Anyone who’s ever noticed that they feel more relaxed or outgoing after having a drink or two has seen firsthand alcohol’s impact on the brain. But as you may have guessed, beyond the feel-good vibes, the side effects from your go-to rosé or spicy marg are not overwhelmingly positive. In fact, buzzkill alert: No level of alcohol consumption is considered safe. Casual drinking has been linked to various cancers and cardiovascular problems, and chronic drinking (defined as eight or more weekly drinks for women or 15 or more for men) carries additional risks, especially for the brain.
It’s not just a euphemism; booze kills brain cells—kind of, at least. Because it’s a neurotoxin, alcohol can actually damage the frontal lobes and inhibit the formation of new brain cells. It’s one of the few substances (along with things like caffeine, nicotine, THC, and certain medications) that can break through the blood–brain barrier, a layer of cells that filters out harmful substances so they can’t harm our most vital organ. Once alcohol reaches the brain, it can damage the neurons that reside there. Over many years, this ongoing assault on these cells can cause alcohol-related dementia, a form of brain damage that can lead to cognitive challenges with memory and problem-solving.
Unlike other types of dementia, this type of alcohol-induced neurocognitive disorder usually progresses slowly. By contrast, folks with traditional dementia can deteriorate quite quickly.
Stages of alcohol-related dementia
Alcohol-related dementia ranges drastically in terms of its severity, says Lisa Savage, PhD, a professor of psychology at Binghamton University and the scientific director of the Developmental Exposure Alcohol Research Center. At one end of the spectrum, you have mild to moderate cognitive impairment. In these cases, most of the damage occurs in the frontal cortex and hippocampus, the parts of the brain important for things like planning, problem-solving, self-control, and memory, she explains. “In milder cases, if someone quits drinking, imaging studies have shown there can be recovery of gray matter, but white matter can be permanently damaged,” says Savage. This means folks may regain skills like emotional regulation and motor skills, but not memory and attention capacity.
At the more severe end of the spectrum is Wernicke-Korsakoff syndrome, which is actually two different brain disorders, Wernicke encephalopathy and Korsakoff syndrome, that often occur progressively. Both are caused by brain damage associated with a combination of alcohol use disorder and vitamin B1 (thiamine) deficiency. Chronic heavy drinkers generally have a poorer diet and struggle to absorb thiamine from food, which increases their risk for the condition, explains Kasia Rothenberg, MD, PhD, staff neuropsychiatrist at Cleveland Clinic’s Lou Ruvo Center for Brain Health. “Alcohol deprives us of thiamine. It prevents the vitamin from being absorbed and uses it for its own metabolism, so there isn’t enough of it for other cells to use for other processes in the body,” she says of the mechanism behind the disorders. “If you catch [Wernicke encephalopathy] within a few days [of symptom onset] and give the person a large dose of thiamine, they can recover,” Savage says. “But if you get past that, they go into the Korsakoff phase, and there’s no treatment. Loss of brain tissue has already occurred.”
Symptoms of alcohol-related dementia
The symptoms of alcohol-induced neurocognitive disorders differ from person to person, and also depend on how much brain damage has been done and what areas have been impacted. “In general, if someone keeps drinking, the situation becomes more and more severe,” Dr. Rothenberg says.
People with mild alcohol-related brain damage may have a hard time:
- Staying focused
- Grasping how others think or feel
- Solving problems
- Concentrating on tasks
- Organizing or planning
- Remembering things they recently learned
- Staying balanced while walking
- Controlling their mood
People with Wernicke encephalopathy may also experience:
- Confusion
- Abnormal eye movements
- Poor coordination
Lastly, symptoms of Korsakoff syndrome can include all of the above, as well as:
- Severe memory loss
- Inability to form new memories or recall something they just learned
- Confabulation, or making things up to try to “fill in the gaps” when one’s memory fails
- Seeing or hearing things that aren’t there
- Problems with decision-making, planning, organizing, and completing tasks
- Emotional apathy
- Lack of motivation
How is alcohol-related dementia diagnosed?
No single test can determine if someone’s drinking has led to brain impairment. Instead, medical providers do several things, including a physical exam to check for symptoms and blood work to test for a thiamine deficiency, Dr. Rothenberg says. They also ask about your medical and drinking history.
“It’s difficult to diagnose because a lot of people tend to underreport their drinking,” Savage says. “Also, for Wernicke-Korsakoff syndrome, people need to say they have a poor diet.” So people must answer honestly…but that may be difficult if their memory is impaired. For this reason, providers may ask loved ones about the patient’s health and day-to-day living. Lastly, if Wernicke-Korsakoff syndrome is suspected, an MRI of the brain may be used to look for damage that can confirm the diagnosis.
Overall, diagnosis may take some time, because it comes down to ruling out other possible conditions, such as frontotemporal dementia or Alzheimer’s disease, Savage says. “We more or less diagnose based on a number of questions on neurological exams and a history of heavy drinking.”
Treating alcohol-related brain damage
It can be difficult to hear, but most longtime alcohol abusers will have permanent brain damage, Dr. Rothenberg says. That’s why it’s crucial to get help as soon as possible.
The first step is going sober, ideally under the supervision of a medical provider. “When you read the literature about addiction, nothing works better than total cessation,” she says. For some people, this may mean joining a peer group like Alcoholics Anonymous. Others may prefer individual counseling such as cognitive behavioral therapy, which has also been shown to be effective. However, people experiencing more severe alcohol abuse may need to be hospitalized or supervised in an inpatient treatment center.
Even if you think you can go cold turkey yourself, it’s essential to get help, because withdrawal can seriously impact the nervous system. “People can have tremors, shakes, and even convulsions,” Savage explains. Educated providers and centers are aware of this and have protocols to help people stop drinking while minimizing or preventing these adverse effects.
Additionally, people with Wernicke encephalopathy often need thiamine via an IV. “Many times, it can reverse the most acute symptoms,” Dr. Rothenberg says.
Lastly, in some cases, medication such as naltrexone and acamprosate may be used to treat alcohol use disorder by reducing alcohol cravings and withdrawal symptoms.
If all of this scares you a bit, remember: how much you drink matters. Usually, only chronic, heavy drinking is associated with alcohol-related dementia. Again, that’s defined as eight or more standard drinks per week for women and 15 or more per week for men. As a refresher, a “standard” drink is:
- 12 ounces of beer with 5 percent alcohol
- 8 ounces of malt liquor with 7 percent alcohol
- 5 ounces of wine with 12 percent alcohol
- 1 shot (1.5 ounces) of liquor or distilled spirits (80-proof)
That said, if this information makes you question whether you want to drink at all, that’s not necessarily a bad thing—there’s never been a better time to mix things up if you want something “fun” and zero-proof to drink. Consider shaking up a fresh mocktail or cracking open one of the countless better-for-you sodas on the market.
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