Sunday, 12 December 2010

Victims of Alcohol (Part Two)

Alcohol Related Dementia

At the end of my second year as a nursing student I had to give a presentation on a self-chosen topic related to health.  I chose alcohol.

In those days education was given in a school in the hospital grounds and also at a general hospital in a nearby city.  We had ward based - both in psychiatric and general hospitals - and community based placements, and gathered a great deal of practical experience there.  I overcame my dread of giving injections at a depot clinic in a day hospital.

My only observation of the old school v graduate nurse debate is that both produce excellent, good, mediocre or bad, indifferent nurses.  That is it!

We had hospital based libraries and much information could be found there.  Computers were very much in their infancy in the sense that it was pre-Wiki and the gathering of all the information that existed in the world had not begun.  And, I did not possess a computer.  My research then was purely library based and also involved contacting agencies and charities who focused on alcohol related problems.

My presentation was well received, but in hindsight, alcohol related dementia was not a part of it.  I never came across it in my research, nor was it mentioned by charities etc, nor was it highlighted that a relevant section and thus learning was missing from my project.  I do not recall any patients diagnosed with it during my time as a student nurse.

But, it existed.

After qualifying I worked in the community for many years and during the last fifteen years, in a nursing/care home setting.  I have worked in my present home for thirteen of these years and am proud to work there.  Initially our resident group was what you would expect of a nursing home, those suffering from age related dementia and a few with enduring mental health problems.

However, over the last five years or so, our resident group has changed; several of our residents have alcohol related dementia and the age at admission is getting younger and younger.  This change is also apparent in our sister homes across the country (we are a very small group and do not wish to become an uncaring chain).

What is Alcohol Related Dementia?

Alcohol related dementia is related to the excessive drinking of alcohol and affects memory, learning and other cognitive  functions.

Recent research suggests that moderate drinking may have a protective affect against Alzheimer's as against heavy drinkers or those who do not drink alcohol.  But is this information reliable?  We have to consider who is included in the research, who drops out and how dementia is identified.  Would some of the subjects in this research not develop Alzheimer's regardless of moderate drinking?

Alcohol has a serious negative effect on the central nervous system and can affect the brain directly as a neurotoxin.  Alcohol generally effects the brain as a result of malnutrition when the person does not eat properly, resulting in vitamin deficiencies (particularly Vit B1 - thiamine) or through alcohol  related liver damage.

Is alcohol related dementia a true dementia?  Evidence would suggest that in its early stages recovery is possible, especially in women.  Alcohol related dementia can present in the early thirties, but is more usual in the fifth to seventh decades.  For recovery to be possible, the person must abstain from drinking, improve their diet and receive vitamin  (especially B1) supplements.

What is Korsakoff's Syndrome?

Korsakoff's is very much like alcohol related dementia, same causes, but results in destruction of certain areas of the brain and changes in memory are the main symptoms.

Korsakoff's is usually preceded, but not always, by Wernicke's encephalopathy.  Wernicke's usually develops suddenly and presents with three main symptoms - although these are not always present.  These are involuntary jerky eye movements or paralysis of muscles that move the eyes, drowsiness and confusion and poor balance, a staggering gait or an inability to walk.

If Wernicke's is suspected treatment must be immediate, consisting of high doses of intravenous or intramuscular thiamine and most symptoms reverse in a few hours.  If left untreated or not treated early enough, brain damage occurs in the mid part of the brain resulting in severe short-term memory loss and is then considered as Korsakoff's.   Wernicke's is a giant alarm bell - it means stop drinking NOW!

This memory loss is filled by confabulation, which is an effort to make sense of the present by filling in the  gaps of the past.  Confabulation, although the reasons for it are sad, is an amazing thing and the stories (not lies) that our residents tell us and truly believe, are wonderful.

Our residents with Korsakoff's are the very same people they were before alcohol abuse took over their lives, mainly good people and sometimes, but rarely, bad.  They accept their situation, that is, living in a care home and rarely, if ever, question the reason for it.  I find them amazing and have a great deal of respect for them.

It is estimated that alcohol related dementia affect over 150,000 of our population; this may seem a small number, but it is probably only the tip of the iceberg, many sufferers being protected by their brave families, or street and hostel dwellers that do not come to the attention of the medical profession and are therefore unreported.

It is estimated that there has been an increase in reported alcohol related dementia - 20% today as apposed to 10% ten years ago - in those of early onset dementia, that is, before the age of 65.  My home would reflect that.

Why are most of us not aware of this alcohol related harm?  Most of us do not realise dementia can be a consequence of alcohol abuse.  Why?

It is not my intention to be a party-pooper as we near this time of festivity.  I drink alcohol myself and enjoy it.  But let us consider that Christmas and New Year will be very difficult for those families who have a alcoholic in their midst.  I shall delay my post re their plight until the New Year.

Anna :o]


Anonymous said...

I am not sure why people are not aware. I have to admit that I didn't even really know what an alcoholic was, even though it was said that my Grandfather was one. He created enough havoc in my Mother's family, but nobody, still today, speaks of it.
Now I know, when my own husband has some type of dimentia, or illness or something that everyone, including his employer, friends and family are ignoring. When I try to discuss it I am told quite frankly that it is a subject that is off limits.
I we have been bullied, abused (rarely physically), badmouthed, made to feel guilty for living and finally and most hurtful, very frightened of and for this man we do not recognize. I invite the kids (adults now) to talk about it and have told them about Al-Anon to help them deal with the "junk" that the alcoholic brings into our lives. Sad thing though, I do now recognized the symptoms of living with an alcoholic in all of us, but they are not ready to. How long will it take for them to understand why our lives have become as it has, why?
This man has,on a couple of occasions, even said he wanted to kill people to get money so he could retire-he just turned 48 years old. Who gets to do that? He has wanted to go be a mountain man, a farmer-if I would sell the produce at a farmers market-he knows nothing of this-apparently he started an on-line and very secret business of some sort.
When I told my sister that I just couldn't figure out what on earth was going on she said "you never will because it just doesn't make sense". She is so right.
I have spent the last two years trying to learn more about this subject, to no avail. This is the first site that I have gone to that lets us know a bit about the "craziness" that goes with alcoholism. So many sites mention it but no examples are given. It really is like there is a monster living in my home.
Thank you for your information and interest. Please... keep us informed!

NorthernTeacher said...

What a sad but brave post.

Yes, the bloggers at HyperCRYPTICal impart their knowledge of all the subjects they write about in a very caring way that obviously (to me) reflects how they are in their work.

HyperCRYPTICal said...

Thanks for your comments Anonymous and Northern Teacher.

Anonymous: Apologies for the delay in response as I have major Internet connection problems at present - and when a 'window' arrives - I attempt to fill it, often without success!

It is sad that many, including family members, refuse to talk about alcohol related problems in their midst and your story reflects this. You have my utmost respect.

If ever you need anyone to talk to, please, if you wish, email me. It would be strictly confidential and nothing that you say would be included in posts.

Northern Teacher: many thanks for the compliment, much appreciated.

Anna :o]

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