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ALCOHOL-INDUCED (MAJOR OR MILD) NEUROCOGNITIVE DISORDER
 

Prediction: Chronic But Reversible

      Occupational-Economic:
  • Progressive cognitive deterioration (memory, apathy, executive functioning) but 66% fully recover if they stop drinking and take thiamine
  • Irrationality (delusions, hallucinations)
      Social:
  • Eventually needs total nursing care
  • Negative emotion (anxiety, depression)
  • Antagonism (hostility)
  • Disinhibition (irresponsibility, impulsivity, dangerous risk taking)
      Medical:
  • Denial of illness; alcohol related hepatic, pancreatic, gastrointestinal, cardiovascular, or renal disease; cerebellar ataxia; peripheral neuropathy; cerebellar atrophy

SYNOPSIS

Alcohol-Induced Neurocognitive Disorder - Diagnostic Criteria, American Psychiatric Association

An individual diagnosed with alcohol-induced neurocognitive disorder needs to meet all of the following criteria:

  • The criteria are met for major or mild neurocognitive disorder:

    • Major Neurocognitive Disorder

    • Evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition) based on:

      • Concern of the individual, a knowledgeable informant, or the clinician that there has been a significant decline in cognitive function; and

      • A substantial impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in its absence, another quantified clinical assessment.

    • The cognitive deficits interfere with independence in everyday activities (i.e., at a minimum, requiring assistance with complex instrumental activities of daily living such as paying bills or managing medications).

    • The cognitive deficits do not occur exclusively in the context of a delirium.

    • The cognitive deficits are not better explained by another mental disorder (e.g., major depressive disorder, schizophrenia).

    • Mild Neurocognitive Disorder

    • Evidence of modest cognitive decline from a previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition) based on:

      • Concern of the individual, a knowledgeable informant, or the clinician that there has been a mild decline in cognitive function; and

      • A modest impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in its absence, another quantified clinical assessment.

    • The cognitive deficits do not interfere with capacity for independence in everyday activities (i.e., complex instrumental activities of daily living such as paying bills or managing medications are preserved, but greater effort, compensatory strategies, or accommodation may be required).

    • The cognitive deficits do not occur exclusively in the context of a delirium.

    • The cognitive deficits are not better explained by another mental disorder (e.g., major depressive disorder, schizophrenia).

  • The neurocognitive impairments do not occur exclusively during the course of a delirium and persist beyond the usual duration of alcohol intoxication and acute withdrawal.

  • The alcohol duration and extent of use are capable of producing the neurocognitive impairment.

  • The temporal course of the neurocognitive deficits is consistent with the timing of the alcohol use and abstinence (e.g., the deficits remain stable or improve after a period of abstinence).

  • The neurocognitive disorder is not attributable to another medical condition or is not better explained by another mental disorder.

This disorder shows cognitive decline from a previous level of performance in one or more cognitive domains of higher cortical functioning:
  • learning and memory
  • complex attention
  • executive function (e.g., impaired planning, organizing, sequencing, abstracting)
  • language (e.g., aphasia)
  • perceptual-motor (e.g., agnosia [failure to recognize or identify objects despite intact sensory function], or apraxia [impaired ability to carry out motor activities despite intact motor function])
  • social cognition
These cognitive deficits persist beyond resolution of alcohol intoxication, withdrawal or delirium. These cognitive deficits cause significant impairment in social or occupational functioning.

Effective Therapies

Two-thirds of cases of alcohol-induced neurocognitive disorder (alcoholic dementia) are reversed by stopping alcohol and treating the underlying medical complications of alcoholism. It is essential that individuals with chronic alcoholism receive 200 mg/day of thiamine to prevent the irreversible neurological damage from Wernicke-Korsakoff syndrome (which presents with short-term memory loss, loss of muscle coordination, abnormal eye movements [nystagmus], confusion, and in severe cases coma and death).

Description

  • Alcohol-Induced Residual and Late-onset Psychotic Disorder World Health Organization ICD-10 (2010)
  • Alcohol Dementia - Wikipedia
  • Wernicke-Korsakoff syndrome is similar, but is irreversible - PubMed Health
  • Alcohol-Induced Persisting Dementia - DSM-IV Diagnostic Criteria, American Psychiatric Association (at BehaveNet.com)
  • Alcohol dementia and alcohol delirium in aged alcoholics.In the present study, 126 alcoholics aged 60 years or older were compared with 104 alcoholics aged 35-45 years. No dementia was found in the younger group, whereas 62.7% of the aged patients had dementia; the dementia being irreversible in 32.9% of such patients. Cases of so-called alcohol dementia excluding organic brain diseases accounted for 42.1%. The percentage of aged alcoholics having dementia increased with age, being far beyond the frequency of senile dementia in the general aged. Among various physical complications, hepatic injury and myocardiopathy were more frequent in the aged alcoholics than in general aged people, suggesting that hypertension, myocardiopathy and hepatic injury underlie the manifestation of dementia. There was no case of dementia attributable to the direct effect of alcohol distinctly exceeding the effects of various physical factors.

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