Friday, August 27, 2010

Alcoholism Can Damage Episodic Memory, Awareness of Memory Deficits

From Medscape Medical News

Deborah Brauser


August 26, 2010 — Alcohol dependence (AD) can negatively affect episodic memory, metamemory, and executive function, according to a small trial from France.

In addition, alcohol-dependent patients in this "first of its kind study" were relatively unaware of their memory deficits and overestimated their memory capacity, report the investigators.

"This overestimation of episodic memory abilities in alcoholics has unquestionable clinical implications," corresponding study author Anne-Pascale Le Berre, clinician and PhD student in neuropsychology at Inserm-EPHE at the University of Caen/Basse-Normandie in France, told Medscape Medical News.

She explained that after being physically weaned off alcohol, patients with chronic alcoholism often undergo cognitive behavioral treatments during which they are taught to anticipate risky situations or those with a high risk for relapse.

"If patients are unaware of memory deficits, and especially overestimate their memory abilities, they will benefit only partially from their clinical treatment, since they will labor under the illusion that they have sufficiently consolidated this important clinical information for everyday life, whereas the reality is actually very different," she said.

Neuropsychological screening for cognitive deficits would also be "really useful at alcohol treatment entry, allowing clinicians to ascertain whether alcoholic patients are capable of undergoing standard therapy or whether it needs to be adjusted to take [into] account these impairments," added Dr. Le Berre.

The study was published online August 24 in Alcoholism: Clinical & Experimental Research.

First Time Metamemory Links Found

Dr. Le Berre and her team evaluated 28 patients with chronic AD (75% male; mean age, 47.9 years; average years of alcoholism, 11.49) early in their abstinence from alcohol (average days of abstinence before inclusion, 12.79) at an alcohol treatment facility and 28 non-AD matched healthy controls (50% male; mean age, 47.8 years).

All patients underwent an objective "feeling-of-knowing" (FOK) measure, which compared predictions about future memory performance during an episodic memory task with actual memory performance, and filled out the subjective Metamemory in Adulthood (MIA) questionnaire.

Additional evaluations of episodic memory and executive functioning were also conducted. None of the participants were taking any psychotropic medications or displayed any psychiatric conditions.

Results showed that the AD patients performed worse on the episodic memory and executive tasks than did the healthy controls.

"On episodic memory more particularly, conscience recollection in chronic alcoholics [was] significantly reduced, while familiarity [was] not," the investigators write.

The AD patients were also less accurate than the control group in the episodic memory task, as seen with the FOK measure, and overestimated their recognition performance, as seen with the MIA questionnaire.

The researchers write that "this study revealed for the first time" that metamemory decline in chronic alcoholism "appears to be influenced by the joint deficit in episodic memory and executive functions that is characteristic of this clinical population.

"In view of our results and the growing interest in the brain substrates of metamemory, it would be useful to study links between metamemory dysfunction and brain lesions consecutive to chronic alcohol consumption," they add.

Dr. Le Berre reported her team is continuing to explore metamemory in alcoholism using other measures than the [FOK], as well as conducting clinical and imaging studies on whether frontal activity underlies metamemory abilities. In fact, assessing "chronic alcohol consumption leading to frontal damage [is] the next step of this study."

Useful in Therapeutic Efforts

"The present study went a step further [than past studies], adding to the traditional memory test battery an assessment of the FOK phenomenon," Edith V. Sullivan, PhD, professor in the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine in California, said in a release.

"While it is striking that the alcoholic group had deficits in memory for new information, FOK analysis indicated that they were fundamentally unaware of their deficit," added Dr.Sullivan, who was not involved with the study.

"The over-estimation...of their memory ability was related to low performance on tests of executive function, which could either inhibit awareness or impair ability to retrieve information. In either case, there was a disconnection between feeling of knowing and accuracy of this knowledge."

She noted recognizing the impairment of overestimating episodic memory by those with AD "could be quite useful in therapeutic and rehabilitation efforts.

"Whether this FOK over-estimation generalizes to other cognitive abilities has yet to be determined but has the patina of being analogous to denial of problems with alcohol consumption that so often characterize recovering alcoholics and impede treatment success," concluded Dr. Sullivan.

This study was funded by Inserm, region Basse-Normandie. The study authors and Dr. Sullivan have disclosed no relevant financial relationships.

Alcohol Clin Exp Res. Published online August 24, 2010.

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