Experience-dependent neuropsychological recovery and the treatment of chronic alcoholism

Goldman, Mark S.

doi:10.1007/bf01108859

Cited by 56 publications

(71 citation statements)

References 81 publications

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“…Inpatient treatment programmes provide an opportunity for moderately to severely cognitively impaired patients to engage in cognitive enhancement or cognitive remediation treatments. Some cognitive remediation studies have yielded promising findings [44,49] . Initial interventions should take account of the preserved and early-recovering functions, with interventions that place greater demand on executive skills phased in at a later stage of treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Although patients are operating with impairment across a range of cognitive functions during early abstinence, this may not be readily evident because of some increases in performance on measures of in verbal functioning. The initial period of mild confusional state (with impairments in attention, memory and comprehension) has been termed the 'cognitive haze' [44] . Neuropsychological deficits have a negative impact on treatment compliance and outcome, both directly, and indirectly through the mediation of other factors [1,45] .…”

Section: Discussionmentioning

confidence: 99%

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Changes in Neuropsychological Functioning during Alcohol Detoxification

et al. 2008

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This study investigates changes in neuropsychological functioning during early abstinence from alcohol. 30 alcohol-dependent inpatients were tested at intake (day 4 of admission) and post detoxification (day 26), using a test-retest design. The neuropsychological battery included measures of pre-morbid IQ, full-scale IQ, verbal and non-verbal measures of memory and executive function. IQ was within the normal range at intake and comparable with age-adjusted normative values and there were some impairments in memory and executive function. There were significant increases in performance scores post detoxification in working memory, verbal fluency and verbal inhibition but not in non-verbal executive function tasks (mental flexibility and planning ability). Despite increased scores on tests of verbal and memory skills after 3 weeks of abstinence, complex executive abilities showed little change. These may have a negative impact on engagement and response to treatment and compromise clinical outcomes, heightening the risk of relapse.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Changes in Neuropsychological Functioning during Alcohol Detoxification

et al. 2008

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“…These patients have what Goldman characterized some years ago as "cognitive haze," a mild confusional state with impairments of attention, memory, and comprehension [3]. In 1990, Goldman wrote concerning patients with alcoholism: "Current practice in the United States is for inpatient stays lasting from 21 to 28 days.…”

Section: Introductionmentioning

confidence: 98%

“…Clearly, the educational component of early treatment could easily overtax the learning capacity of an individual not yet recovered neuropsychologically and physically." [3] To address this problem, Goldman and collaborators developed a series of cognitive remediation procedures that have since been shown to be effective in relieving cognitive haze. The remediation program targets areas of learning, attention, problem-solving, and visual-spatial skills.…”

Section: Introductionmentioning

confidence: 99%

Rehabilitation during alcohol detoxication in comorbid neuropsychiatric patients

Goldstein¹,

Haas²,

Shemansky³

et al. 2005

JRRD

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For this study, we evaluated the effectiveness of a cognitive training program in improving cognitive function in patients with alcoholism comorbid with another neuropsychiatric disorder and going through the subacute phase of detoxication. We employed a randomized clinical trial design in which 20 subjects were assigned to a five-session cognitive rehabilitation program and 20 subjects were assigned to an attention placebo control condition. All subjects received a battery of cognitive tests for reasoning, attention, and visual-spatial abilities. These tests were repeated at the completion of the study. The training consisted of a number of component tasks designed to improve attention, speed of information processing, perceptual analysis, and visual-spatial cognition. We plotted performance on training results across sessions to detect evidence of learning effects. Comparisons of the cognitive tests revealed greater improvement in the training as compared to the attention placebo group on measures of attention and conceptual flexibility. We concluded that the training produced significant improvement over and above natural recovery during detoxication.

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“…In our own recent study, decreased white matter volume in the midbrain of alcoholdependent subjects was related to impaired performance in two executive tasks: the Trail-Making Test part-B (TMT-B) and the WAIS letter-number sequencing test (LNS; Chanraud et al, 2007). Both tasks invoke cognitive flexibility, a component of executive functions, which is known to influence treatment outcome (Goldman, 1990) and experience-dependent recovery (Roehrich and Goldman, 1993) in chronic alcoholism. However, our earlier study did not identify the specific regions of the midbrain and associated white matter tracts that are involved in the alcoholdependent subjects' cognitive flexibility impairment.…”

Section: Introductionmentioning

confidence: 99%

Diffusion Tensor Tractography in Mesencephalic Bundles: Relation to Mental Flexibility in Detoxified Alcohol-Dependent Subjects

Chanraud

Reynaud

Wessa

et al. 2008

Neuropsychopharmacol

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Components of the corticocerebellar circuit and the midbrain individually play a central role in addictive processes and have been associated with altered volumes and impairment of cognitive flexibility in alcohol-dependent subjects. The microstructure of white matter bundles composing the corticocerebellar network and passing through the midbrain was studied using diffusion tensor imaging in a group of detoxified alcohol-dependent men (n ¼ 20) and a group of healthy men (n ¼ 24). The relationship between properties of these white matter bundles and cognitive flexibility performance was investigated in alcohol-dependent subjects. Bundles connecting two regions of interest were analyzed using a fiber-tracking quantitative approach, which provided estimates of the fractional anisotropy and the apparent diffusion coefficient, as well as the number of tracked fibers normalized by the volume of regions of interest. Within the bundles running between the midbrain and pons, a mean of 18% fewer fibers per unit volume were tracked in alcohol-dependent men than in healthy controls. In addition, the normalized number of these fibers correlated with the performance in the Trail-Making Test part-B. Even though the alcohol-dependent subjects were detoxified and apparently neurologically intact, their earlier excessive use of alcohol seems to be associated with altered neural microstructure of mesencephalic white matter bundles, which may contribute to their cognitive flexibility impairment.

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Experience-dependent neuropsychological recovery and the treatment of chronic alcoholism

Cited by 56 publications

References 81 publications

Changes in Neuropsychological Functioning during Alcohol Detoxification

Changes in Neuropsychological Functioning during Alcohol Detoxification

Rehabilitation during alcohol detoxication in comorbid neuropsychiatric patients

Diffusion Tensor Tractography in Mesencephalic Bundles: Relation to Mental Flexibility in Detoxified Alcohol-Dependent Subjects

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