Alcohol-Induced Neurocognitive Disorder

What is alcohol-induced neurocognitive disorder?

As the name indicates, alcohol-induced neurocognitive disorder is a cognitive disorder in which long-term alcohol consumption or chronic alcoholism results in neurocognitive decline beyond what is expected as one ages. Symptoms range in severity from a reduced ability to learn new things to significant personality changes, as just two examples.

Likewise, people with alcohol-induced neurocognitive disorder can develop certain types of dementia, though this is not always the case.^[3]

Symptoms of alcohol-induced neurocognitive disorder

The symptomatology of alcohol-induced neurocognitive disorder revolves around a reduced capacity for learning, impaired memory, and impaired executive functioning.^[4] However, these are broad categories - the symptoms of this disorder range widely, as discussed below:^[1]

• Reduced capacity for learning - It might become difficult to learn simple new tasks, like how to use a new smartphone or smart TV. Staying focused on a particular task might also become difficult.
• Memory impairment - Some patients exhibit a reduced ability to remember simple information (e.g., one’s phone number or address) and complex information (e.g., abstract ideas).
• Impairments in executive functioning - Patients might experience a reduced capacity for impulse control (e.g., engaging in dangerous activities), the inability to plan for the future (e.g., preparing for a family trip), and a reduced ability to make decisions (e.g., what to have for dinner).
• Mood disturbances - This disorder can cause depression, anxiety, and other mood changes in some patients.
• Personality changes - In some cases, patients might experience personality changes (e.g., a formerly gentile person might become hostile and aggressive).
• Reduced motor control - This disorder can result in an inability to perform fine and gross motor movements, like grabbing a pen or walking.

Additionally, alcohol-induced neurocognitive disorder might cause an inability to pay attention, a lack of understanding of what’s happening in the immediate environment, and a reduced ability to communicate effectively with others.

Is alcohol-induced neurocognitive disorder the same as alcoholic dementia?

Alcohol-induced neurocognitive disorder and alcoholic dementia share many of the same symptoms, which is why these terms are often used interchangeably. For example, both conditions include potentially significant changes to personality, memory capabilities, and reasoning skills.

Likewise, both of these conditions typically impair social functioning and the ability to learn new things and might result in mood changes. Both conditions result from excessive use of alcohol over an extended time.

Additionally, both conditions likely fall under the auspices of a major or minor neurocognitive disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).^[5]

However, alcohol-induced neurocognitive disorder and alcohol-related dementia are two distinct conditions with one key difference: the development of dementia.

As noted earlier, not all patients with alcohol-induced neurocognitive disorder develop dementia. Many of the symptoms listed above might manifest and cause severe disruptions in daily functioning. However, the memory deficits of dementia are not a given.

Conversely, alcoholic dementia quite often includes symptoms related to memory loss. The individual might lose the ability to form new memories, recall information, or forget very recent details, like what they had for breakfast.^[6]

Alcohol-induced neurocognitive disorder vs. Korsakoff syndrome

Another condition that’s closely related to alcohol-induced neurocognitive disorder is Korsakoff syndrome.

Again, these two conditions share many of the same dementia-related symptoms described earlier, like confusion, memory loss, and personality changes. However, a significant difference is that Korsakoff syndrome results from a thiamine deficiency rather than being directly caused by excessive alcohol consumption.^[1]

Thiamine, also known as vitamin B1, is a vitamin that’s important for producing energy for brain cells. Without enough thiamine, cells can’t create the energy to do their jobs, resulting in memory loss and other symptoms. Other symptoms of Korsakoff syndrome include:

• Hallucinations
• Short-term memory loss
• Long-term memory loss (though this is lesson common)
• Confabulation, or concocting details to fill in memory gaps
• Inability to understand the presence of the condition

Despite the severity of these symptoms, Korsakoff syndrome is often reversible. Patients who abstain from alcohol, eat a healthy diet, and take vitamins - particularly thiamine - can stop the development of this condition.^[1]

Alcohol-induced neurocognitive disorder vs. Wernicke’s encephalopathy

Wernicke’s encephalopathy is a unique condition that differs more from alcohol-induced neurocognitive disorder than the previous two disorders discussed above.

Like Korsakoff syndrome, Wernicke’s encephalopathy results from a lack of thiamine. Thiamine deficiency results from many other conditions. However, excessive alcohol consumption is the leading cause.^[1]

In addition to having differing causes, Wernicke’s encephalopathy differs from alcohol-induced neurocognitive disorder in several other ways:

• Wernicke’s encephalopathy occurs suddenly, while alcohol-induced neurocognitive disorder develops slowly over time.
• Wernicke’s encephalopathy has very different symptoms from alcohol-induced neurocognitive disorder, including double vision, eye-related muscular paralysis, and rapid, jerky eye movements.
• Wernicke’s encephalopathy can be reversed if caught early enough, whereas alcohol-induced neurocognitive disorder might become chronic.

Despite these differences, Wernicke’s encephalopathy is often confused with alcohol-induced neurocognitive disorder because they share some symptoms, namely confusion and loss of motor control. In addition, Wernicke’s encephalopathy often co-occurs with Korsakoff syndrome, which can cause additional confusion about which condition is actually occurring.

Diagnosing alcohol-induced neurocognitive disorder

A clinical diagnosis can be challenging due to the similarities between alcohol-induced neurocognitive disorder and the other conditions listed above, including other forms of dementia.

