Cognitive impairment and recovery associated with episodic and chronic alcohol use amongst Aboriginal Australians, and the factors that influence continued use after treatment Kylie Dingwall

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Cognitive impairment and recovery associated with
episodic and chronic alcohol use amongst
Aboriginal Australians, and the factors that
influence continued use after treatmentKylie
Dingwall Dr Sheree Cairney
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Neurological impacts Chronic use

• Brain atrophy, ventricular enlargement, widened
  sulci
• Learning, memory, visual spatial, executive
  impairments

Rosenbloom, Sullivan and Pfefferbaum, 2003
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Neurological impacts

• Chronic use Consumption of large amounts of
  alcohol on a daily or near daily basis
• Episodic use or binge use - consumption of
  large amounts of alcohol in one sitting on an
  irregular or episodic basis

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Catalyst
Full video available from www.abc.net.au/catalyst/
stories/s2019179
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• Computerised, non-verbal assessment intended for
  the repeated assessment of cognitive function in
  diverse groups
• A number of subtests measuring
• Visual motor function
• Executive function
• Psychomotor function
• Visual Attention
• Visual Learning and Memory

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Our studies

• Detect cognitive impairments associated with
  episodic alcohol use among Aboriginal people.
• Monitor cognition longitudinally for Aboriginal
  people attending rehab
• Identify and compare impairment and recovery
  profiles of chronic and episodic alcohol users
• Examine the factors contributing to continued
  alcohol use post-treatment

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Non-drinkers vs Heavy Episodic
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Rehabilitation Study

• Setting Residential alcohol treatment programs
  in Northern Territory.
• Participants 41 chronic alcohol users, 40
  episodic users and 24 healthy controls (M age
  34.24 SD 9.73).
• Measurements CogState at baseline (start of
  treatment), then 4 weeks and 8 weeks later.

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Results

• Baseline
• Impaired visual-motor, learning, memory and
  executive functions
• Within 4 weeks
• All except visual-motor function had recovered
• No significant difference between Chronic and
  Episodic users

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Conclusions

• Episodic and chronic alcohol users presented a
  comparable profile of cognitive deficit and
  recovery
• Cognitive performance may improve rapidly with
  abstinence (i.e. within 1 month)
• Persisting visual-motor impairments.
• The majority of alcohol related cognitive
  impairments may arise from the residual
  biochemical effects of alcohol which ameliorate
  following detoxification

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Community Follow up

• Participants 37 alcohol users assessed at
  baseline upon entry to treatment
• Method Re-interviewed and re-assessed after an
  average of 11 months (SD 4.4) after treatment

6-12 months
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Community Follow up

• Outcomes
• 6 (16) abstained
• 31 (84) continued using
• Of continued users
• 3 (10) reduced their alcohol intake
• 23 (74) continued using at the same level
• (change in use was unknown for 5 individuals).
• Improved users (abstained or reduced their use n
  9) were compared to relapsed users (continued
  heavy use n 23)

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Findings

• Relapsed users
• Poorer paired associate learning at baseline
• Poorer paired associate learning, visual
  attention, executive function, learning and
  memory at follow up
• Less likely to return to a community with
  restricted alcohol access
• More likely to experience the psychological
  symptom of worry at follow up

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Summary

• Alcohol affects frontal, hippocampal, cerebellar
  brain regions
• Impairments in executive functions, memory,
  learning, psychomotor function.
• Chronic and Episodic users present similar
  profiles of impairment and recovery
• Cognitive and impairment and accessibility were
  important factors in relapse

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Flipcharts
Available From www.menzies.edu.au/brainstories
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References

• Australian Bureau of Statistics. (2006a).
  National Aboriginal and Torres Strait Islander
  Health Survey 2004-05. Cat. No. 4715.0.
  Canberra Australian Government Publishing
  Service
• Vos, T., Barker, B., Stanley, L., Lopez, A. D.
  (2007). The burden of disease and injury in
  Aboriginal and Torres Strait Islander peoples
  2003. Brisbane School of Population Health, The
  University of Queensland
• Australian Bureau of Statistics. (2008). The
  health and welfare of Australia's Aboriginal and
  Torres Strait Islander Peoples, 2008 Cat. No.
  4704.0. Canberra Australian Government
  Publishing Service
• Carlen, P. L., Wortzman, G., Holgate, R. C.,
  Wilkinson, D. A., Rankin, J. G. (1978).
  Reversible cerebral atrophy in recently abstinent
  chronic alcoholics measured by computed
  tomography scans. Science 200(4345), 1076-7078
• Cairney, S., Clough, A. R., Jaragba, M. J.,
  Maruff, P. (2007). Cognitive impairment in
  Aboriginal people with heavy episodic patterns of
  alcohol use. Addiction, 102, 909-915