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de Vries IRH, Oudman E, Postma A. Personality traits and personality problems in Korsakoff syndrome patients. J Clin Exp Neuropsychol 2024; 46:233-245. [PMID: 38640075 DOI: 10.1080/13803395.2024.2344840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 04/08/2024] [Indexed: 04/21/2024]
Abstract
Personality research is of relevance because it provides insights into the psychological strengths and vulnerabilities of a person. Korsakoff's syndrome (KS) is a severe neuropsychiatric disorder following acute thiamine deficiency, usually as a consequence of alcohol-use disorders. Research on personality traits of KS patients is currently limited. The aim of the current exploratory study was therefore to examine the personality traits and problems of KS patients. We assessed self-reported and informant-reported personality traits and problems in institutionalized KS patients (n = 30). Results indicate that the psychotic personality organization was more frequently present in KS patients compared to a psychiatric reference population, leading to increased vulnerability for the development of severe psychiatric issues. Informants observed more premorbid and current cluster B ("emotional") and C ("anxious") personality behavior in comparison to the general population. Also, rigid- and socially avoidant behavior in KS patients was observed to increase over the years. They also observed personality problems such as emotional-, unpredictable-, dramatic-, anxious and fearful behavior in the present and in the past. KS patients reported themselves as healthy individuals, indicating a lack of self-awareness. We recommend training programs for the medical team focussed on psycho-education and supportive interventions for patients with complex personality problems concomitant to KS.
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Affiliation(s)
- Ineke Roelfina Hendrika de Vries
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
- Slingedael Korsakoff Centre, Lelie Care Group, Rotterdam, The Netherlands
| | - Erik Oudman
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
- Slingedael Korsakoff Centre, Lelie Care Group, Rotterdam, The Netherlands
| | - Albert Postma
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
- Slingedael Korsakoff Centre, Lelie Care Group, Rotterdam, The Netherlands
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Burile GC, Arya N, Seth NH, Fating T. Rehabilitation Strategies for Wernicke-Korsakoff Syndrome: Physiotherapy Interventions and Management Approaches. Cureus 2024; 16:e53948. [PMID: 38469004 PMCID: PMC10926318 DOI: 10.7759/cureus.53948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/10/2024] [Indexed: 03/13/2024] Open
Abstract
Korsakoff syndrome and Wernicke's encephalopathy (WE) show neurological and cognitive deficits. Wernicke-Korsakoff syndrome (WKS) is a compound neurological condition. The cause of this neurological condition could be the consumption of alcohol regularly for a chronic duration. A tailored rehabilitation protocol that focuses on cognitive and physical deficiencies was implemented along with thiamine supplementation for managing a case of a 49-year-old male patient who had a history of high alcohol consumption and was exhibiting typical signs of WKS. After planning a proper physiotherapy plan, it is necessary to look after the patient's progress along with re-evaluation, which reveals notable gains in cognitive function, memory, and functional independence. There is a dearth of research on the impact of physical therapy in managing WKS. The above case report reflects the benefits of combining physiotherapy, cognitive rehabilitation, and balance training to improve patient functionality and independence. Tailored rehabilitation interventions like the Benson relaxation method (BRM), brain gym exercises, Frenkel's exercise, electrical stimulation, sensorimotor training, basic body awareness therapy (BBAT), and gait training can be used to enhance a patient's quality of life. Addressing individual needs is essential in managing WKS, focusing on the importance of comprehensive care beyond cognitive rehabilitation alone.
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Affiliation(s)
- Ghanishtha C Burile
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Neha Arya
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nikita H Seth
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Tejaswini Fating
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Quelch D, Roderique-Davies G, John B. Alcohol-related brain damage: an umbrella (term) for the approaching post-COVID monsoon. Future Healthc J 2023; 10:313-320. [PMID: 38162212 PMCID: PMC10753228 DOI: 10.7861/fhj.2023-0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Individuals with alcohol-related brain damage (ARBD) represent a population whose healthcare needs often go unmet. This is the result of a lack of not only an awareness surrounding the condition by healthcare professionals, but also healthcare service inclusion and delivery, more broadly. The Coronavirus 2019 (COVID-19) pandemic and the associated lockdowns dramatically affected the accessibility and availability of addiction services globally, while also driving changes in alcohol consumption among the most vulnerable. In the absence of change, this culmination of increased high-risk drinking behaviour, lack of awareness by healthcare professionals and severely limited service delivery for individuals living with ARBD post COVID-19, represents a perfect storm that is rapidly approaching our health and care services world-wide. Collectively, this will reduce positive health outcomes in an already at-risk group.
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Affiliation(s)
- Darren Quelch
- Addictions Research Group, Applied Psychology Research and Innovation Group, Faculty of Life Science and Education, University of South Wales, Pontypridd, UK
| | - Gareth Roderique-Davies
- Addictions Research Group, Applied Psychology Research and Innovation Group, Faculty of Life Science and Education, University of South Wales, Pontypridd, UK
| | - Bev John
- Addictions Research Group, Applied Psychology Research and Innovation Group, Faculty of Life Science and Education, University of South Wales, Pontypridd, UK
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Savage SA, Suárez-González A, Stuart I, Christensen I. Successful word retraining, maintenance and transference of practice to everyday activities: A single case experimental design in early onset alcohol-induced brain damage. Neuropsychol Rehabil 2023; 33:1488-1511. [PMID: 35984770 DOI: 10.1080/09602011.2022.2107545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 07/26/2022] [Indexed: 10/15/2022]
Abstract
Word retraining programs have been shown to improve naming ability post-stroke and in progressive aphasias. Here, we investigated benefits for a 22-year-old Danish man (DJ), whose difficulties followed brain damage from heavy alcohol misuse. Using a multiple baseline-across-behaviours design (target behaviour: retrieval of word list items), DJ completed a 4-week "Look, Listen, Repeat" program on a computer. Ninety personally relevant target words were selected to create three matched lists. List 1 was trained for 10 sessions over 2 weeks, followed by 9 sessions for List 2 over 2 weeks, while the third list remained untrained. Naming performance was evaluated at baseline, during the intervention, and at 1 and 4 months post-training. Naming improved following each intervention block (p < .001), with only one data point overlapping between the baseline and treatment phases for trained items. Untrained words remained unchanged (p = 1.00), with 50% of data points non-overlapping across baseline to treatment phases. Performance was maintained over time, and appeared to generalize, with DJ naming more trained objects in their natural setting (85%) than untrained items (64%). While more evidence is needed, brief (20-minute), intensive (5-day/week) word retraining programs may assist word retrieval for people with brain damage associated with alcohol misuse.
