Can Alcoholism Cause Dementia?

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KEY TAKEAWAYS

Yes, alcoholism can cause Dementia, as a result of the lack of thiamine that occurs with excessive alcohol use [1].

80% of alcoholics suffer from a lack of thiamine, resulting in loss of white matter, damage to the gut and cellular function, all leading to alcohol related dementia [2].

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How Alcoholism Causes Dementia

A study undertaken by the National Institute for Health and Care Excellence in 2015 found a link between heavy or binge drinking and alcohol related dementia [3].

The Royal College of Physicians estimates that 35% of heavy drinkers have a form of alcohol related brain damage, such as alcohol related dementia [4].

Alcohol directly alters the brain cells, or indirectly causes damage through vitamin deficiencies, with up to 80% of alcoholics having a thiamine deficiency that damages the brain's ability to communicate with the rest of the body [5].

In a study on alcohol's effects on the brain, it was found that up to 24% of alcoholic dementia sufferers had experienced a loss of white matter in the brain, causing reduced blood flow around the body, leading to a loss of memory and mobility [6].

Intake Level

A study by Anttila et al found that those who drank no alcohol and those who drank frequently were both twice as likely to suffer from a mild cognitive impairment than those who drink infrequently [7].

In a study of over 30 million hospital patients, it was found that in dementia patients aged 64 and younger, 38.9% of cases were alcohol related and 17.6% had already been diagnosed with another alcohol use disorder before an alcoholic dementia diagnosis [8].

A study found that long term consumption of over 14 units of alcohol per week had a higher risk of developing alcohol related dementia than those who consumed less than 14 units per week for the same amount of time [9].

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How Alcoholism Accelerates Dementia In The Brain

Alcohol accelerates symptoms of dementia by causing a lack of thiamine in the body, which is crucial for normal brain and cell function [10].

  • Memory loss
  • Difficulty concentrating
  • Confusion carrying out everyday tasks
  • Struggling when communicating with others, such as speaking or following conversations
  • Forgetting the day or place
  • Changes in mood [15]

These symptoms are also present in alcohol related dementia, including memory loss, personality changes and impaired social skills [16].

Alcoholic dementia symptoms additionally include:

  • Problems learning new things
  • Decreased attentiveness
  • Impaired judgement [17]

Cognitive Symptoms Distinguishing Alcoholic Dementia vs Alzheimer's

In a study comparing neuropsychological tests between Alzheimer's disease and alcoholic dementia, it was found that patients with Alzheimer's disease had lower scores on tests involving word retrieval, memory and recognition, whilst alcohol related dementia sufferers have lower scores on tests involving fine motor control and free recall, demonstrating the cognitive differences when dementia is caused by alcoholism [18].

Physical Symptoms Distinguishing Alcoholic Dementia vs Non-Alcoholic Dementia

Physical symptoms that affect both alcohol related and non-alcohol related dementia include:

  • Pain, up to 50% of dementia sufferers in nursing homes are struggling with pain [19]
  • Urinary incontinence [20]
  • Visual hallucinations [21]
  • Aggressive behaviour, both verbally [swearing, shouting and making threats] and physically [towards objects and other people] [22]

Alcoholic dementia is difficult to differentially diagnose from other forms of dementia due to the overlapping symptoms, as well as a lack of awareness of the dangers of drinking habits [23].

Physical symptoms that primarily affect alcohol related dementia and not other forms of dementia include:

  • Balance issues, alcohol damages the part of the brain controlling balance causing sufferers to fall over even when sober [24]
  • Low body temperature, the American journal of Alzheimer's disease and other dementia's found that patients with alcohol related dementia also developed pneumonia due to a lower body temperature [25]
  • Muscle weakness or atrophy, according to a 2017 survey by Simon et al, 40-60% of alcohol related dementia sufferers also suffer from muscle weakness [26]
  • Alcohol withdrawal symptoms, such as nausea and vomiting, insomnia, shakiness and mood changes [27]

Physical symptoms alter between alcoholic dementia and other forms of dementia because whilst alcohol related dementia is caused by a lack of thiamine leading to damage of the blood brain barrier, alzheimer's disease affects how the brain forms new memories, leading to different symptoms [28].

Effects On The Brain

The effects on the brain of non-alcohol related dementia are:

  • Damage to the frontal lobe of the brain, this affects memory, thoughts, behaviour and movement
  • Cognitive function issues, such as forgetting names, people or places, misplacing things or forgetting conversations that just happened [29]

The effects of alcohol related dementia on the brain are:

  • Brain cells dying (atrophy), meaning there are less cells to carry messages around the body [30]
  • Brain tissue shrinking, causing memory loss, lack of concentration and impulsive behaviour [31]

A study in 2012 by Ende et al shows that unlike non-alcohol related dementia, alcoholic dementia has the potential for brain cell recovery if sufferers abstain from alcohol [32].

