The Neuropsychological Profile of Alcohol-Related Dementia Suggests Cortical and Subcortical Pathology

Abstract

The neuropathology associated with chronic alcohol abuse varies across studies, though research suggests generalized reductions in cortical and subcortical grey and white matter. Neuropsychological findings also differ within the literature. The inconsistent findings with respect to the neuropathology and neurobehavior of patients with histories of alcohol abuse may be due, at least in part, to differing nosology and the highly variable inclusion/exclusion criteria employed by researchers. Oslin et al. [Int J Geriatr Psychiatry 1998;13:203–212] have proposed and recently validated specific criteria for probable alcohol-related dementia (ARD). We were interested in comparing the neuropsychological profile of ARD patients with the neurocognitive profiles of typical cortical and subcortical dementia patients. Participants included 14 ARD patients, 15 patients diagnosed with Alzheimer’s disease (AD), 13 patients diagnosed with subcortical vascular dementia (VaD), and 20 normal controls. Patient subgroups were similar with respect to age (mean = 79), education (mean = 12 years) and dementia severity (MMSE; mean = 22.1). The three dementia patient subgroups demonstrated significantly worse performance than the normal controls subgroup on all neuropsychological tests. The ARD subgroup exhibited very similar executive control deficits to VaD patients. However, the different neurocognitive profiles of the patient subgroups suggest that ARD patients may also, in fact, demonstrate some degree of amnesia given that they perform slightly worse than subcortical patients on delayed verbal free recall and recognition. Nonetheless, the ARD patients did not display as severe impairment as the AD patients on the memory tasks. No significant differences between the three patient groups were identified on language tests. In sum, we present preliminary evidence of a distinct neuropsychological profile for ARD patients that includes impairment on both executive control and memory tests. This pattern of performance suggests that long-term alcohol abuse, in comparison to AD and VaD, may be associated with both cortical and subcortical neuropathology.

Neurocognitive characterizations of Russian heroin addicts without a significant history of other drug use

“…Interestingly, impairments were remarkable despite the relatively short duration of dependency on drugs and/or alcohol. Alcohol and heroin are similar with respect to several of their mechanisms of action and neurotoxic effects, including alterations in grey and white matter, structure and function of the hippocampus, amygdala, nucleus accumbens, anterior cingulate cortex, and OFC among others, and perturbations in neurotransmitter (particularly dopamine) responses and metabolism throughout the mesocorticolimbic system (Alexander-Kaufman et al, 2006;Daglish and Nutt, 2003;Koob and Ahmed, 2004;Schlaepfer et al, 2006;Schmidt et al, 2005). Thus, our results showing more similarities than differences between drug groups are perhaps not surprising.…”

Regional Cerebral Blood Flow in Patients with Alcohol-Related Dementia: A Spect Study

“…Previous neuroimaging studies have related chronic alcohol abuse with generalized volume reductions in cortical and subcortical gray and white matter, though regional specificity of the brain varies across studies (Harper, 1998;Reed et al, 2003;Shear et al, 1994). ARD might be associated with both cortical and subcortical neuropathology based on the neuropsychological tests (executive function and memory) that focused on ARD patients (Nicolas et al, 1993;Schmidt et al, 2005). These findings may be somewhat different from the results of previous studies mainly related to frontal lobe pathology in alcoholism patients.…”

“…Oslin's criteria were proposed for the purposes of improving the validity and reliability of the diagnosis of ARD in order to reduce subjective interpretation and standardize alcohol consumption criteria (Oslin & Cary, 2003). Schmidt et al (2005) reported that the neuropsychological profile of ARD suggested cortical and subcortical pathology using the criteria presented by Oslin et al (1998). In addition, Moriyama mentioned that the criteria by Oslin et al represented a purer form of alcoholic dementia and were useful for the scientific discussion of this condition (Moriyama, Mimura, Kato, & Kashima, 2006).…”

Substance Abuse and Co-occurring Psychiatric Disorders in Older Adults: A Clinical Case and Review of the Relevant Literature

“…Individuals with alcohol-related dementia have demonstrated neuropsychological weaknesses on measures of complex visual-spatial skills, psychomotor speed, executive functioning, and memory (Schmidt et al, 2005;Grant & Adams, 1996). Importantly, for a diagnosis of alcohol-related dementia to be made, the individuals should be abstinent from alcohol for at least 60 days (Oslin et al, 1998).…”