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  • Karen McPhail, RN, MSN

Dementia and Alcohol

With dementia predicted to affect 13.9 million adults in the United States by 2060, understanding why these conditions develop is more critical than ever! Alcohol is one of the most abused substances in the US according to the CDC, Centers for Disease Control & Prevention. An average of 88,000 deaths occur each year related to binge drinking, heavy drinking, and other forms of alcohol abuse. Alcohol use disorder overtime causes damage to internal organs, especially the liver and kidneys and increases ones risk of many cancers, hypertension, heart disease, vascular issues, and diabetes.

In terms of current research on alcohol and dementia, early studies (2010/11) were incorrect in advising that moderate intake could be beneficial for prevention of dementia. While, current studies indicate that dementia risk appears to be highest for individuals with mild cognitive impairment (MCI) who drank 14 drinks per week compared with those who drank less than one drink each week — a relative risk increase of 72%. Current studies also indicate that the relationship between alcohol and dementia is complex and likely to require a great deal more research. So we do not have all the answers clearly at present! What we do know without much research however, is that excessive alcohol intake NEVER leads to anything good! While dementia can be idiopathic in nature (from no specific source), there are subtypes that can be linked to the over consumption of alcohol. Let's explore more about alcohol related effects on cognition:

Alcohol Related Brain Damage (ARBD):

78 percent of people diagnosed with alcohol use disorder displayed some form of dementia or brain pathology. ARBD and Alzheimer’s disease have similar symptoms. Both diseases affect the cholinergic system which plays a critical role in memory. ARBD is a broad term to describe alcohol-induced brain damage that can affect an individual later in life. In contrast to other dementia’s, most people with ARBD who receive good support and remain alcohol-free they can make a full or partial recovery. Also there is a good possibility that their condition will not progress / worsen! ARBC may have some residual effects, but individuals who abstain may be able to remain functional.

Wernicke-Korsakoff Syndrome:

One alcohol related chronic condition is Wernicke-Korsakoff Syndrome, also known as Korsakoff Syndrome. It is the most prevalent form of alcohol-related dementia and Is a combination of two conditions: Wernicke’s encephalopathy and Korsakoff’s dementia. Both conditions are caused by a thiamine (B1) deficiency (alcohol prevents the body from properly processing B1). While the exact causative mechanism for brain damage still unknown, research has indicated that a severe thiamine deficiency disrupts several biochemicals that play major roles in carrying signals among brain cells and in storing and retrieving memories. Disruptions destroy brain cells and cause widespread microscopic bleeding and resulting scar tissue. Several genetic variations that may increase ones susceptibility to Korsakoff syndrome. Poor nutrition may also increase risk. This condition although reversible and treatable, is highly under diagnosed with high mortality rates. Rapid diagnosis, timely interventions, and higher effective thiamine doses result in better outcomes! It is important to be timely! This syndrome is often, but not always preceded by an episode of Wernicke encephalopathy which is an acute brain reaction to a severe lack of thiamine. Chronic memory loss of Korsakoff syndrome often follows an episode of Wernicke encephalopathy, Again, prompt action is key as Wernicke Encephalopathy (WE) is a medical emergency as it results in life-threatening brain disruption, confusion, severe motor issues, staggering and stumbling, lack of coordination, and abnormal involuntary eye movements. Prompt treatment needs to be done with hospitalization and intravenous (IV) thiamine. Thiamine supplementation is the most effective way to treat the common symptoms. Memory and cognition problems are less likely to show signs of improvement, but prompt thiamine treatment may prevent further deterioration. Those with WKS/ KS will receive oral doses of thiamine as a regular supplement. To prevent progression of the WKS/ KS syndrome one needs to abstain completely from alcohol and follow a well-balanced diet. 25 percent of those who develop Korsakoff syndrome eventually recover

1/2 improve, but don't recover completely, and about 25 percent remain unchanged.

Some research suggests that those who recover from an episode may have a normal life expectancy if they abstain from alcohol long term. There should be noticeable improvement in mental and physical functioning within two or three weeks of treatment otherwise there is a high probability that they have transitioning to Korsakoff’s Dementia. Recent research study indicated that sadly, 50% of patients will be expected to die within 8 years of WE episode and main causes of death included serious bacterial infections (44.5%) and cancer (33.3%). Deaths that are related to alcohol use disorder are more often from liver disease aspects rather than dementia. however

Korsakoff’s Dementia:

Korsakoff’s dementia is the cluster of symptoms related to memory and cognitive difficulties. It is generally a longer lasting dementia that is preventable and is usually suspected as a consequence of at least one episode of Wernicke’s encephalopathy.

This chronic neuropsychiatric disorder is associated with memory disturbances in which there are significant deficits in anterograde and retrograde memory. The immediate memory is generally maintained, but the short-term memory is diminished with intact sensorium. Many individuals tend to fabricate stories in the setting of clear consciousness. Gaps in long-term memory are often noted with confabulation to fill in gaps. Individuals usually have difficulty in learning new information, are seen to be forgetful, have poor coordination and often balance issues and difficulty walking. This chronic condition is often seen in those who have had a severe episode that triggers progression and permanent damage or those who have struggled with alcohol use disorder long term.

It is clear that excessive alcohol intake has detrimental effects and needs to be avoided. However, the good news is that with early intervention and support individuals with alcohol use disorder can usually avoid long term cognitive effects and consequences. If you need assistance or support as a caregiver or if you are individual with alcohol use disorder please reach out via our contacts tab. We are here to support, guide, and help!