Assessing Cognitive Functioning

Health professionals must be aware of the possibility of alcohol-related brain damage and be watchful for signs of it in the clinical interview. Since there is a high prevalence of cognitive dysfunction among people with alcohol problems (see Review of the Evidence), drug and alcohol workers should screen for deficits in cognitive function (see Chapter 19 – People with Cognitive Impairment). 

Two forms of cognitive impairment occur more commonly in persons with unhealthy alcohol use than any other. They are: 

• • • Impairment in recent memory (“short-term memory”), formally termed amnestic disorder; and  

    • Frontal lobe (executive) dysfunction. 

There is a range of severity of both these impairments. Amnestic disorder may range from mild impairment (which may be fully reversible) to the most severe which is termed Wernicke–Korsakoff’s syndrome, and typically is irreversible. Amnestic disorder has a high prevalence in alcohol dependent people. It is caused by thiamine (Vitamin B1) deficiency in combination with the neurotoxic effects of alcohol and may be fatal (see Chapter 8 Alcohol withdrawal management). 

Other medical causes of cognitive impairment include: 

If cognitive impairment is suspected, an appropriate medical practitioner should assess the patient. In most cases, if abstinence is achieved, cognitive function improves considerably over the subsequent 2 to 4 weeks. Formal cognitive assessment should preferably be deferred until four weeks have elapsed but a provisional assessment is valuable even immediately after the detoxification period.