Normal neuropsychological abilities of alcoholic men in their late thirties

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.

Effects of aging on frontal white matter microstructure in alcohol use disorder and associations with processing speed

OBJECTIVE

The number of older adults with alcohol use disorder (AUD) is expected to significantly increase in the coming years. Both aging and AUD have been associated with compromised white matter microstructure, although the extent of combined AUD and aging effects is unclear. This study investigated interactions between aging and AUD in cerebral white matter integrity using diffusion tensor imaging (DTI).

METHOD

All participants (44 recently detoxified participants with AUD and 28 healthy controls; ages 31-64 years) completed neurocognitive testing and a DTI scan. Regions of interests were identified on Tract-Based Spatial Statistics images. Hierarchical multiple regression was used to examine interactions between age and AUD status on DTI values [e.g., fractional anisotropy (FA)].

RESULTS

Significant Age × AUD interactions were found across several prefrontal white matter regions (R(2)Δ = 5%-9%). Regional FA was negatively associated with age in the AUD group (rs = -.33 - -.53) but not in the control group (rs = .18 - -.32). This pattern remained after adjusting for lifetime history of drinking and recent drinking. Lifetime alcohol consumption negatively correlated with frontal white matter integrity in the AUD group (rs = -.33 - -.40). Finally, processing speed was significantly slower in the AUD group versus controls (p = .001) and was positively correlated with FA values in frontal white matter regions (rs = .34-.53).

CONCLUSIONS

Cumulative alcohol consumption may affect frontal white matter integrity, and persons with AUD may be more prone to reductions in frontal white matter integrity with advancing age. These reductions in frontal white matter integrity may contribute to reductions in processing speed.

Callosal white matter microstructural recovery in abstinent alcoholics: a longitudinal diffusion tensor imaging study

BACKGROUND

Previous neuroimaging studies of recently detoxified alcohol-dependent patients (RDA) have found significant loss of white matter integrity associated with the shrinkage of the frontal lobes and thinning of the corpus callosum, especially the genu. The current study hypothesized that, in addition to exhibiting the most microstructural white matter disruption in RDA, the genu will also evidence the most recovery after abstinence. This microstructural recovery will be associated with improvements in executive functioning measures.

METHODS

Fifteen RDA were examined approximately 2 weeks after abstinence and again after 1 year of abstinence and compared to 15 age- and education-matched nonalcoholic controls using diffusion tensor imaging (DTI). The effects of group, time, and their interactions on fractional anisotropy, radial diffusivity, and axial diffusivity were evaluated with repeated measures MANOVA; in addition, 2 × 2 ANOVA was used to test changes in measures of executive functioning in the 2 groups.

RESULTS

At 2 weeks of abstinence, DTI of RDA showed significantly lower fractional anisotropy and greater radial diffusivity compared to controls in the genu and body of the corpus callosum. Reexamination after 1 year showed significant time by group interaction with fractional anisotropy increasing and radial diffusivity decreasing in RDA but not controls in these 2 regions. A smaller relapsed group did not show improvements between the 2 time points. Abstinent RDA also showed improvement on Digit Span Backward, a measure of working memory, but did not benefit from practice effects on the Halstead Category Test compared to controls.

CONCLUSIONS

The results suggest susceptibility of the genu and body of the corpus callosum to the effects of alcohol, and the potential for recovery of both these regions after abstinence, perhaps via mechanisms involving myelin reconstitution.

Frontal white matter integrity predictors of adult alcohol treatment outcome

BACKGROUND

Previous research has associated abnormalities in frontal lobe functioning with alcohol relapse. In this study, we used diffusion tensor imaging to investigate whether frontal white matter integrity measured at the start of treatment differs between persons with alcohol use disorders (AUD) who sustain treatment gains and those who return to heavy use after treatment.

METHODS

Forty-five treatment-seeking AUD inpatients and 30 healthy control subjects were included in the study. Six months after completing treatment, 16 of the AUD participants had resumed heavy use (RHU) and 29 others remained abstinent or drank minimally (treatment sustainers [TS]). Voxel-wise group comparisons (TS vs. RHU) were performed on fractional anisotropy (FA), radial diffusivity (RD), and axial diffusivity maps generated from each subject's diffusion tensor imaging scan at the start of treatment.

RESULTS

We found significantly lower FA and significantly higher RD in the frontal lobes of the RHU group, relative to the TS group. The RHU group data are consistent with previous reports of abnormal frontal white matter tract abnormalities in persons with AUD.

