Group and case study of the dysexecutive syndrome in alcoholism without amnesia

Objectives-To test the dysexecutive syndrome (DES) hypothesis of chronic al coholism by the neuropsychological group and case study approaches. Methods-A comprehensive neuropsychological assessment, including the "behav ioural assessment of dysexecutive syndrome", a battery of tests recently de signed to be "ecologically valid", was administered to 17 patients with chr onic alcoholism without amnesia to examine executive functions, intelligenc e, and memory. In terms of each neuropsychological measure, reciprocal anal yses of group means and individual case profiles were conducted: for the fi rst contrasting the alcoholic patients with 17 age matched healthy subjects ; and for the second making intersubject and intrasubject comparison of the patients, according to percentile basis impairment indices obtained from t he control subjects. Results-Despite relatively unimpaired memory and intelligence, the patients as a whole had the impairment of a wide range of executive domains, extend ing to "everyday" problem solving as well as more elementary aspects of exe cutive functions, such as visuospatial performance, mental set shifting, an d the inhibition of habitual behaviour. The profile analysis divided indivi dual patients into four groups: the representative DES characterised by a c lear dissociation between impaired executive functions and preserved intell igence and memory; the group of a modified dysexecutive pattern in which me mory as well as executive functions were impaired with intelligence preserv ed; the group of general cognitive deterioration; and the group of unimpair ed cognitive functioning. About two thirds of the patients were categorised into either the first or the second type of DES. Conclusion-DES characterised by the even more pronounced impairment of exec utive functions than of intelligence and memory afflicts a considerable pro portion of patients with chronic alcoholism. Due to its subtlety, this woul d be potentially left out, unless appropriate behavioural measures were adm inistered. This condition may prevent patients with alcoholism from achievi ng full recovery and benefiting from rehabilitation.