COGNITIVE DISORDERS IN FEMALE ALCOHOLIC PATIENTS

Ioana Crciun1, Ioana Micluia 2, Codrua Popescu3, Rodica Macrea4

Abstract:
Background: Different cognitive dysfunctions (on attentional, executive tasks) have been noticed during alcohol intoxication, cessation, early and late abstinence, and in chronicity. Acute effects of moderate drinking include impaired immediate learning, and subsequent retrieval of information learned while intoxicated. As alcohol dependence progresses, thinking becomes less flexible, with diminished capacity of problem solving, abstract thinking, conceptualization, and simplistic strategies. Aims: To investigate gender specific cognitive deficits in alcohol dependence during immediate abstinence and to reveal the influence of the consumption patterns on cognition. Material and Methods: 77 patients (31 males and 46 females), recruited from Second Psychiatric Clinic Cluj-Napoca., diagnosed with alcohol dependence and thirty matched healthy control subjects participated in the study. The Michigan Alcoholism Screening Test (MAST) has been administrated prior to any cognitive task; following cognitive tests were performed on patients (at baseline-after ten days of abstinence, called immediate abstinence), and on controls: for memory (Rey test, Digit span forward, backwards), verbal memory (RAVLT), attention, processing speed, executive functions (TMA, TMB, Digit symbol). Results: Alcoholic patients scored modest on visual memory, verbal memory tasks. Regarding attention, processing speed, executive function, there could be noticed a split within the alcoholic group, the younger ones solving more rapidly these tasks. Alcoholic women score more modest than alcoholic men on tasks investigating immediate memory, short term visual memory , visual learning. There were no significant gender differences regarding short term verbal memory, auditory verbal learning,visouspatial processing, processing speed, and executive functions. Conclusion: alcoholic patients reveal cognitive deficits on all cognitive domains, compared with their healthy counterparts. Gender disparities in favor of men, despite longer duration of drinking and higher quantities of alcohol, were seen for immediate memory, short term visual memory, visual learning. Key words: cognitions, feminine alcoholism
1

Specialist psychiatrist, PhD, Second Psychiatric Clinic Cluj-Napoca, 43, Victor Babes road, tel/fax: +0400-264590127, mobil: +400-742866424; e-mail: ioana_craciun2004@yahoo.com 2 Professor Dr., University of Medicine and Pharmacy Cluj-Napoca, Department of Psychiatry, Head of Second Psychiatric Clinic Cluj-Napoca, 43, Victor Babes road. 3 Psychologist, PhD, Second Psychiatric Clinic Cluj-Napoca, 43, Victor Babes road. 4 Professor Dr., University of Medicine and Pharmacy Cluj-Napoca, Department of Psychiatry, ClujNapoca, 43, Victor Babes road. Received December 27, 2010, Revised April 11, 2011, Accepted June 30, 2011.

Rezumat: Introducere: Diverse disfuncii cognitive (n special deficite atenionale i ale funciilor executive) se observ n timpul intoxicaiei alcoolice acute, n sevraj, n abstinena imediat i timpurie, n cronicitate. n timpul intoxicaiei acute alcoolice se constat nvare i evocri problematice a informaiei achiziionate. Cu progresia maladiei, procesele gndirii devin mai puin flexibile, cu diminuarea capacitii de gndire abstract, conceptualizare, cu strategii simpliste de rezolvare. Obiective: Investigarea tulburrilor cognitive specifice de gen n abstinena imediat i evidenierea influenei diverselor stiluri de consum de alcool asupra cogniiei. Materiale i metode: 77 pacieni (31 brbai i 46 femei) internai la Clinica Psihiatrie II ClujNapoca i 30 de subieci martori au participat la studiu. Pacienilor li s-a aplicatla 10 zile de abstinen Michigan Alcoholism Screening Test (MAST) i martorilor testul Rey, Digit span direct, indirectpentru memorie, RAVLT pentru memorie verbal, TMA, TMB, Digit symbol pentru investigarea ateniei, vitezei de procesare, funciilor executive . Rezultate: Pacienii alcoolici vdesc scoruri modeste ale memoriei vizuale i verbale. Alccolicii mai tineri rezolv mai rapid i expeditiv saricinile de atenie, vitez de procesare, funcii executive.Femeile cu alcoolism ating scoruri inferioare brbailor alcoolici ale memoriei imediate, ale memoriei vizuale de scurt durat i ale invrii vizuale. Nu s-au constatat diferene semnificative n ceea ce privete memoria verbal de scurt durat, nvarea audioverbal, viteza de procesare vizuospaial, funciile executive. Concluzii: Se constat deficite cognitive globale la pacienii alcoolici. Disparitile de gen se nregistreaz n favoarea brbailor n ciuda cantitilor de alcool mai mari consumate i duratei mai ndelungate de consum, mai ales n ceea ce privete memoria imediat, memoria vizual de scurt durat, nvarea vizual. Cuvinte cheie: cogniii, alcoolism feminin

