Carolien Zeetsen

104 Discussion Aims of this study were to explore the course of cognitive performance and subjective everyday cognitive functioning during treatment towards abstinence and recovery in patients with AUD, ARCI and KS in a large clinical sample, and to determine if changes in cognitive performance are related to changes in everyday cognitive functioning. It was found that cognitive performance improved significantly over the course of treatment and differed between groups. Everyday cognitive functioning also improved significantly over time, according to both the patient and the clinician. Significant differences between groups were only found on the clinician rating. For both cognitive performance and everyday cognitive functioning, patients with AUD scored higher than those with ARCI and KS, and patients with ARCI scored higher than those with KS. Finally, changes in overall cognitive performance were positively correlated to changes in overall everyday cognitive functioning. Overall cognitive performance improved significantly between intake and the sixth week of clinical admission, supporting our hypothesis. In these first six weeks, detoxification and recovery are the main goals of treatment. Although neither being abstinent nor abstinence duration were previously found to be related to cognitive performance (Bruijnen, Jansen, et al., 2019), our findings are in line with the recommendation to perform extended neuropsychological assessment after a minimum of six weeks of abstinence, as this seems to be a sufficient period of time for cognitive functioning to recover to a baseline (Walvoort et al., 2013). Particularly in patients with KS, it is argued that cognitive impairments are mostly irreversible and thus may not recover above a ceiling level after abstinence is reached (Arts et al., 2017). When comparing cognitive performance at discharge in our study to findings by Oudman et al. (2014), we find very similar results. In their study that included 30 patients with KS who were in the chronic phase of the syndrome and had been abstinent for a minimum of six months, a mean MoCA–TS of 18.1 ( SD = 3.9) was found, which is very comparable to our finding of 18.7 ( SD = 3.8). We found the improvement of cognitive performance in all three groups between the sixth week of admission and clinical discharge, not supporting our hypothesis that patients with AUD or KS would not improve further during treatment. This means that all patients with AUD can benefit from prolonged clinical treatment. As the time between T1 and T2 varied between patients, additional analyses were performed to examine a possible relation between admission time and cognitive performance, which was not found. Exploration of the domain scores showed that patients with KS did not change on the memory domain, while patients with ARCI improved over all three assessments. Taking the length of clinical stay and the number of readmissions into account, patients with ARCI recover most from short–term clinical treatment. However, these alcohol–related cognitive impairments may increase the risk of readmission (resulting from a relapse into alcohol use), making this the most vulnerable group of patients.