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Alcohol dependence and Korsakoff’s syndrome: A continuum?

Par : Contributeur(s) : Type de matériel : TexteTexteLangue : français Détails de publication : 2013. Sujet(s) : Ressources en ligne : Abrégé : There is considerable heterogeneity in the alcohol-related consequences on brain structure and function. In accordance with the continuity theory proposed in 1971, there are graded effects of episodic memory deficits and brain damage in the Papez circuit, ranging from mild to moderate in “uncomplicated” alcoholics to more severe in alcoholic patients with Korsakoff’s syndrome. On the contrary, the working memory and executive functions, as well as the structures of the frontocerebellar circuit, are damaged to the same extent in the two groups of patients. A graded deterioration in semantic and procedural memory has also been reported in “uncomplicated” alcoholics and patients with Korsakoff’s syndrome. However, such impairments may principally reflect, via indirect mechanisms, those observed for episodic memory, which is required for the encoding of new semantic and procedural information. Accordingly, the relevance of the concept of continuity seems to be limited to episodic memory and its associated Papez circuit. The continuity theory is therefore not applicable to all memory systems and to all brain circuits. Further neuropsychological and neuroimaging investigations are required to confirm whether the Papez and frontocerebellar circuits are differentially affected by chronic and excessive alcohol consumption. The next step will be to compare brain metabolism and functional connectivity within these two circuits in alcoholic patients with and without Korsakoff’s syndrome. From a clinical perspective, alcoholic patients with episodic memory problems or specific deficits in Papez circuit brain volume similar to those of patients with Korsakoff’s syndrome may be considered at risk of developing alcohol-related neuropsychiatric complications. Thus, when used in strictly defined circumstances, the continuity theory would enable the detection, prevention, and treatment of the latter patients before the development of irreversible and debilitating damage, such as Korsakoff’s disease.
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There is considerable heterogeneity in the alcohol-related consequences on brain structure and function. In accordance with the continuity theory proposed in 1971, there are graded effects of episodic memory deficits and brain damage in the Papez circuit, ranging from mild to moderate in “uncomplicated” alcoholics to more severe in alcoholic patients with Korsakoff’s syndrome. On the contrary, the working memory and executive functions, as well as the structures of the frontocerebellar circuit, are damaged to the same extent in the two groups of patients. A graded deterioration in semantic and procedural memory has also been reported in “uncomplicated” alcoholics and patients with Korsakoff’s syndrome. However, such impairments may principally reflect, via indirect mechanisms, those observed for episodic memory, which is required for the encoding of new semantic and procedural information. Accordingly, the relevance of the concept of continuity seems to be limited to episodic memory and its associated Papez circuit. The continuity theory is therefore not applicable to all memory systems and to all brain circuits. Further neuropsychological and neuroimaging investigations are required to confirm whether the Papez and frontocerebellar circuits are differentially affected by chronic and excessive alcohol consumption. The next step will be to compare brain metabolism and functional connectivity within these two circuits in alcoholic patients with and without Korsakoff’s syndrome. From a clinical perspective, alcoholic patients with episodic memory problems or specific deficits in Papez circuit brain volume similar to those of patients with Korsakoff’s syndrome may be considered at risk of developing alcohol-related neuropsychiatric complications. Thus, when used in strictly defined circumstances, the continuity theory would enable the detection, prevention, and treatment of the latter patients before the development of irreversible and debilitating damage, such as Korsakoff’s disease.

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