Alcohol related brain damage

What causes alcohol related brain damage?

Alcohol related brain damage (also known as alcohol related brain impairment) is caused by drinking alcohol excessively over a prolonged period of time. It can be caused by a combination of reasons including vitamin B1 deficiency (thiamine), the toxic effects of alcohol on nerve cells, head injury and blood vessel damage. There are three main types of alcohol related brain damage; Wernicke’s encephalopathy, Korsakoff’s syndrome and alcoholic dementia. Both Wernicke’s and Korsakoff’s can occur singularly or in combination when it is called Wernicke-Korsakoff syndrome.

Wernicke’s encephalopathy often has a sudden onset and is characterised by movement and balance problems, loss of coordination, confusion, disorientation and abnormal eye movements.

Korsakoff’s syndrome occurs more gradually and the symptoms are usually attention and concentration problems, gaps in memory which are usually filled inaccurately (confabulation) and a difficulty learning new information.

Alcoholic dementia is characterised by a deteriorating ability in planning, decision making and assessment of risk. There tends to be a change in personality, reduced impulse and emotional control which may lead to conflict and socially inappropriate behaviour. In addition there are problems with attention, concentration and memory.

Alcohol related brain damage tends to be more common in people in their 40s and 50s and comprises about 10% of the cases of young onset dementia diagnosed. Middle aged women are more at risk of the negative effects of alcohol due to differences in hormones, body fat composition and height weight ratios.

How can alcohol related brain damage be prevented?

• stick within low risk drinking guidelines of no more than 14 units per week (equates to 6 pints lager or 1.5 bottles of wine per week)
• spread alcohol intake over three or more days
• have alcohol free days
• increase physical and mental activity
• have a healthy balanced diet
• avoid smoking
• manage stress, depression and anxiety symptoms by finding alternative methods of coping than alcohol use
• keeping weight, cholesterol and blood pressure in check

Interventions and support for people with alcohol related brain damage

If the excessive consumption of alcohol is stopped and vitamin B1 levels increase, about 25% of cases recover completely, 50% of the cases show a partial recovery with some degree of damage (but this tends to remain static) and 25% of the cases diagnosed progress with damage to the brain and nervous system and may need long term care eventually.

People who are drinking excessively should have a gradual withdrawal of alcohol as suddenly stopping or rapidly reducing the intake may lead to: tremors, delirium, sweating, hallucinations, depression, anxiety and insomnia.

The person who is drinking alcohol to excess should see their GP for an assessment of the issue and for referral for treatments and services available to treat the alcohol misuse. The GP may refer the person for managed withdrawal of alcohol, counselling and prescribe medication to stop the withdrawal symptoms and reduce the urge to drink alcohol. They may also advise that the person attend a local self-help group. In addition, if the GP suspects that there may be cognitive damage they may refer the person for an assessment of the cognitive damage and for ongoing support if needed.

If alcohol related brain damage is diagnosed, the person and the family should be assisted to:

• devise an individualised plan focusing on strengths and interests
• follow guidance to remain alcohol free
• attend a self-help group
• eat a healthy balanced diet high in thiamine (leafy green vegetables, oily fish and whole grains) and take a vitamin supplement if required