Alcoholic cognitive deterioration and nutritional deficiencies (original) (raw)
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…, 2010
The purpose of this study was to determine whether meeting historical criteria for unsuspected Wernicke's encephalopathy (WE), largely under-diagnosed in vivo, explains why some alcoholics have severe neuropsychological deficits, whereas others, with a similar drinking history, exhibit preserved performance. Demographic, clinical, alcohol related, and neuropsychological measures were collected in 56 abstinent alcoholics and 38 non-alcohol-dependent volunteers. Alcoholics were classified using the clinical criteria established by and validated in their neuropathological study of alcoholic cases. Our alcoholics who met a single criterion were considered 'at risk for WE' and those with two or more criteria with 'signs of WE'. Whole blood thiamine was also measured in 22 of the comparison group and 28 alcoholics. Of the alcoholics examined, 27% met no criteria, 57% were at risk for WE, and 16% had signs of WE. Neuropsychological performance of the alcoholic subgroups was graded, with those meeting zero criteria not differing from controls, those meeting one criterion presenting mild-to-moderate deficits on some of the functional domains, and those meeting two or more criteria having the most severe deficits on each of the domains examined. Thiamine levels were selectively related to memory performance in the alcoholics. Preclinical signs of WE can be diagnosed in vivo, enabling the identification of ostensibly 'uncomplicated' alcoholics who are at risk for neuropsychological complications. The graded effects in neuropsychological performance suggest that the presence of signs of WE explains, at least partially, the heterogeneity of alcoholism-related cognitive and motor deficits.
Alcohol and cognitive impairment
Advances in Psychiatric Treatment, 2014
SummaryThe relationship between alcohol use and cognitive impairment has been notoriously difficult to disentangle. We present what is known about cognitive impairment associated with alcohol use/misuse, covering the spectrum from mild and subtle cognitive change through to severe alcohol-related brain damage, including Wernicke-Korsakoff syndrome. We highlight aids to the diagnosis and management of these conditions, and emphasise the benefits of prompt treatment on outcome. We also review progress in understanding their neurobiology. Suggestions for possible service configuration based on both our clinical practice and national guidelines are given.Learning Objectives•Gain an understanding of the spectrum of clinical presentations found in alcohol-related brain damage.•Understand that the aetiology of these conditions is complex and not solely due to the neurotoxic effects of alcohol.•Be better able to plan for the rehabilitation of individuals with established alcohol-related bra...
Journal of Clinical Medicine
Alcohol-related cognitive disorders have long been an area of study, yet they continue to pose challenges in the diagnosis, treatment, and understanding of underlying neuropsychiatric mechanisms. The present article offers a comprehensive review of Wernicke’s Encephalopathy and Korsakoff’s Syndrome, two conditions often seen on a continuum of alcohol-related brain damage. Drawing on current medical literature, neuroimaging studies, and clinical case reports, we explore the neuropsychiatric and neuropsychological profiles, symptomatology, and differential diagnoses of these disorders. We delve into the biochemical pathways implicated in the development of WE and KS, notably thiamine deficiency and its impact on neurotransmitter systems and neural networks. The article also addresses the challenges in early diagnosis, often complicated by non-specific symptoms and co-occurring psychiatric conditions. Furthermore, we review the current state of treatment protocols, including pharmacolo...