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Affiliation(s)
- Sharon A Savage
- School of Psychological Sciences, The University of Newcastle, Newcastle, Australia
- Psychology Department, University of Exeter , Exeter, UK
| | - Aida Suárez-González
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, University College London, London, UK
| | - Ida Stuart
- Neurorehabilitation Selma Marie, Ølstykke, Denmark
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Jones L, Owens L, Thompson A, Gilmore I, Richardson P. Informing the development of diagnostic criteria for differential diagnosis of alcohol-related cognitive impairment (ARCI) among heavy drinkers: A systematic scoping review. PLoS One 2023; 18:e0280749. [PMID: 36753517 PMCID: PMC9907814 DOI: 10.1371/journal.pone.0280749] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 01/08/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Early detection and diagnosis of alcohol-related cognitive impairment (ARCI) among heavy drinkers is crucial to facilitating appropriate referral and treatment. However, there is lack of consensus in defining diagnostic criteria for ARCI. Uncertainty in attributing a diagnosis of suspected ARCI commonly arises in clinical practice and opportunities to intervene are missed. A systematic scoping review approach was taken to (i) summarise evidence relating to screening or diagnostic criteria used in clinical studies to detect ARCI; and (ii) to determine the extent of the research available about cognitive assessment tools used in 'point-of-care' screening or assessment of patients with suspected non-Korsakoff Syndrome forms of ARCI. METHODS We searched Medline, PsycINFO, Cinahl and the Web of Science, screened reference lists and carried out forward and backwards citation searching to identify clinical studies about screening, diagnosis or assessment of patients with suspected ARCI. RESULTS In total, only 7 studies met our primary objective and reported on modifications to existing definitions or diagnostic criteria for ARCI. These studies revealed a lack of coordinated research and progress towards the development and standardisation of diagnostic criteria for ARCI. Cognitive screening tools are commonly used in practice to support a diagnosis of ARCI, and as a secondary objective we included an additional 12 studies, which covered a range of settings and patient populations relevant to screening, diagnosis or assessment in acute, secondary or community 'point-of-care' settings. Across two studies with a defined ARCI patient sample and a further four studies with an alcohol use disorder patient sample, the accuracy, validity and/or reliability of seven different cognitive assessment tools were examined. The remaining seven studies reported descriptive findings, demonstrating the lack of evidence available to draw conclusions about which tools are most appropriate for screening patients with suspected ARCI. CONCLUSION This review confirms the scarcity of evidence available on the screening, diagnosis or assessment of patients with suspected ARCI. The lack of evidence is an important barrier to the development of clear guidelines for diagnosing ARCI, which would ultimately improve the real-world management and treatment of patients with ARCI.
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Affiliation(s)
- Lisa Jones
- Liverpool Centre for Alcohol Research, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
- Public Health Institute, Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
- * E-mail:
| | - Lynn Owens
- Liverpool Centre for Alcohol Research, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
- Department of Gastroenterology and Hepatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Andrew Thompson
- Liverpool Centre for Alcohol Research, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Ian Gilmore
- Liverpool Centre for Alcohol Research, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Paul Richardson
- Liverpool Centre for Alcohol Research, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
- Department of Gastroenterology and Hepatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
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Improving treatment for people with cognitive impairment and substance misuse issues: Lessons from an inclusive residential treatment program pilot in Australia. Disabil Health J 2022; 15:101295. [DOI: 10.1016/j.dhjo.2022.101295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/30/2021] [Accepted: 09/09/2021] [Indexed: 11/22/2022]
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Allan J, Thompson A, Carlyle M, Thomas M, Medalia A. Feasibility and pilot efficacy of cognitive remediation for people in residential substance use treatment. Drug Alcohol Rev 2021; 41:78-87. [PMID: 33783059 DOI: 10.1111/dar.13288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/01/2021] [Accepted: 03/06/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION There are high rates of cognitive impairment among people seeking treatment for problematic substance use, which is rarely addressed in treatment programs. The aim of this pilot study was to evaluate the feasibility and outcomes of the neuropsychological and educational approach to cognitive remediation (NEAR) in a residential substance treatment setting. METHODS A non-randomised trial conducted between November 2018 and November 2019, compared outcomes for 34 residents who received cognitive remediation (CR) plus treatment as usual (TAU) to 31 residents who received TAU only. Number of groups and attendance, and a measure of client satisfaction assessed feasibility. Cognitive function was assessed at baseline (service admission), and at 2 and 6 months post-admission. RESULTS A total of 95 CR groups were delivered over a 36-week time period with a high degree of treatment fidelity and acceptability to participants. Cognitive outcomes improved across both the CR+TAU and TAU groups by 2 months, which was maintained at 6 months for outcomes related to executive functioning. There were no significant differences between the CR+TAU and TAU groups at 2 or 6 months, although a large effect size and confidence intervals indicated a potentially larger change in cognitive flexibility after receiving CR. DISCUSSION AND CONCLUSIONS This study contributes to our understanding of the implementation of CR in the alcohol and other drug rehabilitation setting. It is feasible to incorporate the NEAR program in treatment. The small sample size and lower than expected treatment dose likely contributed to the lack of significant findings.
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Affiliation(s)
- Julaine Allan
- School of Health and Society, University of Wollongong, Wollongong, Australia
| | - Anna Thompson
- Clinical Directorate, Lives Lived Well, Orange, Australia
| | - Molly Carlyle
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Matthew Thomas
- Bloomfield Mental health Services, Western NSW Local Health District, Orange, Australia
| | - Alice Medalia
- New York State Office of Mental Health, Columbia University Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York City, USA
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Allan J, Thompson A, Meumann N, Medalia A. Implementing cognitive remediation in substance use treatment: The impact of staff perceptions. J Subst Abuse Treat 2021; 124:108310. [PMID: 33771272 DOI: 10.1016/j.jsat.2021.108310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/23/2020] [Accepted: 01/19/2021] [Indexed: 11/25/2022]
Abstract
Cognitive remediation (CR) programs are new to substance treatment and research needs to evaluate their implementation. The context of implementation, specifically staff perceptions, is critical to changing practice. The aim of this study was to identify treatment staff members' perceptions about the benefits and challenges of a new CR intervention in their workplace. The study conducted semi-structured interviews with staff at a residential substance treatment center when the CR program was first being implemented and again six months later. The study interviewed eight staff members in each round (>50% of staff members in the unit) from all role designations. A critical perspective shaped a thematic analysis of challenges to implementation. The study identified benefits of the CR program to clients and staff. However, only one staff member participated in training to deliver the program. In principle, staff members support the program, but this does not necessarily translate into active involvement, even when the study conducted staff engagement activities. CR programs are likely to improve functional outcomes for people in substance rehabilitation programs. However, this study suggests that staff accepting and valuing a new intervention is not enough to sustain it. For CR programs to be feasible, management should schedule and support staff training, and facilitate staff participation in that training. Organizational factors are likely to play a significant role in implementation success or failure, and further research should explore how the organizational culture of alcohol and other drug services impacts the implementation of CR therapy.
