Screening for alcohol-related cognitive impairments – a case study

Introduction:Alcohol is a major health concern that causes hefty health care costs, lower quality of life and economic burden which is aggravated by productivity loss from disability and work absenteeism.

The harmful effects of chronic alcohol excessive consumption on the brain and cognitive functioning have been described in the scientific literature, but are largely underestimated in clinical practice.

Such cognitive disorders can interfere with the motivation process to abandon maladjusted drinking behavior in favor of a healthier lifestyle (such as abstinence or controlled alcohol consumption). They can also limit the patient’s capacity to fully benefit from treatment (notably psychoeducation and cognitive-behavioral treatments). In addition, they may contribute to relapse which is multi-determinated.

Aims:Theme review on the available evidence regarding alcohol-related cognitive impairments. Description of the major cognitive impairments in a group of patients diagnosed with mental and behavioral disorder due to use of alcohol.

Methods:Non-systematic review of the literature was performed in PubMed and Medscape database, the articles were selected according to their relevance. Characterization of a group of patients diagnosed with mental and behavioral disorder due to use of alcohol with cognitive complaints. A cognitive screening tool - Montreal Cognitive Assesment – was applied.

Results:Research about alcohol-related cognitive impairments is challenging, considering the multiple patterns of alcohol abuse, the personal and lifestyle factors, and the vulnerability of specific brain regions.

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.

In our research work we studied a group of 9 patients diagnosed with mental and behavioral disorder due to use of alcohol who complained about cognitive impairments affecting their daily routine. The patients were included in a relapse prevention program and all were alcohol abstinent. In an initial assessment, Montreal Cognitive Assesment was applied as a screening tool, and 8 of the patients showed results under the cut-off point, being the mainly affected domains verbal fluency, memory, attention and visuospatial capacities. These results were consistent with the literature in this field.

Afterwards patients were included in a Neuromodulation Cognitive Program in Centro Hospitalar Psiquiátrico de Lisboa.

Conclusion:In our research we found significant cognitive deficits in a group of patients with mental and behavioral disorder due to use of alcohol and cognitive complaints. This work highlights the importance of recognizing and screening for alcohol-related cognitive impairments, that are largely underestimated in clinical practice and have large implication in treatment and prognosis.