Cognitive Loss and Recovery in Alcoholics
\s=b\ The nature of the memory and visuospatial defects associated with chronic alcoholism, and the recovery of these functions, were investigated in a large group of alcoholic men and well-matched nonalcoholic controls. Both young and old alcoholics displayed significant impairments on tasks requiring the learning of novel associations and the holding of information in memory over longer delay intervals. The recovery of cognitive skills was found to depend on the length of abstinence and the particular behavioral functions examined. Whereas psychomotor skills and short-term memory improved significantly with prolonged abstinence, long-term memory was impaired even after seven years of continuous sobriety. We propose that recovery of short-term memory reflects reestablishment of cortical functioning, while the persistent long-term memory defect indicates more permanent damage to diencephalic structures. (Arch Gen Psychiatry 1983;40:435-442) The information-processing deficits associated with alco¬ holic Korsakoff's syndrome have been extensively stud¬ ied and are well established. These patients display pro¬ found anterograde and retrograde amnesia as well as a variety of visuospatial and abstract-conceptual difficulties, all in the face of normal performance on intelligence tests.1 Traditional neurological teaching maintains that the mem¬ ory disorder of Korsakoff's syndrome emerges only after the acute Wernicke's stage of the illness has been resolved with the administration of thiamine.2,3 It has recently been suggested, however, that the cognitive and neuropathological changes associated with Korsakoff's disease develop gradually during many years of alcohol abuse and are related to the neurotoxic effects of alcohol as well as to nutritional deficiencies. Ryback,4 in particular, has sug-gested that a "continuum of cognitive impairment" may exist in which the long-term alcohol abuser lies somewhere between the patient with Korsakoff's syndrome and the social drinker in memory, perceptual, and problem-solving capacity. As a consequence of this proposal, several groups of investigators have examined whether cognitive defects similar to those seen in patients with Korsakoff's syndrome exist in an attenuated form in the long-term alcoholics without Korsakoff's syndrome.
Cognitive functioning in Wernicke's encephalopathy following chronic alcoholism
International Journal of Medical Science and Public Health
Chronic abuse of alcohol leads to the development of variety of mental and physical health morbidities over the years. All the organs of the body are affected by the overuse of alcohol including the basic cognitive functioning of the brain. Wernicke's encephalopathy (WE) is a neuropsychological
Addiction, 1984
In this review, two forms of alcohol-related brain damage and their possible pathogenesis are discussed. These are the Wemicke-Korsakoff syndrome and alcoholic dementia.
Alcohol-related dementia: an update of the evidence
Alzheimer's Research & Therapy, 2013
It is well established that excessive and prolonged alcohol use can lead to permanent damage to the structure and function of the brain . Despite this, there is little consensus on the characteristics of a dementia syndrome related to sustained alcohol abuse or its relationship to Wernicke-Korsakoff syndrome (WKS). After a long period of neglect, research interest has increased in recent years and has been spurred on by clinical demand, increased reported rates of alcohol abuse in older people, and increasing alcohol consumption by women . In this paper, we aim to review the neuropathology, nosology, epidemiology, clinical features, and neuropsychology of alcohol-related dementia (ARD) and WKS. To retrieve papers for the purpose of this review, the search terms (alcohol OR alcoholism) AND (dementia OR brain damage OR brain injury OR cognitive impairment) were used as keywords in the Medline and PsycINFO databases. Additional terms included Wernicke's encephalopathy, Korsakoff , and Alcohol Amnestic Disorder. Reference lists were also scanned for relevant papers.
The Journal of Neuropsychiatry and Clinical Neurosciences, 2000
This study investigated which cognitive deficits are associated with chronic alcoholism. Neuropsychological profiles and MRI brain structure volumes of 14 patients with Korsakoff's syndrome, 15 patients with chronic alcoholism, and 16 healthy control subjects were compared. The patients with alcoholism had a normal cognitive performance and normal brain structure volumes. The patients with Korsakoff's syndrome had performance deficits on tests of memory, visuoperceptual, and executive functions, as well as reduced brain structure volumes. The results suggest that the cognitive deficits cannot be ascribed to mere chronic consumption of alcohol. If cognitive deficits are present in patients with chronic alcoholism, this may point to an underlying brain disorder.
COGNITIVE IMPAIRMENT DUE TO ALCOHOL ABUSE: CURRENT STATUS OF RESEARCH
Alcohol abuse causes significant changes in cognitive functioning. These effects are related to the fact that ethanol and acetaldehyde, its first metabolite, affect the the brain's neurotransmitter systems. Long-term abuse may lead to the dysexecutive syndrome (DES) exhibited through emotional, behav-ioral and cognitive symptoms. Alcohol has a specific dose-dependent effect on memory that serves as a block of memory consolidation, i.e. transition of the short-term memories to the long-term storage. This effect displays either as reversible amnesias of events from the alcohol abuse period (blackouts), or as an irreversible fixation amnesia within Korsakoff 's syndrome. Refs 34.