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Affiliation(s)
- Julaine Allan
- School of Health and Society, University of Wollongong, NSW, Australia.
| | | | | | - Alice Medalia
- Cognitive Health Services, NY State Office of Mental Health, United States of America; Columbia University Vagelos College of Physicians and Surgeons, United States of America
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Andrews L, Botting N. The speech, language and communication needs of rough sleepers in London. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2020; 55:917-935. [PMID: 32909664 DOI: 10.1111/1460-6984.12572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND There is very little awareness of the speech, language and communication needs (SLCN) of rough sleepers. The small amount of documentation that does exist involves a wider group of homeless adults (not just rough sleepers), and reports that communication needs are an area of concern. AIMS To investigate: (1) the reported prevalence of SLCN amongst UK nationals recorded on the Combined Homeless and Information Network (CHAIN) as sleeping on the streets of London; (2) whether rough sleepers with reported SLCN differ from those without; and (3) what factors best predict patterns of rough sleeping and accommodation stays. METHODS & PROCEDURES A data set of 513 participants was provided by CHAIN, which contained information relating to all new rough sleepers and people with long-term histories of rough sleeping (UK nationals only) recorded by street outreach teams in London between 1 April and 30 June 2013. Also included was data about UK nationals provided with support by the Homelessness and Brain Injury Project. The data set contained information including basic demographics, communication skills, health and social care needs, and institutional background and extended to a 5-year period. OUTCOMES & RESULTS (1) SLCN data were often not recorded with data available for only 62% of individuals on the CHAIN databases. However, for those with SLCN data, the prevalence of SLCN was significantly higher than for the general population (17.1%; p < 0.001). (2) There were no significant differences between those with and without SLCN on additional risk factors, quarters rough sleeping, accommodation stays or staff-recorded alerts. (3) There was a positive correlation between rough sleeping and additional risk factors for those with SLCN (r = 0.32, p < 0.001) and for those without (r = 0.25, p < 0.001). Regression analysis indicated that additional risk factors were more predictive than SLCN in explaining the number of quarters rough sleeping and accommodation stays. CONCLUSIONS & IMPLICATIONS SLCN are highly prevalent amongst rough sleepers and significantly greater than for the UK general population. SLCN are not clearly related to rough sleeping behaviour, but the presence of additional risk factors is highly significant in this regard. Homelessness organizations should provide training for staff in SLCN in order to promote better recording of SLCN, inclusive communication and appropriate support to people who are homeless. Further research is also needed to understand better the communication needs of rough sleepers. What this study adds What is already known on the subject There is very little literature concerning the SLCN of rough sleepers, but that which exists suggests that communication needs are an area of concern. There is relatively little awareness of SLCN in practice in this field. What this paper adds to existing knowledge This study is the first to provide information on SLCN recording in this population. It reports large-scale prevalence data on SLCN in rough sleepers, showing a significantly higher risk in this group. Unexpectedly, SLCN did not clearly relate to patterns of rough sleeping and accommodation, but this may be due to the relatively crude data available in routine practice. What are the potential or actual clinical implications of this work? Wider awareness and training on SLCN in the homelessness sector is needed coupled with more systematic and objective assessment of communication in rough sleepers.
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Affiliation(s)
- Leigh Andrews
- Language and Communication Science, City University of London, London, UK
| | - Nicola Botting
- Language and Communication Science, City University of London, London, UK
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Thompson A, Richardson P, Pirmohamed M, Owens L. Alcohol-related brain injury: An unrecognized problem in acute medicine. Alcohol 2020; 88:49-53. [PMID: 32502599 DOI: 10.1016/j.alcohol.2020.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/12/2020] [Accepted: 05/27/2020] [Indexed: 11/16/2022]
Abstract
Alcohol-related brain injury (ARBI) is an unrecognized and therefore untreated consequence of alcohol use disorder. Here, we explore a 12-month period prevalence of alcohol-related brain injury (ARBI) in alcohol use disorder patients. Inpatients aged ≥18 years reviewed by the Alcohol Care Team's Specialist Nurses between April 1, 2017 and March 31, 2018 were eligible for the study (n = 1276). Screening identified a high-risk subset of patients who matched at least one of the following: 1) more than three alcohol-related admissions in one year; 2) two alcohol-related admissions in any given 30-day period; 3) patient or their significant other had concerns regarding cognition. The high-risk patients were assessed for evidence of ARBI using the Montreal Cognitive Assessment Tool (MoCA). The primary measure of interest was MoCA ≤23. Analysis was conducted between subgroups of the study population to identify prevalence rate ratios for matching the high-risk screening criteria, and MoCA ≤23 in high-risk patients. Two hundred and five patients were identified as high risk for ARBI. The period prevalence rates in this high-risk group for patients with a MoCA ≤23 was 36.1%. Those under the age of 35 years were significantly less likely to match the high-risk criteria. Patients that were homeless or staying in hostels were more likely to match the high-risk criteria and were also at increased risk of MoCA ≤23, compared with those living with family members. In summary, ARBI is common in patients with AUD attending acute hospitals. ARBI is often not diagnosed, and thus further work is required to improve screening for, and identification of, these patients to develop evidence-based clinical pathways that optimize care.
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Affiliation(s)
- Andrew Thompson
- Wolfson Centre for Personalised Medicine, Institute of Translational Medicine, University of Liverpool, United Kingdom; Liverpool Centre for Alcohol Research, University of Liverpool, United Kingdom.
