To diagnose a patient with alcohol use disorder (AUD), the doctor typically asks about their drinking habits, performs a physical examination, orders laboratory tests, and may refer them for a psychological interview. . In Spain, 20,000 people were diagnosed with this condition in 2020, according to a report from the Ministry of Health carried out last year. Many times, patients find themselves with a collapsed system that does not have the necessary resources to carry out exhaustive neuropsychological monitoring, explains Laura Orio, principal researcher at the I+12 Foundation of the 12 de Octubre Hospital in Madrid. The scientist leads a project that has discovered a biomarker that, with a blood test, can detect cognitive deterioration in those who suffer from this disorder.
The team observed that patients with a lower cognitive level showed higher levels of reelin. This protein is found in the brain, it helps its formation in early stages, its proper functioning and protects it when it suffers damage. “We were very surprised. In the scientific community it is understood as a good protein,” details Orio. The scientists also found that people with higher reelin showed another protein, called apolipoprotein E-4 (APOE-4), produced by a genetic mutation and present in a very small percentage of the population. APOE-4 favors the toxic effects of alcohol in its carriers, says Berta Escudero, the other main author of the work, a psychologist and also a researcher at the I+12 Foundation.
To carry out the research, they had a sample of 24 patients with AUD diagnosed in the early abstinence period (four weeks without drinking) and a control group of 34 people. They evaluated the subjects’ cognition using a test for detecting cognitive impairment in alcoholism (TEDCA). The test assesses visuospatial skills (representation of objects), memory and executive function (everything related to attention, concentration and decision making). Those with the worst results also had the highest reelin. The results were published last June in the journal International Journal of Neuropsychopharmacology.
When a patient enters the cessation program, he or she has pharmacological treatment and group therapies. The first is focused, above all, on alleviating the withdrawal syndrome, although there are also deterrent drugs “more aimed at reducing the desire to consume,” explains Francisco Pascual, president of Socidrogalcohol, a non-profit scientific society dedicated to training. , the treatment and prevention of addictions.
After six months of abstinence, the researchers verified that in the patients who felt the worst, both cognitive deterioration and reelin levels had been reduced. It is still early to talk about causality, but they can do so in relational terms, explains the psychologist.
One of the hypotheses proposed by Orio is that this protein appears when alcohol is withdrawn as a response mechanism and then progressively decreases. “The body tries to produce more so that the probability of exerting a protective effect increases,” says Escudero. That is why it is important to measure it during the first weeks of abstinence, so that it serves as an indication.
The levels of reelin that each person has also depend on other factors such as the length of time the patient has been drinking and the amount. The persistence of alcohol use ends up causing this inflammation, or those alterations it causes in the brain, to extend over time and can cause damage to the brain structure, says Javier Carmina, spokesperson for the Spanish Society of Neurology (SEN). which is not part of the investigation.
Alcohol use disorder is linked to cancer, type 2 diabetes, liver and heart disease, but it can also harm mental health and lead to cognitive decline and diseases such as dementia. In addition to all these consequences, it also causes social and work problems for those who suffer from it. However, it is an underdiagnosed problem because society does not understand that alcohol consumption causes diseases beyond dependence, laments Pascual, from Socidrogalcohol, who has not participated in the project. “It is part of our tradition, of our most intimate being, that everything we celebrate is with alcoholic beverages.”
Patients with alcohol consumption and cognitive dysfunction should seek help because it is something that can be improved
Cognitive rehabilitation treatment specifically trains executive functions and short-term memory, necessary in most day-to-day activities, Carmina details. “Once alcohol consumption is stopped, there is a trend towards improvement in several parameters, especially attentional ones, initially.” According to the neurologist, the recovery of patients’ cognitive level depends greatly on how much alcohol the patient has consumed during their addiction.
The project continues. Orio says that they are working on long-term follow-up of patients to find out the mechanism that links reelin and the cognitive impairment caused by alcohol use disorder. They also continue to search for new biomarkers that can serve as indicators.
The four experts agree that this finding can make a big difference for patients. Identifying people with cognitive impairment would make it easier for them to be referred directly to a cognitive stimulation program and instead of getting worse, they would be maintained or even improve, says Escudero. Carmina, from the SEN, concludes: “Patients with alcohol consumption and cognitive dysfunction should ask for help because it is something that can be improved.”
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Source: EL PAIS
