1 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2033, Australia,
2 School of Behavioural Sciences, Macquarie University, Sydney, NSW 2109, Australia,
3 Department of Psychology, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia and
4 Departments of Psychology, and Psychiatry and Behavioural Science, University of Western Australia, Nedlands, WA 6097, Australia
Received 19 November 1998; in revised form 5 April 1999; accepted 17 May 1999
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ABSTRACT |
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INTRODUCTION |
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The present study was designed to identify dissociations between visuo-spatial and organizational impairments in severely dependent drinkers using a case-study approach. Performance on tasks which independently assess organizational and visuo-spatial abilities was examined. It was predicted that patients would show impaired performance on traditional neuropsychological tests, but that this impairment could be attributable to visuo-spatial deficits in some patients and organizational deficits in others.
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MATERIALS AND METHODS |
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Control group. Thirty males from the community were recruited as a control sample. Exclusion criteria for the control group were the same as for the treatment group, except that they were also excluded if they had ever sought treatment for drug- or alcohol-related problems or if their score on the MAST exceeded 5. The age range of the control sample was between 23 and 58 years and years of education ranged from 9 to 18.
Cognitive tests
Subjects completed a battery of cognitive and electrophysiological recording tasks as part of a larger project. Variables analysed included the Block Design subtest of the WAIS-R, Mental Rotation (subjects presented with two cartoon figures and had to state whether the man in each picture held a glass in the same or different hands), Rey Auditory Verbal Learning Test (RAVLT difference in performance between trial 1 and trial 5) and Verbal Memory (lists of nine-item word lists presented sequentially on a Digital VT220 monitor with free recall at the end of each list). Subjects completed 10 lists with no specified learning strategy (natural strategy NS), 10 lists following instructions to use rote learning strategies (RS), and 10 lists following instructions to use elaborative learning strategies (ES), where they were instructed to link the items in the list by forming an integrated story or picture.
Procedure
The experimental procedure was described to subjects and informed consent obtained. They were tested individually over two sessions approximately 1 week apart. During the first session, demographic and drinking-history data were collected and the cognitive tasks completed. During the second session, subjects participated in an experiment examining event-related potential indices of memory processes, although these data will not be reported here.
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RESULTS |
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DISCUSSION |
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These results highlight the need for detailed evaluation of cognitive status during treatment. It has been suggested that cognitive deficits influence treatment effectiveness and are amenable to cognitive rehabilitation (Allen et al., 1997). Furthermore, it has been argued that complex, higher order psychological variables, such as cognitive appraisal and coping strategies, account for much of the variance in relapse rate (Miller et al., 1996
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One mediating factor proposed to influence the relationship between drinking history and cognitive impairment is family history of alcohol-related problems. The reported incidence of problem drinkers was higher for Patient 1 (three of six siblings, father, grandfather, one of four aunts) than for Patient 2 (one out of three siblings). Therefore, it is possible that the dissociations may reflect a genetic vulnerability to the development of visuo-spatial impairments following excessive alcohol consumption. Family history of alcohol-related problems has been linked to visuo-spatial impairments in a number of studies, whereas no association has been reported for frontal lobe functioning (Adams et al., 1998).
A second mediating factor proposed is liver dysfunction, although neither patient reported overt liver damage. Arria et al. (1991) reported that many of the visuo-spatial deficits experienced by severely dependent problem drinkers may be due to underlying liver disease, rather than to the direct effects of alcohol on performance. Walton and Bowden (1997) recently reported no relationship between neuropsychological test performance and liver function tests, although visuo-spatial ability was not independently assessed in their study.
An implication of the results of this study is that a detailed evaluation of cognitive functioning prior to treatment could provide information on the most appropriate treatment programme for a particular individual. Furthermore, examination of the pattern of performance could provide further insights into the role of other mediating factors in the development of cognitive impairment.
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FOOTNOTES |
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REFERENCES |
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