Teixeira Joana, Pinheiro Maria, Pereira Gabriela Álvares, Nogueira Paulo, Guerreiro Manuela, Castanho Miguel, do Couto Frederico Simões
Unidade de Alcoologia e Novas Dependências, Centro Hospitalar Psiquiátrico de Lisboa, Lisbon, Portugal.
Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
Alcohol Clin Exp Res (Hoboken). 2024 May;48(5):918-927. doi: 10.1111/acer.15302. Epub 2024 Mar 17.
Studies on early abstinence suggest that cognitive function is significantly reduced in the first year of abstinence, which raises the question of whether it is relevant to early relapse in patients with substance use disorders. This study investigates the extent to which impairments in executive function and memory predict alcohol relapse in patients with alcohol use disorder (AUD). Understanding these relationships is crucial for improving therapeutic approaches to prevent relapse in patients with AUD.
We selected 116 adult patients (79 male and 37 female) diagnosed with AUD based on DSM-5 criteria, all of whom were undergoing alcohol detoxification treatment. A comprehensive array of neuropsychological tests was administered to assess global cognition, memory, and executive functions. Patients' alcohol use was monitored monthly during a 6-month follow-up period. Logistic regression and Cox regression were used to explore the relationship between cognitive function and the likelihood of alcohol relapse.
Impairments in global cognition, semantic and phonemic fluency, cognitive flexibility, and learning ability during detoxification were significant predictors of relapse in AUD patients, showing similar predictive values at both 3 and 6 months post-treatment. An abnormal Montreal Cognitive Assessment (MoCA) score increased the risk of relapse by 123% (HR: 2.227), and impairments in both semantic and phonemic fluency each increased the risk by 142% (HR: 2.423). Additionally, abnormal performance on the MoCA, Trail Making Test Part B (TMT-B), and California Verbal Learning Test (CVLT) was associated with a higher number of drinking days at 3 months (IRR: 3.764; IRR: 2.237; IRR: 2.738, respectively) and abnormal MoCA and TMT-B scores at 6 months (IRR: 2.451; IRR: 1.859, respectively).
The MoCA test is a valuable tool for predicting relapse risk in AUD patients undergoing detoxification treatment, with similar predictive value for relapse at 3 or 6 months. Learning ability needs to be assessed and their impairments considered in the treatment of AUD patients. Future research should explore strategies for managing patients with impairments in memory and learning ability to enhance treatment effectiveness and prevent relapse.
关于早期戒酒的研究表明，在戒酒的第一年认知功能会显著下降，这就引发了一个问题，即这是否与物质使用障碍患者的早期复发有关。本研究调查了执行功能和记忆障碍在多大程度上可预测酒精使用障碍（AUD）患者的酒精复发情况。了解这些关系对于改进预防AUD患者复发的治疗方法至关重要。
我们根据DSM-5标准选择了116名被诊断为AUD的成年患者（79名男性和37名女性），他们均正在接受酒精戒断治疗。进行了一系列全面的神经心理学测试，以评估整体认知、记忆和执行功能。在6个月的随访期内每月监测患者的酒精使用情况。采用逻辑回归和Cox回归来探讨认知功能与酒精复发可能性之间的关系。
戒酒期间的整体认知、语义和语音流畅性、认知灵活性以及学习能力障碍是AUD患者复发的重要预测因素，在治疗后3个月和6个月显示出相似的预测价值。蒙特利尔认知评估（MoCA）得分异常使复发风险增加了123%（风险比：2.227），语义和语音流畅性障碍各自使风险增加了142%（风险比：2.423）。此外，MoCA、连线测验B部分（TMT-B）和加利福尼亚言语学习测验（CVLT）的异常表现与3个月时更多的饮酒天数相关（发病率比值比分别为：3.764；2.237；2.738），以及与6个月时MoCA和TMT-B得分异常相关（发病率比值比分别为：2.451；1.859）。
MoCA测试是预测接受戒断治疗的AUD患者复发风险的有价值工具，对3个月或6个月复发具有相似的预测价值。在AUD患者的治疗中需要评估学习能力并考虑其障碍情况。未来的研究应探索管理记忆和学习能力受损患者的策略，以提高治疗效果并预防复发。
