Alcohol dementia

Alcohol dementia, which is sometimes associated with Wernicke-Korsakoff syndrome, is a form of dementia caused by long-term or excessive drinking resulting in neurological damage and memory loss. Other names for the condition are alcoholic dementia, alcohol related dementia [Kapaki, Elissavet. "Alcoholic dementia: myth or reality?", "Annals of General Psychiatry", 28 February 2006. Quote: "A broader definition, such as "alcohol related dementia" (ARD) has been introduced to encompass a broader spectrum of alcohol related cognitive disorder." Available online at [http://www.annals-general-psychiatry.com/content/5/S1/S57 annals-general-psychiatry.com] ] and alcohol-induced persisting dementia.

ymptoms/Diagnosis

The symptoms of alcohol dementia are essentially the same as the symptoms present in other types of dementia. There are very few qualitative differences between alcohol dementia and Alzheimer’s disease and is therefore difficult to distinguish between the two [“What’s Alcohol-Related Dementia?” 18 July 2005. health-cares.net. 27 Jan. 2008 .] . Some of these warning signs may include memory loss, difficulty performing familiar tasks, poor or impaired judgment and problems with language. However the biggest indicator is friends or family members reporting changes in personality [Moriyama, Yasushi, et al. “Primary Alcoholic Dementia and Alcohol-Related Dementia.” Psychogeriatrics Sept. 2006: 114-118. Academic Search Premier. EBSCO. University of Minnesota-Duluth Lib., University of Minnesota. 24 Feb. 2008. . ] .Due to the fact that these warning signs are so similar it makes alcohol dementia difficult to diagnose.

Anyone who drinks excessive amounts of alcohol over a long period of time is at risk for succumbing to alcohol related dementia [“What’s Alcohol-Related Dementia?” 18 July 2005. health-cares.net. 27 Jan. 2008 .] . Obviously some people are at a greater risk than others. A male who drinks six or more alcoholic drinks a day is placing themselves at a greater risk, the same goes for females who have four or more alcoholic drinks daily [“What’s Alcohol-Related Dementia?” 18 July 2005. health-cares.net. 27 Jan. 2008 .] . However this type of drinking must be sustained for a substantial amount of time.

It is a common myth that only the elderly are afflicted with types of dementia. This is particularly untrue regarding alcohol dementia, the onset of which can be as early as age thirty [“What’s Alcohol-Related Dementia?” 18 July 2005. health-cares.net. 27 Jan. 2008 .] . Although it is possible to acquire alcohol related dementia early in life it is far more common that the dementia will reveal itself anywhere from age fifty to age seventy [“What’s Alcohol-Related Dementia?” 18 July 2005. health-cares.net. 27 Jan. 2008 .] . Essentially the onset and the severity of this type of dementia is directly correlated to the amount of alcohol that a person consumes over their lifetime.

Criteria for DiagnosingCriteria for alcohol-induced persistent dementia in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)

A. The development of multiple cognitive deficits manifested by both:

1) Memory impairment (impaired ability to learn new information or to recall previously learned information)

2) One (or more) of the following cognitive disturbances:a) Aphasia (language disturbance)b) Apraxia (impaired ability to carry out motor activities despite intact motor function)c) Agnosia (failure to recognize or identify objects despite intact sensory function)d) Disturbance in executive functioning (i.e. planning, organizing, sequencing, abstracting)

B. The cognitive deficits in criteria A1 and A2 each cause significant impairment in social or occupational functioning and represent a significant decline from a previous level of functioning. C. The deficits do not occur exclusively during the course of a delirium and persist beyond the usual duration of substance intoxication or withdrawal.

D. There is evidence from the history, physical examination, or laboratory findings that deficits are etiologically related to the persisting effects of substance use (e.g. a drug of abuse, a medication).

