EALTHRGANISATIONInternational Statistical Classification of Diseases - PDF document

EALTHRGANISATIONInternational Statisti-cal Classification of Diseases and Related HealthProblems 10Revision Version for 2007. Geneva:World Health Organisation; 2007.The Measurement and Appraisal ofAdult Intelligence. 4th ed. Baltimore: Williams &Wilkins; 1958.JP, Wbetween IQ and memory scores in alcoholism andaging. Clin Neuropsychol 1993; 7: 281-296.Wechsler Adult Intelligence Scale-Revised. San Antonio: The Psychological Corpo-ration; 1981. A standardized memory scale forclinical use. J Psych 1945; 19: 87-95.. L’examen clinique en psychologie. Paris:Presses Universitaires de France; 1964.ML, FDW.One-year test-retest reliability of select-ed neuropsychological tests in older adults. J ClinExp Neuropsychol 1988; 10: 60.ACARTNEYILGATE. Intercorrelationof clinical tests of verbal memory. Arch Clin Neu-ropsych 1988; 3: 121-126.J, DI, SP, W. Depression and cognitive function-ing in alcoholism. Addiction 2003; 98: 1521-1529.. Acute alcohol withdrawal: DT riskhigher after age 65. Br Med J 2003; 327: 664-ATRA. Diagnostics and therapy of alco-hol withdrawal syndrome: focus on deliriumtremens and withdrawal seizure. Psychiatr Prax2010; 37: 271-278. Validation of Kaufman, Ishikuma,and Kaufman-Packer's Wechsler Adult Intelli-gence Scale - Revised short forms on a clinicalsample. Psychol Assess 1994; 6: 246-248.S, DT, WH, H. Effects of repeated withdrawalfrom alcohol on recovery of cognitive impairmentunder abstinence and rate of relapse. Alcohol Al-cohol 2010; 45: 541-547.R, BEATTYWW, NPatternsof cognitive impairment among alcoholics: arethere subtypes? Alcohol Clin Exp Res 1995; 19:K, GA, SF, Arecovery from cognitive deficits in abstinent alco-holics. Alcohol Alcohol 1999; 34: 567-574.A, STEWART. Rey’s auditory verballearning test –a review. In: Crawford JR, ParkerDM, eds. Developments in Clinical and Experi-mental Neuropsychology. New York: PlenumPress, 1989.A. Dickov, N. Vuckovic, S. Martinovic-Mitrovic, I. Savkovic, D. Dragin, et al. Alcohol dependent patients who had alcoholdelirium have poorer level of intellectual func-tioning than alcohol dependent patients who hadno delirium, and are of approximately same age,duration of drinking and education level. Suchintellectual decline is sequel of mental deteriora-tion, which is most prominently observed in defi-ciency of attention and productive form of visu-al-motor coordination which are, mainly, relatedfollows alcohol delirium, while it has not beendeficiencies are manifested through low achieve-ments on subtests of mental control, logicalAuditory verbal learning is decreased in bothgroups. Curve of auditory learning in alcoholicswith delirium has slower progression and moreit to patients with frontal lobe syndrome. Follow-occur within the global intellectual decrease andassumed that there is qualitative difference incognitive deficiencies in alcohol dependent pa-tients who had delirium and those with no alco-delirium is in compliance with the dysfunction ofReferencesA, KRecognition of complex mental states in patientswith alcoholism after l

ong-term abstinence. Alco-hol Alcohol 2006; 41: 512-514.OKAVECA, CSF.A comparision of cognitiveperformance in binge versus regular chronic al-cohol misusers. Alcohol Alcohol 1999; 34: 601-K, W. The neurobiology of alco-holism. Neuropathology and CT/NMR findings.Fortschr Neurol Psychiatr 1995; 63: 238-247.HG, JJ, BS, EVANSJL, KRS, VERBATFocal brain matter differences associat-ed with lifetime alcohol intake and visual atten-tion in male but not in female non-alcohol-de-pendent drinkers. Neuroimage 2005; 26: 536-DP, NK, KJJ, PS, KIY, K. The relationship betweenbrain morphometry and neuropsychological per-formance in alcohol dependence. Neurosci Lett2007; 428: 21-26. J, MS, WILTSHIREJ, W. A follow-up study of patients with alcohol-relat-ed brain damage in the community. Aust Drug AlcRev 1988; 7: 83-87. DDOLORATOREATMENT. Pharmacologicalapproaches to the management of alcohol ad-diction. Eur Rev Med Pharmacol Sci 2002; 6:S, SR, SWARTZWELDERExecutive func-tioning early in abstinence from alcohol. AlcoholClin Exp Res 2004; 28: 1338-1346.J, HR, BARRYK, GAlcohol use and cognition at mid-life: the impor-tance of adjusting for baseline cognitive abilityand educational attainment. Alcohol Clin Exp Res2003; 27: 1162-1166. ULLIVANEV, FR, RMJ, P. A profile of neuropsychological deficits in al-coholic women. Neuropsychology 2002; 16: 74-83. XJ, TFunctional characterization ofa kindling-like model of ethanol withdrawal incortical