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ORIGINAL ARTICLE
Year : 2015  |  Volume : 6  |  Issue : 2  |  Page : 133-136

A study on the cognitive dysfunctions in spouses of patients with alcohol dependence syndrome


Department of Psychiatry, Father Muller Medical College, Mangalore, Karnataka, India

Date of Web Publication13-Jul-2015

Correspondence Address:
Dr. Rinet Sonia Dsouza
Department of Psychiatry, Father Muller Medical College, Kankanady, Mangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0975-9727.160681

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  Abstract 

Context: Alcoholism is a disease of the family. Alcoholism is linked to disrupted family role, violence, impaired family communication and physical and psychological illness. Several studies have shown that spouses of alcoholics often present significant rates of mental and physical problems, communication problems, low social activity and poor marital satisfaction. The inconsistent results from previous research clearly demonstrate the need for more evidence. Aims: To study the cognitive dysfunctions in the spouses of patients with alcohol dependence syndrome (ADS). Settings and Design: The data were collected from 30 spouses of patients admitted at the deaddiction centre and psychiatry ward of Father Muller Medical College Hospital Mangalore. Materials and Methods: Samples were selected from spouses of patients admitted consecutively, who met inclusion and exclusion criteria. Samples of the study were evaluated using Standardized Mini Mental State Examination (SMMSE), Trail Making Test B (TMT-B), Digit Symbol Substitution Test (DSST). Statistical Analysis Used: Conventional statistics were used to calculate mean and standard deviation (SD) for the parameters of the study. Results: It was found that 26.6% of the spouses were cognitively impaired showing decreased, impaired cognitive functions, of which 62.5% had history of alcohol consumption of the spouses for 6-10 years of duration. Conclusions: Study proved the decrease in cognitive functions in the spouses of patients with alcohol dependence syndrome.

Keywords: Alcohol dependence syndrome, cognitive dysfunction, digit symbol substitution test, standardized mini mental state examination, trail making test B


How to cite this article:
Dsouza RS, Kumar S, Mathai JP. A study on the cognitive dysfunctions in spouses of patients with alcohol dependence syndrome. Muller J Med Sci Res 2015;6:133-6

How to cite this URL:
Dsouza RS, Kumar S, Mathai JP. A study on the cognitive dysfunctions in spouses of patients with alcohol dependence syndrome. Muller J Med Sci Res [serial online] 2015 [cited 2020 Jul 10];6:133-6. Available from: http://www.mjmsr.net/text.asp?2015/6/2/133/160681


  Introduction Top


Alcoholism is a disease of the family. Alcoholism is linked to disrupted family role, violence, physical and psychological illness. [1] The commonest stressors faced by the spouses were financial problems, physical abuse, abuse of children and social stigma. [2] Studies have shown that children of alcoholics are at increased risk for cognitive impairment. [3],[4] Similarly studies show that spouses of alcoholics often present significant rates of mental, physical and communication problems, low social activity and poor marital satisfaction. [5],[6],[7] But the results are inconsistent. The present study aims at investigating the cognitive dysfunction in spouses of patients with alcohol dependence syndrome (ADS).


  Materials and Methods Top


Source of data

The study was started following the ethical clearance by the institutional ethics committee. The data were collected from the spouses of patients admitted at the deaddiction centre and the psychiatry ward of Father Muller Medical College Hospital, Mangalore, Karnataka, India.

Method of collection of data

Samples for the study were selected from spouses of patients admitted consecutively from October 2013 to January 2014, who met inclusion and exclusion criteria.

Spouses of patents with alcohol dependence syndrome as per ICD-10 criteria, of age between 18-60 years, who gave written informed consent for the study were selected, while those spouses with any chronic lifestyle modifying illness like Diabetes Mellitus, Hypertension or with any history of substance abuse or with any psychiatric disorders or with any major medical illness or those suffering from neurodegenerative diseases and with family history of neurodegenerative diseases in first degree relatives were excluded from the study.

