Neurocognitive impairment due to chronic alcohol consumption in an American Indian community

OBJECTIVE: Studies have shown that clinically ascertained alcoholics tend to have lower scores than nonalcoholics on cognitive performance tests, particularly the Block Design (BD) and Digit Symbol (DS) tests of the Weschler Adult Intelligence Scale-Revised (WAIS-R). The aim of this study was to determine whether similar differences are found in a community sample of Plains Indian men and women with an episodic pattern of drinking and a high lifetime prevalence of alcoholism (71% for men, 44% for women). METHOD: We administered a truncated form of the WAIS-R to 334 members of a Plains Indian tribe (197 women and 137 men). Blind-rated psychiatric diagnoses were assigned according to Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III-R) criteria and based on the Schedule for Affective Disorders, Lifetime Version (SADS-L) interview. We compared 68 currently drinking alcoholics (38 men and 30 women), 116 abstaining alcoholics (59 men and 57 women) and 150 nonalcoholics (40 men and 110 women). RESULTS: Current and past heavy drinking had no impact on WAIS-R scores in women. Male alcoholics who were abstinent > or = 2years had similar scores to nonalcoholic men. Male current drinkers showed a trend for lower overall verbal and performance (PIQ) scores and BD performance subtest. Further analysis showed that drinking for > or = 15 years was significantly associated with reduced DS in male current drinkers. CONCLUSIONS: These findings suggest that for the men in this community sample, the impact on PIQ is due to the direct effect of chronic alcohol consumption on cognitive performance and is at least partially reversible after 2 years of abstinence.     

Treatment-naive active alcoholics have greater psychiatric comorbidity than normal controls but less than treated abstinent alcoholics

BACKGROUND: Most alcoholism research in the U.S. uses convenience samples of treated alcoholics. The findings from treated samples have traditionally been applied to all alcoholics, including the 75% of alcoholics who are untreated. Improper generalization from select samples to an entire population is called 'Berkson's fallacy'. We compared untreated versus treated alcoholics, in order to ascertain whether both groups belonged to the same population with regard to psychiatric comorbidity. METHODS: We compared psychiatric comorbidity in 1) active treatment-naive alcoholics (TNA; n=86) 2) treated long-term abstinent alcoholics (TAA; n=52) and 3) non-alcoholic controls (NAC;n=118). We examined lifetime and current diagnoses, lifetime symptom counts, and psychological measures in the anxiety, mood and externalizing disorder domains. RESULTS: TNA did not differ from NAC in psychiatric diagnosis rates, were abnormal compared to NAC on all psychological measures, had more externalizing symptoms than NAC, and showed a strong trend for men to have more symptoms in the mood and anxiety domains. TAA compared to TNA had higher diagnosis rates (all domains), symptom counts (all domains), and psychological measures of deviance proneness, but were comparable to TNA on anxiety and mood psychological measures. CONCLUSIONS: The abnormal thinking (psychological measures) in TNA (versus NAC) does not extend to behavior (symptoms) to the degree that it does in TAA. These results underline the importance of the use of subdiagnostic measures of psychiatric comorbidity in studies of alcoholics. The finding of lesser comorbidity in TNA versus TAA confirms the presence of Berkson's fallacy in generalizing from treated samples to all alcoholics.     

慢性酒中毒病人认知功能障碍与脑电图变化

探讨慢性酒中毒病人认知功能障碍与脑电图变化的关系。方法··:同期选取慢性酒中毒病人81例及非饮酒者78例进行记忆功能、智力测定及脑电图检查。结果··:慢性酒中毒病人组记忆功能和智力各项分均显著低于正常组 (P<0.001) ;脑电图异常组的记忆两项分测验及总分和记忆商 (MQ)均低于脑电图正常组 (P<0.05 -0.01) ;脑电图异常组的智力测验中语言智商和总智商 (IQ)分低于脑电图正常组 (P<0.05 -0.01)。结论··:慢性酒中毒病人的认知功能减退与酒中毒后脑电生理活动变化有相关性。     

Neuropsychological Effects of Chronic Cannabis Use on the Memory and Intelligence of Adolescents

Fifteen marijuana-dependent adolescent abusers (mean age = 16.9 years) were administered the full Wechsler Memory Scale-Revised and Wechsler Adult Intelligence Scale-Revised. Subjects had no history of other substance or alcohol abuse or dependence, cerebral trauma, psychiatric or nerological disorders. They had been abstinent form marijuana for an average of 27 days, and the majority of them were given urine tests to verify their abstenence. Comparisons among intelligence and memory indices revealed serveral significant findings that are consistent with the pattern produced by cerebral dysfunction. Specifically, memory indices were significantly reduced in relation to both intellectual function and attentional ability. In contrast, intelligence was in the normal range and unchanged relative to the estimated premorbid level. This profile is a characteristic finding in patients who are recovering form chronic impairment of memory function.     

