A few too many? Alcohol as a risk factor for dementia

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‘Alcohol-related cognitive impairment’ is expected to become more common in the future as levels of alcohol consumption increase worldwide. As symptoms can be very similar to Alzheimer’s disease, there is increasing clinical demand to distinguish this as a separate disorder.

Alcohol-related cognitive disorders are currently split into two categories: alcohol related dementia (ARD) and alcohol-induced persisting amnestic syndrome (Wernicke-Korsakoff syndrome, or WKS). ‘Alcohol-related brain damage’ is increasingly used as an umbrella term to cover the heterogeneity of the disorders.

According to current DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) criteria, ARD is caused by the direct and indirect effects of alcohol on the brain, which occur after several years of alcohol abuse. Symptoms of ARD are similar to those of Alzheimer’s disease, and therefore making a diagnosis is difficult. If the dementia symptoms persist after several weeks of abstinence, and other causes of dementia are excluded, then a diagnosis of ARD can be made. WKS is a brain disorder associated with heavy alcohol consumption over an extended period, caused by a deficiency of thiamine (vitamin B1). The key diagnostic feature is short-term memory loss and permanent brain damage can occur if left untreated. Individuals with alcohol-related cognitive disorders have the potential to at least partially recover – both structurally and functionally – if abstinence from alcohol is maintained.

In a new review from Alzheimer’s Research & Therapy, Ridley and colleagues discuss the commonality between ARD and WKS in a clinical setting, and the recommendations for the diagnosis and management of alcohol-related cognitive impairment.

The authors also use epidemiological studies to highlight the challenges of investigating these conditions internationally. For example investigating the levels of drinking required to pose a risk for brain damage is difficult, as different definitions of drinking levels are used across the world. A ‘standard’ measure can range from 8g of alcohol in the UK to 19.75g in Japan. Added to this are the differing patterns of alcohol use and the presence of lifestyle factors that often accompany alcohol abusers, such as head injury, which may also contribute to dementia.

You can read the full article on the website, where you can also register for a free online trial to Alzheimer’s Research & Therapy and sign up for article alerts. For more information on Alzheimer’s Research & Therapy, or to submit a manuscript, please visit the journal website or contact the Editorial Office.