Diferenças no Desempenho das Funções Frontais nos Subtipos de Alcoolismo, de Acordo Com a Tipologia de Lesch
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Data
2008-03-27
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Zago-Gomes, Maria da Penha
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Universidade Federal do Espírito Santo
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Introduction: Alcohol dependence is a heterogeneous disease with a clear variability in clinical presentations, therapeutic results and relapses, indicating different biological vulnerability. Lesch et al (1988) distinguished four categories of alcohol dependence: Type I: with severe symptoms of abstinence; Type II: uses alcohol as a solution for conflicts; Type III: uses alcohol as self-medication for psychiatric symptoms, and Type IV: with a history of neurological lesions preceding the development of alcohol dependence. Cognitive deficits have been usually reported in alcoholics (mainly frontal dysfunction) with direct implications in the treatment. Objectives: This study aimed to evaluate frontal functions in different categories of alcohol dependence according to Lesch’s Typology. Methods: Frontal Assessment Battery (FAB) and Mini-Mental State Examination (MMSE) were applied in 170 alcoholics patients classified into categories according to Lesch’s Typology and in 40 nonalcoholics controls matched for age, gender, socio-demographic characteristics and education. The quotient of intelligence (IQ) was also evaluated in alcoholics. Results: The alcoholics in the present study were classified according to Lesch’s Typology in: Type I = 21.2%, Type II = 29.4%, Type III = 28.8%, and Type IV = 20.6%. It was observed a significant impairment in the performance of tasks demanding cognitive frontal function in patients classified as Type IV as compared to non-alcoholics controls and alcoholics classified as Type I, II and III. This frontal dysfunction was not correlated with the pattern of alcohol intake or with the age for the first use of alcohol, and neither with the education level of the patients. Alcoholics classified as Type IV also showed lower IQ and MMSE scores, and it was the subgroup that showed higher percentage of scores suggesting dementia. However, the frontal dysfunction in this subgroup of alcoholics (Lesch’ Type IV) was still observed even excluding those with dementia scored by MMSE. And yet, this frontal dysfunction was seen even with abstinence over 90 days. In further analysis it was found that the types of alcohol dependence, along with mental and intellectual performance, are factors that can predict a frontal dysfunction. Conclusion: Categorization of clinical type of alcohol dependence by applying a simple classification as Lesch’s Typology, along with mental state and frontal function examinations through the applications of MMSE and FAB instruments, respectively, may be of an extraordinarily relevance in the clinical examination of alcoholics, allowing even the identification of those who have subclinical executive dysfunction, providing significant changes in strategies for individualized approaches, which may be of a great importance in the treatment of alcohol dependence.
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ZAGO-GOMES, Maria da Penha. Diferenças no Desempenho das Funções Frontais nos Subtipos de Alcoolismo, de Acordo Com a Tipologia de Lesch. Tese (Doutorado em Ciências Fisiológicas) - Universidade Federal do Espírito Santo, Centro de Ciências da Saúde, Vitória, 2008.