Alcohol and the Brain: Chronic Effects

357 Pages·1985·38.1 MB·English

by  Gerhard Freund (auth.)

Alcohol and the Brain
Chronic Effects
Alcohol and the Brain
Chronic Effects
Edited by
RALPH E. TARTER, Ph.D.
University of Pillsburgh School of Medicine
Western Psychiatric Institute and Clinic
Pillshur/!,h, Pennsylvania
and
DAVID H. VAN THIEL, M.D.
University of Pillsburgh School qf Medicine
Pillshw·/!,h, Penn.1ylvania
With the assistance of Kathleen Lou Edwards
SPRINGER SCIENCE+BUSINESS MEDIA, LLC
Library of Congress Cataloging in Publication Data
Main entry under title:
Alcohol and the brain.
Includes bibliographies and index.
I. Brain damage. 2. Alcohol-Physiological effect. 3. Alcohol-Toxicology. 4.
Alcoholism -Complications and sequelae. I. Tarter, Ralph E. II. Van Thiel, David H.
III. Edwards, Kathleen Lou. [DNLM: I. Alcohol, Ethyl-adverse effects. 2. Alcohol,
Ethyl-pharmacodynamics. 3. Alcoholism. 4. Brain-drug effects. 5. Brain Diseases
chemically induced. WM 274 A34976)
RC387.5.A49 1985 616.86'1 85-12068
ISBN 978-1-4757-9136-5 ISBN 978-1-4757-9134-1 (eBook)
DOI 10.1007/978-1-4757-9134-1
© 1985 Springer Science+ Business Media New York
Originally published by Plenum Publishing Corporation, New York in 1985
Softcover reprint oftbe hardcover 1st edition 1985
All rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted,
in any form or by any means, electronic, mechanical, photocopying, microfilming,
recording, or otherwise, without written permission from the Publisher
Contributors
DAVID R. ANTONOW, M.D. • Department of Medicine, Division of Gas
troenterology, Veterans Administration Hospital and University of Ken
tucky Medical Center, Lexington, Kentucky 40536
HENRI BEGLEITER, M.D., Ph.D. • Department of Psychiatry, State Uni
versity of New York, Downstate Medical Center, Brooklyn, New York
11203
IVAN DIAMOND, M.D. • Departments of Neurology, Pharmacology, and
Pediatrics, University of California, San Francisco, and Ernest Gallo Clinic
and Research Center, San Francisco General Hospital, San Francisco, Cal
ifornia 94110
KATHLEEN L. EDWARDS, B.S. • Department of Psychiatry, University
of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic,
Pittsburgh, Pennsylvania 15213
M. JEROME FIALKOV, M.D. • Department of Psychiatry, University of
Pittsburgh School of Medicine, and Western Psychiatric Institute and Clinic,
Pittsburgh, Pennsylvania 15213
STANLEY E. FISHER, M.D. • Department of Pediatrics, North Shore Uni
versity Hospital, Cornell University Medical College, Manhasset, New York
11030
GERHARD FREUND, M.D. • Veterans Administration Medical Center and
Departments of Medicine and Neuroscience, University of Florida College
of Medicine, Gainesville, Florida 32602
JUDITH S. GAVALER, B.S. • Department of Medicine, Division of Gas
troenterology, University of Pittsburgh School of Medicine, Pittsburgh,
Pennsylvania 15261
v
vi CONTRIBUTORS
GERALD GOLDSTEIN, Ph.D. • Department of Psychiatry, University of
Pittsburgh School of Medicine, and Highland Drive Veterans Administration
Hospital, Pittsburgh, Pennsylvania 15206
DAVID A. GREENBERG, M.D. • Departments of Neurology, Pharmacol
ogy, and Pediatrics, University of California, San Francisco, and Ernest
Gallo Clinic and Research Center, San Francisco General Hospital, San
Francisco, California 94110
PAULA L. HOFFMAN, Ph.D. • Division of Intramural Clinical and Bio
logical Research, National Institute on Alcohol Abuse and Alcoholism,
Bethesda, Maryland 20205
CRAIG J. McCLAIN, M.D. • Department of Medicine, Division of Gastro
enterology, Veterans Administration Hospital and University of Kentucky
Medical Center, Lexington, Kentucky 40536
EDWARD MAJCHROWICZ, Ph.D. • Laboratory of Preclinical Studies,
National Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland
20852
BERNICE PORJESZ, Ph.D. • Department of Psychiatry, State University
of New York, Downstate Medical Center, Brooklyn, New York 11203
DANIEL F. SCHAFER, M.D. • Department oflnternal Medicine, University
of Nebraska Medical Center and Liver Study Unit, Veterans Administration
Medical Center, Omaha, Nebraska 68105
BORIS TABAKOFF, Ph.D. • Division of Intramural Clinical and Biological
Research, National Institute on Alcohol Abuse and Alcoholism, Bethesda,
Maryland 20205
RALPH E. TARTER, Ph.D. • Department of Psychiatry, University of Pitts
burgh School of Medicine, Western Psychiatric Institute and Clinic, Pitts
burgh, Pennsylvania 15213
DAVID H. VAN THIEL, M.D. • Department of Medicine, Division of Gas
troenterology, University of Pittsburgh School of Medicine, Pittsburgh,
Pennsylvania 15261
D. ADRIAN WILKINSON, D.Phil. • Addiction Research Foundation, To
ronto, Ontario, Canada M5S 2S I
Preface
Chronic and excessive alcohol consumption disrupts a number of biologic sys
tems. Central nervous system pathology, associated with long-standing alcohol
ingestion, has particularly deleterious consequences to the individual. Compro
mising brain functional integrity ultimately militates against psychosocial ad
justment, and this process is inevitably reflected as a substantial economic loss
to society in the form of costs for providing medical and social services, as well
as disability and absenteeism from work.
This book marshals the literature pertinent to the effects of chronic alcohol
abuse on brain structure and functioning. The material is divided into two parts:
basic research and clinical issues. In the first section, the manifest neurologic
consequences are described across the different levels of biologic organization,
