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a Department of
Psychiatry, University of Cambridge, UK, b Clinical Research Unit, National
Hospital of South Hanamaki, Suwa 500, Hanamaki, Iwate, Japan 025-0033, c Drug and Alcohol Service,
Brookfield Hospital, Cambridge, UK
Correspondence to: Dr H Ihara, Clinical Research Unit, National Hospital of South Hanamaki, Suwa 500, Hanamaki, Iwate, Japan 025-0033 mhi202{at}shanamaki.hosp.go.jp
Received 12 April 1999 and in revised form 8 October 1999;
Accepted 31 January 2000
OBJECTIVES
To test the
dysexecutive syndrome (DES) hypothesis of chronic alcoholism by the
neuropsychological group and case study approaches.
METHODSA
comprehensive neuropsychological assessment, including the
"behavioural assessment of dysexecutive syndrome", a battery of
tests recently designed to be "ecologically valid", was
administered to 17 patients with chronic alcoholism without amnesia to
examine executive functions, intelligence, and memory. In terms of each neuropsychological measure, reciprocal analyses of group means and
individual case profiles were conducted: for the first contrasting the
alcoholic patients with 17 age matched healthy subjects; and for the
second making intersubject and intrasubject comparison of the patients,
according to percentile basis impairment indices obtained from the
control subjects.
RESULTSDespite
relatively unimpaired memory and intelligence, the patients as a whole
had the impairment of a wide range of executive domains, extending to
"everyday" problem solving as well as more elementary aspects of
executive functions, such as visuospatial performance, mental set
shifting, and the inhibition of habitual behaviour. The profile
analysis divided individual patients into four groups: the
representative DES characterised by a clear dissociation between
impaired executive functions and preserved intelligence and memory; the
group of a modified dysexecutive pattern in which memory as well as
executive functions were impaired with intelligence preserved; the
group of general cognitive deterioration; and the group of unimpaired
cognitive functioning. About two thirds of the patients were
categorised into either the first or the second type of DES.
CONCLUSIONDES
characterised by the even more pronounced impairment of executive
functions than of intelligence and memory afflicts a considerable
proportion of patients with chronic alcoholism. Due to its subtlety,
this would be potentially left out, unless appropriate behavioural
measures were administered. This condition may prevent patients with
alcoholism from achieving full recovery and benefiting from rehabilitation.
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