In an attempt to explain the cognitive heterogeneity commonly seen in patients with alcoholism, a recent prospective study applied the operational criteria of Caine and colleagues to a group of individuals with uncomplicated alcoholism, so as to determine whether the presence of any of the four signs, determined by history or current examination, could be used to predict performance on a battery of neuropsychological tests. Among the 56 patients with uncomplicated alcoholism who were assessed, 16% displayed two or more signs, 57% showed only one sign, and 27% met no criteria. In this sample of sober, community-dwelling individuals, self-reported dietary deficiency (n = 29) and cerebellar dysfunction (that is, ataxia; n = 20) were frequently described, while oculomotor abnormalities (n = 2) and mental impairment (n = 0) were rarely observed.39 This study revealed a graded effect in cognitive and motor performance among patient subgroups: individuals with alcoholism who did not meet any criteria performed at levels equivalent to healthy controls, whereas patients with one sign showed mild-to-moderate neuro psychological deficits, and patients with two or more signs showed the
