Brain oxidative metabolism and blood flow in alcoholic syndromes

42 alcoholic patients were grouped together according to the symptom-sign clusters derived from original classification variables of AMDP-rating scale system: (1) mild withdrawal, (2) severe withdrawal, (3) Korsakoff's syndrome, and (4) the clinical syndrome of dementia. Groups determined by clusteranalysis were subjected to a discriminant function analysis. Total cerebral blood flow (CBF) and the cerebral metabolic rates of oxygen, carbon dioxide, glucose and lactate were investigated. Patients with mild withdrawal tended to display increased oxygen uptakes reflecting 'pseudonormal' mean values with a wide range of the single data but predominantly elevated over the normal range. In mild withdrawal lactate production showed a tendency to increasing derangement of metabolism. There was much evidence of disturbance of brain oxidative metabolism with progressively decreasing cerebral metabolic rates of glucose, lactate, oxygen, and CBF from mild to severe withdrawal, Korsakoff's syndrome and dementia. Progression of both clinical phenomenology and cerebral dysfunction and/or damage culminates in simplified (reduced, "burnt-out") neuronal functional levels in advanced cases.