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Disorder Verbal Memory in Alcoholics After Delirium Tremens

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Disorder Verbal Memory in Alcoholics After Delirium Tremens European Review for Medical and Pharmacological Sciences 2012; 16: 1052-1060 Disorder verbal memory in alcoholics after delirium tremens A. DICKOV, N. VUCKOVIC, S. MARTINOVIC-MITROVIC, I. SAVKOVIC, D. DRAGIN, V. DICKOV*, D. MITROVIC, D. BUDISA Clinical of Psychiatry, Clinical Center Vojvodina, Novi Sad (Serbia) *Faculty of International Management, European University, Belgrade (Serbia) Abstract. – AIMS, Alcohol delirium tremens Introduction suggests dysfunction of numerous brain regions. Several Authors suggest that alcohol and with- It has been asserted that persons who drink drawal from alcohol could cause neurotoxic le- sions in the frontal lobe and thereby affect cogni- for extended periods of time have poorer results tive function. However, it is not that well known on tests of specific neuropsychological perfor- whether the consequences of the damage follow- mances, although they show no apparent signs ing delirium are only quantitative or qualitative. of brain damage1-7. Researchers were examining PATIENTS AND METHODS, Thirty alcohol-de- impact of the abstinence, duration of drinking pendent patients after alcohol delirium (ADT-n1 and gender on cognitive damages, but results = 30), and 30 alcohol-dependent patients without 8-10 alcohol delirium (ALC-n2=30) were compared were inconsistent . Desire to determine inte- with neuropsychological test-battery. [(Wechsler gral instrument which would bring consistent re- Bellevue Intelligence Scale – WB form I, Wech- sults for cognitive damages caused by alcohol sler memory scale and Rey Auditory Verbal has so far remained with no success. Reason for Learning Test (RAVLT)]. Examinees were select- this failure lies in numerous factors influencing ed as equivalent pairs, in such a manner that they were of approximately same age, i.e. age the development of alcohol dependency, such as difference was 0-5 years, they were of the same heredity, age of the onset of drinking, duration education level, and difference in the duration of of drinking, type of alcohol drink and so on. drinking was not more than 3 years. Distinct problem are consequences of the alco- RESULTS, In the group of ADT patients, IQ was hol disease, where the abstinence crisis stands 97.53, while it is 109.53 for ALC patients. Mental deterioration of the examined group is 40, and in out as significant agent. Multiple abstinence the control group 13. Group of ADT patients had crises increase vulnerability for brain dysfunc- significantly lower achievements on subtests: tions11. One of the mechanisms leading to this arithmetic, block design and digit symbol. ADT type of brain damages is amplification of the ex- patients’ average memory quotient (MQ) is 81.8, citotoxicity, which develops as a consequence of which is three standard deviations lower com- 12 pared to ALC patients (MQ 102.2) and standard the increase of excitatory neurotransmitters . values, according to Wechsler. In the first repeti- Furthermore, abstinence crisis causes changes in tion of the series of 15 words RAVLT, is no differ- certain neuroendocrine systems which augment ence (t-test=1.88; p > 0.05), while the difference psychopathology developed due to the alcohol in other repetitions is significant. Difference is intake. Hormonal system playing significant role also statistically significant regarding recollec- is hypothalamic-pituitary-adrenal (HPA) axis. tion after 30 minutes (t-test=3.66; p < 0.05). CONCLUSION, There is qualitative difference Abstinence syndrome activates HPA axis, which in cognitive deficiencies in alcoholics with deliri- leads to the increased secretion of corticoids13. um tremens and those with no alcohol delirium, Glicocorticoids, type of corticoids, influence while the predominant pathology of the cogni- neural excitability of the CNS. Extended stimu- tive-amnestic deficiency is in compliance with lation of these neurons causes brain damages, the dysfunction of the prefrontal lobe. Following 14 alcohol delirium, verbal memory disorders occur especially in hippocampus . Progressive in- within the intellectual decrease and attention dis- crease of neurochemical and neuroendocrine al- order in general. terations occurring during abstinence crises comprise biological foundation of cognitive Key Words: deficits related to alcohol intake15. The most se- Disorder, Verbal memory, Alcoholism, Delirium tremens. vere form of abstinence crisis is alcohol with- drawal delirium. Consideration whether alcohol 1052 Corresponding Author: Aleksandra Dickov, MD; e-mail: [email protected] Disorder verbal memory in alcoholics after delirium tremens withdrawal delirium is merely a manifestation of Control group was comprised of 30 alcohol the