What is Alcohol-Induced Dementia?
Long-term heavy alcohol consumption or alcohol addiction causes significant brain abnormalities and impairs cognitive functioning. A number of terms have been used to describe these effects, including: ‘alcohol-related dementia’, ‘alcohol-induced dementia’, and ‘alcoholic dementia’. Many individuals labeled as having alcohol-induced dementia are, in fact, suffering from the Wernicke–Korsakoff syndrome (WKS).
Diagnostic Criteria for ‘Substance-Induced Dementia’ are Included in DSM-IV:
A. The development of multiple cognitive deficits manifested by both:
(1) Memory impairment (impaired ability to learn new information or to recall previously learned information)
(2) One (or more) of the following cognitive disturbances:
- Aphasia (language disturbance)
- Apraxia (impaired ability to carry out motor activities despite intact motor function)
- Agnosia (failure to recognize or identify objects despite intact motor-sensory function)
- Disturbance in executive functioning (i.e. planning, organization, sequencing, abstracting)
B. The cognitive deficits in criteria A1 and A2 each cause significant impairment in social or occupational functioning and represent a significant decline from a previous level of functioning.
C. The deficits do not occur exclusively during the course of a delirium and persist beyond the usual duration of substance intoxication or withdrawal
D. There is evidence from the history, physical examination, or laboratory findings that the deficits are aetiologically related to the persisting effects of substance use (e.g. a drug of abuse, a medication)
Wernicke-Korsakoff Syndrome
One of the syndromes of alcoholic dementia is known as Wernicke-Korsakoff syndrome (WKS), which is really two disorders that may occur independently or together: Wernicke’s encephalopathy and Korsakoff syndrome, also known by Korsakoff psychosis. Wernicke’s encephalopathy is characterized by a syndrome involving ophthalmoplegia (abnormal eye movements), ataxia (unsteady gait), and confusion.
What Causes Alcohol-Induced Dementia
Alcohol itself does not cause Wernicke-Korsakoff syndrome as much as the damage to the brain cells that takes place with a thiamine deficiency (vitamin B1). People with severe alcohol use disorders tend to have nutritional deficiencies from a poor diet.
Thiamine deficiency is common among chronic alcoholics, which is a problem because nerve cells require thiamine to function properly. A chronic lack of vitamin B1 can damage them permanently.
Effects of Alcohol-Induced Dementia on the Brain
If Wernicke’s is not adequately treated, it may result in Korsakoff syndrome, or Korsakoff psychosis, which involves significant impairments of memory and other cognitive functions. The most distinguishing symptom is confabulation (fabrication) where the person makes up detailed, believable stories about experiences or situations to cover gaps in memory.
Those suffering from alcohol-induced dementia may have very little ability to learn new things, while many of their other mental abilities are still highly functioning. Sometimes, noticeable personality changes take place.
How Much Alcohol is Too Much Alcohol
‘High’ levels of alcohol consumption can range from 10 ‘standard’ drinks a week to more than 9 ‘standard’ drinks a day. Reduced frontal lobe volume has been associated with an amount of 418 grams a week but has not correlated with lower levels of consumption.
One review suggested that consumption of five to six drinks per day (which, by US standards, equates to 70 to 84 grams) over extended periods results in ‘cognitive inefficiencies’, while consumption of 10 or more standard drinks a day manifests as moderate cognitive deficits equivalent to that found in individuals with diagnosed alcoholism.
Alcohol-Induced Dementia Signs & Symptoms
The signs of alcohol-induced dementia a person exhibits may vary depending on the type of alcohol dementia they have. Some common signs of alcohol dementia include:
- Explained changes in personality or character
- Lying without realizing it
- Abnormal eye movement
- Decreased or abnormal reflexes
- Fabricating stories
- Memory loss
- Muscle weakness
- Difficulties appropriately stringing sentences or words together
- Problems with motor movement and coordination
- Loss of speech
- Difficulties learning
- Trouble with complex problem-solving
- Getting lost on familiar paths
- Difficulties completing simple tasks, like following a cooking recipe
- Confusion regarding the place or time the person is in
Acute Effects of Alcohol
Alcohol usually refers to the molecule ethanol. As an amphiphile, it is rapidly absorbed from the stomach and duodenum after oral consumption and passes the blood-brain barrier. The distribution and elimination show strong variability due to fed- or fasting state, drinking patterns, age, and genetics.
In the central nervous system, ethanol modulates the function of multiple receptors: voltage-gated calcium channels and glutamate receptors are inhibited by alcohols, whereas some others, such as g-aminobutyric acid type A (GABA-A) receptors, glycine receptors, n-acetylcholine- and 5-HT3-receptors, are potentiated.
Prior hypotheses on the effect of alcohol on cell membrane function in the central nervous system are viewed as less relevant to its acute effects. The effects appear to be dose-related since at low dosages alcohol affects monoaminergic transmission and produces disinhibition and euphoria, while at high dosages anxiolytic and sedative effects are more prominent, mediated through increasing GABA activity and inhibiting excitatory amino acids.
