Neurocognitive Functioning and Treatment Outcome Following Detoxification Among Asian Alcohol-Dependent Inpatients

ABSTRACT

Background: The prevalence of alcohol use disorders in Asia is increasing and relapse among treated populations remains the norm, not the exception. The extent to which cognitive impairment influences clinical outcome remains unclear, with research dominated by studies of Caucasian populations. Objectives: This study examines behavioral and self-reported cognitive functioning in detoxified alcohol-dependent (AD) patients in Singapore and its association with outcome. Methods: The cognitive performance of 30 recently-detoxified AD inpatients and 30 demographically-matched controls was compared using visuospatial memory, working memory, set-shifting, planning and reflection impulsivity tests of the CANTAB®, and self-reported dysexecutive symptoms and everyday cognitive difficulties. Patients’ alcohol use and self-reported cognitive functioning were reassessed 3-months post-discharge. Results: Compared to matched controls, AD inpatients exhibited significantly poorer fluid intelligence, visuospatial memory, working memory, set-shifting flexibility and planning/organization, but not reflection impulsivity. In support of Western studies, a significant proportion (three-quarters) were “clinically impaired” on subtests. Significant reductions were observed in alcohol units, frequency and dependency scores at follow-up, though improvements in self-reported cognitive functioning were limited to abstainers. Baseline cognitive performance did not differentiate those who had abstained from alcohol and relapsed at follow-up. Conclusions/Importance: Memory and executive functioning impairments were evident among Asian AD patients alongside self-reported cognitive difficulties, thus cognitively demanding psychological interventions may have limited impact during early detoxification. Future studies can build on these findings, with larger samples and measurement of moderating and mediating factors to extend our understanding of how cognitive impairment influences outcome.

Keywords:

• Alcohol dependence
• executive function
• neuropsychological tests
• treatment outcome
• Asia

Additional information

Notes on contributors

Victoria Manning

Victoria Manning, PhD (Psychology), was at the time the study was conducted, the Senior Research Manager at the National Addictions Management Service, Institute of Mental Health Singapore and adjunct Assistant Professor at Duke-NUS Graduate Medical School. She is now a Senior Fellow at Turning Point, Melbourne and an Adjunct Senior Research Fellow at the Eastern Health Clinical School, Monash University. She is a Chartered Psychologist with a PhD in Dual Diagnosis and cognitive functioning and a Masters Degree in Health Psychology and has conducted addictions research for over 15 years. Her primary research interests are in neurocognitive functioning and novel interventions to optimize treatment outcomes for addiction patients.

Hui Chin Teo

Hui Chin Teo, B. Soc. Sci (Hons), is currently working as a research officer at the National Addictions Management Service (NAMS), Institute of Mental Health, Singapore. She graduated from the National University of Singapore in 2009 with Bachelor of Social Science majoring in Psychology and joined the team since. Prior working experience in psychology includes areas of fMRI (neurocognition) and health sciences (stress and coping). She has published findings on neuropsychological studies of addictions patients and stress coping among their families, and is currently coordinating a clinical trial of Lofexidine for the treatment of opiate-dependent inpatients.

Song Guo

Song Guo, PhD (Pharmacology), is a consultant psychiatrist and the head of research at the Singapore National Addictions Management Service, with a joint position as adjunct instructor at Duke-NUS Graduate Medical School. He has practiced in addictions since 1990, and subsequently served as the director of the National Drug Dependence Treatment Centre, Beijing (2003–2004). He has authored over 30 publications on additive disorders treatments which include pharmacological treatments for tobacco, alcohol and opiate dependence. His interests are primarily in translational and clinical research on addictions, as well as improving treatment effectiveness for behavioral.

Kim Eng Wong

Kim Eng Wong, MD, is the current clinical director of the National Addictions Management Service, Institute of Mental Health (IMH), Singapore. A/Prof Wong has been a pioneer in the field of psychiatry with an illustrious career at IMH, including a 6-year term as the chairman of the medical board, and was awarded the National Outstanding Clinician Mentor Award in July 2011. She was the Chairperson of the Mental Health Committee, which produced the first National Mental Health Blueprint. She has mentored psychiatrists and clinician scientists, many of whom have become outstanding clinicians.

Ting-Kai Li

Ting Kai Li, MD, has a distinguished career in addictions with many prominent leadership and advisory positions in addictions, including a past appointment as director of the U.S. National Institute on Alcohol Abuse & Alcoholism (2002–2008). He is currently Professor of Psychiatry & Behavioral Sciences at Duke University and an honorary fellow of the United Kingdom's Society for the Study of Addiction. Dr. Li has authored more than 400 journal articles and book chapters, has been invited to deliver many major lectureships in countries all over the world, and is the recipient of numerous prestigious awards for his scientific accomplishments.