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Updated on November 19, 2021

Alcoholic Dementia: Symptoms & Treatment

Connection Between Alcohol & Brain Damage

Alcohol damages the brain in a variety of ways over both the short- and long-term.

In the short-term, this includes: 

  • Loss of coordination
  • Impaired speech
  • Memory issues
  • Poor judgement
  • Possible loss of consciousness

These are typically the results of binge drinking

In the long-term, chronic alcohol use increases the risk of permanent brain damage.

Effects include: 

  • Brain atrophy (shrinkage)
  • Memory issues
  • Learning disabilities
  • Permanently reduced balance and coordination

These long-term effects are sometimes referred to as alcoholic dementia. Other times, the term Wernicke-Korsakoff Syndrome (WKS) is used. These two terms are often conflated together, which can cause confusion.6, 10

Both alcoholic dementia and WKS are types of alcohol-related brain damage.5

What is Alcoholic Dementia? 

Alcoholic dementia involves memory loss and a variety of other cognitive impairments.

Both short- and long-term memory is affected by alcoholic dementia. This means it’s challenging to learn new information and remember things already learned. 

Along with memory issues, there are a host of other cognitive issues. 

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) is the official handbook used by the American Psychiatric Association

According to the DSM-V, a person with alcoholic dementia may exhibit memory impairment and one or more of these cognitive impairments1:

  • Aphasia — Loss of ability to use or understand spoken or written language  
  • Apraxia — Inability to perform specific physical actions despite will and knowledge to do so and relevant muscles being intact
  • Agnosia — Failure to recognize individuals, objects, or sounds, despite senses being functional
  • Executive Functioning Deficits — Impaired ability to plan, organize, or think abstractly

Aphasia seems to be less common with alcoholic dementia compared to other dementias.9

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Wernicke-Korsakoff Syndrome 

WKS is a disorder of brain function associated with a lack of thiamine (Vitamin B1)

It can happen to anyone if they are malnourished but is commonly seen in those addicted to alcohol. This is both because they eat poorly and because alcohol interferes with thiamine absorption.7

WKS is made up of two disorders that often occur together: Wernicke's Encephalopathy and Korsakoff Syndrome

Wernicke's Encephalopathy develops first and has three symptoms:  

  1. Confusion and disorientation
  2. Ataxia — Lack of muscle control or coordination 
  3. Eye abnormalities such as abnormal uncontrollable and repetitive eye movements 

Without medical intervention, about 80% of people with Wernicke’s Encephalopathy develop Korsakoff syndrome.8 

The main symptom is severe short memory impairment. A person may have a conversation and learn some new information and then forget it an hour later. 

However, long-term memory seems to be less affected.

Because they can engage in conversation, a person with WKS may appear normal at first glance. The person may not even be aware of the problem. 

Other symptoms of WKS include:

  • Rapid heartbeat 
  • Low blood pressure
  • Permanent nerve damage
  • Impaired physical coordination
  • Weakness in limbs
  • Loss of sense of smell

Wernicke-Korsakoff syndrome is potentially reversible in some circumstances.2 

However, about 20% of people with WKS may never fully recover.9

What Causes Alcohol-Induced Dementia?

There is currently a debate among scientists about the extent to which alcohol by itself damages the brain, as opposed to the damage from thiamine deficiency. 

This is why people sometimes confuse alcoholic dementia with WKS. 

It is possible that alcohol alone can cause dementia. 

Alcohol is a toxin that affects the brain in numerous ways, especially in chronic drinkers. One way it affects it is through brain atrophy.

MRI brain scans show that alcohol use causes certain parts of the brain to shrink over time. This shrinkage could cause dementia.

These include: 

  • Frontal lobes — These are important for voluntary movement, language, and executive function. One study showed shrinkage of 11% in this area in heavy drinkers.11
  • Cerebellum — This controls balance and movement
  • Corpus callosum — This helps with processing speed and enables the left and right hemispheres of the brain to communicate. One study has linked atrophy in this area to dementia.4
  • Hippocampus — This is responsible for learning and memory. It should be noted atrophy of this area is strongly linked to Alzheimer's Disease (a form of dementia).3

Many of the deficits caused by brain atrophy are similar to those seen in alcoholic dementia. 

In addition, heavy drinkers often have liver damage, which can affect metabolism and brain function. Those addicted to alcohol also tend to fall a lot, and head trauma could contribute to dementia.5

However, as stated, the exact cause of alcoholic dementia remains controversial. 

Scientists are still sorting this out, but animal studies show that the brain effects of thiamine deficiency and alcohol toxicity are similar. It has also been suggested that both factors play a role and may reinforce each other.8

What are the Symptoms of Alcoholic Dementia?