CONCLUSIONS

It is possible that the lower FA and higher RD in the RHU group reflect microstructural injury to frontal circuitries, and these may underlie the reduced cognitive control amid heightened reward sensitivity associated with resumption of heavy drinking.

Cognitive performance in long-term abstinent elderly alcoholics

BACKGROUND

To date, there is a wealth of literature describing the deleterious effects of active alcoholism on cognitive function. There is also a growing body of literature on the extent of cognitive recovery that can occur with abstinence. However, there is still a dearth of published findings on cognitive functioning in very long-term abstinence alcoholics, especially in the elderly population.

METHODS

The current study examines 91 elderly abstinent alcoholics (EAA) (49 men and 42 women) with an average age of 67.3 years, abstinent for an average of 14.8 years (range 0.5 to 45 years), and age and gender comparable light/nondrinking controls. The EAA group was divided into 3 subgroups: individuals that attained abstinence before age 50 years, between the ages 50 and 60 years, and after age 60 years. Attention, verbal fluency, abstraction/cognitive flexibility, psychomotor, immediate memory, delayed memory, reaction time, spatial processing, and auditory working memory were assessed. The AMNART and cranium size were used as estimates of brain reserve capacity, and the association of all variables with alcohol use measures was examined.

RESULTS

Overall, the EAA groups performed comparably to controls on the assessments of cognitive function. Only the abstinent in group before 50 years of age performed worse than controls, and this was only in the domain of auditory working memory. EAAs had larger craniums than their controls. This effect was strongest for those who drank the longest and had the shortest abstinence. Such individuals also performed better cognitively.

CONCLUSIONS

Our data showed that elderly alcoholics that drank late into life, but with at least 6 months abstinence can exhibit normal cognitive functioning. Selective survivorship and selection bias probably play a part in these findings. Cognitively healthier alcoholics, with more brain reserve capacity, may be more likely to live into their 60s, 70s, or 80s of age with relatively intact cognition, and to volunteer for studies such as this. Our results do not imply that all elderly alcoholics with long-term abstinence will attain normal cognition.

Performance of recently detoxified patients with alcoholism on a neuropsychological screening test

OBJECTIVE

Early in recovery from alcoholism, cognitive deficits may compromise patients' utilization of rehabilitative information. Cognitive impairment in a sample of newly detoxified inpatients with alcoholism was examined using the Neurobehavioral Cognitive Status Examination (NCSE).

METHODS

Consecutively admitted psychiatric inpatients (N=233) with an alcohol-related primary diagnosis (63% male, mean age 46.3) were administered the NCSE following medical stabilization. Within-samples differences between age and diagnostic groups were examined and scores were compared to normative samples.

RESULTS

Inpatients older than 50 demonstrated significant cognitive deficits for all scales except Attention. In comparison with normative samples, patients with alcoholism produced lower scores, with the most pronounced deficits among middle-aged patients. In alcohol-abusing patients with medical comorbidities, language deficits and more severe memory deficits were observed. Abuse severity or comorbid psychiatric disorder produced no differences in NCSE scores.

CONCLUSIONS

Neuropsychological screening following detoxification in patients diagnosed with an alcohol disorder reflected the effects of increased age and medical comorbidity. Our finding of frequent deficits in abstraction, comprehension, and memory suggests that cognitive-behavioral treatments for inpatients may be less effective if cognitive impairment is not considered.

A dissociation between simple and complex span impairment in alcoholics

We investigated whether the surprisingly good memory performance of alcoholics may result from simple memory performance being spared while performance in complex memory tasks is impaired. Simple word span was contrasted with a complex word span task involving concurrent monitoring and re-organisation of items for recall. To control for disruption of rehearsal in the complex word span task, performance on two additional tasks with disrupted rehearsal but no additional processing components was studied. As hypothesised, the alcoholics showed a deficit in the complex but not the simple word span task. They were also impaired, compared to controls, on both tasks with disrupted rehearsal. The difference between groups remained in the complex span task when scores in simple span and either of the two other tasks were used as covariates. Thus, both executive processes necessary for coping with disrupted rehearsal and additional processes scheduling processing and storage in a complex task may play a role in accounting for working memory deficits found in alcoholics.

