Impaired Executive Functioning Associated with Alcohol-Related Neurocognitive Disorder including Korsakoff’s Syndrome

Abstract

(1) Background: chronic alcohol use is consistently associated with impaired executive functioning, but its profile across the spectrum from mild to major alcohol-related cognitive impairment is, to date, unclear. This study aims to compare executive performances of patients with alcohol-induced neurocognitive disorder, including Korsakoff’s syndrome (KS), by using a computerized assessment battery allowing a fine-grained and precise neuropsychological assessment; (2) Methods: performances of 22 patients with alcohol-related cognitive impairment (ARCI) and 20 patients with KS were compared to those of 22 matched non-alcoholic controls. All participants were diagnosed in accordance with DSM-5-TR criteria and were at least six weeks abstinent from alcohol prior to assessment. Executive function was evaluated using four subtests of Cambridge Neuropsychological Test Automated Battery (CANTAB®); (3) Results: significant differences between groups were found on spatial working memory (updating), sustained attention and inhibitory control, set shifting, and planning. Healthy controls performed significantly better than both patient groups (Games-Howell post hoc; p < 0.05), but no differences in performance were found between the ARCI and KS group; (4) Conclusions: ARCI and KS patients showed significant executive impairments, most prominent in updating, set-shifting and general planning abilities. Findings suggest equivalent levels of executive function in ARCI and KS patients. Our results highlight executive function as a significant hallmark of alcohol-induced neurocognitive disorder and stipulate the importance of early assessment and evaluation of skills to guide treatment.

Aspectos neurocognitivos do alcoolismo

“…A literatura recente relata comprometimento das funções frontais em pacientes acometidos pela SWK e na demência alcoólica [14]. O comprometimento na cognição social dos etilistas tem levantado a hipótese de forte suscetibilidade dos lobos pré-frontais aos efeitos deletérios desta substância.…”

“…Embora a EW tenha sido descrita 6 anos antes, Korsakoff não fez menção direta a esta, mas referiu-se a um quadro prodômico de agitação psicomotora e confusão mental, podendo estar associado a oftalmoplegia e a alterações de marcha sugestivas de ataxia na maioria dos casos. Em 1897, Murawieff já aventara a possibilidade de que as duas entidades teriam a mesma causa, e após estudos em animais, e graças às observações de de Wardener e Lenoxx em prisioneiros de guerra desnutridos, em 1947, verificou-se que o mecanismo que dá origem ao quadro agudo de EW seguido da SWK é a depleção de tiamina [14,28].…”

“…Os controles saudáveis tiveram desempenho significativamente melhor do que ambos os grupos de pacientes, mas não foram encontradas diferenças no desempenho entre o grupo DAA e SK. Diante desses achados, os autores concluíram que os pacientes com DAA e SK apresentaram prejuízos executivos significativos, mais proeminentes nas habilidades de atualização, mudança de contextos e planejamento geral, portanto com resultados equivalentes de função executiva entre pacientes com DAA e SK [14].…”