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What is Alcoholic Dementia (Alcohol-Related Dementia)?

Dementia is a brain disorder that causes a progressive loss of cognitive function. It affects memory and impairs your ability to think and make decisions. Often, it gets to the point where it interferes with your daily life.

Alcohol-related dementia (ARD), also known as alcoholic dementia and alcohol-induced dementia, is an umbrella term for any dementia caused by heavy drinking. Some examples of alcohol dementia are:

  • Alzheimer’s disease — the most common type which, accounts for up to 80% of cases
  • Vascular dementia — caused by decreased blood flow to the brain
  • Wernicke Encephalopathy (WE) — primarily affects the central nervous system
  • Korsakoff Syndrome (KS) — causes memory problems and psychiatric symptoms
  • Wernicke-Korsakoff Syndrome (WKS) — has the symptomatic features of WE and KS

Numerous studies explore the link between alcohol and dementia. According to French research, alcohol is associated with 38.9 percent of early-onset dementia cases, and 17.6 percent of dementia patients had alcohol use disorders.1 

How Can Alcohol Lead to Dementia?

Alcohol-related brain damage seems to be the common cause of alcoholic dementia. One study shows that up to 78% of alcoholics exhibit signs of alcohol-related brain injuries.2 

So how does alcohol cause brain damage and dementia? Here are some possible explanations:

1. Alcohol contains ethanol

Ethanol is the main chemical component of alcoholic drinks. Whether you’re drinking wine, beer, or alcohol, the body metabolizes the ethanol into acetaldehyde. Acetaldehyde has a neurotoxic effect on the brain.

Alcohol damages the frontal lobes - the same parts of the brain that get damaged with dementia. Evidence suggests a loss of white matter and neurons (brain cells) in these areas, as well as a reduction in brain size (brain atrophy).

2. Alcohol misuse causes chronic health problems which damage the brain

Long-term alcohol use and alcohol addiction are associated with various health risks. Some of which can lead to brain damage and other forms of dementia. These include:

Hypertension

Hypertension or high blood pressure is a vascular condition that develops with heavy drinking. It causes blood vessels to constrict and become narrow, which then reduces blood flow to the brain. This depletes the brain of its much-needed oxygen and slowly damages it over time. Eventually, this can lead to vascular dementia.

Liver disease

Excessive alcohol consumption gradually develops into liver disease. This impairs the liver’s ability to filter toxins and dispose of them. Toxins like ammonia build up in the bloodstream and make their way to the brain. These toxins cause permanent or temporary brain injury, resulting in hepatic encephalopathy — a known risk factor of dementia.

Some researchers argue that while it causes symptoms similar to Alzheimer’s, it doesn’t meet the criteria for dementia.3 However, there is evidence that liver disease causes brain lesions and cognitive decline, even without hepatic encephalopathy.4,5

3. Alcohol puts you at risk for traumatic brain injuries

Drinking alcohol has immediate effects on the body. They can put you at risk for falls, motor vehicle accidents, and other incidents that may result in traumatic head injuries — such as getting into fights.

Some physical effects of alcohol include:

  • Lowered social inhibitions
  • Decreased level of alertness
  • Impaired judgment
  • Drowsiness
  • Impaired fine motor skills
  • Difficulty balancing
  • Aggressive behavior

Traumatic brain injury (TBI) disrupts the brain’s nerve fibers and neural networks, thus increasing your risk for neurodegenerative disorders like Alzheimer’s disease.6 Research further shows that it only takes one head injury for dementia to develop in later years. The more head injuries a person sustains, the greater their risk.7

Moreover, a head injury can increase your risk for epilepsy, which has also been associated with alcohol-related dementia.

4. Alcohol causes thiamine deficiency

Drinking too much alcohol causes inflammation of the stomach’s inner lining, preventing the absorption of nutrients such as thiamine. People with alcohol use disorders also tend to have poor diets, so they’re more likely to have vitamin deficiencies.

