Heterogeneity of Executive Function Abilities in Recently Detoxified Patients with Alcohol Use Disorder: Evidence from a Cluster Analysis

Abstract

Background Impairments of executive functions (EF) have been consistently reported in patients with alcohol use disorder (AUD), mostly in studies which were based on comparisons of means between groups. However, given the high heterogeneity in AUD patients, this approach could actually cover a wide range of EF patterns. In the present study, we addressed the paucity of the literature about cognitive heterogeneity in AUD by applying a cluster analytical approach on EF measures. Methods Seventy‐eight withdrawn AUD patients and 77 healthy Control participants completed measures targeting a variety of EF components. We then used cluster analysis to identify subgroups of AUD patients. Furthermore, the AUD subgroups were compared to the Control group to establish their specific EF patterns. Results Findings showed that AUD patients could be divided into 3 clusters based on their EF performances. A first cluster accounting for half of the AUD sample was characterized by unimpaired EF (Cluster 1). The 2 other clusters displayed major EF deficits but differed regarding the deficient EF component. While Cluster 2 was mainly impaired on measures of rule deduction and mental flexibility, Cluster 3 was mainly characterized by a lower processing speed and impaired inhibition of an ongoing motor response. Differences in EF performances of AUD patients could be related to differences in premorbid cognitive reserve, impulsiveness patterns, and withdrawal complications. Conclusions This study highlights the importance of the cognitive heterogeneity in AUD by showing that AUD patients display substantially different EF patterns. Future studies should try to go beyond mere group comparisons to further deepen our understanding about cognitive differences between AUD patients. In the long run, this could lead to more personalized prevention and treatment programs specifically tailored to the patient’s impairments.

Patterns of executive functions and theory of mind in adults with a family history of alcohol use disorder: Combined group and single‐case analyses

“…Results indicated that EF and ToM specificities were present in approximately half of FH+ participants (53.33%), whereas the other FH+ participants had EF and ToM performances within the normal range (47.67%). This result echoes previous findings in AUD which have reported EF and ToM alterations in one out of two patients, suggesting heterogeneous cognitive patterns in this pathology (Maurage et al., 2015; Schmid et al., 2021). Prior studies of EF and SC abilities in FH+ individuals have yielded divergent results, with some suggesting EF and SC alterations (Dougherty et al., 2015; Henderson et al., 2018) and others equivalent behavioral performances across FH+ and FH− individuals (DeVito et al., 2013; Schmidt et al., 2017).…”

“…Whereas some FH+ individuals may have EF and SC difficulties, others may have no such cognitive specificities (Long et al, 2017). The fact that, in a parallel way, several studies have highlighted heterogeneous EF (Schmid et al, 2021) and SC (Maurage et al, 2021) abilities among detoxified patients with AUD lends further weight to this hypothesis. Up to now, studies among FH+ individuals have relied on group comparisons to assess the presence of EF and SC specificities.…”

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

“…For instance, executive dysfunction interferes with motivational processes to abandon excessive drinking patterns, may comprise an individual's effort towards sustained abstinence, and may increase the risk of relapse. As a result, it may generally impair the ability to benefit from treatment [16,17]. Despite accumulating evidence on the impact of alcohol-related executive disfunction, literature on treatment and treatment outcome is sparse and inconclusive [18].…”