Introduction to This Issue: The Seven Ages of Man ... (or Woman)

Abstract

The famous monologue from Shakespeare's As You Like It, from which the title of this contribution is taken, likens the world to a stage and life to a play. The seven stages of man's life are vividly evoked and have resonance today, even as we view the effects of alcohol consumption on the individual across the life course. First we see the infant ‘mewling and puking in his nurse's arms’, then the child ‘creeping like snail unwillingly to school’. The lover (or modern day adolescent) ‘sighing like a furnace’ gives way to the soldier (or young adult) ‘sudden and quick in quarrel’. The ‘justice’ (modern day adult) is ‘full of wise saws and modern instances’ and ‘so plays his part’. With the arrival of the sixth age, we see the older man shrinking in stature. Finally the dying man is again like a child: ‘sans teeth, sans eyes, sans taste, sans everything’. Alcohol-related brain damage is a heterogeneous condition. There is no single causal mechanism. Alcohol and its metabolite acetaldehyde have a direct neurotoxic effect on the brain. Repeated episodes of intoxication and withdrawal, dietary neglect and thiamine and other vitamin deficiencies, traumatic brain injury, cerebrovascular events and alcoholic liver disease also contribute to impairment in brain structure and function. These direct and indirect effects of alcohol interact in the individual, such that no two people drinking the same amount of alcohol develop the same patterns of damage. Individual susceptibility is influenced by prenatal exposure to alcohol, age, gender, genetic predisposition (Guerrini et al ., in this issue), general health, social inequalities and other metabolic influences. Alcohol-related brain damage (ARBD) manifests itself in different ways across the lifespan. In the developing fetal brain, neuronal and glial cells divide rapidly to the extent that they total ∼2 billion in number by …