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Premorbid brain size is a determinant of functional reserve in abstinent crack-cocaine and crack-cocaine–alcohol-dependent adults

Published online by Cambridge University Press:  01 November 1998

VICTORIA DI SCLAFANI
Affiliation:
Department of Psychiatry, University of California, San Francisco
H. WESTLEY CLARK
Affiliation:
Department of Psychiatry, University of California, San Francisco San Francisco Veterans Affairs Medical Center
MARINA TOLOU-SHAMS
Affiliation:
Department of Psychiatry, University of California, San Francisco
COURTNAY W. BLOOMER
Affiliation:
Department of Psychiatry, University of California, San Francisco
GILBERT A. SALAS
Affiliation:
Department of Psychiatry, University of California, San Francisco
DAVID NORMAN
Affiliation:
Department of Radiology, University of California, San Francisco
GEORGE FEIN
Affiliation:
Department of Psychiatry, University of California, San Francisco Department of Radiology, University of California, San Francisco San Francisco Veterans Affairs Medical Center

Abstract

Studies of Alzheimer's disease patients show that individuals with larger premorbid brains have a later onset of disease, or a lessened severity of cognitive impairment, or both. This may be due to a “functional reserve” associated with the greater number of neurons and synapses available in larger brains. We used magnetic resonance imaging and the MicroCog Assessment of Cognitive Functioning to examine the association between intracranial volume (premorbid brain size) and neuropsychological function in abstinent crack-cocaine and crack-cocaine–alcohol dependent individuals. There were no significant differences between the crack-only and the crack–alcohol dependent participants in neuropsychological performance or in intracranial volume. The abstinent cocaine-dependent individuals (both crack-only and crack–alcohol) were significantly impaired in many neuropsychological domains. Intracranial volume accounted for a significant proportion of the variance in neuropsychological performance. This result is consistent with the finding in the Alzheimer's literature that larger brains can maintain function to a greater degree, or for a longer period of time, in the face of cerebral disease or insult. Functional reserve may be a heretofore little recognized protective mechanism of the brain that has consequences for the severity of expression of cerebral disease or insult throughout life. (JINS, 1998, 4, 559–565.)

Type
Research Article
Copyright
© 1998 The International Neuropsychological Society

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