Original Research Article
Cognitive impairment and effects of abstinence on
cognition in patients with alcohol dependence
syndrome
Prakash Ambekar1, Sunil Goyal2*
1
Assistant Professor, Department of Psychiatry, IIMSR Medical College, Badnapur, Jalna, Maharashtra, INDIA.
Professor, Department of Psychiatry, INHS Ashvini Hospital, Colaba, Mumbai, Maharashtra, INDIA.
2
Abstract
Background: Alcohol dependence continues to be one of the most costly health care problems in the world. Brain
damage due to alcohol intake is more common than one may think. Consequent to brain damage, cognitive impairment
has been a cause of concern. In this study, the focus is to examine the cognitive and executive function in alcohol
dependence syndrome patients. Ojectives of the study were to assess different domains of cognition in patients of alcohol
dependence syndrome and to reassess cognitive functioning after four weeks of abstinence. Methods: A total of 50
alcohol dependent male inpatients were recruited for this study in the age range of 20 to 50 years after exclusion of other
morbidities and informed consent. Baseline demographic data of cases alongwith relevant investigations were collected
in first week. Alcohol use further assessed with AUDIT (Alcohol Use Disorder Identification Test). Baseline cognitive
assesment using PGI Battery of Brain dysfunction (PGI-BBD) was done for the study group (Pre-treatment group) after
detoxification i.e. 2 days after benzodiazepines were tapered off. While the management continued in maintainance
phase, Cognitive assessment of the study group (now as post-treatment group) was repeated after one month.
Results: The mean age of subjects in study was 38.40 years. The mean education of subjects was 10.30 years, the mean
AUDIT score was 18.56. Different domains of cognition such as memory, intelligence and percepto-motor functioning
with sub-domains of each were recorded. Study results had validated assumption that there is significant cognitive
impairment among alcohol dependent cases. Dysfunction rates in all domains of memory, intelligence and perception
improved post-treatment in the study group. Conclusion: The cognitive deficits may not be detected in routine clinical
examinations, but with formal neuropsychological assessment using sensitive scales, the extent of impairment can be
assessed both qualitatively and quantitatively. Awareness of alcohol’s effects on cognition can help health-care providers
in addressing the problem and instituting appropriate treatment as well in further research on specific neuro-toxic effects
of alcohol.
Key Words: Alcohol dependence syndrome, Cognitive impairment, Neuro-toxic effects of alcohol.
*
Address for Correspondence:
Dr. Sunil Goyal, Professor, Department of Psychiatry, INHS Ashvini Hospital, Colaba, Mumbai, Maharashtra, INDIA.
Email: drprakshambekar@gmail.com
Received Date: 02/08/2017 Revised Date: 26/09/2017
Accepted Date: 15/10/2017
DOI: https://doi.org/10.26611/107413
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Accessed Date:
18 October 2017
INTRODUCTION
Alcohol dependence continues to be one of the most
costly health care problems in the world. Alcohol
consumption is the world’s third largest risk factor for
disease and disability.1 In the Indian population,
increasing social acceptance and trend to follow western
world are important reasons for the phenomenal increase
in alcohol consumption, with the initiation age going
down to 13.6 years. National Household Survey of Drug
Use recorded alcohol use in the past year in only 21
percent of adult males. The prevalence of current use of
alcohol ranged from a low of 7 percent in the western
state of Gujarat (officially under Prohibition) to 75
percent in the North-eastern state of Arunachal Pradesh.2
Brain damage due to alcohol intake is more common than
one may think. It causes white matter damage throughout
brain after long term alcohol use. Acceleration of age
related loss of myelin may be observed.3 Consequent to
brain damage, cognitive impairment has been a cause of
concern for many decades. Substance dependence has
been defined as- A syndrome manifested by a behavioral
pattern in which the use of a given psychoactive drug, or
class of drugs, is given a much higher priority than other
How to cite this article: Prakash Ambekar, Sunil Goyal. Cognitive impairment and effects of abstinence on cognition in patients with
