CENTRAL AND PERIPHERAL NERVOUS SYSTEM FUNCTION IN ABSTINENT ALCOHOLICS

酗酒者的行为缺陷被概念化为两个方面 神经病理学上不同的综合征：酒精性痴呆和科尔萨科夫综合征 酒精性遗忘症（Alcohol Amnestic Disorder）酒精性痴呆的特征是 弥漫性皮质损伤主要与神经毒性有关， 酒精; Korsakoff精神病与皮质下病变有关， 维生素B1缺乏症（B1）严重的记忆障碍， 其他智力功能的相对节省使科萨科夫的 酒精性痴呆引起的精神病（临床上可能是 与最常见的痴呆症阿尔茨海默氏症没有区别 疾病）。我们最近发现，科尔萨科夫患者的睡眠 其特征在于与正常志愿者相比REM潜伏期减少， 而阿尔茨海默病患者的乳酸水平正常。此外，三角洲睡眠 在老年痴呆症中减少，但在科萨科夫精神病中正常。 大多数患者表现出减少每日排泄的主要 褪黑激素的尿代谢产物，羟褪黑激素，在患者中 科萨科夫精神病这一发现提示松果体受损 功能硫胺素代谢的遗传差异可能导致 发展为科萨科夫精神病大多数科萨科夫综合征患者 我们研究过的精神病患者的转酮醇酶 对焦磷酸硫胺素的亲和力。大多数酗酒者 神经递质系统的认知调节可能在 治疗策略皮质下综合征，而酒精性痴呆可能 需要类似于阿尔茨海默病的治疗策略。这 方案旨在利用临床、神经放射学、生理学 和神经药理学试验来区分这两种;病理学 实体，遵循纵向课程，并将变量与 治疗方案的结果。

Behavioral deficits in alcoholics have been conceptualized in terms of two neuropathologically distinct syndromes: alcoholic dementia an Korsakoff's psychosis (alcohol amnestic disorder) . Alcoholic dementia is characterized by diffuse cortical damage primarily related to the neurotoxicity of alcohol; Korsakoff's psychosis is associated with subcortical lesions due to nutritional (thiamine) deficiency. Severe memory impairment with relative sparing of other intellectual functions distinguishes Korsakoff's psychosis from alcoholic dementia (which may be clinically indistinguishable from the most common cause of dementia, Alzheimer's disease) . We have recently found that sleep in Korsakoff patients is characterized by a reduced REM latency compared to normal volunteers, whereas Alzheimer patients have normal latencies. Furthermore, delta sleeps reduced in Alzheimer's disease, but is normal in Korsakoff's psychosis. Most patients with demonstrated reduced daily excretion of the major urinary metabolite of melatonin, hydroxmelatonin, in patients with Korsakoff's psychosis. This finding is suggestive of impaired pineal function. Genetic differences in thiamine metabolism may predispose patients to develop Korsakoff's psychosis. Most patients with, Korsakoff's psychosis whom we have studies have had a transketolase with reduced affinity for thiamine pyrophosphate. The majority of alcoholics with cognitive modulation of neurotransmitter systems may be effective in treatment strategies subcortical syndrome, whereas alcoholic dementia may require treatment strategies similar to those in Alzheimer's disease. This protocol is intended to utilize clinical, neuroradiological, physiological, and neuropharmacological tests to differentiate these two; pathologic entities, to follow a longitudinal course, and to relate variables in treatment protocols to outcome.