Excessive alcohol use is known to have a direct detrimental effect on the brain and its functionality. Some effects of alcohol abuse include memory loss, poor judgement, indecisiveness, and lack of insight, all of which lead to struggling in daily tasks. This phenomenon is termed Alcohol Dementia/Alcohol-induced Dementia/Alcoholic Dementia/Alcohol-related Dementia which is a type of alcohol-related brain damage (ARBD).

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These dementias can be caused by long-term alcohol abuse. To make matters worse, nutritional deficiencies often accompany prolonged alcohol abuse. This becomes a synergistic factor in the deterioration of brain cells. This means that excessive alcohol can cause early-onset dementia. However, it is important to note that Alcohol-related dementia progression is reversible. Also, that moderate alcohol consumption does not lead to any kind of dementia or loss of cognitive ability.

The Types of Alcohol-related Brain Damage

There are many different types of dementia brought on by alcohol abuse

Alcoholic dementia VS. Alzheimer’s disease:

Alcoholic dementia and Alzheimer’s disease shares some characteristics with each other, for example, they both affect cognitive function and memory. But in fact, they are both completely different diseases with different causes and progression. However, some studies have shown that alcohol consumption can worsen Alzheimer’s symptoms.

Whilst we are talking about types it is noteworthy to mention that Lewy Body Dementia is not associated with alcoholism or smoking. Its risk factors are limited to age, Parkinson’s disease and family history.

Vascular Dementia:

There is a type of dementia that is associated with alcohol. It is called vascular dementia. Its usual causes are mini-strokes, high blood pressure and narrowing of blood vessels inside the brain. Since alcohol has a similar effect on the vascular system, it is a known risk factor for developing vascular dementia. Therefore, if patients with Vascular dementia regularly drink alcohol, it could speed up the progress of their dementia. The main difference between this Alcohol-related Dementia and Vascular Dementia is their cause and alcohol-induced Dementia can regress whilst the latter can’t.

  • Alcoholic dementia: This type of dementia is known to be one of the reversible types. Its main symptoms include reduced organisational skills and trouble planning. Additionally, such patients have problems in decision making and impaired judgement. What’s more, they have difficulty controlling emotions which leads to impulsivity. They also have problems forming relationships due to lack of sensitivity and general apathy causing them to behave inappropriately in social settings. The main difference between Korsakoff syndrome and Alcohol-related dementia is that this does not affect short-term memory.
  • Wernicke-Korsakoff syndrome/ Alcohol-induced Wet brain syndrome: Korsakoff syndrome is a relatively rare subtype of Alcohol-related dementia. It usually occurs when a person is suffering from Wernicke-Korsakoff syndrome, which is a syndrome with two stages- Wernicke Encephalopathy and Korsakoff syndrome. The cause is believed to be Thiamine deficiency. If not treated in a timely manner it is known to decrease the life expectancy of the patient. However, if the patient manages to abstain from alcohol after their treatment the life expectancy reverts to normal.
    1. Wernicke Encephalopathy: It is a sudden onset disease and it is crucial to seek immediate treatment once diagnosed. The signs and symptoms include problems with balance, confusion, (ataxia) loss of coordinated movements, double vision, drooping eyelids, ophthalmoplegia (quick, short eye movements), tachycardia (increased heart rate), positional hypotension (low blood pressure when standing up), lack of energy, fainting and fainting spells.
    2. Korsakoff syndrome: It is the condition that follows Wernicke Encephalopathy. This develops relatively slower than the previous stage and its important feature is loss of short-term memory. As a result of the memory loss, the patient tends to compensate by confabulation. Confabulation is a term commonly associated with Alcoholic dementia; it means to make up explanations or stories whilst believing that they are in fact the truth. Furthermore, Korsakoff syndrome can lead to long-term gaps in memory, trouble in placing context which causes difficulty in understanding and even difficulty in conversing. In its late stages, it may lead to difficulty in solving problems and hallucinations. Korsakoff syndrome can also result in alcohol-related Korsakoff psychosis.
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What are the signs and symptoms of Alcohol-induced Dementia?

The most common early symptom of alcohol-induced dementia is confusion, it is also the one that is spotted most easily. Sometimes losing short-term memory accompanies the confusion. It is worthwhile to note that Skills developed during the patient’s childhood are relatively unaffected.

The symptoms of alcohol-related dementia tend to vary from patient to patient as the alcohol damage isn’t exactly targeted. Brain scans show that different areas of the brain have shrunken for each patient, however, usually, the frontal lobes are always affected. The Frontal lobe is responsible for actions like planning, organising, initiation and self-monitoring. This is termed Frontal Lobe Dementia which is also caused by alcoholism. The symptoms of frontal lobe dementia include the loss of the above-mentioned skills. This shows there is a direct relationship between alcoholism and frontal lobe dementia.