Behavioral and cognitive measurements predict scores on the MAST: a 3-year prospective study

This experiment examined the ability of neuropsychological and behavioral tests of anterior brain functioning to predict changes in alcohol-related behaviors 3 years after the initial evaluation. One hundred four young adult subjects, sixty-six of whom had a positive family history of alcoholism, filled out the Michigan Alcoholism Screening Test (MAST), self-rated the frequency with which they consumed alcohol, and completed a retrospective test of childhood hyperactivity/impulsivity/conduct problems (Wender Behavioral Checklist). Eighty-three of the subjects also completed a neuropsychological battery consisting of cognitive tests of executive functioning (i.e., Trails, Categories Test, Similarities) and motor tests (i.e., TPT, hand dynamometer, finger tapping). Subjects returned to complete the alcohol-related measures during a second testing session 3 years later. Changes in MAST scores, and in alcohol consumption, between the first and second test session were computed, and median splits classified subjects into "high" versus "low" change groups. After factor analysis of the cognitive and behavioral data, hierarchical logistic regression equations assessed the ability of the cognitive and behavioral variables, as well as the presence of a positive family history of alcoholism, to predict future changes in the alcohol outcome measures. Scores from the WENDER behavioral checklist predicted future changes in the MAST scores (p = 0.0026), with more impaired scores associated with higher MAST scores. Tests of executive functioning, in subjects with a positive family history of alcoholism, predicted alcohol consumption (p = 0.033). None of the other predictor variables showed any relationship to the alcohol-related outcome measures.

Single photon emission computed tomography with iodoamphetamine-123 and neuropsychological studies in long-term abstinent alcoholics

Ten long-term abstinent alcoholics (mean abstinence = 7.7 years) were compared with 13 recently detoxified substance-dependent inpatients (mean abstinence = 25 days) and 8 nonalcoholic control subjects on global end regional measures of cortical cerebral blood flow (CBF), and on neuropsychological measures. CBF was assessed using 123iodoamphetamine (IMP) single photon emission computed tomography (SPECT) under conditions of behavioral challenge (Raven's Progressive Matrices). CBF and neuropsychological test performance were worse in the recently detoxified inpatients. Of greater interest, there was a dissociation in the long-term abstinent group, which, while neuropsychologically indistinguishable from controls, showed significantly decreased mean cortical IMP uptake. We conclude that there may be persistent physiologic abnormalities in long-term abstinent alcoholics who have achieved full behavioral recovery. Smoking on the day of SPECT scanning was also identified to be a significant confound to understanding CBF changes in alcoholism.

Anterior brain dysfunctioning as a risk factor in alcoholic behaviors

This study assessed the relationship between neuropsychological and electrophysiological functioning and four alcohol-related measures: the Michigan Alcoholism Screening Test (MAST), the age at which the first drink was taken, frequency of drinking to "get high", and frequency of drinking to "get drunk". Ninety-one young adult men with no history of alcohol dependence were recruited. Subjects completed a variety of alcohol-related scales and a battery of neuropsychological tests. Resting EEG activity was also recorded. Stepwise regression analysis found that neuropsychological tests commonly regarded as measuring frontal and/or temporal neocortex functioning predicted the age at which subjects took their first drink and their scores on the MAST. Tests of frontal functioning, along with tests of memory, also predicted the frequency with which subjects reported drinking to "get drunk". Tests of memory also predicted the frequency at which subjects drank to "get high". On two of the alcohol measures, including age at which the first drink was taken and frequency of drinking to "get high", left-frontal slow alpha EEG activity was a significant predictor. These results suggest that markers of anterior brain functioning/dysfunctioning are associated with self-reports of alcohol-related behaviors, and that disturbances in the integrity of the anterior neocortex may be a risk factor in the development of alcohol-related behaviors.

The HNRC 500--neuropsychology of HIV infection at different disease stages. HIV Neurobehavioral Research Center

The present study examined neuropsychological (NP) functioning and associated medical, neurological, brain magnetic resonance imaging (MRI), and psychiatric findings in 389 nondemented males infected with Human Immunodeficiency Virus-Type 1 (HIV-1), and in 111 uninfected controls. Using a comprehensive NP test battery, we found increased rates of impairment at each successive stage of HIV infection. HIV-related NP impairment was generally mild, especially in the medically asymptomatic stage of infection, and most often affected attention, speed of information processing, and learning efficiency; this pattern is consistent with earliest involvement of subcortical or frontostriatal brain systems. NP impairment could not be explained on the bases of mood disturbance, recreational drug or alcohol use, or constitutional symptoms; by contrast, impairment in HIV-infected subjects was related to central brain atrophy on MRI, as well as to evidence of cellular immune activation and neurological abnormalities linked to the central nervous system.

