Cognitive training and remediation interventions for substance use disorders: a Delphi consensus study

AIMS

Substance use disorders (SUD) are associated with cognitive deficits that are not always addressed in current treatments, and this hampers recovery. Cognitive training and remediation interventions are well suited to fill the gap for managing cognitive deficits in SUD. We aimed to reach consensus on recommendations for developing and applying these interventions.

DESIGN, SETTING AND PARTICIPANTS

We used a Delphi approach with two sequential phases: survey development and iterative surveying of experts. This was an on-line study. During survey development, we engaged a group of 15 experts from a working group of the International Society of Addiction Medicine (Steering Committee). During the surveying process, we engaged a larger pool of experts (n = 54) identified via recommendations from the Steering Committee and a systematic review.

MEASUREMENTS

Survey with 67 items covering four key areas of intervention development: targets, intervention approaches, active ingredients and modes of delivery.

FINDINGS

Across two iterative rounds (98% retention rate), the experts reached a consensus on 50 items including: (i) implicit biases, positive affect, arousal, executive functions and social processing as key targets of interventions; (ii) cognitive bias modification, contingency management, emotion regulation training and cognitive remediation as preferred approaches; (iii) practice, feedback, difficulty-titration, bias modification, goal-setting, strategy learning and meta-awareness as active ingredients; and (iv) both addiction treatment work-force and specialized neuropsychologists facilitating delivery, together with novel digital-based delivery modalities.

CONCLUSIONS

Expert recommendations on cognitive training and remediation for substance use disorders highlight the relevance of targeting implicit biases, reward, emotion regulation and higher-order cognitive skills via well-validated intervention approaches qualified with mechanistic techniques and flexible delivery options.

Disordered eating symptoms in Austrian men of different ages in the context of fitness centers

PURPOSE

To assess eating behavior and associated factors in male fitness-center attendees.

METHODS

An anonymous questionnaire was administered to male fitness center members of Innsbruck (Austria), aged 18-80 years to assess socio-demographic features, weight history, sports activity, eating behavior including disordered eating based on the Eating Disorder Examination Questionnaire (EDE-Q) and DSM-5 key symptoms for eating disorders (anorexia nervosa, binge eating, bulimia nervosa, purging disorder) and body image. Three age groups (younger-middle-aged-older men) were compared regarding the variables described above.

RESULTS

A total of 307 men included displayed high rates of disordered eating as described by EDE-Q cutoff scores (5-11%) as well as by DSM-5 eating disorder symptoms (10%). While EDE-Q cutoff scores did not differentiate between the groups, the prevalences of DSM-5 eating disorder symptoms yielded significant differences indicating a clear decrease with increasing age. Binge eating and bulimic symptoms with excessive exercising as the purging method were the most often reported symptoms.

CONCLUSION

Although described as typically female, disordered eating does occur in male fitness-gym attendees across all ages. The older the men, the less prevalent are the symptoms. Awareness of disordered eating and possible negative effects need to be addressed for attendees and trainers of the gym.

LEVEL OF EVIDENCE

V-descriptive survey study.

Do Social Cognition Deficits Recover with Abstinence in Alcohol-Dependent Patients?

Background

Despite growing evidence of the presence and clinical relevance of deficits in social cognition in individuals with alcohol use disorder (AUD), less is known about the potential of “natural” recovery with abstinence in this neurocognitive domain. This study investigated the abstinence‐based recovery of neurocognitive social abilities in alcohol‐dependent patients (ADP) using a prospective longitudinal design with follow‐up assessment under controlled conditions of abstinence during alcohol dependence inpatient treatment.

Methods

Seventy‐seven participants (42 ADP and 35 healthy controls [HC]) performed social cognition testing, including facial emotion recognition, perspective taking, and affective responsiveness twice (baseline/T1 and follow‐up/T2) during comparable follow‐up periods. Assessment of social cognition in abstinent ADP was conducted at the beginning (T1; within the first 2 weeks) and at the end (T2; within the last 2 weeks) of long‐term (2 months) abstinence‐oriented alcohol dependence inpatient treatment. Only patients abstinent for >14 days (last heavy drinking day >21 days) at baseline (T1) and who remained abstinent at follow‐up (T2) were included.

