WASHINGTON — Although women are less likely than men to abuse alcohol, those that do suffer the same kinds of neuropsychological problems as alcoholic men, according to a new study published in the January issue of Neuropsychology. And, the problems, including impaired working memory and visuospatial abilities, remain months after alcoholic women stop drinking.
With this research, a team from Stanford University and consulting company SRI International’s Neuroscience Program (based in Menlo Park, Calif.) has further clarified sex differences in alcoholism, which affects about 4.6 million U.S. women (about one third of the estimated U.S. alcohol-abusing or alcohol-dependent population). Neuropsychology is published by the American Psychological Association (APA).
Scientists have known how alcoholism damages the nervous system (including the brain) for decades, but primarily in men for two reasons. First, early researchers studied patients at Veterans Administration hospitals, far more likely to be men; second, more men than women abuse alcohol. Once the medical community found that research on men does not necessarily generalize across the sexes, they began to study the effects of alcoholism on women, and found some significant differences.
For one, although women drink less than men and are less likely to use or abuse alcohol, death rates among alcoholic women are 50 to 100 percent higher than among their male counterparts. This higher mortality may be related to other sex differences, including the facts that women exhibit more psychiatric problems than men and metabolize alcohol differently from men, this last perhaps in part due to women’s higher body fat. The current research was intended to assess any possible sex differences in alcoholism-related neuropsychological performance, because knowledge of how (and if) alcohol differentially affects women can inform how we prevent, diagnose and treat the disease.
Edith V. Sullivan, Ph.D., Rosemary Fama, Ph.D., Margaret J. Rosenbloom, Ph.D., and Adolf Pfefferbaum, Ph.D., studied a range of neuropsychological deficits in 43 alcoholic women who were sober, on average, for 3.6 months, and compared their performance with that of a non-alcoholic control group.
The team assessed such abilities as executive function (for example, sequencing and sorting cards); short-term memory and fluency (remembering letter or block combinations; producing as many words as possible that start with a given letter); visuospatial abilities (tracing simple figures embedded in complex figures, copying complex designs, or building with blocks to match pictured designs); upper-limb motor ability (grip strength and fine finger movement), and gait and balance. These abilities have been associated with particular areas of the brain, such as executive function with the frontal lobes and gait and balance with the cerebellum.
Overall, Sullivan et al. found that the women’s pattern of impairment in these tasks was similar to the male pattern of impairment -- with some moderate differences. In common with male alcoholics, the female alcoholics showed the greatest impairment in both verbal and non-verbal short-term (working) memory and visuospatial abilities.
Men, as shown in prior research, were more impaired than women in executive functioning and in gait and balance, although not necessarily to a degree noticeable by the casual observer. However, because men’s gait and balance were studied earlier in their sobriety, it is possible that women would have been impaired to the same degree at that point; further study is needed. Sullivan speculates that female hormones may protect gait and balance to some extent, but cautions, “Even if subtle, these abnormalities are important because they put even recovering alcoholics at an increased risk for falling. These problems are exacerbated in older age, when the untoward effects of alcoholism interact with age.”
For the women alcoholics, the neuropsychological deficits remained significant even after average abstinence of three months, reflecting the chronic nature of the disease even after the acute effects of intoxication have worn off. “The warning for loved ones and health-care providers,” says Sullivan, “is that the seriousness of alcoholism-related dysfunction is commonly under-appreciated, and the time necessary for recovery is underestimated.” Complicating the situation, she adds, “there is some evidence that women are able to cover up their problem more successfully than men, which may suggest that they can better compensate for their cognitive and motor deficits.”
Sullivan suggests that the nervous system’s recovery from alcoholism -- while possible to some degree -- be viewed not in terms of days but rather months or even years, as with cerebral stroke. Active rehabilitation, consequently, may need to continue for some time to enable complete recovery.
In sum, the study confirmed that, as it does in men, alcoholism damages women’s brain structure and function in measurable and specific ways that resist recovery for longer than expected, and can be greater in old age because alcoholism may exacerbate normal age-related brain shrinkage.
Article: “A Profile of Neuropsychological Deficits in Alcoholic Women,” Edith V. Sullivan, Ph.D., Stanford University School of Medicine; Rosemary Fama, Ph.D., SRI International; Margaret J. Rosenbloom, Ph.D., Stanford University School of Medicine and SRI International; and Adolf Pfefferbaum, Ph.D., SRI International; Neuropsychology, Vol. 16, No. 1.
(Full text of the article is available from the APA Public Affairs Office and at http://www.apa.org/journals/neu.html after January 30, 2002)
Edith Sullivan can be reached by phone at 650-498-7328 (Stanford University) or (650) 859-2880 (SRI), or by email at edie@stanford.edu.
The American Psychological Association (APA), in Washington, DC, is the largest scientific and professional organization representing psychology in the United States and is the world’s largest association of psychologists. APA’s membership includes more than 155,000 researchers, educators, clinicians, consultants and students. Through its divisions in 53 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting human welfare.
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Neuropsychology