| | - Paul Richardson
- Liverpool Centre for Alcohol Research, University of Liverpool, United Kingdom; Gastroenterology and Hepatology, Royal Liverpool University Hospital Trust, Ward 5z Link, United Kingdom
| | - Munir Pirmohamed
- Wolfson Centre for Personalised Medicine, Institute of Translational Medicine, University of Liverpool, United Kingdom; Liverpool Centre for Alcohol Research, University of Liverpool, United Kingdom
| | - Lynn Owens
- Wolfson Centre for Personalised Medicine, Institute of Translational Medicine, University of Liverpool, United Kingdom; Liverpool Centre for Alcohol Research, University of Liverpool, United Kingdom; Gastroenterology and Hepatology, Royal Liverpool University Hospital Trust, Ward 5z Link, United Kingdom
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van Dam MJ, van Meijel B, Postma A, Oudman E. Health problems and care needs in patients with Korsakoff's syndrome: A systematic review. J Psychiatr Ment Health Nurs 2020; 27:460-481. [PMID: 31876326 DOI: 10.1111/jpm.12587] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/19/2019] [Accepted: 12/21/2019] [Indexed: 01/04/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Patients with Korsakoff's syndrome suffer from a broad range of comorbid somatic and/or psychiatric conditions. The various health problems in patients with Korsakoff's syndrome limit their ability to perform daily activities and also negatively affect their social functioning. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Patients with Korsakoff's syndrome have complex somatic and psychiatric comorbid conditions co-occurring with behavioural and functional problems. They are compounded by patients' poor self-awareness regarding their health status and functioning. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This review demonstrates that patients with Korsakoff's syndrome should receive integrated care. Integrated care for patients with Korsakoff's syndrome should be based on accurate multidimensional and multidisciplinary diagnostics in which nurses and nurse assistants have a prominent role due to their central position in the care process patients with Korsakoff's syndrome. ABSTRACT: Introduction The literature shows that Korsakoff's syndrome is associated with a wide range of severe comorbid somatic and psychiatric health problems that lead to care needs in several domains of functioning. Aim To provide a comprehensive overview of Korsakoff patients' health conditions and related care needs. Method Following the PRISMA guidelines, we searched MEDLINE, PsycInfo, Cochrane Library and CINAHL up to January 2019. After applying our inclusion criteria, two reviewers independently selected the studies, extracted the data and assessed methodological quality. Results Twelve articles were included. The commonest somatic comorbid conditions were liver disease, cardiovascular disease, COPD and diabetes mellitus. The commonest psychiatric comorbid conditions were mood disorder, personality disorder and psychotic disorder. Anxiety, aggressive/agitated behaviour, depressive symptoms and care needs in social functioning and (instrumental) activities of daily living were also very commonly reported. Discussion In patients with Korsakoff's syndrome, somatic and psychiatric comorbid conditions co-occur with behavioural and functional problems. They are compounded by patients' poor self-awareness regarding their health status and functioning. Adequate responses to their care needs require high-quality integrated care. Implications for practice Patients with Korsakoff's syndrome should receive integrated care based on accurate multidimensional and multidisciplinary diagnostics in which nurses have a prominent role.
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Affiliation(s)
- Mirjam Johanna van Dam
- Department of Experimental Psychology, Helmholtz Research Institute, Utrecht University, the Netherlands.,Slingedael Korsakoff Center, Lelie Care Group, Rotterdam, the Netherlands
| | - Berno van Meijel
- Inholland University of Applied Sciences, Amsterdam, the Netherlands.,Amsterdam UMC, Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.,Parnassia Psychiatric Institute, The Hague, the Netherlands.,GGZ-VS, Academy for Masters in Advanced Nursing Practice, Utrecht, the Netherlands
| | - Albert Postma
- Department of Experimental Psychology, Helmholtz Research Institute, Utrecht University, the Netherlands.,Slingedael Korsakoff Center, Lelie Care Group, Rotterdam, the Netherlands
| | - Erik Oudman
- Department of Experimental Psychology, Helmholtz Research Institute, Utrecht University, the Netherlands.,Slingedael Korsakoff Center, Lelie Care Group, Rotterdam, the Netherlands
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12
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Rao R, Topiwala A. Alcohol use disorders and the brain. Addiction 2020; 115:1580-1589. [PMID: 32112474 DOI: 10.1111/add.15023] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/11/2020] [Accepted: 02/25/2020] [Indexed: 12/15/2022]
Abstract
A diagnosis of alcohol use disorder is associated with a higher risk of dementia, but a dose-response relationship between alcohol intake consumption and cognitive impairment remains unclear. Alcohol is associated with a range of effects on the central nervous system at different doses and acts on a number of receptors. Acute disorders include Wernicke's encephalopathy (WE), traumatic brain injury, blackouts, seizures, stroke and hepatic encephalopathy. The most common manifestations of chronic alcohol consumption are Korsakoff's syndrome (KS) and alcohol-related dementia (ARD). There is limited evidence for benefit from memantine in the treatment of ARD, but stronger evidence for the use of high-dose parenteral thiamine in the progression of neuropsychiatric symptoms for WE. Accumulating evidence exists for pharmacological treatment in the prevention of hepatic encephalopathy. Rehabilitation of people with ARD may take several years, and requires an approach that addresses physical and psychosocial factors.
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Affiliation(s)
- Rahul Rao
- Institute of Psychiatry, Psychology and Neuroscience, Department of Old Age Psychiatry, London, UK.,South London and Maudsley NHS Foundation Trust, Psychological Medicine and Older Adults Directorate, London, UK
| | - Anya Topiwala
- University of Oxford, Big Data Institute, Nuffield Department of Population Health
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Quaglieri A, Mari E, Boccia M, Piccardi L, Guariglia C, Giannini AM. Brain Network Underlying Executive Functions in Gambling and Alcohol Use Disorders: An Activation Likelihood Estimation Meta-Analysis of fMRI Studies. Brain Sci 2020; 10:E353. [PMID: 32517334 PMCID: PMC7348890 DOI: 10.3390/brainsci10060353] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/04/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Neuroimaging and neuropsychological studies have suggested that common features characterize both Gambling Disorder (GD) and Alcohol Use Disorder (AUD), but these conditions have rarely been compared. METHODS We provide evidence for the similarities and differences between GD and AUD in neural correlates of executive functions by performing an activation likelihood estimation meta-analysis of 34 functional magnetic resonance imaging studies involving executive function processes in individuals diagnosed with GD and AUD and healthy controls (HC). RESULTS GD showed greater bilateral clusters of activation compared with HC, mainly located in the head and body of the caudate, right middle frontal gyrus, right putamen, and hypothalamus. Differently, AUD showed enhanced activation compared with HC in the right lentiform nucleus, right middle frontal gyrus, and the precuneus; it also showed clusters of deactivation in the bilateral middle frontal gyrus, left middle cingulate cortex, and inferior portion of the left putamen. CONCLUSIONS Going beyond the limitations of a single study approach, these findings provide evidence, for the first time, that both disorders are associated with specific neural alterations in the neural network for executive functions.
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Affiliation(s)
- Alessandro Quaglieri
- Department of Psychology, “Sapienza” University of Rome, 00185 Rome, Italy; (E.M.); (M.B.); (L.P.); (C.G.); (A.M.G.)
| | - Emanuela Mari
- Department of Psychology, “Sapienza” University of Rome, 00185 Rome, Italy; (E.M.); (M.B.); (L.P.); (C.G.); (A.M.G.)
| | - Maddalena Boccia
- Department of Psychology, “Sapienza” University of Rome, 00185 Rome, Italy; (E.M.); (M.B.); (L.P.); (C.G.); (A.M.G.)
- Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy
| | - Laura Piccardi
- Department of Psychology, “Sapienza” University of Rome, 00185 Rome, Italy; (E.M.); (M.B.); (L.P.); (C.G.); (A.M.G.)
- Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy
| | - Cecilia Guariglia
- Department of Psychology, “Sapienza” University of Rome, 00185 Rome, Italy; (E.M.); (M.B.); (L.P.); (C.G.); (A.M.G.)
- Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy
| | - Anna Maria Giannini
- Department of Psychology, “Sapienza” University of Rome, 00185 Rome, Italy; (E.M.); (M.B.); (L.P.); (C.G.); (A.M.G.)
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Brown P, Heirene RM, Gareth-Roderique-Davies, John B, Evans JJ. Applicability of the ACE-III and RBANS Cognitive Tests for the Detection of Alcohol-Related Brain Damage. Front Psychol 2019; 10:2636. [PMID: 31849759 PMCID: PMC6892773 DOI: 10.3389/fpsyg.2019.02636] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 11/07/2019] [Indexed: 11/28/2022] Open
Abstract
Background and Aims Recent investigations have highlighted the value of neuropsychological testing for the assessment and screening of Alcohol-Related Brain Damage (ARBD). The aim of the present study was to evaluate the suitability of the Addenbrooke’s Cognitive Examination (ACE-III) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) for this purpose. Methods Comparing 28 participants with ARBD (11 with Korsakoff’s Syndrome and 17 with the umbrella “ARBD” diagnosis) and 30 alcohol-dependent participants without ARBD (ALs) we calculated Area Under the Curve (AUC) statistics, sensitivity and specificity values, base-rate adjusted predictive values, and likelihood ratios for both tests. Results High levels of screening accuracy were found for the total scores of both the ACE-III (AUC = 0.823, 95% CIs [0.714, 0.932], SE = 0.056; optimal cut-off ≤86: sensitivity = 82%, specificity = 73%) and RBANS (AUC = 0.846, 95% CIs [0.746, 0.947], SE = 0.052; optimal cut-off ≤83: sensitivity = 89%, specificity = 67%) at multiple cut-off points. Removing participants with a history of polysubstance from the samples (10 ALs and 1 ARBD) improved the diagnostic capabilities of the RBANS substantially (AUC = 0.915, 95% CIs [0.831, 0.999], SE = 0.043; optimal cut-off ≤85: sensitivity = 98%, specificity = 80%), while only minor improvements to the ACE-III’s accuracy were observed (AUC = 0.854, 95% CIs [0.744, 0.963], SE = 0.056; optimal cut-off ≤88: sensitivity = 85%, specificity = 75%). Conclusion Overall, both the ACE-III and RBANS are suitable tools for ARBD screening within an alcohol-dependent population, though the RBANS is the superior of the two. Clinicians using these tools for ARBD screening should be cautious of false-positive outcomes and should therefore combine them with other assessment methods (e.g., neuroimaging, clinical observations) and more detailed neuropsychological testing before reaching diagnostic decisions.
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Affiliation(s)
- Pamela Brown
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom.,Graham Anderson House, Brain Injury Rehabilitation Trust, Glasgow, United Kingdom
| | - Robert M Heirene
- Addictions Research Group, School of Psychology and Therapeutic Studies, University of South Wales, Pontypridd, United Kingdom.,Brain and Mind Centre, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Gareth-Roderique-Davies
- Addictions Research Group, School of Psychology and Therapeutic Studies, University of South Wales, Pontypridd, United Kingdom
| | - Bev John
- Addictions Research Group, School of Psychology and Therapeutic Studies, University of South Wales, Pontypridd, United Kingdom
| | - Jonathan J Evans
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
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15
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Berry J, Jacomb I, Lunn J, Sedwell A, Shakeshaft A, Kelly PJ, Sarrami P, James M, Russell S, Nardo T, Barker D, Holmes J. A stepped wedge cluster randomised trial of a cognitive remediation intervention in alcohol and other drug (AOD) residential treatment services. BMC Psychiatry 2019; 19:70. [PMID: 30760250 PMCID: PMC6372999 DOI: 10.1186/s12888-019-2044-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 01/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Executive functioning impairment is common in substance use disorder and is a major risk factor for poor treatment outcomes, including treatment drop-out and relapse. Cognitive remediation interventions seek to improve executive functioning and offer a promising approach to increase the efficacy of alcohol and other drug (AOD) treatments and improve long-term therapeutic outcomes. This protocol describes a study funded by the NSW Agency for Clinical Innovation that assesses the effectiveness of delivering a six-week group-based intervention of cognitive remediation in an ecologically valid sample of people attending residential AOD treatment services. We primarily aim to investigate whether cognitive remediation will be effective in improving executive functioning and treatment retention rates. We will also evaluate if cognitive remediation may reduce long-term AOD use and rates of health service utilisation, as well as improve personal goal attainment, quality of life, and client satisfaction with treatment. In addition, the study will involve an economic analysis of the cost of delivering cognitive remediation. METHODS/DESIGN The study uses a stepped wedge cluster randomised design, where randomisation will occur at the cluster level. Participants will be recruited from ten residential AOD treatment services provided by the non-government sector. The intervention will be delivered in 12 one-hour group-based sessions over a period of six weeks. All participants who are expected to receive treatment for the duration of the six-week intervention will be asked to participate in the study. The clusters of participants who are randomly assigned to the treatment condition will complete cognitive remediation in addition to treatment as usual (TAU). Primary and secondary outcome assessments will be conducted at pre-cognitive remediation/TAU phase, post-cognitive remediation/TAU phase, two-month follow-up, four-month follow-up, six-month follow-up, and eight-month follow-up intervals. DISCUSSION This study will provide comprehensive data on the effect of delivering a cognitive remediation intervention within residential AOD treatment services. If shown to be effective, cognitive remediation may be incorporated as an adjunctive intervention in current treatment programs. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Register (ANZCTR): ACTRN12618001190291 . Prospectively registered 17th July 2018.
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Affiliation(s)
- Jamie Berry
- Macquarie University, Balaclava Road, North Ryde, NSW 2109 Australia
- Advanced Neuropsychological Treatment Services, PO Box 4070, Strathfield South, NSW 2136 Australia
| | - Isabella Jacomb
- Macquarie University, Balaclava Road, North Ryde, NSW 2109 Australia
| | - Jo Lunn
- We Help Ourselves, PO Box 1779, Rozelle, NSW 2039 Australia
| | - Antoinette Sedwell
- Agency for Clinical Innovation, Level 4, 67 Albert Ave, Chatswood, NSW 2067 Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052 Australia
| | - Peter J Kelly
- Illawarra Health and Medical Research Institute and the School of Psychology, Faculty of Social Sciences, University of Wollongong, Building 41, Room 128, Wollongong, NSW 2522 Australia
| | - Pooria Sarrami
- Agency for Clinical Innovation, Level 4, 67 Albert Ave, Chatswood, NSW 2067 Australia
- South Western Sydney Clinical School, University of New South Wales, Goulburn St, Liverpool, NSW 2170 Australia
| | - Megan James
- Agency for Clinical Innovation, Level 4, 67 Albert Ave, Chatswood, NSW 2067 Australia
| | - Skye Russell
- Agency for Clinical Innovation, Level 4, 67 Albert Ave, Chatswood, NSW 2067 Australia
| | - Talia Nardo
- Macquarie University, Balaclava Road, North Ryde, NSW 2109 Australia
| | - Daniel Barker
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Jennifer Holmes
- Ministry of Health NSW, 73 Miller St, North Sydney, NSW 2060 Australia
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Is physical rehabilitation effective for Wernicke-Korsakoff syndrome? A case report. Int J Rehabil Res 2019; 41:373-376. [PMID: 29994923 DOI: 10.1097/mrr.0000000000000303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Wernicke-Korsakoff syndrome is a type of brain disorder caused by the lack of thiamine, most commonly because of chronic alcohol misuse. It consists of two separate conditions including Wernicke's encephalopathy and Korsakoff syndrome. Various levels of cognitive impairments are associated with the severity of the syndrome. Although the effectiveness of thiamine replacement in the early phases of the syndrome is proven, the efficacy of subsequent treatments, which mainly include rehabilitation protocols after the development of Korsakoff syndrome, is not clear. This is the first report showing the positive effects of physical rehabilitation in a 48-year-old male patient with Wernicke-Korsakoff syndrome.
