What Is Alcoholic Dementia?

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

Alcohol-related dementia can cause problems with memory, learning, 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 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 syndrome involving opthalmoplegia (abnormal eye movements), ataxia (unsteady gait), and confusion.

Causes of Alcohol-Related 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 disorder tend to have nutritional deficiencies from a poor diet.

Thiamine deficiency is common among people with alcohol use disorder, which is a problem because nerve cells require thiamine to function properly. A chronic lack of vitamin B1 can damage nerve cells permanently.

Effects 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.

People with this type of 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.

Signs and Symptoms of Alcohol-Related Dementia

The broader category of alcohol-related dementia includes Wernicke-Korsakoff syndrome as well as a type of dementia characterized by impaired planning, thinking, and judgment.

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 their faculties, able to reason well, draw correct deductions, make witty remarks, or play games that require mental skills, such as chess or cards.

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.

The age of onset of alcohol-related dementia varies, but it's often seen in older adults (around 40 to 50 years old). However, it can occur earlier 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 walk (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.

Research shows that cognitive impairment is partially reversible in people who abstain from drinking.

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.

In addition, 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.

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.

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.