A screening algorithm to identify clinically significant changes in neuropsychological functions in the Diabetes Control and Complications Trial. DCCT Research Group

Neuropsychological (NP) evaluations provide an accepted means of monitoring safety in multi-center long-term medical trials. However, using neuropsychologists to review test protocols and rate level of clinical impairment can be a costly and logistically complex undertaking. To facilitate that process, the DCCT Research Group developed a computerized screening strategy that utilized statistical models to identify individuals with possible cognitive deterioration. Two hundred and eight subjects with insulin-dependent diabetes mellitus were assessed twice, 2 years apart, with an extensive battery of NP tests, and the results were rated by expert clinicians. Multiple logistic regression was used to develop a statistical model to predict clinically significant NP worsening (as determined by clinical raters) on the basis of changes in scores (year 2--baseline) derived from the actual tests. A subsequent performance evaluation with an additional 1087 subjects demonstrated that the computerized algorithm was highly successful in identifying individuals with significantly worsened NP performance. Despite a high false positive rate, the algorithm can achieve an 80-90% reduction in the number of cases requiring evaluation by expert neuropsychologists.

Effect of substance abuse on visuographic function

The effect of substance abuse on visuographic functions was investigated by comparing 4 groups from an Arabian Gulf population: 63 heroin abusers, 14 alcohol abusers, 43 polydrug abusers, and 48 control subjects. The visuographic function was evaluated using Benton's Revised Visual Retention Test. Analysis of covariance yielded an over-all group effect on both number correct and errors. Assessment of significance of differences between groups showed that the polydrug-abusing group and the heroin-abusing group scored significantly lower than the nonabusing group on number correct. All 3 substance-abusing groups scored significantly higher than the non-abusing group on errors, which seems a better predictor of cognitive impairment. Classification of subjects on the basis of their scores on the Benton test showed that a significant proportion of subjects in each substance-abusing group were classified as impaired. It is concluded that the present findings were consistent with prior reports for European and American subjects.

Alcohol, head injury, and neuropsychological function

Evidence is reviewed indicating that the extent of alcohol abuse alone cannot account for the neuropsychological deficits observed in alcoholics, and that alcohol abuse and head injury may interact in some patients to influence neuropsychological status. Alcohol abuse both increases the risk for head trauma and potentiates the resulting brain injury, which can lead to negative neuropsychological consequences. Clinicians involved in the treatment of addiction should assess patients for history of head injury, and neuropsychological deficits consequent to both head injury and ethanol. These deficits may limit patient ability to comply with addiction rehabilitation programs. Conversely, clinicians in acute care and rehabilitation of the sequelae of head trauma should routinely assess their patients for substance abuse, because such abuse can have a significant impact on recovery from brain injury.

Long-term abstinent alcoholics have normal memory

It is generally believed that many non-Korsakoff alcoholics have subtle defects in memory. To determine whether such defects vary as a function of length of abstinence (LOA), we performed extensive memory testing with: (1) recently detoxified (n = 31; LOA-29 days); (2) intermediate-term abstinent (n = 28; LOA = 1.9 years); (3) long-term abstinent (n = 32; LOA-7.0 years) alcoholics; and (4) nonalcoholic controls (n = 37). All subjects were matched on age and education. Alcoholics were matched on years of alcoholic drinking. Memory measures were divided into the following domains: verbal learning, verbal recall, visual learning, visual recall, and paired associate learning. A series of MANOVAs were conducted that revealed a significant relationship between visual learning and length of abstinence, and a significant interaction between age and length of abstinence on visual recall. Long-term abstinent subjects were not significantly different from controls on any test. We conclude that memory disturbance demonstrable among recently detoxified alcoholics in the early weeks of their abstinence is not evident in demographically matched long-term abstinent alcoholics with similar drinking histories.

Systolic blood pressure and neuropsychological test performance of alcoholics

This study examined resting systolic blood pressure (SBP) as a mediator of neuropsychological (NP) test performance in nonhypertensive alcoholics and controls. A median-split was used to assign alcoholics and controls to low and high SBP groups. Results showed that: (1) When SBP level was not considered, alcoholics only performed worse than controls on the WAIS Comprehension subtest. (2) Alcoholics and controls in the high SBP groups had fewer correct items on the WAIS Comprehension and Raven's, Set I tests than subjects in the low SBP groups. (3) Significant Diagnostic Group by SBP Group interaction was found for the Sentence Writing test. For this test only controls in the High SBP Group did worse than controls in the Low SBP Group. (4) Individual group comparisons for all NP tests showed that alcoholics in the High SBP Group were more impaired than controls in the Low SBP Group on the WAIS Comprehension, Shipley Abstraction Age and Stark Visual-Spatial tests; but alcoholics in the Low SBP Group did not differ from, or outperformed, controls in the High SBP Group on the WAIS Comprehension, Shipley Abstraction Age, Raven's, Set I, and Stark Visual-Spatial tests. These data demonstrate that both alcoholism and high SBP adversely and differentially affect the NP test performance of alcoholics and controls.

