnostic assessment was based on a psychiatric interview (ICD-10). Neuropsychological tests were carried out after a minimum of one month of abstinence.Results: Processing speed (p = 0.029), and perceptual reasoning (p = 0.039) were more impaired in the SUD + MD group than in the SUD-MD group. An Analysis of covariance (ANCOVA) controlled for age, education level, learning difficulties and polysubstance use revealed that the groups were most powerfully separated by the Digit Symbol test and the Block Design test.Conclusions: Patients with substance abuse and mood disorders seem to have more deficits in speed processing and perceptual reasoning than substance abuse patients without mood disorders. These processing speed difficulties and perceptual problems may impact prognosis and treatment. The Digit Symbol test and the Block Design test are a fast and sensitive ways to examine treatment effectiveness and monitor treatment progress.

Abnormal fronto-striatal intrinsic connectivity reflects executive dysfunction in alcohol use disorders

The neural bases of cognitive impairment(s) in alcohol use disorders (AUDs) have been explained either with the specific involvement of frontal regions mostly affected by alcohol neurotoxic effects, or with a global brain damage underlying different neuro-cognitive alterations. Novel insights into this issue might come from the analysis of resting-state brain activity, representing a baseline level of intrinsic connectivity within and between the networks underlying cognitive performance. We thus addressed the neural bases of cognitive impairment(s) in 22 AUD patients, compared with 18 healthy controls, by coupling resting-state fMRI with an in-depth neuropsychological assessment of the main cognitive domains. We assessed a relationship between AUD patients' cognitive impairment and two complementary facets of intrinsic brain functioning, i.e., intensity of activation and functional network connectivity, related to the strength of connectivity within and between resting-state networks, respectively. Alcoholic patients' decreased cognitive performance involved specifically an executive domain associated with attentional and working-memory tasks. This impairment reflected an abnormal relationship, in patients versus controls, between cognitive performance and the intensity of intrinsic activity in the dorsolateral prefrontal and striatal nodes of the executive control network. Functional connectivity between the same structures was positively correlated with executive performance in the whole sample, but significantly reduced in patients. The present data suggest that AUD patients' executive impairment reflects dysfunctional connectivity between the cortical and subcortical nodes of the networks underlying cognitive control on goal-directed behavior. This evidence provides a baseline for future studies addressing the abnormal neural architecture underlying cognitive impairment in AUDs and the outcome of rehabilitative treatment.

Hippocampal granule cell loss in human chronic alcohol abusers

Chronic alcohol abuse causes cognitive impairments associated with neurodegeneration and volume loss in the human hippocampus. Here, we hypothesize that alcohol reduces the number of granule cells in the human dentate gyrus and consequently contribute to the observed volume loss. Hippocampal samples were isolated from deceased donors with a history of chronic alcohol abuse and from controls with no alcohol overconsumption. From each case, a sample from the mid-portion of hippocampus was sectioned, immunostained for the neuronal nuclear marker NeuN, and counter stained with hematoxylin. Granule cell number and volume of granular cell layer in the dentate gyrus were estimated using stereology. We found a substantial reduction in granule cell number and also a significantly reduced volume of the granular cell layer of chronic alcohol abusers as compared to controls. In controls there was a slight age-related decline in the number of granule cells and volume of granular cell layer in line with previous studies. This was not observed among the alcoholics, possibly due to a larger impact of alcohol abuse than age on the degenerative changes in the dentate gyrus. Loss of neurons in the alcoholic group could either be explained by an increase of cell death or a reduced number of new cells added to the granular cell layer. However, there is no firm evidence for an increased neuronal death by chronic alcohol exposure, whereas a growing body of experimental data indicates that neurogenesis is impaired by alcohol. In a recent study, we reported that alcoholics show a reduced number of stem/progenitor cells and immature neurons in the dentate gyrus, hence that alcohol negatively affects hippocampal neurogenesis. The present results further suggest that such impairment of neurogenesis by chronic alcohol abuse also results in a net loss of granule cells in the dentate gyrus of hippocampus.

The Risk Factors of the Alcohol Use Disorders-Through Review of Its Comorbidities

Alcohol use disorders (AUDs) represent a severe, world-wide problem, and are usually comorbid with psychiatric disorders, comorbidity increases the risks associated with AUDs, and results in more serious consequences for patients. However, currently the underlying mechanisms of comorbid psychiatric disorders in AUDs are not clear. Studies investigating comorbidity could help us understand the neural mechanisms of AUDs. In this review, we explore three comorbidities in AUDs, including schizophrenia, major depressive disorder (MDD), and personality disorders (PDs). They are all co-morbidities of AUDs with rate of 33.7, 28, and 50–70%, respectively. The rate is significantly higher than other diseases. Therefore we review and analyze relevant literature to explore whether these three diseases are the risk factors of AUDs, focusing on studies assessing cognitive function and those using neural imaging. We found that memory deficits, impairment of cognitive control, negative emotion, and impulsivity may increase an individual's vulnerability to AUDs. This comorbidity may indicate the neural basis of AUDs and reveal characteristics associated with different types of comorbidity, leading to further development of new treatment approaches for AUDs.

Autobiographical memory compromise in individuals with alcohol use disorders: Towards implications for psychotherapy research

It has been found that Autobiographical memory (i.e., memory for personal experiences and facts about the self) are not properly maintained in people with alcohol-use disorders (AUD). The present paper offers a comprehensive overview of findings regarding the consequences of AUD on autobiographical memory. More specifically, we offer a theoretical model (the AMAUD Autobiographical Memory and Alcohol Use Disorders model) according to which chronic alcohol consumption compromises emotion regulation as well as executive control, which maintains the construction of autobiographical memory. Compromises in emotional regulation and executive functioning can be linked to a weak aspiration to construct detailed memories (i.e., autobiographical overgenerality), compromises of subjective reliving, anterograde amnesia, negative self-defining memories, and a difficulty to mentally project oneself forward in time to generate complex autobiographical representations and self-images. By gathering cognitive and clinical aspects of autobiographical decline in AUD, this model constitutes a theoretical foundation that may lead to a better understanding of this decline. Different clinical perspectives are proposed for developing personalized autobiographical memory rehabilitation programs for individuals with AUD.

Specificity of executive functioning and processing speed problems in common psychopathology

OBJECTIVE

Interest continues in neuropsychological measures as cross-disorder intermediate phenotypes in understanding psychopathology. A central question concerns their specificity versus generalizability to particular forms of psychopathology, particularly for executive functioning (EF) and response speed. Three conceptual models examining these relationships were tested to clarify this picture at different levels in the diagnostic hierarchy.

