Memantine treatment in alcohol dementia: rapid PET changes and clinical course.

Alcohol dementia (ALD) usually follows long-term alcohol dependence. The major psychiatric features of ALD are general loss of short-and long-term memory combined with disturbances in concentration and a decrease in intellectual capacity, all of which persist during abstinence. Despite its clinical importance, few studies have been published up to now on medical treatment of ALD and other alcohol-induced mental disorders [1]. The central nervous gluta-matergic system, with its N-methyl-D-aspartate (NMDA) receptors, is suggested to be involved in toxic neuronal loss [2] due to an increased glutamatergic neurotransmission during repeated alcohol withdrawal and may subsequently contribute to the development of ALD. The low-affinity NMDA receptor antagonist memantine (ada-mantine, 1-amino-3,5-dimethyladamantine hydrochloride, CAS 41100-52-1) modulates the glutamatergic system most likely through Ca 2+ influx blockage of NMDA receptors [3] and shows positive effects on memory in the treatment of other psychogeriatric disorders with memory loss such as Alzheimer's dementia (AD) or Parkinson's disease [4]. We would like to report the case of a 71-year-old female patient with chronic alcoholism for at least 30 years. She was found neglected in her home and was admitted to our ward from an emergency unit with symptoms of disorientation, apraxia, ataxia, severe short-and long-term memory disturbances, deficits in intellectual capacity and concentration. There were no signs of electrolyte imbalance on admission. A further thorough neurological investigation and NMR showed a general atrophy without severe basal brain damage of Wer-nicke encephalopathy. No other signs of Wernicke encephalopathy, i.e. ophthalmoplegia or evidence of hepatic encephalopathy such as flapping tremor, were found. Ultrasound of brain arteries showed some plaques without hemodynamic compromise. After excluding Alzheimer's disease or vascular dementia, the diagnosis of ALD according to ICD10 criteria was made.