Alcohol-related brain damage: types, symptoms, diagnosis and treatment

Alcohol-related brain damage is a brain disorder caused by drinking too much alcohol over a prolonged period of time, which can result in memory loss, impaired judgment and difficulties with coordination and balance.

This guide, written by our specialist dementia Admiral Nurses, explores the types, symptoms, diagnosis and treatment of alcohol-related brain damage.

What is alcohol-related brain damage?

When someone drinks excessive amounts of alcohol over many years, it can harm their brain. This damage can cause problems like memory loss, difficulty making decisions, and trouble with balance and coordination.

How does alcohol affect the brain?

Drinking alcohol excessively increases the risk of dementia by:

• causing shrinkage in areas of the brain that are involved in memory
• affecting the brain’s ability to transmit messages
• increasing the risk of high blood pressure, heart disease and stroke, which can affect the blood supply to the brain and lead to vascular dementia
• causing a deficiency of vitamin B1 (thiamine) in the body.

What level of alcohol consumption causes brain damage?

Exceeding the recommended weekly alcohol limit of no more than 14 units of alcohol a week, spread across 3 days or more, increases the risk of developing dementia. The evidence linking dementia with moderate drinking is less conclusive. Some studies have suggested that abstaining from alcohol completely may make you less likely to develop dementia, but it is generally accepted that if you stay within the recommended limits, it is unlikely to increase the risk. There is no completely safe level of alcohol intake, so it is important to follow medical advice.

Is alcohol-related brain damage permanent?

Some damage may be reversible by giving up drinking and with the correct treatment, but for some people, the effects can be permanent.

If the excessive consumption of alcohol is stopped and vitamin B1 levels increase, about 25% of cases recover completely, 50% of the cases show a partial recovery with some degree of damage (but this tends to remain static) and 25% of the cases diagnosed progress with damage to the brain and nervous system and may need long term care eventually.

Types of alcohol-related brain damage

The three main types of alcohol-related brain damage are Wernicke encephalopathy, Korsakoff syndrome and alcoholic dementia. Both Wernick syndrome and Korsakoff syndrome can occur on their own singularly or in combination, which is known as, Wernicke-Korsakoff syndrome.

Wernicke encephalopathy

Wernicke encephalopathy is a brain reaction to a severe lack of thiamine (vitamin B1), which causes confusion, problems with movement and coordination and abnormal involuntary eye movements. The condition usually develops because of alcohol misuse or a poor diet and can lead to permanent brain damage.

Korsakoff syndrome

Korsakoff syndrome is a chronic long-term memory disorder caused by a severe deficiency of thiamine (vitamin B1), which damages the brain cells, causing microscopic bleeds and scar tissue. This affects how signals are processed by the brain cells and causes difficulty storing and retrieving memories.

Korsakoff syndrome makes it very hard to learn new things or remember recent events, and it can also create gaps in long-term memories. While memory problems can be extremely severe, other abilities like thinking and social skills often remain mostly unaffected.

Because Korsakoff syndrome often follows an episode of Wernicke encephalopathy, the disorder is sometimes called Wernicke-Korsakoff syndrome.

Alcoholic dementia (alcohol-induced dementia)

Alcohol-induced dementia is a serious but potentially preventable condition caused by long-term alcohol abuse. When someone consistently drinks too much alcohol it can reduce the volume of the brain’s white matter, which is what helps to transmit signals between brain regions leading to issues with brain function.

Early intervention, abstinence and proper treatment can improve outcomes and quality of life. If you or someone you know is struggling with alcohol use, seek professional help as soon as possible.

Signs and symptoms of alcohol-related brain damage

Wernicke encephalopathy symptoms

Wernicke encephalopathy often has a sudden onset and is characterised by movement and balance problems, loss of coordination, confusion, disorientation and abnormal eye movements.

Korsakoff syndrome symptoms

Korsakoff syndrome occurs more gradually, and the symptoms are usually attention and concentration problems, gaps in memory which are usually filled inaccurately (confabulation) and difficulty learning new information.

