Thirty-nine detoxified elderly alcoholics (mean age = 65.85) completed a comprehensive assessment designed to identify individuals meeting DSM-IV criteria for alcohol-related dementia. Ten subjects meeting criteria (mean age = 69.8; mean Mini-Mental State Examination [MMSE] = 25.1) were compared to the 29 nondemented alcoholics (mean age = 64.5; mean MMSE = 27.8), 9 patients with Alzheimer's disease (mean age = 73.4; mean MMSE = 22.3), and 15 control subjects (mean age = 70.8; mean MMSE = 28). Comparison of neuropsychological test scores revealed several statistically significant differences. Furthermore, the overall pattern of test performance between the two demented groups was different. Alzheimer's patients were more impaired on confrontation naming, recognition memory, animal fluency, and orientation. Alcohol dementia subjects were more impaired than controls on initial letter fluency, fine motor control, and free recall. However, alcohol dementia subjects did not differ from controls on tests of verbal recognition memory. This study suggests that it is possible to clinically differentiate the cognitive deficits of alcohol-related dementia from typical Alzheimer's disease. However, the results are preliminary and are based on small sample sizes so should be interpreted with caution.
Get full access to this article
View all access options for this article.
References
1.
1. Goldstein G.Dementia associated with alcoholism. In: Tarter RE, van Theil DH, Eds. Alcohol and the brain: chronic effects. New York: Plenum Press, 1985: 283–294.
2.
2. Lishman WA. Cerebral disorder in alcoholism: syndromes of impairment. Brain1981; 104:1–20.
3.
3. Lishman WA. Alcoholic dementia: a hypothesis. Lancet1986; 61:1184–1186.
4.
4. Ryan C, Butters N.The neuropsychology of alcoholism. In: Wedding D, Horton AM, Webster J, Eds. The neuropsychology handbook. New York: Springer, 1986: 376–409.
5.
5. American Psychiatric Association.Diagnostic and statistical manual of mental disorders.4th Ed.Washington, DC: APA, 1994.
6.
6. King MB. Alcohol abuse and dementia. Int J Geriatr Psychiatry1986; 1:31–36.
7.
7. Smith DM, Atkinson RM. Alcohol and dementia: neurological and neuropsychological features of 59 patients in a dementia registry. Washington, DC: American Psychiatric Press, 1994.
8.
8. Carlen PL, McAndrews MP, Weiss RT, et al. Alcohol-related dementia in the institutionalized elderly. Alcohol Clin Exp Res1994; 18:1130–1134.
9.
9. Finlayson R, Hurt R, Davis L, Morse R.Alcoholism in elderly persons: a study of the psychiatric and psychosocial features of 216 inpatients. Mayo Clinic Proc1988; 63:761–768.
11. Blow F, Cook FL, Booth B, et al. Age-related psychiatric comorbidities and level of function in alcohol veterans seeking outpatient treatment. Hosp Community Psychiatry1992; 43:990–995.
12.
12. Victor M.Persistent altered mentation due to ethanol. Neurol Clin1993; 11:639–661.
13.
13. McKhann G, Drachman D, Folstein M, et al. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology1984; 34:939–944.
14.
14. Becker JT, Boiler F, Lopez OL, et al. The natural history of Alzheimer's disease: description of study cohort and accuracy of diagnosis. Arch Neurol1994; 51:585–594.
15.
15. Lopez OL, Larumbe MR, Becker JT, et al. Reliability of NTNDSAIREN clinical criteria for the diagnosis of vascular dementia. Neurology1994; 44:1240–1245.
16.
16. Spitzer RL, Williams JB, Gibbon M.Instruction manual for the structured clinical interview of DSM IIIR (SCID). Biomedical Research Department, New York State Psychiatric Institute, 1987.
17.
17. Martin CS, Kaczynski NA, Maisto SA, et al. Patterns of alcohol abuse and dependence symptoms in adolescent drinkers. J Stud Alcohol1995; 56:672–680.
18.
18. Skinner H, Sheu WJ. Reliability of alcohol use indices: the Lifetime Drinking History and the MAST. J Stud Alcohol1982; 43:1157–1170.
