Funcionamiento cognitivo después de seis meses de seguimiento en una muestra de pacientes ambulatorios con trastorno por uso de alcohol Cognitive functioning after six months of follow-up in a sample of alcohol use disorder outpatients

Autores/as

  • Rocío Villa Servicio de Salud Mental del Principado de Asturias (SESPA). Instituto de Investigación Sanitaria del Principado de Asturias (ISPA).
  • Ashkan Espandian Servicio de Psiquiatría del Hospital del Bierzo. Servicio de Salud Mental de Castilla y León (SACYL).
  • Pilar Alejandra Sáiz Martínez Servicio de Salud Mental del Principado de Asturias (SESPA). Instituto de Investigación Sanitaria del Principado de Asturias (ISPA). Área de Psiquiatría, Universidad de Oviedo. Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM).
  • Julia Rodríguez Revuelta Servicio de Salud Mental del Principado de Asturias (SESPA). Instituto de Investigación Sanitaria del Principado de Asturias (ISPA). Área de Psiquiatría, Universidad de Oviedo.
  • María Paz García-Portilla Servicio de Salud Mental del Principado de Asturias (SESPA). Instituto de Investigación Sanitaria del Principado de Asturias (ISPA). Área de Psiquiatría, Universidad de Oviedo. Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM).
  • Julio Bobes Servicio de Salud Mental del Principado de Asturias (SESPA). Instituto de Investigación Sanitaria del Principado de Asturias (ISPA). Área de Psiquiatría, Universidad de Oviedo. Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM).
  • Gerardo Flórez Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM). Unidad Clínica de Conductas Adictivas, Complexo Hospitalario Universitario de Orense.

DOI:

https://doi.org/10.20882/adicciones.1672

Palabras clave:

Trastorno por uso de alcohol, deterioro cognitivo, función ejecutiva, impulsividad, estudio de seguimiento. Alcohol use disorder, cognitive impairment, executive function, impulsivity, follow-up study.

Resumen

Hasta la fecha, ningún estudio de seguimiento había evaluado simultáneamente la función ejecutiva, otras funciones no ejecutivas relacionadas con funciones cognitivas y la impulsividad en una muestra suficientemente grande de pacientes con trastorno por uso de alcohol (TUA) entre moderado y grave. Este estudio tuvo como objetivo principal comparar el desempeño neuropsicológico y su relación con el uso de alcohol en pacientes con TUA y en controles sanos, y determinar la evolución del deterioro cognitivo y el uso de alcohol a largo plazo. Con este fin, se diseñó un estudio de seguimiento de seis meses para comparar una muestra de 100 pacientes ambulatorios con TUA (criterios del DSM-5) emparejados con 100 controles sanos. Los pacientes se reclutaron de tres centros sanitarios diferentes de España, Orense, Gijón y Barcelona. La evaluación consistió en una batería sistematizada de pruebas cognitivas para evaluar las siguientes funciones: atención, memoria anterógrada, velocidad de procesamiento, fluidez verbal, función ejecutiva y actitud implícita hacia bebidas alcohólicas. También se compararon variables clínicas asociadas al consumo de alcohol, como el craving y la impulsividad. Después de seis meses, la memoria anterógrada, memoria de trabajo y resistencia a la interferencia mejoraron notablemente en los pacientes con TUA, aunque no llegaron a igualar la población general. Respecto de las variables clínicas, hubo una pequeña pero significativa mejoría cognitiva relacionada con una reducción del consumo de alcohol y de la impulsividad. La disfunción ejecutiva y otras funciones no ejecutivas relacionadas con el deterioro cognitivo pueden considerarse factores pronósticos en pacientes ambulatorios con TUA entre moderado y grave.
Until now, no follow-up studies had simultaneously evaluated executive functions, other non-executive functions related cognitive functions, and impulsivity in a large enough sample of moderate to severe alcohol use disorder (AUD) patients. The main objective of the present study was to compare neuropsychological performance and its relation to alcohol use in patients with AUD and healthy controls, and to determine the evolution of cognitive impairment and alcohol use over time. For this purpose, a 6-month follow-up study was designed to compare a sample of 100 outpatients with AUD (DSM-5 criteria) with 100 matched healthy controls. The patient group was recruited from three different health centres in Spain located in Orense, Gijón and Barcelona. The assessment consisted of a systematic battery of cognitive tests to evaluate the following functions: attention, anterograde memory, processing speed, verbal fluency, executive function, and implicit attitude toward alcoholic beverages. We also compared clinical variables associated with alcohol use, such as alcohol craving and impulsivity. After 6 months, anterograde memory, working memory, and resistance to interference improved remarkably in AUD patients, although not enough to match the normal population. With regard to clinical variables, there was a small but significant cognitive improvement related to a reduction in alcohol use and impulsivity. Executive dysfunction and other non-executive functions related cognitive functions impairment can be considered prognostic factors in outpatients with moderate to severe AUD.

