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Neurological impacts – Chronic use

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 & Dr Sheree Cairney. Brain atrophy, ventricular enlargement, widened sulci

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Neurological impacts – Chronic use

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  1. 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

  2. Brain atrophy, ventricular enlargement, widened sulci • Learning, memory, visual spatial, executive impairments Neurological impacts – Chronic use Rosenbloom, Sullivan and Pfefferbaum, 2003

  3. 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 Neurological impacts

  4. Catalyst Full video available from www.abc.net.au/catalyst/stories/s2019179

  5. 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

  6. 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 Our studies

  7. Non-drinkers vs Heavy Episodic

  8. 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. Rehabilitation Study Baseline 4 weeks 8 weeks

  9. 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

  10. 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

  11. 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 Community Follow up 6-12 months

  12. 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)

  13. 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 Findings

  14. 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

  15. Flipcharts Available From: www.menzies.edu.au/brainstories

  16. 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 References

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