The symptoms of alcoholic dementia include:

  • Memory impairment
  • Changes in personality
  • Impaired executive functioning (planning, organizing, and abstract thinking)
  • Visuospatial problems (ex: inability to copy a clock)
  • Difficulty following simple instructions (ex: cooking recipes)
  • Physical unsteadiness or lack of coordination  
  • Decreased reflexes
  • Inability to recognize things based on their sound, taste, smell, etc
  • Disorientation
  • Loss of speech

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How is Alcohol-Related Dementia Diagnosed?

A diagnosis of alcohol-related dementia needs to meet four requirements:

  1. It meets the DSM-V criteria (memory impairment and at least one of the four categories of cognitive impairment)
  2. The deficits above cause significant problems at work or in social settings
  3. The deficits persist after withdrawal from alcohol
  4. There is evidence from personal history, physical exam, or tests that these problems are not due to some other cause

Is Alcoholic Dementia Treatable? What are the Options?

The best treatment for alcoholic dementia is total abstinence. If the person is still addicted to alcohol, treatment for the addiction is the first step, and many forms of help are available.

Alcohol addiction treatment begins with detoxification (or ‘detox’ for short). A variety of sedative drugs can help manage alcohol withdrawal symptoms. Medications used to treat alcohol addiction include:

  • Naltrexone
  • Disulfiram
  • Topiramate (not FDA-approved)
  • Baclofen (not FDA-approved)

Is Alcohol-Induced Dementia Reversible?

Unlike other forms of dementia, evidence shows alcohol-induced dementia may be reversible by abstaining from alcohol.10

Some improvement has been seen in just one month of abstinence, with mild improvements after six months.

However, in others, it may take several years. Speed and scale of recovery are affected by age and sex.10 And for some, full recovery may not be possible.10, 11

Do You Have an Alcohol Problem?

The technical term for alcohol addiction is Alcohol Use Disorder (AUD)

Symptoms of AUD include:

  • Inability to stop drinking amount of alcohol
  • Anxiety or depression when not drinking
  • Drinking alone
  • Neglecting professional and personal responsibilities to drink
  • Cravings
  • High tolerance for alcohol
  • Withdrawal symptoms such as sweating, shaking, and nausea

Treatment Options for Alcohol Misuse & Addiction 

Those who are suffering from AUD should seek immediate attention. There are a variety of treatment options available to help.

These include:

Resources

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  1. American Psychiatric Association. “Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5®).” American Psychiatric Publishing, 2013.
  2. Bilici, Rabia, et al. “A Case of Wernicke-Korsakoff Syndrome Treated 1 Year after the Onset of Symptoms.” The Primary Care Companion For CNS Disorders, 2015.
  3. Dhikav, Vikas, and KuljeetSingh Anand. “Hippocampus in Health and Disease: An Overview.” Annals of Indian Academy of Neurology, vol. 15, no. 4, 2012, p. 239.
  4. Frederiksen, Kristian Steen. “Corpus Callosum in Aging and Dementia.” Danish Medical Journal, vol. 60, no. 10.
  5. Graff-Radford, Jonathan. “Can a Head Injury Increase Your Risk of Alzheimer's?” Mayo Clinic, Mayo Foundation for Medical Education and Research, 20 Apr. 2019.
  6. Marshall, Jane. “Alcohol-Related Dementia (Alcohol-Induced Dementia; Alcohol-Related Brain Damage).” New Oxford Textbook of Psychiatry, 2012, pp. 399–402.
  7. Martin, Peter R. “The Role of Thiamine Deficiency in Alcoholic Brain Disease.” Alcohol Research & Health : the Journal of the National Institute on Alcohol Abuse and Alcoholism, vol. 27, no. 2, 2003.
  8. Wernicke-Korsakoff Syndrome.” NORD (National Organization for Rare Disorders), 2021.
  9. Ridley, Nicole J, et al. “Alcohol-Related Dementia: An Update of the Evidence.” Alzheimer's Research & Therapy, vol. 5, no. 1, 2013, p. 3.
  10. Sachdeva, Ankur, et al. “Alcohol-Related Dementia and Neurocognitive Impairment: A Review Study.” International Journal of High Risk Behaviors and Addiction, vol. 5, no. 3, 2016.
  11. Wobrock, Thomas, et al. “Effects of Abstinence on Brain Morphology in Alcoholism.” European Archives of Psychiatry and Clinical Neuroscience, vol. 259, no. 3, 2009, pp. 143–150.
  12. Zhou, Feng C., et al. “Chronic Alcohol Drinking Alters Neuronal Dendritic Spines in the Brain Reward Center Nucleus Accumbens.” Brain Research, vol. 1134, 2007, pp. 148–161.

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