Assessing outcomes of alcohol-related brain damage (ARBD): What should we be measuring?

The recent move towards outcomes-focused assessment in health and social care has made it important to identify which outcomes are relevant to alcohol-related brain damage (ARBD). Clinical outcomes guidance for ARBD is currently absent from policy documentation. Thus, the aim of this review is to evaluate the current evidence base to determine recommendations for the measurement of ARBD outcomes. A total of 71 separate references were identified through a systematic online database and hand search. The screening and exclusion strategy left 7 articles to be included in this review. The findings indicate that research into ARBD has focussed on a number of outcome domains, including type of accommodation and provision of support; drinking status; employment status; number of deaths; mental health and psychiatric symptoms; activities of daily living; social functioning; and cognitive functioning. The identified outcomes suggest that practitioners should focus on a comprehensive range of clinical outcomes for ARBD service users. Nevertheless, the paucity of the existing evidence base makes it difficult to make clinical recommendations for the measurement of ARBD outcomes. Further research is necessary to shed light on long term outcomes for people with ARBD and to increase the strength of the evidence in this area

Evidence for subtle verbal fluency deficits in occasional stimulant users: quick to play loose with verbal rules

Psychostimulants like cocaine and amphetamine are commonly abused by young adults who often state that they take these drugs to increase social or cognitive performance. The current study tested the hypothesis that individuals at early stages of occasional stimulant use show subtle executive dysfunctions such as verbal fluency deficits. 155 young (age 18-25), non-dependent occasional users of stimulants and 49 stimulant naïve comparison subjects performed the Delis-Kaplan Verbal Fluency test. Correlation and median split analyses were conducted to account for stimulant history and co-drug use. Compared to stimulant naïve subjects, occasional stimulant users generated significantly more responses on an over-learned verbal fluency task (Category Fluency), but at the expense of increased error rates (Set Loss and Repetition Errors). These performance differences were not related to lifetime uses of stimulants or marijuana. Taken together, these results support the hypothesis that individuals who are using stimulants occasionally exhibit subtle executive dysfunctions when required to generate verbal sets under time pressure. In particular, occasional stimulant users apply quickly but inaccurately verbal rules, which may represent a mix of diminished cognitive flexibility along with increased rigidity and impulsivity. This specific executive dysfunction may help to identify individuals at risk for stimulant use or dependence

Alzheimer's disease severity, objectively determined and measured

AbstractIntroductionWith expansion of clinical trials to individuals across the spectrum of Alzheimer disease (AD) from preclinical to symptomatic phases, it is increasingly important to quantify AD severity using methods that capture underlying pathophysiology.MethodsWe derived an AD severity measure based on biomarkers from brain imaging, neuropathology, and cognitive testing using latent variable modeling. We used data from ADNI-1 (N = 822) and applied findings to BIOCARD study (N = 349). We evaluated criterion validity for distinguishing diagnostic groups and construct validity by evaluating rates of change in AD severity.ResultsThe AD severity factor cross-sectionally distinguishes cognitively normal participants from MCI (AUC = 0.87) and AD dementia (AUC = 0.94). Among ADNI MCI subjects, worsening scores predict faster progression to AD dementia (HR = 1.17; 95% CI, 1.13–1.22). In ADNI and BIOCARD, the pace of change in AD severity is steepest among progressors, with persisting differences by baseline diagnosis.DiscussionOur content-valid latent variable measurement model is a reasonable approach for grading AD severity across a broad spectrum beginning at preclinical stages of AD