Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, Sydney, NSW, Australia.
Cortex. 2013 Jan;49(1):3-17. doi: 10.1016/j.cortex.2012.05.021. Epub 2012 Jun 17.
Classically, disorders associated with 'alcohol-related brain damage' (ARBD) occur as a result of chronic excessive alcohol misuse and confer significant physical and psychological disability to the individual as well as to the community. These phenotypes are often difficult to detect at early stages and therefore early intervention and treatment is limited. It remains unresolved as to whether there are neurobiological markers of the early stages of such brain damage in young 'at-risk' drinkers, who probably experience 'alcohol-induced brain impairment' prior to the onset of ARBD, per se. This review focuses on neurobiological (in particular, neuropsychological and neuroimaging) markers that are associated with alcohol misuse in young people (13-24 years of age). The findings from this review suggest that a clearer understanding of alcohol misuse (particularly with regards to binge drinking) is needed. Despite this, neurocognitive profile along with supporting neuroimaging evidence appears to be particularly important in the early detection of brain changes that result from excessive alcohol use. In young alcohol misusers, these preventable and potentially reversible deficits may be progressive but if left unresolved such deficits eventually become major contributors to poor outcome (long term) and hamper adherence to treatment. We address five key themes in this review: (i) there are specific drinking patterns in young people; (ii) youth represents a critical period in brain development that is particularly vulnerable to alcohol misuse; (iii) the extent to which there are pre-existing versus alcohol-induced neurobiological changes remains unclear; (iv) vulnerability markers may be mediated by mental health and substance use comorbidities; and (v) cognitive remediation would be a likely candidate for early prevention and treatment as it could help to develop efficient meta-cognitive skills to prevent relapse in young drinkers.
传统上，与“酒精相关脑损伤”（ARBD）相关的疾病是由于慢性过量饮酒引起的，会给个体和社区带来严重的身体和心理残疾。这些表型通常在早期很难被发现，因此早期干预和治疗受到限制。目前还不清楚在年轻的“高危”饮酒者中是否存在这种脑损伤早期阶段的神经生物学标志物，这些年轻的“高危”饮酒者可能在 ARBD 发生之前就已经经历了“酒精引起的脑损伤”。本综述重点关注与年轻人（13-24 岁）饮酒相关的神经生物学标志物（特别是神经心理学和神经影像学标志物）。本综述的研究结果表明，需要更清楚地了解年轻人的饮酒问题（特别是狂饮问题）。尽管如此，神经认知特征以及支持的神经影像学证据似乎对于早期发现由过度饮酒引起的大脑变化尤为重要。在年轻的酒精滥用者中，这些可预防和潜在可逆转的缺陷可能是渐进性的，但如果得不到解决，这些缺陷最终会成为不良后果（长期）的主要原因，并阻碍对治疗的依从性。我们在本综述中讨论了五个关键主题：（i）年轻人有特定的饮酒模式；（ii）青少年时期是大脑发育的关键时期，特别容易受到酒精滥用的影响；（iii）目前尚不清楚是否存在与酒精相关的神经生物学变化；（iv）易损性标志物可能受到心理健康和物质使用共病的影响；（v）认知矫正可能是早期预防和治疗的一个候选方案，因为它可以帮助发展有效的元认知技能，以防止年轻饮酒者复发。