Citas

Anton, R. F., Moak, D. H. & Latham, P. (1995).The obsessive compulsive drinking scale: A self-rated instrument for the quatificacion of thouhgts about alcohol and drinking behavior. Alcoholism, Clinical and Experimental Reserach, 19, 92-99. doi:10.1111/j.1530-0277.1995.tb01475.x.

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

95 (Suppl. 2), 211-217. doi:10.1080/09652140050111771.

Bartels, C., Kunert, H. J., Stawicki, S., Kröner-Herwig, B., Ehrenreich, H. & Krampe, H. (2006). Recovery of hippocampus-related functions in chronic alcoholics during monitored long-term abstinence. Alcohol and Alcoholism,

42, 92-102. doi:10.1093/alcalc/agl104.

Bartsch, A. J., Homola, G., Biller, A., Smith, S. M., Weijers, H. G., Wiesbeck, G. A.,… Bendszus, M. (2007). Manifestations of early brain recovery associated with abstinence from alcoholism. Brain,

130, 36-47. doi:10.1093/brain/awl303.

Bernardin, F., Maheut-Bosser, A. & Paille, F. (2014). Cognitive impairments in alcohol-dependent subjects. Frontiers in Psychiatry,

5, 78. doi:10.3389/fpsyt.2014.00078.

Breese, G. R., Sinha, R. & Heilig, M. (2011). Chronic alcohol neuroadaptation and stress contribute to susceptibility for alcohol craving and relapse. Pharmacology & Therapeutics, 129, 149-171. doi:10.1016/j.pharmthera.2010.09.007.

Brion, M., D’Hondt, F., Pitel, A. L., Lecomte, B., Ferauge, M., de Timary, P. & Maurage, P., (2017). Executive functions in alcohol-dependence: A theoretically grounded and integrative exploration. Drug and Alcohol Dependence,

177, 39-47 doi:10.1016/j.drugalcdep.2017.03.018.

Carmona-Perera, M., Sumarroca-Hernandez, X., Santolaria-Rossell, A., Perez-Garcia, M. & 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.

Connor, J. P., Jack, A., Feeney, G. F. & Young, R. M. (2008). Validity of the Obsessive Compulsive Drinking Scale in a heavy drinking population. Alcoholism Clinical and Experimental Research,

32, 1067-1073. doi:10.1111/j.1530-0277.2008.00668.x.

Crews, F. T., Buckley, T., Dodd, P. R., Ende, G., Foley, N., Harper, C.,… Sullivan, E. V. (2005). Alcoholic neurobiology: Changes in dependence and recovery. Alcoholism Clinical and Experimental Research,

29, 1504-1513. doi: 10.1097/01.alc.0000175013.50644.61.

Cristofori, I., Cohen-Zimerman, S. & Grafman, J. (2019). Executive functions. Handbook of Clinical Neurology, 163, 197-219. doi:10.1016/B978-0-12-804281-6.00011-2.

