Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, APHP, Paris, France.
INSERM U1144, Université de Paris, Paris, France.
Alcohol Clin Exp Res. 2021 Mar;45(3):561-565. doi: 10.1111/acer.14554. Epub 2021 Feb 19.
The prevalence of cognitive impairment is high among alcohol-dependent patients. Although the clinical presentation of alcohol-related cognitive disorder (ARCD) may resemble that of Alzheimer's disease (AD), the prognosis and treatment of the 2 diseases are different. Cerebrospinal fluid (CSF) biomarkers (tau, phosphorylated tau, and amyloid β) have high diagnostic accuracy in AD and are currently being used to discriminate between psychiatric disorders and AD, but are not used to diagnose ARCD. The aim of this study was to characterize CSF biomarkers in a homogeneous, cognitively impaired alcohol-dependent population.
This single-center study was conducted in an addiction medicine department of a Parisian Hospital. We selected patients with documented persistent cognitive impairment whose MoCA (Montreal Cognitive Assessment) score was below 24/30 after at least 1 month of documented inpatient abstinence from alcohol. We measured the CSF biomarkers (tau, phosphorylated tau, and amyloid β 1-42 and 1-40) in 73 highly impaired alcohol-dependent patients (Alcohol Use Disorders Identification Test score over 11 for women and 12 for men) with.
Patients' average age was 60 ± 9.1 years and 45 (61.6%) had a normal CSF profile, 8 (11.0%) had a typical CSF AD profile, and 20 (27.4%) had an intermediate CSF profile.
This study revealed a high prevalence of AD in alcohol-dependent patients with persistent cognitive deficits and several anomalies in their CSF profiles. Thus, it is important to consider AD in the differential diagnosis of persistent cognitive deficits in patients with alcohol dependence and to use CSF biomarkers in addition to imaging and neuropsychological testing to evaluate alcohol-related cognitive impairment.
酒精依赖患者认知障碍的患病率很高。尽管酒精相关认知障碍（ARCD）的临床表现可能与阿尔茨海默病（AD）相似，但这两种疾病的预后和治疗方法不同。脑脊液（CSF）生物标志物（tau、磷酸化 tau 和淀粉样β）在 AD 中的诊断准确性很高，目前用于区分精神疾病和 AD，但不用于诊断 ARCD。本研究旨在描述认知障碍的酒精依赖患者的 CSF 生物标志物特征。
这是一项在巴黎一家医院的成瘾医学科进行的单中心研究。我们选择了有记录的持续认知障碍的患者，其 MoCA（蒙特利尔认知评估）评分在至少 1 个月的记录性住院戒酒后低于 24/30。我们在 73 名认知障碍严重的酒精依赖患者（女性的酒精使用障碍识别测试评分超过 11，男性的酒精使用障碍识别测试评分超过 12）中测量了 CSF 生物标志物（tau、磷酸化 tau 以及淀粉样β 1-42 和 1-40）。
患者的平均年龄为 60±9.1 岁，45 名（61.6%）患者 CSF 谱正常，8 名（11.0%）患者 CSF 谱呈典型 AD 模式，20 名（27.4%）患者 CSF 谱呈中间模式。
这项研究揭示了在有持续认知缺陷的酒精依赖患者中 AD 的高患病率，以及他们的 CSF 谱中的几个异常。因此，在有持续认知缺陷的酒精依赖患者的鉴别诊断中，考虑 AD 非常重要，并且除了影像学和神经心理学测试外，还需要使用 CSF 生物标志物来评估酒精相关的认知障碍。
