Understanding alcohol-induced dementia

Sunrise Senior Living  |  April 18, 2017

Alzheimer's, dementia and other cognitive impairments are some of the greatest health hazards faced by older Americans. 

Specifically, Korsakoff syndrome and other kinds of cognitive impairment brought about by alcohol are among the most severe behavioral illnesses that elder care professionals will encounter. Though notable progress has been made in researching these conditions, various aspects of them remain mysteries to doctors and caregivers. 

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It can be more difficult for family members of patients with Korsakoff syndrome - or other impairments caused by alcohol abuse - to be supportive. Caring for someone with memory loss can be challenging, and in these situations children or spouses may bear personal trauma from the afflicted senior's drinking. Those working in senior care must have patience, kindness and knowledge to offer the family as well as the patient, and both families and caregivers should familiarize themselves with the facts of all alcohol-related mental disorders.

Alcohol-induced dementia is among the greatest challenges seniors and elder care professionals will face.Alcohol-induced dementia is among the greatest challenges seniors and elder care professionals will face.

Known varieties of alcohol-induced dementia
The conditions listed below are often referred to under the umbrella term of alcohol-induced dementia:

  • Korsakoff syndrome: Identified by Russian neuropsychiatrist Sergei Korsakoff, this disease is generally believed to stem from extremely low levels of thiamine, also known as vitamin B-1. According to the Alzheimer's Association, long-term alcohol abuse can drastically reduce thiamine in the body, though it's not the only reason for the vitamin's reduced presence. This causes the brain to lack the energy necessary for memory to work as it should. Difficulties with short- and long-term memory are common, as are complicated lies devised - without the individual's full cognizance - to cover up things they've forgotten. The full spectrum of dementia symptoms - loss of body-function and motor controls, emotional distress and aggression, serious memory loss, impaired judgment - can result if untreated. 
  • Wernicke-Korsakoff syndrome: Also known as alcohol-induced persisting amnestic syndrome, the National Institutes of Health explained that this variant of Korsakoff's is preceded by - and sometimes intermittently involves - episodes of Wernicke's encephalopathy. When Wernicke's manifests itself, vision and motor skills may fail, significant disorientation occurs and hemorrhagic lesions develop in the brain. Severe thiamine deficiency can cause Wernicke's encephalopathy without leading to WKS.

While NIH studies have concretely established that drinking can cause dementia episodes as a result of ethanol neurotoxicity, not all professionals in psychiatry and neurology believe that alcohol alone causes long-term dementia. Nevertheless, any neurotoxin diminishes cognitive ability when regularly consumed in high volumes - as by an alcoholic. Lifelong drinkers who reach retirement age are highly likely to have reduced comprehension and memory retention along with a host of other health problems like liver failure, cirrhosis and cardiac issues. 

Connection to Alzheimer's risk
The World Health Organization states that about 60 to 70 percent of all dementia cases are caused by Alzheimer's. Because of alcohol's connection to dementia and its variants listed above, there had been suspicion of a link between longtime alcohol abuse - 35 drinks or more per week, over 30 to 60 years - and Alzheimer's by some. As of now, this has been disproved.

Multiple studies overseen by the NIH, as well as a 2008 research effort by Susham Gupta and James Warner published in The British Journal of Psychiatry, have failed to show specific connections between heavy drinking and Alzheimer's.

Treatment and care strategies
Korsakoff syndrome, Wernicke's encephalopathy and WKS can be treated and, if not outright cured, have their effects significantly mitigated. Thiamine supplements taken orally or via injection, by restoring this vitamin to the brain, can allow for certain diminished functions to improve or fully return. The Alzheimer's Association notes that approximately only 25 percent of those suffering from either iteration of Korsakoff's have made full recoveries, and about one-fourth of those with these conditions will have them for life. However, about 75 percent  can recover to some degree over time, though the condition must be found and treated promptly. 

It should also be emphasized that individuals who have recovered from WKS were only likely to stay symptom- or episode-free if they abstained from alcohol. Convincing a longtime drinker that his or her behavior is destructive to themselves and to loved ones is an extremely delicate matter.

Because of this, caregivers dealing with seniors suffering from any dementia connected to alcohol abuse should be aware, and educated, so they are able to remain calm and level-headed. Family members should do their best to comfort and have open discussions with their loved one, to make sure that they know are supported. The National Council on Alcoholism and Drug Dependence offers tips for how to have these conversations, such as not using threats or bribes, not arguing and not trying to make your loved one feel guilty.  In situations where the estrangement is too great, elder care professionals must do their best to steer alcoholic seniors toward treatment, or - if the dementia has progressed too far for intervention - do their best to make the individual comfortable. 

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