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The effect of errorless learning on psychotic and affective symptoms, as well as aggression and apathy in patients with Korsakoff's syndrome in long-term care facilities. Int Psychogeriatr 2019; 31:39-47. [PMID: 29923469 DOI: 10.1017/s1041610218000492] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED ABSTRACTObjectives:Errorless learning is a promising rehabilitation principle for learning tasks in patients with amnesia, including patients with Korsakoff's syndrome. Errorless learning might possibly also contribute to decreases in behavioral and psychiatric problems, as patients in long-term care facilities become more independent after training. The aim of this study was to examine the effects of errorless learning on potential changes in psychotic and affective symptoms, aggression and apathy, in contrast with a control group who received care as usual. METHODS The current study is a quasi-experimental study on errorless learning and psychotic and affective symptoms, aggression, and apathy in patients with Korsakoff's syndrome, living in long-term care facilities for patients with Korsakoff's syndrome (KS) in the Netherlands. The GIP-28, HoNOS-ABI, and NVCL-20 were administered to a group of patients with KS who received errorless learning training (n = 51) and a patient control group who received care as usual (n = 31). Wilcoxon Signed-Rank Tests were performed to examine psychotic and affective symptoms, aggression, and apathy at baseline and at follow-up in the errorless learning group and the control group. RESULTS Errorless learning training effectively reduced psychotic symptoms (including provoked confabulations), affective symptoms, and agitation/aggression. There were no significant changes (increases nor decreases) in the control group. Levels of apathy were stable over time in both groups. CONCLUSIONS Results with respect to psychotic and affective symptoms, aggression, and apathy are discussed in depth. Patients with KS can become more autonomous in a cared for setting using errorless learning principles. This might also result in decreases in behavioral and psychiatric problems in patients.
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Heirene R, John B, Roderique-Davies G. Identification and Evaluation of Neuropsychological Tools Used in the Assessment of Alcohol-Related Cognitive Impairment: A Systematic Review. Front Psychol 2018; 9:2618. [PMID: 30619013 PMCID: PMC6305333 DOI: 10.3389/fpsyg.2018.02618] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 12/05/2018] [Indexed: 12/27/2022] Open
Abstract
Background: Neuropsychological assessment is central to identifying and determining the extent of Alcohol-Related Cognitive Impairment (ARCI). The present systematic review aimed to synthesize and discuss the evidence appraising the neuropsychological tests used to assess ARCI in order to support clinicians and researchers in selecting appropriate tests for use with this population. Methods: We searched for studies investigating the psychometric, diagnostic and practical values of tools used in the screening, diagnosis, and assessment of Korsakoff's Syndrome (KS), Alcohol-Related Dementia (ARD), and those with a specific diagnosis of Alcohol-Related Brain Damage (ARBD). The following databases were searched in March 2016 and again in August 2018: MEDLINE, EMBASE, Psych-INFO, ProQuest Psychology, and Science Direct. Study quality was assessed using a checklist designed by the authors to evaluate the specific factors contributing to robust and clearly reported studies in this area. A total of 43 studies were included following the screening of 3646 studies by title and abstract and 360 at full-text. Meta-analysis was not appropriate due to heterogeneity in the tests and ARCI samples investigated in the studies reviewed. Instead, review findings were narratively synthesized and divided according to five domains of assessment: cognitive screening, memory, executive function, intelligence and test batteries, and premorbid ability. Effect sizes (d) were calculated to supplement findings. Results: Overall, several measures demonstrated sensitivity to the cognitive deficits associated with chronic alcoholism and an ability to differentiate between gradations of impairment. However, findings relating to the other psychometric qualities of the tests, including those important for the accurate assessment and monitoring of ARCI (e.g., test-retest reliability), were entirely absent or limited. Additionally, the synthesis of neuropsychological outcomes presented here supports the recent impetus for a move away from discrete diagnoses (e.g., KS, ARD) and the distinctions between them toward more broad and inclusive diagnostic conceptualizations of ARCI, thereby recognizing the heterogeneity in presentation. Conclusions: Based on the evidence reviewed, provisional recommendations for appropriate tests in each domain of assessment are presented, though further validation of most tests is warranted. Review findings can support efficient and evidenced-based test-selection and guide future research in this area.
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Affiliation(s)
- Robert Heirene
- Addictions Research Group, University of South Wales, School of Psychology & Therapeutic Studies, Pontypridd, United Kingdom
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Rao RT, Draper B. Addressing alcohol-related dementia should involve better detection, not watchful waiting. Br J Psychiatry 2018; 212:67-68. [PMID: 29436326 DOI: 10.1192/bjp.2017.14] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Alcohol-related dementia represents an underrecognised mental disorder with both clinical and public mental health aspects. There is considerable scope for improving its assessment within both mainstream and specialist mental health services, but ongoing challenges remain in ensuring its timely detection so that appropriate preventative and rehabilitative interventions can be applied. Declaration of interest None.
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Affiliation(s)
- Rahul Tony Rao
- Consultant Old Age Psychiatrist and Visiting Researcher,South London and Maudsley NHS Foundation Trust and Institute of Psychiatry,Psychology and Neurology,London,UK
| | - Brian Draper
- School of Psychiatry University of New South Wales and the Academic Department for Old Age Psychiatry,Prince of Wales Hospital,Randwick,Australia
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Abstract
SummaryThe relationship between alcohol use and cognitive impairment has been notoriously difficult to disentangle. We present what is known about cognitive impairment associated with alcohol use/misuse, covering the spectrum from mild and subtle cognitive change through to severe alcohol-related brain damage, including Wernicke-Korsakoff syndrome. We highlight aids to the diagnosis and management of these conditions, and emphasise the benefits of prompt treatment on outcome. We also review progress in understanding their neurobiology. Suggestions for possible service configuration based on both our clinical practice and national guidelines are given.Learning Objectives•Gain an understanding of the spectrum of clinical presentations found in alcohol-related brain damage.•Understand that the aetiology of these conditions is complex and not solely due to the neurotoxic effects of alcohol.•Be better able to plan for the rehabilitation of individuals with established alcohol-related brain damage in your local service area.
