Matsui Toshifumi, Sakurai Hideki, Toyama Tomomi, Yoshimura Atsushi, Matsushita Sachio, Higuchi Susumu
Clinical Center for Neurodegenerative Disease, National Hospital Organization, Kurihama Medical and Addiction Center 5-3-1 Nobi, Yokosuka, Kanagawa 239-0841, Japan.
Nihon Arukoru Yakubutsu Igakkai Zasshi. 2012 Jun;47(3):125-34.
Alcohol-related dementia (ARD) is one of the most common dementing disorders in middle-aged people and occurs in heavy drinkers who are estimated to be 10 - 15 % of the adult men in a community. While the concept of ARD is multifactorial and includes all cognitive deficits in alcoholics, the central clinical manifestations are exemplified by Korsakoff's syndrome (KS), a persistent neuropsychiatric syndrome, characterized by amnesia and disorientation that is caused by thiamine deficiency along with excessive alcohol consumption. Antemortem detection of intracranial changes has been made possible by MRI and many studies have revealed that alcoholics have atrophic changes in frontal lobe, cerebellum, medial temporal lobe and hippocampus. However, these brain regions are vulnerable to excessive alcohol and seem to be independent of cognitive deficits in alcoholics. This review shows the regional differences in gray matter volumes between cognitively normal alcoholics and patients with KS. By employing a 3-dimensional MRI method for voxel-based morphometry that enables an automated, unbiased, comprehensive assessment, we demonstrate that parahippocampal/hippocampal atrophy is specific to KS and thalamic atrophy and the third ventricle enlargement are more severe in patients with KS than in cognitively normal alcoholics.
酒精相关痴呆（ARD）是中年人中最常见的痴呆症之一，发生在重度饮酒者中，据估计，在一个社区中，重度饮酒者占成年男性的10%至15%。虽然ARD的概念是多因素的，包括酗酒者的所有认知缺陷，但其核心临床表现以科萨科夫综合征（KS）为例，这是一种持续性神经精神综合征，其特征是失忆和定向障碍，由硫胺素缺乏以及过量饮酒引起。MRI使生前检测颅内变化成为可能，许多研究表明，酗酒者额叶、小脑、颞叶内侧和海马体存在萎缩性变化。然而，这些脑区易受过量酒精影响，似乎与酗酒者的认知缺陷无关。本综述显示了认知正常的酗酒者与KS患者之间灰质体积的区域差异。通过采用基于体素的形态学三维MRI方法，能够进行自动化、无偏倚、全面的评估，我们证明海马旁/海马萎缩是KS特有的，丘脑萎缩和第三脑室扩大在KS患者中比认知正常的酗酒者更严重。
