Longterm outcomes for alcohol related cognitive impairment (arci) in an acute hospital setting

Excess alcohol can cause neuro-cognitive impairment. There is a paucity of outcome data for patients with alcohol-related cognitive impairment (ARCI). This study used the Montreal Cognitive Assessment (MoCA) as a screening tool to detect ARCI and retrospectively assess survival outcomes at 2 and 5 years. Patients identified as at risk of ARCI had an initial MOCA (iMoCA) performed by the alcohol care team. A database for patients who met screening criteria was created. NHS Spine was inbuilt, to update individual mortality (in days) from iMOCA. It was closed at 5 years from the final entrant and a retrospective review of electronic records was performed. Of the 210 patients who met screening criteria for ARCI; majority (144) were male, mean age was 52 (26–80) and 149 (70.9%) had no underlying Chronic Liver Disease (CLD). 109 (51.9%) patients had an abnormal iMoCA with 74 (35%) scoring <24. Of these 74, 26 (35.1%) died within 2 years compared with 25 (24.8%) of patients with MoCA >24. Subgroup analysis found 16/49 (32.7%) of patients with no-CLD and low iMoCA died within 2 years, compared with 19/74 (25.7%) in the no-CLD and normal iMoCA group. 10/25 (40%) of patients with low iMoCA and CLD died within 2 years, compared with 6/27 (22.2%) who had normal iMoCA and CLD. Mortality at 5years for low iMoCA + no-CLD was 24/49 (49%) which was similar to normal iMoCA + CLD 14/27 (51.9%). For non-cirrhotics, survival outcomes were better at 2 years if iMoCA <24 and any MoCA follow up recorded. p value of 0.01 (graph 1). For those who showed cognitive recovery with serial MoCA, there was no demonstrable survival benefit during the follow up period. Despite the limitations of this study there are important messages that have not been previously recorded. There is a clear relationship, 10.3% difference, between early mortality (defined as 2 years) and low iMoCA, particularly in those with co-existent CLD. We have also identified a statistically significant survival benefit in the non-cirrhotics who received ARCI follow up. There is a lack of recognition of ARCI and minimal services currently available to patients. Overall poor outcomes, but improvement for those engaging with services, underscores the need for further research in this area and crucially, the ongoing development of new models of care.