Results

ADP, who on average were nearly 2 months abstinent at T1, showed poorer social cognition in all 3 areas (emotion recognition, perspective taking, and affective responsiveness) than HC. There was no difference between groups on the change in performance over time, and group differences (ADP vs. HC) remained significant at T2, indicating persistent social cognition deficits in ADP following controlled abstinence during inpatient treatment.

Conclusions

Our findings indicate no natural recovery of social cognition impairments in ADP during an intermediate to long‐term period of abstinence (2+ months), the usual active treatment phase. Research aimed at developing interventions that focus on the improvement of social cognition deficits (e.g., social cognition training) and determining whether they benefit short‐ and long‐term clinical outcomes in AUD seems warranted.

Prevalence of eating disorders in middle-aged women

OBJECTIVE

Little is known about the prevalence and correlates of eating disorders (ED) in middle-aged women.

METHOD

We mailed anonymous questionnaires to 1,500 Austrian women aged 40-60 years, assessing ED (defined by DSM-IV), subthreshold ED, body image, and quality of life. We broadly defined "subthreshold ED" by the presence of either (1) binge eating with loss of control or (2) purging behavior, without requiring any of the other usual DSM-IV criteria for frequency or severity of these symptoms.

RESULTS

Of the 715 (48%) responders, 33 [4.6%; 95% confidence interval (CI): 3.3-6.4%] reported symptoms meeting full DSM-IV criteria for an ED [bulimia nervosa = 10; binge eating disorder = 11; eating disorder not otherwise specified (EDNOS) = 12]. None displayed anorexia nervosa. Another 34 women (4.8%; CI: 3.4-6.6%) displayed subthreshold ED. These women showed levels of associated psychopathology virtually equal to the women with full-syndrome diagnoses.

DISCUSSION

ED appear common in middle-aged women, with a preponderance of binge eating disorder and EDNOS diagnoses as compared to the "classical" diagnoses of anorexia and bulimia nervosa. Interestingly, middle-aged women with even very broadly defined subthreshold ED showed distress and impairment comparable to women with full-scale ED.

The menopausal transition--a possible window of vulnerability for eating pathology

OBJECTIVE

No published studies, to our knowledge, have examined the association of menopausal status with eating disorders and body image in women. We assessed these associations in a large sample of middle-aged women.

METHOD

We administered an anonymous questionnaire to a randomly selected nonclinical sample of women aged 40-60 in Innsbruck, Austria. The questionnaire covered demographic items, menopausal status, weight history, measures of body image, and current eating disorders as diagnosed by DSM-IV criteria. Using modified WHO criteria, we classified the respondents' current stage of menopausal transition as premenopausal (N = 192), perimenopausal (N = 110), or naturally postmenopausal (N = 134). In a separate analysis, we also examined the small group of women with surgically induced menopause (N = 12).

RESULTS

The three groups were similar in all demographic features except age, and did not differ significantly on current body mass index (BMI), weight-control behaviors, or dieting history after age adjustment. However, perimenopausal women reported a significantly greater prevalence of eating disorders as compared to premenopausal women. Perimenopausal women also reported significantly higher self-ratings of "feeling fat" and higher Body Shape Questionnaire scores than premenopausal women. Women with surgically induced menopause also showed an elevated prevalence of eating and body image pathology.

DISCUSSION

Our data suggest that the menopausal transition is associated with an increased prevalence of eating disorders and negative body image. Menopause, like puberty, may perhaps represent a window of vulnerability to these conditions, likely because of changes in hormonal function, body composition, and conceptions of womanhood.

Cognitive remediation therapy during treatment for alcohol dependence

OBJECTIVE

Cognitive impairments in individuals with alcohol dependence may interfere with the progress of treatment and contribute to the progression of the disease. This study aimed to determine whether cognitive remediation (CR) therapy applied during treatment for alcohol dependence improves cognitive functioning in alcohol-dependent inpatients. A secondary aim was to evaluate whether the benefits of CR generalize to noncognitive clinically meaningful outcomes at the end of inpatient treatment.

METHOD

Forty-one alcohol-dependent patients entering inpatient treatment for alcohol dependence were randomly assigned to receive conventional treatment (n = 21) or an additional 12 sessions of computer-assisted CR focusing on cognitive enhancement in attention/executive function and memory domains (n = 20). Assessments of cognitive abilities in these domains as well as of psychological well-being and alcohol craving were conducted at baseline (at the beginning of inpatient treatment) and after CR (at the end of treatment).

