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...