What to know about alcoholic dementia

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Alcohol-related dementia is a type of brain disorder where a person develops issues with thinking or processing and memory.

Wernicke-Korsakoff syndrome is a common name for the condition, though experts can divide it further into Wernicke encephalopathy and Korsakoff syndrome.

Wernicke-Korsakoff syndrome can occur due to other conditions, but misuse of alcohol is a common underlying factor for its development due to long-term vitamin deficiency.

Worldwide occurrence is between 0–2%. However, alcohol consumption is not a direct factor. Experts noted that France, well known for wine consumption, has an average 0.4% rate of alcohol-related dementia. By comparison, Australia has a prevalence of about 3%.

Wernicke-Korsakoff syndrome occurs due to a deficiency in vitamin B1 or thiamine. This is a common deficiency in people who misuse alcohol, but it can also occur due to other disorders or conditions.

A thiamine deficiency over a long period of time can cause brain atrophy or damage. It can affect several areas of the brain.

Vitamin B1 deficiency causes the brain to waste away. It can affect several areas of the brain, but it most commonly affects the mammillary bodies found on the hypothalamus.

B1 deficiency can also affect the:

• dorsomedial thalami
• periaqueductal gray
• the walls of the third ventricle
• the tectal plate
• medial temporal lobe (may cause amnesia)

While the above areas may be affected due to the body’s thiamine deficiency, the toxicity of alcohol may directly damage the cortex. The cortex affects several areas of higher thinking, including:

• memory
• learning
• thinking
• problem solving
• emotions
• functions related to the senses

Wernicke-Korsakoff syndrome typically presents with three main areas of symptoms. A person may not experience each of the symptoms. They can also have different levels of severity.

The three symptom areas include:

• vision disturbances: may include vision loss, diplopia, or strabismus
• gait abnormalities: may include a wide-based, short-stepped gait and an inability to stand or move without assistance
• mental status changes: may include limited speech, apathy, and indifference to the environment

A person may also demonstrate other changes and symptoms that can include:

• confabulations (the inability to recall information and then making up information to fill in the gap that is believed to be real)
• agitation or anger
• hallucinations

Continued consumption of alcohol can cause symptoms to progress and get worse.

Wernicke-Korsakoff syndrome breaks can further break down into two separate conditions: Wernicke encephalopathy and Korsakoff syndrome, each presenting with different symptoms.

Wernicke encephalopathy causes an acute confusional state in the person. With treatment, the symptoms often reverse.

Korsakoff syndrome causes confabulation, memory loss, and gait abnormalities. These often occur if treatment for Wernicke encephalopathy does not work. The symptoms are often irreversible.

There is no formal testing to diagnose alcohol-related dementia. However, Doctors use a thorough social history, the findings from the physical and neurologic exams, and the presentation of symptoms to diagnose the condition.

The symptoms a person has can resemble those of several other conditions related to alcohol use, including:

• intoxication
• head injury
• withdrawal
• infection

Experts recommend that screeners check anyone with memory loss for alcohol use. This may help prevent delayed diagnosis.

When a medical professional suspects alcohol dementia, some experts recommend the use of prophylactic thiamine administration. If symptoms improve, it could indicate Wernicke-Korsakoff syndrome.

Treatment typically involves the use of oral or injectable thiamine supplements.

A doctor may recommend injections for people who:

• have a strong history of alcohol use
• present with acute symptoms of Wernicke encephalopathy

Once acute symptoms come under control, a doctor may further examine the person for signs of Korsakoff syndrome.

In cases where they suspect Korsakoff syndrome, a doctor will likely recommend long-term use of thiamine, possibly combined with other vitamins and magnesium. This regimen may help improve symptoms over time.

A doctor may consider other causes of the symptoms if the person does not show any signs of improvement. An individual may also need assistive technology and other modifications to help them with everyday tasks.

Alcohol-related dementia can improve in some cases. However, a person will likely need to take thiamine supplements and stop or significantly cut back on alcohol consumption for the best results.

Even with treatment, some symptoms, such as gait changes, confabulation, or memory loss, may not improve. Some people will need to move into a long-term care facility. Prognosis is generally guarded.

People living with alcohol-related dementia may find some lifestyle changes helpful. This can include:

• use of assistive devices for movement or remembering things
• eating a healthy diet
• regular exercise
• avoiding alcohol

Alcohol-related dementia often occurs in people who experience long-term alcohol misuse. Excessive, prolonged consumption can cause a vitamin deficiency, which can cause parts of the brain to deteriorate.

The damage to the brain then leads to symptoms that can include issues with a person’s gait, memory loss, hallucinations, and other issues.

Treatment typically involves the use of thiamine supplements in oral or injected forms. A person may need these for long-term periods of time. They may also need to live in assisted living housing if their symptoms are severe.

Lifestyle changes, such as eating a balanced diet and stopping the use of alcohol, generally help. However, the outlook is often guarded, and a person may never fully recover from the condition.