cultured neurons after chronic intermit-tent ethanol exposure. Brain Res 1997; 767:. A potential contribution toethanol withdrawal kindling: Reduced GABA func-tion in the inferior collicular cortex. Alcohol ClinExp Res 1993; 17: 1290-1294.. The alcohol withdrawal“kindling” phenomenon: Clinical and experimentalfindings. Alcohol Clin Exp Res 1996; 20: 121A-X, THAVUNDAYILJ, SS, G. Re-sponse of the HPA-axis to alcohol and stress as afunction of alcohol dependence and family historyof alcoholism. Psychoneuroendocrinology 2007;32: 293-305.M, MK, SHPA-axis activity in alcoholism: examples for agene–environment interaction. Addict Biol 2008;13: 1-14. EIFERTJ, SI, BM, TP, RJ, WH, S. Effects of acutealcohol withdrawal on memory performance in al-cohol-dependent patients. A pilot study. Addict Bi-ol 2003; 8: 75-80.P, H. Correlations between charac-teristics of the hallucinations in delirium tremensand psychological variables. Eur Arch PsychiatryNeurol Sci 1986; 236: 187-194.A, BA, HR, MDelirium and long-term cognitive impairment. IntRev Psych 2009; 21: 30-42. Disorder verbal memory in alcoholics after delirium tremens 1058 A. Dickov, N. Vuckovic, S. Martinovic-Mitrovic, I. Savkovic, D. Dragin, et al.(MQ=102.2) in alcohol dependent patients withno delirium is significantly lower, and amountsto 7.3. Result points to more isolated memorydisorder in patients with delirium. This is alsoconfirmed by the data that the MQ is 3 standarddeviations lower compared to the standard, ex-pected values in the group of alcohol dependentpatients have lower scores on subtests: mentalcompared to standard

values. These subtests be-long to verbal tests, in other words, scales of ver-bal memory. Mental control subtest points to thefunction of attention and concentration. Lack offlexibility, i.e. rigidity in thinking, is manifestedpoor results of associative learningŽ points to.Poorer achievements on subtest logical memoryare indicators of frontal typeŽ memory disorder.Low achievements mental control, logical mem-dent patients have no isolated poorer achieve-ments on the memory scale. It has also been con-firmed in one similar researchthat there is nodifference in logical memory and visual retentionbetween alcohol dependent persons and those whogot similar results that alcoholdependent persons have no poorer results on Ben-not differ between persons addicted to alcoholand those who are not, addicted ones have shownwhich include memory of verbal materials, pro-cedure similar to Rey AVLT. That supports theresearch suggesting that AVLT can be more sen-sitive to detecting memory disorders in clinicalpopulation, since it is less prone to compensatoryResults we obtained in our research are simi-lar. Expected values, compared to standard val-ues by Rey, are decreased in both groups. Differ-not statistically significant in the first repetitionother repetitions. Curve of learning in alcoholicswith delirium has slower progression and moreit to patients with frontal lobe syndrome. Differ-ence is also statistically significant regarding rec-Apart from the reduced attention, group of al-cohol dependent patients with no delirium has re-duces sequential thinking and social functioning(low picture arrangementŽ scores). Damage toportant in the processing of social informationand in the recognition and attribution of complexal capacity of this social cognitive brain networkis not spared in patients with alcoholism. Othergroup has poorer achievements on instable sub-tests, which is one of the signs of organic braindecline. This has also been confirmed by thehigher deterioration index in the group of deliri-Difference in digit span is not significant,since the score is low in both groups. Based onthe results of factorial analysis, Kaufmanduces that arithmetic, digit span and digit symbolare the most sensitive subtests on the factor of at-tention distractibility. It can be deduced from thisthat there is pronounced factor of distractibilityLow scores on object assemblyŽ indicate poorervisual-motor coordination in productive form.Both of these functions, attention and productiveform of visual-motor coordination, are mainly re-lated to the prefrontal lobe. In his research, Loe-followed changes in cognitive func-tioning of patients addicted to alcohol who hadmultiple withdrawal crises and those who are notaddicted to alcohol. He tested them following thedetoxification, after three months and after sixmonths. Examinees had significantly poorer re-sults than the control group, on first and secondmeasurement, especially on subtests of attentionand executive functions. This study gives evi-be related to decreas