Thiamine (Vitamin B1) provides energy to the brain, facilitates the transmission of nerve impulses, and maintains the structural integrity of membranes that protect nerves. Given its role in brain function, a deficiency would likewise result in neurological problems.2

The problems caused by vitamin B1 or thiamine deficiency include:

  • Wernicke Encephalopathy (WE)
  • Korsakoff Syndrome (KS)
  • Wernicke-Korsakoff Syndrome (WKS)

These conditions produce symptoms that are similar to dementia, which is why they’re sometimes referred to as alcohol-related dementia.

5. Drinking and alcohol withdrawal increases your risk for seizures

Drinking to the point of intoxication disrupts brain function. It interferes with neurotransmitters which are responsible for controlling the excitability of brain cells. This excitability of neurons is what triggers seizures in patients with alcohol dementia. People with epilepsy and chronic alcoholics in withdrawal are especially vulnerable.

The problem with seizures is that they damage the hippocampal area of the brain. This can affect a person’s memory and lead to dementia.9

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What are the Primary Symptoms of Alcoholic Dementia?

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) describes alcohol dementia as a condition that results in multiple cognitive deficits. Among its symptoms are:

  • Impaired memory — including being unable to recall previously learned information and learn new information
  • Aphasia — a language disturbance that makes it difficult for a person to express themselves in words
  • Apraxia — the inability to carry out tasks despite showing interest or having the physical ability to perform them
  • Agnosia — an impaired ability to recognize objects, faces, voices, or places
  • Poor executive functioning — struggling with mental skills that help you manage tasks, like planning and organizing

A person with alcohol-induced dementia will exhibit these symptoms even when they aren’t intoxicated or undergoing withdrawal. They will also suffer a significant decline in function.

That being said, alcohol dementia can produce a range of symptoms. It depends on which areas of the brain are affected and how severe the condition is. Below are common types of alcoholic dementia and some early signs you can watch out for.

Alzheimer’s Disease

People with Alzheimer's will struggle to make sense of their environment. Memory lapses are also common in the early stages of this condition. For instance, they might forget about a recent conversation or ask the same question repeatedly.

Other early signs of Alzheimer’s include:

  • Impaired judgment
  • Being less spontaneous
  • Showing less initiative
  • Losing or misplacing objects
  • Confusion (e.g., wandering and getting lost)
  • Mood swings
  • Increased aggression
  • Struggling with financial responsibilities (e.g., paying bills on time)

Alzheimer’s dementia is progressive. Someone who has mild Alzheimer’s may appear healthy at first. But as their condition worsens, so do a person’s symptoms.

Vascular Dementia

Symptoms of vascular dementia sometimes overlap with Alzheimer's disease and other forms of dementia. However, each person can have different symptoms depending on which part of the brain has reduced blood flow. 

People with vascular dementia also tend to struggle more with problem-solving skills and thinking speed rather than memory loss.

Other vascular dementia symptoms include:

  • Slowed thinking
  • Difficulty concentrating or paying attention
  • Reduced ability to organize thoughts and actions
  • Struggling to decide what to do next
  • Impaired analytical skills
  • Unsteady gait
  • Inability to organize and plan
  • Restlessness and agitation

The symptoms of vascular dementia may occur gradually or appear suddenly, such as after a mild stroke. 

Wernicke-Korsakoff Syndrome

This condition usually starts with thiamine deficiency. If it isn’t treated, it can develop into Wernicke’s encephalopathy.

The signs of Wernicke encephalopathy include:

  • Decreased mental acuity
  • Confusion
  • Poor muscle coordination
  • Muscle weakness
  • Leg tremors
  • Loss of balance
  • Vision problems
  • Abnormal eye movement (e.g., drooping eyelid)
  • Inability to move eyes

Wernicke encephalopathy can progress into Korsakoff if left untreated. However, Korsakoff syndrome may also occur independently or simultaneously with Wernicke.

The signs of Korsakoff syndrome include:

  • Inability to create new memories or learn new things
  • Changes in personality
  • Making up stories to compensate for long-term memory gaps (confabulation)
  • Seeing or hearing things that aren’t there (hallucinations)

When these symptoms overlap, it is known as Wernicke-Korsakoff Syndrome. This can further progress into Korsakoff psychosis.