METHOD

Participants (total n = 641, age 18-60) yielded complete structured diagnostic interviews and a neuropsychological test battery comprising measures of executive function, processing speed, and IQ. Repeated measures multivariate analysis of variance, linear regression, and structural equation modeling (SEM) were used to test (a) a specificity model, which proposes that individual disorders are associated with component EF processes and speed; (b) a severity model, which proposes that the total number of comorbid disorders explain poor EF and/or slow speed; and (c) a higher-order dimensional model, which proposes that internalizing versus externalizing disorders are differentially related to EF or speed.

RESULTS

EF effects were best explained by a specificity model, with distinct aspects of EF related to attention deficit hyperactivity disorder versus antisocial substance use disorders. Speed, on the other hand, emerged as a general indicator of externalizing psychopathology in the dimensional model, as well as overall severity of psychopathology in the severity model.

CONCLUSIONS

Granular approaches are likely to be most productive for linking EF to psychopathology, whereas response speed has underused potential as an endophenotype for psychopathology liability. Results are discussed in terms of an integrated conceptualization of neuropsychological processes and putative neural systems involved in general and specific aspects of psychopathology. (PsycINFO Database Record

T2 relaxation time alterations underlying neurocognitive deficits in alcohol-use disorders (AUD) in an Indian population: A combined conventional ROI and voxel-based relaxometry analysis

Long-term heavy alcohol consumption has traditionally been associated with impaired cognitive abilities, such as deficits in abstract reasoning, problem solving, verbal fluency, memory, attention, and visuospatial processing. The present study aimed at exploring these neuropsychological deficits in alcohol-use disorders (AUD) in an Indian population using the Postgraduate Institute Battery of Brain Dysfunction (PGIBBD) and their possible correlation with alterations in T2 relaxation times (T2-RT), using whole-brain voxel-based relaxometry (VBR) and conventional region of interest (ROI) approach. Multi-echo T2 mapping sequence was performed on 25 subjects with AUD and 25 healthy controls matched for age, education, and socioeconomic status. Whole-brain T2-RT measurements were conducted using VBR and conventional ROI approach. The study was carried out on a 3T whole-body MR scanner. Post processing for VBR and ROI analysis was performed using SPM 8 software and vendor-provided software, respectively. A PGIBBD test battery was conducted on all subjects to assess their cognitive abilities, and the results were reported as raw scores. VBR and ROI results revealed that AUD subjects showed prolonged T2-RTs in cerebellum bilaterally, parahippocampal gyrus bilaterally, right anterior cingulate cortex, left superior temporal gyrus, left middle frontal gyrus, and left calcarine gyrus. A significant correlation was also observed between the neuropsychological test raw scores and alterations in T2-RT in AUD subjects. Our results are consistent with previous studies suggesting tissue disruption or gliosis or demyelination as a possible reason for prolonged T2-RTs. This damage to brain tissue, which is evident as prolonged T2-RT, could possibly be associated with impaired cognitive abilities noticeable in AUD subjects.

Cognitive dysfunction and functional disability in alcohol-dependent adults with or without a comorbid affective disorder

INTRODUCTION

Little is known about the relationship between cognitive dysfunction and functional disability in alcohol dependence with comorbid affective disorders. We investigated the neuropsychology of alcohol dependence in detoxified adults with and without affective comorbidity and examined the factors associated with prolonged functional disability.

METHODS

From a total of 42 participants (age range = 18-44 years), 12 out of 21 alcohol-dependent participants had a comorbid affective disorder, 12 had an affective disorder only, and 9 were healthy controls. Participants completed a semi-structured clinical interview, questionnaires and comprehensive neuropsychological assessment.

RESULTS

Following detoxification (median = 35 days; M = 41.2 days, SD = 17.9), visual learning and memory functioning was worse in alcohol-dependent individuals. Comorbid affective disorders did not appear to exacerbate cognitive dysfunction. Psychiatric comorbidity and current depressive symptoms were predictive of poorer functional disability. Furthermore, learning and memory, and response inhibition, contributed significantly and independently to predicting functional disability over and above clinical and demographic factors.

CONCLUSIONS

Psychiatric comorbidity does not appear to be associated with more pronounced neuropsychological dysfunction in alcohol dependence. Conversely, both comorbid affective disorders and cognitive factors were critical in determining the functional outcomes of alcohol-dependent adults recently undergoing medically supervised inpatient detoxification.

Social support and mental health among adults prior to HIV counseling and testing in Durban, South Africa

Poor social support and mental health may be important modifiable risk factors for HIV acquisition, but they have not been evaluated prior to HIV testing in South Africa. We sought to describe self-perceived mental health and social support and to characterize their independent correlates among adults who presented for voluntary HIV testing in Durban. We conducted a large cross-sectional study of adults (≥18 years of age) who presented for HIV counseling and testing between August 2010 and January 2013 in Durban, South Africa. We enrolled adults presenting for HIV testing and used the Medical Outcomes Study's Social Support Scale (0 [poor] to 100 [excellent]) and the Mental Health Inventory (MHI-3) to assess social support and mental health. We conducted independent univariate and multivariable linear regression models to determine the correlates of lower self-reported Social Support Index and lower self-reported MCH scores. Among 4874 adults surveyed prior to HIV testing, 1887 (39%) tested HIV-positive. HIV-infected participants reported less social support (mean score 66 ± 22) and worse mental health (mean score 66 ± 16), compared to HIV-negative participants (74 ± 21; 70 ± 18; p < 0.0001). In a multivariable analysis, significant correlates of less social support included presenting for HIV testing at an urban hospital, not having been tested previously, not working outside the home, and being HIV-infected. In a separate multivariable analysis, significant correlates of poor mental health were similar, but also included HIV testing at an urban hospital and being in an intimate relationship less than six months. In this study, HIV-infected adults reported poorer social support and worse mental health than HIV-negative individuals. These findings suggest that interventions to improve poor social support and mental health should be focused on adults who do not work outside the home and those with no previous HIV testing.

Systematic review of neurocognition in people with co-occurring alcohol misuse and depression

BACKGROUND

Alcohol misuse and depression represent two major social and health problems globally. These conditions commonly co-occur and both are associated with significant cognitive impairment. Despite this, few studies have examined the impact on cognitive functioning of co-occurring alcohol misuse and depression. This study aims to critically review findings from peer-reviewed published articles examining neuropsychological test performance among samples of people with co-occurring alcohol misuse and depression.

