Cognitive Screening and Neuropsychological Profiles of Alcohol-Dependent Patients Undergoing Detoxification

Joy Low (). Cognitive Screening and Neuropsychological Profiles of Alcohol-Dependent Patients Undergoing Detoxification Professional Doctorate, School of Psychology, The University of Queensland.

       
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Author Joy Low
Thesis Title Cognitive Screening and Neuropsychological Profiles of Alcohol-Dependent Patients Undergoing Detoxification
School, Centre or Institute School of Psychology
Institution The University of Queensland
Thesis type Professional Doctorate
Supervisor Dr. Genevieve Dingle
Dr. Mark Daglish
Total pages 238
Language eng
Abstract/Summary Cognitive impairment is common in individuals with chronic alcohol dependence and liver damage. Cognitive deficits that commonly present as a result of alcohol dependency, including executive dysfunction, visuo-spatial deficits, and motor impairments, impact on the individual’s ability to engage in activities of daily living. To date, few studies have investigated the cognitive functioning of alcohol-dependent patients during the detoxification period. The present study aims to further our understanding of the cognitive and psychosocial consequences of chronic alcohol dependence and liver damage measured during the detoxification period, and identify any clinical and/or neuropsychological markers which can assist in improved treatment for patients. Aims: The two studies presented in this thesis explored cognitive functioning in adults with alcohol dependence during medicated detoxification. The first study investigated the relationships among measures of alcohol use, liver function, and cognitive function in 142 patients undergoing detoxification. A theoretical model was posited and tested, acknowledging direct and indirect relationships between cognitive function and other variables. The second study was aimed at gaining an in-depth understanding of alcohol-dependent patients’ level of cognitive functioning during detoxification using neuropsychological test data from 20 of the patients. The neuropsychological profile was expected to provide a better understanding of the effects of numerous variables, such as chronic alcohol use, multiple detoxifications, and liver damage, on specific neuropsychological domains. The characterisation of neuropsychological profiles for these participants would inform of the extent of damage to the brain by alcohol. The best way to quantify their impairment was thought to be by exploring their individual cognitive decline from estimated pre-morbid levels and comparisons with normative populations. Method: In both studies, cognitive screening and psychosocial functioning data for 142 patients, and comprehensive neuropsychological results for a selected 20 participants, were collected and analysed using descriptive statistics and comparisons to normative samples. Results: In Study 1, the Modified Mini Mental State Examination (3MS) was found to be more sensitive to measures of liver functioning than the verbal fluency tasks. In the total sample, age was significantly correlated with semantic fluency scores, demonstrating an association between increasing age and poorer performance, particularly in males. A significant negative correlation between phonemic fluency scores and serum level of the liver enzyme GGT levels in females suggest potential susceptibility of females to the effects of liver damage with excessive alcohol consumption. However, there was a significant positive correlation between average amounts of alcohol consumption with semantic fluency in females, suggesting an anomaly. Finally, there was an unexpected lack of significant association between the alcohol measures and the measures of cognitive functioning, resulting in the inability to conduct further mediation analyses to confirm the theoretical model posited. In Study 2, the 20 participants demonstrated average to above average estimated pre-morbid cognitive functioning. Their current cognitive functioning, however, was found to be typically below that of the normative sample. Nonetheless, the participants’ verbal skills appeared to be relatively preserved. New visual learning and memory, as well as processing speed were found to be significantly below the mean expected for their age and education. The participants also demonstrated generally mild executive function deficits. Finally, use of a deficit index for each participant revealed that the majority of the participants demonstrated declines in current cognitive functioning based on their estimated pre-morbid cognitive functioning. The single most useful neuropsychological test was identified to be the Rey-Osterrieth Complex Figure (immediate and delayed recall) which showed that these two measures were identifying the most number of participants demonstrating a decline on the test. Discussion: By furthering our understanding of the cognitive and psychosocial sequelae associated with chronic alcohol dependence and alcohol-related liver damage, health services may more appropriately direct resources and target interventions to assist patients during the interim detoxification period to promote optimal care and minimise the risk of relapse.
Keyword Alcohol-dependent
detoxification
Neuropsychological Profiles
cognitive screening

 
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Created: Wed, 15 Feb 2012, 16:45:05 EST by Joy Low on behalf of Faculty of Social & Behavioural Sciences