Who is More at Risk of Developing Alcohol-Related Dementia?

Based on a cross-study analysis, the following increases your risk for alcohol dementia:2

  • If you are male
  • If you have a dual diagnosis (e.g., alcohol use disorder and mental health disorder)
  • If you have other physical conditions that increase your risk for ARD (e.g., liver disease, vitamin B1 deficiency, and epilepsy)
  • If you are socially isolated (e.g., single or does not get support from family and friends)
  • If you have a history of brain injury

The presence of more than one risk factor increases the chances of developing alcohol-related dementia. Generally speaking, however, anyone with an alcohol disorder is at risk. This includes people who struggle with alcohol use and addiction.

Is Alcoholic Dementia a Normal Part of Aging?

The risk for dementia increases as you grow old. But contrary to popular belief, it isn’t a normal part of aging.10

For instance, the average older adult may forget things from time to time. In comparison, someone with dementia will slowly forget how it's like to perform basic activities. 

At most, the memory problems caused by normal aging will inconvenience you. Dementia impairs cognitive ability in a way that it becomes difficult to function properly.

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Potential Complications of Alcoholic Dementia 

Unless a person stops drinking alcohol, alcohol-related dementia only worsens with time. It can lead to permanent brain damage which consequently, causes them to cease normal functioning.

People with severe dementia symptoms might not be able to:

  • Care for themselves (e.g., poor hygiene)
  • Perform basic activities (e.g., eating and bathing)
  • Recognize friends or family members
  • Communicate what they think or feel
  • Follow instruction
  • Move about (immobility)
  • Find their way around places

These can lead to complications that reduce a person's quality of life, such as:

1. Malnutrition

Some types of alcohol dementia cause a person to lose their sense of smell and taste. As food becomes tasteless and they are left to fend for themselves, they might not eat as often, or they might not eat at all. This can lead to nutritional deficiencies, which further aggravate their condition.

Keep in mind that dementia severely affects memory. For example, a person with dementia might not remember what food is for or how to use a spoon.

2. Harm to self and others

A person with severe dementia may suffer from mood swings and a confused mental state, so they are easily agitated. Since they can’t make sense of things, situations can quickly escalate into violence where they might hurt themselves or others.

3. Accidental injuries

Alcoholic dementia increases the risk for falls by 2 to 8 times.11 This can be a problem for elderly individuals with degenerative bone disorders. Falls can easily cause fractures if they have osteoporosis or osteoarthritis.

4. Infections

Pneumonia and urinary tract infections (UTIs) are prevalent in older adults. Since people with dementia tend to have poor hygiene, their chances of being infected are greater. Infections can also go unnoticed since they can’t express themselves. These infections can spread throughout the body and cause sepsis.

Consequently, infections such as pneumonia and sepsis can increase a person’s risk for dementia.12 So if you have alcohol-related dementia, they can potentially worsen your condition.

5. Neglect/Abuse

Up to 55 percent of dementia patients have a history of abuse. They are often abused by family members who may be overwhelmed with having to care for them. However, healthcare workers may also abuse them while they’re seeking treatment. 13

6. Korsakoff Psychosis

Wernicke's encephalopathy can progress into Korsakoff psychosis, which is both severe and untreatable. Patients who have this condition will develop amnesia. They won't be able to recall new information and memories from before its onset.

What Treatments are Available for Alcohol-Induced Dementia? 

When it comes to alcohol dementia, medical professionals aim to prevent dementia symptoms from becoming worse. Patients must undergo substance use treatment so they can successfully quit alcohol.

Patients with Wernicke’s encephalopathy and Korsakoff syndrome may be given oral thiamine in addition to receiving addiction treatment. Oral thiamine treats the vitamin deficiencies which resulted from alcohol misuse.

Is Alcoholic Dementia Reversible?