Improvement in cognitive functioning of alcoholics following orthotopic liver transplantation

Cognitive functioning in alcoholic cirrhotics before and 1 year following orthotopic liver transplantation was compared with age- and sex-matched normal subjects. The alcoholic group improved significantly following transplantation on tests measuring psychomotor, visuopractic and abstracting abilities whereas the performance of normal controls remained virtually unchanged. In contrast, memory capacity in alcoholics with cirrhosis did not statistically improve following successful transplantation. Further investigation, using more sophisticated measures of memory function, are required to determine whether memory deficits are either associated with alcohol neurotoxicity or an irreversible component of hepatic encephalopathy. These findings suggest that a reversible hepatic encephalopathy underlies many of the neuropsychologic deficits observed in cirrhotic alcoholics and can be ameliorated following successful liver transplantation.

Effects of alcoholism and instructional conditions on speed/accuracy tradeoffs

The speed and accuracy of neuropsychological performance in alcoholics and nonalcoholics were assessed for each item within a four-test computerized battery. Subjects were randomly assigned to one of three instructional conditions: Speed-emphasis instructions, Accuracy-emphasis instructions, or Typical instructions emphasizing speed and accuracy equally. Across conditions, alcoholics were less accurate and took longer to perform than controls. Examining speed and accuracy components separately within each condition, as predicted, the greatest differences in accuracy scores between alcoholics and controls appeared in the Speed-emphasis condition, while the greatest group differences in speed scores appeared in the Accuracy-emphasis condition. The results indicate that the relationships between speed and accuracy are dissimilar between alcoholics and controls; alcoholics exhibit speed/accuracy tradeoffs in that they are unable to adjust performance to meet speed or accuracy demand without suffering substantial compromise in the other aspect of performance. These results have implications for future studies concerning methodological approaches to speed and accuracy assessment and provide support for an information-processing deficit associated with chronic alcohol abuse.

Dichotic asymmetries in aging and alcoholic subjects

It has been suggested that certain cognitive changes found both with aging and with chronic alcoholism are accompanied by alterations in hemispheric functional asymmetries. One prevalent view states that these well-delineated cognitive changes are directly related to a selective disruption of right hemisphere function. The present study tested this hypothesis using dichotic listening measures of functional asymmetry. Both alcoholics and older nonalcoholics evidenced patterns of cognitive preservation and impairment similar to those seen in patients with known right hemisphere dysfunction. Nevertheless, dichotic listening findings did not reveal any selective effect on the right hemisphere, as previously proposed. The dichotic studies supported the view that both hemispheres are affected by aging and alcoholism. Patients with right hemisphere lesions demonstrated characteristic and predictable changes in dichotic asymmetries, illustrating the reliability of the dichotic measures as indices of hemispheric function.

The effect of alcohol consumption on recency discrimination ability: an early screening test for alcohol-induced cognitive impairment

In this short study the relationship between recency discrimination ability and a measure of alcohol intake was examined using a series of regression analyses. Semi-partial correlations were extracted in order to evaluate which variables (level of alcohol consumption, age and IQ) best predicted recency discrimination performance on both verbal and non-verbal tasks. Results showed that while IQ best predicted performance on the verbal task both IQ and alcohol intake were significant predictors on the non-verbal task. The results are discussed in relation to current findings and the continuity hypothesis.

Cognitive ability and drinking behavior in a national sample of young adults

The role of verbal intelligence (VI) as an antecedent and moderator of alcohol-related problems was investigated for a national sample of young adults. A measure of VI was used to predict alcohol related behavior 5 years later. Results indicated that lower VI was associated with lower risk for drinking per se. Lower VI was also associated with higher risk for alcohol-related problems among those who drink. These findings were robust across gender, age, and to a large extent across different areas of alcohol related problems. Cognitive-behavioral functions associated with intelligence, such as social judgement, social inference, and social skills, are proposed as possible moderators of the relationship between intelligence and alcohol-related problems.

