Perceptual and Motor Skills, 1990, 70, 816-818. O Perceptual and Motor Skills 1990
COGNITIVE IMPAIRMENT IN ALCOHOLICS ARTHUR S. TAMKIN
VA Medical Center, Medical College of Georgia, Augusto
AND
'
JOHN J. DOLENZ VA Medical Center, Topeka, Kansas
Summary.-The research literature shows that, as a result of chronic alcohol abuse, there occur impairments in abstract reasoning, problem-solving, and perceptual-motor functioning. In an earlier study, Tamkin (1983) obtained significant differences between alcoholics and paired neurotic inpatient controls only on abstract reasoning measured on the Weigl Color-Form Sorting Test. Verbal functions and r e c d of designs showed no group differences. This study sought to replicate the Weigl test results and to examine other types of cognitive impairments in alcoholics relative to published norms. The study subjects were 104 male alcoholics in an alcohol rehabilitation unit. The tests used were the Weigl, Trails A and B, and three subtests of the WAIS. The proportion of impaired Weigl performances was similar to that obtained in 1983, and all the other test scores were significantly poorer than their published norms.
Investigations of cognitive functioning in alcoholics have found specific, rather than generalized, deficits (Eckardt & Martin, 1986; McCrady & Smith, 1986). As a result of chronic alcohol abuse, impairments have been shown to occur in abstract reasoning, problem-solving, and perceptual-motor functioning (Goodwin & Hill, 1975; Kish, 1970; Kish & Cheney, 1969; Kleinknecht & Goldstein, 1972; Parsons, 1975; Parsons & Farr, 1981). Most of the differences between alcoholics and controls were due to the long-term alcoholics, who presented 10 or more years of heavy drinking (Parsons, 1975). Verbal abilities are resistant to impairment (Kish, 1970; Tarter, 1975). Tamkin (1983) explored the pattern of deficit for 30 alcoholics and for a paired control of 30 nonalcoholic neurotics as well as the relationship between deficits and extent of alcoholism. He used the following tests: Weigl Color-Form Sorting (Tamkin & Kunce, 1982), Bender-Gestalt recall score, and the subtests of the WAIS Verbal Scale. These groups differed only on the Weigl test which shows that the alcoholics had more difficulty in shifting the sorting criterion. Their verbal abilities were intact, and the results were independent of the extent of alcoholism. This study was an attempt to replicate Tarnkin's findings for alcoholics using a different clinical group composed of male veterans to explore the generality of the findings. The subjects in the alcoholic group were 104 male veterans in an alcohol rehabilitation unit of an inpatient medical center. All 'Re uesrs for reprints should be sent to Arthur S. Tamkin, Psychology Service (IlbB), VA ~ e j i c a Center, l Augusta, Georgia 30910. All subjects were drawn from VA Medical Center, Big Spring, Texas. The authors are gateful to the late E. Mansell Pattison, M.D., for his review of the manuscript and to Paulette F. Fulghum for typing the manuscript.
817
IMPAIRMENT IN ALCOHOLICS
subjects were selected in a random manner and all testing was performed by the same psychologist (J.J.D.) to control for examiner effects. Mean age was 42.0 yr. (SD = 11.2), and mean education was 11.8 yr. of schooling (SD=
3.2). The subjects, prior to selection for this study, were first treated in the detoxification unit. When medically and cognitively cleared, they were transferred to the rehabilitation unit where on an average of four days later they were administered the psychological tests. Only alcoholics without brain-related impairments were selected. Examples of exclusions were cardiovascular accident, dementia, organic brain syndrome, and inability to care for oneself. To replicate the findings for alcoholics in the earlier study (Tamkin, 1983), all subjects completed the Weigl Color-Form Sorting Test and the WAIS subtests of Vocabulary, Similarities, and Digit Symbol. I n addition, all subjects completed Trails A and B. The present findings were that 59 alcoholics (56.7%) could shift concepts on the Weigl and 45 (43.3%) could not. Using the data of the 1983 study, which showed 10 alcoholics able to shift (47.6%) and 11 (52.4%) unable to shift, X , 2 was 3.24 ( p < . l o ) . Since there is no significant difference between the Weigl performance in this study and that in 1983, the earlier findings for the Weigl are replicated. From 43% to 52% of alcoholics have impaired conceptual thinking. Table 1 lists the findings on the WAIS subtests and Trails A and B for the alcoholics and contraststheir pe~forrnancewith published norms derived from normal subjects. The alcoholics consistently perform poorer than the norms, with p values ranging from < .025 to < .0005, for one-tailed t tests. -
~
TABLE 1 MEANSA N D STANDARD DEVLATIONS FORALCOHOLICS AND NORMATIVE GROUPSON COGNITIVE TESTS Cognitive Test WAIS Vocabulary*
M
SD WAIS Similarities*
M
SD WAISDigitSymbol*
M
SD Trails A t
M
SD Trials B t
M
SD
P
Alcoholics, N = 104
Norms
n
9.12 2.46
10.00 3.00
500
-2.75
COGNITIVE IMPAIRMENT IN ALCOHOLICS ARTHUR S. TAMKIN
VA Medical Center, Medical College of Georgia, Augusto
AND
'
JOHN J. DOLENZ VA Medical Center, Topeka, Kansas
Summary.-The research literature shows that, as a result of chronic alcohol abuse, there occur impairments in abstract reasoning, problem-solving, and perceptual-motor functioning. In an earlier study, Tamkin (1983) obtained significant differences between alcoholics and paired neurotic inpatient controls only on abstract reasoning measured on the Weigl Color-Form Sorting Test. Verbal functions and r e c d of designs showed no group differences. This study sought to replicate the Weigl test results and to examine other types of cognitive impairments in alcoholics relative to published norms. The study subjects were 104 male alcoholics in an alcohol rehabilitation unit. The tests used were the Weigl, Trails A and B, and three subtests of the WAIS. The proportion of impaired Weigl performances was similar to that obtained in 1983, and all the other test scores were significantly poorer than their published norms.
