Abstract
This article reviews the evidence for neuropsychological impairments in excessive drinkers. The view that the neuropsychological impairments reflect clinically heterogeneous manifestations of a unitary ‘Wernicke-Korsakoff complex’ resulting from thiamine deficiency is discounted on the basis of a variety of mediating factors which have been demonstrated to affect the pattern of cognitive abilities and deficits in excessive drinkers. In contrast, this article argues that detailed analysis of the apparent clinical heterogeneity in the cognitive status of these patients may provide a means for determining the most appropriate treatment regime and rehabilitation procedures for an individual. These impairments are applied to a theoretical model of information processing identifying dissociable impairments which have been described as the ‘frontal-lobe’ and the ‘right hemisphere’ hypotheses of the effects of alcohol on cognitive functioning. Interpretation of research results in terms of functional characteristics rather than localization characteristics is proposed. Two mediating factors, thiamine deficiency and liver dysfunction, are discussed in relation to their differential involvement in these impairments.