Neuropsychological problems associated with alcoholism
Introduction
Alcohol is a depressant of the central nervous system, ethanol, whose effects vary dependingcardiorespitatria depression.
In Spain, deeply rooted by Mediterranean consumption patterns, (Galán, 2014), the prevalence reaches 77.5% for general consumption and almost 14% for daily consumption.
At first, as with any other substance, it would be necessary to define in a general way, what is poisoning, what is abuse and what is dependency.
Intoxication is a transitional syndrome caused by taking or exposure to a substance and that causes psychological changes and maladaptive behavior. Abuse is an absence pattern that causes deterioration in the person and dependence where tolerance appears, the desired effect of the substance requires increasing the doses and abstinence, where the appearance of the withdrawal syndrome causes the greatest consumption to relievethe symptoms or consumption of other substances that replace it.
Phases of poisoning and behavioral alterations:
- Excitation: up to 0.5gr/l: Location, disinhibition and euphoria appears.
Up to 0.75gr/l: There are movement difficulties, coordination problems and loss of visual acuity.
Up to 1gr/l: loss of reflexes and difficulty in movements and coordination. Up to 1.5gr/l: Loss of self-criticism and important mood changes.
Up to 2 gr/l: emotional lability, ataxia, dysarthria and behavioral disinhibition.
- Drunken.
- Coma: 3gr/l onwards: ataxia, stupor, comma and increases the possibility of death.
Neuropsychological alterations
Delirium tremens
It occurs a few days after the suspension of continued consumption of alcohol, or the drastic reduction of the number usually ingested. Sometimes the start can be delayed 1 or 2 weeks. During the nights he aggravates. (NICE, 2010)
Symptoms
- Changes in the level of consciousness
- Confusional states and space-time disorientation
- Perceptual disorders: visual or auditory hallucinations
- Motor disorders: reduction in movements, agitation
Cerebellar degeneration
Degeneration of all the elements of the cerebellar cortex, an atrophy of the anterior portion of the upper vermis and adjacent areas of the cerebellar hemispheres appears, it can appear alone or as a symptom of Wernicke-Korsakoff syndrome (Martínez, Rábano, 2002)
Clinical manifestations:
– Highlights the "drunk march". Ataxia appears in the trunk and lower extremities, balancing and loss of balance, dysarthria and loss of motor coordination in arms.
Wernicke-Korsakoff
It is produced by the failure in the synthesis of vitamin B1A in the liver, and its consequent deficit. Cortical atrophy appears, and on the other hand, a subcortical damage with the affectation of the hippocampus, the amygdala, the dinephal, middle brain, spinal cord and sometimes the cerebellum
Clinical manifestations:
- Acute phase: mental confusion, apathy, ataxia and ocular paralysis.
- Chronic phase: emotional and cognitive alterations. It is fundamentally characterized by anterograde amnesia although retrograde amnesia also appears.
Explanatory hypothesis of neuropsychology deterioration in chronic alcoholism and Wernicke-Korsakoff syndrome
- Right hemisphere hypothesis
In chronic alcoholism, the damage is more pronounced in the right hemisphere compared to the left, which causes the alterations to be sinsoperceptive and spatial viso. (Iruairrazaga et al, 2001)
- Premature aging hypothesis
All brain areas deteriorate similarly by the toxic effects of alcohol
- Continuum hypothesis
It states that the deterioration in brain functions is part of a continuum, do not appear immediately, being the lower pole that corresponds to occasional drinkers and the opposite pole those affected by the Wernicke-Korsakoff syndrome.
Evaluation
Patients with chronic alcoholism have a series of both cognitive and behavioral deficits, which have to be valued. The deficits are presented in a wide variety of areas such as memory, where the ability to generate new learning or short -term memory is affected;Attention, deficits can be seen in the processing speed or in the executive functions, which can show design syndrome or problems in problem solving capacity. For this we will use different instruments that could be:
Memory
For Key Numbers of Wais Numbers Visual Memory, or the test of the figure of King, for the working memory the battery Halstead Reatain or The Delayed Alternation Task. For learning, TAVEC or the Learning Subtest Words of Barcelona could be used.
Attention
We could start with the processing speed, if it were affected with the numbers of numbers (WAIS) or the symbol-digito test, for the sustained attention the CPT or for the selective care the subtest of incomplete figures (WAIS) or forAnosoagnosia that could be present in Wernicke-Korsakoff syndrome El Tea.
Executive functions
For mental flexibility, Trail Malking Test could be used or Wisconsin’s letters, for the inhibition of responses the Stroop test or the task not-not, for the ability to plan the London Tower.
conclusion
As we see chronic alcoholism, it greatly deteriorates the lives of patients, all areas of their lives are very deteriorated, the deficits caused and their consequences can influence the way they relate to their environment, being able not only to be affected aspectssocial or family, also work or academic.
It is also observed that the approach to this type of patients should be integral, not only focus on the physiological consequences that chronic consumption of alcohol entails, but to value, evaluate and treat behavioral, cognitive, emotional and social areas.
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