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]