Brain-behavior relations and effects of aging and common comorbidities in alcohol use disorder: A review.

Abstract

Objective: Alcohol use disorder (AUD) is a complex, dynamic condition that waxes and wanes with unhealthy drinking episodes and varies in drinking patterns and effects on brain structure and function with age. Its excessive use renders chronically heavy drinkers vulnerable to direct alcohol toxicity and a variety of comorbidities attributable to nonalcohol drug misuse, viral infections, and accelerated or premature aging. AUD affects widespread brain systems, commonly, frontolimbic, frontostriatal, and frontocerebellar networks. Method and Results: Multimodal assessment using selective neuropsychological testing and whole-brain neuroimaging provides evidence for AUD-related specific brain structure-function relations established with double dissociations. Longitudinal study using noninvasive imaging provides evidence for brain structural and functional improvement with sustained sobriety and further decline with relapse. Functional imaging suggests the possibility that some alcoholics in recovery can compensate for impairment by invoking brain systems typically not used for a target task but that can enable normal-level performance. Conclusions: Evidence for AUD-aging interactions, indicative of accelerated aging, together with increasing alcohol consumption in middle-age and older adults, put aging drinkers at special risk for developing cognitive decline and possibly dementia.

<p>Cognitive Impairments in Early-Detoxified Alcohol-Dependent Inpatients and Their Associations with Socio-Demographic, Clinical and Psychological Factors: An Exploratory Study</p>

“…The results of this study showed that with regard to socio-demographic factors, patients with low education performed worse in tests assessing memory, executive functions and visuospatial abilities compared to the group with high education, while older adults scored lower in tasks related to attention and executive functions compared to younger ones. 50,51 The early detection of alcohol-related cognitive impairment in older people with AUD can improve social outcomes in both drinking behavior and the social consequences of alcohol-related dementia. 70 Woods et al found that heavy alcohol consumption was associated with greater cognitive impairment in older adults.…”

“…These studies suggested that factors such as age, education, duration of alcohol use, severity of alcohol use and polysubstance abuse are associated with cognitive impairment and brain recovery in alcohol dependence; however, the results are mixed and further research is needed. 11,12,25,[46][47][48][49][50][51][52] The length of abstinence also plays a keyrole, because it allows the brain volume to recover, albeit possibly influenced by a few aspects of the dependence itself. 53,54 For example, in 2009, Pitel et al found that recovery of episodic memory in abstainers was correlated with drinking history.…”

The Many Levels of Relapse to Drinking: Commentary on Meyerhoff and Durazzo (ACER 2020)

“…As alcohol-free or alcohol-reduced days proceed, more brain structural and functional recovery ensues. In this way, what typifies the downward spiral and self-perpetuating cycle of addiction reverses itself (Koob and Le Moal, 2006;Sullivan and Pfefferbaum, 2019). To the extent that the frontal cortex is selectively affected by AUD (Meyerhoff and Durazzo, 2020), is vulnerable to the age-alcoholism interaction (Sullivan et al, 2018), and plays a role in AUD recovery raises a further question regarding whether older men and women who seek sobriety can show the same resilience in recovery as their younger counterparts.…”

Brain Structure and Function in Recovery

“…More comprehensive coverage of alcohol-related impairment is provided in several recent reviews. 3,4 In discussing recovery, several caveats warrant attention. First, there is a paucity of data from individuals who address their alcohol misuse without seeking formal treatment.…”