Cognitive functioning of alcoholics and its relationship with prognosis

In a preliminary study a group of 30 alcoholics were subjected to psychological tests to explore the influence of regular alcohol intake on their cognitive functioning and its relationship with prognosis. The functions chosen were, arousal and maintenance of attention, verbal intelligence and performance intelligence. Tests used were the Binet Kamat test of intelligence and Bhatia short scale. Level of education was positively correlated with attention-span and verbal intelligence, but not with performance intelligence. The inter-test discrepancy alone on the performance intelligence test could be assessed for evaluation of cognitive impairment. Poor P.Q. scorers sought medical consultation before their mid thirties and had earlier onset of alcoholism. Elder addicts (above 35 years) showed more abstraction deficiency. The higher the P.Q. the higher was its' positive correlation with adjustment to work, but not to family.

Neuropsychological performance of young nondrinkers, social drinkers, and long- and short-term sober alcoholics

Neuropsychological performance of 23-42-year-old males with diverse drinking histories was assessed. Comparisons were made among nondrinkers, social drinkers, short-term sober (less than 30 days) alcoholics and long-term sober (greater than 30 days) alcoholics. Results of these comparisons provided little support for the notion that neurotoxic effects of chronic alcohol consumption are directly related to cognitive impairment. Instead, these results suggested that performance differences among the groups were more closely related to subclinical withdrawal symptoms or native ability than to long-term alcohol consumption. Because none of the dependent measures was related to length of abstinence, and because Wechsler's Adult Intelligence Scale-R Vocabulary differences among groups paralleled neuropsychological test performance differences, it is suggested that differences among groups may reflect differences in native ability. In addition, there were no differences between social drinkers and nondrinkers, nor were there any significant correlations among drinking variables and performance of social drinkers, providing further evidence against a direct relationship between alcohol consumption and cognitive performance.

Learning in young alcoholics

A group of young male alcoholics with a mean age of 26.7 years performed less well than matched controls on a test of complex maze learning. The relatively short period of time during which these alcoholics had been drinking to excess (M = 5.7 years) suggests that acquired deficits may appear earlier in the drinking history of many alcoholics than has been previously assumed. Data from the maze was analyzed by modelling each individuals' cumulative error scores with a two-parameter hyperbolic function. The model provided an excellent fit to individual data and group differences were observed in both parameters of the model. It is concluded that curve fitting provides an efficient method for representing individual performance on a multitrial learning task.

The interrelationship of substance abuse and posttraumatic stress disorder. Epidemiological and clinical considerations

This chapter reviews the data available on the relationship of substance abuse and posttraumatic stress disorder (PTSD). Delimiting the review to those studies of Vietnam veterans, we found that levels of combat exposure seemed to be positively related to subsequent alcohol use, although not all studies confirmed this relationship. When studies of patients seeking treatment for PTSD were examined, we learned that 60-80% of these patients had concurrent diagnoses of substance abuse, alcohol abuse, or dependence. Methodological limitations of all the studies are discussed and conclusions regarding the status of the PTSD-substance abuse relationship are drawn cautiously. Alternative suggestions for treatment are presented and discussed.

EEG, visually evoked and event related potentials in young abstinent alcoholics

EEG, visually evoked potentials (VEP), and event related potentials (P300) were recorded from 60 males aged 25-40 (20 abstinent alcoholics, 20 social drinkers, and 20 lifetime nondrinkers). Alcoholics were at least 1 month abstinent, medication free, and neuropsychologically normal. Residual effects of alcohol abuse were not detected in EEG power and cortical coupling analyses, or VEP amplitude, latency, and amplitude/intensity slope measures. Only P300 measures, recorded while subjects were actively engaged in a visual oddball task (20% targets), differentiated alcoholics from nonalcoholics. Alcoholics had reduced N2-P3 amplitude and delayed N2 latencies compared to social drinkers and nondrinkers. Because P300 abnormalities have been reported for individuals with positive family history for alcoholism, it is not clear whether these results reflect familial influence or residual effects of alcohol abuse. Issues relating to age, health and medication status of abstinent alcoholics, and use of social drinkers as comparison groups in studies of brain dysfunction in "recovering" alcoholics are also discussed.

"Dose/duration effect" relationship between alcohol consumption and cerebral atrophy: a psychological and neuroradiological evaluation

The purpose of this study was to assess the occurrence of brain atrophy in alcoholic patients as measured by two methods--psychological testing and CAT scanning. The study focused upon the relationships between gross cerebral atrophy and two variables which are considered to be major determinants in the development of brain damage. The variables are (1) the quantity-frequency of alcohol intake, and (2) the duration of problematic drinking. The results show that the degree of brain damage is related to the intensity of exposure to alcohol and clearly indicate that psychological testing is a reliable method for, at least, an initial diagnosis of or screening for alcohol-related cerebral atrophy.

