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ARBD Profile — MRCPsych Paper B MCQ

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HardSubstance MisuseARBD ProfileMRCPsych Paper B

A 56-year-old man has a long history of heavy alcohol use and previous malnutrition. He has remained abstinent and medically stable for 9 months. Neuropsychological assessment shows preserved alertness, fluent language, praxis and immediate digit span. However, acquisition and delayed recall of new episodic information are severely impaired. There is temporally graded retrograde amnesia and occasional confabulation. He also performs poorly on planning, set-shifting and response-inhibition tasks, with perseverative errors. There has been no progressive deterioration during abstinence, and he has no focal neurological signs, gait disorder or urinary symptoms. Which neuropsychological profile best accounts for these findings?

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Correct answer: A — Korsakoff amnestic profile with additional frontal-executive dysfunction

The best answer is A. Alcohol-related brain damage commonly combines a Korsakoff amnestic syndrome with frontal-executive dysfunction. The key pattern is severe impairment in learning and retaining new episodic information, often accompanied by temporally graded retrograde amnesia and confabulation, despite preserved alertness, language and immediate memory span. Planning, set-shifting, inhibition and perseveration deficits reflect additional frontal-network injury. Alzheimer disease would usually show progressive deterioration and broader cortical deficits. Behavioural-variant frontotemporal dementia is dominated initially by personality, behaviour and social-cognitive change rather than disproportionate amnesia. Subcortical vascular impairment is suggested by focal signs, vascular disease or a stepwise course. Normal-pressure hydrocephalus requires a compatible gait disorder, usually with urinary dysfunction.

Reference: Department of Health and Social Care, Clinical guidelines for alcohol treatment, section 20: People with alcohol related brain damage, updated 17 April 2026. https://www.gov.uk/guidance/clinical-guidelines-for-alcohol-treatment/20-people-with-alcohol-related-brain-damage