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Alcoholism and dementia

Alcohol-induced dementia is a controversial disorder which entails global, persisting and disabling cognitive impairment resulting from and temporally related to prolonged, "heavy use" of ethanol. The qualifiers global, persisting and disabling bear mention. Recent thought on alcohol-induced dementia ranges from the contention that alcohol is just as common a cause of dementia as vascular disorders to argument that alcohol-induced dementia cannot be accepted as an independent entity until its neuropathological basis has been established. DSM-IV invokes the term "alcohol, induced persisting dementia", which is grouped with the other cognitive impairment disorders. Still, no specific inclusionary criteria are offered to distinguish alcohol dementia from other dementias. The most commonly reported findings in the brains of patients with long-standing "heavy alcohol use" is mild to moderate sulcal widening (especially of the frontal regions) as well as third and lateral ventricular enlargement as measured by imaging an post-mortem studies. Recent pathological studies have focused on neuronal loss in subcortical brain regions in an attempt to account for global cognitive impairment. Also MRI and PET studies provide some support for the association of alcohol abuse, cognitive impairment and frontal lobe pathology. A fascinating aspect is that with abstinence, the brain shrinkage is sometimes reversible. Much of the controversy surrounding alcohol-induced dementia (AD) has result in difficulties in differentiating it from Wernicke-Korsakoff syndrome (WKS). Patients with WKS showed some impairment of stance and gait. Polyneuropathy and nystagmus are also quite common symptoms. In the majority of alcohol misusers, cognitive deficits are subtle and tend to a large extent to be reversible with abstinence. A number of theories have been advanced to explain the mechanism by which "chronic alcohol abuse" might lead to dementia. Until a criterion standard for alcohol-induced dementia can be established through careful research, this reportedly common disorder will remain in doubt.

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Liappas, I. Alcoholism and dementia. Ann Gen Hosp Psychiatry 2 (Suppl 1), S39 (2003).

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