We have described a potential continuum between ARBD, WE and KS with respect to changes in human behavior and brain structure. The clinical diagnosis of ARBD and WE remains difficult; however, an awareness of current research findings and a high index of suspicion can aid in the detection of these conditions. An intimate relationship seems to exist between alcohol use and thiamine deficiency, and we hypothesize that both ARBD and WE may develop as a result of repeated episodes of subclinical thiamine deficiency.138 Neuroradiological examination (with MRI) is a valuable tool in the diagnosis of acute WE and enables in vivo tracking of the progression of brain pathology from ARBD to KS. An awareness of the facts presented herein by clinicians and other health workers could help minimize the overall burden of ARBD. Moreover, public education programs should be promoted so that individuals using alcohol become aware of the associated risks and gain an understanding that components of the structural and functional changes linked to alcohol use are potentially reversible with abstinence.
