Introduction

The relationship between alcohol use and dementia is complex. There is a J-shaped relationship between alcohol use and cognitive impairment and evidence shows that one-quarter of the dementia population have alcohol related problems. It is estimated that alcohol-related dementia (ARD) contributes for about 10% of all cases of dementia, especially early-onset dementia, but is largely overlooked or seen as a comorbid factor.

Objectives

To clarify the relationship between alcohol use, alcohol-related brain damage and dementia; to review the clinical features, neuropathology, nosology and neuropsychology of ARD and alcohol-induced persisting amnestic syndrome (Wernicke-Korsakoff syndrome- WKS).

Methods

We performed a review of systematic reviews from the last 10 years. A total of 28 systematic reviews were identified.

Results

Heavy alcohol use has been shown to be a contributory factor and necessary factor in the development of multiple brain diseases. It may cause brain damage in multiple ways: direct neurotoxic effect of acetaldehyde; thiamine deficiency. It is also a risk factor for other conditions, such as hepatic encephalopathy, epilepsy and head injury.

Conclusions

Clinical observation favors the diagnosis of ADR as a distinct entity, but broader evidence reflects significant commonality between ARD and WKS, tough neuropsychological studies have largely attempted to differentiate these syndromes. Repeated episodes of WKS may cause cognitive deterioration. In contrast to other common causes of dementia, the decline in cognitive functioning in ARD is relatively non-progressive if abstinence is maintained, or even partially reversible, as supported by neuroimaging evidence. Given the increase in per capita consumption, it is expected a disproportionate increase in ARD.

Introduction

Starting in December 2019, the coronavirus SARS-CoV-2 emerged and soon acquired a pandemic dimension. The evidence that 1 in 3 patients presented neuropsychiatric symptoms highlighted SARS-CoV-2 neurotropic properties. The involvement of the Central Nervous System (CNS) seems to be associated with poor prognosis, and it can occur independently of the respiratory system.

Objectives

To assess neuropsychiatric symptoms in SARS-CoV-2 patients and possible mechanisms of CNS invasion; to reflect on what changes should be made in order to avoid short and long-term complications.

Methods

A non-systematic literature review was performed, including publications between January and August 2020.

Results

The most frequent CNS presentations included fatigue (38-75%), headache (6,5-34%), nausea or vomiting (1-13,7%). Regarding PNS involvement, three kinds of hypoesthesia (hyposmia, hypogeusia, and hypopsia) were commonly present. Additionally, cases of neurological syndromes associated with SARS-CoV2 were reported, being related to a poor prognosis in cases such as brainstem infiltration. Another major concern regarding CNS involvement is the possibility of permanent neurological disabilities. Importantly there are reports of patients who tested positive for SARS-CoV-2 in CFS, without samples from nasopharyngeal swabs.

Different hypothesis are postulated to explain possible mechanisms through which SARS-CoV-2 affects CNS, including: direct invasion through the olfactory nerve, hematogenous route through ACE-2 (angiotensin-converting enzyme) receptor expressed in blood-brain-barrier; or indirect mechanisms.

Conclusions

Here we discuss the neuropsychiatric manifestations of SARS-CoV-2 infection and the potential mechanisms by which they occur at an early stage. Awareness, prevention and early treatment of potential neuropsychiatric symptoms of COVID-19 should not be overlooked, especially because they seem to predict a worse prognosis.

Introduction

The current SARS-CoV-2 pandemic has many implications, one of them being alcohol consumption. The impact of long-term distancing measures in terms of alcohol use and misuse is yet unknown. Any increase, would not only add to the usual disease burden associated with alcohol, but also add to the COVID-19 load, given that alcohol use may weaken the immune response.

Objectives

To characterize and compare the pattern of alcohol consumption throughout the pandemic in patients with the diagnosis of Alcohol Use Disorder; to identify factors considered as most relevant in the increase of alcohol consumption.

Methods

We conducted a observational study in an outpatient population in Centro Hospitalar Psiquiátrico de Lisboa (Portugal) with diagnosis of Alcohol Use Disorder, 6 months after the pandemic lockdown. We characterized our sample regarding social, demographic and clinical categories. We applied auto-filled questionnaires, particularly: Mental Health Inventory (MHI), Positive Mental Health Scale (PMHS) and Severity of Alcohol Dependence Questionnaire (SADQ-C).

Results

A total of 65 patients were included. More than 30% changed their drinking habits because of the pandemic. Nearly half of these increased consumption, and half decreased (16% vs 14%). The increase affected particularly men, and was related with the severity of alcohol dependence, stress-related coping strategies and psycopathology; on the other hand, a lowered level of consumption based on the decrease of alcohol accessability and affordability.

Conclusions

The current situation is unique in terms of mass physical distancing and may trigger different behaviours that should be monitored. Governments should give public health warning about excessive alcohol consumption to protect vulnerable individuals.