Funcionamiento cognitivo en pacientes con trastorno por uso de alcohol que inician tratamiento ambulatorio de deshabituación alcohólica

Rocio Villa, Ashkan Espandian, Pilar A. Sáiz, Mónica Astals, Joana K. Valencia, Emilia Martínez-Santamaría, Sandra Álvarez, María Paz García-Portilla, Julio Bobes, Gerardo Flórez

Resumen


El objetivo principal del presente estudio es analizar la presencia del deterioro cognitivo asociado al consumo de alcohol en los pacientes con trastorno por uso de alcohol moderado o grave que demandan tratamiento de deshabituación alcohólica ambulatorio. Para ello, se comparó una muestra de 111 pacientes con trastorno por uso de alcohol activo que iniciaban tratamiento ambulatorio versus 100 controles sanos. Se compararon variables sociodemográficas y clínicas asociadas al consumo de alcohol, como el craving de alcohol y la impulsividad. También se empleó en la comparación una batería sistematizada de pruebas cognitivas que permitía valorar las siguientes funciones: atención, memoria anterógrada, velocidad de procesamiento, fluidez verbal, función ejecutiva y actitud implícita ante las bebidas alcohólicas. En comparación con los controles sanos, los pacientes con trastorno por uso de alcohol moderado o grave presentaban un rendimiento significativamente inferior en todas las pruebas utilizadas, y por ello en todas las funciones cognitivas evaluadas, con la excepción de dos pruebas, el Iowa Gambling Test y el Implicit Association Test. El análisis a través de una matriz de correlaciones del grupo de pacientes indica que los pacientes que refieren más impulsividad y un consumo abusivo de alcohol más cronificado y con más adicción son los que presentan un mayor deterioro en su función cognitiva. El daño cognitivo asociado al consumo de alcohol se distribuyó de forma heterogénea entre los pacientes. El presente estudio confirma la presencia del deterioro cognitivo asociado al consumo de alcohol en los pacientes que demandan tratamiento ambulatorio.


Palabras clave


Alcoholismo; Trastorno por uso de alcohol; Impulsividad; Daño cerebral asociado al consumo de alcohol; Función ejecutiva

Texto completo:

PDF PDF (English)

Referencias


Aharonovich, E., Campbell, A. N. C., Shulman, M., Hu, M. C., Kyle, T., Winhusen, T. y Nunes, E. V. (2018). Neurocognitive Profiling of Adult Treatment Seekers Enrolled in a Clinical Trial of a Web-delivered Intervention for Substance Use Disorders. Journal of Addiction Medicine, 12, 99-106. doi:10.1097/adm.0000000000000372.

Anton, R. F. (2000). Obsessive-compulsive aspects of craving: Development of the Obsessive Compulsive Drinking Scale. Addiction, 95 (Suppl. 2), 211-217.

Bech, P. (1990). Psychometric developments of the Hamilton scales: the spectrum of depression, dysthymia, and anxiety. Psychopharmacology Series, 9, 72-79.

Bernstein, M. H., McSheffrey, S. N., van den Berg, J. J., Vela, J. E., Stein, L. A., Roberts, M. B., … Clarke, J. G. (2015). The association between impulsivity and alcohol/drug use among prison inmates. Addictive Behaviors, 42, 140-143. doi:10.1016/j.addbeh.2014.11.016.

Briere, F. N., Rohde, P., Seeley, J. R., Klein, D. y Lewinsohn, P. M. (2014). Comorbidity between major depression and alcohol use disorder from adolescence to adulthood. Comprehensive Psychiatry, 55, 526-533. doi:10.1016/j.comppsych.2013.10.007.

Carmona-Perera, M., Sumarroca-Hernandez, X., Santolaria-Rossell, A., Perez-Garcia, M. y Reyes Del Paso, G. A. (2019). Blunted autonomic responses to emotional stimuli in alcoholism: relevance of impulsivity. Adicciones, 31, 221-232. doi:10.20882/adicciones.1146.

del Ser Quijano, T., Sanchez Sanchez, F., Garcia de Yebenes, M. J., Otero Puime, A., Zunzunegui, M. V. y Munoz, D. G. (2004). Spanish version of the 7 Minute screening neurocognitive battery. Normative data of an elderly population sample over 70. Neurologia, 19, 344-358.

Draper, B., Karmel, R., Gibson, D., Peut, A. y Anderson, P. (2011). Alcohol-related cognitive impairment in New South Wales hospital patients aged 50 years and over. Australian and New Zealand Journal of Psychiatry, 45, 985-992. doi:10.3109/00048674.2011.610297.

Elwood, R. W. (1995). The California Verbal Learning Test: Psychometric characteristics and clinical application. Neuropsychology Review, 5, 173-201.