alcohol dependence syndrome. MedPulse – International Journal of Psychology. October 2017; 4(1): 13-21. http://www.medpulse.in
MedPulse – International Journal of Psychology, ISSN: 2579-0919, Volume 4, Issue 1, October 2017 pp 13-21
behaviors that once had higher value. 4 The essential
feature of dependence is a cluster of cognitive,
behavioral, and physiological symptoms indicating that
the individual continues substance use despite significant
substance-related problems.5 Before discussing the effect
of alcohol on cognition, an understanding of normal
cognition is required. Cognition refers to the set of
interwoven processes, such as memory, language, and
problem solving, that we bring to generate structures and
strategies to apply to our perceptions.6 In existing
literature, neuro-cognitive test measures are often
grouped into a variety of domains or dimensions such as
attention, memory functions, verbal skills, construction /
performance skills, concept formation and reasoning.6
Among the specific functions that can be assessed are
orientation, the ability to learn necessary skills, solve
problems, think abstractly, reason and make judgments,
the ability to retain and recall events, mathematical ability
and other forms of symbol manipulation, control over
primitive reactions and behaviour, language use and
comprehension, attention, perception and praxis.7 The
deleterious effects of alcoholism on cognitive functioning
were reported in the literature as early as the 1880s. In
1881, Carl Wernicke first described an illness8, Korsakoff
SS a Russian psychiatrist, described the disturbance of
memory in the course of long-term alcoholism in a series
of articles.9 By the 1960s, the studies by Fitzhugh and
coworkers introduced the clinical neuropsychological
model to the study of cognitive function in alcoholism
and marked the beginning of systematic research in this
area.10,11 There are fewer studies done in India for
cognitive evaluation of alcohol dependent subjects. In this
study, the focus is to examine the cognitive and executive
function in alcohol dependent subjects and effect of
abstinence from alcohol for one month.
MATERIALS
The study was carried out in the Department of
Psychiatry, in a tertiary care center. Ethics comittee
approval was taken. Study was conducted between April
2011 to May 2012. Individuals in study and comparative
group were enrolled after applying inclusion and
exclusion criteria and after taking informed consent.
Study group: A total of 50 alcohol dependent male
inpatients were recruited for this study. To avoid selection
bias all successive cases admitted in the psychiatry ward,
meeting inclusion and exclusion criteria were included.
The subjects were all male patients in the age range of 20
years to 50 years.
Inclusion Criteria
1. Patients diagnosed as case of alcohol dependent
syndrome
2. Age: 20 – 50 yrs
3. Gender: Male
Exclusion Criteria
1. Subjects having history of psychiatric illness
2. History of traumatic brain injury, seizures and
loss of consciousness
3. Systemic illnesses affecting cognition
4. History of drug abuse other than alcohol and
tobacco.
Tools
1. Specially designed semi-structured proforma to
collect demographical data
2. Post Graduate Institute of Medical Education and
Research, Chandigarh Battery of Brain
dysfunction (PGI-BBD)12
3. Alcohol Use Disorder Identification Test
(AUDIT)13
4. Hamilton Rating Scale for Depression (HAMD)14
5. Hamilton Rating Scale for Anxiety (HAM-A)15
PGI Battery of Brain dysfunction (PGI-BBD): The
PGI-BBD was developed by Dr Dwaraka Prasad and Dr
Santosh K Verma of Post Graduate Institute of Medical
Education and Research, Chandigarh in 1990. This is a
comprehensive battery and consists of tests to measure
both verbal and performance quotient, memory and
visuo-special ability. PGI-BBD is taken as a measure of
cognitive functioning because it is standerdised on Indian
population.It is battery of five tests It consists of
following tests
1. PGI-Memory Scale
2. Bhatia Battery of Performance Tests of
Intelligence ( short form)
3. Verbal Adult Intelligence Scale ( Adaptation by
Verma)
4. Nahor Benson test
5. Bender Gestalt Test
For each test rating, Dysfunctional rating is graded into
three categories i.e. 0, 2 and 3, raw score was changed to
converted score, which in turn converted to dysfunctional,
in the grade of increasing severity of impairment. Zero
dysfunctional rating indicates no impairment, one
indicates mild impairment and three indicates significant
impairment on a given domain.