Samples of the study were evaluated using following scales to estimate the cognitive functions:

  1. Standardized Mini Mental State Examination (SMMSE)
  2. Trail Making Test- B (TMT-B)
  3. Digit Symbol Substitution Test (DSST)


Standardized mini mental state examination (SMMSE)

The SMMSE is a bed-side screening test for cognitive impairment, derived from the Mini - Mental State Examination (MMSE), developed by Folstein, which is the most widely used instrument to measure cognitive impairment. SMMSE takes about five to ten minutes to administer. It contains 12 items which are asked in sequence to generate a total score of 30.The scores of less than 18 indicate severe cognitive impairment while 18-23 point to mild impairment and scores above 24 is reflective of no impairment. Questions that are not answered should be treated as errors. [8]

Trail making test-B (TMT-B)

TMT originally constructed in 1938 as "Partington's Pathways" or "Divided Attention Test" is a timed test of speed for attention, sequencing, mental flexibility, visual search and motor function. TMT is available in various formats, namely TMT-Part A and TMT Part B, oral Trail Making test and color trail test. [9]

TMT-Part B, is associated with the processes of distinguishing between numbers and letters, integration of two independent series, ability to learn an organizing principle and apply it systematically, reveal retention and integration, verbal problem solving and planning. It is a useful tool in identifying general frontal lobe dysfunctions by indicating an inability to execute and modify a plan of action. [10]

Digit symbol substitution test (DSST)

It is a test of visuomotor co-ordination, motor persistence, sustained attention and response speed. Rapid information processing is required in order to substitute the symbols accurately and quickly.

The test consists of a sheet in which number 1-9 are randomly arranged in 4 rows of 25 squares each. The subjects substitute each number with a symbol using a number symbol key given at the top of the page. The time taken to complete the test in seconds forms the score and errors are noted down. It requires combing the newly learned number or symbol pairs, accurate visual perception, appropriate age co-ordination, short term memory and ongoing processed attention. This test is extremely sensitive to cognitive deterioration. It is affected by age and by impairment of visual performance. [11]


  Results Top


SMMSE

There was significant low scores with respect to attention and concentration (mean = 2.375).

But there was no much difference in the scores of other domains - orientation (mean = 9.75).

  • registration (mean = 3)
  • recall (mean = 3)
  • language (mean = 6.875)
  • construction (mean = 0.75)


TMT-B and DSST

Although there was no much difference in the time taken to complete both the tests in all the participants, but 26.6% spouses committed more number of errors on these tests (mean = 3.75 for TMT-B and 2.875 for DSST) [Figure 1].
Figure 1: Chart showing the results of TMT-B and DSST

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Majority of spouses participated in the study were 96.6% females. It was found that 26.6% of the spouses were cognitively impaired. Among those 26.6% cognitively impaired spouses 87.5% were females [Figure 2], 75% were in the age group 30-40 years group [Figure 3], 62.5% had middle school education [Figure 4].
Figure 2: Pie chart showing the sex distribution among the cognitive declined cases

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Figure 3: Chart showing the age distribution cognitive declined cases

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Figure 4: Chart showing education among the cognitive declined cases

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Among the cognitive declined cases, 62.5% had spouses of alcohol consumption for the duration of six to ten years [Figure 5], whereas 50% of the cognitive declined cases had spouses who consume 240-420 ml of alcohol [Figure 6].
Figure 5: Chart showing the duration of alcohol consumed by the spouses of the cognitive declined cases

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Figure 6: Chart showing the quantity of alcohol consumed by the spouses of cognitive declined cases

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  Discussion Top


This study found cognitive impairment of 26.6% among the participants of the study showing decreased, impaired cognitive functions like decrease in attention, concentration, impaired memory etc., of which 62.5% had history of alcohol consumption of the spouses for six to years of duration.

The spouses develop ways of dealing with the concomitant stress, a coping behavior which seems to be rather uniform even though spouses of alcoholics are, of course, a heterogeneous group with varying Backgrounds. [7] One population-based study found a small, but significant trend for female spouses of male at-risk drinkers to experience more mental distress than spouses of controls. [12]