ed brain plasticity.Wechslers memory scale mainly covers areaof verbal memory, and only on one subtest non-verbal memory. Importance of this scale is thatory quotient) can be compared to the quotient ofthe Wechsler scale of intelligence. This is of highimportance for it indicates mutual relation ofquotient in the group of alcohol dependent pa-tients who had alcohol delirium is 97.5, andmemory quotient 81.8, making the difference inquotients 15.7. Difference between intelligencequotient (IQ=109.5) and memory quotient Disorder verbal memory in alcoholics after delirium tremens For the group of alcohol dependent patients withdelirium, IQ is 97.53, while for the alcohol depen-dent patients with no delirium it is 109.53. Mentaldeterioration of the examined group is 40, which isan indicator of highly likely deterioration, while inthe control group it is 13, which classifies them in-to category of potential deterioration. Given dataindicate more significant intellectual decline of or-ganic brain syndrome type in the group of alcoholAlcohol dependent patients who had alcoholdelirium also have poorer achievements on digitarithmetic. These three subtests and digit spansubtest fall into the group of instable tests. Lowerachievements on these subtests indicate cognitiveform I) on 1080 examinees. He did not aim to de-termine the essence of the intelligence at thatsuring effects of the intelligence. Even nowadaysthe measure of general intelligenceŽ presentsof intellectual functioning of examinees. Intelli-gence quotient (IQ) is comprised of verbal intelli-gence quotient (IQp). Such a division of intelli-gence on verbal and performance part finds nofull justification in neuropsychology, since thesefunctions often overlap within one scale. At thesame time, subtests dont assess clear neuropsy-systems within each subtest. Due to all previouslysaid, interrelation of achievements on particular Figure 1.Learning curve of RAVLT,AVLTNumber of repetition Number of words ADT/ADT/Alc/pppAlcStan.Stan.ADT/ADT/Alc/RepetitionADTAlcStan.*T testT testT testAlcStan.Stan.14.65.38.61.882.13.5� 0.0525.78.011.64.464.23.035.88.913.45.145.33.247.19.913.84.044.64.657.210.4144.044.94.3Recollection 6.49.9…3.36……0.01…… Stan.: Standard values by rey.Table IV.Rey auditory verbal learning test (RAVLT). A. Dickov, N. Vuckovic, S. Martinovic-Mitrovic, I. Savkovic, D. Dragin, et al. main indicators of the dependency syndrome isappearance of the abstinence symptoms follow-ing the cessation in drinking. Most often, ner-vous system diseases are complications of alco-holism. Alcohol epilepsies occur in 10-15% of.Alco-hol epileptic seizures most often accompany al-cohol delirium. In our research, we found no sta-tistically significant difference between personswith epileptic seizures who had delirium andthose who did not. Liver damages occurred in40% in alcohol dependent patients followingdelirium, 46% in alcohol dependent patients withno delirium, which is not statistically significantand implies that alcohol delirium cannot b

eIn 1945, Wechslerstandardized his Intelli-gence Scale for the first time (Wechsler-BellavueCognitive deficits related to the abnormalfunctioning of the prefrontal cortex are recog-. In this paper, 30 alcohol depen-dent patients who had delirium tremens and 30patients with no delirium tremens were treated.statistically significant difference in demographicgroups, we excluded influence of the age, dura-tion of drinking and primary intellectual level onthe consequences of alcohol and alcohol deliri-Average age of delirious patients in our re-search is 46.67 years. Donigerrisk increases after the age of 65. One of the*ADT alcohol dependent patients with delirium tremens; **Alc alcohol dependent patients with no delirium tremens; ***Dif- SubtestADT*Alc**Difference Significant difference***Information 11.312.20.9Comprehension 9.512.93.4Arithmetic5.79.84.1*Similarities 10.8121.2Digit span5.77.31.8Picture completion9.810.20.4Picture arrangement7.38.71.4Block design6.811.64.8*Object assembly5.48.32.9Digit symbol3.78.14.4*IQ97.53109.57Table II.Wechsler bellevue intelligence scale. Standards by wechslerADT/Alc/ADT/SubtestADTAlcMe*SD**standardstandardAlcInformation 5.85.95.70.4000Orientation 6.06.06.00000Mental control2.85.36.61.9-2SD0-1.5SDLogical memory 4.66.78.02.5-1SD00Digit span8.710.710.22.2000Visual reproduction5.310.48.353.1000Associative learning9.813.713.93.1-1SD0-1SDMQ81.8102.21026.5-3SD0-3SD Table III.Wechsler memory