METHODS
Enrollment of cases and controls was done after applying
inclusion and exclusion criteria. HAM-D and HAM-A
scale was given to rule out depressive and anxiety
disorders respectively. Informed consent was taken from
subjects. Baseline demographic data of cases alongwith
relevant investigations mentioned in proforma were
entered in semi-structured proforma in first week of
admission. Alcohol use further assessed with AUDIT
(Alcohol Use Disorder Identification Test). Baseline
cognitive assesment using PGI-BBD was done for study
MedPulse – International Journal of Psychology, ISSN: 2579-0919, Volume 4, Issue 1, October 2017
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Prakash Ambekar, Sunil Goyal
group (Pre-treatment group) after detoxification ie 2 days
after benzodiazepines were tapered off. Patients were
managed with enforced abstinence, vitamin supplements,
alcohol psycho education, individual and group
psychotherapy and relapse prevention counseling.
Suitable anti-craving agent was added in fourth week of
treatment. Cognitive assessment of study group (posttreatment group) was repeated after one month of initial
assessment. Ethics committee approval was taken for this
study. The data was analysed using Statistical Package for
Social Sciences (SPSS) version 20. To check for
normality, the Shapiro-Wilk test was applied. Pretreatment and post-treatment group was compared with
the help of Wilcoxon Signed Ranks Test. Correlation of
age of onset of alcohol use, years of alcohol consumption
and AUDIT scores with different domains of cognition is
done using Spearman’s rank correlation coefficient. Pvalues less than 0.05 were taken as significant.
RESULTS
The present study was carried out amongst 50 male participants. The mean age of subjects in study was 38.40 years.
Table 1: Mean scores of alcohol related variables in the study group (n=50)
Variables
Minimum
Maximum
Mean
Age of onset of alcohol use (yrs)
15
38
23.90
Presenting age of study group (yrs)
26
49
38.40
Drinking years
03
29
14.48
AUDIT score
14
27
18.56
Tobacco use (years)
00
34
10.96
It was seen from Table 1 that mean age of onset 23.90 years of age (Range- 15-38 years). Within the group the years of
consumption of alcohol ranged from 3 to 29 years with mean duration being 14.48 years..The mean AUDIT score was
18.56 with range 14 to 27. Of the total alcohol dependent patients, 74% (n=37) were tobacco consumers or smokers and
mean duration of tobacco consumption was 10.96 years.
Domains
Remote
memory
Recent
memory
Mental balance
Attention and
concentration
Delayed recall
Immediate
recall
Retention of
similar pairs
Retention of
dissimilar pairs
Visual
retention
Visual
recognition
Table 2: PGI-Memory Scale Dysfunctional Scores
Dysfunction Pre-treatment group (n=50)
Post-treatment group (n=50)
0
28
29
2
15
17
3
07
04
0
29
36
2
18
13
3
03
01
0
17
17
2
17
17
3
16
16
0
26
43
2
14
07
3
10
00
0
13
26
2
14
10
3
23
14
0
23
30
2
16
17
3
11
03
0
27
38
2
12
10
3
11
02
0
04
14
2
22
19
3
24
17
0
05
19
2
27
23
3
18
08
0
20
29
2
18
15
3
12
06
Copyright © 2017, Medpulse Publishing Corporation, MedPulse – International Journal of Psychology, Volume 4, Issue 1 October 2017
MedPulse – International Journal of Psychology, ISSN: 2579-0919, Volume 4, Issue 1, October 2017 pp 13-21
As seen from Table 2 that dysfunction rating on PGI-MS revealed that 22 (44%) pre-treatment group patients had
dysfunctional remote memory as compared to 21 (42%) in post-treatment. Recent memory dysfunction was 21 (42%)
and 14 (28%) in pre-treatment, post-treatment groups respectively. Mental balance dysfunction was 33(66%) and 33
(66%) in pre-treatment and post-treatment respectively. Attention and concentration dysfunction was 24 (48%) and 7
(14%) in pre-treatment and post-treatment respectively. Delayed recall dysfunction was 37 (74%) and 24 (48%) in pretreatment and post-treatment respectively. Immediate recall dysfunction was 27 (54%) and 20 (40%) pre-treatment and
post-treatment respectively. Dysfunction for retention of similar pairs was 23 (46%) and 12 (24%) in pre-treatment and
post-treatment respectively. Dysfunction for retention of dissimilar pairs was 46 (92%) and 36 (72%) in pre-treatment
and post-treatment respectively. Visual retention dysfunction was 45 (90%) and 31 (62%) pre-treatment and posttreatment respectively. Visual recognition dysfunction was 30(60%) and 21 (42%) in pre-treatment and post-treatment
respectively.