19.
19. Sobell LC, Sobell MB. Timeline followback: a technique for assessing self-reported alcohol consumption. In: Litten RZ, Allen J, Eds. Measuring alcohol consumption: psychosocial and biological methods. New Jersey: Humana Press, 1992: 41–72.
21. Yesavage JA, Rose TL, Lapp D.Validity of the Geriatric Depression Scale in subjects with senile dementia. Palo Alto, CA: Clinical Diagnostic and Rehabilitation Unit, Palo Alto Veterans Administration Medical Clinic, 1981.
22.
22. Yesavage JA, Brink TL. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res1983; 17:37–49.
23.
23. Yesavage JA. The use of self-rating depression scales in the elderly. In: Poon LW, ed. Handbook for clinical memory assessment of older adults. Washington, DC: American Psychological Association, 1986.
24.
24. Hamilton M.A rating scale for depression. J Neurol Neurosurg Psychiatry1960; 23:56–62.
25.
25. Hamilton M.Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol1961; 6:278–296.
26.
26. Morris JC, Mohs RC, Rogers H, et al. The Consortium to Establish a Registry for Alzheimer's Disease (CERAD): clinical and neuropsychological assessment of Alzheimer's disease. Psychopharmacol Bull1988; 4:641–652.
27.
27. Folstein MF, Folstein SE, McHugh PR. Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician. J Psychosom Res1975; 12:189–198.
28.
28. Nelson HE. The National Adult Reading Test (NART): test manual. Windsor, Berkshire, UK: NFER-Nelson, 1982.
29.
29. Nelson HE, O'Connell A.Dementia: the estimation of premorbid intelligence levels using the National Adult Reading Test. Cortex1978; 14:234–244.
30.
30. Crawford JR. Current and premorbid intelligence measures in neuropsychological assessment. In: Crawford JR, Parker DM, McKinlay WW, Eds. A handbook of neuropsychological assessment. Hove, UK: Lawrence Erlbaum, 1992.
31.
31. Reitan RM, Wolfson D.The Halstead-Reitan Neuropsychological Test Battery: theory and clinical interpretation. Tucson, AZ: Neuropsychology Press, 1993.
32.
32. Wechsler D.WAIS-R manual. New York: The Psychological Corporation, 1981.
33.
33. Delis DC, Kramer JH, Kaplan E, Ober BA. California Verbal Learning Test. New York: Psychological Corporation, 1987.
34.
34. Kaplan ER, Goodglass H, Weintraub S.The Boston Naming Test.2nd Ed.Philadelphia: Lea & Febiger, 1983.
35.
35. DeRenzi E, Faglioni P.Normative data and screening power of a shortened version of the Token Test. Cortex1978; 14:41–49.
36.
36. Rey A.L'examen psychologique dans les cas d'encèphalopathie traumatique. Arch Psychol1941; 28:286–340.
37.
37. Osterrieth PA. Le test de copie d'une figure complexe. Arch Psychol1944; 30:206–356; translated by Corwin J, Bylsma FW. Clin Neuropsychologist 1993; 7:9–15.
38.
38. Benton AL, Hamsher KD, Varney NR, Spreen O.Contributions to neuropsychological assessment: a clinical manual. Oxford, UK: Oxford University Press, 1983.
40. Berg EA. A simple objective technique for measuring flexibility in thinking. J Gen Psychol1948; 39:15–22.
41.
41. Grant DE, Berg EA. A behavioral analysis of degree of impairment and ease of shifting to new response in a Weigl-type card sorting problem. J Exp Psychol1948; 39:404–411.
42.
42. Klove H.Clinical neuropsychology. In: Forster FM, ed. The medical clinics of North America. New York: WB Saunders, 1963.
43.
43. Oslin D, Atkinson RM, Smith DM, Hendrie H.Alcohol related dementia: proposed clinical criteria. Int J Geriatr Psychiatry1998; 13:203–212.
44.
44. Roman GC, Tatemichi TK, Erkinjuntti T, et al. Vascular dementia; diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology1993; 43:250–260.
