Psychiatry Research, 541225-239 Elsevier 225 Decreased Cingulate and Precuneate Glucose Utilization in Alcoholic Korsakoff’s Syndrome Eileen M. Joyce, Daniel E. Rio, Urs E. Ruttimann, John W. Rohrbaugh, Peter R. Martin, Robert R. Rawlings, and Michael J. Eckardt Received June 9, 1993; revised version received December 20, 1993; accepted February 18, 1994. zyxwvutsrqpon Abstract. Localized cerebral glucose utilization was determined for nine abstinent alcoholic men with Kotsakoffs syndrome and 10 age-matched normal men who underwent positron emission tomography with [tsF]2-fluoro-2deoxyglucose (FDG). Patients with Korsakoff’s syndrome showed relatively decreased glucose utilization in cingulate and precuneate areas. These decreases persisted even after correction for group differences in ventricular and sulcal cerebrospinal fluid measured on computed tomography. Electroencephalographic recordings at the time of FDG uptake showed no group differences, a finding that demonstrates that the metabolic differences could not be explained by differences in physiological arousal at the time of scanning. It is concluded that the decreased glucose utilization in the patients reflects a disruption of memory circuitry, the Papez circuit, caused by diencephalic lesions induced by thiamine deficiency. Key Words. Alcohol dependence, positron emission tomography, computed tomography, electroencephalography, cingulate cortex. The traditional description of the alcoholic Korsakoffs syndrome is of a severe amnestic disorder associated with previous episodes of thiamine malnutrition (Victor et al., 1989). Neuropathological findings include diencephalic and brainstem lesions in all cases, and loss of brain weight and volume in up to a third of cases (Harper, 1983; Victor et al., 1989). Structural neuroimaging results (from computed tomography [CT] and magnetic resonance imaging [MRI]) have been consistent with these post-mortem observations, suggesting that global shrinkage of the brain in addition to focal diencephalic and brainstem lesions occurs in alcoholic patients with Korsakoff’s syndrome (Shimamura et al., 1988; Jacobson et al., 1990; Jernigan et al., 1991). In addition to memory impairment, patients with alcoholic Korsakoff’s syndrome can have abnormalities in visuoperceptive ability, problem solving, plan- ning, and abstract thinking, as well as changes in personality (Talland, 1965; Oscar Eileen M. Joyce, Ph.D., M.R.C.P., M.R.C.Psych., is Senior Lecturer, Academic Department of Psvchiatrv, Charing Cross and Westminster Medical School, London. UK. Daniel E. Rio, Ph.D., is Research-Physicistr Urs E. Ruttimann, Ph.D., is Biomedical Engineer; Robert R. Rawlings, M.S., is Statistician: and Michael J. Eckardt. Ph.D., is Chief. Laboratorv of Clinical Studies. National lnstitute on Alcohol Abuse and Alcoholism; Bethesda, MD, USA. John W. Rohrbaugh, Ph.D., is Associate Professor, Department of Psychiatry, Washington University, St. Louis, MO, USA. Peter R. Martin, M.D., is Professor, Department of Psychiatry, Vanderbilt University Medical School, Nashville, TN, USA. (Reprint requests to Dr. E.M. Joyce, Academic Dept. of Psychiatry, Charing Cross and Westminster Medical School, St. Dunstan’s Rd., London W6 8RP, UK.) 0165-1781/94/$07.00 @ 1994 Elsevier Science Ireland Ltd