Abstract
Background and AimsRecent investigations have highlighted the value of neuropsychological testing for the assessment and screening of Alcohol-Related Brain Damage (ARBD). The aim of the present study was to evaluate the suitability of the Addenbrooke’s Cognitive Examination (ACE-III) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) for this purpose.MethodsComparing 28 participants with ARBD (11 with Korsakoff’s Syndrome and 17 with the umbrella “ARBD” diagnosis) and 30 alcohol-dependent participants without ARBD (ALs) we calculated Area Under the Curve (AUC) statistics, sensitivity and specificity values, base-rate adjusted predictive values, and likelihood ratios for both tests.ResultsHigh levels of screening accuracy were found for the total scores of both the ACE-III (AUC = 0.823, 95% CIs [0.714, 0.932], SE = 0.056; optimal cut-off ≤86: sensitivity = 82%, specificity = 73%) and RBANS (AUC = 0.846, 95% CIs [0.746, 0.947], SE = 0.052; optimal cut-off ≤83: sensitivity = 89%, specificity = 67%) at multiple cut-off points. Removing participants with a history of polysubstance from the samples (10 ALs and 1 ARBD) improved the diagnostic capabilities of the RBANS substantially (AUC = 0.915, 95% CIs [0.831, 0.999], SE = 0.043; optimal cut-off ≤85: sensitivity = 98%, specificity = 80%), while only minor improvements to the ACE-III’s accuracy were observed (AUC = 0.854, 95% CIs [0.744, 0.963], SE = 0.056; optimal cut-off ≤88: sensitivity = 85%, specificity = 75%).ConclusionOverall, both the ACE-III and RBANS are suitable tools for ARBD screening within an alcohol-dependent population, though the RBANS is the superior of the two. Clinicians using these tools for ARBD screening should be cautious of false-positive outcomes and should therefore combine them with other assessment methods (e.g., neuroimaging, clinical observations) and more detailed neuropsychological testing before reaching diagnostic decisions.
Highlights
It has been estimated that 50–80% of people who misuse alcohol will experience some degree of cognitive impairment (Bernardin et al, 2014)
Between-group comparisons for all test scores are presented in Table 2, along with standardized (Cohen’s d, pooled SD used as the standardizer) and unstandardized effect sizes to provide a detailed understanding of findings (Lakens, 2013; Pek and Flora, 2018)
The Alcohol-Related Brain Damage (ARBD) group scored significantly lower than alcohol-dependent individuals with no such diagnosis (ALs) on all test indices apart from the Attention and Visuospatial scores of both tests; these differences approached our adjusted alpha level of 0.0042
Summary
It has been estimated that 50–80% of people who misuse alcohol will experience some degree of cognitive impairment (Bernardin et al, 2014). In chronic and severe cases of alcohol-dependence, the neurocognitive impairment may progress to an extent where more debilitating and permanent damage occurs. In such cases, the person may receive a diagnosis of Alcohol-Related Brain Damage (ARBD; Royal College of Psychiatrists, 2014), or one of the more discretely defined diagnoses subsumed within this larger conceptual category such as Korsakoff ’s Syndrome (see Heirene et al, 2018 for an overview of ARBD diagnoses). Recent investigations have found that neuropsychological testing is highly effective at identifying individuals with ARBD and distinguishing them from both healthy controls and alcoholdependent individuals with mild cognitive impairment (ALC). The aim of the present study was to evaluate the suitability of the Addenbrooke’s Cognitive Examination (ACE-III) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) for this purpose
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