Effects of day-of-injury alcohol intoxication on neuropsychological outcome in the acute recovery period following traumatic brain injury

Some researchers have found that day-of-injury alcohol intoxication is associated with worse outcome following traumatic brain injury (TBI). The purpose of this study is to examine the effects of day-of-injury intoxication on the acute neuropsychological outcome from TBI. Participants were 36 patients with TBI (18 sober, 18 intoxicated) matched on injury severity characteristics and demographic variables. A larger group of 146 patients (112 sober, 36 intoxicated) with TBI was also selected for analyses; not matched on injury severity or demographic variables. Patients had no history of pre-injury alcoholism and were assessed within 10 days post-injury on 13 cognitive measures. Unexpectedly, patients who were sober at the time of injury performed lower on many of the cognitive measures compared to those who were intoxicated. In contrast to the research literature, these results suggest that individuals who were intoxicated at the time of injury performed similarly, and in some cases, better than those who were sober at the time of injury.     

Neurological and neuropsychological effects of low and moderate prenatal alcohol exposure

Several explanations for the diverse results in research on foetal alcohol spectrum disorders or alcohol‐related neurodevelopmental disorder might be at hand: timing, amount and patterns of alcohol exposure, as well as complex epigenetic responses. The genetic background of the offspring and its interaction with other prenatal and post‐natal environmental cues are likely also of importance. In the present report, key findings about the possible effects of low and moderate doses of maternal alcohol intake on the neuropsychological development of the offspring are reviewed and plausible mechanisms discussed. Special focus is put on the serotonergic system within developmental and gene–environment frameworks. The review also suggests guidelines for future studies and also summarizes some of to‐be‐answered questions of relevance to clinical practice. Contradictory findings and paucity of studies on the effects of exposure to low alcohol levels during foetal life for the offspring's neuropsychological development call for large prospective studies, as well as for studies including neuroimaging and multi‐omics analyses to dissect the neurobiological underpinnings of alcohol exposure‐related phenotypes and to identify biomarkers. Finally, it remains to be investigated whether any safe threshold of alcohol drinking during pregnancy can be identified.     

Gender effects in diagnosing alcohol abuse and dependence

Using a national population sample of 43,809 adults, male and female responses were compared for 41 indicators of alcohol abuse and dependence. While men reported all indicators more often than did women, the male to female ratio of positive responses varied according to both the construct represented by the item and its underlying prevalence. Items that might be construed as signs of weakness — physical effects, psychological effects, and loss of control or powerlessness — had lower male/female ratios than other items. Excess male prevalence was greatest for the least prevalent indicators. The paper presents alternative interpretations of these findings and discusses their implications for diagnostic classification.     

Corpus callosum atrophy and neuropsychological outcome following carbon monoxide poisoning.

This study assessed the effects of carbon monoxide (CO) poisoning on the corpus callosum (CC). Sixty-two CO-poisoned patients had MRI scans and a battery of neuropsychological tests within 24 h (day of exposure) of CO poisoning and at 6 months post CO exposure. Serial quantitative magnetic resonance imaging (QMRI) analysis of the CC was carried out, with the day of exposure scans compared to the 6-month scans. There was no difference between normal subjects' CC and the baseline scans in the CO-poisoned patients. We detected a 15-mm2 loss in the cross-sectional surface area of the CC between baseline and the 6-month follow-up scans. The effect on the CC was generalized atrophy rather than CC subregion-specific changes. Neuropsychological test results performed at baseline and at 6 months did not correlate with the level of CC atrophy. Independent of any CC effects, the patients exhibited impaired memory, attention, and executive functioning on baseline testing, with variable improvement in cognitive function at 6 months. Quantitative MRI analysis allows for the detection of subtle CC changes that may not otherwise be observed following CO poisoning. The long-term effects of CO on the brain have been historically underestimated; however, we found subtle but significant CC atrophy and cognitive impairments following CO poisoning.     

Motor performance during and following acute alcohol intoxication in healthy non-alcoholic subjects

Chronic alcohol abuse has adverse effects on skeletal muscle, and reduced muscle strength is frequently seen in chronic alcoholics. In this study the acute effects of moderate alcohol intoxication on motor performance was evaluated in 19 non-alcoholic healthy subjects (10 women, 9 men). A randomised double-blinded placebo controlled design was applied to subjects receiving alcohol in juice and pure juice at two separate test periods. Isokinetic and isometric muscle strength and endurance were determined before, during, 24 and 48 h after the ingestion of alcohol in juice and juice (placebo). To detect a reduced activation of the central motor pathways superimposed external electrical stimulations during voluntary contractions were applied. Creatine kinase (CK) was measured to detect any alcohol-induced changes in sarcolemmal integrity. No change was seen in isokinetic as well as in isometric muscle performance during or following the alcohol intoxication as compared to the non-alcoholic condition. Also, no central activation failure was observed. No significant difference in CK increment was observed comparing the alcoholic- and non-alcoholic condition. In conclusion, a single episode of moderate alcohol intoxication (1,4 g/l) does not impair motor performance, and no accelerated exercise-induced muscle damage is seen.     

