VERBAL AND VISUAL-MOTOR DIGIT SPANS OF ALCOHOLICS
BEFORE AND AFTER TREATMENT: 68 CASES
R. COCCHI,
D. AGOSTINI. R. PARADISI,
C. SEBASTIANELLI, D. DONNINI
Summary
Sixty-eight
inpatients (
Subjects
reach their Digit Spans according to WAIS norms. They did V-MDS by showing
digits randomly printed in special tables, pointing to the number sequence
heard, by non dominant hand using.
Scores
for VDS differ from scores for V-MDS both before (.005) and after treatment
(.0009). A difference was also found in prevalence (VDS >, = or < V-DMS)
before and after treatment (.0009).
Mean
scores of V-MDS increased after treatment (.0009). After treatment, the number
of years of alcohol dependence correlated to both VDS (.05) and V-MDS (.02),
but age only to V-MDS (.003).
These
results show i. Confirmation that VDS and V-DMS measure other mechanism,
probably half-brain differences; ii. Age and length of alcohol dependence
influenced the scores after therapy in a different way; iii. Recovery is better
for V-MDS.
Key
words: Verbal Digit Span; Visual-Motor digit Span; Alcoholics; Pre- and
post-therapy evaluation; Age; Length of alcohol dependence.
Theoretcal and research bases
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In a unit
for the treatment of alcoholics the addition of neuro-psychology tests enhances
the means of clinical evaluation, making it more refined and objective. The testing
of Verbal (VDS) and Visual-Motor Digit Span (V-MDS) - both on entry and
discharge from the unit - adds the evaluation of short-term memory to the
general improvement brought to light by laboratory investigation.
The Digit
Span test through direct repetition of numbers, come out according to WAIS
norms, is a complex task involving acoustic input and oral output. For
right-hand dominant individuals showing clear advantage
for the
right ear, the Digit Span test may involve some degree of connection between
the two brain hemispheres.
The digit
Span test through direct repetition of numbers looks prevalently into
short-term acoustic memory, the integrity of acoustic-verbal transfer and the
ability to carry out normal speech. With the same acoustic input one can verify
the visual-motor response. This can do by asking the patient to point to the
numbers on charts where the nine digits are set out at random. In this way we
could assess any eventual differences between oral and visual-motor results in
the same person.
We
carried out it on subjects suffering from several different forms of dementia,
comparing them to various control groups (Cocchi, Sellerini & Pola, 1987;
Cocchi, Pola, Rossetti & Pala, 1987; Cocchi, Zerbi & Savoldi, 1988;
Cocchi, Rossetti & Pola, 1990).
From
first research carried out by this department on 82 alcoholic patients, we
clearly observed that the two digit span tests, VDS and V-MDS, bring into play
other brain areas. (Cocchi, Agostini & Donnini, 1993; Cocchi et al., 1993).
We
assumed in this research too - as the simplest hypothesis - that the V-MDS
carried out with non dominant hand by right-handed subjects involves mainly the
right half-brain.
"Central
acoustic pathways, starting at the cochlear nuclei, partly cross at the
bulbo-pontine juncture but are also partly direct. Through the lateral
lemniscus of the lower quadrigeminal body of the medial geniculatus body these
pathways reach the primary acoustic area of the same side brain cortex.
This is
situated on the upper surface of the first temporal convolution (namely the
areas 41 and 42 of Heschl's transverse brain convolution." (Cocchi, Zerbi
& Savoldi, 1988).
By this
we can suppose that a visual-motor response to the Digit Span test, moreover
carried out with non dominant hand, explores thorough acoustic,
acoustic/visual-motor and motor areas of non dominant half-brain.
This
third study carried out on alcoholic patients set out to verify the two
responses to DS; on entry to the clinic or during the first few days of
hospitalization, compared to the corresponding results obtained on discharge
from the unit. As in the previous studies, here too, we correlated age and
length of alcoholic dependence to both Digit Spans.
Subjects, materials and method.
Subjects: 68 subjects taken
into our unit all suffering from alcohol dependence (DSM-III, R: 303.92-3).
These were one non selected consecutive series of all those who completed the
normal curative cycle except two cases; both reverted to alcohol dependence and
had a second admission from data collection for this study.
We
consider therefore only their first admission. On admission we noted age, sex
and length of alcohol dependence for each of the 68 subjects.
During
their 4-week period of treatment the patients followed a common therapy
consisting of:
*
complete withdrawal from the use of alcohol;
* one
benzodiazepine (chlordemetyldiazepam 3-6 mg per day, bromazepam 4.5-12 mg per
day, etizolam 1.5 mg per day);
*
methadoxine 1500 mg per day;
* B
vitamins (B1, 250 mg per day + B6, 250 mg per day + B12, 1000 mcg per day);
* sodium
and potassium citrates + vitamin complex, Biochetasi (TM), one powder per day)
and calcium carbonate + citric acid + vitamin complex (Calcidon (TM), one
capsule per day);
*
silimarine, 240 mg per day;
*
individual variations, such as frequent administration of folates following the
discovery of anaemia with macrocytosis due to B12 deficiency, can occur.