Influence of premorbid risk factors on neuropsychological performance in alcoholics

This report provides new evidence that neuromedical risk factors influence levels of behavioral impairment in alcoholics. Using a factorial model, the effects of age, neuromedical risk history, and duration of sobriety were studied in relation to neuropsychological performance. The data showed a consistent interaction between duration of abstinence and risk status: Recently detoxified alcoholics (sober 1 month) with a positive premorbid risk history had worse neuropsychological performance than did those without such historical risk events. By contrast, long-term abstinent alcoholics (sober 4 years) did not demonstrate the interaction between alcohol history and positive premorbid risk history. The present results are held to mean that neuromedical risk factors may exert a differential influence on test scores of recently detoxified men, suggesting a source of variance in neurobehavioral studies of alcoholism requiring attention by investigators.

The impact of mild head injury on neuropsychological capacity in chronic alcoholics

A series of neuropsychological tests known to be sensitive to the effects of chronic alcoholism was administered to 25 detoxified alcoholic patients with histories of mild head injury and 25 detoxified alcoholics matched for age, race, socioeconomic status, education and drinking history parameters, but without histories of head injury. None of the tests was performed at significantly different levels by the two groups. It was concluded that mild head injury did not compound the effects of chronic alcoholism among these patients, although it was noted that both groups demonstrated the anticipated impairments on the tests. It was also suggested that researchers need not exclude alcoholic subjects with mild head injury histories from studies involving the use of standard neuropsychological tests.

Neuropsychological impairment and behavioral limitations exhibited within an alcohol treatment program

The present study investigated the generalizability of neuropsychological test data to behavioral problems/limitations exhibited by alcoholics within an inpatient treatment program. Ratings supplied by alcohol counselors of problematic behaviors were used to form two groups (N = 40) representing behaviorally impaired (B1) and behaviorally unimpaired (BU) alcoholics. The neuropsychological performance of BI subjects was found to be impaired, relative to BU subjects, on composite measures of motor skill, problem solving, psychomotor speed, and memory. BI subjects, relative to the BU group, were also found to have significantly longer histories of alcoholism, more frequent neurological examination abnormalities, and higher incidences of suboptimal nutrition. Taken as a whole, these data suggest that neuropsychological measures may have some potential for assisting in the generating of valid inferences regarding both underlying cerebral pathology and the behavioral consequences of such as expressed within the alcohol treatment milieu.

Assessing the influence of confounding subject variables in neuropsychological research in alcoholism and related disorders

With the recent emphasis on clinical research there has developed a greater sophistication in identifying and uncovering possible confounding subject variables. The investigator searching for etiologies and underlying relationships is accordingly increasingly faced with the question of how to deal with, or control numerous subject variables which may covary with the condition or disorder under study. The present paper describes some of these variables and the problems their presence raises for the conduct of clinical research. Although most of the examples described such as childhood hyperactivity, head injury, psychopathology, and physical disorders of the subjects are specifically relevant to neuropsychological research in alcoholism, many of them should be pertinent also for related areas of inquiry. The difficulties and problems in controlling, ruling out and taking such variables into account, as well as guidelines and strategies for their treatment and management, are considered. The question of the generality of findings which arises when so many subject variables are controlled is discussed. It is concluded that we are just on the threshold of identifying and clarifying the behavioral effects of numerous subject variables, conditions and disorders. The implications of this situation for the validity of our current research findings are discussed.

Minimal brain dysfunction and neuropsychological test performance in offspring of alcoholics

Previous studies have indicated that alcoholics report a high frequency of problem behaviors in childhood. Additionally, certain neuropsychological deficits are often evident. Both childhood problem behavior and antecedent neuropsychological deficits have been suggested as risk factors for the later development of alcoholism. However, neither set of variables nor their interrelationship have been previously investigated in a sample at high risk for the development of alcoholism. In this study, unaffected offspring of an alcoholic parent and unaffected offspring of nonalcoholic parents were examined. Although attention deficit disorder/hyperactivity and conduct disorder prior to age twelve predicted the onset of drinking, the frequency of childhood behaviors was similar in both groups. Further, the neuropsychological performances of the high-risk and low-risk samples were also similar and within normal limits. The theoretical and methodological implications of these findings for future research are discussed.