Feasibility of the neuropsychological spectrum in prediction of outcome following head injury

This study provided further substantiation of the neuropsychological spectrum conceptualization (Templer, Campodonico, Trent, Spencer, & Hartlage, to appear; Templer, Spencer, & Hartlage, 1993; Templer, Campodonico, Trent, & Spencer, 1991). Two hundred and two traumatic brain injury patients were administered the Wechsler Adult Intelligence Scale-Revised, the Luria-Nebraska Neuropsychological Battery, the Wisconsin Card Sorting Test, the Booklet Category Test, and Trails A and B. The correlations between neuropsychological and intellectual tests were significantly lower than the correlations within intelligence tests and within neuropsychological tests. Neuropsychological tests predicted outcome better than intelligence tests. This was interpreted in terms of outcome for severely brain-damaged patients being more dependent upon basic neuropsychological functioning than on abstract thinking ability. © 1996 John Wiley & Sons, Inc.     

Genetic effects on anger control and their interaction with alcohol intoxication: A self-report study

Individual differences in anger control are important to consider when trying to understand intoxicated aggression (Parrott and Giancola, 2004). We explored, first, genetic and environmental effects on anger control both in self-reported sober and alcohol intoxicated states, and whether the same genetic and environmental effects influence it in both these states, and second, a possible interaction between genetic effects and alcohol in the control of anger. In the population based sample (N = 8964) of Finnish twins (18-33 years) and their siblings (18 years or older), genetic effects on anger control were found both for the self-reported sober (27% for men, 34% for women) and alcohol intoxicated states (29% for men, 37% for women), with high genetic correlations (from .77 to .85) between these states. Genetic effects (26% for men, 29% for women) were also found for the difference in anger control between the self-reported sober and alcohol intoxicated states, suggesting the effect of alcohol on anger control depends on the genotype of the individual.     

Separate and combined effects of smoking and alcohol abuse in middle-aged men

Alcohol abuse is a major predictor of premature death, and also an independent risk factor for coronary death. Alcoholics are often heavy smokers. In a large primary prevention trial in middle-aged men with 7,495 participants, registration data were used to identify subjects with alcohol problems. Smokers had slightly lower blood pressure and were somewhat leaner than non-smokers, but had slightly higher serum cholesterol levels. Alcohol-registered subjects also tended to have lower blood pressure levels, and higher serum cholesterol. The relative risk of non-fatal myocardial infarction during the follow-up period of 11.8 years was essentially doubled in smokers compared to non-smokers, regardless of registration for alcohol problems. Among the non-alcoholic subjects, the relative risk of coronary death in smokers was double that of non-smokers, whereas the risk in non-smoking alcoholic subjects was not significantly increased. In smoking alcoholics the relative risk was substantially raised to 4.2 (3.0-7.0; 95% c.i.). In multivariate analysis both smoking and alcohol abuse were independently associated with coronary death. A possible mechanism might be through a combination of tobacco-induced coronary arteriosclerosis and the cardiotoxic effects of alcohol. As to total mortality, a smoking non-alcoholic man had a relative risk of dying almost double that of a non-alcoholic non-smoker. Among non-smoking alcoholics the risk was three times and, in smoking alcoholics over four times that of the non-alcoholic non-smokers.     