Erdozain, A. M., Morentin, B., Bedford, L., King, E., Tooth, D., Brewer, C., … Carter, W. G. (2014). Alcohol-related brain damage in humans. PloS One, 9, e93586. doi:10.1371/journal.pone.0093586.

Evren, C., Durkaya, M., Evren, B., Dalbudak, E. y Cetin, R. (2012). Relationship of relapse with impulsivity, novelty seeking and craving in male alcohol-dependent inpatients. Drug and Alcohol Review, 31, 81-90. doi:10.1111/j.1465-3362.2011.00303.x.

Florez, G., Espandian, A., Villa, R. y Saiz, P. A. (2019). Clinical implications of cognitive impairment and alcohol dependence. Adicciones, 31, 3-7. doi:10.20882/adicciones.1284.

Galvin, R., Brathen, G., Ivashynka, A., Hillbom, M., Tanasescu, R. y Leone, M. A. (2010). EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. European Journal of Neurology, 17, 1408-1418. doi:10.1111/j.1468-1331.2010.03153.x.

Golpe, S., Isorna, M., Barreiro, C., Brana, T. y Rial, A. (2017). Binge drinking among adolescents: Prevalence, risk practices and related variables. Adicciones, 29, 256-267. doi:10.20882/adicciones.932.

Hagen, E., Erga, A. H., Hagen, K. P., Nesvag, S. M., McKay, J. R., Lundervold, A. J. y Walderhaug, E. (2016). Assessment of executive function in patients with substance use disorder: A comparison of inventory- and performance-based assessment. Journal of Substance Abuse Treatment, 66, 1-8. doi:10.1016/j.jsat.2016.02.010.

Hayes, V., Demirkol, A., Ridley, N., Withall, A. y Draper, B. (2016). Alcohol-related cognitive impairment: current trends and future perspectives. Neurodegenerative Disease Management, 6, 509-523. doi:10.2217/nmt-2016-0030.

Horton, L., Duffy, T., Hollins Martin, C. y Martin, C. R. (2015). Comprehensive assessment of alcohol-related brain damage (ARBD): Gap or chasm in the evidence? Journal of Psychiatric and Mental Health Nursing, 22, 3-14. doi:10.1111/jpm.12156.

Jakubczyk, A., Klimkiewicz, A., Mika, K., Bugaj, M., Konopa, A., Podgorska, A., … Wojnar, M. (2013). Psychosocial predictors of impulsivity in alcohol-dependent patients. Journal of Nervous and Mental Disease, 201, 43-47. doi:10.1097/NMD.0b013e31827aaf9d.

Koob, G. F. (2003). Alcoholism: Allostasis and beyond. Alcoholism, Clinical and Experimental Research, 27, 232-243. doi:10.1097/01.alc.0000057122.36127.c2.

Koob, G. F. y Volkow, N. D. (2010). Neurocircuitry of addiction. Neuropsychopharmacology, 35, 217-238. doi:10.1038/npp.2009.110.

Laramee, P., Leonard, S., Buchanan-Hughes, A., Warnakula, S., Daeppen, J. B. y Rehm, J. (2015). Risk of all-cause mortality in alcohol-dependent individuals: A systematic literature review and meta-analysis. EBioMedicine, 2, 1394-1404. doi:10.1016/j.ebiom.2015.08.040.

Litten, R. Z., Ryan, M. L., Falk, D. E., Reilly, M., Fertig, J. B. y Koob, G. F. (2015). Heterogeneity of alcohol use disorder: Understanding mechanisms to advance personalized treatment. Alcoholism, Clinical and Experimental Research, 39, 579-584. doi:10.1111/acer.12669.

Maharasingam, M., Macniven, J. A. y Mason, O. J. (2013). Executive functioning in chronic alcoholism and Korsakoff syndrome. Journal of Clinical and Experimental Neuropsychology, 35, 501-508. doi:10.1080/13803395.2013.795527.

Moretti, R., Caruso, P., Dal Ben, M., Gazzin, S. y Tiribelli, C. (2017). Thiamine and alcohol for brain pathology: Super-imposing or different causative factors for brain damage? Current Drug Abuse Reviews, 10, 44-51. doi:10.2174/1874473711666180402142012.

Mujica-Parodi, L. R., Carlson, J. M., Cha, J. y Rubin, D. (2014). The fine line between ‘brave’ and ‘reckless’: amygdala reactivity and regulation predict recognition of risk. Neuroimage, 103, 1-9. doi:10.1016/j.neuroimage.2014.08.038.

Niemela, O. (2016). Biomarker-based approaches for assessing alcohol use disorders. International Journal of Environmental Research and Public Health, 13, 166. doi:10.3390/ijerph13020166.

Nyhus, E. y Barcelo, F. (2009). The Wisconsin Card Sorting Test and the cognitive assessment of prefrontal executive functions: A critical update. Brain and Cognition, 71, 437-451. doi:10.1016/j.bandc.2009.03.005.