METHOD

A comprehensive literature search was conducted, yielding six studies reporting neuropsychological profiles of people with co-occurring alcohol misuse and depression. Results comparing cognitive functioning of people with this comorbidity to those with alcohol misuse alone, depression alone, healthy controls and published norms were examined as well as those describing the correlation between depressive symptoms and cognitive functioning in people with alcohol use disorders.

RESULTS

In the majority of instances, the comorbid groups did not differ significantly from those with depression only or alcohol misuse only, nor from healthy controls or published norms. In the cases where a difference in neuropsychological test scores between groups was found, it was not consistently identified across studies. However, visual memory was identified in two studies as being impaired in comorbid samples and is worthy of inclusion in future studies.

LIMITATIONS

Due to the small number of included studies and the large variation in inclusion criteria as well as differing assessment tools and methodologies between studies, the review did not include a quantitative synthesis.

CONCLUSIONS

Research into cognitive deficits among people with singly occurring versus co-occurring alcohol misuse and depression is accumulating. Evidence suggests that the neuropsychological performance among samples with this comorbidity is generally not severely impaired and is unlikely to preclude benefit from treatment.

Inhibition during early adolescence predicts alcohol and marijuana use by late adolescence

OBJECTIVE

Adolescent substance use has been associated with poorer neuropsychological functioning, but it is unclear if deficits predate or follow the onset of use. The goal of this prospective study was to understand how neuropsychological functioning during early adolescence could predict substance use by late adolescence.

METHOD

At baseline, participants were 175 substance-use-naïve healthy 12- to 14-year-olds (41% female) recruited from local schools. Participants completed extensive interviews and neuropsychological tests. Each year, participants' substance use was assessed. By late adolescence (ages 17 to 18), 105 participants transitioned into substance use and 75 remained substance-naïve. Hierarchical linear regressions examined how baseline cognitive performance predicted subsequent substance use, controlling for common substance use risk factors (i.e., family history, externalizing behaviors, gender, pubertal development, and age).

RESULTS

Poorer baseline performance on tests of cognitive inhibition-interference predicted higher follow-up peak drinks on an occasion (β = -.15; p < .001), more days of drinking (β = -.15; p < .001), and more marijuana use days (β = -.17; p < .001) by ages 17 to 18, above and beyond covariates. Performances on short-term memory, sustained attention, verbal learning and memory, visuospatial functioning, and spatial planning did not predict subsequent substance involvement (ps > .05).

CONCLUSIONS

Compromised inhibitory functioning during early adolescence prior to the onset of substance use was related to more frequent and intense alcohol and marijuana use by late adolescence. Inhibition performance could help identify teens at risk for initiating heavy substance use during adolescence, and potentially could be modified to improve outcome.

Impairments in learning by monetary rewards and alcohol-associated rewards in detoxified alcoholic patients

BACKGROUND

Excessive alcohol consumption has been linked to structural and functional brain changes associated with cognitive, emotional, and behavioral impairments. It has been suggested that neural processing in the reward system is also affected by alcoholism. The present study aimed at further investigating reward-based associative learning and reversal learning in detoxified alcohol-dependent patients.

METHODS

Twenty-one detoxified alcohol-dependent patients and 26 healthy control subjects participated in a probabilistic learning task using monetary and alcohol-associated rewards as feedback stimuli indicating correct responses. Performance during acquisition and reversal learning in the different feedback conditions was analyzed.

RESULTS

Alcohol-dependent patients and healthy control subjects showed an increase in learning performance over learning blocks during acquisition, with learning performance being significantly lower in alcohol-dependent patients. After changing the contingencies, alcohol-dependent patients exhibited impaired reversal learning and showed, in contrast to healthy controls, different learning curves for different types of rewards with no increase in performance for high monetary and alcohol-associated feedback.

CONCLUSIONS

The present findings provide evidence that dysfunctional processing in the reward system in alcohol-dependent patients leads to alterations in reward-based learning resulting in a generally reduced performance. In addition, the results suggest that alcohol-dependent patients are, in particular, more impaired in changing an established behavior originally reinforced by high rewards.

Decreased Verbal Learning but not Recognition Performance in Alcohol-dependent Individuals During Early Abstinence

Objective:Alcoholism ultimately leads to impairment of memory and other cognitive functions. This can interfere with treatment, if cognitively impaired alcohol-dependent individuals have difficulties recalling and implementing skills acquired during therapy. We investigate if alcohol-dependent individuals without clinically apparent withdrawal symptoms may still be impaired in higher-order cognitive functions.

Methods:Thirty-four alcohol-dependent patients and 20 matched healthy controls were tested with the Verbal Learning and Memory Test which includes seven measurement points. The test comprises free recall, free recall after distraction and after 30 minute delay, and a word recognition task. Testing was performed between day seven and day 10 after the beginning of abstinence, when clinical withdrawal symptoms had ceased.

Results:Compared to healthy controls, alcohol-dependent patients performed worse in free recall after delay, but not in word recognition. Healthy controls showed a more linear progression of improvement in verbal memory performance. Overall, alcohol-dependent individuals showed reduced verbal learning efficiency. The extent of impaired recall after distraction was positively associated (one-tailed test) with history of delirium (r=0.34, p=0.04), seizures (r=0.46, p=0.01), and years since diagnosis for alcohol dependency (r=0.39, p=0.01).

Conclusions:Our results provide evidence that unmedicated alcohol-dependent patients without obvious withdrawal symptoms had impaired verbal recall, but normal recognition performance, at seven to 10 days after onset of abstinence. This deficit may deteriorate treatment outcomes due to poorer implementation of skills newly-learned during this time period.

Assessment of Alcohol-related Memory Deficits: A Comparison between the Rivermead Behavioural Memory Test and the California Verbal Learning Test

Objectives: Neuropsychological assessment of memory disorders is an important prerequisite in the treatment of patients with alcohol-related cognitive disorders. Although many memory tests are available in clinical practice, a question remains regarding which test is most appropriate for this purpose. Our study's goal was to evaluate the discriminative power of indices of a standard memory test (the California Verbal Learning Test; CVLT) versus the subtests of an ecologically valid everyday memory test (the Rivermead Behavioural Memory Test; RBMT) in patients with alcohol-use disorder.

Method: The patients included 136 with Korsakoff's syndrome (KS), 73 alcoholics with cognitive impairment (CI) not fulfilling the criteria for KS, and 24 cognitively unimpaired alcoholics (ALC).