葛根解酒胶囊对小鼠急性酒精中毒的预防及治疗作用

目的:探讨葛根解酒胶囊对急性酒精中毒小鼠的预防及治疗作用。方法:跳楼试验:选昆明小鼠30只,随机分为三组,每组10只,对照组:给予50%酒精0.2 ml·10g-1灌胃;药物治疗组:给予浓度为12 mg·ml-1的葛根解酒胶囊溶液0.2ml·10g-1灌胃,1h后各只给予50%酒精0.2ml·10g-1灌胃;非药物治疗组:给予生理盐水0.2ml·10g-1灌胃,1h后各只给予50%酒精0.2ml·10g-1灌胃;10min后将小鼠放到单杆上,观察并记录小鼠在单杆上停留的时间。水迷宫试验:经过水迷宫训练的昆明小鼠30只,随机分为3组,对照组:50%的酒精0.2ml·10g-1灌胃,20 min之后投入水迷宫;药物治疗组:50%的酒精0.2ml·10g-1灌胃,10min后浓度为12mg·ml-1葛根解酒胶囊溶液0.2ml·10g-1腹腔注射,再过10min后把小鼠投入水迷宫;非药物治疗组:50%的酒精0.2ml·10g-1灌胃,10min后生理盐水0.2ml·10g-1,腹腔注射,再过10min后把小鼠投入水迷宫,记录小鼠投入水迷宫后能否找到并爬上平台的只数,并记录其平均游泳速度。结果:药物治疗组维持平衡时间(266.9±52.4s)明显长于非药物治疗组(173.5±74.1s)和对照(155.8±54.8s)(P0.01);葛根解酒胶囊能够促进小鼠找到平台(P0.05),药物治疗组小鼠的游泳速度(17.2±9.4cm·s-1)比非药物治疗组(8.02±4.8cm·s-1)及对照组(7.01±4.1cm·s-1)快(P0.05)。结论:葛根解酒胶囊对急性酒精中毒有一定预防及治疗作用。     

Couples- versus individual-based therapy for alcohol and drug abuse: effects on children's psychosocial functioning

The study compared the effect of couples-based versus individual-based therapy for men who entered outpatient substance abuse treatment on the psychosocial functioning of children in their homes. Men were randomly assigned to (a) behavioral couples therapy (BCT), (b) individual-based treatment (IBT), or (c) couples-based psychoeducational attention control treatment (PACT). For both children of alcohol--(N = 71) and drug-abusing men (N = 64), parents' ratings of children's psychosocial functioning was higher for children whose fathers participated in BCT at posttreatment and at 6- and 12-month follow-up than for children whose fathers participated in IBT or PACT. BCT resulted in greater improvements in parents' dyadic adjustment and fathers' substance use. Thus, couples-based intervention that addresses both issues may have greater benefits for children in these homes.     

The neuropsychological similarities of mild and more severe head injury.

Reports in the literature have suggested that the neuropsychological effects of mild head injury are selective, represented by impairment of attention, information processing, and memory, and that evaluations with comprehensive and standard test batteries are likely to miss such deficits. The present study compared groups of individuals with mild head injuries, more severe head injuries, and non-brain-damaged controls using 19 tests from the Halstead-Reitan Battery. The results indicated that the group with mild head injuries performed significantly poorer than the controls, and that the group with more severe head injuries scored significantly more poorly than either of the other groups. Comparisons of the pattern of test scores for the two head-injured groups were remarkably similar across the 19 tests, yielding a rank difference correlation of 0.87. The findings yielded no evidence of selective or delimited impairment in the group with mild head injuries, but instead, showed them to have test results that were very similar, though showing less neuropsychological impairment, to the group of subjects with more severe head injuries. These findings suggest that a comprehensive neuropsychological test battery is necessary to detect the broad range of deficits that may result from mild head injury.     

Neuroendocrinological responses to alcohol intoxication in healthy males: Relationship with impulsivity,drinking behavior,and subjective effects

Ambiguous biochemical and subjective responses to alcohol may relate to preexisting individual differences in alcohol expectations, experience, or impulsivity. This study examined cortisol and alpha‐amylase responses to alcohol and their association with trait impulsivity, alcohol expectancy, and subjective reports of alcohol's effects. Eighty‐seven males assigned to an alcohol, sober, or placebo group provided biochemical and self‐report measures. Both cortisol and alpha‐amylase increased following alcohol administration. Impulsivity correlated with cortisol changes, and the greatest rise in cortisol correlated with high stimulating effects in the alcohol group. These findings emphasize the importance of individual differences in alcohol responses and support a relationship between hormonal responses and alcohol use.     

Detecting neuropsychological malingering: effects of coaching and information.

Concerns that patients presenting for neuropsychological assessment may not be putting forth maximum effort during testing has prompted the development of measures designed to detect malingering and incomplete effort. Two of these measures are the Computerized Assessment of Response Bias-97 (CARB-97) and Word Memory Test (WMT). Despite widespread use of these instruments, no study has been published determining the vulnerability of neuropsychological malingering measures to explicit coaching or brain injury information. The present study, using analog participants, found that the CARB-97 and WMT differentiate "normal" from "malingered" instructional sets, and show little difference between nai;ve and coached malingering efforts. There was also little difference between providing brain injury information and a no-information condition, but when effects were present, the information group generally scored worse. Further, it was found that response times (RTs), in addition to items correct, may also be effective in detecting those who are not giving their full effort.