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British Medical Bulletin 50:99-114 (1994)
© 1994 The British Council

research-article

Aetiology of alcoholic brain damage: alcoholic neurotoxicity or thiamine malnutrition?

E M Joyce

Academic Department of Psychiatry, Charing Cross and Westminster Medical School, University of London London, UK

Abstract

The clinical presentation of brain damaged alcoholics is heterogenous and includes minimal cognitive impairment, amnesia and dementia. Whichever neurobiological technique is used, eg neuropathology, structural and functional neuroimaging, the clinico-pathological evidence suggests that thiamine malnutrition, affecting the diencephalon, can account for all clinical forms. Alcohol neurotoxicity can cause neuronal damage in cerebral cortex and can contribute to cognitive impairment but there is little direct evidence to support the need for a distinct clinical category of alcoholic dementia. Most organic brain syndromes in alcoholics therefore can be considered as variants of the Wemicke-Korsakoff syndrome and rigorous attention should be paid to the nutritional status of all alcoholics.


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