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Cognitive impairment and recovery associated with episodic and chronic alcohol use amongst Aboriginal Australians, and the factors that influence continued use after treatment Kylie Dingwall & Dr Sheree Cairney. Brain atrophy, ventricular enlargement, widened sulci

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Cognitive impairment and recovery associated with episodic and chronic alcohol use amongst Aboriginal Australians, and the factors that influence continued use after treatmentKylie Dingwall & Dr Sheree Cairney

neurological impacts chronic use

Brain atrophy, ventricular enlargement, widened sulci

  • Learning, memory, visual spatial, executive impairments

Neurological impacts – Chronic use

Rosenbloom, Sullivan and Pfefferbaum, 2003

neurological impacts

Chronic use – Consumption of large amounts of alcohol on a daily or near daily basis

  • Episodic use or ‘binge’ use - consumption of large amounts of alcohol in one sitting on an irregular or episodic basis

Neurological impacts

catalyst
Catalyst

Full video available from www.abc.net.au/catalyst/stories/s2019179

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Computerised, non-verbal assessment intended for the repeated assessment of cognitive function in diverse groups

  • A number of subtests measuring:
    • Visual motor function
    • Executive function
    • Psychomotor function
    • Visual Attention
    • Visual Learning and Memory
our studies

Detect cognitive impairments associated with episodic alcohol use among Aboriginal people.

  • Monitor cognition longitudinally for Aboriginal people attending rehab
  • Identify and compare impairment and recovery profiles of chronic and episodic alcohol users
  • Examine the factors contributing to continued alcohol use post-treatment

Our studies

rehabilitation study

Setting: Residential alcohol treatment programs in Northern Territory.

  • Participants: 41 chronic alcohol users, 40 episodic users and 24 healthy controls (M age = 34.24; SD = 9.73).
  • Measurements: CogState at baseline (start of treatment), then 4 weeks and 8 weeks later.

Rehabilitation Study

Baseline

4 weeks

8 weeks

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Results

  • Baseline:
  • Impaired visual-motor, learning, memory and executive functions
  • Within 4 weeks:
  • All except visual-motor function had recovered
  • No significant difference between Chronic and Episodic users
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Conclusions

  • Episodic and chronic alcohol users presented a comparable profile of cognitive deficit and recovery
  • Cognitive performance may improve rapidly with abstinence (i.e. within 1 month)
  • Persisting visual-motor impairments.
  • The majority of alcohol related cognitive impairments may arise from the residual biochemical effects of alcohol which ameliorate following detoxification
community follow up

Participants: 37 alcohol users assessed at baseline upon entry to treatment

  • Method: Re-interviewed and re-assessed after an average of 11 months (SD = 4.4) after treatment

Community Follow up

6-12 months

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Community Follow up

  • Outcomes:
  • 6 (16%) abstained
  • 31 (84%) continued using
  • Of continued users:
    • 3 (10%) reduced their alcohol intake
    • 23 (74%) continued using at the same level
    • (change in use was unknown for 5 individuals).
  • Improved users (abstained or reduced their use; n = 9) were compared to relapsed users (continued heavy use; n = 23)
findings

Relapsed users:

  • Poorer paired associate learning at baseline
  • Poorer paired associate learning, visual attention, executive function, learning and memory at follow up
  • Less likely to return to a community with restricted alcohol access
  • More likely to experience the psychological symptom of worry at follow up

Findings

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Summary

  • Alcohol affects frontal, hippocampal, cerebellar brain regions
  • Impairments in executive functions, memory, learning, psychomotor function.
  • Chronic and Episodic users present similar profiles of impairment and recovery
  • Cognitive and impairment and accessibility were important factors in relapse
flipcharts

Flipcharts

Available From: www.menzies.edu.au/brainstories

references

Australian Bureau of Statistics. (2006a). National Aboriginal and Torres Strait Islander Health Survey 2004-05. [Cat. No. 4715.0]. Canberra: Australian Government Publishing Service

  • Vos, T., Barker, B., Stanley, L., & Lopez, A. D. (2007). The burden of disease and injury in Aboriginal and Torres Strait Islander peoples 2003. Brisbane: School of Population Health, The University of Queensland
  • Australian Bureau of Statistics. (2008). The health and welfare of Australia's Aboriginal and Torres Strait Islander Peoples, 2008 [Cat. No. 4704.0]. Canberra: Australian Government Publishing Service
  • Carlen, P. L., Wortzman, G., Holgate, R. C., Wilkinson, D. A., & Rankin, J. G. (1978). Reversible cerebral atrophy in recently abstinent chronic alcoholics measured by computed tomography scans. Science 200(4345), 1076-7078
  • Cairney, S., Clough, A. R., Jaragba, M. J., & Maruff, P. (2007). Cognitive impairment in Aboriginal people with heavy episodic patterns of alcohol use. Addiction, 102, 909-915

References