Alcohol abuse is recognized as a major health problem in the United States and in many countries throughout the world. Alcohol may cause cognitive problems and in certain conditions may cause dementia. Let’s look at what role alcohol has in causing alcohol-related dementia and how this differs to Alzheimer’s disease.
Both Alzheimer’s dementia and alcohol-related dementia cause brain damage. In Alzheimer’s, plaques and tangles made up of protein fragments cause nerve cell death, and chemicals involved with the transmission of messages within the brain, are decreased. Brain damage becomes more extensive as the disease progresses and the brain shrinks.
In alcohol-related dementia cognitive problems result from (1) the toxic effects of alcohol on the liver and the brain and (2) from secondary damage to other organs that occur as a result of alcohol abuse, such as vitamin deficiency, malnutrition, increased risk of stroke and head injury.
Statistical Differences Between the Different Types of Dementia
Alzheimer’s disease accounts for between 50 and 60 per cent of all cases of dementia.
Statistics on alcohol-related dementia are more difficult to quantify as there is controversy about alcohol as the primary cause and also what role alcohol has in secondary damage. We do know that alcoholics are at greater risk of dementia and that in four to 20 per cent of cases of dementia, alcohol plays a negative role.
Wernicke-Korsakoff syndrome is the most well known types of dementia associated with alcohol. It is a two stage type of dementia associated with alcohol. Wernicke encephalopathy is the acute phase and Korsakoff syndrome or Korsakoff ‘psychosis’ is the long-lasting more chronic stage.
Wernicke-Korsakoff syndrome is attributed to a deficiency of thiamine (vitamin B-1). Thiamine helps brain cells produce energy from sugar and when levels are too low it does not function properly.
Symptoms of Wernicke-Korsakoff syndrome include confusion, apathy, hallucinations, communication problems, problems with learning new information and severe memory impairment. One of the classic signs of this syndrome is the tendency to confabulate, that is, to invent information because of failing memory.
Recent research suggests a genetic variation called APOE-e4 may be associated with a higher risk of Wernicke-Korsakoff in individuals who drink heavily. APOE-e4 is also linked to a higher risk of developing Alzheimer’s disease.
Treatment of Wernicke-Korsakoff Syndrome
If the condition is caught early and drinking stops, treatment with high-dose thiamine may reverse some, but not usually all brain damage. Where treatment is delayed damage is more severe and is thought that about 80 per cent will suffer from dementia.
In general, the damage caused by alcohol involves mild to moderate memory impairment, slowed cognition and problems with so-called executive functions (the mental processes involved in goal directed activities, for example dressing, cooking, work). Neuroimaging does show up death of cells but the amount of apparent damage does not always reflect the levels of cognitive impairment you would expect.
For Wernicke-Korsakoff syndrome and alcohol dementia it is essential that abstinence from alcohol is observed. Help with detox may be required. Symptoms can be improved.
The acetylcholinesterase inhibitors like Aricept used to stabilize symptoms of Alzheimer’s are not used in alcohol dementia or Wernicke-Korsakoff syndrome.
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