Results: KS patients performed significantly lower on all RBMT and CVLT variables than CI patients. ALC patients performed significantly better than CI patients on only one RBMT subtest, and had a significantly lower rate of forgetting and higher scores on free recall on CVLT. A combination of RBMT subtests and CVLT indices was able to discriminate KS patients from CI and ALC patients. The RBMT subtests could not significantly distinguish ALC from CI patients. Both rate of forgetting and a comparison between free and cued recall testing on the CVLT showed the largest between-group differences.

Conclusion: Although the RBMT provides information about everyday memory performance, the CVLT indices are better able to distinguish between uncomplicated alcoholics and those with cognitive impairment or KS.

Chronic alcohol consumption and its effect on nodes of frontocerebellar and limbic circuitry: comparison of effects in France and the United States

Alcohol use disorders present a significant public health problem in France and the United States (U.S.), but whether the untoward effect of alcohol on the brain results in similar damage in both countries remains unknown. Accordingly, we conducted a retrospective collaborative investigation between two French sites (Caen and Orsay) and a U.S. laboratory (SRI/Stanford University) with T1-weighted, structural MRI data collected on a common imaging platform (1.5T, General Electric) on 288 normal controls (NC), 165 uncomplicated alcoholics (ALC), and 26 patients with alcoholic Korsakoff's syndrome (KS) diagnosed at all sites with a common interview instrument. Data from the two countries were pooled, then preprocessed and analyzed together at the U.S. site using atlas-based parcellation. National differences indicated that thalamic volumes were smaller in ALC in France than the U.S. despite similar alcohol consumption levels in both countries. By contrast, volumes of the hippocampus, amygdala, and cerebellar vermis were smaller in KS in the U.S. than France. Estimated amount of alcohol consumed over a lifetime, duration of alcoholism, and length of sobriety were significant predictors of selective regional brain volumes in France and in the U.S. The common analysis of MRI data enabled identification of discrepancies in brain volume deficits in France and the U.S. that may reflect fundamental differences in the consequences of alcoholism on brain structure between the two countries, possibly related to genetic or environmental differences.

Decreased white matter integrity in fronto-occipital fasciculus bundles: relation to visual information processing in alcohol-dependent subjects

Chronic alcohol abuse is characterized by impaired cognitive abilities with a more severe deficit in visual than in verbal functions. Neuropathologically, it is associated with widespread brain structural compromise marked by gray matter shrinkage, ventricular enlargement, and white matter degradation. The present study sought to increase current understanding of the impairment of visual processing abilities in alcohol-dependent subjects, and its correlation with white matter microstructural alterations, using diffusion tensor imaging (DTI). To that end, a DTI study was carried out on 35 alcohol-dependent subjects and 30 healthy male control subjects. Neuropsychological tests were assessed for visual processing skills and deficits were reported as raw dysfunction scores (rDyS). Reduced FA (fractional anisotropy) and increased MD (mean diffusivity) were observed bilaterally in inferior and superior fronto-occipital fasciculus (FOF) fiber bundles. A significant inverse correlation in rDyS and FA values was observed in these fiber tracts whereas a positive correlation of these scores was found with the MD values. Our results suggest that FOF fiber bundles linking the frontal lobe to occipital lobe might be related to visual processing skills. This is the first report of an alteration of the white matter microstructure of FOF fiber bundles that might have functional consequences for visual processing in alcohol-dependent subjects who exhibit no neurological complications.

Comorbidities, confounders, and the white matter transcriptome in chronic alcoholism

BACKGROUND

Alcohol abuse is the world's third leading cause of disease and disability, and one potential sequel of chronic abuse is alcohol-related brain damage (ARBD). This clinically manifests as cognitive dysfunction and pathologically as atrophy of white matter (WM) in particular. The mechanism linking chronic alcohol intoxication with ARBD remains largely unknown but it is also complicated by common comorbidities such as liver damage and nutritional deficiencies. Liver cirrhosis, in particular, often leads to hepatic encephalopathy (HE), a primary glial disease.

METHODS

In a novel transcriptomic study, we targeted the WM only of chronic alcoholics in an attempt to tease apart the pathogenesis of ARBD. Specifically, in alcoholics with and without HE, we explored both the prefrontal and primary motor cortices, 2 regions that experience differential levels of neuronal loss.

RESULTS

Our results suggest that HE, along with 2 confounders, gray matter contamination, and low RNA quality are major drivers of gene expression in ARBD. All 3 exceeded the effects of alcohol itself. In particular, low-quality RNA samples were characterized by an up-regulation of translation machinery, while HE was associated with a down-regulation of mitochondrial energy metabolism pathways.

CONCLUSIONS

The findings in HE alcoholics are consistent with the metabolic acidosis seen in this condition. In contrast non-HE alcoholics had widespread but only subtle changes in gene expression in their WM. Notwithstanding the latter result, this study demonstrates that significant confounders in transcriptomic studies of human postmortem brain tissue can be identified, quantified, and "removed" to reveal disease-specific signals.

Cognitive impairments in alcohol-dependent subjects

Chronic excessive alcohol consumption induces cognitive impairments mainly affecting executive functions, episodic memory, and visuospatial capacities related to multiple brain lesions. These cognitive impairments not only determine everyday management of these patients, but also impact on the efficacy of management and may compromise the abstinence prognosis. Maintenance of lasting abstinence is associated with cognitive recovery in these patients, but some impairments may persist and interfere with the good conduct and the efficacy of management. It therefore appears essential to clearly define neuropsychological management designed to identify and evaluate the type and severity of alcohol-related cognitive impairments. It is also essential to develop cognitive remediation therapy so that the patient can fully benefit from the management proposed in addiction medicine units.

Symptoms of common mental disorder and cognitive associations with seropositivity among a cohort of people coming for testing for HIV/AIDS in Goa, India: a cross-sectional survey

Background

The majority of research on HIV/AIDS and mental health has been carried out among clinical populations: the time of onset of comorbid depression and the mechanisms for this are therefore unclear. Although there is evidence to suggest that asymptomatic people living with HIV/AIDS exhibit some cognitive deficits, the prevalence of poor cognitive functioning among people in low income settings at an early, pre-clinical stage has not yet been investigated.

