Time based prospective memory deficits associated with binge drinking: Evidence from the Cambridge Prospective Memory Test (CAMPROMPT)
Introduction
Binge drinking (BD) is a growing problem in Britain and is a common drinking pattern amongst young adults at university (Heather et al., 2011), with studies showing a higher prevalence of BD in university students compared with their non-student peers (e.g., Gill, 2002, Norman and Conner, 2006). The current study used the Office for National Statistics (ONS, 2007) definition of BD which defines it as males consuming 8/more units and women consuming 6/more units on at least 1 occasion per-week—which is about double the recommended UK daily ‘safe limits’ for men/women (note: a single UK unit of alcohol (8 g ethanol) contains 0.343 US fluid ounces of ethanol). BD leads to a higher risk of associated health and psychological problems compared with those who drink sensibly (Courtney and Pilich, 2009, Jennison, 2004). Despite its commonality, relatively few studies have investigated the neuro-cognitive effects of BD in nonclinical adult samples. Past research shows that BDs experience greater difficulty than non-BD controls when completing tasks involving frontal lobe activities, including working memory (WM; e.g., Townshend and Duka, 2005, Weissenborn and Duka, 2003) and executive functions (EF; see, e.g., Blume et al., 2000, Goudriaan et al., 2007, Hartley et al., 2004, Johnson et al., 2008, Townshend and Duka, 2005). WM and EF play crucial roles in attention, organisation, decision-making and goal-monitoring in memory and cognition (Miller and Wallis, 2009). Research on what impact BD has upon laboratory-based cognitive tasks is informative, but it is equally important to establish how BD affects memory function within an everyday context. The utilisation of tasks that are more akin to remembering within an everyday context may provide a greater insight into the types of memory problems drug users may experience within the real world, increasing the ecological validity of a study. The use of a time and event based task in the present study aims to achieve this.
Prospective memory (PM) is the cognitive ability of remembering to carry out planned intentions/actions at future points in time (Brandimonte et al., 1996, McDaniel and Einstein, 2007) and is critical to remembering within an everyday context, e.g., remembering to meet with friends, run errands or just post a letter on time. The average day is often punctuated by interruptions and distractions drawing attention away from the main activities planned; which can lead to minor PM lapses (e.g., forgetting shopping items can be inconvenient) or fairly major ones (e.g., forgetting an important medication can have serious health repercussions). WM and EF rely heavily upon prefrontal/frontal lobe resources in the brain (e.g., Johnson et al., 2008, Miller and Wallis, 2009) and evidence from brain-imaging studies also highlight strong links between PM and activity in these prefrontal/frontal regions (Burgess et al., 2001, Kliegel et al., 2008, Simons et al., 2006). Given that PM may share similar resources to WM and EF, coupled with evidence presented earlier that BD has been shown to impair WM/EF, one might predict that BD also leads to PM deficits. If so, lower PM performance in recreational BDs compared with non-binge controls is expected. This was considered in a study by Heffernan et al. (2010a) in which teenage recreational BDs were compared with age-matched non-binge controls on self-reported PM (using the Prospective and Retrospective Memory Questionnaire: PRMQ) and objective PM (using the Prospective Remembering Video Procedure: PRVP—during which the participant is expected to remember particular actions at specific locations whilst viewing a short CD clip of a busy shopping high street). After statistically controlling for other drugs, mood and strategy use, the Heffernan et al. study revealed no significant differences between BDs and non-binge controls on self-reported memory lapses, but BDs recalled significantly fewer action-location combinations on the PRVP; it was concluded that BD had impaired objective PM. However, the PRVP was produced ‘in house’ and is not a standardised PM test. The idea for the PRVP comes from earlier research (Titov and Knight, 2001) and its validity has come under criticism due to the lack of a secondary ongoing activity during the PRVP task, i.e., the only task is to recall a list of actions when locations (reminders) appear during the CD clip, making it more retrospective, than prospective—where one typically interrupts an ongoing task to recall a PM item (see Farrimond et al., 2006). Therefore the findings from Heffernan et al. (2010a) are confounded by the nature of the PRVP. The current study therefore adopted a standardised PM task where the person is interrupted from an ongoing task in order to carry out a series of PM tasks.
The aims of the present study were twofold: firstly, to determine whether the lack of any differences between BDs and non-binge controls on self-reported memory lapses (Heffernan et al., 2010a) is a consistent finding; and secondly, to assess whether the objective PM deficits found in the Heffernan et al. (2010a) study could be verified using a standardised objective measure of PM using the Cambridge Prospective Memory Test (CAMPROMPT: Wilson et al., 2005). Since other recreational drug use (e.g., smoking, cannabis, ecstasy) may impair PM independently (see Heffernan et al., 2010b, Bartholomew et al., 2010, Rodgers et al., 2011), polydrug users were excluded here. Since mood can interact with drug use upon memory (Parrott and Garnham, 1998, Parrott et al., 2004) this was incorporated as a covariate into the analyses. Finally, it would be prudent to control for variations in strategies used to aid memory and IQ, since these might also impact upon memory capabilities; therefore both were incorporated as covariates into the analyses. If BD does impair PM then this should be reflected in lower scores on the CAMPROMPT relative to non-binge controls. The two groups will also be compared on self-reported memory lapses in order to estimate the levels of self-awareness of putative memory problems in BD.
Section snippets
Respondents
From an original 104 people screened, 48 were omitted from the study on the basis that they; (a) had reported using one or more of a range of other substances (including tobacco, ecstasy or cannabis) alongside alcohol, (b) had used alcohol within the past 48-h, or (c) reported that they had suffered from/were suffering from a psychiatric condition (e.g., substance-dependence, clinical depression or amnesia). The remaining 56 participants were university undergraduate students aged 18–35-years
Descriptive analysis
Table 1 contains the means and standard deviations (in brackets) comparing BDs and NBDs on age, the number of alcohol units consumed per session, the number of drinking sessions per-week, length of alcohol use (in years), last alcoholic drink (in hours), scores on the NART, HADS Anxiety and Depression Scales, the PMQ strategy-scale (PMQ-STRAT), the PRMQ Prospective Memory Lapses (PRMQ-PML) and Retrospective Memory Lapses (PRMQ-RML) subscales; and the CAMPROMPT time-based, event-based and total
Discussion
This study had two aims: firstly, to determine whether the lack of any differences between BDs and NBDs on self-reported memory lapses found by Heffernan et al. (2010a) is a consistent finding; and secondly, to assess whether the objective PM deficits found by Heffernan et al. (2010a) could be verified using a standardised objective PM measure in the form of the CAMPROMPT. With regards the first question, BDs and NBDs did not differ in terms of self-reported memory failures on the PRMQ. With
Role of funding source
This work was not supported by any funding source.
Contributors
Dr. Heffernan and Dr. O’Neill designed the study and protocol. Dr. Heffernan and Dr. O’Neill conducted the background literature search. Dr. O’Neill collected and analysed the data. Dr. Heffernan assisted in data analysis. All authors contributed to writing the manuscript.
Conflict of interest
There are no conflicts of interest for Drs. Heffernan or O’Neill.
Acknowledgements
None.
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