Impaired Global Precedence Effect in Severe Alcohol Use Disorder and Korsakoff's Syndrome: A Pilot Exploration through a Global/Local Visual Paradigm

International audienceIn healthy populations, visual abilities are characterized by a faster and more efficient processing of global features in a stimulus compared to local ones. This phenomenon is known as the global precedence effect (GPE), which is demonstrated by (1) a global advantage, resulting in faster response times for global features than local features and (2) interference from global distractors during the identification of local targets, but not vice versa. This GPE is essential for adapting visual processing in everyday life (e.g., extracting useful information from complex scenes). We investigated how the GPE is affected in patients with Korsakoff's syndrome (KS) compared to patients with severe alcohol use disorder (sAUD). Three groups (including healthy controls, patients with KS and patients with sAUD) completed a global/local visual task in which predefined targets appeared at the global or local level during either congruent or incongruent (i.e., interference) situations. The results showed that healthy controls (N = 41) presented a classical GPE, while patients with sAUD (N = 16) presented neither a global advantage nor global interference effects. Patients with KS (N = 7) presented no global advantage and an inversion of the interference effect, characterized by strong interference from local information during global processing. The absence of the GPE in sAUD and the interference from local information in KS have implications in daily-life situations, providing preliminary data for a better understanding of how these patients perceive their visual world

Impaired Global Precedence Effect in Severe Alcohol Use Disorder and Korsakoff's Syndrome: A Pilot Exploration through a Global/Local Visual Paradigm

International audienceIn healthy populations, visual abilities are characterized by a faster and more efficient processing of global features in a stimulus compared to local ones. This phenomenon is known as the global precedence effect (GPE), which is demonstrated by (1) a global advantage, resulting in faster response times for global features than local features and (2) interference from global distractors during the identification of local targets, but not vice versa. This GPE is essential for adapting visual processing in everyday life (e.g., extracting useful information from complex scenes). We investigated how the GPE is affected in patients with Korsakoff's syndrome (KS) compared to patients with severe alcohol use disorder (sAUD). Three groups (including healthy controls, patients with KS and patients with sAUD) completed a global/local visual task in which predefined targets appeared at the global or local level during either congruent or incongruent (i.e., interference) situations. The results showed that healthy controls (N = 41) presented a classical GPE, while patients with sAUD (N = 16) presented neither a global advantage nor global interference effects. Patients with KS (N = 7) presented no global advantage and an inversion of the interference effect, characterized by strong interference from local information during global processing. The absence of the GPE in sAUD and the interference from local information in KS have implications in daily-life situations, providing preliminary data for a better understanding of how these patients perceive their visual world

[Alcohol induced neurocognitive disorder: screening strategies and tools].

International audienceAlcohol induced neurocognitive disorder: screening strategies and tools. Chronic and excessive alcohol consumption results in cognitive disorders partially reversible with abstinence. These heterogeneous cognitive impairments affect executive functions, episodic memory and social cognition. They may interfere with the motivational process to abandon excessive drinking behavior, impair patients' ability to benefit from treatment and increase the risk of relapse. Alcohol-related neuropsychological deficits should thus be evaluated and considered for personalized alcohol treatment. Several screening tools available in clinical settings enable clinicians to detect patients with cognitive impairments and to offer them appropriate and adjusted treatment

Atteintes cognitives liées au trouble de l’usage d’alcool : rétablir l’équilibre ?

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Trimethylamine N-oxide (TMAO) and indoxyl sulfate concentrations in patients with Alcohol Use Disorder

International audienceBackground: Trimethylamine N-oxide (TMAO) and indoxyl sulfate (IS) are produced by the microbiota and the liver, and can contribute to brain aging and impaired cognitive function. This study aims to examine serum TMAO and IS concentrations in patients with alcohol-use disorder (AUD) at the entry for alcohol withdrawal, and the relationships with several biological, neuropsychological, and clinical parameters. Methods: TMAO and IS were quantified in thirty AUD inpatients and fifteen healthy controls (HC). The severities of AUD and alcohol withdrawal syndrome (AWS), and general cognitive abilities were assessed in AUD patients. Results: TMAO concentrations did not differ between HC and AUD patients. Several biomarkers assessing nutritional status and liver function were significantly different in AUD patients with the lowest TMAO concentrations compared to other AUD patients. IS concentration was significantly lower in AUD patients and a significant positive predictor of serum prealbumin variation during the acute phase of alcohol withdrawal. No relationship was observed between the concentrations of these metabo-23 lites and the severities of alcohol dependence, AWS, or cognitive deficits. Conclusions: Our data 24 suggest that AUD patients with low concentrations of TMAO or IS should probably benefit from a 25 personalized refeeding program during the acute phase of alcohol withdrawal

Direct voxel-based comparisons between grey matter shrinkage and glucose hypometabolism in chronic alcoholism

International audienceAlcoholism is associated with widespread brain structural abnormalities affecting mainly the frontocerebellar and the Papez’s circuits. Brain glucose metabolism has received limited attention, and few studies used regions of interest approach and showed reduced global brain metabolism predominantly in the frontal and parietal lobes. Even though these studies have examined the relationship between grey matter shrinkage and hypometabolism, none has performed a direct voxel-by-voxel comparison between the degrees of structural and metabolic abnormalities. Seventeen alcoholic patients and 16 control subjects underwent both structural magnetic resonance imaging and 18 F-2-fluoro-deoxy-glucose-positron emission tomography examinations. Structural abnormalities and hypometabolism were examined in alcoholic patients compared with control subjects using two-sample t-tests. Then, these two patterns of brain damage were directly compared with a paired t-test. Compared to controls, alcoholic patients had grey matter shrinkage and hypometabolism in the fronto-cerebellar circuit and several nodes of Papez’s circuit. The direct comparison revealed greater shrinkage than hypometabolism in the cerebellum, cingulate cortex, thalamus and hippocampus and parahippocampal gyrus. Conversely, hypometabolism was more severe than shrinkage in the dorsolateral, premotor and parietal cortices. The distinct profiles of abnormalities found within the Papez’s circuit, the fronto-cerebellar circuit and the parietal gyrus in chronic alcoholism suggest the involvement of different pathological mechanisms