Crowe, S. F., Cammisuli, D. M. & Stranks, E. K. (2019). Widespread cognitive deficits in alcoholism persistent following prolonged abstinence: An updated meta-analysis of studies that used standardised neuropsychological assessment tools. Archives of Clinical Neuropsychology,

35, 31-45. doi:10.1093/arclin/acy106.

del Ser Quijano, T., Sanchez Sanchez, F., Garcia de Yebenes, M. J., Otero Puime, A., Zunzunegui, M. V. & 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.

Dohle, S., Diel, K. & Hofmann W. (2018). Executive functions and the self-regulation of eating behavior: A review. Appetite, 124, 4-9. doi:10.1016/j.appet.2017.05.041. 

Draper, B., Karmel, R., Gibson, D., Peut, A. & 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. doi:10.1007/BF02214761.

Florez, G., Espandian, A., Villa, R. & Saiz, P. A. (2019). Clinical implications of cognitive impairment and alcohol dependence. Adicciones,

31, 3-7. doi:10.20882/adicciones.1284.

Giuffredi, C., Gennaro, C., Montanari, A., Barilli, A. & Vescovi, P. (2003). Alcohol addiction: Evaluation of alcohol abstinence after a year of psycho-medical-social treatment. Addiction Biology,

8, 219-228. doi:10.1080/1355621031000117455.

Hagen, E., Erga, A. H., Hagen, K. P., Nesvag, S. M., McKay, J. R., Lundervold, A. J. & 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.

Hamilton, M. (1960). A rating scale for depression. Journal of Neurology Neurosurgery and Psychiatry, 23, 56-62. doi:10.1136/jnnp.23.1.56.

Harada, S., Agarwal, D. P., Goedde, H. W. & Miyake, K. (1985). Quantitative and qualitative biochemical parameters for alcohol abuse. Alcohol,

2, 411-414. doi:10.1016/0741-8329(85)90105-3.

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

Herman, A. M. & Duka, T. (2019). Facets of impulsivity and alcohol use: What role do emotions play? Neuroscience and Biobehavioral Reviews, 106, 202-216. doi:10.1016/j.neubiorev.2018.08.011. 

Kaiser, A., Bonsu, J. A., Charnigo, R. J., Milich, R. & Lynam, D. R. (2016). Impulsive personality and alcohol use: Bidirectional relations over one year. Journal of Studies on Alcohol and Drugs,

77, 473-482. doi:10.15288/ jsad.2016.77.473.

Koob, G. F., Sanna, P. P. & Bloom F. E. (1998). Neuroscience of addiction. Review. Neuron,

21, 467-76. doi:10.1016/s0896-6273(00)80557-7.

Kopera, M., Wojnar, M., Brower, K., Glass, J., Nowosad, I., Gmaj, B. & Szelenberger, W. (2012). Cognitive functions in abstinent alcohol-dependent patients. Alcohol,

46, 666-671.

Körner, N., Schmidt, P. & Soyka, M. (2015). Decision making and impulsiveness in abstinent alcohol-dependent people and healthy individuals: A neuropsychological examination. Substance Abuse Treatment Prevention and Policy, 10, 24. doi:10.1186/s13011-015-0020-7.

Leeman, R. F., Hoff, R. A., Krishnan-Sarin, S., Patock-Peckham, J. A. & Potenza, M. N. (2014). Impulsivity, sensation-seeking, and part-time job status in relation to substance use and gambling in adolescents. Journal of Adolescent Health,

54, 460-466. doi:10.1016/j.jadohealth.2013.09.014.

Le Berre, A. P., Fama, R. & Sullivan, E. V. (2017). Executive functions, memory, and social cognitive deficits and recovery in chronic alcoholism: A critical review to inform future research. Alcoholism, Clinical and Experimental Research,

41, 1432-1443. doi:10.1111/acer.13431.

Miyake, A. & Friedman, N. P. (2012). The nature and organization of individual differences in executive functions: Four general conclusions. Current Directions in Psychological Science, 21, 8-14. doi:10.1177/0963721411429458.

Mujica-Parodi, L. R., Carlson, J. M., Cha, J. & 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.

