An Overview of Alcoholic Dementia

Wernicke-Korsakoff syndrome affects memory, learning, and other cognitive skills

older man drinking at bar
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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 longtime 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. Also, like Alzheimer's, once alcoholic dementia develops it is difficult or impossible to reverse.

Wernicke-Korsakoff Syndrome

One of the syndromes of alcoholic dementia is known as Wernicke-Korsakoff syndrome, which is really two disorders that may occur independently or together: Wernicke’s encephalopathy and Korsakoff psychosis.

Korsakoff psychosis typically develops as Wernicke symptoms begin to subside or stop. Wernicke's encephalopathy causes damage in several parts of the brain, including the thalamus and hypothalamus. Korsakoff psychosis results when these parts of the brain involved with memory are permanently damaged.

Causes

Alcohol itself does not cause Wernicke-Korsakoff syndrome as much as the atrophy of 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

Wernicke's encephalopathy, sometimes called alcoholic encephalopathy, involves damage to multiple areas in the central nervous system. It may also include symptoms caused by alcohol withdrawal.

Korsakoff syndrome, or Korsakoff psychosis, involves impairment of memory and intellect/cognitive skills, such as problem-solving or learning, along with multiple symptoms of nerve damage. The most distinguishing symptom is confabulation (fabrication) where the person makes up detailed, believable stories about experiences or situations to cover gaps in memory. Korsakoff psychosis involves damage to areas of the brain.

Those suffering from dementia may have very little ability to learn new things, while many of their other mental abilities are still highly functioning. Along with the decline in cognitive skills, sometimes noticeable personality changes take place.

Signs and Symptoms

Confusion may be the most obvious early symptom of dementia, but this confusion is also accompanied by obvious memory problems. Those suffering from dementia may remember in great detail events that happened years ago, but are not able to recall events that took place in the past few minutes.

Another early symptom is 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.

Symptoms of Wernicke encephalopathy include:

Symptoms of Korsakoff syndrome:

  • Inability to form new memories
  • Loss of memory (sometimes severe)
  • Making up stories (confabulation)
  • Hallucinations

Testing

Examination of the nervous/muscular system can reveal damage to many of the body's nerve systems damaged by alcoholic dementia, 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

A person with alcoholic dementia may also appear poorly nourished. The following tests can be used to check a person's nutrition level:

  • Serum albumin (general nutrition)
  • Serum vitamin B1 levels
  • Transketolase activity in red blood cells

Additionally, liver enzymes may be high in people with a history of longterm alcohol abuse.

Treatment

Early treatment is the key to successfully treating alcoholic dementia. If caught early enough and the damage to the brain and nerves is mild, patients can show much improvement by quitting alcohol and improving their diet.

However, if someone has been diagnosed with Wernicke-Korsakoff syndrome, there is really no treatment that will completely restore all of their cognitive functions. Treatment goals are usually aimed at controlling symptoms and preventing dementia from getting worse. Vitamin B1 is usually administered to try to improve:

  • Confusion or delirium
  • Difficulties with vision and eye movement
  • Lack of muscle coordination

However, vitamin B1 treatment rarely improves the loss of memory and intellect that takes place with Korsakoff psychosis.

Of course, treatment for alcoholic dementia includes stopping alcohol consumption. Quitting drinking will prevent additional loss of brain function and damage to nerves. Also, improving the patient's diet can help, but it does not substitute for alcohol abstinence in preventing further alcoholic dementia.

Potential Complications

Unfortunately, according to the National Institutes of Health, Wernicke-Korsakoff syndrome patients often develop serious complications, including:

  • Alcohol withdrawal
  • Difficulty with social interaction
  • Injury caused by falls
  • Permanent alcoholic neuropathy
  • Permanent loss of thinking skills
  • Permanent loss of memory
  • Shortened life span

Prevention

Because Wernicke-Korsakoff syndrome is most often found in chronic alcoholics, quitting or moderating alcohol consumption is the best way to prevent the condition from developing. However, there are other risk factors for developing the condition, including:

  • Anorexia
  • Overly-stringent dieting
  • Fasting
  • Starvation
  • Weight loss surgery
  • Uncontrolled vomiting
  • AIDS
  • Kidney dialysis
  • Chronic infection
  • Cancer that has spread throughout the body

Sources:

Alzheimer's Association. "Korsakoff Syndrome." Alzheimer's & Dementia 2016

U.S. National Library of Medicine. "Wernicke-Korsakoff syndrome." Medical Encyclopedia Updated February 2016

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