Alcohol-Related Dementia. Be Aware of Alcohol Consumption

There are currently 55 million people worldwide with a diagnosis of dementia. There are several risk factors for dementia, including increased alcohol consumption. However, prolonged excessive alcohol intake is a direct cause of Alcohol-Related Dementia (ARD). In addition, with our aging population, there is more concern about an upsurge in cognitive disorders related to longstanding lifestyle habits and preventable causes.

Key takeaways:
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    Excessive, prolonged alcohol intake increases the risk of developing cognitive impairment leading to Alcohol Related Dementia.
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    Alcohol-related dementia, unlike other types of dementia, may not be progressive if the person reduces or withdraws from alcohol.
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    Wernicke-Korsakoff Syndrome (WKS) is a thiamine deficient, neurological syndrome of memory loss and confusion. Prolonged excessive alcohol consumption disrupts gastric absorption of thiamine, causing WKS.
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    In the withdrawal from alcohol, someone with a history of prolonged excessive intake must be under direct medical supervision and may take weeks to withdraw safely.
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    Alcohol addiction in a diagnosed dementia such as Alzheimer’s can accelerate cognitive decline if someone continues to consume alcohol. Therefore, reducing or eliminating alcohol under your healthcare provider’s direction may slow progression.

Alcohol intake in moderation for the older adult is a maximum of two drinks per day in men and a maximum of one drink per day in women. However, in the case of alcohol-related dementia, research shows that people who drink excessively over a prolonged period are at a greater risk of developing ARD.

At this level of consumption, the genuine danger of brain cell damage is possible, causing cognitive impairment. Also called Alcohol Related Neurocognitive Impairment, people with increased alcohol intake tend to have inadequate dietary intake. Thiamine deficiency is associated with alcohol addiction and is responsible for severe neurological complications related to ARD.

Thiamine deficiency is not the only risk factor for ARD. Alcohol misuse can damage brain cells due to alcohol contributing to cerebrovascular disease. The alcohol addiction cycle of binging and then withdrawing also places immediate stress on the brain impairing cognitive function. People with alcohol addiction may have more falling cases, which can lead to head trauma.

Signs of dementia related to excessive alcohol consumption are like all types of dementia, but some core features are more evident.

Short-term memory impairment: repeating the same stories, trouble remembering things.

Language difficulty: finding the right words or substituting inappropriate words.

Difficulty with tasks that a person used to do quickly: cooking a meal, repairing a structure.

Missing essential events or appointments.

Misplacing items: repeatedly misplacing a wallet, keys, or essential documents.

  • Abnormal eye movements (nystagmus).
  • Loss of muscle coordination (ataxia).
  • Loss of muscle strength (atrophy).
  • Decreased reflexes (hyporeflexia).
  • Increased heart rate (tachycardia).
  • Decrease body temperature (hypothermia).
  • Hallucinations.
  • Confusion.
  • Making up stories (confabulation).

Wernicke-Korsakoff Syndrome (WKS)

This syndrome occurs when a person’s brain is deficient in thiamine (Vitamin B1). Thiamine is vital in producing energy from glucose consumption. WKS is most common in people with chronic, prolonged alcohol intake (alcohol use disorder) and most often occurs in men over 40.

The use of alcohol irritates the gastric mucosa causing a disturbance in the absorption of vitamins and other nutrients, including thiamine. Estimations report that 80% of people with alcohol addiction have a thiamine deficiency. In addition, other conditions can lead to WKS, including malabsorption syndromes, poor nutrition, extensive cancers, HIV, and chronic infections.

WKS is a neurological disorder and occurs in two stages: Wernicke’s Encephalopathy and, if left untreated, progression into Korsakoff Syndrome.

Wernicke’s Encephalopathy - an acute brain reaction due to the severe decline of thiamine. It is a medical emergency that may respond to injectable thiamine. Unfortunately 20% of people will die, and 85% will develop Korsakoff syndrome.

Features include:

  • Abnormal involuntary eye movements (nystagmus).
  • Loss of muscle coordination (ataxia).
  • Confusion.
  • Muscle loss.

Korsakoff Syndrome - most times, but not always, follows Wernicke’s Encephalopathy.

Features include:

  • Memory loss affecting the ability to form new memories.
  • Confabulation: when the person makes up elaborate stories to cover the gaps in memory.
  • Personality changes.

Diagnosis

If you or your loved one has a cognitive impairment related to alcohol consumption, an appointment with your medical practitioner is paramount for a clinical diagnosis. A medical assessment, including lab tests, radiological imaging, and cognitive screening, will help to determine the cause of the decline. Treatment will depend on if the reason is alcohol-related or from another source, such as vascular dementia or Alzheimer’s. A referral to a neurologist or geriatrician may also follow to determine the best course of treatment.

Treatment

A person with alcohol-related dementia may slow the progression or even improve cognition if they reduce or eliminate alcohol consumption. If they continue to drink, their cognitive decline will be progressive and most likely worsen.

The withdrawal from alcohol can take several weeks, and needs to be under medical supervision in a controlled environment.

Medications, including large doses of thiamine, will assist in reducing the risk of the medical complications of withdrawal.

Improving nutritional intake by eating a more balanced diet is also a critical factor in treatment.

Counseling and talk therapies for you and your loved one will help with coping and strategies in the withdrawal process. Support groups can also be beneficial.

Dementia with alcohol addiction

When someone with an alcohol addiction develops dementia, such as Alzheimer’s, it presents another challenge. This group represents people that will likely have an accelerated decline in their function due to the accompanying alcohol addiction. In addition, because this person will not necessarily remember when they last had a drink, they tend to overuse alcohol even more.

Check with your healthcare provider on strategies to possibly wean down the amount of alcohol by efforts such as replacing it with non-alcoholic beer and wine alternatives. When someone with an alcohol addiction has a sudden stoppage in alcohol levels, it can result in a medical emergency, including delirium tremens or cardiac complications.

Alcohol addiction can be the root cause of dementia or worsen an already diagnosed or underlying dementia. In either case, reducing or withdrawing alcohol is the key factor to lowering complications or, in some cases, improving cognitive status. Contacting your healthcare provider is the first step.

Dealing with a loved one with addiction is challenging. Contacting your medical practitioner, a private counselor, or organizations such as AlAnon, or your local Alzheimer’s Association can provide the needed support and strategies you need to help you and your loved one in recovery.

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