Alcohol-Related Dementia

Alcohol-related dementia is a loss of memory, thinking and judgement caused by drinking too much alcohol over many years. It is one form of alcohol-related brain damage (ARBD). Stopping drinking is the most important step, because it can prevent further damage, and some people improve.

If someone who drinks heavily suddenly becomes confused, unsteady or has unusual eye movements or double vision, get emergency medical help. This can be Wernicke's encephalopathy, a medical emergency that needs urgent treatment with thiamine (vitamin B1).

If you are dependent on alcohol, don't stop suddenly without medical support. Sudden withdrawal can be dangerous. A GP or doctor can arrange a safe plan.

Is it really dementia?

The names can be confusing, and organisations use them differently.

• Alcohol-related brain damage (ARBD) is the umbrella term, also called alcohol-related brain injury (ARBI).
• Alcohol-related dementia, also called alcoholic or alcohol-induced dementia, is described by Dementia UK and Cleveland Clinic as a type of ARBD.
• Wernicke's encephalopathy is a sudden brain reaction to a severe lack of thiamine.
• Korsakoff syndrome is a long-term memory disorder, usually from severe thiamine deficiency. It often follows Wernicke's encephalopathy, and together they are called Wernicke-Korsakoff syndrome.

Alzheimer's Society says that severe ARBD can look like dementia but is not strictly a type of it, because it doesn't keep getting worse once a person stops drinking and has treatment.

Separately, heavy drinking also raises the long-term risk of other dementias, mainly Alzheimer's disease and vascular dementia.

Symptoms

Memory problems usually appear first, and symptoms often develop slowly. They can include:

• Thinking: poor focus, trouble planning and making decisions, poor judgement and risky behaviour, not realising there is a problem
• Memory: trouble recalling recent or past events, and difficulty with names and faces
• Language: struggling to find words, or communicating less
• Mood and personality: apathy, depression, impulsiveness, mood swings, aggression or paranoia
• Movement: unsteadiness and falls, even when sober, and clumsiness or slurred speech

People with Korsakoff syndrome may fill memory gaps with inaccurate details without realising it, known as confabulation. They can have severe trouble forming new memories, while other thinking and social skills often remain largely intact.

Stages

There is no single agreed staging system. Dementia UK describes three stages:

Cleveland Clinic describes four, beginning with mild cognitive impairment. Moving through these stages is linked to continued drinking, and stopping can prevent further decline.

Causes

Alcohol can damage the brain in several ways:

• It kills brain cells, causing the brain to shrink
• It damages blood vessels, raising the risk of strokes
• It depletes thiamine, partly by stopping the gut absorbing it, and a poor diet adds to this
• Falls and head injuries, and repeated withdrawal without medical help, can cause more damage

Who is at risk?

• Roughly 1 in 3 people with alcohol dependence have some level of ARBD, according to Alzheimer's Society
• It is usually diagnosed in people aged about 40 to 60, younger than most common dementias
• It accounts for about 10% of young onset dementia, according to Dementia UK
• More men are affected, because men are more likely to drink heavily, although Dementia UK says women in this age group are more at risk

It isn't known why some heavy drinkers develop ARBD and others don't.

How much alcohol is too much?

Occasional drinking doesn't cause alcohol-related dementia. Alzheimer's Society says drinking around 25 units or more a week can affect thinking, and that most people diagnosed have drunk considerably more for years.

In the UK, the advice is no more than 14 units a week, spread over three or more days. That is about six pints of lager or one and a half bottles of wine. Dementia UK says there is no completely safe level.

How it is diagnosed

Start with a GP. Alzheimer's Society says a diagnosis needs three things: long-term memory or thinking problems that affect daily life, a history of long-term heavy drinking, and other possible causes being ruled out.

Tests can include blood tests, brain scans and memory tests. Memory and thinking are most reliably assessed after several weeks without alcohol. Family accounts can help, as people often underestimate how much they drink. Many diagnoses are made in hospital.

Treatment

• Stopping alcohol is the most important step. People who are dependent may need medically supervised detox, in hospital or residential rehab.
• Thiamine: high doses, usually by injection at first, are used for Wernicke's and Korsakoff syndrome. Early treatment is vital.
• Medicines: none specifically treats alcohol-related dementia, though naltrexone or acamprosate may be prescribed for alcohol dependence.
• Diet: a balanced diet and vitamin supplements if needed.
• Rehabilitation and support: cognitive behavioural therapy, memory rehabilitation, counselling and support groups. Severe cases often need residential care.

Can it be reversed?

Sources differ on this. Cleveland Clinic says the brain damage can't be reversed, although stopping drinking prevents it getting worse and some people partly regain function. Dementia UK says some damage can be partly or fully reversed.

Dementia UK gives this rough guide for people who stop drinking and whose thiamine levels recover, and Alzheimer's Society gives similar proportions for Wernicke-Korsakoff syndrome:

• About 25% recover completely, or make a good recovery
• About 50% recover partly, with lasting problems that tend to stay stable
• About 25% have damage that continues or is mostly permanent, and may need long-term care

Some people recover within a few months, while others take years to become fully independent.

Life expectancy

None of the sources we reviewed give a life expectancy figure. Cleveland Clinic says it depends on whether drinking stops, how severe the damage is, age and overall health, and other alcohol-related conditions. Untreated Wernicke-Korsakoff syndrome can be life-threatening. See our page on dementia life expectancy for other types.

Supporting someone

Regular routines, breaking tasks into small steps, short sentences and labelled cupboards can all help, as can doing tasks with the person rather than for them. In the UK, Dementia UK's Admiral Nurse Helpline is on 0800 888 6678. If you're unsure which type of dementia is involved, see mixed dementia.