Dementia syndromes Dementia syndromes associated with the associated with the

consumption of alcohol consumption of alcohol and alcoholic dementiaand alcoholic dementia

Angela Arciniegas

DEMENTIADEMENTIA

Persistent intellectual impairment syndrome and acquired(Kolb, 2006).

Acquired cognitive disorder due to an organic process that affects the brain by direct effect of a general medical condition, by persisting effects of a substance or multiple etiologies (Ugalde, 2010).

Criteria for the diagnosis of F1x.73 Persisting Dementia Induced by Substance- CIE-10

A.  The development of multiple cognitive deficits manifested by:

1. memory impairment (impaired ability to learn new information or to recall previously learned information)

2. One (or more) of the following cognitive disturbances:(a) aphasia (language disturbance)  (b) apraxia (impaired ability to carry out motor activities despite intact motor function)(c) agnosia (failure to recognize or identify objects despite intact sensory function) (d) impaired executive functioning (eg., planning, organizing, sequencing, abstracting)

B. The cognitive deficits in each of the Criteria A1 and A2 cause significant impairment in social or occupational functioning and represent a significant decline from a previous level of functioning.

C. The deficits do not occur exclusively during the course of a delirium and persist beyond the usual duration of substance intoxication or withdrawal.

D. Demonstration through history, physical examination, or laboratory findings that deficits are etiologically related to the persisting effects of substance (eg., A drug of abuse, a medication).

Neurological diseases caused by Neurological diseases caused by alcoholalcohol

1. Alcohol intoxication

2. Withdrawal

3. Diseases related to nutritional disorders

4. Diseases of unknown pathogenesis

Gual, A. (2002). Monografìa alcohol. Adicciones Vol 14.

DISEASE OF THE CNSDISEASE OF THE CNS

Due to excessive consumption (acute or chronic), or abrupt cessation of consumption.

Neurological syndromes caused by toxic effects of ethanol and acetaldehyde and nutritional deficiencies occur.

Gual, A. (2002). Monografìa alcohol. Adicciones Vol 14.

Related Diseases with Nutritional Related Diseases with Nutritional and vitamin deficiency disordersand vitamin deficiency disorders

1. Syndrome Wernicke –Korsakoff

2. Alcoholic cerebellar degeneration

3. Alcoholic polyneuropathy

Gual, A. (2002). Monografìa alcohol. Adicciones Vol 14.

Syndrome Wernicke-KorsakoffSyndrome Wernicke-Korsakoff

Persisting amnestic disorder.

Given the lack of thiamine (vitamin B1).

Related to chronic alcohol abuse

It is characterized by bilateral and symmetrical diencephalic injury. It primarily affects the mammillary bodies.

Accompanied by malnutrition and defects in the intestinal absorption of nutrients.

Two related pictures but can occur independently

Wernicke Korsakoff

Table of acute onset or subacute onset secondary to thiamine deficiency

No treatment of Wernicke syndrome may evolve into the Korsakoff psychosis.

48 a 72 hrs

Calvo, H. (2003). Alcohol y Neuropsicología. Trastornos Adictivos;5(3):256-68

Structures involvedStructures involved

MAMMILLARYCORE

THALAMUS HIPO

THALAMUSCEREBELLUM

HIPPOCAMPUS

Neuropsychology of alcohol abuseNeuropsychology of alcohol abuse

Deterioration in visuoperceptual abilitiesImpaired motor performanceMemory impairmentDecreased learning abilityDecreased ability to abstract verbal and nonverbal.Cognitive rigidityDeficiency in generating alternative plans and conduct

Pathological, neurophysiological Pathological, neurophysiological and neuroimaging changesand neuroimaging changes

TAC: first cerebral cortical atrophy and later subcortical atrophy.

RM: Alterations in cerebrospinal fluid, the volume of bilateral anterior hippocampus is smaller.

EEG: A higher alcohol consumption decreases the activity of the EEG and increases the amplitude of the waves of less frequency. A significant level of affectation of the trunk and the diencephalon.

Chirivella, J., Espert, R. & Gadea, M. (1996). DÉFICITS NEUROPSICOLÓGICOS ASOCIADOS AL CONSUMO DE ALCOHOL —UNA APROXIMACIÓN MULTIDISCIPLINAR—Psicología Conductual, Vol. 4,

Nº 3, pp. 377-392.