酒依赖患者乙醇脱氢酶不同基因型与认知功能受损关系的研究

目的：研究酒依赖患者乙醇脱氢酶2不同基因型（ADH2＊1／ADH2＊1（野生型）、ADH2＊1／ADH2＊2（杂合型）、ADH2＊2／ADH2＊2（突变型））患者认知功能受损状况。方法：分别应用韦氏成人智力量表和韦氏记忆量表对107例酒依赖患者进行智力和记忆功能评定,对不同基因型患者认知受损的状况进行比较。结果：突变型患者智商、记忆商均显著低于野生型及杂合型。结论：突变型酒依赖患者认知功能受损更加严重。     

阿立哌唑与氯丙嗪对慢性精神分裂症认知功能的影响

目的比较阿立哌唑与氯丙嗪对慢性精神分裂症认知功能的影响。方法入组60例慢性精神分裂症患者,其中随机分成阿立哌唑组和氯丙嗪各30例治疗12周,采用韦氏成人智力量表（WAIS—RC）,韦氏记忆量表（WMS）,威斯康星卡片分类测验（WCST）及持续操作测验（Crq9在治疗前及治疗12周后进行认知功能测定。结果治疗12周后阿立哌唑组WAIS、WCST、WMS、CPT中绝大多数指标评分均较治疗前有显著改善（P〈0．05或P〈0．01）,而氯丙嗪组各项认知功能评分元显著改善（P〉0．05）。两组治疗后的比较除WCST中正确反应数、WMS中背数、CPT中正确数及反应时间外,其余各项认知功能指标中阿立哌唑组均较氯丙嗪组有显著改善（P〈0．05）。结论阿立哌唑对慢性精神分裂患者认知功能障碍有良好的改善,更有利于患者整体康复,值得临床推广。     

Basic aspects of blood platelet monoamine oxidase activity in hospitalized men alcoholics

Platelet MAO activity (tryptamine as substrate) was assessed in 44 hospitalized men alcoholics to examine the relationships between MAO levels and variables related to alcohol misuse and physiological status. Mean MAO levels were lower in this population than in normal controls and hospitalized psychiatric patients. MAO activity correlated with age but was independent of variables derived from self-reported drinking histories and scales of alcohol dependence. Similarly, platelet MAO activity was not related to the misuse of other drugs. Of the variance in MAO activity, 38% could be accounted for by age, and the values of Mg++, low density lipoproteins and eosinophil combined. The significance of low platelet MAO activity in alcoholics is discussed.     

Visuoperceptive deficits in long-term alcoholics and alcoholics with Korsakoff's psychosis

Compared with control subjects, alcoholics with Korsakoff's psychosis were significantly impaired in performance on the digit-symbol subtest of the Wechsler Adult Intelligence Scale and in four tasks assessing related processes. Other alcoholics showed similar, but not as severe, visuoperceptive deficits when compared with controls.     

Alcohol Gel Ingestion Among Homeless Eastern and Central Europeans in London: Assessing the Effects on Cognitive Functioning and Psychological Health

Background: Intentional consumption of alcohol-based hand gels has been reported especially amongst non-UK national, alcohol dependent, homeless individuals in London. Whilst alcohol misuse is known to be associated with impaired cognitive functioning and mental health problems, the effects of additional ingestion of alcohol gel are unknown. Objectives: To explore cognitive and psychological functioning in users who intentionally ingest alcohol gel compared with ethyl-alcohol only misusers and controls. Methods: Male, Central and Eastern European alcohol only misusers, (n = 14; mean age 39 years), alcohol gel users (n = 14; mean age 43 years) and controls (n = 12; mean age 31 years) were recruited from a London Homeless Service during 2013/14. Alcohol misusers, alcohol gel users and controls were compared on the Forwards and Backwards Digit Span Test; Block Design test; Retrospective and Prospective Memory Questionnaire (PRMQ) and the Hospital and Anxiety Depression Scale (HADS). Results: Alcohol gel users performed significantly worse on the Block Design task (p < .01) and PRMQ (p < .01) relative to both alcohol only and control groups, and significantly worse on the digit span relative to controls (p = .01). Both alcohol misusing groups scored comparatively on digit span backwards (p < .01), with both groups performing significantly worse than controls. The alcohol gel group reported significantly higher levels of anxiety relative to controls (p = .02). Conclusions: Whilst there could be constitutional differences between alcohol misusers who additionally abuse alcohol gel, the findings suggest that alcohol gel ingestion may have a greater impact on psychological functioning than traditional alcohol misuse.     

