Alcohol and dementia

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 lead to vascular dementia (a form of dementia caused by problems with blood flow to the brain)
• causing a deficiency of vitamin B1 (thiamine) in the body, leading to alcohol-related brain damage

There appears to be a particularly strong link between heavy drinking and young onset dementia – where symptoms develop before the age of 65.

How much alcohol is it safe to drink?

There have been many studies into the link between alcohol and dementia, with different results – but it is clear that exceeding the recommended weekly alcohol limit 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.

A few inconclusive studies have suggested that drinking alcohol in moderation (specifically red wine) could have a protective effect against dementia, but if you do not drink alcohol, there is no reason to start as the evidence is limited.

What are the recommended guidelines for safe drinking?

The Government and NHS recommend drinking no more than 14 units of alcohol per week. This should be spread across at least three days, with several alcohol-free days each week.

These are the typical alcohol units of popular drinks:

• single measure of spirits, eg vodka, gin, whisky, rum (25ml): one unit
• bottle of regular strength lager/beer/cider (330ml): 1.7 units
• can of regular strength lager/beer/cider (500ml): 2.4 units
• pint of regular strength alcohol lager/beer/cider: three units
• small glass of wine (125ml): 1.5 units
• standard glass of wine (175ml): 2.1 units
• large glass of wine (250ml): three units
• bottle of alcopop (275ml): 1.5 units

You should also avoid binge drinking: consuming more than eight units of alcohol in a single session for men, or six units for women.

What is alcohol-related brain damage?

Alcohol-related brain damage (ARBD) is caused by drinking alcohol excessively over a long period of time. Alcohol-related dementias are more commonly seen in people in their 40s and 50s, and account for around 10% of cases of young onset dementia.

There are three types of ARBD: Wernicke’s encephalopathy and Korsakoff’s syndrome (which can occur together, known as Wernicke-Korsakoff syndrome), and alcoholic dementia.

Wernicke’s encephalopathy often develops suddenly. Signs include:

• movement and balance problems
• loss of coordination
• confusion
• disorientation
• abnormal eye movements

Korsakoff’s syndrome develops more gradually. Signs include:

• attention and concentration problems
• gaps in memory which are usually filled incorrectly (confabulation)
• difficulty learning new information
• Signs of alcoholic dementia include:
• difficulties with planning, making decisions and assessing risk
• changes in personality
• poor impulse and emotional control, which may lead to conflict and socially inappropriate behaviour
• problems with attention, concentration and memory

Unlike other forms of dementia, ARBD may be reversible if the person stops drinking alcohol excessively. About 25% of people recover completely, 50% recover partially, and 25% continue to deteriorate.

It is important for a person who drinks alcohol in excess to speak to their GP before stopping as quitting suddenly could cause dangerous withdrawal effects.

Tips for cutting down on alcohol

• Know the limits: make sure you understand the alcohol guidelines, including how many units your alcoholic drinks contain, so you can keep track across the day and week
• Identify your triggers: think about when and why you drink alcohol – is it after a stressful day, when you’re bored, or when you’re celebrating something, for example? Once you’ve worked out your triggers, you can think about what you could do instead of having an alcoholic drink
• Set a weekly goal to keep yourself focused. You could use an app to track your progress, such as MyDrinkaware
• Find support: tell someone close to you, like your partner or a friend, that you are trying to cut back on alcohol so they can encourage you
• Try to avoid situations where you might be tempted to drink excessively. For example, you could meet a friend in a café rather than the pub
• Switch to low- or zero-alcohol drinks: there are many great options including alcohol-free beer, cider, wine and even gin
• Celebrate your progress with a non-alcoholic reward, such as a takeaway coffee, a new book or a manicure

If you need additional support, you can ask your GP about alcohol services or contact an organisation like Drinkline (0300 123 1110), Alcoholics Anonymous or Alcohol Change

What to do if a person with dementia drinks too much alcohol

While drinking in moderation can be an enjoyable part of life, it may have a negative impact on a person with dementia, for example by increasing confusion, disorientation and the risk of falls.

Dementia may cause some people to drink too much alcohol. This could be because:

• they have a form of dementia that affects their impulse control, like frontotemporal dementia
• they forget how much alcohol they have drunk
• they forget when they last drank alcohol
• they have changes in taste that make alcohol more appealing

If the person with dementia seems to be consuming alcohol excessively, some of the tips above might help. You may want to avoid having alcohol in the home and provide low- or zero-alcohol alternatives instead.

A healthcare professional can advise you on whether the person should reduce their alcohol intake and help devise a plan for cutting back or stopping drinking.

Bear in mind that alcohol may interfere with some forms of medication that the person with dementia may be taking. This may stop the medication working well and increase the risk of side effects. A GP or pharmacist can advise you about whether it is safe to drink alcohol when taking a medication.