Methods

We used a cross-sectional survey design to test the hypotheses that symptoms of Common Mental Disorder (CMD) and low scores on cognitive tests would be associated with seropositivity among participants coming for testing for HIV/AIDS. Participants were recruited at the time of coming for testing for HIV/AIDS; voluntary informed consent was sought for participation in research interviews and data linkage with HIV test results. Baseline questionnaires including sociodemographic variables and measures of mental health (PHQ-9, GAD-7, panic disorder questions, AUDIT and delayed word list learning and recall and animal naming test of verbal fluency) were administered by trained interviews. HIV status data was extracted from clinical records.

Results

CMD and scoring below the educational norm on the test of verbal fluency were associated with testing positive for HIV/AIDS in bivariate analysis (OR = 2.26, 1.31-3.93; OR = 1.77, 1.26-2.48, respectively). After controlling for the effects of confounders, the association between CMD and seropositivity was no longer statistically significant (AOR = 1.56, 0.86-2.85). After adjusting for the effects of confounders, the association between low scores on the test of verbal fluency and seropositivity was retained (AOR = 1.77, 1.27-2.48).

Conclusions

Our findings provide tentative evidence to suggest that low cognitive test scores (and possibly depressive symptoms) may be associated with HIV status among people who have yet to receive their HIV test results. Impaired cognitive functioning and depression-like symptoms may be the result of the same underlying neurological damage. CMD and cognitive impairment may overlap to a greater extent than previously assumed. If replicated, this may have implications for the way in which we measure and treat CMD and cognitive functioning among people living with HIV/AIDS.

Mental state decoding and mental state reasoning in recently detoxified alcohol-dependent individuals

Impaired social cognition has been associated with interpersonal problems and with the development of and relapse into alcohol abuse. In the present study, self-reported trait empathy, decoding of complex mental states and cognitive and affective mental state reasoning were assessed in alcohol-dependent participants, and the association with executive function and psychopathological characteristics was investigated. Twenty recently detoxified alcohol-dependent patients and 20 matched healthy controls were assessed with an abbreviated German version of the interpersonal reactivity index, the revised reading the mind in the eyes test, the faux pas story test, the trail making test and the letter-number-sequencing test. Patients were impaired relative to controls with regard to mental state decoding on the eyes test and showed reduced faux pas detection and impaired mental state reasoning reflected by lower faux pas understanding and faux pas empathy scores. There were no group differences regarding self-reported trait empathy. Performance on the sociocognitive measures was related to executive functioning and the severity of depressive symptoms. Although self-report measures might not always reliably detect impairments of social cognition, behavioural measures suggest pronounced impairments of mental state decoding and mental state reasoning in association with alcohol dependence. Findings ought to be incorporated into current treatment strategies.

Applicability of the Rivermead Behavioural Memory Test - Third Edition (RBMT-3) in Korsakoff's syndrome and chronic alcoholics

PURPOSE

To examine the applicability of the newly developed Rivermead Behavioural Memory Test - Third Edition (RBMT-3) as an ecologically-valid memory test in patients with alcohol-related cognitive disorders.

PATIENTS AND METHODS

An authorized Dutch translation of the RBMT-3 was developed, equivalent to the UK version, and administered to a total of 151 participants - 49 patients with amnesia due to alcoholic Korsakoff's syndrome, 49 patients with cognitive impairment and a history of chronic alcoholism, not fulfilling the Korsakoff criteria, and 53 healthy controls. Between-group comparisons were made at subtest level, and the test's diagnostic accuracy was determined.

RESULTS

Korsakoff patients performed worse than controls on all RBMT-3 subtests (all P-values < 0.0005). The alcoholism group performed worse than controls on most (all P-values < 0.02), but not all RBMT-3 subtests. Largest effects were found between the Korsakoff patients and the controls after delayed testing. The RBMT-3 had good sensitivity and adequate specificity.

CONCLUSION

The RBMT-3 is a valid test battery to demonstrate everyday memory deficits in Korsakoff patients and non-Korsakoff patients with alcohol abuse disorder. Korsakoff patients showed an impaired performance on subtests relying on orientation, contextual memory and delayed testing. Our findings provide valuable information for treatment planning and adjustment in patients with alcohol-related cognitive impairments.

Decoding of emotional components in complex communicative situations (irony) and its relation to empathic abilities in male chronic alcoholics: an issue for treatment

BACKGROUND

Previous research has shown that deficits in the domain of emotions strongly characterize alcoholism. Patients diagnosed with alcoholism show impairments in emotional mimic recognition, as well as in the domain of emotional prosody. These data suggest that male alcoholics might suffer from a generalized emotional impairment associated with dysfunctions in empathy. Taken altogether, those deficits might influence alcoholics' relational domain and their performance in complex communicative situations such as ironic interactions. The present study investigates the ability of chronic male alcoholics to recognize the emotional component of ironic contexts and its relation to the comprehension of ironic meaning as a function of their empathic abilities.

METHODS

Forty-four male subjects participated in a story comprehension task. They were asked to read stories with either an ironic or a nonironic ending. Participants were asked to fill in a questionnaire about communicative intentions and the emotional states of the stories' characters. Moreover, the correct comprehension of the ironic meaning was assessed through a self-reported questionnaire and related to the empathy quotient (EQ) which was measured in a preexperimental phase.

RESULTS

Alcoholic subjects showed a lower EQ in comparison to healthy subjects and recognized significant fewer ironic endings. Social skills results were particularly impaired. The correlation between EQ and ironic endings recognition was significant. Moreover, alcoholics showed a tendency to attribute positive emotions to both ironic and nonironic contexts, showing an opposite pattern in comparison with control subjects who tended to associate negative emotions to ironic contexts.

CONCLUSIONS

The present study indicates that emotional recognition deficits that have been previously observed in chronic alcoholics extend to complex interactive contexts. This deficit is associated with a more general impairment of empathy, especially in its social skill component. Clinical implications of the present results are discussed.

Learning from positive and negative monetary feedback in patients with alcohol dependence

BACKGROUND

Chronic and excessive consumption of alcohol is associated with structural, physiological, and functional changes in multiple regions of the human brain including the prefrontal cortex, the medial temporal lobe, and the structures of the reward system. The present study aimed to assess the ability of alcohol-dependent patients (ADP) to learn probabilistic stimulus-reward contingencies and to transfer the acquired knowledge to new contexts. During transfer, the relative preference to learn from positive or negative feedback was also assessed.

METHODS

Twenty-four recently detoxified ADP and 20 healthy controls engaged in a feedback learning task with monetary rewards. The learning performance per se and transfer performance including positive versus negative learning were examined, as well as the relationship between different learning variables and variables comprising alcohol and nicotine consumption patterns, depression, and personality traits (harm avoidance and impulsivity).