Nowakowska-Domagala, K., Jablkowska-Górecka, K., Mokros, L., Koprowicz, J. & Pietras, T. (2017). Differences in the verbal fluency, working memory and executive functions in alcoholics: Short-term vs. long-term abstainers. Psychiatry Research,

249, 1-8. doi:10.1016/j.psychres.2016.12.034.

Nyhus, E. & 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. & 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. & Barratt, E. S. (1995). Factor structure of the Barratt Impulsiveness Scale. Journal of Clinical Psychology, 51, 768-774. doi:10.1002/1097-4679(199511)51:6<768::aid-jclp2270510607>3.0.co;2-1.

Pelletier, S., Nalpas, B., Alarcon, R., Rigole, H. & Perney, P. (2016). Investigation of cognitive improvement in alcohol-dependent inpatients using the Montreal Cognitive Assessment (MoCA) Score. Journal of Addiction, 2016, 1539096. doi:10.1155/2016/1539096.

Romero-Martínez, A., Vitoria-Estruch, S. & 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.

Ros-Cucurull, E., Palma-Álvarez, R. F., Cardona-Rubira, C., García-Raboso, E., Jacas, C., Grau-López, L.,… Roncero, C. (2018). Alcohol use disorder and cognitive impairment in old age patients: A 6 months follow-up study in an outpatient unit in Barcelona. Psychiatry Research, 261, 361-366. doi:10.1016/j.psychres.2017.12.069.

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

Stavro, K., Pelletier, J. & 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. & 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. & Wagenmakers, E. J. (2013). Performance of healthy participants on the Iowa Gambling Task. Psychological Assessment, 25, 180-193. doi:10.1037/a0029929.

Stephan, R. A., Alhassoon, O. M., Allen, K. E., Wollman, S. C., Hall, M., Thomas, W. J.,… Grant I. (2017). Meta-analyses of clinical neuropsychological test of executive dysfunction and impulsivity in alcohol use disorder. American Journal of Drug and Alcohol Abuse,

43, 24-43.

doi:10.1080/00952990.2016.1206113.

Sullivan, E. V., Rosenbloom, M. J., Lim, K. O. & Pfefferbaum, A. (2000). Longitudinal changes in cognition, gait, and balance in abstinent and relapsed alcoholic men: Relationships to changes in brain structure. Neuropsychology,

14, 178-188.

Topiwala, A., Allan, C. L., Valkanova, V., Zsoldos, E., Filippini, N., Sexton, C.,… Ebmeier, K. P. (2017). Moderate alcohol consumption as risk factor for adverse brain outcomes and cognitive decline: Longitudinal cohort study. BMJ,

357, j2353. doi:10.1136/bmj.j2353.

Verdejo-García, A., Rivas-Pérez, C., Vilar-López, R. & Pérez-García, M. (2007). Strategic self-regulation, decision-making and emotion processing in poly-substance abusers in their first year of abstinence. Drug and Alcohol Dependence,

86, 139-146. doi:10.1016/j.drugalcdep.2006.05.024.

Villa, R., Espandian, A., Sáiz, P. A., Astals, M., Valencia, J. K., Martínez-Santamaría, E.,... Flórez, G. (2021). Cognitive functioning in patients with alcohol use disorder who start outpatient treatment. Adicciones, 33, 161-174. doi:10.20882/adicciones.1326.

Volkow, N. D. & Li, T. K. (2005). Drugs and alcohol: treating and preventing abuse, addiction and their medical consequences. Pharmacology & Therapeutics,

108, 3-17. doi:10.1016/j.pharmthera.2005.06.021.

Wechsler D. (2008). Wechsler adult intelligence scale – Fourth (WAIS-IV). San Antonio (TX): Pearson Assessment.

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.

World Medical Association. (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310, 2191-2194. doi:10.1001/jama.2013.281053.

Zahr, N. M. & Pfefferbaum, A. (2017). Alcohol’s Effects on the Brain: Neuroimaging Results in Humans and Animal Models. Alcohol Research: Current Reviews,

38, 183-206.

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Publicado

2021-06-15

Número

Vol. 34 Núm. 4 (2022)

Sección

Originales