Materials:
* the
first increasing set of numbers taken from WAIS digit span subtest there used
for the direct repetition of the numbers heard, as red out by the examiner;
used by us in the same way;
* the
second increasing set of numbers taken from WAIS digit span subtest there used
for the reverse repetition of digits. We used however this later to elicit
V-MDS by picking out the same numbers as heard, with the index of the
non-dominant hand, on a special table;
* special
tables showing numbers 1-9 set out at random, used for the visual-motor
response and uncovered in front of the subject straight after the examiner has
read out the sequence of numbers to be shown with non dominant hand.
Method:
Double
testing of VDS and V-MDS on admission to and discharge from the clinic; Testing
and scoring according to WAIS norms. Before the V-MDS test we told the subject
not to say the numbers being shown, even to him/herself at a whisper. We used
each special table only once in the same subject under test.
Statistics:
Chi
Square; Student test for two matched samples; Linear regression and
correlation.
Results
68 Ss
matched the requirements for this study. Sex distribution:
Length of
alcohol dependence: from 1-48 years (mean 16,3, with SD = ll.2).
We show
the other findings in tables 1-3 and diagrams 1-5.
Table
1:
Comparison between the score distributions for the two digit span tests before
treatment.
|
|
Verbal Digit Span |
Visual-motor Digit Span |
||
|
Scores |
No. of Ss. |
Total scores |
No. of Ss |
Total scores |
|
|
||||
|
3 |
3 |
9 |
2 |
6 |
|
4 |
21 |
84 |
21 |
84 |
|
5 |
17 |
85 |
24 |
120 |
|
6 |
23 |
138 |
16 |
86 |
|
7 |
4 |
28 |
5 |
35 |
|
Totals |
68 |
344 |
68 |
341 |
Chi
Square = 14.879 with 5 df; p = .005
Table 2:
Comparison between the score distributions for the two digit span tests after
treatment.
|
|
Verbal Digit Span |
Visual-motor Digit Span |
||
|
Scores |
No. of Ss. |
Total scores |
No. of Ss |
Total scores |
|
|
||||
|
3 |
1 |
3 |
0 |
0 |
|
4 |
17 |
68 |
11 |
44 |
|
5 |
25 |
125 |
29 |
145 |
|
6 |
19 |
114 |
16 |
96 |
|
7 |
6 |
42 |
11 |
77 |
|
8 |
0 |
0 |
1 |
8 |
|
Totals |
68 |
352 |
68 |
370 |
Chi
Square = 29.031 with 5 df; p = .0009
From
tables 1-2 we can see that VDS is different from V-MDS both before and after
therapy. This fact suggests that we are dealing with results gained through
brain areas that work at least in part in a different way.
Table
3: Comparison between
the two digit span test results, before and after treatment.
|
Scores |
Verbal Digit Span |
|
Visual-motor Digit Span |
||
|
|
No. of
Ss and total score |
|
No. of
Ss total score |
||
|
|
Before |
After |
|
Before |
After |
|
3 |
3 9 |
1 3 |
|
2 6 |
0 0 |
|
4 |
21 84 |
17 .68 |
|
21 84 |
11 44 |
|
5 |
17 85 |
25 125 |
|
24 120 |
29 145 |
|
6 |
23 138 |
19 114 |
|
16 96 |
16 96 |
|
7 |
4 28 |
6 42 |
|
5 35 |
11 72 |
|
8 |
0 0 |
0 0 |
|
0 0 |
1 8 |
Table 3
shows clearly that the treatment modifies the direction of comparison between
the two digit span tests, and a net trend towards the balance of VDS and V-MDS.
Table 4: Comparison of direction of
the two digit span, before and after treatment.
|
Direction of comparison |
Before treatment |
After treatment |
||
|
No. of Ss |
% |
No. of Ss |
% |
|
|
|
||||
|
VDS vs V-MDS |
35 |
51.48 |
9 |
13.24 |
|
VDS = V-MDS |
18 |
26.47 |
35 |
51.47 |
|
VDS < V-MDS |
15 |
22.05 |
24 |
35.29 |
|
Totals |
68 |
1000.00 |
68 |
100.00 |
Chi
Square = 22.893, with 2 df; p = .0009.
The Table 4 clearly shows that the treatment modifies the comparison
direction between both Digit Spans with a net trend to the balance between VDS
and V-MDS. The pairing
between the two Digit Spans does not reach 52%, while the remaining cases can
have a prevalence of VDS or V-MDS.
