OC-060 An Observational Prospective Clinical Audit to Determine the Presence of Alcohol-Related Brain Injury (ARBI) in Patients Presenting to Acute Care

Abstract

IntroductionAlcohol dependence is a relapsing condition resulting in significant comorbidity and subsequent use of health resources. Patients are repeatedly admitted into acute care for acute alcohol withdrawal management and stabilisation of their physical condition. Patients are frequently labelled as treatment resistant/non-compliant, despite the fact that a significant proportion of these individuals may have underlying alcohol-related brain injury (ARBI), which results in reduced capacity to understand or engage in treatment.1 Unfortunately, it is rare that assessment for ARBI is undertaken, and therefore the condition goes undetected.MethodsPatients presenting to acute care with an alcohol-related problem were assessed for risk of ARBI by the Alcohol Specialist Nurse performing a MoCA© .2 A score of <26 triggered a referral to a dedicated ARBI clinic delivered by a liaison psychiatrist. The aims of this study were to a) explore the scale of the problem, b) describe the complexity of the patient group c) provide evidence for the need and development of bespoke, integrated care pathways.ResultsEighty-nine patients were diagnosed as having ARBI (MoCA < 26) in 12 months 35 female; 57 male, with a mean age of 54 yrs (SD = 10). These patients had average of 9 hospital admissions in 5 years (range 1 to 48). Patients primary reason for admission was; 31 (46%) ALD/Cirrhosis, 21 (23%) alcohol excess (o) 13 (15%) seizure, 6 (7%) ARBI, 2 (1%) stroke and 6 (7%) other. In the previous 5 years; 50 (56%) patients had a fracture, 10 had multiple fractures and 20 had >2 grand mall seizures. Median alcohol consumption was 24 units per day (IQR = 15) at baseline and showed no statistical difference at 3 or 6 month follow-up.ConclusionScreening for ARBI results in detection of otherwise undiagnosed cognitive impairment that renders traditional alcohol treatment approaches ineffective. This group of patients have significant co-morbid conditions likely to benefit from integrated bespoke pathways of care. An acute admission should be utilised as an ideal window of opportunity to assess the patient while they are alcohol free, and plan appropriate treatment which has the potential to prevent people progressing to end stage dementia.References1 Wilson K. Alcohol and brain damage in adults with reference to high-risk groups. Royal College of Psychiatrists. Report number: CR185, 2014.2 Wester AJ, Westhoff J, Kessels RPC, et al. The Montreal Cognitive Assessment (MoCA) as a measure of severity of amnesia in patients with alcohol-related cognitive impairments and Korsakoff Syndrome. Clinical Neuropsychiatry. 2013;10:131141.Disclosure of InterestNone Declared

Informing the development of diagnostic criteria for differential diagnosis of alcohol-related cognitive impairment (ARCI) among heavy drinkers: A systematic scoping review

“…Negative attitudes among healthcare professionals towards people with problems with alcohol or other substances are known to undermine access to diagnosis, treatment, and successful health outcomes [ 48 , 49 ]. Poor compliance with treatment is erroneously perceived as “feckless” with very little recognition of this patient group’s diminished ability to understand, remember, and therefore comply with clinical advice and treatment [ 21 ]. ARCI criteria must therefore be both practical for screening the large numbers of patients presenting in acute hospital and community settings, cognisant of the range of contributing factors that may form part of an ARCI patient’s presentation (including comorbid diagnoses and ongoing alcohol and poly-substance use) and allow for comparisons of different interventions to be made.…”

“…People with ARCI may experience variable psychiatric and social problems as a result of these impairments including difficulties with reasoning and problems with impulse control [ 14 ]. This may go some way to explaining why they have difficulties with adherence to traditional approaches to alcohol treatment, leading to development of multiple co-morbidities and poor treatment outcomes overall [ 21 ].…”