differences in neurocognitive functioning in early and late onset alcohol dependent inpatients. leen...
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Differences in neurocognitive functioning in early and late onset alcohol dependent inpatients.Leen Joos, MScCAPRI - AntwerpPsychiatrisch Centrum Broeders Alexianen – Boechout
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Introduction
vs.
EARLY Onset Alcohol dependent patients (EOA)
LATE Onset Alcohol dependent patients (LOA)
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IntroductionClinical and demographic differences
EOA: youngermore paternal family history of alcohol abusemore traumatic experiencesmore antisocial traitsworse prognosis
higher severity of alcohol dependencemore cravingmore other drug use besides alcohollonger alcohol & substance-abusing career
higher trait impulsivityhigher sensation seeking and aggressionweak impulse control
Demir e.a., 2002; Dom e.a., 2006, 2007; Evren e.a., 2009; Johnson e.a., 2000
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IntroductionClinical and demographic differences
EOA: youngermore paternal family history of alcohol abusemore traumatic experiencesmore antisocial traitsworse prognosis
higher severity of alcohol dependencemore cravingmore other drug use besides alcohollonger alcohol & substance-abusing career
higher trait impulsivityhigher sensation seeking and agressionweak impulse control
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IntroductionNeuropsychological differences
EOA: less cognitive flexibility (Demir e.a., 2002)
more commission errors (Continuous Perf Task) ~ impulsive action (Bjork e.a., 2004)
steeper discount rates (Delay Discounting Task)~ impulsive choice (Dom e.a., 2006)
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Introduction
EOA: highly impulsive (impulsive choice and action)less cognitive flexibility
BUT: - previous research is limited- sample sizes are small- tasks are mainly focused on impulse control
Hypothesis: EOA show more deficits than LOA on tasks measuring neuropsychological functioning.
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MethodSubjects
92 alcohol dependent inpatients: EOA: n=35 (age of onset ≤ 25 years)LOA: n=57 (age of onset > 25 years)
INCLUSION criteria: - Current (past 12 months) alcohol dependence (DMS-IV)- Abstinent
EXCLUSION criteria: - Use of psychoactive medication- Current (past 12 months) dependence on other drugs besides alcohol- Acute psychic or severe somatic disorders
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MethodSubjects
EOAn=35
LOAn=57
Gender (male %) 88.6% 84.2%
Age *** 35.91 (8.9) 46.25 (8.4)
Years of drinking *** 14.56 (8.6) 8.20 (6.6)
Age of onset *** 19.46 (4.6) 37.28 (8.2)
IQ 93.66 (8.5) 97.25 (10.9)
Family history of drug abuse 42.9% 26.3%
Substances used ** - Only alcohol - Alcohol + other drugs
51.4%48.6%
86.0%14.1%
*p<.05; **p<.01; ***p<.001
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MethodMeasuresQuestionnaires
- DSM-IV personality disorders (ADP-IV)- Trait impulsivity (BIS-11)- Trait anxiety (STAI) - Depression (BDI-II) - ADHD (ASRS)
- Quantity/frequency measures of alcohol use, past 6 months (TLFB)
- Craving (OCDS) - Nicotine dependence (FTND)
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Method
MeasuresNeuropsychological tests (1/2)
1. Short-term memory / Working memoryDigit span (WAIS-III; Swets Test Publishers, 2000)
Pattern Recognition Memory (PRM; CANTAB; www.camcog.com)
Delayed Matching to Sample (DMS; CANTAB; www.camcog.com)
2. Attention Rapid Visual Presentation Task (RVP; CANTAB;
www.camcog.com)
3. PlanningTower of London (TOL; Vandenheuvel e.a., 2003)
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Method
MeasuresNeuropsychological tests (2/2)
4. Response inhibitionStop Signal Task (SST; Eagle e.a., 2008)
Stroop Colour-Word Task (Cox e.a., 2006)
5. Decision makingDelay Discounting Task (DDT; Wittmann e.a., 2007)
6. Reflection impulsivityInformation Sampling Task (IST; Clark e.a., 2006)
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Results
Clinical characteristics
EOAn=35
LOAn=57
Trait Impulsivity (BIS-11) *** 71.00 (9.8) 62.15 (10.9)
Trait Anxiety (STAI) * 52.17 (12.2) 46.74 (10.9)
Depression (BDI-II) 16.09 (10.4) 13.11 (8.23)
Level of impairment/distress(ADP-IV – total score) ***
246 (63.7) 201.09 (56.6)
Diagnosis Antisocial PersonalityDisorder (ADP-IV) ***
17.6% 0%
Diagnosis ADHD (ASRS) * 37.1% 14%
*p<.05; **p<.01; ***p<.001
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Results
Characteristics Alcohol Use
EOAn=35
LOAn=57
Craving (OCDS) * 5.37 (2.7) 3.89 (3.0)
Mean use/drinking day (TLFB) * 21.53 (14.6) 14.97 (8.3)
Max use/drinking day (TLFB) * 33.86 (19.5) 25.09 (14.26)
% non-smokers (FTND) 11.4% 17.5%
*p<.05; **p<.01; ***p<.001
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Results
1. Short-term memory / Working memoryEOA perform BETTER than LOA on:
Delayed recognition memory (PRM): p<.05Delayed visual memory (DMS): p<.05Working memory (DMS): p=.062
No sign differences on Digit Span
2. Attention No sign differences on RVP
3. PlanningEOA perform BETTER than LOA on TOL (p<.05)
Difficult trials - step 4-5-6: p<.05Easy trials - step 2-3: ns
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Results
4. Response inhibition No sign differences on SST or Stroop Task
5. Decision making No sign differences on DDT
6. Reflection impulsivityEOA showed a MORE IMPULSIVE response pattern
than LOA (IST): p<.05
e.g. they gathered LESS information in more risky situations
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Summary
EOA act MORE IMPULSIVE than LOA inrisky situations involving rewards and losses
EOA perform BETTER than LOA on tasks measuringDelayed Recognition MemoryDelayed Visual MemoryPlanning
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Discussion
Sample selection?
1. Previous results were biased2. Our sample: less comorbidity
less drug dependence
Medication free &Pure alcohol dependent
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Discussion
Less comorbidity: 1.
2. Good cognitive abilities are a protective factor for EOA
NOT to go into poly-substance dependence
Differences between EOA and LOA on neurocognitive measures are
less pronounced.