these being brain morphology, neurochemistry, neurophysiology, and neuro
psychology. In recognition of the multifactorial etiology of alcohol-related brain
pathology, the influence and role of hepatic, endocrine, and nutritional factors
are also examined. The second section addresses clinical syndromes and dis
orders. It will be noted that evidence accrued from recent research suggests that
neurologic disturbances may actually antedate the onset of drinking in some
alcoholics. Other clinically important issues discussed are the effects of alcohol
on neurologic development, aging, and dementia. The book concludes with a
discussion of the alcohol withdrawal syndrome, its mechanisms and manifes
tations.
A fundamental objective of the editors was to illustrate that the consequences
of chronic alcohol excess can be comprehensively understood within the per
spective of interrelated hierarchical systems of brain organization. Hence, the
reader will observe that the literature contained herein encompasses the current
state of knowledge pertinent to histologic, gross anatomic, biochemic, physio
logic, and psychologic processes. It is our hope that organizing the subject matter
in this fashion will not only be informative with respect to substance, but also
provide the reader with a useful conceptual framework.
vii
viii PREFACE
A number of individuals were integral to this project, and to them the editors
express their strongest appreciation. We are grateful to the authors for their
willingness to contribute to this multidisciplinary effort. Our deepest thanks are
extended to Cheryl Schmitt and her staff in the Word Processing Department of
Western Psychiatric Institute and Clinic: Michele Bevilacqua, Theresa Cukanow,
Marty Levine, Margaret Malloy, Cynthia Meister, and Deborah Reichbaum.
Without their professionalism and expeditious preparation of numerous drafts
and revisions, this work would have been substantially delayed. Finally, the
editors want to acknowledge their appreciation for the contribution of Kathy Lou
Edwards. In her role of editorial assistant she performed many chores, attended
to innumerable details, and throughout kept up the momentum to hasten this
project to completion.
Ralph E. Tarter, Ph.D.
David H. Van Thiel, M.D.
Pittsburgh, Pennsylvania
Contents
I. Basic Research
1. Neuropathology of Alcohol Abuse 3
GERHARD FREUND
1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.1. Systemic and Brain Diseases Interacting with the
Effects of Alcohol Abuse . . . . . . . . . . . . . . . . . . . . . . . . 5
1.2. Quantification and Interpretation . . . . . . . . . . . . . . . . . . 6
2. Organic Brain Syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
2.1. Cerebral Cortex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
2.2. Central Brain Structures . . . . . . . . . . . . . . . . . . . . . . . . . 9
3. Degenerative Brain Syndromes . . . . . . . . . . . . . . . . . . . . . . . . . 10
3. l. Cerebellar Degeneration . . . . . . . . . . . . . . . . . . . . . . . . . 10
3.2. Degeneration of the Corpus Callosum
(Marchiafava-Bignami Disease) . . . . . . . . . . . . . . . . . . 10
3.3. Central Pontine Myelinolysis . . . . . . . . . . . . . . . . . . . . . 11
4. Malnutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
5. Brain Diseases Facilitated by Alcohol Abuse . . . . . . . . . . . . . 13
5.1. Subdural Hematoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
5.2. Multiple Infarctions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
6. Summary and Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
lx
X CONTENTS
2. Ethanol's Action on Brain Biochemistry . . . . . . . . . . . . . . . . . . . . 19
PAULA L. HOFFMAN AND BORIS TABAKOFF
1. Introduction: Neurochemical Effects of Ethanol 19
2. Na+, K+ -Activated Adenosine Triphosphatase
(ATPase) Activity .................................. . 21
3. Ca2 + Metabolism .................................. . 23
4. Catecholamine Systems .............................. . 26
5. Serotonin Systems .................................. . 34
6. Cholinergic Systems ................................ . 35
7. GABA Systems .................................... . 38
8. Glutamate ......................................... . 42
9. Opiates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
10. Neurotransmitter/Neuromodulator Interactions . . . . . . . . . . . . 47
11. Receptor-Effector Coupling . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
12. Molecular Mechanisms of Ethanol's Actions-Is There a
Single Primary Site for Ethanol's Actions? . . . . . . . . . . . . . . . 51
13. Identification of Neurotransmitter and Neuromodulator
Systems Contributing to Ethanol Tolerance . . . . . . . . . . . . . . . 53
14. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
15. Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
3. Endocrine Effects of Chronic Alcohol Abuse:
Hypothalamic-Pituitary-Gonadal Axis . . . . . . . . . . . . . . . . . . . . . 69
DAVID H. VAN THIEL AND JUDITH S. GAVALER
I . Historical Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
2. Ethanol Effects on Endocrine Cells . . . . . . . . . . . . . . . . . . . . . 70
2.1. Leydig Cell Membrane Effects of Ethanol Exposure . . 70
2.2. Leydig Cell Effects of Ethanol Exposure . . . . . . . . . . . 71
3. Effects beyond the Gonad That Contribute to Alcohol-
Induced Gonadal Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
4. Role of Estrogens in the Pathogenesis of Alcohol-Induced
Gonadal Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
5. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77