RESULTS

Results indicated that, relative to patients completing conventional treatment, those who received supplemental CR showed significant improvement in attention/executive function and memory domains, particularly in attention (alertness, divided attention), working memory, and delayed memory (recall). In addition, patients receiving CR during alcohol-dependence treatment showed significantly greater improvements in psychological well-being (Symptom Checklist-90-Revised) and in the compulsion aspect of craving (Obsessive Compulsive Drinking Scale-German version).

CONCLUSIONS

CR during inpatient treatment for alcohol dependence is effective in improving cognitive impairments in alcohol-dependent patients. The benefits generalize to noncognitive outcomes, demonstrating that CR may be an efficacious adjunctive intervention for the treatment of alcohol dependence.

Eating disorders in men: current features and childhood factors

BACKGROUND

Disturbed interactions with one's body and with other persons are two major features in eating disorders. This study was designed to assess current and childhood characteristics of eating-disordered men.

METHODS

The authors interviewed 32 men with eating disorders (anorexia nervosa: N=9, bulimia nervosa: N=15, eating disorders not otherwise specified: N=8) and 43 control participants with no such history similar in age and educational status. The Structured Clinical Interview for DSM-IV was used to assess Axis I disorders and a self-designed interview to assess actual social and sexual characteristics and childhood body-focused and social behaviors including sexual and physical abuse.

RESULTS

The two groups differed significantly with regard to clinical, sexual and social features, with a three times higher rate of psychiatric disorders, fewer sexual and social relationships in the index group than in the controls. Eating-disordered men differed significantly from controls on most measures of body-focused and social behaviors, displaying higher rates of thumb sucking, nail biting, auto-aggressive behavior, and nudity as a familial taboo during childhood, as well as less parental bodily caressing than did controls. The index group reported significantly poorer relationships to their parents, fewer friends and persons of trust, and more often had adjustment problems at school than did their counterparts.

CONCLUSIONS

Our data show that disturbed interactions with one's body and with other persons in eating-disordered men are associated with a body-denying and distant family climate and an auto-aggressive, anxious and inhibited social behavior during childhood.

Anterior cingulate grey-matter deficits and cannabis use in first-episode schizophrenia

BACKGROUND

Despite the high prevalence of cannabis use in schizophrenia, few studies have examined the potential relationship between cannabis exposure and brain structural abnormalities in schizophrenia.

AIMS

To investigate prefrontal grey and white matter regions in patients experiencing a first episode of schizophrenia with an additional diagnosis of cannabis use or dependence (n=20) compared with similar patients with no cannabis use (n=31) and healthy volunteers (n=56).

METHOD

Volumes of the superior frontal gyrus, anterior cingulate gyrus and orbital frontal lobe were outlined manually from contiguous magnetic resonance images and automatically segmented into grey and white matter.

RESULTS

Patients who used cannabis had less anterior cingulate grey matter compared with both patients who did not use cannabis and healthy volunteers.

CONCLUSIONS

A defect in the anterior cingulate is associated with a history of cannabis use among patients experiencing a first episode of schizophrenia and could have a role in poor decision-making and in choosing more risky outcomes.

Executive function and memory in relation to olfactory deficits in alcohol-dependent patients

BACKGROUND

Prior research indicates that chronic alcoholism is accompanied by olfactory deficits. These have been suggested to reflect dysfunctions in olfactory brain regions. The present study investigated the role of neurocognitive functioning in tests (executive function and memory) sensitive to the functional integrity of brain areas that are crucial to olfactory processing in patients with alcohol dependence.

METHODS

Performance on olfactory functions (detection threshold, quality discrimination, identification), executive function (Wisconsin Card Sorting Test), and memory (German version of the California Verbal Learning Test) was assessed in 32 alcohol-dependent patients and 30 healthy comparison subjects, comparable in age, gender, and smoking status.

RESULTS

Compared with controls, alcohol-dependent patients were impaired in all 3 domains, olfactory functions, executive function, and memory. In patients, olfactory discrimination ability was positively correlated with executive function performance. Regression analyses conducted to clarify the relation between group (patients vs controls), executive function, memory, and olfactory functions indicated that group was the only significant predictor of olfactory detection threshold and identification, and both group and executive function were found to be the significant predictors of olfactory discrimination.

