Psychological impairment in alcoholics.

A minority of alcoholics will show obvious evidence of dementia but the majority will appear clinically intact. Despite the fact that almost 50% of those 'intact' alcoholics will be found to have structural brain damage, on routine tests of intelligence they will fall in the normal range. More detailed psychometric testing will however reveal deficits in non-verbal abstracting ability, tactile performance and psychomotor speed with a perceptual component. Neither consumption variables nor the extent of structural brain damage are closely related to the degree of impairment. Age and premorbid intelligence are however so related. Much of the impairment is recoverable with time but visuo-spatial abilities and abstract problem solving may remain impaired for a year or two and some aspects of long-term memorising may be permanently impaired. In general, older alcoholics show less capacity for recovery. The possibility that brain damage and cognitive impairment may antedate the alcoholism is considered as is the possibility that alcohol may be particularly damaging to the ageing brain. The relevance of pathophysiological disturbances and nutritional deficiency is also considered. Evidence is now accumulating that cognitive defect is an important predictor of outcome following treatment. In the management of states of impairment attention should be paid to remedying nutritional deficiencies and the general principles of rehabilitation should be borne in mind.