scale. Disorder verbal memory in alcoholics after delirium tremens no delirium 109, 53. Mental deterioration of theexamined group is 40, while in control group itGroup of alcohol dependent patients who hadachievements (more than 4 pondered scores) onum, have poorer results than alcohol dependentpatients with no delirium on subtests of mentalto standard values on subtest of logical memorytoo(Table III).Results of Rey Auditory Verbal LearningTest (RAVLT)Compared to the standard values according toRey, expected values are decreased in bothgroups. The difference between the examinedand control group is not statistically significantonly in the first repetition of the word series of� 0.05), while it is sig-nificant in other repetitions. Learning curve foralcohol dependent patients with delirium hasslower progression and more flattened learningwith frontal lobe syndrome. Difference is alsoIn our material, 8 alcohol dependent patientsfrom the first and 12 from the second group havenever established abstinence longer than threemonths. Statistical analysis revealed no statisti-cally significant difference (0.05). Delirious patients had established, in aver-age, 1, 6 abstinences, and non-delirious 1.33. Av-erage duration of abstinence in patients with7.7. Difference was not statistically significant (= 0.11). In families of both groups of alcohol depen-while in 2 cases other mental disorders existed inthe control group. Difference between groupsDiagnosis of alcohol liver lesion, establishedium. Difference was not statistically significantseizures caused by alcohol appeared

in 18 pa-tients with delirium and 20 with no delirium.Difference was not statistically significant (Results of the Neuropsychological Assessment of Memory Functions IQ for the group of alcohol dependent pa-tients with delirium is 97.53, and for those with ADTAlcStatistic testAge46.946.7SD1-4.32SD2-3.93= 1.38� 0.05Primary 4401High school1717Higher/university99Duration of drinking (years)18.616.4-test = 0.876� 0.05W�ithout abstinence 3 months812= 1.2 � 0.05�No of abstinences 3 months 1.61.33-test = 2.71 = 0.54Average duration of abstinence9.37.7-test = 1.61= 0.11Positive family heredity1618= 2.15 = 0.34Alcohol liver lesion 1214= 0.67 = 0.79Epileptic symptoms1820= 0.28 = 0.78Table I. Includes mainly the domain of verbal memory,and only in one subtest of non-verbal memory.Importance of this scale is that we can compareresults of the memoryŽ (expressed as memoryquotient) with the intelligence quotient from theWechsler intelligence scale. This scale is used forand general mental abilities. Reliability:The reli-ability coefficients for the WMS-III Primary sub-tests and Primary Indexes were on average foundto be higher than for the WMS-R. Internal con-sistency reliability coefficients ranged for .70s tothe .90s. Validity:Correlation with the WMS-Rwas not direct because of the many changes in thescales. The Verbal Memory of the WMS-R had a.72 correlation coefficient with the Auditory Im-with General Memory of the WMS-III. The Gen-eral Memory of the WMS-R and the Auditorymemory .67 of the WMS-III. As expected thecorrelations were lower for visually presentedmaterial with .34 for verbal memory and visualmemory indexes. When correlated with the Chil-drens Memory Scale, the WMS-III auditory in-dexes correlated highest with the correspondingCMS indexes. Studies comparing the WMS-IIIand the WIAT show highest correlations betweenthe WMS-III auditory indexes and working mem-ory indexes and the WIAT subtests and compos-ites, similar to results found with the CMS andthe WIAT. In comparing the WMS-III with theWAIS-III there is a pattern of the auditory memo-ry correlating more strongly with the VIQ and thevisual memory measures correlating more strong-ly with the PIQ as an indication of convergentand divergent validity; while they are related,they measure different constructs.RAVLThas evolved over the years, and severalvariations of the test have emerged. The standardRAVLT format starts with a list of 15 words,which an examiner reads aloud at the rate of oneper second. The patients task is to repeat all thewords he or she can remember, in any order. Thisprocedure is carried out a total of five times.Then the examiner presents a second list of 15words, allowing the patient only one attempt atasked to remember as many words as possiblefrom the first list. The RAVLT has proven usefulin evaluating verbal learning and memory, in-tion, retention, encoding versus retrieval, andsubjective organization. Reported reliability forthe Rey Auditory Verbal Learning Test was

