Le Berre Anne-Pascale, Fama Rosemary, Sullivan Edith V
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California.
Neuroscience Program, SRI International, Menlo Park, California.
Alcohol Clin Exp Res. 2017 Aug;41(8):1432-1443. doi: 10.1111/acer.13431. Epub 2017 Jul 4.
Alcoholism is a complex and dynamic disease, punctuated by periods of abstinence and relapse, and influenced by a multitude of vulnerability factors. Chronic excessive alcohol consumption is associated with cognitive deficits, ranging from mild to severe, in executive functions, memory, and metacognitive abilities, with associated impairment in emotional processes and social cognition. These deficits can compromise efforts in initiating and sustaining abstinence by hampering efficacy of clinical treatment and can obstruct efforts in enabling good decision making success in interpersonal/social interactions, and awareness of cognitive and behavioral dysfunctions. Despite evidence for differences in recovery levels of selective cognitive processes, certain deficits can persist even with prolonged sobriety. Herein is presented a review of alcohol-related cognitive impairments affecting component processes of executive functioning, memory, and the recently investigated cognitive domains of metamemory, social cognition, and emotional processing; also considered are trajectories of cognitive recovery with abstinence. Finally, in the spirit of critical review, limitations of current knowledge are noted and avenues for new research efforts are proposed that focus on (i) the interaction among emotion-cognition processes and identification of vulnerability factors contributing to the development of emotional and social processing deficits and (ii) the time line of cognitive recovery by tracking alcoholism's dynamic course of sobriety and relapse. Knowledge about the heterochronicity of cognitive recovery in alcoholism has the potential of indicating at which points during recovery intervention may be most beneficial.
酒精中毒是一种复杂且动态变化的疾病，有戒酒期和复饮期，受多种易患因素影响。长期过量饮酒与认知缺陷有关，从轻度到重度，涉及执行功能、记忆和元认知能力，还伴有情绪过程和社会认知方面的损害。这些缺陷会妨碍临床治疗效果，从而影响戒酒的启动和维持，还会阻碍在人际/社会互动中做出明智决策以及认识到认知和行为功能障碍。尽管有证据表明选择性认知过程的恢复水平存在差异，但某些缺陷即使在长期戒酒的情况下仍会持续存在。本文综述了与酒精相关的认知障碍，这些障碍影响执行功能、记忆以及最近研究的元记忆、社会认知和情绪加工等认知领域的组成过程；还探讨了戒酒过程中的认知恢复轨迹。最后，本着批判性审视的精神，指出了当前知识的局限性，并提出了新的研究方向，重点关注：（i）情绪 - 认知过程之间的相互作用以及导致情绪和社会加工缺陷发展的易患因素的识别；（ii）通过追踪酒精中毒戒酒和复饮的动态过程来确定认知恢复的时间线。了解酒精中毒认知恢复的异时性有可能指明在恢复过程中的哪些阶段进行干预可能最为有益。