Alcoholism As A Risk Factor For Dementia

A study by the BMJ in 2018 found that drinking over 14 units of alcohol per week experienced a 17% increase in dementia in comparison to those who drank less than 14 units [33].

Research by Koch et al on patients over 72 found that those who abstain from alcohol and those who drink more than 14 units both increased their risk of developing dementia [34].

A 2020 report in the Lancet found excessive alcohol use as one of the key risk factors in the development of dementia [35].

At-Risk Groups For Alcoholism As The Cause of Dementia

20% of men suffer from alcoholic dementia, while it affects only 5-6% of women.

Women are more vulnerable to alcohol related dementia side effects such as brain shrinkage, the loss of white matter and lesser cognitive function [36].

A case study published in 2013 by Boot et al found that those with a history of anxiety and depression have been shown to result in a greater likelihood of developing alcohol related dementia, as well as having a family history of Parkinson's disease [37].

Alcohol has been proven to have a greater effect on the elderly, particularly in regard to cognitive function, due to factors such as having lower amounts of body water and thiamine than younger drinkers, leading to more risk of alcohol related dementia [38].

Diagnosing Dementia Caused By Alcoholism

The criteria for diagnosing alcohol related dementia in The Diagnostic and Statistical Manual for Mental Disorders is:

In order to improve the validity of alcohol related dementia diagnosis and distinguish from other forms of dementia, Oslin et al's criteria includes:

  • A diagnosis at least 60 days after the last alcohol use
  • Significant alcohol use, a minimum of 35 drinks a week for men and 28 for women, for around 5 years
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It also argues that alcoholic dementia diagnosis is supported by:

  • Organ damage, specifically hepatic or pancreatic
  • Loss of coordination, balance and speech
  • After 60 days of abstinence, cognitive impairment is either stabilised or improved

But symptoms that could indicate other forms of dementia include:

  • Language impairment
  • Focal neurological signs, such as problems with the nerves, spinal cords or brain function [40]

Oslin et al's criteria suggests that alcohol related dementia sufferers are less cognitively impaired than other forms of dementia and that symptoms may improve with treatment; also that alcoholic dementia has less issues with language and more issues with motor skills than other forms of dementia [41].

As well as analysing symptoms of alcohol related dementia, doctors will perform tests to analyse memory and thinking skills after a period of abstaining from alcohol [42].

When Alcoholism Does Not Result In Dementia, But Should

Alcoholism causes a loss of vitamin B1, or thiamine, which may cause alcohol related dementia, but may also be a symptom of anaemia, which mimics symptoms of alcohol related dementia such as irritability, personality changes and memory impairment [43].

There are diseases that affect cognitive function similarly to alcohol related dementia such as:

  • Kidney diseases, such as end stage renal disease or chronic kidney disease [44]
  • Insulin deficiency and insulin resistance in diabetic patients [45]
  • Neuromuscular disorders such as muscular dystrophy and myotonic dystrophy [46]

Similarities in symptoms may cause an incorrect diagnosis of alcoholic dementia, especially if the patient in question also has a problem with alcohol use.

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When Dementia Looks Like It's Caused By Alcoholism, But Isn't

Medication-induced dementia resembles alcohol related dementia as it has similar symptoms such as confusion, trouble generating thoughts and difficulty with memory [47].

Drugs impair cognition via metabolic effects or synapse interferences, as well as crossing the blood brain barrier, mimicking the effects of alcoholic dementia [48].

In a study by Wilkinson et al into prescription drugs and dementia, it was found that 30% of the drugs used in the study were associated with the cause of dementia [49].

Alcohol causes Dementia by:

  • Damaging the brain cells and neuron receptors through a lack of thiamine in the body [50]
  • The loss of white matter in the brain, causing the loss of mobility and memory [51]

Unlike other forms of dementia, alcohol related dementia is reversible, as studies by Asada et al have shown a return in cognitive function and recovery in previously damaged parts of the brain [52].

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Last Updated: January 18, 2023

About the author

Harriet Garfoot

Harriet Garfoot BA, MA has an Undergraduate degree in Education Studies and English, and a Master's degree in English Literature, from Bishop Grosseteste University. Harriet writes on stress & mental health issues, and is a member of the Burney Society. Content reviewed by Peter Szczepanski (Clinical Lead).