CONCLUSIONS

Olfactory deficits in alcohol dependence appear to be associated with prefrontal cognitive dysfunction. Results indicate that olfactory quality discrimination deficits are related to executive function impairment. These findings add to the available research on frontal lobe dysfunction in alcoholism, suggesting that alcohol-related olfactory discrimination deficits may be associated with impairment in the functional integrity of the prefrontal lobe.

Childhood body-focused behaviors and social behaviors as risk factors of eating disorders

BACKGROUND

The risk factors for adolescent eating disorders are poorly understood. It is generally agreed, however, that interactions with one's body and interactions with others are two important features in the development of anorexia and bulimia nervosa. Therefore, we assessed a variety of childhood body-focused behaviors and childhood social behaviors in eating-disordered patients as compared to non-eating-disordered subjects.

METHOD

We compared 50 female inpatients with eating disorders (anorexia or bulimia nervosa), 50 female inpatients with polysubstance dependence, and 50 nonpatient female control subjects with no history of eating or substance abuse disorders (all defined by DSM-IV criteria), using a semi-structured interview of our own design. We asked questions about (1) childhood body-focused behaviors (e.g. thumb-sucking) and body-focused family experiences (e.g. bodily caresses), and (2) childhood social behaviors (e.g. numbers of close friends) and family social styles (e.g. authoritarian upbringing).

RESULTS

Many body-focused measures, such as feeding problems, auto-aggressive behavior, lack of maternal caresses, and family taboos regarding nudity and sexuality, characterized eating-disordered patients as opposed to both comparison groups, as did several social behaviors, such as adjustment problems at school and lack of close friends. However, nail-biting, insecure parental bonding, and childhood physical and sexual abuse were equally elevated in both psychiatric groups.

CONCLUSION

It appears that eating-disordered patients, as compared to substance-dependent patients and healthy controls, show a distinct pattern of body-focused and social behaviors during childhood, characterized by self-harm, a rigid and 'body-denying' family climate, and lack of intimacy.

Olfactory functions and volumetric measures of orbitofrontal and limbic regions in schizophrenia

OBJECTIVE

Olfactory deficits in schizophrenia patients have been suggested to reflect medial temporal and/or prefrontal brain abnormalities. In this study, we examined the relationship between different olfactory functions and volumes of the hippocampus-amygdala complex (HAC) and the orbitofrontal brain region using magnetic resonance imaging (MRI).

METHODS

Thirty-three young men with schizophrenia (DSM-IV) and 40 healthy controls performed unirhinal olfactory assessment including the main olfactory functions (threshold, discrimination, and identification), and odor judgements (intensity, edibility, familiarity, and pleasantness). Volumes of regions in the medial temporal lobe (hippocampus and amygdala) and the prefrontal region (orbitofrontal gray and white matter) were measured on MRI scans.

RESULTS

Compared with controls, patients showed bilaterally impaired thresholds, quality discrimination and identification, as well as edibility judgements. Olfactory deficits were not attributable to smoking, premorbid intelligence, or impaired thresholds. Relative to controls, patients had bilateral reduced hippocampus and amygdala volumes. In patients, smaller hippocampus volumes were associated with poorer olfactory discrimination ability.

CONCLUSIONS

Olfactory deficits in schizophrenia appear to be associated with morphometric abnormalities in the medial temporal rather than the orbitofrontal region (OFR). These results indicate that olfactory quality discrimination deficits are related to structural hippocampus abnormalities. Future studies of genetic and behavioral high-risk samples seem warranted.

Various bilateral olfactory deficits in male patients with schizophrenia

Olfactory identification deficits in schizophrenia patients are well documented. Less is known about the functioning of other olfactory domains and the possibility of lateralized dysfunctions. Thirty male schizophrenia patients and 30 male healthy controls underwent unirhinal assessment of various olfactory domains: detection threshold (dimethyl disulfide, phenyl ethanol), quality discrimination, and odor ratings (familiarity, pleasantness, edibility, intensity) of pure chemicals (Munich Olfaction Test), as well as familiarity and edibility judgments and identification of everyday odors. Aside from impaired identification, patients showed impaired familiarity and edibility judgments of everyday odors. With regard to odor ratings of pure chemicals, group differences were observed only in pleasantness ratings, with higher ratings in patients. Furthermore, patients had reduced sensitivity with dimethyl disulfide and reduced quality discrimination compared with controls. Further analyses showed that identification deficits were not attributable to reduced sensitivity but may be associated with impairments in quality discrimination. Olfactory dysfunctions were found across both nostrils. Results suggest specific dysfunctions in olfactory processing in schizophrenia patients, including early stages of the odor identification process.

