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Alcohol-Induced Dementia: Symptoms and Treatment for the Elderly
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Alcohol-Induced Dementia: Symptoms and Treatment for the Elderly

November 09, 2020

If your loved one is suddenly experiencing cognitive and behavioral changes like memory problems, confusion, impaired judgment, impulsive or inappropriate tendencies, or trouble with planning and other everyday tasks, you may be worried they have Alzheimer’s disease or another form of dementia. While most common forms of dementia are irreversible and their causes are not entirely understood, there are some exceptions. If you know or suspect your loved one drinks an excessive amount of alcohol, they may be showing signs of alcohol-induced or alcohol-related dementia.  

bottles of alcohol

Causes of Alcohol-Related Brain Damage and Dementia

When people drink too much alcohol over many years, they may experience alcohol-related brain damage (ARBD), sometimes called alcohol-induced dementia. The National Institute on Alcohol Abuse and Alcoholism defines heavy alcohol use as more than four drinks on any day for men and more than three drinks on any day for women. According to the Centers for Disease Control and Prevention, those totals equate to binge-drinking, and heavy drinking is defined as 15 drinks or more per week for men or eight drinks or more per week for women.

ARBD, Alzheimer’s disease and other forms of dementia can present with similar symptoms because they all affect the cholinergic system, which plays an important role in memory, according to American Addiction Centers. While several studies have not found a clear connection between alcohol intake and Alzheimer’s, excessive alcohol intake has been shown to cause ARBD.

Regular heavy drinking can cause ARBD in a range of ways:

  • Cell damage caused by alcohol’s toxins
  • Chemical changes in the brain caused by intoxication and withdrawal
  • Shrinkage of brain tissues
  • Thiamine (vitamin B1) deficiency, due to alcohol’s interference in the storage and usage of thiamine, poor absorption of the nutrient due to alcohol’s irritating effects on the gastrointestinal system, and poor diet
  • Alcohol-related cerebrovascular disease
  • Head injuries sustained while under the influence of alcohol 

The good news? Unlike most other forms of dementia, this type of damage can be halted and, in many cases, reversed if a person stops drinking alcohol and replaces thiamine that has been depleted due to alcohol intake. 

Types of Alcohol-Induced Dementia and Their Symptoms 

The Alzheimer’s Society divides alcohol-related, or alcohol-induced, dementia into two main types:

  1. Alcoholic dementia: This is an often fully or partially reversible form of dementia that may lead to poor planning and organizational skills; problems with decision-making and judgment; impulsiveness and difficulty controlling emotions; attention and reasoning problems; lack of sensitivity to the feelings of others; and/or socially inappropriate behavior. This form of dementia differs from Korsakoff syndrome in that not everyone affected has day-to-day memory loss.
  2. Korsakoff syndrome: While it’s the most well-known form of ARBD, Korsakoff syndrome is much less common than other forms of ARBD such as alcoholic dementia. It often develops as part of a condition known as Wernicke-Korsakoff syndrome, which encompasses two stages: Wernicke encephalopathy followed by Korsakoff syndrome. It is caused by a thiamine deficiency. 
  • Wernicke encephalopathy: This condition often appears suddenly and needs immediate treatment. Symptoms may include confusion; balance and movement issues; loss of coordination; vision problems like double vision, drooping eyelids or quick eye movements; a faster-than-normal heartbeat; low blood pressure when standing; a lack of energy; and fainting. If Wernicke encephalopathy isn’t treated quickly, it can lead to Korsakoff syndrome. Not everyone experiences a clear episode of Wernicke encephalopathy before Korsakoff syndrome develops.
  • Korsakoff syndrome: This condition tends to develop more slowly and is defined by a loss of short-term memory. Someone with Korsakoff syndrome might have a normal conversation and seem like themselves, only to forget the conversation and the people involved moments later. People with Korsakoff syndrome may also demonstrate these symptoms: confabulation (the urge to make up stories or explanations while believing the invented information), some long-term memory gaps, trouble putting words into context, problems understanding or processing information, and hallucinations. 

Treatments and Possible Solutions

If your loved one experiences the symptoms mentioned above, they may need to undergo testing to rule out other conditions like stroke or a tumor. They, and you, will be asked about how long symptoms have lasted and about their history of alcohol use.

If you know or suspect that your loved one drinks excessively, it is critical that you mention it to their doctor so they can receive a faster diagnosis and treatment.

Blood tests can show blood alcohol levels, markers of liver damage caused by alcoholism, and levels of thiamine. Your loved one will likely also need assessments that measure thinking and memory skills and screening for depression and other mental health conditions.

People with alcoholic or alcohol-related dementia not classified as Wernicke-Korsakoff syndrome (or Korsakoff syndrome) may see significant symptom improvement or reversal if they quit drinking alcohol and improve their diet.

If Wernicke encephalopathy is suspected, a person must get immediate medical treatment, typically consisting of high doses of thiamine and other B vitamins injected slowly into a vein. With timely treatment, most symptoms of this condition can be reversed within a few days. If Wernicke encephalopathy is left untreated or is not treated properly or rapidly, some people may have permanent brain damage, and very severe cases can even lead to death.

In the case of Korsakoff syndrome without Wernicke encephalopathy (or without a diagnosis of it), treatment includes injections of thiamine – sometimes for an extended period – until symptoms subside, often followed by an extended course of oral thiamine, other vitamins and magnesium.

For all cases of alcohol-related brain damage and/or dementia, avoiding alcohol intake is a cornerstone of treatment and recovery.Your loved one may need to be hospitalized while dealing with the effects of alcohol withdrawal if they are severe. These can include sweating, nausea, vomiting, anxiety, agitation, delirium, hallucinations and even seizures.

Your loved one will then also need treatment and support to stay away from alcohol, which may include a stay in an addiction treatment rehabilitation facility, medications to reduce cravings for alcohol and participation in self-help groups. Talk to your loved one’s doctor about treatment options and resources. 

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