Determinants of health-related quality of life in recently detoxified patients with severe alcohol use disorder

International audienceAbstract Background Health-related quality of life (HRQoL) is an important clinical outcome in Alcohol Use Disorder (AUD) and is considered as a relevant indicator of treatment success. While a better understanding of the factors affecting HRQoL would enable to adjust patients’ care to favour treatment outcome, the determinants of HRQoL in AUD remain unclear. This study aims at describing HRQoL in AUD patients and at identifying its best predictors. Methods 53 recently detoxified patients with severe AUD (sAUD) underwent a cognitive assessment and filled in a HRQoL questionnaire dedicated to AUD patients (Alcohol Quality of Life Scale; AQoLS), as well as questionnaires concerning socio-demographics, alcohol history, sleep quality, depression, anxiety and impulsivity. 38 healthy controls (HC) underwent the same assessment (except AQoLS) in order to identify the altered cognitive and clinical variables that could potentially be determinants of HRQoL in sAUD. Results sAUD patients reported that alcohol affects their HRQoL mainly in the “negative emotions”, “control”, “relationships”, and “sleep” domains. Compared to HC, they were impaired on episodic memory, working memory, executive functions, and processing speed tasks. They also reported lower sleep quality, higher depression, anxiety and impulsivity. No association was found between AQoLS total score and socio-demographics, cognitive performance, or sleep quality in patients. We found a significant correlation between HRQoL and depression/anxiety as well as impulsivity. Anxiety and impulsivity were indeed the only significant predictors of HRQoL, explaining 47.7% of the variance. Conclusion Anxiety and impulsivity are crucial determinants of HRQoL in recently detoxified sAUD patients. Since anxiety and impulsivity are frequent issues in addiction and especially in AUD, they should be particularly considered by clinicians to favour treatment outcomes

Troubles cognitifs dans l’alcoolodépendance : intérêt du dépistage dans l’optimisation des prises en charge

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PROGNOSTIC FACTORS FOR LOW-RISK DRINKING AND RELAPSE IN ALCOHOL USE DISORDER: A MULTIMODAL ANALYSIS

International audienceAims: To specify the determinants of low-risk alcohol drinking and relapse at different timepoints after detoxification in patients with severe Alcohol Use Disorder (AUD).Methods: Fifty-four AUD patients and 36 healthy controls (HC) were evaluated early inabstinence (T1). They underwent clinical, neuropsychological and neuroimaging (structuralMRI and 18FDG-PET) investigations.AUD patients were subsequently classified as “low-risk drinkers” (LR) or “relapsers” (R)based on their alcohol drinking at 6 months (T2) and one year (T3) after discharge, using theirmedical record or self-reported drinking estimation at follow-up.Results: Based on the alcohol status at T2 and compared to HC, only R had alexithymia,lower gray matter volume in the midbrain and hypermetabolism in the cerebellum andhippocampi. Based on the alcohol status at T3 and compared to HC, only R had more severenicotinic dependence, lower episodic and working memory performance, lower gray mattervolume in the amygdala, ventromedial prefrontal cortex and anterior cingulate gyrus, andhypermetabolism in cerebellum, hippocampi and anterior cingulate gyrus. Moreover, R hadbilateral frontal hypometabolism, whereas LR only presented right frontal hypometabolism.Conclusion: Nicotine dependence, memory impairments, and structural brain abnormalitiesin regions involved in impulsivity and decision-making might contribute to a one-yearrelapse. Treatment outcome at one year may also be associated with an imbalance between ahypermetabolism of the limbic system and a hypometabolism of the frontal executive system.Finally, cerebellar hypermetabolism and alexithymia may be determinants of relapse at both 6months and one year

Validation of a brief screening tool for alcohol-related neuropsychological impairments (BEARNI)

International audienceBackground: Alcohol-related neuropsychological impairments mainly affect episodic memory, working memory and visuospatial abilities, as well as executive and motor functioning. These impairments can prevent alcoholic patients early in abstinence from benefiting fully from treatment, and reduce their ability to remain abstinent. A neuropsychological assessment at alcohol treatment entry therefore seems essential for making the relevant clinical decisions. However, very few alcohol treatment departments have the financial and human resources needed to conduct an extensive neuropsychological examination of each alcoholic patient. The goal of the present study was therefore to assess the validity and the psychometric properties of the Brief Evaluation of Alcohol-Related Neuropsychological Impairments (BEARNI), a new screening tool especially designed to assess patients at alcohol treatment entry. Methods: A total of 254 healthy controls completed the BEARNI, and 58 of them also performed an extensive neuropsychological battery. 73 alcoholic patients underwent both the BEARNI and the neuropsychological battery. This extensive neuropsychological battery of proven classification accuracy served as the reference (i.e., gold standard) for determining the alcoholic patients' cognitive status. Results: An exploratory factor analysis validated the BEARNI's underlyin