Evidence for impersistence in young male alcoholics

This investigation compared a group of 30-year-old male Veterans Administration inpatient alcoholics with an IQ, age, and education matched comparison group of nonpsychiatric VA outpatients or blue collar employees on three measures of persistence: Matching to Familiar Figures Test (MFFT), Retarded Rotation Test (RRT), and Mirror Tracing (MT). Alcoholics were found to make significantly more errors on the MFFT and MT tasks, but didn't differ significantly from nonalcoholics on the RRT. The alcoholics were also differentiated from the nonalcoholics on an overall index of persistence based on a combination of the three measures. The ramifications of the findings for understanding the etiology of the neuropsychological deficits manifested by alcoholics are discussed.

Minimal brain dysfunction symptoms claimed by primary and secondary alcoholics: relation to cognitive functioning

A group of chronic alcoholics were classified as Primary or Secondary alcoholics according to a self-administering questionnaire. Primary, compared to Secondary, alcoholics claimed a significantly higher number of childhood symptoms associated with the Hyperkinetic and/or the Minimal Brain Dysfunction (Hk/MBD) Syndromes. Primary alcoholics also performed significantly poorer on the Shipley and Raven tests than Secondary alcoholics and had more severe alcoholic dependence scores. High Hk/MBD patients performed more poorly than Low Hk/MBD patients on the Shipley and Raven tests. The results support the hypothesis that a childhood history of Hk/MBD might be a predisposing factor to a more severe type of alcoholism. The results also suggest that certain alcoholics may have premorbid deficits in cognitive functions.

Altered mood and norepinephrine metabolism following withdrawal from alcohol

Affective symptoms were evaluated in chronic alcoholics during a 2-week period following detoxification from alcohol. Increased ratings were apparent both on the Manic State Rating Scale (MSRS) and on the Ma Scale of the Minnesota Multiphasic Personality Inventory (MMPI) in a subgroup of these patients. Primary symptoms included grandiosity, irritability, and mildly increased psychomotor activity. Alcoholics who had been detoxified for several months or hospitalized medical patients did not show similar symptoms. Measurements of urinary 3-methoxy-4-hydroxyphenylethylene glycol (MHPG), a metabolite of norepinephrine which has been associated with manic-depressive illness, also showed increased excretion in a subpopulation of recently detoxified patients. The coexistence of depressed mood in these patients may have led to symptoms of hypomania being previously overlooked, although signs of depression are common in mania itself.

The alcoholic brain: CT scan and psychological findings

One hundred male alcoholics without overt clinical signs of brain damage were interviewed, psychologically tested and scanned by means of a CT 1010 EMI scanner. Fifty age-matched controls, lifelong abstainers or light drinkers, were used for comparison. Fifty-six alcoholics from the initial sample were followed up after periods varying from 30 to 152 weeks, and radiological changes during the follow-up were assessed. The main results of the study can be summarized as follows: (1) All CT scan indices were significantly different in alcoholics and controls. Alcoholics had larger ventricles, wider cerebral sulci and wider Sylvian and interhemispheric fissures. Cerebellar sulci were visible only in alcoholics. These differences were greater for older alcoholics and controls, but were also present in the younger subjects. (2) In the alcoholic group the size of the ventricular system, and the width of the sulci, Sylvian and interhemispheric fissures were positively and significantly correlated with age. The duration of the drinking history and the age of onset were not significantly correlated with CT scan indices. (3) In those alcoholics whose age was greater than the mean for the whole group, the size of the ventricular system and width of the Sylvian fissure were significantly and negatively correlated with the duration of abstinence prior to scanning. (4) Other features such as decreased tolerance, a positive family history of alcoholism and 'social decline' were not significantly related to the severity of CT scan abnormalities. (5) When the effects of age and premorbid intelligence were controlled, alcoholics showed significant cognitive impairment when compared with controls. The differences in the scores of psychological tests and CT scan indices were greater between alcoholics and controls of high IQ than between those of low IQ. This discrepancy is likely to be due to a selection bias. (6) No significant correlations were found between the degree of cognitive impairment and clinical features. The size of the ventricular system was positively and significantly correlated with the discrepancy between immediate and delayed recall of verbal material. There were no other significant correlations between cognitive impairment and CT scan indices. (7) Those subjects who had remained abstinent during the follow-up period, when considered as a group, showed a significant reduction in the size of the ventricular system. When cortical indices and V/B ratio were combined, patients whose scans had improved at follow-up differed from the rest with regard to the length of abstinence prior to re-scanning.