Algorithm for personalized therapy of patients with alcoholism with comorbid disorders of the detoxifying function of the liver and cognitive disorders

Background. Disfunctions of the metabolic processes of the liver as a result of exposure to alcohol intoxication reduce cognitive functioning and induce cognitive disorders. The severity of complications of alcoholism is associated with the severity of metabolic disorders. In patients with alcoholism with comorbid liver damage, signs of cognitive impairment are observed already in the early stages of the disease and are accompanied by disorders of attention, memory, perception, which in the future often lead to social maladaptation and disability. Objective. Identification of the relationship between indicators of disturbance of the detoxifying function of the liver and cognitive disorders in patients with alcohol dependence in order to develop an algorithm for personalized therapy. Materials and Methods. Based on the Addictive State Department of Mental Health Research Institute, the study sample (n=40) was formed of males, whose mean age was 42.4±11.9 years, with mental and behavioral disorders diagnosed according to ICD-10, associated with alcohol use (F10), impaired detoxifying liver function and cognitive impairment. To assess the dynamics of the mental state in patients with alcohol dependence, psychological testing was carried out twice (at admission and after complex therapy) using the Hamilton anxiety scale. Cognitive impairment was screened using the Montreal Cognitive Scale (MoCA), short-term and long-term memory was assessed using psychodiagnostic tests (Pictograms, Learning 10 words). The obsessive-compulsive scale (OCS) of craving for alcohol was used for self-assessment of ideational manifestations of attitudes towards alcohol. The dynamics of blood biochemical parameters (ALT, AST, total bilirubin, direct and indirect bilirubin, cholesterol, alkaline phosphatase) were studied in dynamics. Results. Against the background of ongoing drug therapy, there was a regression of obsessive-compulsive craving for alcohol, which was confirmed by a decrease in the mean score for OCS from 36.5±4.2 to 3.47±2.03 points. Blood biochemical parameters (ALT, AST, total bilirubin, cholesterol) normalized. Cognitive abilities improved, which was justified by an increase in the total number of MoCA scores (22.7±4.3 points at the time of admission, 26.5±1.6 points after therapy). Findings. In patients with severe alcohol dependence on the background of liver damage, as evidenced by a 3-fold or more increase in serum ALT and mood disorders AST compared with the norm, low indicators of short-term and long-term memory, severe impairment of visual-constructive praxis and abilities, concentration of attention, which was confirmed by the total (15.9±1.3 points) values according to the Montreal Cognitive Assessment Scale. Restoration or compensation of the detoxifying function of the liver and improvement of cognitive potential due to the use of drugs combining hepatoprotective and neuroprotective effects in a combined therapy regimen becomes a favorable factor for subsequent stages of patient rehabilitation and prevention of relapses of alcohol dependence.