Table 3: Comparison of memory of pre-treatment group and post-treatment group after one month of abstinence
Domains
Mean scores of pre-treatment group
Mean scores of post-treatment group Significance
Remote
5.40
5.48
0.157
memory
Recent
4.52
4.70
0.020
memory
Mental
6.56
7.14
<0.001
balance
Attention and
9.02
9.86
<0.001
concentration
Delayed recall
7.42
8.10
<0.001
Immediate
7.82
8.76
<0.001
recall
Retention of
4.30
4.72
<0.001
similar pairs
Retention of
dissimilar
9.60
10.48
<0.001
pairs
Visual
7.44
8.54
<0.001
retention
Visual
8.24
8.70
<0.001
recognition
As seen in the Table 3 that no significant difference was found in the mean scores of remote memory of patients after
admission as compared to that after one month of abstinence (p=0.157). The mean scores of recent memory in pretreatment condition is lesser than that of post treatment condition and this difference was found to be statistically
significant (p = 0.020). This shows that there has been an improvement in the cognitive condition in the study group post
treatment. Significant difference was found in other domains of cognitions also which indicates that there has been an
improvement in patients after treatment (p<0.001).
Table 4: Dysfunctional rating of performance quotient
Dysfunction
Pre-treatment group(n=50)
Post-treatment group(n=50)
00
10
32
Performance Quotient (PQ)
02
28
17
03
12
01
00
22
38
P/K X 100
02
26
12
03
02
00
Domains
As Table 4 shows that dysfunctional ratings for performance quotient (PQ) and there in was impairment of 40 (80%), 18
(36%) and 12 (24%) in pre-treatment and post-treatment respectively. Further PQ evaluation revealed that mean scores of
69.54 and 82.82. There was significant improvement between pre-treatment and post-treatment group (p<0.001).
Table 5: Comparison performance quotient of pre-treatment group and post-treatment group after one month of abstinence
Domains
Mean scores of pre-treatment group
Mean scores of post-treatment group Significance
Performance
69.54
82.82
<0.001
Quotient (PQ)
P/K X 100
210.06
182.80
<0.001
Note: P/K –Ratio of test quotient of pass along test and Kohs Block design test.
MedPulse – International Journal of Psychology, ISSN: 2579-0919, Volume 4, Issue 1, October 2017
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Prakash Ambekar, Sunil Goyal
Table 5 shows, statistically significant difference in mean scores of performance quotient of pre-treatment group and
post-treatment group (p<0.001). This implies significant improvement in performance quotient after one month of
abstinence and treatment.
Table 6: Dysfunctional rating of Verbal Adult Intelligence Scale in subjects
Domains
Dysfunction
Pre-treatment group(n=50)
Post-treatment group(n=50)
0
22
30
Information
2
25
20
3
03
00
0
42
43
Digit span
2
08
07
3
00
00
0
45
46
Arithmetic
2
04
03
3
01
01
0
26
35
Comprehension
2
24
15
3
00
00
0
16
24
2
13
15
3
01
00
4
10
07
Verbal Quotient
5
02
00
6
06
04
7
00
00
8
02
00
As Table 6 shows, testing for Verbal quotient revealed that 28 (56%) and 20 (40%) dysfunction Pre-treatment and posttreatment respectively in Information quotient. Digit span dysfunction observed to be 8 (16%) and 7 (14%) Arithmetic
dysfunction observed to be 5 (10%) and 4 (8%) the respective groups. Dysfunction in comprehension quotient was
observed to be 24 (48%) and 15 (30%) in the pre-treatment and post-treatment group respectively.
