What Is Alcoholic Dementia?

Excessive drinking over a period of years may lead to a condition commonly known as alcoholic dementia, or alcohol-related dementia (ARD). In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), it is referred to as alcohol-induced major neurocognitive disorder.

Alcohol-related dementia can cause problems with memory, learning, judgment, and other cognitive skills.

Overview of Alcohol-Related Dementia

Alcohol has a direct effect on brain cells, resulting in poor judgment, difficulty making decisions, and lack of insight. In short, alcohol misuse over many years can cause dementia in some cases. Nutrition problems, which often accompany long-time alcohol misuse, can be another contributing factor to alcohol-related dementia, since parts of the brain may be damaged by vitamin deficiencies.

Alcohol-related dementia is similar in some ways to Alzheimer’s disease in that it affects memory and cognitive ability.

Wernicke-Korsakoff Syndrome

One of the syndromes of alcohol-related 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 three-part syndrome involving ophthalmoplegia (abnormal eye movements), ataxia (unsteady gait), and confusion.

Causes of Alcohol-Related Dementia

Alcohol itself does not directly cause Wernicke-Korsakoff syndrome as much as the damage to the brain cells that takes place from a thiamine deficiency (vitamin B1) caused by alcohol. Alcohol blocks the absorption of thiamine in the gut, creating a deficiency, which is a problem because nerve cells require thiamine to function properly. A chronic lack of vitamin B1 can damage nerve cells permanently.

People with severe alcohol use disorder also tend to have nutritional deficiencies from a poor diet and irregular eating habits.

Effects on the Brain

Most research indicates that moderate drinking has very little negative impact on health and is considered beneficial for cardiac health. Moderate drinking is defined as less than two drinks for men and less than one drink for women per day. However, a 2017 study found that even moderate amounts of alcohol consumption over many years lead to shrinkage of an area of the brain involved in the formation of new memory (the hippocampus). The scientists could not definitively conclude whether this change was due to a temporary shift in cellular fluid versus actual cell death.

Many studies show that heavy drinkers have less brain volume overall with evidence of impaired memory, attention span, judgment, and other aspects of cognitive functioning. Neural connections are weakened or lost, and the reward system pathways no longer function as they once did. The end stage of alcoholism is linked with severe brain damage as well as liver problems that can add additional symptoms of brain fog, confusion, and delirium.

Signs and Symptoms of Alcohol-Related Dementia

While forgetfulness and short-term memory might be the first signs, a person may go on to experience difficulties with executive functioning (like organizing and planning) and, in a later stage, problems with motor abilities.

WKS happens in two stages. Wernickes encephalopathy is the acute stage resulting from thiamine deficiency. If it is not adequately treated, it may lead to Korsakoff syndrome (or Korsakoff psychosis), which involves significant impairments of memory as well as delirium and hallucinations. Sometimes, noticeable personality changes take place, with increased agitation and anger, and a person can become almost unrecognizable to friends and family.

The most distinguishing symptom is confabulation (fabrication) where the person makes up detailed, believable stories about experiences or situations to cover gaps in memory.

Symptoms of WKS may present as someone telling the same stories or asking the same questions over and over, with no recollection that the questions have just been asked and answered. In conversation, someone may repeat the same piece of information 20 times, remaining wholly unaware that they are repeating the same thing.

Remarkably, at the same time, they can seem to be in total possession of most of their faculties, able to reason well, draw correct deductions, make witty remarks, or play games that require mental skills, such as chess or cards. This makes alcohol-related dementia easy to hide for some people, and difficult to diagnose at times.

Age of Onset and Prognosis

The age of onset of alcohol-related dementia varies, but it's often seen in middle-aged adults around 40 to 50 years old. However, it can occur earlier or later depending on the amount of alcohol a person consumes.

For instance, research suggests that a five-year history of drinking 35 alcoholic beverages a week for men and 28 for women presents a "sufficient" risk for the development of ARD.

The life expectancy of people with ARD varies, and more research is needed in this area. One study found that 50% of patients with an alcohol-related Wernicke-Korsakoff syndrome were expected to die within 8 years of a Wernicke's encephalopathy episode; the main causes of death were cancer and bacterial infections.

While the statistics can be intimidating, try to remember that they don't determine your journey with ARD. Quality of life and life expectancy vary significantly from person to person. Talk to a doctor to address your symptoms and learn how you can manage and, in some cases, even reverse signs of your illness.

Diagnosing Alcohol-Related Dementia

The DSM outlines diagnostic criteria for alcohol-related dementia including multiple cognitive deficits such as memory impairment. A doctor may issue a patient a test to determine if they display any of the following signs:

• Agnosia: Failure to recognize/identify objects
• Aphasia: Language disturbance
• Apraxia: Impaired ability to perform motor functions
• Disturbance in executive functioning: Such as planning or organizing

A doctor will ask a patient questions to determine whether their cognitive impairments result in disturbances to their daily functioning.

They will also take a patient's history, perform a physical exam, and conduct lab tests. They will determine if a patient's health status is consistent with the effects of substance misuse.

In alcohol-related dementia, examination of the nervous system can also 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 walking (gait) and coordination

Treatment for Alcohol-Related Dementia

Early treatment is the key to successfully treating alcohol-related dementia. If caught early enough, patients with the more general type of ARD can significantly improve their condition by quitting alcohol and eating a balanced 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; however, diet does not substitute for alcohol abstinence in preventing alcohol-related dementia from worsening.

Abstinence of up to one year is linked with improved attention, working memory, and problem-solving abilities. However, learning and short-term memory impairments may be more difficult to reverse even with abstinence.

Coping With Alcohol-Related Dementia

It isn't easy to cope with alcohol-related dementia, but there are resources that can help. You may also choose to share your diagnosis with supportive family and friends—you don't have to navigate your condition alone.

• Support Groups: Although AA meetings are highly effective for many people, there are a number of additional support groups such as Celebrate Recovery, Secular Organizations for Sobriety (S.O.S.), SMART Recovery, Women for Recovery, LifeRing, and so on.
• Self-care: It is important to stay balanced by developing positive self-care habits by carving out time to take time to care for your own physical, emotional, and spiritual needs.
• Nutrition: You want to be sure you're eating a nutritious diet that will support your brain function. Eating well-balanced meals can also help manage any cravings to drink that you experience.
• Routine: It helps your physical and mental health if you adhere to a daily routine. While you don't have to do the same things each day, knowing what time you wake up, eat meals, see loved ones, do activities, and go to sleep can go a long way in supporting your recovery journey.
• Hire an Assistant: You might consider hiring a caretaker to help you with tasks that you have trouble doing such as grocery shopping and/or cooking meals. They can even help you organize your home in a way that makes it easy for you to access things—which can be especially helpful if you're having trouble with motor function.

A Word From Verywell

Alcohol-related dementia with changes in mental status, memory loss, and personality may be the consequence of longstanding alcohol consumption. However, if you catch the signs early, it is possible to reverse some of the disease process with nutrition therapy and abstinence from alcohol. Once it progresses to Korsakoff syndrome, the damage to the brain and nervous system may be too severe to reverse.

Prevention is the key to reducing the risk of any major health problems and psychosocial consequences of heavy drinking. If you have difficulty controlling your alcohol use and want help, there are many treatment options and resources to help you through your journey toward sobriety and wellness.