Brion Mélanie, D'Hondt Fabien, Pitel Anne-Lise, Lecomte Benoît, Ferauge Marc, de Timary Philippe, Maurage Pierre
Laboratory for Experimental Psychopathology, Psychological Sciences Research Institute, Université catholique de Louvain,10 Place C. Mercier, B-1348 Louvain-la-Neuve, Belgium.
Univ. Lille, CNRS UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, psyCHIC team,1 Place de Verdun, F-59045 Lille, France; CHU Lille, Clinique de Psychiatrie, CURE, F-59000, Lille, France.
Drug Alcohol Depend. 2017 Aug 1;177:39-47. doi: 10.1016/j.drugalcdep.2017.03.018. Epub 2017 May 19.
Alcohol-dependence is related to large-scale cognitive impairments, particularly for executive functions (EF). These deficits persist even after long-term abstinence and have a major impact on patients' everyday life and relapse risk. Earlier studies, based on multi-determined tasks, mostly focused on inhibition and did not offer a theoretically-grounded and exhaustive view of the differential deficit across EF. The present paper proposes a model-based exploration of EF in alcohol-dependent individuals (ALC), to precisely compare the specific deficit related to each executive subcomponent.
Forty-seven recently detoxified ALC were compared to 47 matched healthy participants on a nine-tasks validated neuropsychological battery, simultaneously exploring and comparing the three main executive subcomponents (shifting, updating, and inhibition). Psychopathological comorbidities were also controlled for.
Reaction time indexes revealed a global slowing down among ALC, whatever the EF explored. Accuracy indexes revealed a moderate deficit for inhibition tasks but a massive impairment for shifting and updating ones. Complementary analyses indicated that the executive deficits observed were centrally related to alcohol-dependence, while comorbid depressive symptoms appeared to intensify the deficits observed.
By offering a direct comparison between the three major EF, these results showed that alcohol-related executive deficits extend beyond the classically described inhibition impairment. This impairment encompasses each EF subcomponent, as ALC actually presented stronger deficits for updating and shifting abilities. This first observation of a multifaceted EF deficit stresses the need for an individualized evaluation and rehabilitation of EF during and/or after the detoxification process.
酒精依赖与大规模认知障碍有关，尤其是执行功能（EF）。即使经过长期戒酒，这些缺陷仍然存在，并对患者的日常生活和复发风险产生重大影响。早期基于多任务测定的研究大多集中在抑制方面，没有从理论基础上全面地看待执行功能各方面的差异缺陷。本文提出了一种基于模型的对酒精依赖个体（ALC）执行功能的探索，以精确比较与每个执行子成分相关的特定缺陷。
将47名近期戒毒的酒精依赖者与47名匹配的健康参与者进行比较，采用经过验证的九项任务神经心理测试组合，同时探索和比较三个主要的执行子成分（转换、更新和抑制）。还对精神病理共病进行了控制。
反应时间指标显示，无论探索哪种执行功能，酒精依赖者都出现了整体反应减慢。准确性指标显示，抑制任务存在中度缺陷，但转换和更新任务存在严重损害。补充分析表明，观察到的执行功能缺陷主要与酒精依赖有关，而共病的抑郁症状似乎加剧了观察到的缺陷。
通过对三种主要执行功能进行直接比较，这些结果表明，与酒精相关的执行功能缺陷超出了经典描述的抑制障碍。这种障碍涵盖了每个执行功能子成分，因为酒精依赖者在更新和转换能力方面实际上存在更严重的缺陷。对执行功能多方面缺陷的首次观察强调了在戒毒过程中和/或戒毒后对执行功能进行个体化评估和康复的必要性。