Table 7: Comparison of Verbal Quotient of pretreatment group and post-treatment group after one month of abstinence
Domains
Mean scores of pre-treatment group
Mean scores of post-treatment group
Significance
Information
78.24
82.18
<0.001
Digit span
84.98
88.28
<0.001
Arithmetic
89.12
91.04
0.006
Comprehension
79.32
83.18
<0.001
Verbal Quotient
82.91
86.17
<0.001
Table 7 shows that there was significant difference in mean scores of pre-treatment and post-treatment group (p<0.05).
This shows significant improvement in verbal quotient of study group after treatment and a month of abstinence.
Table 8: Dysfunctional rating of Perceptomotor functioning:
Dysfunction
Pre-treatment group(n=50)
Post-treatment group(n=50)
0
31
40
Nahor-Benson Test
2
18
10
3
01
00
0
17
37
Bender Gestault Test
2
33
13
3
00
00
Domains
Table 8 shows the prevalence of perceptomotor impairment is more in pre-treatment group as compared to post-treatment
group.
Table 9: Comparison of percepto-motor task after admission and after one month of abstinence
Domain
Mean scores of pre-treatment group
Mean scores of post-treatment group
Significance
Error score
2.16
1.54
<0.001
Table 9 shows, statistically significant difference in mean scores of Nahor Benson test in pre-treatment group and posttreatment group (p<0.001). This implies significant improvement in percepto-motor task after treatment and abstinence
for one month.
Copyright © 2017, Medpulse Publishing Corporation, MedPulse – International Journal of Psychology, Volume 4, Issue 1 October 2017
MedPulse – International Journal of Psychology, ISSN: 2579-0919, Volume 4, Issue 1, October 2017 pp 13-21
Table 10: Comparison of percepto-motor task of pre-treatment group and post-treatment group after one month of abstinence
Domains
Mean scores of pre-treatment group
Mean scores of post-treatment group
Significance
Visuo-motor task
5.30
3.60
<0.001
(Raw Score)
Table 10 shows, statistically significant difference in mean scores of BVMGT in pre-treatment group and post-treatment
group (p<0.001). This implies significant improvement in percepto-motor task after treatment and abstinence for one
month. Dysfunction on Nahor Benson testing was observed to be 19 (38%) and 10 (20%) in pre-treatment and posttreatment respectively. Nahor-Benson testing on pre-treatment and post-treatment group had shown mean error scores of
2.16 and 1.54 and statistically significant post-treatment improvement. Dysfunction on Bender Visual – Motor Gestalt
testing observed to be 33 (66%) in 13 (26%) in pre-treatment and post-treatment respectively. Bender Visual – Motor
Gestalt on pre-treatment and post-treatment group had shown mean raw scores of 5.30 and 3.60 and statistically
significant post-treatment improvement.
Table 11: Correlation of years of drinking with various cognitive domain of study group on admission (n=50)
Domain
Onset of alcohol use
Drinking years
AUDIT
Remote memory
-0.048
-0.735**
-0.355*
Recent memory
0.155
-0.371**
-0.231
Mental balance
0.104
-0.743**
-.0366**
Attention and concentration
-0.029
-0.508**
-0.311*
Delayed recall
-0.012
-0.649**
-0.283*
Immediate recall
0.218
-0.638**
-0.139
Retention of similar pairs
0.065
-0.611**
-0.357*
Retention of dissimilar pairs
-0.193
-0.343*
-0.363**
Visual retention
-0.14
-0.21
-0.244
Visual recognition
-0.058
-0.162
-0.278
Performance Quotient
0.262
-0.715**
-0.203
Information
0.179
-0.651**
-0.269
Digit span
0.177
-0.435**
-0.138
Arithmetics
0.15
-0.457**
-0.18
Comprehension
-0.107
-0.562**
-0.297*
Verbal Quotient
0.179
-0.674**
-0.231
Nahor Benson test
-0.375**
0.715**
0.234
Bender-Gestault Test
-0.255
0.804**
0.323*
Note-Figures in the table reflects Spearman’s rank correlation coefficient
* Indicates correlation is significant at p<0.05, **Indicates correlation is significant at p<0.01
As Table 11 shows, increase in years of consuming
alcohol of study group is associated with more cognitive
impairment in all domains (p<0.05) except with visual
retention and recognition. AUDIT scores shows negative
correlation with remote memory, mental balance,
attention and concentration, delayed recall, retention of
similar and dissimilar pairs and comprehension. There is
no significant correlation found between age of onset of
alcohol use and cognitive impairment except on Nahor
Benson test (p=0.007).