var-ied; 0.70 for List A and 0.38 for recall of List B.Test-retest reliability for a one-year interval be-. The RAVT is closely correlated with theCalifornia Test of Verbal Learning-Children Ver-sion.Correlation ratings of 0.50 to 0.65 with oth-er factor grouping and other learning toolsports RAVLT validity. Such functions as acquisi-tion, storage, and retrieval were indicated asWe compared our groups on following items:age, education level, and duration of drinking,duration of abstinence, number of abstinences,heredity, alcohol liver lesions and symptomaticWithin the statistical data we used non para-metric analysis (chi Square); significance of dif-ferences between dependent variables meansprocesses in appropriate PC statistical program(Statistic for Windows version 7.0), while thegraphic displays were made in Microsoft OfficeSample included examinees from the age of30-60 years. Average age of the examined groupgroup 46, 7 (M2=53; SD2=3.93). There is no sta-tistically significant difference regarding the ageThe examined and control group were, as re-gards education level, fully equalised: in eachgroup, 4 examinees had primary education, 17finished high school and 9 examinees finishedhigher school and university.Average duration of drinking of alcohol de-pendent patients who had delirium tremens was18.6 years, and in control group 16.4 years. Sta-tistical analysis (� 0.05) showedno statistically significant difference. Based on the given data, equalising of theA. Dickov, N. Vuckovic, S. Martinovic-Mitrovic, I. Savkovic, D. Dragin, et al. withdrawal delirium is merely a manifestation ofthe severe form of abstinence crisis or it is asyndrome developing on the foundation of previ-the clinical point of view, very interesting. In or-persons who had delirium and those who had on-ly the diagnosis of alcohol dependency. One re-search has shown that there is no significant dif-dependent persons who had no abstinence crises,while alcohol dependent patients following delir-ium shown significantly lower results, particular-ly in the area of recognition. Another researchconfirms decline of cognitive functioning follow-ing delirium tremens and determines that the de-gree of the damage correlates with the psy-chomotor agitation and intensity of hallucina-. Further researches have confirmed thatcognitive sequels after the delirium are long last-. The aim of this paper was to establish thedifference in the verbal memory disorder be-tween alcohol dependent patients who had deliri-Research is prospective clinical study. It hased disorders of the Clinical of Psychiatry in theClinical Centre Vojvodina in Novi Sad, Serbia.In forming of the sample for the research,group of 30 alcohol dependent patients (nfollowing delirium tremens was taken. Require-ments for the diagnosis are the criteria of theF10.40 code (Delirium tremens), tenth interna-tional classification of mental and behaviouralviously diagnosed delirious states, suffered cran-iocerebral trauma, presence of diagnosed en-docranial tumours,

diagnosed temporal epilepsy,presence of psychotic disorders, current presenceof affective disorders, mental deficiency syn-drome, diagnosis of other substance related dis-orders, existence of neurological and neuromus-Exploration of patients was conducted threemonths after delirium tremens, since it is believedthat is the period in which the abstinence symp-Control group was comprised of 30 alcoholdependent patients (n=30) who did not havedelirium tremens. All of them met criteria for theF10.2 code (Alcohol dependence) ICD-10. Ex-Testing has also been conducted three monthsfollowing the establishing of abstinence. Patientsin this group have been chosen as equivalents toThey were of approximately same age, i.e. agedifference ranged 0-5 years.Difference in duration of drinking was notFollowing instruments were used for collect-A simple needs of this research, included the followingitems: age, education level, and duration of drink-ing, duration of abstinence, number of absti-nences, heredity, alcohol liver lesions and sympto-Neuropsychological TestsThis test is comprised of five verbal and fiveconsists of verbal intelligence quotient (IQv) andperformance intelligence quotient (IQp). In 1986,Wechsler made a revision of the described scale,and today mainly revised version of Wechsler in-telligence scale is used. Since the battery of testsused in this research is large, we have decided touse the original Wechsler intelligence scale. Weof Oscar-Berman et al. Testing alcohol depen-dent patients, he