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A Case-Comparison Study of Executive Functions in Alcohol-Dependent Adults With Maternal History of Alcoholism
A Case-Comparison Study of Executive Functions in Alcohol-Dependent Adults With Maternal History of Alcoholism
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European Psychiatry 24 (2009) 195e200
Original article
Department of Addictology, University of Lille 2, Faculty of Medicine, University Hospital of Lille, 57 Bd de Metz, 59037 Lille Cedex, France
b
Department of Psychology, URECA EA 1059, University of Lille 3, France
c
Department of Addictology, University Hospital Paul Brousse, Villejuif, France
Received 9 July 2008; received in revised form 4 December 2008; accepted 10 December 2008
Available online 4 February 2009
Abstract
Introduction. e As executive dysfunctions frequently accompany alcohol dependence, we suggest that reports of executive dysfunction in
alcoholics are actually due, in some case to a maternal history of alcohol misuse (MHA). A history of maternal alcohol dependence increases
the risk for prenatal alcohol exposure to unborn children. These exposures likely contribute to executive dysfunction in adult alcoholics. To
assess this problem, we propose a case-comparison study of alcohol-dependent subjects with and without a MHA.
Methods. e Ten alcohol-dependent subjects, with a maternal history of alcoholism (MHA) and paternal history of alcoholism (PHA), were
matched with 10 alcohol-dependent people with only a paternal history of alcoholism (PHA). Executive functions (cancellation, Stroop, and
trail-making A and B tests) and the presence of a history of three mental disorders (attention deficit hyperactivity disorder, violent behavior while
intoxicated, and suicidal behavior) were evaluated in both populations.
Results. e Alcohol-dependent subjects with MHA showed a significant alteration in executive functions and significantly more disorders
related to these functions than PHA subjects. The major measures of executive functioning deficit are duration on task accomplishment in all
tests. Rates of ADHD and suicidality were found to be higher in MHA patients compared to the controls.
Conclusion. e A history of MHA, because of the high risk of PAE (in spite of the potential confounding factors such as environment) must
be scrupulously documented when evaluating mental and cognitive disorders in a general population of alcoholics to ensure a better identification of these disorders. It would be helpful to replicate the study with more subjects.
2009 Elsevier Masson SAS. All rights reserved.
Keywords: Alcohol dependence; Maternal history of alcoholism; Prenatal alcohol exposure; Executive function disorders
1. Introduction
Empirical studies have surprisingly shown that, drinking
practice and duration are relatively weak predictors of neuropsychological impairments in abstinent alcoholics, but that
neuropsychological morbidity is rather related to age [19,42],
high-density alcoholism families (multigenerational history of
alcoholism) [15], early onset of alcohol consumption [37] and
childhood hyperactivity [52]. In addition, structural brain
changes have been suggested as a possible substrate underlying
* Corresponding author. Tel.: 33 3 20 44 58 38; fax: 33 3 20 44 54 37.
E-mail address: ocottencin@chru-lille.fr (O. Cottencin).
0924-9338/$ - see front matter 2009 Elsevier Masson SAS. All rights reserved.
doi:10.1016/j.eurpsy.2008.12.003
cognitive impairments (basal ganglia, corpus callosum, cerebellum, and hippocampus) [30]. Neuroimaging, neuropathological studies [35,40], and examination of event-related
potentials [21] suggest that the frontal brain systems are especially susceptible to alcoholism-related damage. This frontal
lobe damage is manifested clinically as alterations of executive
functions [22,30]. While certain cognitive functions such as
psychomotor performance and short-term memory [11], verbal
recall and visuospatial ability [48] can improve or return to
normal levels after abstinence, executive function impairments
do persist [8,36,53], even after long periods of abstinence [34].
On the other hand, numerous studies also suggest that
executive functions are impaired in people with prenatal
196
197
Table 1
Matching of alcohol-dependent populations: one exposed prenatally to alcohol and the other not exposed. Child protective services means that the patient or
control benefitted of an in-home placement during childhood.
Patient
Control
Patient
Control
Patient
Control
Patient
Control
Patient
Control
Patient
Control
Patient
Control
Patient
Control
Patient
Control
Patient
Control
Sex
Age
Duration of alcoholism
Alcoholism in father
Alcoholism in mother
M
M
M
M
M
M
M
M
F
F
F
F
M
M
M
M
M
M
M
M
48
53
46
46
38
36
34
37
43
41
33
32
29
26
41
39
27
28
34
34
13
14
16
16
16
16
20
18
14
14
15
16
19
18
16
17
16
16
15
14
25
28
20
17
6
8
4
5
11
13
4
4
1
2
5
7
2
1
5
4
Yes
No
Yes
Yes
No
No
Yes
Yes
No
No
performance duration
MHA+
MHA-
120
86
+/-28
100
80
60
130
+/-32
128
+/-28
60
+/-9
95
+/-21
84
+/-42
54
+/-19
87
+/-23
51
+/-8,5
39
+/-8
40
20
0
Cancelling
Stroop 1
(Verbal)
Stroop 2
(Color)
Trail A
Trail B
Neuropsychological Tests
Fig. 1. Neuropsychological assessment of patients with or without maternal
exposure to alcohol (MHA and MHA).
198
3. Results
3.1. Executive function disorders (Fig. 1)
All control subjects with PHA performed the cancellation
test without error in a time of 45 s or less. Nine of the subjects
with MHA took more than 50 s to complete the test, and five
made errors. The paired Wilcoxon test showed a significant
difference in the time required for the test ( p 0.0039) but not
in the number of errors ( p 0.0625).
All control subjects and 7 subjects with MHA could
perform the Stroop test, but 3 study subjects could not
concentrate, became very irritable and refused to continue.
The paired Wilcoxon test showed a significant difference in
the time taken to perform the test for colors ( p 0.0015) and
colored words (0.0313) but not in the interference score
( p 0.0625).
In part A of the trail-making test, all control subjects
connected figures 1e25 without error within 60 s, while 70%
of the subjects with MHA required more than 60 s. Three
subjects made at least two errors. Results for part B were
similar: the subjects with MHA took longer to complete the
test than the control population did. The statistical analysis
found a significant difference in the time needed to complete
both test A ( p 0.0137) and test B ( p 0.0078), but not in
the number of combined errors ( p 0.25).
3.2. Disorders potentially related to executive functions
ADHD was diagnosed retrospectively for 8 subjects with
MHA, who had scores greater than 8 on the 11-item Tarter
scale. No control subject was so diagnosed. The Wilcoxon test
of paired series showed a significant difference between the
two groups ( p 0.002).
All subjects with MHA had at least one episode of
intoxication with violence in their history, compared with only
2 in the control population.
Finally, according to the MINI-DSM IV [44], 7 subjects
with MHA were at risk of suicide, but only one subject in the
control group.
4. Discussion
Our investigation of executive functions demonstrated that
alcohol-dependent patients with MHA (very high probability
of in utero alcohol exposure) performed significantly more
poorly than the alcohol-dependent patients without MHA.
Executive functions are cognitive functions used by subjects
faced with non routine actions to adapt their behavior to the
environment. They are therefore involved in executing intentional behavior, in activities requiring the definition of an
objective and strategy, the planning of actions, cognitive
flexibility and the mobilization of sustained and selective
attention [22]. Their dysfunction could therefore have important repercussions on the social functioning of those affected,
as seen frequently in alcohol-dependent people. The relation
199
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