Treatments

If the symptoms of alcohol dementia are caught early enough, the effects may be reversed. The person must stop drinking and start on a healthy diet, replacing the lost vitamins, including but not limited to, thiamine [“What’s Alcohol-Related Dementia?” 18 July 2005. health-cares.net. 27 Jan. 2008 .] . Recovery is more easily achievable for women than men, but in all cases it is necessary that they have the support of family and friends and abstain from alcohol. [“What’s Alcohol-Related Dementia?” 18 July 2005. health-cares.net. 27 Jan. 2008 .] . There is also a case study of a patient who was treated with memantine; the patient was a 71 year old female who was treated with memantine for five weeks, at a dosage of 30mg/daily to help improve memory and cognitive functioning [Preuss, U.W, M. Bahlmann et al. “Memantine Treatment on Alcohol Dementia: Rapid PET Changes and Clinical Course.” European Neurology 2001 vol. 45 issue 1: 52-58. Academic Search Premier. EBSCO. University of Minnesota Duluth Lib. 3 March 2008 .] . After the five week treatment the patient had shown improvement on the Mini-Mental State Examination from 18 to 22 points and her tests on the CERAD (Consortium to Establish a Registry for Alzheimer’s Disease) improved from zero to five on the Wordlist Recall and six to eight on the Drawing test [Preuss, U.W, M. Bahlmann et al. “Memantine Treatment on Alcohol Dementia: Rapid PET Changes and Clinical Course.” European Neurology 2001 vol. 45 issue 1: 52-58. Academic Search Premier. EBSCO. University of Minnesota Duluth Lib. 3 March 2008 .] . This is the only study of its kind but has promising outcomes for further research.

Four Perspectives for Studying Alcohol Dementia

There are four different perspectives for looking at and studying alcohol dementia. They are the neuropathological, biochemical, neuroradiological, and clinical. The neuropathological approach is problematic to use when it comes to alcohol dementia. Using this approach there is very little evidence to suggest possible neurotoxicity of the brain from alcohol consumption, and that more likely most cases are actually Wernicke-Korsakoff’s syndrome [Moriyama, Yasushi, et al. “Primary Alcoholic Dementia and Alcohol-Related Dementia.” Psychogeriatrics Sept. 2006: 114-118. Academic Search Premier. EBSCO. University of Minnesota-Duluth Lib., University of Minnesota. 24 Feb. 2008. . ] .

The biochemical approach suggests that there is possible damage to the brain related to large levels of alcohol consumption, but there is nothing conclusively linking it to alcohol dementia [Moriyama, Yasushi, et al. “Primary Alcoholic Dementia and Alcohol-Related Dementia.” Psychogeriatrics Sept. 2006: 114-118. Academic Search Premier. EBSCO. University of Minnesota-Duluth Lib., University of Minnesota. 24 Feb. 2008. . ] . More evidence is present using the neuroradiological that suggests the shrinkage of white matter that may be related to excessive alcohol consumption may lead to problems with attention and working memory [Moriyama, Yasushi, et al. “Primary Alcoholic Dementia and Alcohol-Related Dementia.” Psychogeriatrics Sept. 2006: 114-118. Academic Search Premier. EBSCO. University of Minnesota-Duluth Lib., University of Minnesota. 24 Feb. 2008. . ] . Both of the approaches provide compelling possible evidence, but as of today neurotoxicity of the brain caused by alcohol leading to a state of dementia is not proven conclusively by either [Moriyama, Yasushi, et al. “Primary Alcoholic Dementia and Alcohol-Related Dementia.” Psychogeriatrics Sept. 2006: 114-118. Academic Search Premier. EBSCO. University of Minnesota-Duluth Lib., University of Minnesota. 24 Feb. 2008. . ] .