The next
five graphics shows new information.
Discussion.
This
third study of VDS and V-MDS in alcoholic subjects highlighted the points of
interest, which we already observed in the previous research (Cocchi, Agostini
& Donnini, 1993; Cocchi et al., 1993). The fact that the two Digit Span
tests could measure different mechanisms both before and after treatment is
upheld. As the most probable hypothesis we can assume the mechanisms measured
in VDS as prevalently involved at least in language areas.
On the
other hand, those measured in V-MDS seem involved in areas of voluntary
movement of non dominant hand. This hypothesis has its support in anatomic
feasibility. The significant difference regarding the direction of comparison
between VDS and V-MDS before and after therapy also reinforces this point of
view.One of us found nearly 90% of same Digit Spans in a control group of
normal subjects (Cocchi, Zerbi & Savoldi, 1988). According to research
carried out by Filley, Kelly and Heaton (1986),
cases of
presenile dementia present a better retention of visual-constructive faculties,
connected to the right half-brain, than oral skills controlled by the left
one.Interestingly, the same authors found the exact opposite in cases of senile
dementia. Basso et al., 1987, confirmed the different vulnerability between the
two half-brains related to age, in patients who had suffered a stroke. It is
also important to note that, after treatment, recovery of almost half a unit
(on average) occurs in the V-MDS (Graph. 1), when compared to only a 0.12
average increase for VDS.
As for
the link between the two Digit Spans post treatment and the age of the subject
(graph. 2-3), only V-MDS shows some significant correlation. On the other hand,
for the relationship to length of alcohol dependence (graph. 4-5), both VDS and V-MDS post treatment correlate
significantly.In our previous research on Digit Span on entry to the clinic the
relationship between age and spans in males resulted in negative significant
correlation for both digit spans (as age increased there was a decrease in the
span). This correlation had been found stronger in V-MDS. (Cocchi, Agostini
& Donnini, 1993).
Again, on admission males showed a negative correlation
between length of alcohol dependence and digit spans (as the period of
dependence increased a decrease in response to both digit spans was found). In
this comparison too, the correlation with V-MDS reached a higher level of
significance.These correlations on admission of females were found not
significant (Cocchi et al., 1993). The different response for V-MDS after
therapy also confirms differing recovery capacity, higher for the Digit Span,
which seems to bring into play mainly mechanisms of non dominant half-brain.
Whether this after therapy result is a
product of alcohol withdrawal or due to the therapy or both, for the moment is
a causal relationship that is hard to explain. In fact, we found a certain
degree of recovery also in this area, after therapy. ConclusionThe study
on VDS and V-MDS in 68 patients tested on admission and soon before discharge
shows that the VDS scores differ significantly from those for V-MDS, both
before and after one month therapy. The distribution of the prevalence between
the digit spans on entry and after treatment is significantly different. At the
end of therapy the average score for V-MDS is significantly higher. Length of
alcohol dependence correlates with after treatment scores for VDS and V-MDS
while age only correlates with the V-MDS after therapy results. These results
show i. Confirmation that VDS and V-DMS measure different brain mechanisms,
probably half-brain differences; ii. Age and length of alcohol dependence
differently influence the scores after therapy; iii. Recovery is better in
V-MDS.Further research, already under way, will attempt to shed more light on
the influence of age and length of alcohol dependence on Digit Spans' scores.
References.
Basso A., Bracchi M., Capitani E., Laiacona
M., Zenobio M.E.: Age and evolution of language area functions. A study in
adult stroke patients. Cortex 1987: 23: 231-42.
Cocchi R., Sellerini M., Pola A.: Ricerche
sulla validita' del Digit Span nei test di memoria. In: Pavoni E, Saraceni F,
eds. Atti del I Congresso Nazionale SIPG. Vol. II. Idelson, Napoli 1986:
535-39.
Cocchi R., Pola A., Rossetti R., Pala P.:
Digit Span verbale e visivo-motorio in dementi e in soggetti di controllo: tre
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Nazionale della SIPG. Vol. I. Idelson, Napoli 1987: 153-56.
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della SIPG. Idelson, Napoli 1990: 223-27.
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Cocchi R., Agostini D., Donnini D.: Digit
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Cocchi R., Agostini D., Donnini D., Aliotta
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Intellet. 1993: 6: 263-268.
Filley
C.M., Kelly J., Heaton R.K.: Neuropsychologic features of early- and late-onset
Alzheimer's disease. Arch. Neurol. 1986: 43: 574-76.
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G.A.: The "magical" number 7, plus or minus two: Some limits on our
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Printed on It. J. Intellect. Impair. 1994, 7: 197-203.
Author's address: dr Renato COCCHI, Via Rabbeno, 3
42100 Reggio Emilia (Italy).
renatococchi@libero.it
Italian
translation
Theoretcal and research bases
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