Numerous studies show that quitting drinking reverses alcohol-related dementia. It helps with the partial recovery of white matter and damaged brain cells, improving a person's motor skills and cognitive abilities.14

Thiamine supplements also reduce the impact of alcohol-related brain injury in patients with Wernicke-Korsakoff Syndrome. This helps improve their brain function and reverse acute symptoms.15

Researchers agree that alcohol-related dementia isn't completely reversible. People who fail to get immediate treatment may eventually develop permanent brain damage.14,15

How Long Does Treatment Take to Work?

Alcohol treatment takes several weeks to start taking effect. After 6 to 7 weeks, the brain starts regaining its volume, and the patient will exhibit neuropsychological improvements.16

However, the duration of thiamine treatment isn’t standardized. Some medical practitioners suggest a short-course treatment that lasts for 3 to 5 days.17 Others recommend taking thiamine supplements for an extended period, even after the patient has recovered.14

Signs You Have a Drinking Problem (+ Treatment Options)

If you have an alcohol disorder, medical professionals recommend seeking treatment as soon as possible. Below are six signs of alcoholism you can watch out for:

  1. Inability to control your drinking
  2. Intense alcohol cravings
  3. Experiencing withdrawal when you stop drinking
  4. Increasing tolerance to alcohol
  5. Impaired decision making
  6. Spending more time drinking despite consequences

People who misuse alcohol can seek help from treatment facilities that offer inpatient and outpatient rehab programs

Those with more severe alcohol use can initially opt for medication-assisted treatment (MAT). Medications can reduce alcohol withdrawal and prevent relapse during early recovery. Afterwards, they can proceed with addiction treatment.

Recovering individuals and chronic alcoholics may also get additional support from sober living homes. Alternatively, you can join self-help groups such as Alcoholics Anonymous (AA). These peer-based systems help patients sustain long-term sobriety after receiving substance use treatment.

Other Harmful Brain Effects of Chronic Alcohol Use

Alcohol-related dementia isn’t the only consequence of long-term alcohol use. By causing extensive damage to the brain, alcohol can either lead to mental health problems or worsen pre-existing conditions such as anxiety, depression, and bipolar disorders.

Alcohol is a dangerous and addictive substance with long-term consequences. Thankfully, most of these complications can be alleviated with early diagnosis and substance use treatment. If you have an alcohol problem, or if you suspect misuse in a loved one, find a health professional that can provide medical advice.

Resources

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(1) “Contribution of alcohol use disorders to the burden of dementia in France 2008–13: a nationwide retrospective cohort study.” The Lancet Public Health.

(2) “Alcohol-related dementia: an update of the evidence.” National Center for Biotechnology Information.

(3) “More than half of liver patients experience neurocognitive impairments.” Loyola University Health System.

(4) “Liver Disease as a Risk Factor for Cognitive Decline and Dementia: an Under-Recognized Issue.” American Association for the Study of Liver Diseases.

(5) “Cognitive functions in patients with liver cirrhosis: assessment using community screening interview for dementia.” PubMed

(6) “What is the Relationship of Traumatic Brain Injury to Dementia?”. PubMed.

(7) “Head injury and 25-year risk of dementia.” Alzheimer’s and Dementia Journal.

(8) “Alcohol and epilepsy.” PubMed.

(9) “Dementia and epilepsy.” American Academy of Neurology.

(10) “Memory, Forgetfulness, and Aging: What's Normal and What's Not?” National Institute on Aging.

(11) “Analysis of the risk and risk factors for injury in people with and without dementia.” National Center for Biotechnology Information.

(12) “Assessment of common infections and incident dementia using UK primary and secondary care data.” The Lancet.

(13) “Domestic violence and elderly dementia sufferers.” SAGE Journals.

(14) “Alcohol-related dementia (alcohol-induced dementia; alcohol-related brain damage).” Oxford Medicine Online..0 

(15) “The Role of Thiamine Deficiency in Alcoholic Brain Disease.” National Institute on Alcohol Abuse and Alcoholism.

(16) “Manifestations of early brain recovery associated with abstinence from alcoholism.” PubMed.

(17) “Thiamine (vitamin B1) treatment in patients with alcohol dependence.” PubMed.

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