found out that the tests used toidentify amnestic syndrome, in other words dif-sults of memory tests, were efficient in bothcombinations (WMS or WMS-R).Reliability:Reliability coefficients for the subtests rangefrom 0.62 to 0.88. The Verbal IQ, PerformanceIQ, and Full Scale IQ have reliability coefficientsof 0.84, 0.86, and 0.90, respectively. Validity:The Authors investigate correlations between theWBIS and other tests of cognitive ability. Thecoefficients are e as follows: Stanford-Binet,1937 rev., 062; Otis, 0.73; Raven Progressive Disorder verbal memory in alcoholics after delirium tremens Review for Alcohol delirium tremenssuggests dysfunction of numerous brain regions.Several Authors suggest that alcohol and with-drawal from alcohol could cause neurotoxic le-sions in the frontal lobe and thereby affect cogni-tive function. However, it is not that well knownwhether the consequences of the damage follow-ing delirium are only quantitative or qualitative. PATIENTS AND METHODS,Thirty alcohol-de-pendent patients after alcohol delirium (ADT-n1= 30), and 30 alcohol-dependent patients withoutalcohol delirium (ALC-n2=30) were comparedwith neuropsychological test-battery. [(WechslerBellevue Intelligence Scale – WB form I, Wech-sler memory scale and Rey Auditory VerbalLearning Test (RAVLT)]. Examinees were select-ed as equivalent pairs, in such a manner thatthey were of approximately same age, i.e. agedifference was 0-5 years, they were of the sameeducation level, and difference in the duration ofdrin

king was not more than 3 years. RESULTSIn the group of ADT patients, IQ was97.53, while it is 109.53 for ALC patients. Mentaldeterioration of the examined group is 40, and inthe control group 13. Group of ADT patients hadsignificantly lower achievements on subtests:arithmetic, block design and digit symbol. ADTpatients’ average memory quotient (MQ) is 81.8,which is three standard deviations lower com-pared to ALC patients (MQ 102.2) and standardvalues, according to Wechsler. In the first repeti-tion of the series of 15 words RAVLT, is no differ--test=1.88; � 0.05), while the differencein other repetitions is significant. Difference isalso statistically significant regarding recollec-tion after 30 minutes (-test=3.66; ) There isqualitative diffum tremens and those with no alcohol delirium,while the predominant pathology of the cogni-tive-amnestic deficiency is in compliance withthe dysfunction of the prefrontal lobe. Followingalcohol delirium, verbal memory disorders occurorder in general.Disorder, Verbal memory, Alcoholism, Delirium tremens. Disorder verbal memory in alcoholicsafter delirium tremens A. DICKOV, N. VUCKOVIC, S. MARTINOVIC-MITROVIC, I. SAVKOVIC, D. DRAGIN, V. DICKOV*, D. MITROVIC, D. BUDISAClinical of Psychiatry, Clinical Center Vojvodina, Novi Sad (Serbia)*Faculty of International Management, European University, Belgrade (Serbia) Aleksandra Dickov, MD; e-mail: dickovlela@gmail.comIntroductionIt has been asserted that persons who drinkfor extended periods of time have poorer resultson tests of specific neuropsychological perfor-mances, although they show no apparent signsof brain damage.Researchers were examiningimpact of the abstinence, duration of drinkingand gender on cognitive damages, but resultswere inconsistent. Desire to determine inte-sults for cognitive damages caused by alcoholhas so far remained with no success. Reason forthis failure lies in numerous factors influencingthe development of alcohol dependency, such asheredity, age of the onset of drinking, durationof drinking, type of alcohol drink and so on.Distinct problem are consequences of the alco-hol disease, where the abstinence crisis standsout as significant agent. Multiple abstinencecrises increase vulnerability for brain dysfunc-. One of the mechanisms leading to thistype of brain damages is amplification of the ex-citotoxicity, which develops as a consequence ofthe increase of excitatory neurotransmittersFurthermore, abstinence crisis causes changes inis hypothalamic-pituitary-adrenal (HPA) axis.Abstinence syndrome activates HPA axis, whichleads to the increased secretion of corticoidsGlicocorticoids, type of corticoids, influenceneural excitability of the CNS. Extended stimu-lation of these neurons causes brain damages,crease of neurochemical and neuroendocrine al-terations occurring during abstinence crisescomprise biological foundation of cognitivedeficits related to alcohol intakevere form of abstinence crisis is alcohol with-drawal delirium. Consideration whether alcohol 2012; 16: 1052