RESULTS

Patients did not show a significant general learning deficit in the acquisition of stimulus-response-outcome associations. Fifteen healthy subjects and 13 patients reached the transfer phase, in which ADP showed generally lower performance than healthy controls. There was no specific deficit with regard to learning from positive or negative feedback. The only near-significant (negative) correlation between learning variables and drug consumption patterns, depression, and personality traits emerged for harm avoidance and positive learning in controls.

CONCLUSIONS

Impaired transfer performance suggests that ADP had problems applying their acquired knowledge in a new context. Potential relations to dysfunctions of specific brain structures and implications of the finding for therapy are discussed.

Widespread and sustained cognitive deficits in alcoholism: a meta-analysis

The cognitive repercussions of alcohol dependence are well documented. However, the literature remains somewhat ambiguous with respect to which distinct cognitive functions are more susceptible to impairment in alcoholism and to how duration of abstinence affects cognitive recovery. Some theories claim alcohol negatively affects specific cognitive functions, while others assert that deficits are more diffuse in nature. This is the first meta-analysis to examine cognition in alcohol abuse/dependence and the duration of abstinence necessary to achieve cognitive recovery. A literature search yielded 62 studies that assessed cognitive dysfunction among alcoholics. Effect size estimates were calculated using the Comprehensive Meta-Analysis V2, for the following 12 cognitive domains: intelligence quotient, verbal fluency/language, speed of processing, working memory, attention, problem solving/executive functions, inhibition/impulsivity, verbal learning, verbal memory, visual learning, visual memory and visuospatial abilities. Within these 12 domains, three effect size estimates were calculated based on abstinence duration. The three groups were partitioned into short- (< 1 month), intermediate- (2 to 12 months) and long- (> 1 year) term abstinence. Findings revealed moderate impairment across 11 cognitive domains during short-term abstinence, with moderate impairment across 10 domains during intermediate term abstinence. Small effect size estimates were found for long-term abstinence. These results suggest significant impairment across multiple cognitive functions remains stable during the first year of abstinence from alcohol. Generally, dysfunction abates by 1 year of sobriety. These findings support the diffuse brain hypothesis and suggest that cognitive dysfunction may linger for up to an average of 1 year post-detoxification from alcohol.

Impaired conditional reasoning in alcoholics: a negative impact on social interactions and risky behaviors?

AIMS

To study the 'social brain' in alcoholics by investigating social contract reasoning, theory of mind and emotional intelligence.

DESIGN

A behavioral study comparing recently detoxified alcoholics with normal, healthy controls.

SETTING

Emotional intelligence and decoding of emotional non-verbal cues have been shown to be impaired in alcoholics. This study explores whether these deficits extend to conditional reasoning about social contracts.

PARTICIPANTS

Twenty-five recently detoxified alcoholics (17 men and eight women) were compared with 25 normal controls (17 men and eight women) matched for sex, age and education level.

MEASUREMENTS

Wason selection task investigating conditional reasoning on three different rule types (social contract, precautionary and descriptive), revised Reading the Mind in the Eyes Test, Trait Emotional Intelligence Questionnaire (modified version) and additional control measures.

FINDINGS

Conditional reasoning was impaired in alcoholics. Performance on descriptive rules was not above chance. Reasoning performance was markedly better on social contract and precautionary rules, but this performance was still significantly lower than in controls. Several emotional intelligence measures were lower in alcoholics compared to controls, but these were not correlated with reasoning performance.

CONCLUSIONS

Conditional reasoning, including reasoning about social contracts and emotional intelligence appear to be impaired in alcoholics. Impairment seems to be particularly severe on descriptive rules. Impairment in social contract reasoning might lead to misunderstandings and frustration in social interactions, and reasoning difficulties about precautionary rules might contribute to risky behaviors in this population.

Disability associated with alcohol abuse and dependence

BACKGROUND

 Alcohol use disorders (AUD), i.e., alcohol dependence and abuse, are major contributors to burden of disease. A large part of this burden is because of disability. However, there is still controversy about the best disability weighting for AUD. The objective of this study was to provide an overview of alcohol-related disabilities.

METHODS

Systematic literature review and expert interviews.

RESULTS

There is heterogeneity in experts' descriptions of disabilities related to AUD. The major core attributes of disability related to AUD are changes of emotional state, social relationships, memory and thinking. The most important supplementary attributes are anxiety, impairments of speech and hearing.

CONCLUSIONS

This review identified the main patterns of disability associated with AUD. However, there was considerable variability, and data on less prominent patterns were fragmented. Further and systematic research is required for increasing the knowledge on disability related to AUD and for application of interventions for reducing the associated burden.

Long-lasting reduction in hippocampal neurogenesis by alcohol consumption in adolescent nonhuman primates

Binge alcohol consumption in adolescents is increasing, and studies in animal models show that adolescence is a period of high vulnerability to brain insults. The purpose of the present study was to determine the deleterious effects of binge alcohol on hippocampal neurogenesis in adolescent nonhuman primates. Heavy binge alcohol consumption over 11 mo dramatically and persistently decreased hippocampal proliferation and neurogenesis. Combinatorial analysis revealed distinct, actively dividing hippocampal neural progenitor cell types in the subgranular zone of the dentate gyrus that were in transition from stem-like radial glia-like cells (type 1) to immature transiently amplifying neuroblasts (type 2a, type 2b, and type 3), suggesting the evolutionary conservation of milestones of neuronal development in macaque monkeys. Alcohol significantly decreased the number of actively dividing type 1, 2a, and 2b cell types without significantly altering the early neuronal type 3 cells, suggesting that alcohol interferes with the division and migration of hippocampal preneuronal progenitors. Furthermore, the lasting alcohol-induced reduction in hippocampal neurogenesis paralleled an increase in neural degeneration mediated by nonapoptotic pathways. Altogether, these results demonstrate that the hippocampal neurogenic niche during adolescence is highly vulnerable to alcohol and that alcohol decreases neuronal turnover in adolescent nonhuman primate hippocampus by altering the ongoing process of neuronal development. This lasting effect, observed 2 mo after alcohol discontinuation, may underlie the deficits in hippocampus-associated cognitive tasks that are observed in alcoholics.

Distinct affective processing of emotionally stimulating written words and pictures in patients with alcohol dependence

We explored the affective processing of patients with alcohol dependence to emotionally stimulating written words and pictures. The alcoholic group demonstrated dichotomous responses and was incapable of compromising in neutral conditions. The dichotomous response pattern and positivity offset differed between words and pictures in patients with alcohol dependence.

