For both groups, the investigators found an association between poorer copy accuracy and increased radial diffusivity in the occipital forceps and external capsule. (2009) examined associations between regional white-matter microstructural integrity (measured with DTI) and visuoconstruction accuracy (as measured by the Rey-Osterrieth Complex Figure Test) in alcoholics and healthy controls. Although parietal cortical volume (measured with conventional MRI) was not a predictor of visuospatial ability in alcoholics, cerebellar hemispheric white matter was such a predictor ( Sullivan, 2003). Morphometry studies have shown volume deficits among alcoholics, compared with controls, within the parietal lobes ( Fein et al., 2002 Gazdzinski et al., 2005b Chanraud et al., 2007), and cortical shrinkage in the parietal lobes has been associated with poor performance in spatial processing ( Fein et al., 2009). Cortical regions throughout the entire cerebrum are involved, as well as the cerebellum and the thalamus (reviewed by Fitzpatrick et al., 2008, 2012). In accordance with the neuropsychologic deficits observed, brain abnormalities have been identified in a large network of interconnected areas communicating with each other in feedforward and feedback loops to serve visuospatial cognition.

Despite the array of subcomponents that have been examined, however, alcoholics’ impairments in visuospatial cognition are evident and endure over time. These tests clearly do not measure homogeneous abilities. Other examples of tests on which alcoholics have performed poorly are the Wechsler Memory Scale Drawing Test ( Sullivan et al., 2000b), a letter/symbol cancellation test ( Beatty et al., 1996), the Mental Rotation Test ( Beatty et al., 1996), the Hidden Figures Test ( Sullivan et al., 2000b Fama et al., 2004), the Rey-Osterrieth Complex Figure Test ( Beatty et al., 1996 Sullivan et al., 2000b), and the Gollin Incomplete Pictures Test ( Sullivan et al., 2000b Fama et al., 2004). This discrepancy was largely accounted for by scores on three of the individual Performance subtests, which relied strongly on visuospatial cognitive capacities: Block Design, Object Assembly, and Digit Symbol. Early demonstrations of these deficits in alcoholics were apparent as relatively lower scores on Wechsler Adult Intelligence Scale Performance subtests compared to Verbal subtests (reviewed by Ellis and Oscar-Berman, 1989). Neuropsychologic tests consistently have shown that alcoholics suffer from persistent deficits in visuospatial cognition ( Beatty et al., 1996 Oscar-Berman and Schendan, 2000 Sullivan et al., 2000b, 2002b, 2010 Fama et al., 2004 Fein et al., 2006). Gravitz, in Handbook of Clinical Neurology, 2014 Impairments

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