Alcohol related brain damage

Dr Louise McCabe

Lecturer in Dementia Studies

University of Stirling

Today’s presentation

• What is ARBD?

• Prognosis

• Prevalence

• 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 population

– 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

figures

• 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 03-06

& increases

Scotland 3.2 4.3 34%

West of Scotland 4.1 5.3 31%

East of Scotland 2.8 3.7 33%

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 deprivation

• 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 under-diagnosed 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

Stigma

• 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 understand – 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

But • In 2003 two expert groups set up: dual diagnosis and

ARBD• In 2006 Alcohol and ageing working group convened• In 2007 – Commitment 13

Concluding comments• Need more research on prevalence and

epidemiology

• Need better understanding of prognosis and treatment

• Need evaluations of successful services and identification of routes for knowledge transfer