severe form of abstinence crisis or it is a dependent patients (n2=30) who did not have syndrome developing on the foundation of previ- delirium tremens. All of them met criteria for the ously altered brain structure and function is, from F10.2 code (Alcohol dependence) ICD-10. Ex- the clinical point of view, very interesting. In or- cluding criteria were the same. der to make this distinction, researches have been Testing has also been conducted three months done, attempting to detect cognitive deficits in following the establishing of abstinence. Patients persons who had delirium and those who had on- in this group have been chosen as equivalents to ly the diagnosis of alcohol dependency. One re- the patients of the experimental group, i.e.: search has shown that there is no significant dif- 1. They were of approximately same age, i.e. age ference in cognitive functioning between alcohol difference ranged 0-5 years. dependent persons who had no abstinence crises, 2. They were of the same education level. those with mild and moderately severe crises, 3. Difference in duration of drinking was not while alcohol dependent patients following delir- more than 3 years. ium shown significantly lower results, particular- ly in the area of recognition16. Another research Following instruments were used for collect- confirms decline of cognitive functioning follow- ing data: ing delirium tremens and determines that the de- A simple form, specially developed for the gree of the damage correlates with the psy- needs of this research, included the following chomotor agitation and intensity of hallucina- items: age, education level, and duration of drink- tions17. Further researches have confirmed that ing, duration of abstinence, number of absti- cognitive sequels after the delirium are long last- nences, heredity, alcohol liver lesions and sympto- ing18. The aim of this paper was to establish the matic epileptic seizures caused by alcohol. difference in the verbal memory disorder be- tween alcohol dependent patients who had deliri- um tremens and those who did not, based on neu- Neuropsychological Tests ropsychological examination. Wechsler Bellevue Intelligence Scale (WB form I)20 Patients and Methods This test is comprised of five verbal and five non-verbal subtests. Intelligence quotient (IQ) Research is prospective clinical study. It has consists of verbal intelligence quotient (IQv) and been conducted at the Clinic for Substance relat- performance intelligence quotient (IQp). In 1986, ed disorders of the Clinical of Psychiatry in the Wechsler made a revision of the described scale, Clinical Centre Vojvodina in Novi Sad, Serbia. and today mainly revised version of Wechsler in- In forming of the sample for the research, telligence scale is used. Since the battery of tests group of 30 alcohol dependent patients (n1=30) used in this research is large, we have decided to following delirium tremens was taken. Require- use the original Wechsler intelligence scale. We ments for the diagnosis are the criteria of the find justification for such a decision in the work F10.40 code (Delirium tremens), tenth interna- of Oscar-Berman et al21. Testing alcohol depen- tional classification of mental and behavioural dent patients, he found out that the tests used to disorders (ICD-10)19. Excluding criteria are pre- identify amnestic syndrome, in other words dif- viously diagnosed delirious states, suffered cran- ference between the intelligence quotient and re- iocerebral trauma, presence of diagnosed en- sults of memory tests, were efficient in both docranial tumours, diagnosed temporal epilepsy, combinations (WMS or WMS-R). Reliability: presence of psychotic disorders, current presence Reliability coefficients for the subtests range of affective disorders, mental deficiency syn- from 0.62 to 0.88. The Verbal IQ, Performance drome, diagnosis of other substance related dis- IQ, and Full Scale IQ have reliability coefficients orders, existence of neurological and neuromus- of 0.84, 0.86, and 0.90, respectively22. Validity: cular damages. The Authors investigate correlations between the Exploration of patients was conducted three WBIS and other tests of cognitive ability. The months after delirium tremens, since it is believed coefficients are e as follows: Stanford-Binet, that is the period in which the abstinence symp- 1937 rev., 062; Otis, 0.73; Raven Progressive toms of transient brain syndrome are persisting. Matrices, 0.55, and the Army Alpha test, 0.53. 1053 A. Dickov, N. Vuckovic, S. Martinovic-Mitrovic, I. Savkovic, D. Dragin, et al. Wechsler Memory Scale (WMS)23 in evaluating verbal learning and memory, in- Includes mainly the domain of verbal memory, cluding proactive inhibition, retroactive inhibi- and only in one subtest of non-verbal memory. tion, retention, encoding versus retrieval, and Importance of this
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