氯胺酮滥用者认知功能障碍的临床研究

目的：探讨氯胺酮滥用者认知功能损害状况及其影响因素。方法：回顾性地分析46例住院患者的临床资料,并对韦氏记忆测验的记忆商洲Q）和韦氏成人智力测验的智商（100水平与31名正常对照组进行比较。结果：氯胺酮滥用者的MQ平均为85．4±8．4,总智商（FIQ）为8514±9．0,均显著低于对照组。滥用者MQ在临界及以下水平者为47．8％,FIQ在临界及以下水平者占43．5％。滥用者MQ异常组年龄平均21．9±3．8岁,显著小于RQ正常组。结论：氯胺酮滥用者存在明显的认知功能损害,年龄较小者的MQ易受损害。     

Effects of alcohol on baseline startle and prepulse inhibition in young men at risk for alcoholism and/or anxiety disorders

OBJECTIVE: This study examined the hypothesis that a decreased reaction to alcohol and a deficit in prepulse inhibition (PPI) of the startle reflex are characteristics of male offspring of alcoholics without comorbid anxiety disorder. METHOD: Male offspring (N = 51) with a parental history of (1) alcoholism only, (2) anxiety disorder only, (3) alcoholism and anxiety disorder, and (4) no psychiatric disorder participated in an experiment examining the effects of alcohol on the acoustic startle reflex and on PPI. The experiment was carried out in two sessions in which subjects received an alcoholic beverage and placebo beverage on alternate days. RESULTS: The magnitude of startle was reduced by alcohol in each group. However, the degree of reduction was less in the offspring of alcoholics only compared to the other groups. In addition, PPI was reduced in the offspring of alcoholics only compared to the offspring of parents with no psychiatric disorder. CONCLUSIONS: A reduced reactivity to the effect of alcohol and a deficit in PPI might constitute vulnerability markers for alcoholism, but only in offspring of alcoholics without comorbid anxiety disorder.     

Risk factors for neuropsychological impairment in alcoholics: antisocial personality, age, years of drinking and gender

One hundred eighty-two alcoholics were studied using subtests from the Halstead-Reitan Neuropsychological Battery, Wechsler Adult Intelligence Scale and the Wechsler Memory Scale. Alcoholics who displayed antisocial personality disorder (ASPD) were more impaired on the Brain Age Quotient, a summary measure of neuropsychological impairment. Multivariate analyses indicated that presence of ASPD contributed significantly to this impairment, independent of age, length of drinking history or gender. Discriminant analysis using these variables as predictors allowed for clinically useful levels of prediction of neuropsychological impairment in individual subjects.     

Attention and memory in illicit amphetamine users

The purpose of this study was to assess cognitive functioning in a group of illicit amphetamine users. A neuropsychological test battery (Wechsler Memory Scale-Revised (WMS-R) and the digit symbol, block design and vocabulary subtests of the Wechsler Adult Intelligence Scale-Revised (WAIS-R) and the National Adult Reading Test (NART)) was administered to 78 amphetamine users (mean age=22.5 years; 46 males, 33 females). Severity of amphetamine dependence was found to be associated with poorer performance on both memory and attention/concentration indices of the WMS-R. The relative contribution of amphetamine dependence, concurrent drug use and other drug related factors to neuropsychological functioning are discussed.     

Sub-diagnostic psychiatric comorbidity in alcoholics

BACKGROUND: Psychiatric comorbidity in alcohol use disorders is clearly established, however most studies ignore data on psychiatric symptom counts that do not meet criteria for a diagnosis. We examined psychiatric symptom counts and psychological measures in the domains of anxiety, mood and externalizing pathology in 48 long-term abstinent alcoholics (LTAA) compared to 48 age/gender comparable light/non-drinking controls (NC). METHODS: Continuous measures of pathology (i.e., symptoms counts and psychological assessments) in each domain were compared between groups for: (1) all study participants, (2) excluding individuals with a lifetime psychiatric diagnosis in the domain, and (3) excluding individuals with a current psychiatric diagnosis in the domain. RESULTS: Psychiatric symptom counts and psychological pathology were greater in LTAA than NC. The differences between groups on these measures were not reduced by removal of individuals with lifetime or current diagnoses. CONCLUSIONS: The bulk of the difference between LTAA and NC in psychiatric illness was carried by sub-diagnostic psychopathology. In comparison to the limited view provided by using only symptomatology that meets criteria for a diagnosis, the use of continuous measures of psychiatric symptomatology and psychological abnormality yields a much more accurate picture of psychiatric illness co-occurring with alcoholism.     

