Although it is commonly believed that chronic alcohol abuse results in
loss of neocortical neurons, this assumption has not been properly te
sted. We used new stereological techniques to make a precise and unbia
sed estimate of the total number of neurons in the neocortex of brains
obtained at necropsy from 11 chronic alcoholic men and 11 control men
. The groups were matched with respect to age and height. Total mean n
eocortical neuron numbers in the two groups did not differ (alcoholics
23.4 x 10(9), controls 23.2 x 10(9)). Estimation of macroscopic brain
volumes showed significant reductions in alcoholics compared with con
trols of the volume/weight ratios of white matter (11%, p = 0.013) and
of archicortex (30%, p = 0.028). The volume of the ventricles in the
alcoholic group was enlarged by 26%, but this was not statistically si
gnificant. There was no difference in the volumes of the neocortices.
Our study confirms that chronic alcoholics lose white matter, and this
could provide the basis for their functional impairment. However, the
results also suggest that the observed brain damage in the alcoholic
group is potentially reversible since preserved nerve-cell bodies migh
t allow lost or malfunctioning axons to be re-established and restored
to function after prolonged abstinence and/or treatment. By contrast,
lost neocortical neurons cannot be replaced.