DEMENTIA IN THE ELDERLY MALE ALCOHOLIC - A RETROSPECTIVE CLINICOPATHOLOGICAL STUDY

Although intellectual decline associated with alcohol use has been ext ensively documented, the neuropathological basis for this cognitive ch ange remains controversial. We have therefore undertaken a naturalisti c survey of a population of patients identified as having an excessive alcohol intake. Records of all autopsies on patients resident in a ch ronic hospital between 1983 and 1993 were reviewed for evidence of alc ohol abuse. Multiple brain pathology was found in the demented alcohol ic patients. The most unexpected finding in this series was that seven of 12 cases of dementia with history of alcohol abuse presented with significant cerebrovascular disease, meeting NINDS-AIREN criteria for vascular dementia, suggesting that cerebrovascular disease may be a si gnificant component of dementia in older alcoholics. Our finding that in four of six cases mamillary pathology may be secondary to vascular lesions suggests that unless these lesions are sought, the presence of mamillary pathology may lead to overdiagnosis of nutritional factors as the basis for alcoholic dementia.