Treatment and PrognosisTreatment and Prognosis

Wernicke: should be considered a medical emergency.

Potentially reversible

Acute treatment with thiamine.

The prognosis for a Korsakoff syndrome already established is bad, although some patients remit partially after treatment.

Gual, A. (2002). Monografìa alcohol. Adicciones Vol 14.

Alcoholic cerebellar degenerationAlcoholic cerebellar degeneration

Anterior and superior vermis of hemispheric areas adjacent.

More common in men than in women.Ataxia of the trunk and lower extremities

Unsteady gait coordination with conservation of the upper extremities.

NistagmusDysarthriaTremors

Gual, A. (2002). Monografìa alcohol. Adicciones Vol 14.

Treatment and PrognosisTreatment and Prognosis

The pathogenesis of degeneration is unknown.

The disease is slowly progressive over the years.

It may improve with adequate nutritional intake and cessation of alcohol intake.

Gual, A. (2002). Monografìa alcohol. Adicciones Vol 14.

ALCOHOLIC POLYNEUROPATHYALCOHOLIC POLYNEUROPATHY

Probably the most common nutritional complication affecting the NS of alcoholics.

Symptoms begin distally.First lower limbs (sometimes exclusively).

Insidious and progressive course

Complaints of pain, numbness and weakness.

Gual, A. (2002). Monografìa alcohol. Adicciones Vol 14.

Treatment and PrognosisTreatment and Prognosis

Alcohol withdrawal.Administration of B vitaminsImprovement of nutritional status

Slow and often incomplete recovery

Gual, A. (2002). Monografìa alcohol. Adicciones Vol 14.

Alcoholic dementiaAlcoholic dementia

“Frame of acute cognitive impairment with impaired complex reasoning, abstract thinking, memory, judgment and care, with preservation of linguistic abilities”.

Calvo, H. (2003). Alcohol y Neuropsicología. Trastornos Adictivos;5(3):256-68

Alcoholic dementiaAlcoholic dementia

Attributed to the development of cerebral atrophy, resulting from prolonged alcohol consumption.

Suggests a generalized impairment of higher cognitive functions.

Behavioral changes similar to those of a fronto-temporal dementia (emotional lability, irritability, explosive behavior, etc.).

Calvo, H. (2003). Alcohol y Neuropsicología. Trastornos Adictivos;5(3):256-68

Findings in animal researchFindings in animal research

Episodes of chronic intoxication and withdrawal in rats showed impaired hippocampal neural plasticity.

The cortex and hippocampus, highly involved in learning and memory, atrophy after chronic ethanol ingestion.

Anatomically localized damage thalamic ventrolateral nucleus.

Vetreno, R., Hall, J. & Savage, L. (2011). Alcohol-related amnesia and dementia: Animal models have revealed thecontributions of different etiological factors on neuropathology, neurochemicaldysfunction and cognitive impairment. Neurobiology of Learning and Memory. 96: 596–608.

ReferencesReferences

Bakalkin, G., Ögren, S. & Kuzmin, A. (2008). Adaptaciones moleculares, asociadas a dependencia etílica, de los circuitos cerebrales neurocognitivos. European College of Neuropsychopharmacology.

Calvo, H. (2003). Alcohol y neuropsicología. Trastornos adictivos. España.

Chirivella, J., Espert, R. & Gadea, M. (1996). DÉFICITS NEUROPSICOLÓGICOS ASOCIADOS AL CONSUMO DE ALCOHOL —UNA APROXIMACIÓN MULTIDISCIPLINAR—Psicología Conductual, Vol. 4, Nº 3,, pp. 377-392.

Gual, A. (2002). Monografía alcohol. Adicciones Vol 14.

Kolb, B. Whishaw, I (2006). Neuropsicología humana. Colombia: Editorial médica Panamericana.

Martinez, V. & Bartolomé, R. (2001). Alcoholismo: bases para la intervención. España: Colección Estudios.

Vetreno, R., Hall, J. & Savage, L. (2011). Alcohol-related amnesia and dementia: Animal models have revealed thecontributions of different etiological factors on neuropathology, neurochemicaldysfunction and cognitive impairment. Neurobiology of Learning and Memory. 96: 596–608.