Body-image dissatisfaction in gay versus heterosexual men: is there really a difference?

BACKGROUND

Gay men are thought to experience body-image concerns or disorders more frequently than heterosexual men. It is unclear, however, whether these putative concerns are due to unrealistic body ideals (aspiring to a body shape that is difficult or impossible to attain), body-image distortion (misperceiving the actual shape of one's body), or both.

METHOD

We administered a well-established computerized body-image test, the "somatomorphic matrix," to 37 gay men recruited from the community in April 1999 and compared the results with previous data from 49 community-recruited heterosexual comparison men and 24 clinic-recruited heterosexual men with eating disorders.

RESULTS

Gay men were indistinguishable from the community-recruited heterosexual comparison men on measures of both body ideals and body-image distortion. By contrast, eating-disordered men were significantly distinguishable from both other groups on body-image distortion. The lack of differences between community gay and heterosexual men on body-image indices seems unlikely to represent a type II error, since the somatomorphic matrix showed ample power to detect abnormalities in the eating-disordered men, despite the smaller sample size of the latter group.

CONCLUSION

Contrary to our hypotheses, gay men did not differ significantly from heterosexual men on measures of body image. These unexpected findings cast doubt on the widespread belief that gay men experience greater body-image dissatisfaction than heterosexual men. If our findings are valid, it follows that some previous studies of body image in gay men may possibly have been influenced by selection bias.

Olfactory functioning in patients with alcohol dependence: impairments in odor judgements

AIMS

Prior studies indicate that alcohol-dependent patients have impaired olfactory sensitivity, odor quality discrimination and identification ability. However, olfactory functioning with regard to the immediate, perception driven odor associations is unknown. Therefore, this study assessed olfactory judgements in nonamnesic and nondemented patients with alcohol dependence.

METHODS

Thirty alcohol-dependent patients and 30 healthy control subjects, well matched for gender, age and smoking status, and screened for olfactory sensitivity, were asked to rate intensity, familiarity, edibility and pleasantness of 16 odors using visual rating scales.

RESULTS

Compared with controls, patients showed lower scores in odor familiarity and impaired edibility judgements. These impairments were observed bilaterally, were present independently of age, gender, general mental abilities and length of abstinence, and not attributable to smoking or impaired olfactory sensitivity. No differences between groups were found in odor intensity and pleasantness judgements.

CONCLUSION

These results extend prior findings of alcohol-related olfactory deficits, indicating impairments in olfactory processes of odor familiarity and edibility in alcohol-dependent patients. Although the basis of these deficits is still unknown, our finding of a distinct pattern of olfactory functional impairment and sparing (intensity, pleasantness) [corrected] suggests that there is no generalized [corrected] olfactory dysfunction, but [corrected] neural olfactory networks may be affected differently. However, alcoholism appears to be associated with a variety of disturbances in olfactory processing [corrected]

No deterioration of cognitive performance in an aggressive unilateral and bilateral antidepressant rTMS add-on trial

BACKGROUND

Cognitive functions were assessed before and following a course of repetitive transcranial magnetic stimulation (rTMS) in patients with depression participating in a sham-controlled, randomized trial of rTMS as adjunct to antidepressant treatment.

METHOD

Forty-one medicated inpatients with a DSM-IV diagnosis of a depressive episode were consecutively randomly assigned to 1 of 3 groups comparing 2 active rTMS conditions with sham stimulation. The rTMS was applied either at high frequency over the left dorsolateral-prefrontal cortex (DLPFC) (10 sessions x 10 trains x 10 seconds 20 Hz at 100% motor threshold [MT], 90-second intertrain interval) or in a combined high- and low-frequency manner to the left and right DLPFC, respectively (10 sessions x 1 train x 10 minutes at 120% MT). Thirty-eight patients completed a neuropsychological test battery at baseline and following day 14. The cognitive assessment focused on motor skills, attention, executive functions, learning, and memory. Data were collected from November 1999 to August 2002.

RESULTS

Active treatment groups did not differ with respect to assessed cognitive measures and thus were pooled. A comparison of short-term changes (baseline-day 14) in neuropsychological performance revealed a more favorable time course of the actively treated patients for encoding in the verbal memory test compared with the sham-stimulated patients.

