Victoria Manning1,2,3, Hui Chin Teo1, Song Guo1, Kim Eng Wong1, Ting-Kai Li4. 1. a Institute of Mental Health, National Addictions Management Service , Singapore , Singapore. 2. b Turning Point, Eastern Health , Melbourne , Australia. 3. c Eastern Health Clinical School , Monash University , Melbourne , Australia. 4. d Department of Psychiatry , Duke University , Durham , North Carolina , USA.
Abstract
BACKGROUND: The prevalence of alcohol use disorders in Asia is increasing and relapse among treated populations remains the norm, not the exception. The extent to which cognitive impairment influences clinical outcome remains unclear, with research dominated by studies of Caucasian populations. OBJECTIVES: This study examines behavioral and self-reported cognitive functioning in detoxified alcohol-dependent (AD) patients in Singapore and its association with outcome. METHODS: The cognitive performance of 30 recently-detoxified AD inpatients and 30 demographically-matched controls was compared using visuospatial memory, working memory, set-shifting, planning and reflection impulsivity tests of the CANTAB®, and self-reported dysexecutive symptoms and everyday cognitive difficulties. Patients' alcohol use and self-reported cognitive functioning were reassessed 3-months post-discharge. RESULTS: Compared to matched controls, AD inpatients exhibited significantly poorer fluid intelligence, visuospatial memory, working memory, set-shifting flexibility and planning/organization, but not reflection impulsivity. In support of Western studies, a significant proportion (three-quarters) were "clinically impaired" on subtests. Significant reductions were observed in alcohol units, frequency and dependency scores at follow-up, though improvements in self-reported cognitive functioning were limited to abstainers. Baseline cognitive performance did not differentiate those who had abstained from alcohol and relapsed at follow-up. CONCLUSIONS/IMPORTANCE: Memory and executive functioning impairments were evident among Asian AD patients alongside self-reported cognitive difficulties, thus cognitively demanding psychological interventions may have limited impact during early detoxification. Future studies can build on these findings, with larger samples and measurement of moderating and mediating factors to extend our understanding of how cognitive impairment influences outcome.
BACKGROUND: The prevalence of alcohol use disorders in Asia is increasing and relapse among treated populations remains the norm, not the exception. The extent to which cognitive impairment influences clinical outcome remains unclear, with research dominated by studies of Caucasian populations. OBJECTIVES: This study examines behavioral and self-reported cognitive functioning in detoxified alcohol-dependent (AD) patients in Singapore and its association with outcome. METHODS: The cognitive performance of 30 recently-detoxified AD inpatients and 30 demographically-matched controls was compared using visuospatial memory, working memory, set-shifting, planning and reflection impulsivity tests of the CANTAB®, and self-reported dysexecutive symptoms and everyday cognitive difficulties. Patients' alcohol use and self-reported cognitive functioning were reassessed 3-months post-discharge. RESULTS: Compared to matched controls, AD inpatients exhibited significantly poorer fluid intelligence, visuospatial memory, working memory, set-shifting flexibility and planning/organization, but not reflection impulsivity. In support of Western studies, a significant proportion (three-quarters) were "clinically impaired" on subtests. Significant reductions were observed in alcohol units, frequency and dependency scores at follow-up, though improvements in self-reported cognitive functioning were limited to abstainers. Baseline cognitive performance did not differentiate those who had abstained from alcohol and relapsed at follow-up. CONCLUSIONS/IMPORTANCE: Memory and executive functioning impairments were evident among Asian ADpatients alongside self-reported cognitive difficulties, thus cognitively demanding psychological interventions may have limited impact during early detoxification. Future studies can build on these findings, with larger samples and measurement of moderating and mediating factors to extend our understanding of how cognitive impairment influences outcome.
Authors: Victoria Manning; Katherine Mroz; Joshua B B Garfield; Petra K Staiger; Kate Hall; Dan I Lubman; Antonio Verdejo-Garcia Journal: Subst Abuse Treat Prev Policy Date: 2019-06-06
Authors: Antonio Verdejo-Garcia; Valentina Lorenzetti; Victoria Manning; Hugh Piercy; Raimondo Bruno; Rob Hester; David Pennington; Serenella Tolomeo; Shalini Arunogiri; Marsha E Bates; Henrietta Bowden-Jones; Salvatore Campanella; Stacey B Daughters; Christos Kouimtsidis; Dan I Lubman; Dieter J Meyerhoff; Annaketurah Ralph; Tara Rezapour; Hosna Tavakoli; Mehran Zare-Bidoky; Anna Zilverstand; Douglas Steele; Scott J Moeller; Martin Paulus; Alex Baldacchino; Hamed Ekhtiari Journal: Front Psychiatry Date: 2019-12-23 Impact factor: 4.157