Mood and neuropsychological changes in women with midlife depression treated with escitalopram

OBJECTIVE: This study assessed mood and neuropsychological function in a population of middle-aged women with major depressive disorder treated with escitalopram. METHODS: Psychometric data measuring severity of depression were collected from 19 women and neuropsychological data were collected from 17 women aged between 45 and 65 years with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis of major depression in a study in the Behavioral Neuroendocrinology Program at the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine. All women were treated with escitalopram in an open-label design. Mean age was 55.94 years and mean number of years of education was 16.36 years. Diagnosis of major depressive disorder was assessed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and mood was evaluated with the 21-item Hamilton Depression Rating Scale (HAM-D) at baseline and at weekly follow-ups for 12 weeks. Cognition was assessed at baseline and 3 months after treatment using a neuropsychological test battery, which included an abbreviated measure of Full Scale Intelligence Quotient, measures of attention and processing speed, verbal and nonverbal memory, executive functioning, and verbal fluency. Self-report data were collected on current menopause status and current hormone therapy use in the postmenopausal women. Paired sample t tests were used to analyze the change in total HAM-D scores and neuropsychological variables. RESULTS: Statistically significant improvements were found in total HAM-D score, Wechsler Memory Scale III Logical Memory 1st Recall, I, and II scores, Wechsler Memory Scale III Visual Reproduction I scores, and Trail Making Test Part B scores. There was a statistically significant decrease in Controlled Oral Word Association Test FAS scores. CONCLUSIONS: Treatment of depression with escitalopram in a population of middle-aged women was shown to improve mood and cognitive efficiency in complex attention, short- and long-term recall of contextual information, short-term recall of visual information, and cognitive flexibility; however, it was shown to worsen phonemic fluency.     

Is withdrawal-induced anxiety in alcoholism based on β-endorphin deficiency?

RATIONALE: Associations between several psychopathological alterations and lowered beta-endorphin(beta E) plasma levels have already been stated in former studies. However, whereas single measures during static conditions generally failed in linking beta E levels with psychopathology, dynamic changes of beta E in particular have been shown to be associated with spells of anxiety and depression. During alcohol withdrawal, a decreased secretion of beta E with a delayed normalization has been reported, but up to now only few data became available regarding the interaction of plasma beta E and psychopathological parameters. OBJECTIVES: The aim of our study was to test the hypothesis whether beta E during acute alcohol withdrawal is associated with anxiety, depression, and craving. METHODS: We observed self-rated anxiety, depression, and craving during alcohol withdrawal and assessed beta E levels (RIA) in a consecutive sample of 60 alcoholics on day 1 and day 14 after onset of withdrawal, and in 30 healthy volunteers. To control for mutual interactions of beta E and the pituitary-adrenocortical hormone secretion, plasma corticotropin (ACTH) and cortisol were also determined. RESULTS: In accordance with prior studies, beta E was significantly lowered on day 1 and day 14 of alcohol withdrawal relative to controls. Plasma levels of ACTH correlated significantly with beta E in alcoholics at both time points and in controls, without differing significantly between the groups. Self-rated anxiety, depression, and alcohol craving decreased significantly between day 1 and day 14. Levels of beta E were inversely correlated with anxiety day 1 (r=-0.58) and day 14 (r=-0.71). Partial correlation coefficients controlling for ACTH plasma levels revealed that this correlation was largely independent from ACTH. In addition, a significant inverse relationship was found between beta E and craving on day 14 (r=-0.28). No association appeared between beta E and depression. CONCLUSIONS: Our results give first evidence that lowered beta E during alcohol withdrawal may contribute to anxiety as a common disturbance during this state.     

