Masaru Mimura

(Showa University, Japan)

In the context of memory and social functioning, three studies on prognosis of alcohol related problems were conducted, focusing on different aspects of memory and executive function.

[Study 1] This investigated what neuropsychological tests predict alcoholic patients’ future outcome. We administered seven neuropsychological tests to 22 chronic alcoholics after 7 weeks of detoxification. Included in the tests were tasks for attention and working memory as well as a battery of tests called the Behavioral Assessment of the Dysexecutive Syndrome (BADS). Two functional outcome indices, i.e., resumption of drinking and occupation were evaluated 18 months after discharge. Alcoholics’ performance on BADS predicted alcohol-nonspecific outcome (occupation) but not alcohol-specific (drinking) outcome. In contrast, other neuropsychological tests did not predict any of the two outcome indices. The results suggest that ecologically valid neuropsychological tests such as BADS are the better predictors of alcoholics’ social outcome.

[Study 2] Long-term social outcome of 26 alcoholic Korsakoff amnesics was evaluated at 81.9 months after onset. Initial neuropsychological examination performend at 14.3 months after onset disclosed dense amnesia in contrast to normal intelligence and attention. The patients were also impaired in the Wisconsin Card Sorting Test (WCST). At approximate 7 years follow-up, three patients were dead and 11 patients were still institutionalized. Only three patients returned to work. The results suggest that Korsakoff amnesics have poorer social outcome than amnesics caused by other etiologies such as head injuries and encephalitis.

[Study 3] Among 26 Korsakoff patients in Study 2, eight received longitudinal neuropsychological assessment at two points (18.5 months and 84.3 months). Dense amnesia together with preserved intelligence and attention showed no interval change throughout assessments. In contrast, frontal executive impairment as indexed by WCST performance showed slight but steady improvement at follow-up. However, memory compensation including external aids and mnemonic strategies were only infrequently used even at follow-up7. Patients with severe executive dysfunction administered less compensation.

These three studies may suggest that executive dysfunctions play a crucial role in the prognosis of alcoholic amnesic patients.