Abstract
Alcohol consumption patterns and recognition of health outcomes related to hazardous drinking vary widely internationally, raising the question whether these national differences are reflected in brain damage observed in alcoholism. This retrospective analysis assessed variability of alcoholism's effects on brain cerebrospinal fluid (CSF) and white matter volumes between France and the United States (U.S.). MRI data from two French sites (Caen and Orsay) and a U.S. laboratory (SRI/Stanford University) were acquired on 1.5T imaging systems in 287 controls, 165 uncomplicated alcoholics (ALC), and 26 alcoholics with Korsakoff's Syndrome (KS). All data were analyzed at the U.S. site using atlas-based parcellation. Results revealed graded CSF volume enlargement from ALC to KS and white matter volume deficits in KS only. In ALC from France but not the U.S., CSF and white matter volumes correlated with lifetime alcohol consumption, alcoholism duration, and length of sobriety. MRI highlighted CSF volume enlargement in both ALC and KS, serving as a basis for an ex vacuo process to explain correlated gray matter shrinkage. By contrast, MRI provided a sensitive in vivo biomarker of white matter volume shrinkage in KS only, suggesting a specific process sensitive to mechanisms contributing to Wernicke's encephalopathy, the precursor of KS. Identified structural brain abnormalities may provide biomarkers underlying alcoholism's heterogeneity in and among nations and suggest a substrate of gray matter tissue shrinkage. Proposed are hypotheses for national differences in interpreting whether the severity of sequelae observe a graded phenomenon or a continuum from uncomplicated alcoholism to alcoholism complicated by KS.
Highlights
According to the Global Status Report on Alcohol and Health (2014) published by the World Health Organization (WHO) [http://www.who.int/substance_abuse/publications/global_alco hol_report/en/], alcohol consumption amount, patterns, and health outcomes vary widely by country
The ALC patients were interviewed to determine drinking history variables such “duration of alcoholism” operationalized according to the age of onset of alcoholism, which is the age when a patient met for the first time the diagnostic criteria for alcohol dependence, “lifetime alcohol consumption,” which is the estimated quantity of alcohol consumed in kg since the patient started drinking alcohol in a regular way, and “length of sobriety,” which is the number of days of abstinence prior the inclusion in the study according to the date of last drink
Statistical results for MANOVAs and analysis of variance (ANOVA) conducted on cerebrospinal fluid (CSF) and white matter volumes are presented in Table 3 and Figure 2 and described
Summary
According to the Global Status Report on Alcohol and Health (2014) published by the World Health Organization (WHO) [http://www.who.int/substance_abuse/publications/global_alco hol_report/en/], alcohol consumption amount, patterns, and health outcomes vary widely by country. Total alcohol consumption per capita (age 15 years and over) in France (10.0–12.4 liters with 56% wine drinkers) is higher than in the United States (U.S.) (7.5–9.5 liters with 50% beer drinkers), as is the prevalence of heavy episodic (binge) drinking. Both countries have a similar estimated pattern of drinking scores assessing four different dimensions of heavy drinking occasions (daily drinking, frequency of getting drunk, usual quantity per drinking session, holiday binge drinking), drinking with meals, and drinking in public places (Rehm et al, 2003). National and multi-national studies on the untoward effects of hazardous drinking have the potential of raising awareness, identifying sources of alcoholrelated problems, and indicating areas to target in reversing or ameliorating resulting problems
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