DISCUSSION
The mean age of subjects in study was 38.40 years. The
mean education of subjects in two groups was 10.30
years. PGI-BBD scoring system is also standardized and
adjusted for age and education. Hence the factor of age
and education affecting cognitive functioning is
eliminated.
Memory: In the present study, there was lesser
prevalence of impairment in various domains of memory
on PGI- Memory Scale in the post-treatment group than
the pre-treatment group. This suggests that the
impairment in memory is reversible in some of the
patients after treatment and abstinence for one month.
When pre-treatment group is compared to post-treatment
group after one month of abstinence, there is significant
improvement in recent memory, mental balance, attention
and concentration, immediate recall (sentences), delayed
recall (words), retention for similar and dissimilar pairs,
visual retention and visual recognition. The improvement
observed in remote memory in post-treatment group was
not significant. Our results are in concordance with few
previous studies 16,17, 18, 19, 20, 21, 22,, 23
Intelligence: Performance quotient: Present study
shows that dysfunctional rating of Revised Bhatia’s short
Battery of Performance tests of Intelligence in study
group. There is significant improvement in performance
quotient of the study group after one month of abstinence.
This suggests that the impairment in performance
quotient improves in the patients after treatment and
MedPulse – International Journal of Psychology, ISSN: 2579-0919, Volume 4, Issue 1, October 2017
Page 18
Prakash Ambekar, Sunil Goyal
abstinence for one month. On evaluation of Performance
Quotient (PQ), there was significant improvement in
post-treatment group in comparison to pre-treatment
group (p<0.001).
Verbal quotient: Our study that there was lesser
prevalence of impairment in domains of verbal
intelligence on dysfunctional rating of Verbal Adult
Intelligence Scale in post-treatment group than pretreatment group. This suggests that the impairment in
Verbal Quotient is reversible in some of the patients after
treatment and abstinence for one month. On analysis of
sub-domains of Verbal Quotient (VQ) on Verbal Adult
Intelligence scale, there is significant improvement in
information, digit span, arithmetic and comprehension
quotients in post-treatment group. These results are in
concordance with study Bhat et al.24 The result of more
improvement in verbal quotient as compared to
performance quotient is also reported in previous studies.
These studies observe impairments in fluid-intelligence
skills of visuo-spatial processing and problem solving ie
performance quotient persist during the intermediate-term
abstinence period in most recovering alcoholic dependent
patients, as evidenced by lower Performance IQ subtest
scores relative to Verbal IQ subtest scores.25.26
Perceptomotor Functioning: Present study revealed that
there was lesser prevalence of impairment in perceptomotor functioning on Nahor Benson test as well as
Bender Gestault test in post-treatment group than pretreatment group. This suggests that the impairment in
percepto-motor functioning may be reversible in the
patients after treatment and abstinence for one month.
