Alcohol related brain damage
Dr Louise McCabe
Lecturer in Dementia Studies
University of Stirling
Today’s presentation
What is ARBD?
Individual factors
Findings from research
Concluding comments
Alcohol related brain damage
• A group of conditions where alcohol is
determined as the primary reason for brain
damage with similar outcomes but
different specific causes
– Wernicke Korsakoff Syndrome
– ‘Alcohol induced persistent dementia’
– Alcohol-related dementia (and so on)
Alcohol and the brain
• Alcohol damages the brain in a number of ways:
Direct toxicity to the brain cells
Interference with vitamin absorption
Falls and accidents
Vascular damage/hypertension
Indirect nutritional deficiencies due to poor diet
• Susceptibility differs between individuals,
drinking patterns and different drinks
ARBD linked to:
• Liver cirrhosis (hepatic encephalopathy)
• Socio-economic factors such as
deprivation – multiple factors contribute
• Patterns of drinking
• Types of alcohol drunk
• Genetics – potential link
Wernicke Korsakoff’s
• Acute phase (Wernicke’s encephalopathy)
– delirium type symptoms
• Vitamin treatment – parenteral thiamine
• Without treatment
– 20% die
– 85% develop long term symptoms
(Korsakoff’s syndrome)
Alcohol related dementia
• Alcohol use is a risk factor for dementia
– 9-23% of older people with a history of alcohol abuse
have dementia compared with 5% of the general
– People with dementia are more likely to have alcohol
problems than those who do not have dementia
• Alcohol related dementia has a higher
prevalence than WKS and is likely to have
multiple causes – a ‘silent epidemic’
ARBD prognosis
• Better prognosis than common types of
cognitive impairment with abstinence
• Continued abstinence allows brain to
recover and stability in symptoms is seen,
this may be a good indicator that an
individual has ARBD
• Recovery can take up to two years
¼ recover fully
¼ good recovery
¼ minimal recovery
¼ no recovery – but stability in symptoms
Prevalence of ARBD
• Not known and not included in recent
epidemiological studies (e.g. DementiaUK)
• Probably rising (fast)
• Estimates:
– 10% of dementia cases (Harvey 1998)
– 21-24% of dementia cases have alcohol as
contributing factor (Smith and Atkinson 1995)
Local prevalence of ARBD
• Some local authorities have estimated
• Some populations much higher
prevalence: e.g. hostel population in
Glasgow, 21%
• Other indicators: Pabrinex prescribing –
increasing steadily
10 year increases in ARBD
hospital discharges
(Ayrshire and Arran report, 2008)
Rates per 10,000
96 – 99
Rates per 10,000
& increases
West of Scotland
East of Scotland
Deprivation and ARBD
• There is little difference in the amount
drunk by different socio-economic groups
in Scotland but there is a big difference in
the amount of alcohol related morbidity
when levels of deprivation are compared
• ARBD prevalence linked to levels of
• WKS directly linked to poor nutrition
ARBD and age
• Alcohol related neuropsychiatric conditions
are found to increase with age
• Older brains and bodies more susceptible
to damage from alcohol
• Alcohol misuse common among older men
and increasing among older women
• Alcohol misuse significantly underdiagnosed among older people
Prevalence: age and gender
• Still more men than women but increasing
in both groups
• Still more among late middle age and
older age groups
• More older people with ARBD in hospital
compared with younger people with ARBD
• Research shows stigma for:
– Cognitive impairment (dementia)
– Alcohol as a moral issue
– Ageing and ageism
• Stigma evident at all levels of society –
individual, institutional and cultural
Stigma evident in
specialist services
• Research in specialist homes/units for
people with ARBD found no involvement
by alcohol specialists
• Some staff in specialist homes felt ARBD
was self-inflicted – ‘nobody is taking them
and pouring the drink down them’
Lack of awareness in
specialist services
• Experienced staff didn’t seem to
– link between alcohol and brain damage
– Importance of abstinence
Awareness among publicans
• They don’t bring up the link between
alcohol use and cognitive impairment or
brain damage but do know about it and
have experience of it
• ARBD not included in training or health
promotion materials and activities
Barriers to effective support
• Lack of awareness and stigma
• Long period of rehabilitation and recovery
difficult to deal with
• Fall between the gaps:
– Alcohol services not equipped to deal with
cognitive impairment
– Dementia services not equipped to deal with
alcohol problems
ARBD – policy responses in Scotland
• Alcohol problems have been and continue to be a key
concern of governments
• Focus is usually on younger people, families and
children – not ageing and cognitive impairment
• In 2003 two expert groups set up: dual diagnosis and
• In 2006 Alcohol and ageing working group convened
• In 2007 – Commitment 13
Concluding comments
• Need more research on prevalence and
• Need better understanding of prognosis
and treatment
• Need evaluations of successful services
and identification of routes for knowledge