Types of Alcohol-Related Brain Damage (ARBD)
The Alzheimer’s Society divides alcohol-related, or alcohol-induced Dementia into two main types:
- Alcohol-Induced Dementia: This is an often fully or partially reversible form of Dementia that may lead to poor planning and organizational skills; problems with decision-making and judgment; impulsiveness and difficulty controlling emotions; attention and reasoning problems; lack of sensitivity to the feelings of others; and socially inappropriate behavior. This form of Dementia differs from Korsakoff syndrome in that not everyone affected has day-to-day memory loss.
- Korsakoff Syndrome: While it’s the most well-known form of ARBD, Korsakoff syndrome is much less common than other forms of ARBD, such as alcohol induced Dementia. It often develops as part of a condition known as Wernicke-Korsakoff syndrome, which encompasses two stages: Wernicke encephalopathy followed by Korsakoff syndrome. A thiamine deficiency causes it.
- Wernicke Encephalopathy: This condition often appears suddenly and needs immediate treatment. Symptoms may include confusion, balance, and movement issues; loss of coordination; vision problems like double vision, drooping eyelids, quick eye movements; a faster-than-normal heartbeat; low blood pressure when standing; a lack of energy; and fainting. If Wernicke’s encephalopathy isn’t treated quickly, it can lead to Korsakoff syndrome. Unfortunately, not everyone experiences an apparent episode of Wernicke encephalopathy before Korsakoff syndrome develops.
- Korsakoff Syndrome: This condition tends to develop more slowly and is defined by short-term memory loss. Someone with Korsakoff syndrome might have a normal conversation and seem like themselves, only to forget the dialogue and the people involved moments later.
Testing
In alcohol-induced dementia, examination of the nervous system can reveal various types of damage, including:
- Abnormal eye movement
- Decreased or abnormal reflexes
- Fast pulse (heart rate)
- Low blood pressure
- Low body temperature
- Muscle weakness and atrophy
- Problems with walk (gait) and coordination
Treatment for Alcohol-Induced Dementia
Early treatment is the key to successfully treating alcohol-induced dementia. If caught early enough, patients with the more general type of alcohol-related dementia can show much improvement by quitting alcohol and improving their diet.
Prompt treatment with thiamine (vitamin B1) for people with Wernicke encephalopathy can potentially prevent or lessen the development of Wernicke-Korsakoff syndrome. However, vitamin B1 treatment rarely improves the loss of memory that takes place once Korsakoff psychosis has developed.
Quitting drinking will prevent additional loss of brain function and damage. Also, improving the patient’s diet can help, but it does not substitute for alcohol abstinence in preventing further alcoholic dementia.
Symptoms of Alcoholism
As stated by the National Institute on Alcohol Abuse and Alcoholism, these are the signs to be aware of in terms of this condition:
- Appearing intoxicated more regularly
- Appearing tired, unwell or irritable
- An inability to say no to alcohol
- Becoming secretive or dishonest
- Drinking more, or longer than one intended
- Wanting to cut down or stop drinking, or tried to, but haven’t been able to do so
- Spending a lot of time drinking, being sick or getting over the aftereffects
- Experiencing craving, a strong need, or urge to drink
- Founding that drinking, or being sick from drinking, often interferes with taking care of your home or family, job troubles or school problems
- Continuing drinking even though it was causing trouble with family or friends
- Giving up or cutting back on activities that are important or interesting to you, in order to drink
- More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)
- Continuing to drink even though it was making you feel depressed, anxious, or adding to another health problem, or after having had a memory blackout
- Having to drink much more than you once did to get the effect you want. Or finding that your usual number of drinks have much less effect than before
- Finding that when the effects of alcohol are wearing off, you have withdrawal symptoms, such as trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, or sweating.
Treatment for alcoholism
When it comes to Alcoholism treatment, it is normal to think of 12-step programs or 28-day inpatient rehab, but it becomes difficult to think of more options of treatment for this condition. There are a variety of treatment methods currently available. According to the National Institute on Alcohol Abuse and Alcoholism, there are three types of treatment:
- Behavioral Treatments for alcoholism: are aimed at changing drinking behavior through counseling. They are led by health professionals and supported by studies showing they can be beneficial.
- Medications for alcoholism: Three medications are currently approved in the United States to help people stop or reduce their drinking and prevent relapse. They are prescribed by a primary care physician or other health professional and may be used alone or in combination with counseling.
- Peer-Support Groups for alcoholism: Alcoholics Anonymous (AA) and other 12-step programs provide peer support for people quitting or cutting back on their drinking. Combined with treatment led by health professionals, mutual-support groups can offer a valuable added layer of support. Due to the anonymous nature of mutual-support groups, it is difficult for researchers to determine their success rates compared with those led by health professionals.
Reclaim Your Life From Alcohol-Induced Dementia
Early treatment is the key to successfully treating alcohol-induced dementia. If caught early enough, patients with the more general type of alcohol-related dementia can show much improvement by quitting alcohol and improving their diet. We Level Up Washington can provide you, or someone you love, the tools to recover from alcoholism with professional and safe treatment. Feel free to call us to speak with one of our counselors. We can inform you about this condition by giving you relevant information. Our specialists know what you are going through. Please know that each call is private and confidential.
