An Overview of Alcoholic Dementia

Wernicke-Korsakoff Syndrome

Common symptoms of alcoholic dementia

Verywell / Nusha Ashjaee 

In This Article

Excessive drinking over a period of years may lead to a condition known as alcoholic dementia (formally described as alcohol-induced major neurocognitive disorder in the DSM 5), which can cause problems with memory, learning, and other cognitive skills.

Overview

Alcohol has a direct effect on brain cells, resulting in poor judgment, difficulty making decisions, and lack of insight. Nutrition problems which often accompany long-time alcohol abuse can be another contributing factor, since parts of the brain may be damaged by vitamin deficiencies.

Alcoholic 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 alcoholic 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

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 disorders tend to have nutritional deficiencies from a poor diet.

Thiamine deficiency is common among chronic alcoholics, which is a problem because nerve cells require thiamine to function properly. A chronic lack of vitamin B1 can damage them permanently.

Thiamine works in the brain by helping brain cells produce energy from sugar. If there is a deficiency of thiamine, brain cells do not produce enough energy to function properly.

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.

Those suffering from 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

The broader category of alcohol-related dementia (ARD) 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 in absolutely stereotyped expression.

Remarkably, at the same time, they can seem to be in complete 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.

Testing

In alcohol related dementia, examination of the nervous system can 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

Early treatment is the key to successfully treating alcoholic dementia. If caught early enough, patients with the more general type of alcohol related dementia can show much improvement by quitting alcohol and improving their diet.

If you or a loved one are struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area. 

For more mental health resources, see our National Helpline Database.

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, but it does not substitute for alcohol abstinence in preventing further alcoholic dementia.

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Article Sources
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  1. Ridley NJ, Draper B, Withall A. Alcohol-related dementia: an update of the evidence. Alzheimers Res Ther. 2013;5(1):3. doi:10.1186/alzrt157

  2. Korsakoff Syndrome. Alzheimer's Disease and Dementia. Published 2019.