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Title: Variables associated with cognitive impairment in adults who misuse alcohol as assessed by the Addenbrooke’s Cognitive Examination (revised)
Author: Macdonald, Sarah
ISNI:       0000 0004 2723 048X
Awarding Body: University of Glasgow
Current Institution: University of Glasgow
Date of Award: 2012
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Background:The Addenbrooke’s Cognitive Examination-Revised (ACE-R) is a widely used screening tool for Dementia. Although it is recommended for use in detecting cognitive impairment in people who misuse alcohol (Scottish Government 2007), the ACE-R has not been validated with this population. This study compared the performance of a group of people who misuse alcohol on the ACE-R with published normative data. The study examines whether deficits in ACE-R performance are associated with previous experience of a withdrawal from alcohol, duration of alcohol use and units consumed per week. Methods:Data from 77 attendees at the Alcohol Liaison Service in NHS Ayrshire and Arran who had completed the ACE-R was extracted from an existing database and included in the study. The ALS group ACE-R total and domain scores were compared to those of the original validation control group used by Mioshi et al (2006). Using independent t–tests, differences in overall ACE-R performance and domain performance were examined. Independent t-tests were also used to determine the impact of previous withdrawal on ACE-R scores. Correlation analyses and multiple regression were used to examine relationships between aspects of drinking history (previous withdrawal, duration of use and units consumed per week) and ACE-R outcome. Results:Total ACE-R scores, memory and fluency domain scores were significantly lower in the ALS group compared to normative data (p<0.001) It was not possible compare attention, language and visuospatial domain scores between groups as parametric assumptions were not met and only mean control group data was available. Attendees with a history of alcohol withdrawal had significantly poorer scores on the domain of attention compared to those who had not (p=0.009). They appeared to have lower overall ACE-R scores although this differnce was not significant (p=0.128). This analysis was underpowered. Longer duration of alcohol drinking was associated with lower verbal fluency (r=-0.362), lower memory (r=-0.239) and lower visuospatial (rs=-0.234) domain scores. Units consumed weekly were not significantly associated with any ACE-R domain score or total score. Longer duration of alcohol use and previous withdrawal experience together accounted for 10% of the variance in ACE-R total scores (p=0.02). Conclusion:It is likely that most people who chronically and hazardously misuse alcohol will experience persisting cognitive impairment. The ACE-R appears to be a good measure for the assessment such difficulties in this population. This study suggests that it is not possible to accurately judge the severity of cognitive impairment in people who drink hazardously on the basis of duration of alcohol use and previous withdrawal experience alone. The study has methodological limitations and more rigorous research examining the use of the ACE-R with this population is necessary.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psy.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry ; BF Psychology