244 Following admission to the great surprise of investigators, he did n o t show a n y withdrawal features on abstinence. INVESTIGATIONS H a e m o g r a m , urine analyses, blood u r e a , blood sugar, blood cholesterol, C . S . F . analysis. X-ray skull, a n d scrum electrolytes were normal. X-ray chest showed bilateral tuberculous lesions of lungs a n d he was p u t on appropriate a n t i - tuberculous regime. A detailed neuropsychological valua­ tion by the neuropsychologist showed bilateral frontal a n d parietal lobe involve­ m e n t with no temporal lobe dysfunction or dementing features. Patient's abstract reasoning was moderately affected. Affect was one of indifference to the tests. Perceptual organization a n d spatial rela­ tionships were impaired. N o dysphasia, agraphia or finger agnosia could be de­ tected. T h e r e was evidence of dyscal- culia a n d he exhibited no memory loss on P . G. I. M e m o r y Scale. A C T S C A N showed widened basal cisterns, sylvian fissure, cortical sulci a n d dilated ventricles. L a c u n a r infarcts were present in both fronto-polar region?. T h e features were suggestive of cerebral at­ rophy with fronto-polar lacunar infarcts. TREATMENT Patient was p u t on oral thiamine hydrochloride 100 mgs t.i.d. a n d tablet B Complex 1 t.i.d. After 3 weeks patient had recovered from his deficits a n d was discharged. DISGUSSION T h e subclinical psychological deterio­ ration as had been described is a type of cognitive dysfunction in Alcoholics which would not always be clinically a p p a r e n t a n d might only be deducted on psycholo­ gical test (Brewer and Perret, 1971; J o n e s a n d Parsons, 1971; T a r t e r , 1973). I t was K.S. MOHAN, et al. considered to be a variant of alcoholic dementia (Cutting, 1978). T h e word " D e m e n t i a " seemed to be a misnomer for this entity but for w a n t of a b e t t e r term had been retained. It should be empha­ sized tl at it was totally different from the global n a t u r e of deficits and poor prog­ nosis of alcoholic d e m e n t i a . This concept of sub-clinical psychological deterioration had gained acceptance due to demons­ trable cognitive impairments in different degrees in chronic alcoholics without any clinical evidence of dementia. None of the workers had shown any direct rela­ tionships to the brain d a m a g e . However, the evidence that chronic alcoholic consu­ mption could result in brain d a m a g e was suggested by Jones a n d Parsons (1971) In this category the symptoms were of insidious onset a n d partially reversible with prolonged abstinence (Clarke and H a u g h t o n , 1975). It h a d been associated with a history of severe drinking or more than 10 years d u r a t i o n . T h e psychologi­ cal impairments t h a t h a d been described in the literature w e r e ; poor abstractibility (Page a n d Linden, 1974), i m p a i r m e n t of frontal lobe functions (Ron, 1977) a n d . deficit in perception a n d memory for n o n ­ verbal stimuli (Gregson a n d Taylor, 1977). I n the present case there was only i m p a i r m e n t of abstract thinking, calcula­ tions, perceptual organizations a n d spatial relationships. It h a d been suggested by p n e u m o e n c e p h a l o g r a p h y a n d autopsy that, the lesions were mainly confined to the frontal lobes ( H a u g , 1968). In the present study the C. T . S C A N showed gross cerebral atrophy in contrast to the mild cognitive deficits. T h e t r e a t m e n t of such-sub-clinical psychological deteriora­ tion type had n o t been properly documen­ ted in the literature, however the partial reversibility a n d arrest of further progress were of clinical significance. I n view of gross cerebral atrophy, the authors are of the opinion that the term alcoholic demen-