There is considerable evidence that cognitive performance changes when a person is under stress. Unrelieved chronic stress can produce deleterious cognitive changes including problems with thinking, memory, concentration and behavior. These changes can influence many parts of life, such as one's ability to work or even to complete everyday tasks (i.e. driving, cooking, taking care of others). Symptoms of stress also include depression of intellectual functioning, cognitive distortions and misinterpretations of situations, events and interpersonal exchanges. In addition, people who are overstressed may have ruminative and unproductive patterns of thinking and indecisiveness. They worry and anticipate that "something bad" will happen and fear that they are losing control. They become distractible, impatient, and easily irritated. Further, memory can be impaired and there is a tendency to engage in negative, unrealistic and pessimistic thinking patterns. [13] Also some studies have shown how stress, via the physiological responses that accompany it, can alter memory. In contrast, more severe or prolonged stressors can have deleterious effects upon broad aspects of cognition. Recent evidence suggests that some of these effects can probably be attributed to reversible changes in the morphology of neurons within the hippocampus, a region of the brain that is central to learning and memory. Finally, taken to the extreme, truly prolonged exposure to stress can cause irreversible loss of hippocampal neurons, and may be relevant to the cognitive deficits seen in many individuals. [14] Other factors that may even lead to the increased stress level in the spouses of ADS patients are - duration of alcohol consumption and quantity consumed per day.

Study limits in being an observational study with a smaller sample size of just 30, with short duration to conduct the study. Larger sample size with the involvement of controls and longer duration of the study would have provided the better results.


  Conclusions Top


Female spouses of the ADS patients have cognitive impairment with the prolonged duration of alcohol consumption in their partners. This study throws light on the possible cognitive impairment, however large sample prospective studies in future are required to reach to a conclusion on this issue.


  Acknowledgement Top


Sincere thanks to Ms. Praseena K, Lecturer, Department of Bostatistics, Father Muller Medical College, Mangalore in helping for the statistical analysis for the parameters of the study.

 
  References Top

1.
Revathy S. Psychosocial profile of the wives of alcoholics and non alcoholics. Indian Journal of Continuing Education (IJCNE) 2009;10:19-24.  Back to cited text no. 1
    
2.
Benegal V. India: Alcohol and public health. Addiction 2005;100:1051-6.  Back to cited text no. 2
    
3.
Elgán TH, Hansson H, Zetterlind U, Kartengren N, Leifman H. Design of a Web-based individual coping and alcohol-intervention program (web-ICAIP) for children of parents with alcohol problems: Study protocol for a randomized controlled trial. BMC Public Health 2012;12:35.  Back to cited text no. 3
    
4.
McGrath CE, Watson AL, Chassin L. Academic achievement in adolescent children of alcoholics. J Stud Alcohol 1999;60:18-26.  Back to cited text no. 4
    
5.
Fals-stewart W. The occurrence of partner physical aggression on days of alcohol consumption: A longitudinal diary study. J Consult Clin Psychol 2003;71:41-52.   Back to cited text no. 5
    
6.
Dawson DA, Grant BF, Chou SP, Stinson FS. The Impact of partner alcohol problems on women′s physical and mental health. J Stud Alcohol Drugs 2007;68:66-75.   Back to cited text no. 6
    
7.
Hansson H, Zetterlind U, Aberg-Orbeck K, Berglund M. Two-year outcomes of coping skills training, group support and information for spouses of alcoholics: A randomized controlled trial. Alcohol Alcohol 2004;39:135-40.  Back to cited text no. 7
    
8.
Molloy DW, Alemayehu E, Roberts R. Reliability of standardized mini mental state examination compared with the traditional mini mental state examination. Am J Psychiatry 1991;148:102-5.  Back to cited text no. 8
    
9.
Tombaugh TN. Trail Making Test A and B. Normative data stratified by age and education. Arch Clin Neuropsychol 2004;19:203-14.  Back to cited text no. 9
    
10.
Greenlief CL, Morgolis RB, Enker GJ. Application of the trail making test in differentiating neuropsychological impairment of elderly persons. Percept Mot Skills 1985;61:1283-9.  Back to cited text no. 10
    
11.
Rao SL, Subbakrishna DK, Gopukumar K. NIMHANS Neuropsychology Battery-2004 Manual. 1 st ed. Bangalore: National Institute of Mental Health and Neurosciences (NIMHANS) Publications; 2004. p. 11-7.  Back to cited text no. 11
    
12.
Rognmo K, Torvik FA, Røysamb E, Tambs K. Alcohol use and spousal mental distress in a population sample: The nord- Trøndelag health study. BMC Public Health 2013;13:319.  Back to cited text no. 12
    
13.
Miner D. Brain Health 2007. Available from: http://www.brainfitnessforlife.com/effects-of-stress-on-cognition/. [Last accessed on 2013 Sep 24].  Back to cited text no. 13
    
14.
McEwen BS, Sapolsky RM. Stress and cognitive function. Curr Opin Neurobiol 1995;5:205-16.  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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Abstract
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