Alcoholic Dementia: Symptoms, Causes, Stages, & Treatment

What Is Alcohol Dementia?

Alcohol-related dementia is a form of memory loss and cognitive impairment caused by years of excessive alcohol use. All forms of alcohol-related dementia are a form of alcohol-induced brain damage linked to the neurotoxic effects of ethanol (alcohol). In some cases, ARD can be reversed with early treatment and prolonged sobriety, but for some, the symptoms can persist.

People with ARD exhibit many of the same signs as people with other forms of dementia, including short-term memory loss, learning problems, and impaired cognitive functioning. It’s also possible for people with ARD to experience alcoholic personality changes and even to lose their balance and coordination skills. Many people with alcohol-related dementia also struggle with a loss of motivation, trouble concentrating, and more difficulties with decision-making and problem-solving.^3,4

Wernicke-Korsakoff Syndrome

Some forms of ARD are caused by Wernicke-Korsakoff syndrome (WKS), or ‘wet brain’. WKS is an alcohol-induced syndrome that includes two different conditions: Wernicke’s encephalopathy (WE) and Korsakoff syndrome (KS). WE is the acute swelling of the brain and KS is the development of chronic neurological symptoms that can result from WE.^4,5

Wernicke’s encephalopathy is a sudden and severe swelling of the brain that’s linked to a thiamine (vitamin B1) deficiency and is most common in heavy, long-term drinkers. The main symptoms include confusion, loss of coordination, and changes in vision. Over half of the people who develop WE will develop Korsakoff’s syndrome, which involves chronic neurocognitive problems. People with Wernicke-Korsakoff syndrome often have structural damage and abnormalities in the regions of the brain that help with memory, learning, and thinking.^1,2,5

The three main symptoms of Wernicke-Korsakoff Syndrome include:^2,3,5

• Confused mental state: People may experience symptoms of delirium, psychosis, or extreme confusion, loss of short-term memory, and trouble thinking & concentrating.
• Ataxia, or the inability to control movements: Loss of coordination, muscle spasms or uncontrolled tics and tremors.
• Visual changes and eye problems: Inability to control movements of the eye, double or blurred vision, inability to visually recognize (agnosia).

Symptoms of Alcoholic Dementia

The symptoms of alcohol-related dementia can vary from person to person. Some cases of alcohol-related dementia are very sudden and severe, and others are milder and slower to develop.^1,2,5 In the DSM 5, ARD is now diagnosed as alcohol-related cognitive impairment, which is a neurocognitive disorder caused by excessive drinking.³

ARD is suspected when a person has a history of excessive alcohol use (35+ drinks per week for men, 28+ drinks per week for women) and develops clinical signs of dementia within 60 days of their last drink.

Additional signs and symptoms of alcohol-related dementia include:^3,5,6

• Impaired cognitive functioning
• Inability to learn or retain new information
• Mental confusion, psychosis, or delirium
• Trouble processing information or thinking clearly
• Aphasia or other speech or communication problems (i.e. slurring, alogia, etc.)
• Short-term memory loss or amnesia
• Difficulty thinking, making decisions, or solving problems
• Changes in mood & personality (i.e. more irritable, impulsive, anxious, apathetic, etc.)
• Problems with coordination & balance (i.e. ataxia, dropping things, tremors, etc.)
• Vision or eye problems (blurred/double vision, eye tics or uncontrolled eye movement)
• Ophthalmoplegia (or paralysis of the eye that prevents movement)
• Loss of motivation, drive, or personal initiative to do things/achieve goals
• Lowered blood pressure and tachycardia (racing heart)
• Lowered body temperature
• Muscle weakness or atrophy
• Insomnia or difficulty sleeping

Causes of Alcohol-Related Dementia

Researchers haven’t identified a singular cause of ARD, and most believe it can be triggered by various factors. Long-term, heavy use of alcohol is the one common cause of ARD, but the risk of developing this condition may vary from person to person.^1,2,7 Some people may be at higher risk based on their genetics, neurological or psychological make-up.

Potential causes of ARD include:^4,8

Excessive & Prolonged Alcohol Use

Those at the highest risk for ARD are heavy, long-time drinkers. Over time, many people with an alcohol use disorder develop a tolerance to alcohol, which causes them to drink more heavily. This perpetuates the cycle of heavy drinking and increases the likelihood of ARD and other long-term complications.

The negative effects of alcohol seem to accumulate over time, placing people at higher risk as they age and are often triggered by withdrawals.⁷ Alcohol has many different effects on the body, brain, and mental status that are similar to those observed in ARD, and some of these effects can persist after a person stops drinking.

