Alcohol and Brain Damage

In this review, two forms of alcohol-related brain damage and their possible pathogenesis are discussed. These are the Wernicke-Korsakoff syndrome and alcoholic dementia. There is little doubt that thiamine deficiency is the factor responsible for Wernicke's encephalopathy. However, additional factors might play a role in the development of Korsakoff's psychosis. Many cases of Wernicke's encephalopathy are undiagnosed by clinicians whose awareness of the various manifestations of this disease needs to be increased. Thiamine deficiency may lead to brain damage by blocking the oxidative metabolism of glucose, ammo acids and fatty acids. There is no definite evidence that marginal thiamine deficiency causes disease. Certain individuals may be especially prone to the effects of thiamine deficiency for genetic reasons. There is clearly a spectrum of mental impairment in alcoholics which cannot be attributed to thiamine deficiency. Some of these abnormalities correlate with the neuroradiological and pathological signs of cerebral atrophy. Mental impairment and atrophy in alcoholics are partly reversible with abstinence. Alcohol itself might be neurotoxic which would explain some of these phenomena.