Additionally, a common symptom is loss of short-term memory. Patients with alcohol-induced dementia tend to forget details of recent conversations which may lead to difficulty in making sense of a situation. For example, a patient might have forgotten where their previous home was which makes it hard for them to understand the events that took place during the time they spent in that home.

Another common symptom amongst these patients is loss of balance which causes them to be unsteady on their feet even in a sober state. This occurs because the alcohol damages the part of the patient’s brain (cerebellum) which controls posture, coordination, and balance.

Repeated alcohol abuse and depression related to dementia are some of the problematic behavioural changes in such patients. Other mood-related changes include irritability and apathy. These changes make it more difficult for the patient to withdraw from alcohol abuse and they can suffer from loss of communication and relationships due to their cold demeanour.

The following is an overview of Alcohol-related Dementia signs and symptoms according to Mayo Clinic:

  • Difficulty in planning, organising, and solving problems
  • The unclear thought process, illogical actions
  • Struggling with setting goals, making decisions and judgements
  • Not finding the motivation for daily tasks (even vital ones like eating/drinking)
  • managing their emotions (having frequent outbursts)
  • difficulty in navigating through interpersonal interactions (apathetic, indifferent behaviour towards others)
  • Impaired ability to learn things
  • Personality changes
  • Problems with memory
  • Problems with keeping balance
  • Diminished initiative and lack of spontaneity.

What is the treatment for Alcohol-related Dementia?

According to the treatment guideline for Alcohol-related Dementia, the initial stage requires the patient to abstain from alcohol completely and stabilise their health. It is preferred that patients suffering from Alcohol-related dementia are admitted to the hospital during this stage.

Alcohol withdrawal is a very painful process. The patient usually ends up in delirium. During which, they become increasingly confused and distracted. They also suffer from disorientation and mood swings. The signs in such patients include increased heart rate, increased sweating and general anxiety. Delirious patients also hallucinate sometimes.

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During the treatment, the patient is administered a drug that mimics the effect of alcohol on the brain to ease the pain of withdrawal symptoms. The patient is then slowly weaned off from these drugs and they are monitored closely at this time. In a hospital setting the patient is also administered salts, fluids, and high levels of vitamin B1 (Thiamine) through IV.

The treatment of Alcohol-related Dementia is not limited to medication, the patient also needs therapeutic support. Namely, counselling or one-on-one therapy that encourages an alcohol-free lifestyle. Furthermore, the patient should join group therapy sessions once they are discharged from the hospital facility.

However, taking the step towards non-medicinal treatment proves difficult for many patients. This is due to the behavioural changes caused by Alcohol-related Dementia. This includes symptoms like denial, reduced insight and impulsivity. This can cause the patient to behave erratically during therapy sessions and often lose focus as a result.

Numerous patients end up having a prolonged stay at the hospital due to a lack of special care. However, this can be avoided according to the patient’s condition. If their behaviour is relatively committed and docile, they can be discharged to continue their non-medicinal treatment from the comfort of their own home. Community support during such times is helpful.

An example of such community support is a self-help group known as Alcoholics Anonymous. This is a support group for patients struggling with alcohol abstinence. This group provides support from many other individuals struggling with similar problems and is directed by a mediator.

During the time of discharge, the patient is prescribed a low dose medicine that mimics the effect of alcohol for when they are craving it. They are given proper instructions on how to use the drug. They are also required to take a very high dose of thiamine (vitamin B1) tablets. They are also advised to maintain health and take a balanced diet.

It is a known fact that patients recovering from Alcohol-related Dementia can be increasingly difficult to deal with. However, their caring family members and friends must know that it will be beneficial for them to seek some counselling or hire paid carers to help them out during this difficult time. For such people, some support groups also have a ‘complex needs’ department which is equipped to help deal with such persons.

Alcohol abuse can have long term consequences. If a loved one is suffering from symptoms, it is time to seek help. During the process, paid carers can greatly help take the burden off the primary carer, and offer companionship and care for the patient.

Dr Jamie WilsonFounder and Chief Medical Officer at Hometouch

Dr Jamie Wilson is hometouch’s founder and Chief Medical Officer. Jamie’s creation of hometouch was inspired by his work as a dementia psychiatrist in the NHS, and he has written about healthcare issues in The Times and the Evening Standard. Jamie has a MBBS from the University of Leeds and has spent a decade in the NHS, working as a Psychiatric Registrar and Memory Specialist at Imperial College Hospital.

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