Alcohol-related Withdrawals

For many, the symptoms of ARD begin after they have been binge drinking and then suddenly slow down or stop. For long-time heavy drinkers, cutting back or stopping can trigger alcohol withdrawal symptoms. These withdrawals can include delirium tremens (DTs), nausea, chest pain, sweating, shaking, increased heart rate, and even life-threatening seizures. Along with these physical withdrawals, psychological withdrawal symptoms from alcohol often include delirium, psychosis, irritability, confusion and other symptoms of ARD.^1,3,6

Neurotoxic Effects of Alcohol

Some researchers and experts believe that alcohol’s neurotoxicity is responsible for ARD. Ethanol, or alcohol, is believed to be a neurotoxic chemical that causes oxidative stress and damages neurons and brain cells.^2,7 Over time, the toxins in alcohol may cause damage to the hippocampus, hypothalamus, and cerebellum, as well as the prefrontal cortex.⁷ This theory is supported by brain imaging studies that have recorded structural changes and damage in the brains of long-term heavy drinkers, which can be temporary or permanent.¹

Thiamine (Vitamin B1) Deficiency

Extended and excessive alcohol use causes inflammation of the stomach lining and digestive tract, reducing the body’s ability to absorb vitamins. One of the vitamins that heavy drinkers often become deficient in is Thiamine or vitamin B1. Thiamine is essential for glucose metabolism and is also used by the liver, heart, and brain. Excessive alcohol use can reduce levels of Thiamine, which can trigger Wernicke encephalopathy.⁷

Over half of people who develop this condition go on to develop Korsakoff syndrome, which involves symptoms of alcohol-related dementia.^1,2,5 When treated early, these symptoms can sometimes be halted or even reversed before causing lasting damage.²

Alcohol-induced Brain Damage

Neuroimaging studies have demonstrated structural damage and shrinkage of the brain in people with long histories of alcohol abuse.^1,2 Over time, excessive drinking can lead to a loss of white matter in the brain, a loss of neurons, and a shrinkage of brain regions linked to thinking, memory, and learning. In some cases, long-term sobriety can reverse this damage and allow the brain to heal, grow, and repair itself. In some cases, brain damage from years of heavy drinking is irreversible, causing permanent changes in a person’s cognitive functioning.^1,7

Malnutrition and Excessive Alcohol Use

Excessive and frequent consumption of alcohol interferes with digestion and blocks the absorption of essential nutrients. Alcohol-damaged livers worsen these effects, decreasing the ability to convert and release nutrients and increasing the risk of malnutrition. Severe alcoholics are also more likely to have poor nutritional habits, increasing the risk of malnutrition.⁵ Most researchers believe that malnutrition increases the risk of ARD in heavy drinkers and may even trigger it through vitamin and mineral deficiencies.^1,7,8

Who Develops Alcohol Dementia?

While it’s possible for young adults to develop ARD, most people diagnosed with ARD are males over 45 who have a history of severe alcoholism. Some researchers suggest that men who consume 35+ and women who consume 28+ drinks per week for a 5-year period are at risk of developing ARD.^6,7

Besides long-term, heavy alcohol abuse, other factors that increase the risk of developing ARD include:^1,2,7,8

• Poor nutrition and dietary deficiencies
• Poor liver functioning or cirrhosis damage
• Shorter sobriety or recovery time
• Receiving chemotherapy treatments
• Being over the age of 45
• Having another underlying illness or infection
• High levels of stress
• Low levels of support, social isolation

How is Alcoholic Dementia Diagnosed?

Alcohol-related dementia is a complex condition with symptoms that can mimic those of other disorders.  This can make it harder to detect and diagnose ARD compared to other conditions.² Other dementia-causing disorders like Alzheimer’s and cardiovascular diseases need to be ruled out. Additionally, ARD cannot be diagnosed when a person is still actively drinking to ensure that the symptoms aren’t caused by alcohol intoxication or withdrawal.

Diagnostic tests that may be used to facilitate the diagnosis of ARD include:^4,5

• Brain imaging tests like an MRI, CT scan, or EEG
• Blood tests to check magnesium, thiamine, and other labs
• Mental status exam, psychiatric evaluation, or other cognitive functioning tests
• Genetic testing to rule out other potential causes of dementia
• Substance use assessment and urine drug screen to rule out effects of other drugs

Treatment for Alcohol-Related Dementia

Alcohol-related dementia is a serious condition that usually requires hospitalization to triage and stabilize a person. Most people with ARD will require inpatient hospitalization to help stabilize their health and monitor their condition. Often, the initial treatment involves IV Thiamine (vitamin B1) supplements, fluids to stay hydrated, and other medications to help with the alcohol detox and withdrawal process.^1,2,4

After the acute phase of treatment, people are usually encouraged to seek treatment for their addiction. Maintaining long-term sobriety is key, as improvements are often noted for people who make it to 1 year and 2 years of sobriety.^2,7 The specific type of treatment a person needs and the setting in which they receive treatment (i.e. inpatient rehab vs outpatient groups) depends on the severity of their addiction.⁸

Can Alcoholic Dementia Be Reversed?

