Effects of abstinence and relapse upon neuropsychological function and cerebral glucose metabolism in severe chronic alcoholism

Abstract

Prolonged excessive consumption of alcohol has been associated with a variety of cognitive disorders accompanied by neuropathological and neurochemical abnormalities of the brain, particularly in the frontal lobes. Studies with positron emission tomography (PET) have shown decreased local cerebral metabolic rates for glucose (lCMRglc) in frontal regions, with correlated abnormalities on neuropsychological tests sensitive to executive functioning. This investigation was designed as a pilot study to examine the effects of abstinence and relapse in patients with severe chronic alcoholism studied longitudinally with PET and with neuropsychological evaluation to assess both general and executive functioning. Six patients, including 4 who remained relatively abstinent and 2 who relapsed following their initial evaluation, were studied twice, with inter-evaluation intervals ranging from 10 to 32 months. The patients who remained abstinent or who had minimal alcohol use showed partial recovery of lCMRglc in two of three divisions of the frontal lobes and improvement on neuropsychological tests of general cognitive and executive functioning, whereas the patients who relapsed had further declines in these areas. These results, although based upon a relatively small number of subjects, provide preliminary support for at least partial recovery of metabolic and cognitive functioning in individual patients who abstain from alcohol.

Alcohol: Effects on Neurobehavioral Functions and the Brain

“…Improvement with abstinence Neurobehavioral functioning may improve within 3 to 4 weeks of abstinence (Crews et al 2005;Sullivan 2000), accompanied by at least partial reversal of brain shrinkage (O'Neill et al 2001;Pfefferbaum et al 1995;Shear et al 1994) and some recovery of metabolic functions in the frontal lobes (Johnson-Greene et al 1997) and cerebellum Martin et al 1995;Seitz et al 1999). Frontal lobe blood flow continues to increase with abstinence, returning to approximately normal levels within 4 years (Gansler et al 2000).…”

“…Frontal lobe blood flow continues to increase with abstinence, returning to approximately normal levels within 4 years (Gansler et al 2000). Relapse to drinking leads to resumption of shrinkage (Pfefferbaum et al , 1998, continued declines in metabolism and cognitive function (Johnson-Greene et al 1997), and evidence of neuronal cell damage (Martin et al 1995). Abstinence up to 7 years resolves many neurocognitive deficits associated with alcoholism, except for the suggestion of lingering deficits in spatial processing (Fein et al 2006b).…”

Ethanol Reduces rCFB Activation of Left Dorsolateral Prefrontal Cortex during a Verbal Fluency Task

“…Patients with frontotemporal dementia typically also show a poor performance on the verbal fluency test (Elfgren, Passant, & Risberg, 1993;Elfgren, Ryding, & Passant, 1996). Moreover, several studies indicate that the frontal cortical regions are especially vulnerable to the detrimental influence of alcohol (Adams et al, 1995;Charness, 1993;JohnsonGreene et al, 1997;Jones & Parsons, 1971;Volkow et al, 1992), with correlations between abnormalities on tests of executive functioning and decreased metabolic rates for glucose in the frontal lobes of severe chronic alcoholic subjects (Adams et al, 1995;Johnson-Greene et al, 1997).…”

Cognitive recovery following alcohol detoxification: A computerised remediation study

“…Fifty per cent of individuals exhibit no neuropsychological deficits within 2-3 weeks of abstinence (Rourke & Loberg, 1996), and only 10% of individuals meet DSM criteria for a persistent dementia (Horvath, 1973). These findings are supported by neuroradiological evidence that demonstrates that a similar course of substrate recovery may occur as indicated by increases in brain volume (Carlen, Wortzman, & Holgate, 1978;Mann, Mundle, Strayle, & Wakat, 1995;Pfefferbaum et al, 1995) or metabolism (Johnson-Greene et al, 1997) on longitudinal neuroimaging scans following detoxification.…”