The nucleus basalis (Ch4) in the alcoholic Wernicke-Korsakoff syndrome: reduced cell number in both amnesic and non-amnesic patients
a Department of Pathology, Neuropathology Division, The
University of Sydney 2006, NSW 2006, Australia, b Prince of Wales Medical
Research Institute, High Street, Randwick, NSW 2031, Australia, c Neuropsychology Unit, Royal Prince Alfred
Hospital, Camperdown, NSW 2050, Australia
Correspondence to: Dr K M Cullen, Neuroscience Unit, School of Biological Sciences A08, The University of Sydney, Sydney, NSW 2006, Australia.
Received 27 November 1996 and in revised form 27 January 1997;
Accepted 12 February 1997
BACKGROUND
The cholinergic nucleus basalis (Ch4)
is an exclusive site of neurofibrillary degeneration in alcoholic
patients with Wernicke's encephalopathy. AimTo test
the hypothesis that the loss of Ch4 neurons contributes to the memory
disorder, Korsakoff's psychosis, commonly seen in Wernicke's encephalopathy.
METHODSMagnocellular basal forebrain neurons
were quantified in alcoholic patients with Wernicke's encephalopathy,
both with and without Korsakoff's psychosis, and neurologically
asymptomatic alcoholic and non-alcoholic controls. Because amnesic and
non-amnesic patients with Wernicke's encephalopathy share common
periventricular lesions, both thiamine deficient groups as well as
alcoholic patients with no neurological complications were included to
determine the lesion specific to memory impairment.
RESULTSCh4 cell number did not differ
significantly between alcoholic and non-alcoholic controls and there
was no correlation between cell number and lifetime alcohol intake.
However, Ch4 cell number in all groups was significantly correlated
with the volume of its major projection target, the cerebral cortex.
Ch4 cell number in the non-amnesic Wernicke's encephalopathy group was
significantly below controls (24%), with cell number in patients with
Korsakoff's psychosis 21% below controls. There was considerable
overlap in cell number between groups. On discriminant analysis, there
was significantly greater cell loss in three non-amnesic patients with
Wernicke's encephalopathy than in some patients with Korsakoff's psychosis. The non-amnesic patient with the greatest cell loss was
impaired on attentional tasks.
CONCLUSIONWhereas neurons in the nucleus basalis
are at risk in thiamine deficient alcoholic patients, cell loss is
minor and does not account for the profound memory disorder.
© 1997 by Journal of Neurology, Neurosurgery, and Psychiatry
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