The Clinical approach gives the most compelling and supportive evidence for alcohol dementia. One clinical observation showed a man who after excessive drinking showed symptoms that “mimicked those of an advanced stage of Alzheimer’s disease [Moriyama, Yasushi, et al. “Primary Alcoholic Dementia and Alcohol-Related Dementia.” Psychogeriatrics Sept. 2006: 114-118. Academic Search Premier. EBSCO. University of Minnesota-Duluth Lib., University of Minnesota. 24 Feb. 2008. . ] .” This patient did not show any of the typical signs associated with Wernicke-Korsakoff’s syndrome such as restricted eye movement, and he even improved almost completely, which is also not part of Wernicke-Korsakoff’s syndrome [Moriyama, Yasushi, et al. “Primary Alcoholic Dementia and Alcohol-Related Dementia.” Psychogeriatrics Sept. 2006: 114-118. Academic Search Premier. EBSCO. University of Minnesota-Duluth Lib., University of Minnesota. 24 Feb. 2008. . ] . This case suggests that the patient had alcohol dementia, and that, while rare, alcohol dementia is an actual syndrome.

Controversies

The main controversy that accompanies alcohol dementia is its relationship with Wernicke-Korsakoff’s syndrome. This connection between both syndromes is not completely understood, and is hard to verify. The symptoms of both are similar, and alcohol seems to be a common cause between the two. A distinguishing factor between them is that Wernicke-Korsakoff’s syndrome is characterized by restricted eye movement, and an acute onset while alcohol dementia has a gradual onset(5). There is a small amount of evidence to suggest they might be linked despite these differences. One case of this exhibited a patient who had repeated episodes of Wernicke-Korsakoff’s syndrome [Moriyama, Yasushi, et al. “Primary Alcoholic Dementia and Alcohol-Related Dementia.” Psychogeriatrics Sept. 2006: 114-118. Academic Search Premier. EBSCO. University of Minnesota-Duluth Lib., University of Minnesota. 24 Feb. 2008. . ] . While there was not much change between the persons first and second episodes, after consecutive episodes a gradual decline in mental capabilities, closely related to those of alcohol dementia, were recorded [Moriyama, Yasushi, et al. “Primary Alcoholic Dementia and Alcohol-Related Dementia.” Psychogeriatrics Sept. 2006: 114-118. Academic Search Premier. EBSCO. University of Minnesota-Duluth Lib., University of Minnesota. 24 Feb. 2008. . ] . This leaves room to consider the connection between the two is deeper than may have originally been thought. Whether or not “long-term alcohol use may have direct neurotoxic effects on the brain, leading to a characteristic dementia syndrome” is still a major question [Moriyama, Yasushi, et al. “Primary Alcoholic Dementia and Alcohol-Related Dementia.” Psychogeriatrics Sept. 2006: 114-118. Academic Search Premier. EBSCO. University of Minnesota-Duluth Lib., University of Minnesota. 24 Feb. 2008. . ] .

Other controversies related to alcohol dementia mainly relate to how difficult it is to study. Alcohol dementia is listed in the Diagnostic and Statistic Manual of Mental Disorders, 4th edition (DSM-IV), but there is concern that some of the terminology used to describe alcohol dementia and those at risk for it is vague [Moriyama, Yasushi, et al. “Primary Alcoholic Dementia and Alcohol-Related Dementia.” Psychogeriatrics Sept. 2006: 114-118. Academic Search Premier. EBSCO. University of Minnesota-Duluth Lib., University of Minnesota. 24 Feb. 2008. . ] .Other problems that relate to the study of alcohol dementia are possibly inaccurate documentation of abstinence, differences between this and other forms of dementia, and issues related to lack of studies using the DSM-IV criteria [Moriyama, Yasushi, et al. “Primary Alcoholic Dementia and Alcohol-Related Dementia.” Psychogeriatrics Sept. 2006: 114-118. Academic Search Premier. EBSCO. University of Minnesota-Duluth Lib., University of Minnesota. 24 Feb. 2008. . ] .

Well-Known Sufferers

* Socialite Leonore Lemmon

References

External links

* [http://alcoholism.about.com/cs/dementia/a/aa990714.htm Alcoholism & Substance Abuse: Alcohol Dementia]
* [http://www.alzheimers.org.uk/Facts_about_dementia/What_is_dementia/info_korsakoffs.htm Facts about Dementia]
* [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1892448&dopt=Abstract Clinical concept of alcoholic dementia]