The effect of moderate to heavy alcohol consumption on neuropsychological performance as measured by the repeatable battery for the assessment of neuropsychological status

BACKGROUND

Excessive alcohol use is associated with damage to the structure and function of the brain and impairment of cognition and behavior. Traditional test batteries used to assess cognitive performance in alcoholics are extensive and costly, limiting their use across various clinical and research settings. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a relatively new instrument that attempts to overcome some of these limitations. As yet the individual effect of moderate to heavy alcohol consumption on RBANS performance has not been examined. The primary aim of this study was to explore and quantify differences in performance between controls and drinkers on the RBANS and to examine the influence of age, gender, and alcohol use patterns on test performance.

METHODS

Data from a subset of "Using Our Brains" (UoB) donors (n = 28) still actively drinking and meeting criteria for moderate to heavy alcohol use (30 to 80 g of ethanol per day) (Harper, 1988) and 28 matched controls (age, education, and premorbid Intelligence Quotient) were compared.

RESULTS

Participants in the alcohol group performed below the healthy control group on the visuospatial and immediate memory index, and also on the RBANS total score p < 0.001 and showed a greater decline in RBANS scores from estimated cross-sectional premorbid levels. There was a positive association between alcohol ingestion in the preceding 12 months and the language index p < 0.03 and the semantic fluency subtest (p < 0.03). Age was negatively associated with story memory (p < 0.02), coding (p < 0.001), list recognition (p < 0.01), story recall (p < 0.03), and figure recall (p < 0.02).

CONCLUSION

Our results suggest that the RBANS is able to detect and characterize differences in verbal fluency, visuospatial skills, components of declarative memory, and psychomotor speed between healthy controls and moderate to heavy active alcohol users. Executive functions, commonly affected by alcoholism and not included in the RBANS, require assessment with additional measures.

Permanent impairment of birth and survival of cortical and hippocampal proliferating cells following excessive drinking during alcohol dependence

Experimenter-delivered alcohol decreases adult hippocampal neurogenesis and hippocampal-dependent learning and memory. The present study used clinically relevant rodent models of nondependent limited access alcohol self-administration and excessive drinking during alcohol dependence (alcohol self-administration followed by intermittent exposure to alcohol vapors over several weeks) to compare alcohol-induced effects on cortical gliogenesis and hippocampal neurogenesis. Alcohol dependence, but not nondependent drinking, reduced proliferation and survival in the medial prefrontal cortex (mPFC). Apoptosis was reduced in both alcohol groups within the mPFC, which may reflect an initiation of a reparative environment following alcohol exposure as decreased proliferation was abolished after prolonged dependence. Reduced proliferation, differentiation, and neurogenesis were observed in the hippocampus of both alcohol groups, and prolonged dependence worsened the effects. Increased hippocampal apoptosis and neuronal degeneration following alcohol exposure suggest a loss in neuronal turnover and indicate that the hippocampal neurogenic niche is highly vulnerable to alcohol.

Neurocognitive profiles of people with comorbid depression and alcohol use: implications for psychological interventions

Depression and alcohol use disorders frequently co-occur and are highly prevalent. Both conditions are known to impair cognitive functioning, yet research into the role of these impairments in response to Cognitive Behaviour Therapy (CBT) is limited. The purpose of the present study was to examine the relationship between baseline neuropsychological performance, severity of depressive symptoms and alcohol use disorders. Participants with current depression and hazardous alcohol use were functioning in the average range on all neuropsychological measures prior to treatment entry. Baseline measures of drinking severity and a range of cognitive functions were inversely correlated. After controlling for other baseline variables, superior baseline cognitive functioning predicted greater reductions in depression severity after 17 weeks. These predictive effects occurred across both brief and extended interventions. Findings suggest that improvement in depression following psychological treatment is enhanced by greater fluid reasoning ability and is predicted by executive functioning, regardless of the treatment length or problem focus.

Recollective experience in alcohol dependence: a laboratory study

AIMS

Alcohol dependence has been linked to dysfunction of fronto-temporo-striatal circuits which mediate memory and executive function. The present study aimed to explore the specificity of recognition memory changes in alcohol dependence.

DESIGN

setting and participants Twenty hospitalized alcohol-dependent detoxified patients and 20 healthy control subjects completed a verbal list discrimination task. Measurements Hits and false alarm rates were analysed. Additionally, both the dual process signal detection model (DPSD) and the process dissociation procedure (PDP) were used to derive estimates of the contribution of recollection and familiarity processes to the recognition memory performance in patients and controls.

FINDINGS

Alcohol-dependent patients showed intact hit rates, but increased false alarm rates and an impaired ability to remember the learning context. Both the DPSD model and PDP estimates yielded significantly reduced recollection estimates in the alcohol-dependent compared to control subjects. Whether or not familiarity was impaired, depended upon the sensitivity of the estimation procedure.

CONCLUSION

Taken together, the result pattern suggests a significant impairment in recollection and mild familiarity changes in recently detoxified, predominantly male, alcohol-dependent subjects.

Effects of the glucocorticoid antagonist, mifepristone, on the consequences of withdrawal from long term alcohol consumption

BACKGROUND

Studies were carried out to test the hypothesis that administration of a glucocorticoid Type II receptor antagonist, mifepristone (RU38486), just prior to withdrawal from chronic alcohol treatment, would prevent the consequences of the alcohol consumption and withdrawal in mice.

MATERIALS AND METHODS

The effects of administration of a single intraperitoneal dose of mifepristone were examined on alcohol withdrawal hyperexcitability. Memory deficits during the abstinence phase were measured using repeat exposure to the elevated plus maze, the object recognition test, and the odor habituation/discrimination test. Neurotoxicity in the hippocampus and prefrontal cortex was examined using NeuN staining.

RESULTS

Mifepristone reduced, though did not prevent, the behavioral hyperexcitability seen in TO strain mice during the acute phase of alcohol withdrawal (4 hours to 8 hours after cessation of alcohol consumption) following chronic alcohol treatment via liquid diet. There were no alterations in anxiety-related behavior in these mice at 1 week into withdrawal, as measured using the elevated plus maze. However, changes in behavior during a second exposure to the elevated plus maze 1 week later were significantly reduced by the administration of mifepristone prior to withdrawal, indicating a reduction in the memory deficits caused by the chronic alcohol treatment and withdrawal. The object recognition test and the odor habituation and discrimination test were then used to measure memory deficits in more detail, at between 1 and 2 weeks after alcohol withdrawal in C57/BL10 strain mice given alcohol chronically via the drinking fluid. A single dose of mifepristone given at the time of alcohol withdrawal significantly reduced the memory deficits in both tests. NeuN staining showed no evidence of neuronal loss in either prefrontal cortex or hippocampus after withdrawal from chronic alcohol treatment.

