The CERAD Neuropsychological Assessment Battery Is Sensitive to Alcohol-Related Cognitive Deficiencies in Elderly Patients: A Retrospective Matched Case-Control Study.

OBJECTIVES: Adverse effects of heavy drinking on cognition have frequently been reported. In the present study, we systematically examined for the first time whether clinical neuropsychological assessments may be sensitive to alcohol abuse in elderly patients with suspected minor neurocognitive disorder. METHODS: A total of 144 elderly with and without alcohol abuse (each group n=72; mean age 66.7 years) were selected from a patient pool of n=738 by applying propensity score matching (a statistical method allowing to match participants in experimental and control group by balancing various covariates to reduce selection bias). Accordingly, study groups were almost perfectly matched regarding age, education, gender, and Mini Mental State Examination score. Neuropsychological performance was measured using the CERAD (Consortium to Establish a Registry for Alzheimer's Disease). Classification analyses (i.e., decision tree and boosted trees models) were conducted to examine whether CERAD variables or total score contributed to group classification. RESULTS: Decision tree models disclosed that groups could be reliably classified based on the CERAD variables "Word List Discriminability" (tapping verbal recognition memory, 64% classification accuracy) and "Trail Making Test A" (measuring visuo-motor speed, 59% classification accuracy). Boosted tree analyses further indicated the sensitivity of "Word List Recall" (measuring free verbal recall) for discriminating elderly with versus without a history of alcohol abuse. CONCLUSIONS: This indicates that specific CERAD variables seem to be sensitive to alcohol-related cognitive dysfunctions in elderly patients with suspected minor neurocognitive disorder. (JINS, 2018, 24, 360-371).

Cost of diseases related to alcohol consumption in the Brazilian Unified Health System.

OBJECTIVE: To estimate the direct costs associated to outpatient and hospital care of diseases related to alcohol consumption in the Brazilian Unified Health System. METHODS: Attributable populational risks were estimated for the selected diseases related to the use of 25 g/day or more of ethanol (risk consumption), considering a relative risk (RR) ≥ 1.20. The RR estimates were obtained from three meta-analysis. The risk consumption rates of the Brazilian population ≥ 18 years old were obtained by a national survey. Data from the Hospital Information System of SUS (HIS-SUS) were used to estimate the annual costs of the health system with the diseases included in the analysis. RESULTS: The total estimated costs for a year regarding diseases related to risk consumption were U$8,262,762 (US$4,413,670 and US$3,849,092, for outpatient and hospital care, respectively). CONCLUSIONS: Risk consumption of alcohol is an important economic and health problem, impacting significantly the health system and society.

Cost of diseases related to alcohol consumption in the Brazilian unified health system / Custos de doenças relacionadas ao consumo de álcool no sistema único de saúde

ABSTRACT OBJECTIVE To estimate the direct costs associated to outpatient and hospital care of diseases related to alcohol consumption in the Brazilian Unified Health System. METHODS Attributable populational risks were estimated for the selected diseases related to the use of 25 g/day or more of ethanol (risk consumption), considering a relative risk (RR) ≥ 1.20. The RR estimates were obtained from three meta-analysis. The risk consumption rates of the Brazilian population ≥ 18 years old were obtained by a national survey. Data from the Hospital Information System of SUS (HIS-SUS) were used to estimate the annual costs of the health system with the diseases included in the analysis. RESULTS The total estimated costs for a year regarding diseases related to risk consumption were U$8,262,762 (US$4,413,670 and US$3,849,092, for outpatient and hospital care, respectively). CONCLUSIONS Risk consumption of alcohol is an important economic and health problem, impacting significantly the health system and society.

RESUMO OBJETIVO Estimar os custos diretos associados ao atendimento ambulatorial e hospitalar de doenças relacionadas com o consumo de álcool no Sistema Único de Saúde brasileiro. MÉTODOS Riscos atribuíveis populacionais foram calculados para doenças selecionadas relacionadas ao uso de 25 g/dia ou mais de etanol (consumo de risco), considerando-se o risco relativo (RR) ≥ 1,.20. As estimativas de RR foram obtidas a partir de três meta-análises e as taxas de consumo de risco em brasileiros ≥ 18 anos obtidos em pesquisa nacional. Os dados do Sistema de Informações Hospitalares do SUS (SIH-SUS) e do Sistema de Informações Ambulatoriais do SUS (SIA-SUS) foram utilizados para estimar os custos anuais do SUS com as doenças incluídas na análise. RESULTADOS Os custos totais estimados em um ano com todas as doenças relacionadas com consumo de risco foram US$8.262.762 (US$4.413.670 e US$3.849.092 para pacientes ambulatoriais e internados, respectivamente). CONCLUSÕES Consumo de risco de álcool representa importante problema econômico e de saúde, com um impacto significativo para o sistema de saúde e para a sociedade.

[Diagnosis, assessment, and treatment of alcohol withdrawal syndrome].

Alcohol withdrawal syndrome is the one of the most critical status among alcohol related disorders. Early detection, diagnosis, and appropriate treatment of alcohol withdrawal syndrome are keys to a successful outcome. This article describes the concrete method of diagnosis, assessment, and treatment of alcohol withdrawal syndrome.

The measurement of problem drinking in young adulthood.

OBJECTIVE: Researchers and clinicians have been struggling for more than 20 years to define problem drinking. This study focuses on young adults and aims to examine the construct validity of three dimensions of problem drinking and to empirically determine appropriate cutpoints for problem drinking along these dimensions. METHOD: A stratified sample of 1,269 young adults who reported drinking alcohol in the year prior to 1995 was used in these analyses. Respondents were originally interviewed in 1985 in middle schools in a southeastern U.S. county. RESULTS: Symptoms of dependency and drunkenness were relatively common in this sample, but adverse consequences were rare. Results of analyses using the Chi-squared Automatic Interaction Detector (CHAID) and the SUrvey DAta ANalysis (SUDAAN) software suggest that drunkenness and adverse consequences are the most significant predictors of problems in other areas of life. Symptoms of dependency were significant only in interaction with drunkenness, although the analyses were limited to only lifetime measures of dependency. Appropriate cutpoints, based on these analyses, appear to be (1) drunk at least six times in the past year, (2) four or more lifetime symptoms of dependency and (3) one or perhaps two or more adverse consequences in the past year. CONCLUSIONS: Results suggest that frequency of drunkenness may be the single best indicator of problem drinking among young adults and that adverse consequences may indicate a more serious form of problem drinking than do symptoms of dependency. In addition, appropriate cutpoints on these dimensions for young adults appear to be similar to those that have been used in studies of adolescents. Further study of both adolescents and young adults is suggested.

Schedules for Clinical Assessment in Neuropsychiatry (SCAN): introduction to WV's mental health community.

The Schedules for Clinical Assessment in Neuropsychiatry (SCAN) is a semi-structured clinical interview used by trained clinicians to assess and diagnose psychiatric disorders among adults. The SCAN core is the Present State Examination (PSE) which has been developed and tested globally during the past four decades with good validity and reliability. The SCAN was developed within the framework of the World Health Organization (WHO) and the National Institute of Mental Health (NIMH) Joint Project on Diagnosis and Classification of Mental Disorders, Alcohol and Related Problems (1). The use of the SCAN gives the flexibility to diagnose mental disorders based on the current International Classification of Disease (ICD), Diagnostic and Statistical Manual (DSM) systems or other diagnostic systems that may develop in the future. A major purpose of the SCAN is to allow comparisons of psychiatric diagnoses to be made across the world.