Investigations of cognitive functioning in alcoholics have found specific, rather than generalized, deficits (Eckardt & Martin, 1986; McCrady & Smith, 1986). As a result of chronic alcohol abuse, impairments have been shown to occur in abstract reasoning, problem-solving, and perceptual-motor functioning (Goodwin & Hill, 1975; Kish, 1970; Kish & Cheney, 1969; Kleinknecht & Goldstein, 1972; Parsons, 1975; Parsons & Farr, 1981). Most of the differences between alcoholics and controls were due to the long-term alcoholics, who presented 10 or more years of heavy drinking (Parsons, 1975). Verbal abilities are resistant to impairment (Kish, 1970; Tarter, 1975). Tamkin (1983) explored the pattern of deficit for 30 alcoholics and for a paired control of 30 nonalcoholic neurotics as well as the relationship between deficits and extent of alcoholism. He used the following tests: Weigl Color-Form Sorting (Tamkin & Kunce, 1982), Bender-Gestalt recall score, and the subtests of the WAIS Verbal Scale. These groups differed only on the Weigl test which shows that the alcoholics had more difficulty in shifting the sorting criterion. Their verbal abilities were intact, and the results were independent of the extent of alcoholism. This study was an attempt to replicate Tarnkin's findings for alcoholics using a different clinical group composed of male veterans to explore the generality of the findings. The subjects in the alcoholic group were 104 male veterans in an alcohol rehabilitation unit of an inpatient medical center. All 'Re uesrs for reprints should be sent to Arthur S. Tamkin, Psychology Service (IlbB), VA ~ e j i c a Center, l Augusta, Georgia 30910. All subjects were drawn from VA Medical Center, Big Spring, Texas. The authors are gateful to the late E. Mansell Pattison, M.D., for his review of the manuscript and to Paulette F. Fulghum for typing the manuscript.
817
IMPAIRMENT IN ALCOHOLICS
subjects were selected in a random manner and all testing was performed by the same psychologist (J.J.D.) to control for examiner effects. Mean age was 42.0 yr. (SD = 11.2), and mean education was 11.8 yr. of schooling (SD=
3.2). The subjects, prior to selection for this study, were first treated in the detoxification unit. When medically and cognitively cleared, they were transferred to the rehabilitation unit where on an average of four days later they were administered the psychological tests. Only alcoholics without brain-related impairments were selected. Examples of exclusions were cardiovascular accident, dementia, organic brain syndrome, and inability to care for oneself. To replicate the findings for alcoholics in the earlier study (Tamkin, 1983), all subjects completed the Weigl Color-Form Sorting Test and the WAIS subtests of Vocabulary, Similarities, and Digit Symbol. I n addition, all subjects completed Trails A and B. The present findings were that 59 alcoholics (56.7%) could shift concepts on the Weigl and 45 (43.3%) could not. Using the data of the 1983 study, which showed 10 alcoholics able to shift (47.6%) and 11 (52.4%) unable to shift, X , 2 was 3.24 ( p < . l o ) . Since there is no significant difference between the Weigl performance in this study and that in 1983, the earlier findings for the Weigl are replicated. From 43% to 52% of alcoholics have impaired conceptual thinking. Table 1 lists the findings on the WAIS subtests and Trails A and B for the alcoholics and contraststheir pe~forrnancewith published norms derived from normal subjects. The alcoholics consistently perform poorer than the norms, with p values ranging from < .025 to < .0005, for one-tailed t tests. -
~
TABLE 1 MEANSA N D STANDARD DEVLATIONS FORALCOHOLICS AND NORMATIVE GROUPSON COGNITIVE TESTS Cognitive Test WAIS Vocabulary*
M
SD WAIS Similarities*
M
SD WAISDigitSymbol*
M
SD Trails A t
M
SD Trials B t
M
SD
P
Alcoholics, N = 104
Norms
n
9.12 2.46
10.00 3.00
500
-2.75