CONCLUSIONS

The results suggest mifepristone may be of value in the treatment of alcoholics to reduce their cognitive deficits.

The relationships of sociodemographic factors, medical, psychiatric, and substance-misuse co-morbidities to neurocognition in short-term abstinent alcohol-dependent individuals

Co-morbidities that commonly accompany those afflicted with an alcohol use disorder (AUD) may promote variability in the pattern and magnitude of neurocognitive abnormalities demonstrated. The goal of this study was to investigate the influence of several common co-morbid medical conditions (primarily hypertension and hepatitis C), psychiatric (primarily unipolar mood and anxiety disorders), and substance use (primarily psychostimulant and cannabis) disorders, and chronic cigarette smoking on the neurocognitive functioning in short-term abstinent, treatment-seeking individuals with AUD. Seventy-five alcohol-dependent participants (ALC; 51+/-9 years of age; three females) completed comprehensive neurocognitive testing after approximately 1 month of abstinence. Multivariate multiple linear regression evaluated the relationships among neurocognitive variables and medical conditions, psychiatric, and substance-use disorders, controlling for sociodemographic factors. Sixty-four percent of ALC had at least one medical, psychiatric, or substance-abuse co-morbidity (excluding smoking). Smoking status (smoker or nonsmoker) and age were significant independent predictors of cognitive efficiency, general intelligence, postural stability, processing speed, and visuospatial memory after age-normed adjustment and control for estimated pre-morbid verbal intelligence, education, alcohol consumption, and medical, psychiatric, and substance-misuse co-morbidities. Results indicated that chronic smoking accounted for a significant portion of the variance in the neurocognitive performance of this middle-aged AUD cohort. The age-related findings for ALC suggest that alcohol dependence, per se, was associated with diminished neurocognitive functioning with increasing age. The study of participants who demonstrate common co-morbidities observed in AUD is necessary to fully understand how AUD, as a clinical syndrome, affects neurocognition, brain neurobiology, and their changes with extended abstinence.

Decreased volume of the brain reward system in alcoholism

BACKGROUND

Reinforcement of behavioral responses involves a complex cerebral circuit engaging specific neuronal networks that are modulated by cortical oversight systems affiliated with emotion, memory, judgment, and decision making (collectively referred to in this study as the "extended reward and oversight system" or "reward network"). We examined whether reward-network brain volumes are reduced in alcoholics and how volumes of subcomponents within this system are correlated with memory and drinking history.

METHODS

Morphometric analysis was performed on magnetic resonance brain scans in 21 abstinent long-term chronic alcoholic men and 21 healthy control men, group-matched on age, verbal IQ, and education. We derived volumes of total brain and volumes of cortical and subcortical reward-related structures including the dorsolateral-prefrontal, orbitofrontal, cingulate cortices, and the insula, as well as the amygdala, hippocampus, nucleus accumbens septi (NAc), and ventral diencephalon.

RESULTS

Morphometric analyses of reward-related regions revealed decreased total reward-network volume in alcoholic subjects. Volume reduction was most pronounced in right dorsolateral-prefrontal cortex, right anterior insula, and right NAc, as well as left amygdala. In alcoholics, NAc and anterior insula volumes increased with length of abstinence, and total reward-network and amygdala volumes correlated positively with memory scores.

CONCLUSIONS

The observation of decreased reward-network volume suggests that alcoholism is associated with alterations in this neural reward system. These structural reward system deficits and their correlation with memory scores elucidate underlying structural-functional relationships between alcoholism and emotional and cognitive processes.

Social cognition in alcoholism: a link to prefrontal cortex dysfunction?

AIMS

Alcoholism is associated with a range of cognitive deficits. These deficits might be explained by the 'frontal lobe hypothesis' which suggests a specific vulnerability of the prefrontal cortex (PFC) to the neurotoxic effects of alcohol. Social cognition is thought to be processed in the PFC, but so far only few studies have addressed the issue of social cognition deficits in alcoholism. This review aims to evaluate the deficits in social cognition in alcoholic patients. In addition an outline for future perspectives is given.

METHODS

Medline and Psyclit searches were performed for a 30-year period (1977-2007).

RESULTS

Alcoholism is associated clearly with social cognition impairments which include emotional face and prosody perception problems, theory of mind deficits and humour processing difficulties.

CONCLUSIONS

In summary, the social cognition impairments are consistent with the frontal lobe hypothesis of alcoholism. Future studies should focus on (i) the delineation of the basic cognitive processes which underlie social cognition deficits; and (ii) their relevance as predictors of treatment outcome in alcoholism.

Alcoholism leads to early perceptive alterations, independently of comorbid depressed state: an ERP study

INTRODUCTION

Alcoholism is associated with a deficit in the processing of emotional facial expressions (EFE) and with a delayed P3b component, partially mediated by earlier perceptive deficits (P100, N170). Since alcohol dependence often occurs with depression, we aim at investigating whether classical event-related potentials (ERP) alterations observed in alcoholism are modulated or not by depression.

METHODS

Four groups (controls; alcoholics; depressed; alcoholics-depressed) of 12 participants performed two different discrimination tasks, a gender and an emotional one. They had to decide as quickly as possible about the gender or the emotion displayed by facial stimuli during an ERP recording session (32 channels). Reaction times (RTs), P100, N100, N170 and P3b were recorded.

RESULTS

At the behavioural level, control participants discriminated EFE (but not gender) more rapidly than the three other groups. At the ERP level, the differences observed on RTs for emotional task were neurophysiologically indexed by a delayed P3b component. This delay was associated with earlier ERP alterations (P100, N100, N170), but only in participants suffering from alcohol dependence, in association or not with depression.

DISCUSSION

On the one hand, individuals with alcoholism, associated or not with a comorbid depression, were impaired in the processing of EFE. This deficit was neurophysiologically indexed by early perceptive (P100, N100, N170) and decisional (P3b) alterations. On the other hand, non-alcoholic patients with depression only exhibited P3b impairment. These results lead to potential implications concerning the usefulness of the ERP for the differential diagnosis in psychiatry, notably concerning the comorbidities in alcoholism.