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Brion M, D'Hondt F, Lannoy S, Pitel AL, Davidoff DA, Maurage P. Crossmodal processing of emotions in alcohol-dependence and Korsakoff syndrome. Cogn Neuropsychiatry 2017; 22:436-451. [PMID: 28885888 DOI: 10.1080/13546805.2017.1373639] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Decoding emotional information from faces and voices is crucial for efficient interpersonal communication. Emotional decoding deficits have been found in alcohol-dependence (ALC), particularly in crossmodal situations (with simultaneous stimulations from different modalities), but are still underexplored in Korsakoff syndrome (KS). The aim of this study is to determine whether the continuity hypothesis, postulating a gradual worsening of cognitive and brain impairments from ALC to KS, is valid for emotional crossmodal processing. METHODS Sixteen KS, 17 ALC and 19 matched healthy controls (CP) had to detect the emotion (anger or happiness) displayed by auditory, visual or crossmodal auditory-visual stimuli. Crossmodal stimuli were either emotionally congruent (leading to a facilitation effect, i.e. enhanced performance for crossmodal condition compared to unimodal ones) or incongruent (leading to an interference effect, i.e. decreased performance for crossmodal condition due to discordant information across modalities). Reaction times and accuracy were recorded. RESULTS Crossmodal integration for congruent information was dampened only in ALC, while both ALC and KS demonstrated, compared to CP, decreased performance for decoding emotional facial expressions in the incongruent condition. CONCLUSIONS The crossmodal integration appears impaired in ALC but preserved in KS. Both alcohol-related disorders present an increased interference effect. These results show the interest of more ecological designs, using crossmodal stimuli, to explore emotional decoding in alcohol-related disorders. They also suggest that the continuum hypothesis cannot be generalised to emotional decoding abilities.
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Affiliation(s)
- Mélanie Brion
- a Laboratory for Experimental Psychopathology , Psychological Sciences Research Institute, Université catholique de Louvain , Louvain-la-Neuve , Belgium
| | - Fabien D'Hondt
- b Univ. Lille, CNRS , UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives , Lille , France.,c CHU Lille , Clinique de Psychiatrie, CURE , Lille , France
| | - Séverine Lannoy
- a Laboratory for Experimental Psychopathology , Psychological Sciences Research Institute, Université catholique de Louvain , Louvain-la-Neuve , Belgium
| | - Anne-Lise Pitel
- d INSERM, École Pratique des Hautes Études , Université de Caen-Basse Normandie, Unité U1077, GIP Cyceron, CHU Caen , Caen , France
| | - Donald A Davidoff
- e Harvard Medical School , Boston , MA , USA.,f Department of Neuropsychology , McLean Hospital , Belmont , USA
| | - Pierre Maurage
- a Laboratory for Experimental Psychopathology , Psychological Sciences Research Institute, Université catholique de Louvain , Louvain-la-Neuve , Belgium
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22
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Venkataraman A, Kalk N, Sewell G, Ritchie CW, Lingford-Hughes A. Alcohol and Alzheimer's Disease-Does Alcohol Dependence Contribute to Beta-Amyloid Deposition, Neuroinflammation and Neurodegeneration in Alzheimer's Disease? Alcohol Alcohol 2017; 52:151-158. [PMID: 27915236 DOI: 10.1093/alcalc/agw092] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 11/11/2016] [Indexed: 12/23/2022] Open
Abstract
Aims To investigate the underlying neurobiology between alcohol use, misuse and dependence and cognitive impairment, particularly Alzheimer's disease (AD). Methods Review of the literature using searches of Medline, Pubmed, EMBASE, PsycInfo, and meeting abstracts and presentations. Results The role of alcohol as a risk factor and contributor for cognitive decline associated with AD has received little attention. This is despite the high prevalence of alcohol use, the potential reversibility of a degree of cognitive impairment and the global burden of AD. Until now the focus has largely been on the toxic effects of alcohol, neuronal loss and the role of thiamine. Conclusion We propose alcohol adds to the cognitive burden seen in dementia through additional mechanisms to neurodegenerative processes or may contribute at various mechanistic points in the genesis and sustenance of AD pathology via neuroinflammation. We describe the common underlying neurobiology in alcohol and AD, and examine ways alcohol likely contributes to neuroinflammation directly via stimulation of Toll-like receptors and indirectly from small bowel changes, hepatic changes, withdrawal and traumatic brain injury to the pathogenesis of AD. Short Summary Alcohol use, misuse and dependence cause cognitive impairment. We propose alcohol adds to the cognitive burden seen in dementia through additional mechanisms to neurodegenerative processes or may contribute at various mechanistic points in the genesis and sustenance of AD pathology via neuroinflammation.