The co-occurrence of alcoholism with other psychiatric disorders in the general population and its impact on treatment

It is apparent from previous studies in clinical populations that there is a high comorbidity rate between alcoholism and other psychiatric diagnoses. However, this may simply be an expression of Berkson's bias (i.e., an increased tendency for persons with multiple diagnoses to seek and receive treatment and thus fall into study populations drawn from treatment sources). In this article, we use data from the Epidemiologic Catchment Area survey to examine the comorbidity between alcohol abuse and dependence, other substances of abuse and nonsubstance psychiatric disorders in a sample of approximately 20,000 persons drawn from the general population. We also examine the effect of comorbidity on psychiatric treatment. Every one of the psychiatric diagnoses we examined was more likely to occur in alcoholics than in nonalcoholics. Associations were particularly strong with antisocial personality disorder, other substance use and mania. The association between alcoholism and depressive disorders was positive but not very strong. The presence of other illnesses increased the likelihood of utilization of treatment services by alcoholics but did not increase the likelihood that drinking problems would be communicated to a doctor. The findings confirm prior studies of comorbidity in clinical samples and suggest the need for increased vigilance toward alcoholism by physicians.     

Psychiatric comorbidity in older long-term abstinent alcoholics

Background

We compared 89 older abstinent alcoholics (OAA, mean abstinence of 14.8 years), to 53 age and gender-comparable older non-alcoholic controls (ONC) with regard to lifetime and current psychiatric diagnoses, lifetime psychiatric symptom counts, and psychological measures in the mood, anxiety, and externalizing disorder domains. We compared these findings with our previously reported results in analogous middle-aged samples (MAA versus MNC).

Methods

The methods used were the same as in our previous study of MAA versus MNC.

Results

OAA had more lifetime psychiatric and mood disorder diagnoses than ONC. They also had more lifetime symptoms and psychological test evidence of psychiatric disorder in all domains. However, OAA were less different from ONC than were MAA from MNC on most psychiatric and psychological measures. In both studies, differences between alcoholics and controls were dramatically larger in the externalizing compared with the mood and anxiety domains, and there was little evidence that psychiatric comorbidity measures impacted abstinence duration.

Conclusions

The finding that OAA had less psychiatric illness than MAA may involve a combination of selective survivorship, selection bias, and cohort differences. Although selection bias may be present in clinical studies of samples of any age, it is a more potent problem in older samples. However, given these potential biases, our results underestimate psychiatric comorbidity in OAA, strengthening our finding of increased psychiatric disorder in OAA versus ONC.     

Alcohol dependence among Alaska Natives entering alcoholism treatment: a gender comparison

OBJECTIVE: An ongoing study of phenotypes of alcohol dependence among Alaska Natives provides an opportunity to investigate the nature and patterns of alcohol problems among Alaska Native men and women admitted to treatment in three residential programs in Anchorage, Alaska. METHOD: A comprehensive, standardized clinical assessment (including the SSAGA-I diagnostic interview, family history information, personality traits and cognitive functioning) of consecutive admissions to each of the three programs is being undertaken by trained interviewers. To date, 200 (103 male) subjects have been assessed. The mean (+/- SD) age of the sample is 32+/-8.5 years old. The development of alcohol problems, the psychological and physical consequences of chronic drinking, the flushing response, withdrawal symptoms and comorbid lifetime psychiatric conditions were examined. RESULTS: The sample was characterized by an early onset of drinking and an acute exacerbation and clustering of drinking problems during late adolescence, followed by the development of severe alcohol dependence. A high lifetime prevalence of DSM-III-R major depressive disorder was found, typically complicated by chronic drinking. The rates of other substance dependencies were relatively low, except for cannabis and cocaine dependence among female subjects. CONCLUSIONS: This sample of treatment-seeking Alaska Natives was found to have an early onset and severe form of DSM-III-R alcohol dependence, with few gender differences noted. While the prevalence of alcohol abuse and alcohol dependence among Native American populations has been reported to be quite high, the onset and patterning of symptoms among this sample of treated Alaska Natives has revealed more similarities with treated alcoholics from the majority population than important differences specific to Alaska Natives.     

Aggressiveness,family history of alcoholism,and the heart rate response to alcohol intoxication

Some sons of male alcoholics (SOMAs) are characterized by an increased heart rate (HR) response to alcohol intoxication, which is thought to reflect increased sensitivity to alcohol-induced reward. Such a response has also been related to increased physical aggression. However, the confounding effect of aggression in SOMAs may be obscuring the interpretation of these findings. The HR response to alcohol was therefore assessed in 4 groups: high/low aggressive SOMAs and high/low aggressive non-SOMAs. Results indicate that aggressive SOMAs had the highest intoxicated HR response and that they reported the most alcohol consumption. This suggests that in some cases the high comorbidity between alcohol misuse and aggression is related to an increased sensitivity to alcohol-induced reward.