1. Differences in neurocognitive functioning in early and late onset alcohol dependent inpatients. Leen Joos, MSc CAPRI - Antwerp Psychiatrisch Centrum Broeders Alexianen – Boechout

2. 1 Introduction vs. EARLY Onset Alcohol dependent patients (EOA) LATE Onset Alcohol dependent patients (LOA)

3. 2 Introduction Clinical and demographic differences EOA: younger more paternal family history of alcohol abuse more traumatic experiences more antisocial traits worse prognosis higher severity of alcohol dependence more craving more other drug use besides alcohol longer alcohol & substance-abusing career higher trait impulsivity higher sensation seeking and aggression weak impulse control Demir e.a., 2002; Dom e.a., 2006, 2007; Evren e.a., 2009; Johnson e.a., 2000

4. 3 Introduction Clinical and demographic differences EOA: younger more paternal family history of alcohol abuse more traumatic experiences more antisocial traits worse prognosis higher severity of alcohol dependence more craving more other drug use besides alcohol longer alcohol & substance-abusing career higher trait impulsivity higher sensation seeking and agression weak impulse control

5. 4 Introduction Neuropsychological differences EOA: less cognitive flexibility (Demir e.a., 2002) more commission errors (Continuous Perf Task) ~ impulsive action (Bjork e.a., 2004) steeper discount rates (Delay Discounting Task) ~ impulsive choice (Dom e.a., 2006)

6. 5 Introduction EOA: highly impulsive (impulsive choice and action) less cognitive flexibility BUT: -previous research is limited -sample sizes are small -tasks are mainly focused on impulse control Hypothesis: EOA show more deficits than LOA on tasks measuring neuropsychological functioning.

7. 6 Method Subjects 92 alcohol dependent inpatients: EOA: n=35 (age of onset ≤ 25 years) LOA: n=57 (age of onset > 25 years) INCLUSION criteria: - Current (past 12 months) alcohol dependence (DMS-IV) - Abstinent EXCLUSION criteria: - Use of psychoactive medication - Current (past 12 months) dependence on other drugs besides alcohol - Acute psychic or severe somatic disorders

8. 7 Method Subjects EOA n=35 LOA n=57 Gender (male %)88.6%84.2% Age ***35.91 (8.9)46.25 (8.4) Years of drinking ***14.56 (8.6)8.20 (6.6) Age of onset ***19.46 (4.6)37.28 (8.2) IQ93.66 (8.5)97.25 (10.9) Family history of drug abuse42.9%26.3% Substances used ** - Only alcohol - Alcohol + other drugs 51.4% 48.6% 86.0% 14.1% *p<.05; **p<.01; ***p<.001

9. 8 Method Measures Questionnaires -DSM-IV personality disorders (ADP-IV) -Trait impulsivity (BIS-11) -Trait anxiety (STAI) -Depression (BDI-II) -ADHD (ASRS) -Quantity/frequency measures of alcohol use, past 6 months (TLFB) -Craving (OCDS) -Nicotine dependence (FTND)

10. 9 Method Measures Neuropsychological tests (1/2) 1. Short-term memory / Working memory Digit span (WAIS-III; Swets Test Publishers, 2000) Pattern Recognition Memory (PRM; CANTAB; www.camcog.com)www.camcog.com Delayed Matching to Sample (DMS; CANTAB; www.camcog.com)www.camcog.com 2. Attention Rapid Visual Presentation Task (RVP; CANTAB; www.camcog.com)www.camcog.com 3. Planning Tower of London (TOL; Vandenheuvel e.a., 2003)

11. 10 Method Measures Neuropsychological tests (2/2) 4. Response inhibition Stop Signal Task (SST; Eagle e.a., 2008) Stroop Colour-Word Task (Cox e.a., 2006) 5. Decision making Delay Discounting Task (DDT; Wittmann e.a., 2007) 6. Reflection impulsivity Information Sampling Task (IST; Clark e.a., 2006)

12. 11 Results Clinical characteristics EOA n=35 LOA n=57 Trait Impulsivity (BIS-11) *** 71.00 (9.8)62.15 (10.9) Trait Anxiety (STAI) *52.17 (12.2)46.74 (10.9) Depression (BDI-II) 16.09 (10.4) 13.11 (8.23) Level of impairment/distress (ADP-IV – total score) *** 246 (63.7)201.09 (56.6) Diagnosis Antisocial Personality Disorder (ADP-IV) *** 17.6%0% Diagnosis ADHD (ASRS) *37.1%14% *p<.05; **p<.01; ***p<.001

13. 12 Results Characteristics Alcohol Use EOA n=35 LOA n=57 Craving (OCDS) *5.37 (2.7)3.89 (3.0) Mean use/drinking day (TLFB) *21.53 (14.6)14.97 (8.3) Max use/drinking day (TLFB) *33.86 (19.5)25.09 (14.26) % non-smokers (FTND)11.4%17.5% *p<.05; **p<.01; ***p<.001

14. 13 Results 1. Short-term memory / Working memory EOA perform BETTER than LOA on: Delayed recognition memory (PRM): p<.05 Delayed visual memory (DMS): p<.05 Working memory (DMS): p=.062 No sign differences on Digit Span 2. Attention No sign differences on RVP 3. Planning EOA perform BETTER than LOA on TOL (p<.05) Difficult trials - step 4-5-6: p<.05 Easy trials - step 2-3: ns

15. 14 Results 4. Response inhibition No sign differences on SST or Stroop Task 5. Decision making No sign differences on DDT 6. Reflection impulsivity EOA showed a MORE IMPULSIVE response pattern than LOA (IST): p<.05 e.g. they gathered LESS information in more risky situations

16. 15 Summary EOA act MORE IMPULSIVE than LOA in risky situations involving rewards and losses EOA perform BETTER than LOA on tasks measuring Delayed Recognition Memory Delayed Visual Memory Planning

17. 16 Discussion Sample selection? 1. Previous results were biased 2. Our sample:less comorbidity less drug dependence Medication free & Pure alcohol dependent

18. 17 Discussion Less comorbidity: 1. 2. Good cognitive abilities are a protective factor for EOA NOT to go into poly-substance dependence Differences between EOA and LOA on neurocognitive measures are less pronounced.

19. 18 Thanks for your attention! Questions? Leen.joos@ua.ac.be