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Affiliation(s)
- Ashwin Venkataraman
- Neuropsychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences, Imperial College London, 5th Floor Burlington Danes Building, 160 Du Cane Road, LondonW12 0NN, UK
| | - Nicola Kalk
- Department of Oncology, Charing Cross Hospital, Fulham Palace Rd, LondonW6 8RF, UK
| | - Gavin Sewell
- Department of Oncology, Charing Cross Hospital, Fulham Palace Rd, LondonW6 8RF, UK
| | - Craig W Ritchie
- Centre for Clinical Brain Sciences, University of Edinburgh, The Chancellor's Building, 49 Chancellor's Building, Little France, Edinburgh EH16 4SB, UK
| | - Anne Lingford-Hughes
- Neuropsychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences, Imperial College London, 5th Floor Burlington Danes Building, 160 Du Cane Road, LondonW12 0NN, UK
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Gerridzen IJ, Moerman-van den Brink WG, Depla MF, Verschuur EML, Veenhuizen RB, van der Wouden JC, Hertogh CMPM, Joling KJ. Prevalence and severity of behavioural symptoms in patients with Korsakoff syndrome and other alcohol-related cognitive disorders: a systematic review. Int J Geriatr Psychiatry 2017; 32:256-273. [PMID: 27918121 DOI: 10.1002/gps.4636] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 10/06/2016] [Accepted: 11/08/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Experiences from clinical practice suggest that behavioural symptoms in patients with Korsakoff syndrome (KS) are a frequent problem. Knowledge about behavioural symptoms is important in understanding and managing these symptoms. The aim of this study is to review the prevalence and severity of behavioural symptoms in KS. METHODS Relevant articles were identified by searching Medline (PubMed), PsycINFO, Embase and CINAHL up to 4 June 2014. Two reviewers independently selected the studies, extracted their baseline data and assessed methodological quality using a standardized checklist. RESULTS Fifteen studies fulfilled the inclusion criteria. A diversity of diagnoses was used indicating that KS and other alcohol-related cognitive disorders and terms were used interchangeably. None of the studies were primarily designed to estimate the prevalence or severity of behavioural symptoms in patients with KS. Most studies had serious methodological limitations. The reported prevalence estimates of behavioural symptoms in the included studies varied strongly. Most prevalent were depressive symptoms and disorders (2-50%, median 27%) and agitation and aggression (10-54%, median 27%). None of the reported, mean severity estimates met pathological thresholds. The highest severity estimates were found for apathy. CONCLUSIONS Good quality studies on behavioural symptoms in patients with KS are lacking. Observational research designed to provide reliable estimates of the prevalence and severity of behavioural symptoms in patients with KS is needed. This could improve understanding and managing these symptoms and help care staff to better support the needs of this specific patient group. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Ineke J Gerridzen
- Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.,Nursing Home Markenhof, Atlant Care Group, Beekbergen, The Netherlands
| | | | - Marja F Depla
- Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Els M L Verschuur
- Nursing Home Markenhof, Atlant Care Group, Beekbergen, The Netherlands.,HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Ruth B Veenhuizen
- Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Johannes C van der Wouden
- Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Cees M P M Hertogh
- Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Karlijn J Joling
- Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Hayes V, Demirkol A, Ridley N, Withall A, Draper B. Alcohol-related cognitive impairment: current trends and future perspectives. Neurodegener Dis Manag 2016; 6:509-523. [DOI: 10.2217/nmt-2016-0030] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Excessive alcohol use is associated with a wide range of physical, psychological and social consequences, and is responsible for a significant proportion of the burden of disease globally. An area which has received increasing interest is alcohol-related brain damage, not just because of the cost to the individual and society through resource utilization, but also because of the potential for prevention and reversibility. This paper aims to review the current literature on this subject and seeks to explore issues around diagnosis and treatment of alcohol-related brain damage.
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Affiliation(s)
- Victoria Hayes
- Drug & Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia
- School of Public Health & Community Medicine, Faculty of Medicine, UNSW, Sydney, Australia
| | - Apo Demirkol
- Drug & Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia
- School of Public Health & Community Medicine, Faculty of Medicine, UNSW, Sydney, Australia
| | - Nicole Ridley
- Drug & Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia
| | - Adrienne Withall
- School of Public Health & Community Medicine, Faculty of Medicine, UNSW, Sydney, Australia
| | - Brian Draper
- School of Psychiatry, UNSW, Sydney, Australia
- Academic Department of Old Age Psychiatry, Prince of Wales Hospital, Randwick, Australia
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Rao R, Draper B. Alcohol-related brain damage in older people. Lancet Psychiatry 2015; 2:674-675. [PMID: 26249282 DOI: 10.1016/s2215-0366(15)00215-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 04/18/2015] [Accepted: 04/23/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Rahul Rao
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Brian Draper
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Academic Director for Old Age Psychiatry, Prince of Wales Hospital, Sydney, NSW, Australia
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Horton L, Duffy T, Martin C. Neurocognitive, psychosocial and functional status of individuals with alcohol-related brain damage (ARBD) on admission to specialist residential care. DRUGS: EDUCATION, PREVENTION AND POLICY 2015. [DOI: 10.3109/09687637.2015.1050997] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Horton L, Duffy T, Martin CR. Assessing outcomes of alcohol-related brain damage (ARBD): What should we be measuring? DRUGS: EDUCATION, PREVENTION AND POLICY 2015. [DOI: 10.3109/09687637.2014.991278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Alcohol-related dementia (ARD) is a controversial concept. Alcohol-related brain damage (ARBD) is a term used to cover a spectrum of conditions and disorders: this includes alcohol-related dementia, Korsakoff's syndrome, Wernicke's encephalopathy, alcohol-related brain injury, and alcohol amnesic syndrome. In other words, these are the conditions that have been induced by chronic alcohol consumption, resulting in some degree of brain damage. The prevalence data are varied.
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Horton L, Duffy T, Martin C. Interventions for alcohol-related brain damage (ARBD): Do specific approaches restrict the evolution of comprehensive patient care? DRUGS-EDUCATION PREVENTION AND POLICY 2014. [DOI: 10.3109/09687637.2014.924481] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Svanberg J, Evans JJ. Impact of SenseCam on memory, identity and mood in Korsakoff's syndrome: A single case experimental design study. Neuropsychol Rehabil 2013; 24:400-18. [DOI: 10.1080/09602011.2013.814573] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Svanberg J, Evans JJ. Neuropsychological Rehabilitation in Alcohol-Related Brain Damage: A Systematic Review. Alcohol Alcohol 2013; 48:704-11. [DOI: 10.1093/alcalc/agt131] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bates ME, Buckman JF, Nguyen TT. A role for cognitive rehabilitation in increasing the effectiveness of treatment for alcohol use disorders. Neuropsychol Rev 2013; 23:27-47. [PMID: 23412885 PMCID: PMC3610413 DOI: 10.1007/s11065-013-9228-3] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 01/31/2013] [Indexed: 12/14/2022]
Abstract
Neurocognitive impairments are prevalent in persons seeking treatment for alcohol use disorders (AUDs). These impairments and their physical, social, psychological and occupational consequences vary in severity across persons, much like those resulting from traumatic brain injury; however, due to their slower course of onset, alcohol-related cognitive impairments are often overlooked both within and outside of the treatment setting. Evidence suggests that cognitive impairments can impede treatment goals through their effects on treatment processes. Although some recovery of alcohol-related cognitive impairments often occurs after cessation of drinking (time-dependent recovery), the rate and extent of recovery is variable across cognitive domains and individuals. Following a long hiatus in scientific interest, a new generation of research aims to facilitate treatment process and improve AUD treatment outcomes by directly promoting cognitive recovery (experience-dependent recovery). This review updates knowledge about the nature and course of cognitive and brain impairments associated with AUD, including cognitive effects of adolescent AUD. We summarize current evidence for indirect and moderating relationships of cognitive impairment to treatment outcome, and discuss how advances in conceptual frameworks of brain-behavior relationships are fueling the development of novel AUD interventions that include techniques for cognitive remediation. Emerging evidence suggests that such interventions can be effective in promoting cognitive recovery in persons with AUD and other substance use disorders, and potentially increasing the efficacy of AUD treatments. Finally, translational approaches based on cognitive science, neurophysiology, and neuroscience research are considered as promising future directions for effective treatment development that includes cognitive rehabilitation.
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Affiliation(s)
- Marsha E Bates
- Center of Alcohol Studies, Rutgers, The State University of New Jersey, 607 Allison Road, Piscataway, NJ 08854-8001, USA.
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