Tables 10 and 11 show on evaluation of percepto-motor
functioning, there is significant improvement in posttreatment groups. This is in concordance with study done
by Bhat et al.24 and few other studies 27,28
Correlation of cognitive impairment: The correlation of
cognitive impairment of pre-treatment group with age of
onset of alcohol use, years of alcohol consumption and
AUDIT scores. There is no significant correlation found
between age of onset of alcohol use and cognitive
impairment. Increase in years of consuming alcohol of
study group is associated with more cognitive impairment
in all domains (p<0.05) except with visual retention and
recognition. AUDIT scores shows negative correlation
with remote memory, mental balance, attention and
concentration, delayed recall, retention of similar and
dissimilar pairs and comprehension. Alcohol use over a
period of time causes brain damage. It causes widening of
sulci and ventricular enlargement 29,30,31,32. Widened sulci
have been found consistently in patients of all ages with
chronic alcoholism. This widening is particularly
apparent in the frontal and the fronto-parieto-temporal
areas.31Also, alcoholism can interfere with memory,
emotion, and other functions associated with damage to
limbic system and diencephalic structures. This can also
cause diffuse cortical damage affecting the functioning of
both brain hemispheres (e.g., abstracting and problemsolving abilities, poor attention, disinhibition, and
perseverative responding). Impairment in performance
and verbal quotient may be attributed to cerebral
atrophy.33 As several studies of alcoholism have reported
significant correlations between intellectual impairment
and cerebral atrophy.34,35,36 Nutritional deficiencies and
alcohol withdrawal seizures which are commonly present
in alcohol dependent patients may be contributing factor
for cognitive impairment.37 Improvement in various
domains of cognition suggests reversibility of brain
damage with abstinence of one month and treatment. It
has been found that cerebral atrophy reverses over time as
abstinence continues, with more complete recovery of
cortical volume in younger than in older alcoholics.21,38
Another explanation for improvement in cognitive
functioning is the ability of the brain to compensate for a
decline in function. One could implicate that plasticity,
i.e. the ability of the brain to modify its organization and
ultimately its function, may be one of the possibilities to
account for improvement in cognitive functioning that is
seen. Several factors are known to affect this plasticity
and some of the known ones are experience, gonadal
hormones, anti-inflammatory agents, growth factors,
dietary factors, genetic factors, stress and brain injury.39
Study done by Bhat et al 24 shows significant difference
in almost all domains of cognition was in contrast to this
study showing significant difference in only some of the
domains. This discordance in above results may be due to
high baseline mean scores of participants in the study
group of above subscales as compared to those of the
study done by Bhat et al.24 Previous studies have shown
that longer period of abstinence is needed so as to assess
the recovery of cognitive functioning in alcohol
dependent patients after abstinence.40,41,42 This study had
also shown positive correlation between years of alcohol
consumption and various domains of cognitive
functioning. This indicates cumulative deleterious effect
of alcohol on brain. However, there are inconsistent
results of correlation between AUDIT scores and various
cognitive domains of study group. This may be attributed
to denial and minimisation defense mechanisms, which
are commonly seen in alcohol dependent patients.
LIMITATIONS
Practice effect can be a confounding factor in analysis
and may have some role in improvement of scale scores
in the study group, post-treatment. In this study, only
male patients were studied so we can’t generalise these
findings to females. Study group was re-evaluated after
Copyright © 2017, Medpulse Publishing Corporation, MedPulse – International Journal of Psychology, Volume 4, Issue 1 October 2017
MedPulse – International Journal of Psychology, ISSN: 2579-0919, Volume 4, Issue 1, October 2017 pp 13-21
one month but as discussed above some studies mention
further improvement in cognitive domains as period of
abstinence increases. So the period of one month of
abstinence from alcohol is inadequate for assessment of
complete improvement of cognitive functioning.
CONCLUSION
Study had validated assumption that there is significant
cognitive impairment among alcohol dependent cases.
These deficits may not be detected in routine clinical
examinations, but with formal neuropsychological
assessment using sensitive scales, the extent of
impairment can be assessed both qualitatively and
quantitatively. Dysfunction rates in all domains of
memory, intelligence and perception improved posttreatment in the study group. Post-treatment, the study
group had significant improvement in recent memory,
mental balance, attention and concentration, immediate
and delayed recall, retention of similar and dissimilar
pairs, visual retention and recognition, verbal and
performance quotient and percepto-motor functioning.
Increase in years of consuming alcohol of study group is
associated with more cognitive impairment in memory,
intelligence and percepto-motor ability. Awareness of
alcohol’s effects on cognition can help health-care
providers in addressing the problem and instituting
appropriate treatment. This study is among the rare Indian
studies to assess cognitive function in alcohol dependent
patients. Since it is an interventional study, it analyses
effects of one month of abstinence after month and
treatment. It not just establishes the presence of these
residual cognitive differences in alcohol dependent
patients but also correlates them with various variables.
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