Alcoholic Dementia

Abstract

At least four distinct cerebral diseases -Wernicke-Korsakoff, Marchiafava-Bignami, pellagrous encephalopathy, and acquired hepatocerebral degeneration -have a close association with chronic alcoholism. Each is characterized by a distinctive pathologic change and a reasonably wellestablished pathogenesis; in each the role of alcohol in the causation is secondary. The question posed in this review is whether there is, in addition to the established types of dementia associated with alcoholism, a persistent dementia attributable to the direct toxic effects of alcohol on the brain -i.e., a primary alcoholic dementia. The clinical, psychologic, radiologic, and pathologic evidence bearing on this question is critically reviewed. None of the evidence permits the clear delineation of such an entity. The most serious flaw in the argument for a primary alcoholic dementia is that it lacks a distinctive, well-defined pathology, and it must remain ambiguous until such time as its morphologic basis is established.Resume: La d£mence alcoolique: une revue critique. Au moins quatre maladies ce>6brales distinctes -le Wernicke-Korsakoff, le Marchiafava-Bignami, l'encephalopathie de la pellagre, la degdnerescence h6patoce>6brale acquise -ont une association etroite avec l'alcoolisme chronique. Chacune est caracte>is£e par des changements anatomopathologiques distincts et une pathogenese bien etablie. Le role de I'acool est secondaire dans chacune. Dans cette revue, nous posons la question suivante: en plus des types de dfimence reconnus comme dtant associ^s a l'alcoolisme, y a-t-il une demence persistante attribuable aux effects toxiques directs de l'alcool sur le cerveau, i.e., une ddmence alcoolique primaire? Nous revoyons de facon critique les donn^es cliniques, psychologiques, radiologiques et anatomopathologiques reliees a cette question. Aucune observation ne permet de deTinir clairement une telle entite\ La lacune la plus sfirieuse vient du fait qu'il n'existe pas de 16sion anatomopathologique distinctive. La situation demeurera ambigue tant que ses assises morphologiques ne seront pas Stablies.Can. J. Neurol. Sci. 1994; 21: 88-99 That the long-continued abuse of alcohol may lead to a deterioration of intellect, behavior, and personality has been appreciated for many years. Maudsley (1879),' in his book "The Pathology of Mind", commented upon the weak will-power, blunting of moral sense, and childish intellect of the alcoholic and likened his mental state to that observed in the late stages of senile dementia. Lawson, 2 writing in the first volume of Brain (in 1878) attributed both memory defects and a general decay of intellectual function to alcoholism. And Bevan Lewis 3 in 1889, remarked upon impairments of attention, judgment, and memory as well as deterioration of the finer sensibilities and moral nature of alcoholics. Thus an association between alcoholism and intellectual decay was appreciated early on; however, the nature of this association was quite unclear and seemed to excite little curiosity.The cli...

Actividad prefrontal y alcoholismo de fin de semana en jóvenes

“…Dicho consumo produce alteraciones morfológicas y neuroquímicas en el sistema nervioso central tanto de humanos (Charness, 1993) como en animales de experimentación (Walker, Hunter y Abraham, 1981) y ocasiona modificaciones estructurales en el SNC aunque estos efectos no son uniformes en las diferentes estructuras cerebrales. Los cambios que ocurren en regiones como el hipocampo o el neocortex son de especial relevancia porque son estructuras implicadas en procesos como la atención, memoria o procesos ejecutivos, los cuales están alterados en el alcoholismo (Beracochea, Durkin y Jaffard, 1986;Victor, 1994), de hecho, en torno a un 75% de alcohólicos manifiestan disfunciones neuropsicológicas significativas (Landa, Fernández-Montalvo y Tirapu, 2004;Roehrich y Goldman, 1993) aunque algunos resultados con neuroimagen por Resonancia Magnética se ha demostrado que la mayor reducción de volumen cerebral como consecuencia del consumo de alcohol ocurre en los lóbulos frontales y en otras estructuras como el hipocampo, el tálamo o el cerebelo (Moselhy, Georgiou y Kahn, 2001;Pfefferbaum, Sullivan, Mathalon y Lim, 1997;Sullivan, 2000), estructuras que están estrechamente relacionadas con procesos como la memoria y el aprendizaje, la atención, la resolución de problemas o la organización de la conducta.…”

The diagnostic value of tau protein, β-amyloid (1-42) and their ratio for the discrimination of alcohol-related cognitive disorders from Alzheimer's disease in the early stages

“…According to Victor (1994) a good number of such cases can be attributed to several secondary, alcohol-related syndromes such as the Wernicke-Korsakoff syndrome, acquired hepatocerebral degeneration, pellagrous encephalopathy and Marchiafava-Bignami disease. However, it has been suggested that progressive cognitive impairment can occur in the absence of the above-established syndromes, and has been attributed to the direct toxic effect of ethanol on the brain.…”

Daño cerebral relacionado con el alcohol. Situación actual y llamada a la acción

“…There have been several attempts to establish operative diagnostic criteria (Oslin & Cary, 2003). However, the existence of a specific dementia directly related to ethanol toxicity has been debated for a long time (Victor, 1994). The psychopathologic characterisation of AD is inaccurate, although some authors distinguish two different patterns: frontal and sub-cortical.…”

“…State of the art and a call for action a combination of diencephalic amnesia, confabulation, false recognisances and space-temporal disorientation, with typically preserved instrumental functions. Other important syndromes would be Marchiafava-Bignami, pellagrous encephalopathy and acquired hepatocerebral degeneration, all of them with a reasonably well-established pathogenesis (Victor, 1994). However, the picture is not so clear in daily practice.…”