Alcoholic dementia symptoms

Alcoholic dementia is characterised by a deteriorating ability in planning, decision-making and assessment of risk. There tends to be a change in personality, reduced impulse and emotional control which may lead to conflict and socially inappropriate behaviour. In addition, there are problems with attention, concentration and memory.

Causes and risk factors for alcohol-related brain damage

Alcohol-related brain damage tends to be more common in people in their 40s and 50s and comprises about 10% of cases of young onset dementia (where symptoms develop before the age of 65) is diagnosed. Women in this age bracket are more at risk of alcohol-related brain damage due to differences in hormones, body fat composition and height-weight ratios.

Getting diagnosed with alcohol-related brain damage

If you are concerned about symptoms of alcohol-related brain damage, the first port of call is your GP. They will carry out some initial tests and if necessary, may refer you for specialist assessment and support. You should also speak to the GP if you are worried about how much alcohol you or someone close to you is drinking.

Stages of alcohol-induced dementia

In the early stages of dementia, symptoms are often subtle and hard to detect. While people can usually live independently, they may experience mild memory issues – such as misplacing items – along with challenges in making complex decisions or expressing themselves. Personality and mood changes may also emerge.

In the middle stages of alcohol-related dementia, symptoms worsen significantly, and people can experience more severe memory loss, struggle with daily tasks, have difficulties with communication; and they may begin to hear, see, or believe things that are not real.

In the later stages of dementia, symptoms can be very severe, and people will require assistance with basic tasks like eating and bathing. They may exhibit unpredictable or uninhibited behaviours. Communication becomes extremely difficult, and they may eventually lose the ability to communicate verbally.

Treatment for alcohol-related brain damage

It is important that a person who is drinking alcohol excessively does not stop suddenly, as this may lead to serious and potentially dangerous withdrawal symptoms. The GP can refer them for support with reducing their alcohol intake in a gradual, managed way. The GP may also refer the person to a memory clinic for further assessment of their dementia symptoms. If a diagnosis of dementia is made, the specialist should discuss possible treatment options and any ongoing support.

Wernicke encephalopathy treatment

The main treatment for Wernicke encephalopathy is thiamine (vitamin B1) replacement, this is done through a vein as an infusion, rather than an injection. Starting treatment early is vital to avoid permanent brain damage or the development of Korsakoff syndrome.

Korsakoff syndrome treatment

While some damage may be irreversible, treatment for Korsakoff syndrome is focused on managing symptoms and preventing further progression. High-dose thiamine is usually given, via injections, especially in the early stages, and stopping alcohol use entirely is critical to prevent further brain damage. While some symptoms, particularly memory loss, may be permanent, early and consistent treatment can improve quality of life and prevent further decline.

Alcoholic dementia

The main treatment for alcoholic dementia is stopping drinking alcohol completely, which may require a detox overseen by a medical professional for people who are physically dependent on alcohol rather than stopping or reducing intake at home. A healthy, balanced diet is also key, as lacking essential vitamins (like thiamine) and minerals can worsen brain damage. Therapy, counselling, and support groups can help people relearn daily skills and manage the emotional and mental challenges of recovery.

Preventing alcohol-related brain damage

• Stick within low-risk drinking guidelines of no more than 14 units per week (equates to six pints lager or one and a half bottles of wine per week)
• Spread alcohol intake over three or more days
• Have alcohol-free days
• Increase physical and mental activity
• Have a healthy balanced diet
• Avoid smoking
• Manage stress, depression and anxiety symptoms
• Keeping weight, cholesterol and blood pressure in check

Tips for living with and caring for someone with alcohol-related brain damage

If alcohol-related brain damage is diagnosed, the person and their family should be supported to:

• devise a tailored, personalised plan focusing on strengths and interests
• understand the benefits of following an alcohol-free lifestyle
• attend a support group
• eat a healthy balanced diet high in thiamine (leafy green vegetables, oily fish and wholegrains) and take a vitamin
• supplement if required as chronic alcohol use damages the gut lining, leading to the potential for poor absorption of essential vitamins and minerals
• ensure they sleep enough