Neuropsychological functioning and alcohol dependence

Purpose of review Alcohol dependence is a significant challenge to society and health-care services. The associated cognitive deficits are thought to affect behavioral control, therapy and liability to relapse. The present review demonstrates important new findings. Recent findings Recent interest focused on compensatory functional circuits, components of executive functioning, externally induced attentional biases and the relevance of the cognitive deficits for therapy and rehabilitation. Summary Recent studies found widespread compromised fronto–cortico–cerebellar circuits to underlie cognitive deficits. The inclusion of cerebellar structures to support functions traditionally associated with cortical and even prefrontal structures is important. However, most importantly, alcohol-dependent patients use additional and generally higher-order executive functions to compensate for deficient task performance. The compensatory mechanisms might help to explain close to normal functioning in basic cognitive domains enabled by support of executive components. But deficits in executive functions themselves might emerge more directly. New approaches concerning executive functioning, analyzing functional components of executive tasks, found response inhibition and decision-making to be impaired but normal performance in simple working memory tasks. Multiple withdrawals have been shown to lead to a higher degree of executive deficit. The causing mechanism underlying the attentional bias induced by alcohol-related words (stroop effect) is still under debate. Correlation of cognitive deficits with therapy outcome turned out to be weak. However, important interactions of cognitive deficits with personality, therapy-setting and successful coping, together with the finding that cognitive performance of alcohol-dependent patients could be enhanced by motivating instructions, might open new strategies in treatment planning and cognitive rehabilitation.