BACKGROUND Different levels of cognitive dysfunctions have been noticed during alcohol intoxication, especially on attentional, executive tasks (1), cessation, early and late abstinence (2), and in chronicity or within the complications or end states. Besides blackouts during acute alcohol intoxication, even moderate drinking may be involved in reversible cognitive deficits with protracted abstinence. These global cognitive impairments are slightly detectable only by psychometric tools at the onset of the dysfunctional alcohol intake behavior, becoming more obvious over time. Acute effects of moderate drinking include impaired immediate learning, and subsequent retrieval of information learned while intoxicated (2). Selective processing of cues indicative of social threat is responsible for the maintenance of a certain level of social anxiety, whereas alcohol use disorders are supposed to develop impairments in information processing that accompany alcohol consumption, which inhibit elaborative processing of stressful or anxiety-related cues, or restrict attentional capacity to immediately salient stimuli (3). As alcohol dependence progresses, thinking becomes less flexible, with diminished capacity of problem solving, abstract thinking, conceptualization, and simplistic strategies; these above mentioned decreased executive functions, regulated by the prefrontal cortex, may be involved in regulating different behaviors, that escape an efficient anticipation of future consequences, like violence, risk driving (1).

Alcohol consumption and abuse may be explained by the theory of metacognitions (awareness of the current state of cognition, and appraisal of the significance of thought and memories). Positive metacognitions about alcohol argue alcohol consumption as a means of cognitive-affective regulation (4). Negative metacognitions regarding alcohol concern the perception of lack of executive control over behavior (4). Although masculine alcoholism exceeds epidemiologically that of feminine alcohol dependence, this gap tends to be equalized; the pattern of alcohol consumption follows a clear cut gender pattern (solitary, stigmatizing, hidden in women), with more rapid and deep social, somatic and cognitive decline in women (5, 6). Aims: To investigate gender specific cognitive deficits in alcohol dependence during immediate abstinence and to reveal the influence of the consumption patterns on cognition. MATERIAL AND METHODS 77 patients (31 males and 46 females), recruited from Second Psychiatric Clinic ClujNapoca., diagnosed according to ICD-10 and DSM-IV-TR criteria with alcohol dependence and thirty matched healthy control subjects participated in the study. The Michigan Alcoholism Screening Test (MAST) has been administrated prior to any cognitive task in order to characterize drinking habits only to alcoholic patients; various cognitive tests were performed on patients (at baseline-after ten days of abstinence, called immediate abstinence), and on controls: for memory (Rey test, Digit span forward, backwards), verbal memory (RAVLT), attention, processing speed, executive functions (TMA, TMB, Digit symbol). Other psychiatric, neurological and somatic comorbidities, that could affect cognition, were excluded. Statistical analysis has been performed with SPSS program, version 15 . t test has been employed for the comparisons of the independent samples; t test was used to compare samples at different time points; .criterion has been used for gender comparisons. RESULTS The two groups (patients and controls) were homogenous regarding age (mean 46, 97 years of patients with standard deviation-SD=8, 62, versus mean 42, 4 years-SD=11, 83 in controls) and educational level (mean 10, 80 years with SD=2, 85 in patients versus 12 years-SD=3, 31 in controls). The duration of alcohol consumption recorded 13.7 years in women, SD=5, 72 versus 17.5 years in men, SD=8, 14, (t=2, 69, DF=75 and p=0,017). The quantity of alcohol beverages significantly exceeded in men over women (t=2, 87, p<0.05): women drink 12, 79 sd (standard drink), SD=6, 98, while men drink 17, 75 sd (SD=8, 06) every day. Visual memory, explored by the Rey test, revealed following results: the mean scores were 23, 69, SD=10.18 for alcoholics versus 44, 43, for controls. The comparison of these means by T test shows a difference of -21,04 (confidence interval 95% ranges from-25,22 to -16,86; due to the fact that this interval does not contain the point 0.00, the difference is significant at the level 5%) (Fig. 1).

