Alcohol related brain damage Dr Louise McCabe Lecturer in Dementia Studies University of Stirling.
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Transcript of Alcohol related brain damage Dr Louise McCabe Lecturer in Dementia Studies University of Stirling.
Alcohol related brain damage
Dr Louise McCabe
Lecturer in Dementia Studies
University of Stirling
Today’s presentation
• What is ARBD?
• Prognosis
• Prevalence
• Individual factors
• Findings from research
• Concluding comments
Alcohol related brain damage• A group of conditions where alcohol is
determined as the primary reason for brain damage with similar outcomes but different specific causes– Wernicke Korsakoff Syndrome– ‘Alcohol induced persistent dementia’– Alcohol-related dementia (and so on)
Alcohol and the brain• Alcohol damages the brain in a number of ways:
– Direct toxicity to the brain cells– Interference with vitamin absorption– Falls and accidents– Vascular damage/hypertension– Indirect nutritional deficiencies due to poor diet
• Susceptibility differs between individuals, drinking patterns and different drinks
ARBD linked to:• Liver cirrhosis (hepatic encephalopathy)
• Socio-economic factors such as deprivation – multiple factors contribute
• Patterns of drinking
• Types of alcohol drunk
• Genetics – potential link
Wernicke Korsakoff’s• Acute phase (Wernicke’s encephalopathy)
– delirium type symptoms
• Vitamin treatment – parenteral thiamine
• Without treatment– 20% die– 85% develop long term symptoms
(Korsakoff’s syndrome)
Alcohol related dementia
• Alcohol use is a risk factor for dementia– 9-23% of older people with a history of alcohol abuse
have dementia compared with 5% of the general population
– People with dementia are more likely to have alcohol problems than those who do not have dementia
• Alcohol related dementia has a higher prevalence than WKS and is likely to have multiple causes – a ‘silent epidemic’
ARBD prognosis• Better prognosis than common types of
cognitive impairment with abstinence• Continued abstinence allows brain to
recover and stability in symptoms is seen, this may be a good indicator that an individual has ARBD
• Recovery can take up to two years
• ¼ recover fully
• ¼ good recovery
• ¼ minimal recovery
• ¼ no recovery – but stability in symptoms
Prevalence of ARBD• Not known and not included in recent
epidemiological studies (e.g. DementiaUK)
• Probably rising (fast)
• Estimates: – 10% of dementia cases (Harvey 1998)– 21-24% of dementia cases have alcohol as
contributing factor (Smith and Atkinson 1995)
Local prevalence of ARBD• Some local authorities have estimated
figures
• Some populations much higher prevalence: e.g. hostel population in Glasgow, 21%
• Other indicators: Pabrinex prescribing – increasing steadily
10 year increases in ARBD hospital discharges
(Ayrshire and Arran report, 2008)
Rates per 10,000 96 – 99
Rates per 10,000 03-06
& increases
Scotland 3.2 4.3 34%
West of Scotland 4.1 5.3 31%
East of Scotland 2.8 3.7 33%
Deprivation and ARBD• There is little difference in the amount
drunk by different socio-economic groups in Scotland but there is a big difference in the amount of alcohol related morbidity when levels of deprivation are compared
• ARBD prevalence linked to levels of deprivation
• WKS directly linked to poor nutrition
ARBD and age• Alcohol related neuropsychiatric conditions
are found to increase with age
• Older brains and bodies more susceptible to damage from alcohol
• Alcohol misuse common among older men and increasing among older women
• Alcohol misuse significantly under-diagnosed among older people
Prevalence: age and gender
• Still more men than women but increasing in both groups
• Still more among late middle age and older age groups
• More older people with ARBD in hospital compared with younger people with ARBD
Stigma
• Research shows stigma for:– Cognitive impairment (dementia)– Alcohol as a moral issue– Ageing and ageism
• Stigma evident at all levels of society – individual, institutional and cultural
Stigma evident in specialist services
• Research in specialist homes/units for people with ARBD found no involvement by alcohol specialists
• Some staff in specialist homes felt ARBD was self-inflicted – ‘nobody is taking them and pouring the drink down them’
Lack of awareness in specialist services
• Experienced staff didn’t seem to understand – link between alcohol and brain damage
– Importance of abstinence
Awareness among publicans
• They don’t bring up the link between alcohol use and cognitive impairment or brain damage but do know about it and have experience of it
• ARBD not included in training or health promotion materials and activities
Barriers to effective support• Lack of awareness and stigma
• Long period of rehabilitation and recovery difficult to deal with
• Fall between the gaps:– Alcohol services not equipped to deal with
cognitive impairment– Dementia services not equipped to deal with
alcohol problems
ARBD – policy responses in Scotland
• Alcohol problems have been and continue to be a key concern of governments
• Focus is usually on younger people, families and children – not ageing and cognitive impairment
But • In 2003 two expert groups set up: dual diagnosis and
ARBD• In 2006 Alcohol and ageing working group convened• In 2007 – Commitment 13
Concluding comments• Need more research on prevalence and
epidemiology
• Need better understanding of prognosis and treatment
• Need evaluations of successful services and identification of routes for knowledge transfer