Diagnosing Alcoholic Dementia:

Currently, while alcohol-related dementia is recognized clinically, its use as a diagnosis is still somewhat rare because it is deemed that further research is required to establish a set of criteria for diagnosis that isn’t subjective, and that isn’t so heavily inspired by the presentation of Alzheimer’s.

According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the current criteria for alcohol-induced persisting dementia requires:

1. Numerous cognitive failings evidenced by negative impact to memory function that prevents the acquiring of new information and the recollection of previously acquired information, and any or all of the following:
   • Impaired language skills (aphasia)
   • Reduced ability in fine or gross motor skills (apraxia)
   • Loss of ability to identify objects, but not because of sensory impairment (agnosia)
   • Executive dysfunction resulting in reduced or loss of ability to organize, solve problems, or make plans
2. The cognitive failings from (1) each present serious deterioration in the individual’s ability to function in their job or socially, and overall, the combined reduction in abilities is pronounced.
3. Presenting symptoms don’t just occur in a delirium and last longer than inebriation or withdrawal
4. Findings — gathered through a deep examination of causes and origins through lab tests, physical exams, and the patient’s history — determine that deficits are because of substance abuse.

In assessing the nervous system for damage related to ARD, indicators can include:

• Rapid eye movement
• Below normal blood pressure
• Below normal temperature
• Uncontrolled eye movement
• Reduced or impaired reflexes
• Fast or irregular heartbeat (tachycardia and arrhythmia)
• Problems walking
• Issues with coordination

Types of Alcoholic Dementia:

Types of alcoholic dementia include:

1. Wernicke’s encephalopathy
2. Korsakoff’s syndrome
3. Wernicke-Korsakoff syndrome (WKS), also known as wetbrain

With both ARD and WKS, the resulting symptoms are somewhat common with many individuals displaying memory impairment or loss, apathy, and a reduced ability in executive functions like making plans, etc.; but because of the absence of a specific criteria for diagnosis, either one is rarely listed as the condition. Outside of impairment of executive function, cognitive, and motor skills, one of the most significant changes seen by those closest to the individual is personality changes.

• Wernicke’s encephalopathy

  This is a neurological condition of sudden onset that largely impacts the central and peripheral nervous systems and is defined by:

  • Depth perception, balance, and coordination problems – broad based or drunken type of walking
  • Altered mental state – confusion, slurred speech, hesitation, indecision, and uncertainty
  • Nystagmus – uncontrolled and repeated eye movements due to weakness or paralysis of muscles controlling eye movement

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  Wernicke’s encephalopathy is a reversible condition; however, if left untreated, it can progress to Korsakoff’s syndrome.

• Korsakoff’s syndrome develops gradually and is a latter phase complication of Wernicke’s encephalopathy. It is characterized by:

  • Deficits in attention and concentration
  • Gaps in memory, especially recent memories, which are usually filled with false or inaccurate information
  • Changes in behavior
  • Confusion
  • Psychotic symptoms such as auditory, visual, and tactile hallucinations and delusional beliefs

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  Individuals experience complete eradication of particular parts of their brain. Largely, the evidential symptoms of alcohol-related dementia fall between Korsakoff’s psychosis and an overall dementia, oftentimes featuring symptoms from each.

  Korsakoff’s syndrome can lead to coma and death if left untreated.

• Wernicke-Korsakoff syndrome (WKS) is a combination of Wernicke’s encephalopathy and Korsakoff’s syndrome. It’s triggered by a B12 (thiamine) deficiency, and the name comes from the names for two phases of the same disease.

  Acute phase – Wernicke’s encephalopathy
  Chronic phase – Korsakoff’s psychosis

  Because of the B12 deficiency, the supply of energy needed by the brain is insufficient. This deficit causes the greatest impact to the hypothalamus, which regulates a person’s growth, appetite, and body temperature, as well as a portion of control related to emotional responses. It also controls connections in different areas of the brain related to memory function, as well as mammillary bodies, hormones, and metabolism.

  Someone with WKS may have the appearance of someone without symptoms of a condition or a disorder for periods of time, but symptoms include:

  • Retelling stories repeatedly, being unaware the story has been told before
  • Asking the same questions repeatedly and not recalling the questions have already been answered

Causes of Alcoholic Dementia:

The exact link between dementia and alcohol is not fully understood, but drinking heavily or in excess can result in adverse effects on a person, and those health deficits increase the likelihood for developing dementia.

Examples include: 

• Deficiencies in a person’s nutrition in relation to their levels of thiamine, B-6, B-12, C, D, E, and co-deficiency of copper and zinc
• Dehydration due to the diuretic characteristic of alcoholic drinks — cause the body to expel waste liquid quicker than normal
• Poisoning from heavy alcohol use. Alcohol has been clinically shown to poison the brain, acting as a neurotoxin when it travels through the bloodstream. It disturbs parts of the brain related to critical functions like heart rate, temperature, and breathing. Permanent brain damage can occur when poisoning from alcohol is left untreated.

Alcohol does not directly cause any dementia, but for those with an alcohol dependency, their consumption will typically decrease vitamin B12 levels to a point that can trigger Wernicke-Korsakoff syndrome, and when combined with a poor diet — as seen with the majority of heavy drinkers, the resulting nutritional deficit will result in ARD.

Treatment for Alcoholic Dementia:

If alcohol-related dementia is detected early, the effects may be reversed with the right treatment plan.

The initial phase is stabilization focuses on the withdrawal of alcohol from the person’s system, and this will likely take place in a hospital or clinical type setting. During this withdrawal phase, the individual will likely experience extreme sweating, delirium, hallucinations, and potentially some agitated behaviors. This portion of the treatment can include sedation, IV fluid replacement, and high doses of B12 injections.

Once stabilized, the individual will need to partake in treatment services offered to individuals with alcohol dependence.

• Cognitive-behavioral therapy – to bring understanding and adopt alternate behaviors when the desire to drink manifests, with the goal of modifying their lifestyle and gradually stopping drinking alcohol.
• Self-help groups – to help stay free from alcohol
• Certain drugs will be prescribed to address a person’s craving associated with using alcohol, and cause them to feel or physically be sick if they decide to drink.
• Healthy diet and replacement therapy for vitamin deficiency

The second phase is rehabilitation so they can reintegrate with society and function independently in everyday life.

Rehab includes a focus on:

• improving cognitive function, like memory
• improving executive function, like making plans and being organized

For some, this will include shelter living, and others can live back at home when they have a good support system in place.

Recovery prospects

Roughly 25% will leave treatment with very good results from their recovery, about half will make a partial recovery and possibly need to stay in community housing for a period, and the other 25% will make little to no progress toward recovery and may need residential care on a long-term basis.

Complications of Alcoholic Dementia:

The potential long-term impact on someone’s life from alcohol-related dementia can include:

• Peripheral neuropathy – nerve damage in the legs and arms, loss of feeling in the affected extremities
• Pronounced apathy – as a result of frontal lobe damage connected to alcohol-related dementia, and this may look so much like depression, and even other types of dementia like Alzheimer’s, that, without the presence of more qualitative differences, it is difficult to tell them apart.
• Alcohol-related brain damage (ARBD) – along with ARD and KWS, while none are clinically dementia, they all share a lot of the same symptoms. ARBD can be partially or fully reversible.