Early Improvement of Neuropsychological Impairments During Detoxification in Patients with Alcohol Use Disorder

Abstract

Aims To assess recovery of alcohol-related neuropsychological deficits in a group of patients with pure severe alcohol use disorder (AUD) during a detoxification program using the Brief Evaluation of Alcohol-Related Neuropsychological Impairment (BEARNI) test. Methods Thirty-two patients with severe AUD using DSM-IV criteria (24 men, mean age = 45.5 ± 6.8 years old) were assessed using the BEARNI 8 ± 2 days after alcohol cessation (T1) and then were reassessed within 18 ± 2 days after alcohol cessation (T2). The primary study endpoint was the number of patients initially impaired at T1 who recovered cognitive functions at T2 assessment. Results At T1, 59% (n = 19) patients with pure severe AUD had at least one impaired cognitive function assessed by the BEARNI. At T2, 63% of the patients with AUD with deficits at T1 had normal BEARNI cognitive scores (χ2 = 7.7, P = 0.005); specifically, the percentages of participants with normal subtest scores were 63% on memory (χ2 = 12.4, P = 0.0004), 100% on verbal fluency (χ2 = 16; P = <0.0001), 60% on alphabetical span (χ2 = 12.8; P = 0.0003) and 67% on visuospatial (χ2 = 15, P = 0.0001). Conclusions The cognitive impairments of two-thirds of patients with pure AUD included in the present study recovered within 18 days of abstinence, earlier than reported in previous studies.

Recovery of neuropsychological function following abstinence from alcohol in adults diagnosed with an alcohol use disorder: Systematic review of longitudinal studies

“…This may indicate a co-occurring impact of smoking and AUD on attentional capacity (or indeed, working memory) in some patients. As mentioned previously, Angerville, Ritz [ 23 ] who used a composite cognitive score which included attentional capacity as one of the contributing functions, found that lower age of onset of first alcohol use and higher AUDIT score associated with poorer recovery.…”

“…Recovery was indicated to occur by a month of abstinence onwards for two basic processing speed tasks [ 15 ], Digit Symbol Substitution (DS) and Symbol Search (SS), but processing speed of correct responses on RVP was still impaired by six months [ 19 ]. A task with somewhat ‘moderate’ executive complexity requiring flexibility (Alternating Verbal Fluency, AVF) did display improvement by 18 ± 2 days [ 23 ]. Interestingly, this is the only study to have used a verbal task of processing speed, perhaps indicating that this improves faster than visual processing speed.…”

“…Furthermore, as a supplementary finding in the same cohort from a secondary source, processing speed recovery in non-smokers was associated with increasing volumes in lobar grey and white matter regions and subcortical regions during 7.5 months of abstinence, though volume increase was similar between smokers and non-smokers, so this is unlikely to explain functional recovery differences between the two groups [ 16 ]. Angerville, Ritz [ 23 ] did assess predictors of Brief Evaluation of Alcohol-Related Neuropsychological Impairment ‘cognitive score’, which encompasses processing speed, attentional capacity, working memory updating/tracking, verbal fluency, flexibility, verbal long-term memory, and visual interference. Alcohol Use Disorders Identification Test (AUDIT) scores (which measures alcohol consumption, dependence symptoms, and negative consequences) and age of onset of first alcohol consumption were both significant predictors, with lower age of onset and higher AUDIT score associated with poorer recovery.…”

“…Composite span measures may be confounded by impairments of working memory [ 14 ]), and both indicated improvement, but it is hard to separate this from possible working memory changes. Similarly, Angerville, Ritz [ 23 ] used the Alphabetical Span subtest, which involves working memory manipulation, and also found indications of initial impairment (though this was not confirmed using tests of significance), and improvement by 18 days. Furthermore, differences may also be confounded by the modality of span used, as visuospatial and verbal tasks may involve modality-specific processes [ 26 ].…”

Predicting alcohol relapse post‐detoxification: The role of cognitive impairments in alcohol use disorder patients

“…The literature identifies a multifaceted array of relapse triggers, encompassing biological, psychological, social, and spiritual dimensions (Sliedrecht et al., 2019). A relevant portion has concentrated on the psychological determinants, particularly the role of neurocognitive factors and cognitive impairments (Angerville et al., 2023; Sasaki et al., 2023).…”