CONCLUSIONS

Unilateral rTMS as well as bilateral combined rTMS revealed no detrimental effects on cognition, as compared with the sham group. Moreover, neither the add-on design nor the used aggressive parameters had a negative impact on cognitive measures in comparison with sham. Repetitive transcranial magnetic stimulation might have mild beneficial cognitive effects partly independent of its antidepressant efficacy.

No benefit derived from repetitive transcranial magnetic stimulation in depression: a prospective, single centre, randomised, double blind, sham controlled "add on" trial

Repetitive transcranial magnetic stimulation (rTMS) has been reported to demonstrate slight effects in the treatment of depression. Hence, a novel bilateral versus unilateral and sham stimulation design was applied to further assess rTMS' antidepressant effects. Forty one medication free patients with major depression, admitted to a psychiatric unit specialising in affective disorders, were consecutively randomised into 3 groups. Group A1 (n = 12) received unilateral active stimulation consisting of high frequency (hf) rTMS over the left dorsolateral prefrontal cortex (LDLPC) and subsequent sham low frequency (lf) rTMS over the right dorsolateral prefrontal cortex (RDLPC). Group A2 (n = 13) received simultaneous bilateral active stimulation consisting of hf-rTMS over the LDLPC and lf-rTMS over the RDLPC. Group C (n = 13) received bilateral sham stimulation. Stimulation was performed on 10 consecutive workdays. All patients received antidepressant medication on the first day of stimulation, which was continued during and after the stimulation period. As no significant difference in antidepressant outcome between group A1 and A2 was found, the two groups were pooled. The time course of the outcome variables Hamilton depression rating scale (HDRS(21)) and Beck depression inventory (days 0, 7, 14, 28) by repeated measures analysis of variance revealed no significant group differences (in terms of a group by time interaction), whereas there was a significant effect of time on all three outcome variables in all groups. The results suggest that rTMS as an "add on" strategy, applied in a unilateral and a bilateral stimulation paradigm, does not exert an additional antidepressant effect.

Body fat perception in eating-disordered men

OBJECTIVE

We sought to assess the relative roles of body fat ideals and body fat perception in men with eating disorders.

METHOD

We compared 27 men meeting criteria for a current eating disorder (17 with anorexia nervosa and 10 with bulimia nervosa), 21 male mountain climbers, and 21 control men, using a computerized test of body image, the "somatomorphic matrix."

RESULTS

When asked to choose the body that they "ideally would like to have," men with eating disorders selected an image with body fat closely comparable to that chosen by the control men. On perceived body fat, however, the groups differed dramatically. The eating-disordered men perceived themselves to be almost twice as fat as they actually were, whereas the control subjects showed virtually no such distortion. These findings resemble those of a previous study of women, which found that women dieters showed abnormal body fat perception, but not body fat ideals, when compared with non-dieters.

CONCLUSION

These observations suggest that distorted body perception, rather than body ideal, may be central to eating disorders in men. This distinction may be important for both research and therapy.

Reduced olfactory sensitivity, discrimination, and identification in patients with alcohol dependence

BACKGROUND

Various olfactory deficits have been reported in the alcohol-induced amnestic syndrome (Korsakoff's syndrome). Less is known about olfactory functioning in nonamnesic and nondemented alcoholic patients.

METHODS

Olfactory performance of 30 alcohol-dependent patients was assessed unirhinally using the Sniffin' Sticks (threshold, discrimination, identification, composite TDI score) and compared with that of 30 healthy controls, matched for sex, age, and smoking status.

RESULTS

Patients showed significantly reduced olfactory sensitivity (higher threshold), discrimination, and identification compared with controls. No group differences were observed in laterality. Identification and discrimination group differences remained significant after controlling for differences in sensitivity. Olfactory deficits in patients were present independent of age, gender, and duration of abstinence (<3 months) and were not attributable to smoking or general cognitive abilities. More than half of the patients (56.7%) could be classified as hyposmic. Lower overall olfactory functioning (TDI) was associated with longer duration of a regular alcohol intake and higher values of gamma-glutamyltransferase (GGT).

CONCLUSIONS

Olfactory dysfunction is common in nonamnesic and nondemented patients with alcohol dependence. Results suggest a detrimental effect of alcohol on central olfactory processing.