How is ARBD assessed and diagnosed?
Once an individual is referred for assessment for ARBD there are several assessments and evaluation options that can lead to an ARBD diagnosis. The NICE guidelines state that those who present to alcohol treatment services should routinely receive cognitive assessment. Those who continue to consume hazardous amounts of alcohol should be carefully monitored within clinical and community settings to quickly identify ARBD. Ideally, assessments should be undertaken after 3 months of abstinence to get a more accurate picture of cognitive impairments.
There are a number of assessments that are used to ascertain if an individual has ARBD. These assessments will usually be cognitive assessments that measure short and long-term memory, executive functioning (such as attention, planning, and control), general cognitive functioning, and visuospatial processing which is the ability to identify and interpret visual information such as map reading skills and judging distances.
Currently, there is not one single test that is designed for assessing ARBD. Instead, there are a number of assessments that are usually used to assess other conditions that may be useful in considering an ARBD diagnosis.
Recent research in South Wales aimed to identify which assessments were currently used in assessing ARBD and which of them were most useful and reliable in screening and diagnosing ARBD. One of the assessments that were used most frequently in South Wales was the Addenbrooke’s Cognitive Examination-3 (ACE-III), although this assessment was not originally designed for assessing ARBD.
The ACE-III is used to assess:
- Visuospatial processing
Some assessments that are frequently used to assess ARBD are:
- Abbreviated Mental Test Score (AMTS) to assess memory and general cognitive function. A GP will usually be able to administer this short assessment.
General Practitioner Assessment of Cognition – Basic test usually used to assess dementia that may also be undertaken by a GP.
Mini-Mental State Examination (MMSE) – General test of cognitive functioning that is more likely to be used in specialist services such as memory clinics.
Montreal Cognitive Assessment (MoCA) – Oral and visual assessment to assess general cognitive skills which is also used in specialized services and care homes.
- Frontal Assessment Battery (FAB) – This assesses frontal lobe functioning which most other assessments do not.
The range of conditions that frequently coexist longside ARBD is also large and varied with this research reporting that 61 different comorbidities were reported for the individuals identified. The majority of these were head injuries (14.2%) and psychiatric conditions (13.8%). These psychiatric conditions included depression, psychosis and obsessive compulsive disorder. A number of cerebrovascular disorders were also reported (6.3%; stroke, small vessel disease), and a number of individuals were also reported to have alcohol-related liver disease (8%).
Although it may be more difficult to diagnose an individual with comorbid conditions, a holistic approach may be beneficial. This means that individuals should be managed and treated on a case-by-case basis and taking all physical, mental and environmental factors into consideration and treating the individual and not just the symptoms of each condition. Effective communication between services may assist in ensuring that an individual has access to all the services that they need.
Comorbidity is a term used to describe the presence of one or more further conditions that exist alongside a primary condition. This may make diagnosing and treating an individual with ARBD more difficult as multiple and overlapping conditions may make it harder to connect symptoms together and to make a diagnosis. Treatment may be more difficult because it may be difficult to find suitable placement and treatment pathways that will address the multiple conditions and it may be more difficult to identify signs of improvement.
In a recent study at the University of South Wales, a wide range of comorbid medical and psychiatric conditions were found. Almost half of all individuals identified with ARBD had at least one other comorbid condition.