Alcohol Related Brain Disorders

Alcohol-Related Brain Damage (ARBD)

Alcohol Related Brain Disorders (ARBD) is an umbrella term that covers different conditions including Wernicke- Korsakoff syndrome (wet brain) and alcohol-induced dementia. These conditions are caused by excessive drinking over a long period of time. The majority of those who receive prompt treatment and remain abstinent from alcohol can make a full or partial recovery without worsening of the condition.

ARBD by definition refers to a long-term decline in memory and thinking impairment caused by the excessive use of alcohol and the subsequent lack of thiamine (Vitamin B 1) which is essential for brain and nerve cell function.

The uncontrolled misuse of alcohol causes ARBD by chemically changing the brain, damaging nerve cells, and shrinking brain tissue.  Poor diet and the irritation of the stomach lining exacerbated by vomiting may cause poor absorption of nutrients creating a deficiency in thiamine. Alcohol also interferes with the body’s absorption of thiamine.

Repeated head injuries caused by falls or fights brought on by intoxication may also lead to ARBD.

The abuse of alcohol has been linked to high blood pressure, higher cholesterol levels, and an increased risk of strokes and heart attacks. These conditions may all cause damage to the brain.

Alcohol directly affects the brain and how it functions. Chronic alcohol abuse can damage brain cells and interfere with a person’s ability to make decisions and use his or her judgment. Additionally, many people who drink heavily over an extended period of time experience problems with nutrition as a result of alcohol consumption and poor eating habits. All of these factors can contribute to the development of alcoholic dementia.

Alcoholic dementia shares many similarities with Alzheimer’s disease, including a decline in cognitive function and memory. Also like Alzheimer’s disease, alcoholic dementia is often irreversible once the condition has set in.

There are several symptoms that point towards alcoholic dementia and often earliest sign is confusion. Short-term memory problems that begin in the early stages of alcoholic dementia may also be present.

As the disease progresses, individuals will experience worsening symptoms of alcoholic dementia. Each condition related to alcoholic dementia will cause different symptoms.

Symptoms of Alcohol-related dementia may include:

  • Impulsivity
  • Difficulty in controlling emotions
  • Poor planning skills and problems in assessing possible risks
  • Insensitivity to other people’s feelings
  • Inappropriate social behaviour
  • Constant repetition

Signs and symptoms of alcoholic dementia and the conditions it may cause often start slowly. This can make it difficult to diagnose until it has progressed too far. However, there are several tests that can be done if alcoholic dementia is suspected.

Testing and Treatment

Examining the nervous and muscular system can help determine nerve damage possibly caused by alcoholic dementia. Using blood tests to establish nutrition levels is also a helpful tool according to many physicians.

Tests that may be used to diagnose alcoholic dementia include:

  • Muscular and nervous system tests ( Abnormal eye movement, muscle weakness, low blood pressure, and increased pulse)
  • Liver enzyme testing
  • Blood tests to determine Vitamin B1 and Transketolase activity

Alcoholic dementia detected in its early stages may significantly improve with treatment. Quitting drinking is commonly the first step in treating this condition. Additionally, thiamine may be administered to improve eye movement and vision problems, confusion, and muscle coordination. Left untreated this condition may worsen and lead to other conditions.

Wernicke’s Korsakoffs Syndrome – Wet Brain

Korsakoff’s syndrome is the most commonly known form of ARBD (Alcohol-related brain damage). However, it is less common than alcoholic dementia.

Korsakoff’s syndrome often evolves as part of a condition known as Wernicke-Korsakoff syndrome. This has two separate but related stages: Wernicke’s encephalopathy – an acute brain reaction to a severe lack of Thiamine –followed by Korsakoff’s syndrome. Wernicke-Korsakoff syndrome is diagnosed in about one in eight people with alcoholism. However, not everyone has an obvious case of Wernicke’s encephalopathy before Korsakoff’s syndrome develops.

How does Wernicke’s encephalopathy develop?

An encephalopathy is a condition that affects the function of the brain. Wernicke’s encephalopathy usually develops suddenly, often after abrupt and untreated withdrawal from alcohol. There are varying symptoms that are not always obvious and can make it difficult to diagnose.

Symptoms of Wernicke’s encephalopathy may include:

  • Disorientation, confusion or mild memory loss
  • Underweight
  • Involuntary eye movements/paralysis of muscles that move the eyes
  • Poor balance, unsteady movement, and/ or lack of coordination

Wernicke’s encephalopathy is a medical emergency that causes life-threatening brain disruption. High doses of thiamine and other B vitamins will need to be administered intravenously. With effective and timeous treatment the effects may wear off within days. Without the required treatments permanent brain damage or death may occur.

Korsakoffs Syndrome

In the instance where Wernicke’s encephalopathy is untreated or treatment is delayed or insufficient Korsakoff’s syndrome gradually develops. Research indicates that severe thiamine deficiency disrupts several biochemicals responsible for storing and retrieving memory. The disruptions destroy brain cells and cause extensive microscopic bleeding and scar tissue.

Most cases of Kosakoffs syndrome result from the abuse of alcohol though the condition has been noted in AIDS patients as well as those who are severely undernourished,  have chronic illnesses or have undergone bariatric surgery.

Scientists have not yet been able to establish why heavy drinking causes this severe thiamine deficiency in some alcoholics while others are primarily affected by the damage that alcohol causes to the liver, stomach, heart, intestines or other body systems.

Symptoms of Korsakoffs Syndrome may include:

  • Problems learning new information
  • Short term memory loss
  • Long term memory gaps
  • Confabulation*
  • Hallucinations

Confabulation is a symptom of various memory disorders in which made-up stories fill in any gaps in memory. German psychiatrist Karl Bonhoeffer coined the term “confabulation” in 1900. He used it to describe when a person gives false answers or answers that sound fantastical or made up.

It is important to understand that the person who has this syndrome may have a coherent conversation and within a short space of time will have forgotten the conversation and perhaps to whom they were speaking.

Diagnosis

The diagnosis of Korsakoff Syndrome is clinical as there are no tests or neuroimaging tools with which to confirm this disorder.  Often symptoms may be masked by conditions such as intoxication, withdrawal, infections, or head injury.

A medical exam including a questionnaire pertaining to memory and cognitive changes along with a history of heavy drinking coupled with the judgement of the physician is the standard for diagnosis.

Treatment

In most cases a doctor will prescribe medication to control symptoms. The doctor will advise the patient on ways to increase levels of thiamine and may prescribe vitamin supplements. Vitamin B1 through an oral medication or by intravenous or intramuscular injections may be recommended.

Thiamine may improve the symptoms of confusion or delirium. It may also influence issues with vision and eye movement, and improve muscle coordination. However, vitamin B1 will not improve the intellect or memory of people who have Wernicke-Korsakoff syndrome.

People with wet brain need to seek treatment for their alcohol use disorder in order to stop or slow the progression of the disorder.

The best way to prevent alcoholic dementia and health complications linked to chronic alcohol abuse is to seek treatment for alcohol addiction. While this decision can be difficult, it can quite literally save your life and improve your overall health and wellbeing. 

There is always help and there is always hope.

Call 081-444-7000 or email Change@ChangesRehab.co.za to get the help you need today.

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