Alcohol and the Adult Brain

Citation

Kelemen, G. (2017), "Alcohol and the Adult Brain", Drugs and Alcohol Today, Vol. 17 No. 1, pp. 68-69. https://doi.org/10.1108/DAT-01-2016-0001

It is uncommon that a deficiency disease manifests two entirely different patterns of symptoms. Endemic thiamine deficiency, called beriberi and related to the consumption of milled rice, is characterised by weakness, oedema, cardiac failure and/or peripheral neuropathy. This fatal “oriental” disease, mainly affecting infants, was also identified as a serious problem in the Japanese military from the year 1878. Another “occidental” clinical picture including brain anatomy of the same aetiology affecting the central nervous system, whose causation had not been known at that time, was described by the German Pathologist, Carl Wernicke, in 1881 and the Russian Neuropsychiatrist, Sergei Korsakoff, in 1887. Whilst Wernicke localised a lesion in the brains of the patients showing this picture, Korsakoff went on to relate this condition to heavy alcohol drinking. Since these two conditions often go together, by the end of the nineteenth century the name Wernicke-Korsakoff Syndrome (WKS) became prevalent, postulating a single cause. At the time of the Russo-Japanese War (1904-1905), when more than 20,000 Japanese casualties were attributed to beriberi and one-third of Russians suffering from psychosis were attributed to alcohol, nobody surmised that there is a common aetiological factor in these two conditions, namely, a deficiency in thiamine. Two decades prior to the isolation of thiamine (1926) the Japanese Government started standardising rice milling to prevent insufficiencies in the population’s diet. By the end of the 1930s, apart from some low-income countries, beriberi stopped being a major healthcare concern. On the other hand, by the twenty-first century WKS appeared to have become a problem of the ageing populations of higher-income countries.

One simple and clear message throughout this book, written mainly by clinical psychologist researchers, is that thiamine should be given in all cases of alcohol-related brain damage (ARBD). There are several distinct adult populations with thiamine deficiency, therefore making diagnosis difficult because of the lack of a widely applied, simple means of detection; and significant co-morbidity. ARBD is a pragmatic umbrella term for the cohort of excessive alcohol drinking individuals with thiamine deficiency who suffer from neurocognitive conditions. Apart from the aim of publicising this new generic term, the authors also want to establish improved diagnostic criteria in order to facilitate these patients’ access to the appropriate services and lay a foundation for research translatable to practical interventions. As alcohol inhibits the absorption and usage of thiamine, it is vital not only to practise thiamine replacement, but also to help patients achieve abstinence through psychosocial care.

Diane Caine and her colleagues’ publication on new operational criteria for the identification of Wernicke encephalopathy (WE) in 1997 have had a seminal impact on authors’ approaches. The team conducted a retrospective analysis of a sample with a known history of alcohol dependence and, after post-mortem diagnoses, found that WE was much more prevalent than had been expected. The diagnosis of living persons based on classical WE triad resulted in a poor true positive rate, hence Caine and her colleagues introduced new criteria in order to increase diagnostic sensitivity.

In 1960 E.M. Jellinek, a founder of the field of alcohol science, came to the conclusion that alcoholism is not a specific but a generic term. The Jellinekian approach seems to have been revived in this well-written book, published 55 years later. Whilst research on ARBD may help to improve the public health campaign by basing it on epidemiological data, the treatment of each specific disorder can be improved by using a case-by-case approach in developing a care plan and by encouraging multidisciplinary teamwork, which is essential for treating these complex needs of population.