16 14 12 10 8 6 4 2 0 pr 1 pr 2 pr 3 pr 4 pr 5 pr rec

* * * * * *

pacieni alcoolici control

*- significant difference Fig. 1. Results on Rey visual test of alcoholic sample and controls Verbal learning, tested by RAVLT, emphasized following mean values: M = 44,20, SD = 9,40 for alcoholic patients and M = 56,96, SD = 4,91 for controls; the difference between the two groups -12,75 (confidence interval of 95% ranges from-16,34 to -9,17 (due to the fact that this interval doesnt include the point 0,00, the difference is statistically significant at 0,05% ) (Fig. 2).

30 25 20 15 10 5 0
pr 1 pr 2 pr 3 pr 4 pr 5 pr rec pr 20

* * * * * *

control pacieni alcoolici

* - significant difference Fig.2. Comparative RAVLT of alcoholics and controls

Attention, processing speed, executive functions, explored by TMA, TMB, Digit symbol revealed following results (Table 1): the mean values of the time scores on TMA of alcoholic patients less than 45 years of age (M = 62,57, SD = 19,85) were significantly shorter than those realized by older alcoholic patients (M = 76,76, SD = 25,47) (Table no1). Patients 45 years N = 35 M SD 62,57 19,85 173,20 74,44 Patientsi 45 years N = 42 M SD 76,76 25,47 186,33 80,93

t -2,68 -0,73

p 0,009 0,465

TMA TMB

Digit Symbol

39,54

15,74

34,09

13,32

1,64

0,104

Table 1. Results of alcoholic patients on TMA, TMB, Digit symbol No significant differences between the two sample could be noticed on TMB (t = -0,73, df = 75, p = 0,465), respectively Digit symbol (t = 1,64, df = 75, p = 0,104) (Table 2). A further analysis regarded the gender comparison inside the alcoholic sample. From all data, we shall point the results on a memory task, Digit span forward and backwards (Fig. 3).
6

5,29 5 4,67

4 3,48 3,21 3

men women

digit span forward

digit span backward

Fig. 3. Gender distribution of results on Digit span forward and backwards in the alcoholic sample The comparison of mean scores (t test) on the forward task emphasized significant gender differences (t = 2,62, df = 75, p = 0,010), men scoring higher (M = 5,29, SD = 1,18) than women (M = 4,67, SD = 0,87). On the backwards task, men score also higher (M = 3,48, SD = 1,31) than women (M = 3,48, SD = 1,31), the difference being not statisticcaly significant (t = 1,11, DF = 75, p = 0,269). A further aim of the current study is to reveal the influence of drinking habits on cognitive tasks (Table 2). RAVLT (N = 46) trial 1 Duration -0,369* trial 2 -0,256 trial 3 -0,273 trial 4 -0,240 trial 5 Rec trial Trial at 20 -0,082 RAVLT total -0,323* 5

(years) Quantity (sd/day)

0,292* -0,057 -0,025 -0,037 -0,032 -0,002

0,410** -0,138 -0,079 -0,032

Table 2. Relation between drinking habits and RAVLT A negativesignificant corelation could be established between duration of alcohol consumption and the results on RAVLT first trial (r = -0,369, p < 0,05), 5th trial (r = 0,292, p < 0,05), recognition (r = -0,410, p < 0,01), and total RAVLT (r = -0,323, p < 0,05) (Table 2). No significant correlation between the quantity of alcohol intake and results on RAVLT could be noted. A significant positive corelation (R = 0,324, p < 0,05) between the duration of drinking and time scores on TMA and a negative significance (r = -0,458, p < 0,01) between duration of alcohol intake and results on Digit symbol test could be noticed. DISCUSSION The overall modest scores on cognitive tasks are concordant with other authors (7, 8, 9, 10), while few (11) did not notice any cognitive impairments. CONCLUSION Alcoholic patients reveal cognitive deficits on all cognitive domains, compared with their healthy counterparts. Gender differences of drinking habits revealed a shorter duration and smaller quantities of alcohol intake in women than men. The current study emphasiezed the fact that alcoholic women score more modest than alcoholic men on tasks investigating immediate memory, short term visual memory , visual learning. There were no significant gender differences regrading short term verbal memory, auditory verbal learning,visouspatial processing, processing speed, and executive functions. REFERENCES
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