Although intellectual decline associated with alcohol use has been extensively documented, the neuropathological basis for this cognitive change remains controversial. We have therefore undertaken a naturalistic survey of a population of patients identified as having a n excessive alcohol intake. Records of all autopsies on patients resident in a chronic hospital between 1983 and 1993 were reviewed for evidence of alcohol abuse. Multiple brain pathology was found in the demented alcoholic 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 significant 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.
KEY WORDS-alcoholic dementia; Wenicke-Korsakoff syndrome; vascular dementia; mamillary lesions Dementia is a common problem in the elderly and it has been estimated that approximately 7-21 O/O of clinical cases of dementia are alcohol related . Conversely, it has been suggested that 4 4 5 % of elderly drinkers may be cognitively impaired. An increased prevalence of dementia has been reported in older compared to young heavy drinkers ; also, more pronounced ventricular dilatation and cortical atrophy are found in aged compared to young alcoholics and in aged alcoholics compared to age-matched non-alcoholics .
Although the intellectual decline associated with alcohol use has been extensively documented (Hill,