ABSTRACT
AIMS: In patients with a history of chronic alcohol abuse, neurocognitive disorders (NCD) are not uncommon. The current study aimed to explore the course of cognitive performance, as measured by the Montreal Cognitive Assessment (MoCA), and everyday cognitive functioning, as measured by the Patient Competency Rating Scale (PCRS), in a large group of patients with alcohol use disorder (AUD) admitted to the Center of Excellence for Korsakov and Alcohol-related Cognitive Impairments. METHODS: A multiple time-series design was used, in which the MoCA was administered at three time points of assessment, and the PCRS was completed by both the patient and a clinician at two time points, all during clinical treatment. RESULTS: A total of 524 patients were included, 71 of whom were diagnosed with AUD only, 284 with AUD and mild NCD (ARCI) and 169 with AUD, major NCD and fulfilling criteria for Korsakoff's syndrome (KS). CONCLUSIONS: Cognitive performance improved for all three groups during treatment, sustained abstinence and recovery from AUD. A low memory performance on the MoCA without improvement over time was predictive for KS, while improvement on this domain did not differentiate between AUD and ARCI. Changes in overall cognitive performance and orientation in patients with KS were positively related to changes in everyday cognitive functioning.
Subject(s)
Alcoholic Korsakoff Syndrome/psychology , Alcoholism/rehabilitation , Cognitive Dysfunction/psychology , Adult , Aged , Aged, 80 and over , Alcohol-Induced Disorders, Nervous System/physiopathology , Alcohol-Induced Disorders, Nervous System/psychology , Alcoholic Korsakoff Syndrome/physiopathology , Alcoholism/physiopathology , Alcoholism/psychology , Cognitive Dysfunction/physiopathology , Executive Function , Female , Hospitalization , Humans , Male , Memory , Mental Status and Dementia Tests , Middle Aged , Neurocognitive Disorders/physiopathology , Neurocognitive Disorders/psychologyABSTRACT
Chronic alcohol use induces silent changes in the structure and function of the central and peripheral nervous systems that eventually result in irreversible, debilitating repercussions. Once identified, nutritional supplementation and cessation measures are critical in preventing further neurologic damage. The proposed mechanisms of neuronal injury in chronic alcohol abuse include direct toxic effects of alcohol and indirect effects, including those resulting from hepatic dysfunction, nutritional deficiencies, and neuroinflammation. Clinical manifestations include cerebellar ataxia, peripheral neuropathy and Wernicke-Korsakoff encephalopathy. Continued exploration of the pathophysiologic mechanisms may lead to the discovery of early interventions that can prevent permanent neurologic injury.
Subject(s)
Alcohol-Induced Disorders, Nervous System/physiopathology , Alcoholism/physiopathology , Alcohol-Induced Disorders, Nervous System/etiology , Alcohol-Induced Disorders, Nervous System/metabolism , Alcohol-Induced Disorders, Nervous System/psychology , Alcohol-Related Disorders/metabolism , Alcohol-Related Disorders/physiopathology , Alcohol-Related Disorders/psychology , Alcoholic Korsakoff Syndrome/etiology , Alcoholic Korsakoff Syndrome/metabolism , Alcoholic Korsakoff Syndrome/physiopathology , Alcoholic Korsakoff Syndrome/psychology , Alcoholic Neuropathy/etiology , Alcoholic Neuropathy/metabolism , Alcoholic Neuropathy/physiopathology , Alcoholism/complications , Alcoholism/metabolism , Alcoholism/psychology , Cerebellar Ataxia/etiology , Cerebellar Ataxia/metabolism , Cerebellar Ataxia/physiopathology , Humans , Neurotransmitter Agents/metabolismABSTRACT
OBJECTIVES: Caring for people with Korsakoff syndrome (KS) residing in specialized long-term care facilities (LTCFs) can be distressing because of challenging neuropsychiatric symptoms (NPS). However, good-quality studies on NPS in this under-researched population are lacking. This study examined the prevalence and severity of NPS in people with KS living in specialized LTCFs and the associated caregiver distress. DESIGN: Cross-sectional, observational study. Data were obtained using structured interviews with care staff, elderly care physicians, and residents. SETTING: Nine specialized LTCFs in the Netherlands. PARTICIPANTS: KS residents admitted for at least 3 months. MEASUREMENTS: The prevalence and severity of NPS were measured with the Neuropsychiatric Inventory-Questionnaire (NPI-Q). The associated caregiver distress was assessed with the NPI Distress Scale (NPI-D) according to the nurse or nurse assistant. RESULTS: Almost all of the 281 residents (96.4%) showed at least 1 NPS and 45.8% showed 5 or more symptoms. Irritability/lability (68.3%), agitation/aggression (58.7%), and disinhibition (52.7%) were most prevalent. Although the mean level of severity for all NPS was relatively low, half of the residents (49.1%) had at least 1 severe NPS. Care staff experienced low levels of distress associated with NPS. CONCLUSION: NPS are highly prevalent in KS residents. Unexpectedly, these did not have any severe impact on residents and care staff. Acquiring more insight into the persistence and course of NPS, and its associations, among KS residents is important to better understand and reduce these symptoms and, ultimately, improve the quality of care for these residents.