Ostafin, B. D., Marlatt, G. A. y Greenwald, A. G. (2008). Drinking without thinking: An implicit measure of alcohol motivation predicts failure to control alcohol use. Behaviour Research and Therapy, 46, 1210-1219. doi:10.1016/j.brat.2008.08.003.

Patton, J. H., Stanford, M. S. y Barratt, E. S. (1995). Factor structure of the Barratt impulsiveness scale. Journal of Clinical Psychology, 51, 768-774.

Rehm, J., Rehm, M. X., Shield, K. D., Gmel, G. y Gual, A. (2013). Alcohol consumption, alcohol dependence and related harms in Spain, and the effect of treatment-based interventions on alcohol dependence. Adicciones, 25, 11-18.

Rehm, J., Shield, K. D., Gmel, G., Rehm, M. X. y Frick, U. (2013). Modeling the impact of alcohol dependence on mortality burden and the effect of available treatment interventions in the European Union. European Neuropsychopharmacology, 23, 89-97. doi:10.1016/j.euroneuro.2012.08.001.

Rehm, J., Allamani, A., Aubin, H. J., Della Vedova, R., Elekes, Z., Frick, U., … Wojnar, M. (2015a). People with alcohol use disorders in specialized care in eight different European countries. Alcohol and Alcoholism, 50, 310-318. doi:10.1093/alcalc/agv009.

Rehm, J., Allamani, A., Della Vedova, R., Elekes, Z., Jakubczyk, A., Landsmane, I., … Wojnar, M. (2015b). General practitioners recognizing alcohol dependence: a large cross-sectional study in 6 European countries. Annals of Family Medicine, 13, 28-32. doi:10.1370/afm.1742.

Rickham, P. P. (1964). Human Expermentation, Code of Ethics of the World Medical Association. Declaration of Hensinki. British Medical Journal, 2, 177.

Ridley, N. J., Draper, B. y Withall, A. (2013). Alcohol-related dementia: An update of the evidence. Alzheimer’s Research & Therapy, 5, 3. doi:10.1186/alzrt157.

Romero-Martinez, A., Vitoria-Estruch, S. y Moya-Albiol, L. (2020). Cognitive profile of long-term abstinent alcoholics in comparison with non-alcoholics. Adicciones, 32, 19-31. doi:10.20882/adicciones.1079.

Sachdeva, A., Chandra, M., Choudhary, M., Dayal, P. y Anand, K. S. (2016). Alcohol-related dementia and neurocognitive impairment: A review study. International Journal of High Risk Behaviors & Addictions, 5, e27976. doi:10.5812/ijhrba.27976.

Scarpina, F. y Tagini, S. (2017). The Stroop Color and Word Test. Frontiers in Psychology, 8, 557. doi:10.3389/fpsyg.2017.00557.

Shoval, G., Shmulewitz, D., Wall, M. M., Aharonovich, E., Spivak, B., Weizman, A. y Hasin, D. (2014). Alcohol dependence and suicide-related ideation/behaviors in an Israeli household sample, with and without major depression. Alcoholism, Clinical and Experimental Research, 38, 820-825. doi:10.1111/acer.12290.

Stavro, K., Pelletier, J. y Potvin, S. (2013). Widespread and sustained cognitive deficits in alcoholism: A meta-analysis. Addiction Biology, 18, 203-213. doi:10.1111/j.1369-1600.2011.00418.x.

Steinborn, M. B., Langner, R., Flehmig, H. C. y Huestegge, L. (2018). Methodology of performance scoring in the d2 sustained-attention test: Cumulative-reliability functions and practical guidelines. Psychological Assessment, 30, 339-357. doi:10.1037/pas0000482.

Steingroever, H., Wetzels, R., Horstmann, A., Neumann, J. y Wagenmakers, E. J. (2013). Performance of healthy participants on the Iowa Gambling Task. Psycholological Assessment, 25, 180-193. doi:10.1037/a0029929.

Volkow, N. D., Koob, G. F. y McLellan, A. T. (2016). Neurobiologic advances from the brain disease model of addiction. New England Journal of Medicine, 374, 363-371. doi:10.1056/NEJMra1511480.

Wollenweber, F. A., Halfter, S., Brugmann, E., Weinberg, C., Cieslik, E. C., Muller, V. I., … Eickhoff, S. B. (2014). Subtle cognitive deficits in severe alcohol addicts--do they show a specific profile? Journal of Neuropsychology, 8, 147-153. doi:10.1111/jnp.12001.

Zahr, N. M. y Pfefferbaum, A. (2017). Alcohol’s effects on the brain: Neuroimaging results in humans and animal models. Alcohol Research: Current Reviews, 38, 183-206.




DOI: https://doi.org/10.20882/adicciones.1326

Enlaces refback

  • No hay ningún enlace refback.