The Role of Cognitive Reserve, Family Relationships and Social Vulnerability in Alcohol Use Disorder

According to World Health Organization (WHO), Alcohol Use Disorder (AUD) affects 400 million people in the world and is linked to 5% of total deaths per year, killing 2,6 million people. The highest alcohol consumption is in the European and African Region and the most severe consequences are in low-income countries. Alcohol, in fact, is linked to over 200 pathologies and also to early cognitive decline (Stavro et al., 2013; World Health Organization, 2024). Cognitive Reserve (CR) is the brain’s capability to cope with traumatic brain injury, age-related decline or pathology, and it plays a pivotal role in preserving as many cognitive functions as possible, from the damages caused by AUD. In this study, CR is assessed through an index, the Cognitive Reserve Index (CRI), which obtained by educational level, job complexity and cognitively engaging activities (Nucci et al., 2012). This index is a strong predictor, in both clinical and healthy populations, of cognitive functioning, that we measured through Global Examination of Mental State (GEMS). What we aimed to explore is whether people with higher CRI could be shielded from alcohol-related cognitive damage and to what extent. When it comes to AUD, however, it is especially important to take into consideration also familial and social aspects of those affected and we wanted to clarify their role in cognitive functioning. We investigated them using SCORE-15 questionnaire and Social Vulnerability Index (SVI). We recruited 44 people with a history of AUD and 44 healthy subjects, which formed the Experimental and the Control Group, respectively. We then collected sociodemographic data and administered each one of the subjects the instruments (CRI, SCORE-15, SVI, GEMS) and a scale on how they would rate their Quality of Life at the moment of the administration. The data showed that, both in the clinical and healthy populations, higher Cognitive Reserve was associated with higher Education. Higher CR was also linked to better cognitive performance and lower Social Vulnerability. We found an association between SVI and GEMS, too, but only in the Experimental Group. These suggested that CR could play a protective role against cognitive degeneration in both healthy and clinical populations and, also, that in pathological conditions higher education might be a protective factor, while higher Social Vulnerability might be a risk factor. Nevertheless, in regression analysis, neither CRI, SCORE-15 nor SVI (alone or interacting) predicted cognitive functioning (GEMS score). This may be linked to the small size of our sample, the heterogeneity between our two groups or the variability among cognitive manifestation in AUD. Despite not finding any predictive power in those variables, this study showed the importance to consider AUD and its cognitive consequences as a biopsychosocial disorder, stressing the weight of lifetime experiences (both in early life and in adulthood), family relationships and social networks in shaping the course and the outcome of this disorder.