'Drink to forget' – a case report

Introduction:

The harmful effects of chronic alcohol excessive consumption on the brain and cognitive functioning have been described in the scientific literature, and are increasingly becoming the focus of attention of addiction medicine professionals.

Attention, working memory, speed of processing, visuospatial abilities, executive functions, impulsivity, learning, memory and verbal fluency have all been shown to be impaired in alcoholism. These deficits are influenced by a wide range of variables and may range from mild to severe but usually remain undiagnosed, unless they are speci?cally investigated.

Alcohol-related cognitive impairments are largely underestimated in clinical practice, even though they could limit the benefit of alcohol treatment and hamper the patient’s ability to remain abstinent or to respect the therapeutic contract.

Aims:

Theme review on the available evidence regarding the alcohol-related cognitive impairment.

Presentation of a case report concerning a patient with alcohol dependence syndrome and cognitive complaints included in a Neuromodulation Cognitive Program.

Methods:

Non-systematic review of the literature was performed in PubMed and Medscape database; the articles were selected according to their relevance. A patient´s clinical record was reviewed and presented.

Results:

We present a case report of a 44-year-old male with mental and behavioral disorder due to use of alcohol – dependence syndrome - and comorbid anxiety disorder, who complains of memory and impulse control problems. The patient has alcohol consumption since 21 years old, with gradual increase mainly after 37 years old. He describes drinking mainly beer and some spirits drinks. He was admitted to inpatient care and after discharge he started the relapse prevention intervention. After 5 months of alcohol abstinence he maintained memory complaints and impulse control problems affecting his daily life.

The patient was evaluated by a team of experts and some screening tools were applied (Montreal Cognitive Assessment, Addenbrooke Cognitive Examination and Frontal Assessment Battery). In this patient, verbal fluency, memory, attention, visuospatial capacities and impulsivity have all been shown to be impaired. These results were consistent with those described in the literature.

The patient was included in a Neuromodulation Cognitive Program at Centro Hospitalar Psiquiátrico de Lisboa.

Conclusion:

This case report highlights the neurocognitive effect of excessive and long-term consumption of alcohol, in a patient without relevant comorbidities; and therefore it brings a better understanding of alcohol-related cognitive disorders usually hidden by confounding factors.

It is essential to take into account the cognitive dimension of alcohol-dependent patients in order to adapt their treatment and to palliate their difficulties in activities of daily life.