L'objectif de cette these etait de mieux comprendre les effets de la consommation chronique d’alcool sur la cognition et plus particulierement sur la memoire. Les resultats de nos etudes ont montre, chez les alcooliques non-Korsakoff (AL), une veritable atteinte de la memoire episodique, peu liee aux dysfonctionnements executifs. Ces troubles neuropsychologiques se normalisaient avec l'abstinence alors que la reprise meme limitee de la consommation d’alcool entrainait une degradation cognitive. Les memes composantes de la memoire episodique et de la memoire de travail etaient alterees chez les AL et les patients Korsakoff (SK). Les SK presentaient toutefois des troubles plus severes de la memoire episodique et de certaines fonctions executives. Les systemes esclaves de la memoire de travail et les autres fonctions executives evaluees etaient alteres de maniere similaire dans les deux groupes d'alcooliques. Concernant les repercussions de ces troubles cognitifs sur les capacites a acquerir de nouvelles informations complexes, l'apprentissage des categories et des caracteristiques de nouveaux concepts et de la procedure de resolution de la tour de Toronto etait ralenti chez les AL. L'acquisition des noms des concepts, particulierement difficile, etait toutefois possible chez les AL grâce a l'utilisation de l'apprentissage sans erreur. Les capacites d'apprentissage semantique des SK etaient differemment alterees selon la nature des informations a acquerir. Enfin, le ralentissement de la dynamique d’apprentissage procedural cognitif des SK entrainait l'absence d'automatisation de la procedure, malgre un niveau de performance final equivalent a celui des sujets controles
Fetal alcohol spectrum disorders (FASDs) are often characterized by symptoms of inattention and hyperactivity. Many children with FASDs receive a diagnosis of attention-deficit/hyperactivity disorder (ADHD). However, it is unclear whether treatment with standard stimulant medication is effective in FASDs. This study evaluated response to stimulant medication in a group of children with heavy prenatal alcohol exposure and ADHD (ALC-ADHD) and nonexposed children with ADHD (Con-ADHD). Children, aged 7–15, were assessed with the QuotientTM ADHD System, which provides an objective measure of three core symptoms of ADHD (motion, attention and shifts in attention state). Subjects were evaluated twice, with and without stimulant medication. A significant group × stimulant interaction was found for measures of accuracy (P = 0.06), commission errors (P = 0.02), head movement (P = 0.03), head displacement (P < 0.01) and magnitude of head movement (P = 0.02). Subjects in the Con-ADHD group evidenced greater improvement with stimulant medication than those in the ALC-ADHD group. Importantly, in contrast, children in the ALC-ADHD group performed worse on several measures when tested on stimulant medication than when tested without a stimulant. These findings suggest that stimulant treatment for attention deficits in children with FASD is questionable. They also suggest that prenatal alcohol exposure should be considered as a contributory factor in the etiology of ADHD in individuals who do not show a positive response to stimulant medication. Future research should evaluate which aspects of ADHD are affected by stimulants in individuals with FASD and whether other treatments, including nonstimulant medication, may be more effective. (The research was supported by NIAAA grants R01 AA010417 T32 AA013525 to EPR and AA019605 to SNM.)
This chapter describes the alcohol use disorder (AUD) and Korsakoff's syndrome (KS) and reviews the studies investigating errorless (EL) learning in these populations before drawing conclusions about its usefulness and identifying directions for future research. The severity and persistence of amnesia in KS makes it difficult for most patients to live autonomously and independently. The patient learned to enter information into an electronic memory aid when trained with EL principles and did so better than when taught with an EF approach. The remaining studies involved patients with KS specifically but focused on learning different tasks: face–name associations, route learning, and activities of daily living. The chapter demonstrates that patients with alcohol-related cognitive disorders have the potential to learn new concepts, associations, and skills using EL principles. It discusses that have used EL principles for teaching new concepts, names, routes, and instrumental activities of daily living in patients with AUD and KS. The neuropsychological profile associated with AUD is heterogeneous.