According to research, people with ARD who receive early treatment have the best outcomes, and only 1 in 3 who receive no treatment will survive. In cases of Wernicke-Korsakoff syndrome, about 20% who receive treatment will fully recover, and another 25% will significantly improve  with treatment. In about 25% of treated WKS cases, there is no improvement or reversal of symptoms.⁵

The outlook for people experiencing symptoms of ARD is better for people who stay sober, with most showing marked improvements at 1 and 2 years of sobriety.⁷ Even after a week of sobriety, most people with symptoms of WKS or ARD will show cognitive improvements. Relapsing can trigger the cycle of binge and withdrawal, increasing the likelihood that ARD symptoms will worsen.⁷

Treatment for Alcoholism

There are many effective treatments for alcohol use disorder. Most involve long-term individual and group therapy, and medications or self-help groups are often a component of this treatment. Addiction treatment can be provided in various settings, including inpatient rehab, outpatient rehab, residential or sober living homes, and offices providing group or individual therapy.⁸

Treatment options for alcohol use disorders include:

Support Groups and Group Therapy

Group therapy is helpful to many people who are in recovery from an addiction to drugs or alcohol and may be provided in an outpatient treatment program, inpatient detox center, or in the community. Many people in recovery also seek out support groups like  Alcoholics Anonymous or SMART Recovery for additional support. In groups, people who are trying to overcome addiction will share their experiences, support other group members, and learn valuable skills to help in their recovery.⁸

Therapeutic Interventions

Therapeutic interventions for alcohol use disorder can be provided by a licensed addiction therapist or other trained professional. A variety of different therapy approaches can be effective in treating addictive disorders. It’s a good idea for people to learn about the options so they can make an informed decision about their treatment and choose a therapist who is a good fit for their needs.

Therapeutic options for alcohol use disorder include:^8,9

• Cognitive behavioral therapy (CBT): CBT is a structured therapy that can help people change problematic thought and behavior patterns with skills to overcome urges, make good decisions, and cope with stress in healthier ways.
• Motivational interviewing (MI): MI is a style of coaching that supports people trying to make a long-term change by helping them identify the need for change, set realistic goals, and make actionable plans to achieve them.
• Contingency management: Contingency management is a form of treatment that uses incentives and rewards to motivate people towards their treatment goals, including rewarding clean drug screens and sobriety.
• Family therapy or couples therapy: Family therapy and couples therapy involve joint sessions with other family members or a significant other and focus on improving communication, resolving conflicts, and developing stronger and healthier bonds.
• Seeking safety: Seeking safety is a trauma-informed therapy approach often used in group therapy settings to help people with a dual diagnosis of addiction and PTSD through a structured book that teaches healthier coping skills.

Medications

For many people with alcohol-related dementia, medication is a necessary part of treatment and helps to address the physiological and neurological damage done by alcohol. Some medications used to treat ARD are only used short-term during the withdrawal and detox phase, while others are recommended for longer-term use.⁸

Medications commonly used to treat alcohol-related dementia include:^1,2,8

• Thiamine supplements: Many people who have been drinking heavily for a long period of time are deficient in vitamin B1 (Thiamine), which can cause symptoms of dementia related to Wernicke-Korsakoff syndrome. IV infusions of Thiamine are often recommended early on to combat symptoms of ARD.
• Benzodiazepines: Many people who develop ARD have a physical dependence on alcohol, and can expect to experience intense withdrawal symptoms when they stop drinking. Because alcohol withdrawals can be fatal, most hospitals and treatment centers use benzodiazepines to reduce the risk of seizures and prevent DTs.
• Relapse prevention medications for alcohol use disorder: Naltrexone, Acamprosate or Disulfiram are often prescribed to people in early recovery from alcohol use disorder to help curb cravings and prevent relapse. These medications promote long-term sobriety, which creates the necessary conditions for the brain to heal and repair the damage done by alcohol.

Coping With Alcohol Related Dementia

Alcoholic dementia is a severe and debilitating condition that requires hospitalization followed by intensive treatment for addiction. If you or a loved one notices the signs of ARD, it’s important to go to a hospital or inpatient addiction treatment center immediately. Early identification and treatment of ARD is essential and can prevent long-term or permanent damage to the brain.^1,2,4

In addition to getting medical and addiction treatment, coping skills that can help with ARD include:

•  Making healthy lifestyle choices: Adequate nutrition, sleep, and regular exercise are some of the most important pillars of a healthy lifestyle and are very important for people in recovery from ARD. Eating healthy food, sleeping for 7-8 hours per night, and staying active are also good for your brain, helping to promote healing and repair.
•  Aiming for regular social interactions: Social interactions with friends, family, and others in your support system is also essential for your body and brain during the recovery from alcoholic dementia. Regularly seeing and interacting with others can improve your mood while also helping you tap into social and linguistic areas of your brain that may have been damaged by ARD.
•  Keeping a journal or written log: Keeping a journal is a great coping skill and a healthy outlet for you to express your feelings and thoughts. Journaling can also help you track your progress over time and provides a written record you can look back on during times when your memory fails you.
• Exposing yourself to new situations: One of the most common symptoms of ARD is the inability to learn new things, which is why exposing yourself to new ideas, information, situations, and tasks is so important during the recovery from ARD. Even if you cannot absorb or process everything that’s happening, new stimuli can help your brain remember how to learn and process information again.
• Sticking to a consistent daily routine: Forming a new daily routine or schedule is an important aspect of recovery for many people overcoming addiction. Replacing old habits with new ones takes effort and discipline, but it does become easier over time. That’s why it helps to have a consistent daily routine that helps to cement these new, healthy habits into your brain.