To begin the process, patients undergo physical, mental, and neurological evaluations to assess the level of functioning and the deficiencies that are occurring. To do so, doctors rely on various diagnostic tests, including:^[5]

• Brain scans, like magnetic resonance imaging (MRI), positron emission tomography (PET), or computerized tomography (CT), help determine if there’s a brain-based cause of the condition, like a stroke or the presence of amyloid proteins (which are related to the development of Alzheimer’s).
• Lab tests, like blood and spinal fluid tests, check for physical conditions that might cause dementia-like symptoms. For example, a blood draw would reveal a deficiency of B-12 vitamins, which can produce cognitive deficits.
• Cognitive tests examine a patient’s memory, executive functioning, and attention, among other skills.

These tests exclude other conditions rather than confirm the presence of alcohol-induced neurocognitive disorder. To diagnose alcohol-induced neurocognitive disorder, clinicians must first determine if it’s a mild or major neurocognitive disorder based on the diagnostic criteria in the DSM-5.

Minor neurocognitive disorders involve a modest decline in cognitive abilities in at least one of the following areas:^[5]

• Memory
• Language
• Learning
• Attentiveness
• Decision-making, organizing, and planning
• Perceptual motor skills
• Social skills

Additionally, the DSM-5 requires concern from the patient or others in their life that mild cognitive decline is occurring. Likewise, a clinical assessment must verify a modest impairment in cognitive functioning.

A minor neurocognitive disorder mustn’t be better explained by another mental health condition and cannot occur only amid delirium. Additionally, the deficits in cognition related to a minor neurocognitive disorder do not interfere with activities of daily living.

Major neurocognitive disorders involve all of the concerns discussed above. However, cognitive decline is substantial, and the patient’s ability to perform cognitive tests is significantly impaired.^[5] Furthermore, a major neurocognitive disorder significantly impairs a patient’s ability to function on a day-to-day basis and diminishes their ability to live independently.

Again, diagnosing a major neurocognitive disorder requires that the symptoms are not due to a different mental health disorder.

Causes of alcohol-induced neurocognitive disorder

One of the primary causes of this disorder is the excessive intake of alcohol, which is often associated with alcohol use disorder.

Alcohol use disorder is characterized by heavy drinking that leads to social or occupational problems (e.g., missing work due to hangovers), engaging in dangerous situations (e.g., drunk driving), and the inability to reduce the amount and frequency of drinking, among many other unfavorable conditions.^[7]

In addition to the natural connection between alcohol use disorder and the development of related neurocognitive deficits, other factors are at play, namely tolerance, dependence, and addiction. Though these situations are different, each can lead to alcohol-induced cognitive impairment:

• Tolerance refers to the body’s reduced response to alcohol, thus necessitating larger and larger amounts to achieve the same effect. This increase in alcohol intake is a primary risk factor for the development of alcohol-induced neurocognitive disorder.
• Dependence develops after long-term use of alcohol. Without it, the body responds with severe withdrawal symptoms like nausea, tremors, and headaches. People dependent on alcohol drink more frequently, which increases the chance of developing alcohol-induced neurocognitive disorder.
• Addiction is a brain-based disorder in which a person has an intense, long-term desire to drink alcohol. The use of alcohol can have significant adverse effects on the brain’s functioning, as evidenced by alcohol-induced neurocognitive disorder. This includes shrinkage of neurons in the brain, inability to consolidate memories, and, in some cases, overdose, which can lead to permanent, alcohol-related brain damage or death.^[8]

Prevention of alcohol-induced neurocognitive disorder

The key to preventing alcohol-induced neurocognitive disorder is to reduce alcohol consumption. This can be easier said than done, but there are many effective approaches for minimizing alcohol intake or stopping it altogether. These include:^[9]

• Identify triggers that urge you to drink, and avoid those triggers.
• Identify healthy alternatives to deal with triggers. For example, if stress causes you to drink, substitute drinking for exercise to cope with stress.
• Keep track of how much you drink and how often. Set attainable goals for reducing both. If you currently drink at least four days a week, set a goal to reduce that to three days a week, then two days a week, and so forth.
• Find other activities to fill your free time. As an example, instead of going to the bar with friends, join a club sport to play with friends.
• Reduce or eliminate alcohol in your home. The harder it is for you to access, the less likely you are to drink alcohol.

If you feel your drinking might result from a serious problem, it’s worth consulting with a mental health professional. Getting help can take many forms, all of which can be effective in reducing alcohol intake and treating more serious issues like addiction. This might include:^[10]

• Participation in Alcoholics Anonymous (AA) and other support groups
• Behavioral therapy with a mental health provider
• Drug therapy, such as naltrexone, acamprosate, or disulfiram

Treatment for alcohol-induced neurocognitive disorder

All is not lost if alcohol-induced neurocognitive disorder develops. In many cases, a partial or full reversal of this condition is possible if the condition is identified early on and if abstinence from drinking alcohol commences immediately.

The treatments outlined in the previous section - joining a support group, behavioral therapy, and drug therapy - are all effective for treating the underlying conditions that lead to alcohol-induced neurocognitive disorder.

For example, AA provides social support for your journey to be alcohol-free. Sharing your experience and hearing the experience of others can be invaluable for taking positive steps toward sobriety and maintaining sobriety for the long term.

As another example, cognitive-behavioral therapy can effectively identify triggers that lead to drinking. Furthermore, it’s also effective in changing negative thought processes and building skills for coping with an ongoing drinking problem.^[10]

Drug treatments are also a viable option for some people.^[10] Naltrexone helps reduce the urge to drink heavily, while acamprosate improves one’s ability to abstain from drinking altogether. Disulfiram slows the body’s metabolism of alcohol, which causes nausea and other undesirable effects. The unpleasant nature of these effects helps some people stay sober.

Ultimately, a treatment that works for one person might not work for another. Several different treatments might be necessary to find success. What is certain is that hard work and dedication to the process are paramount for successful treatment.

Helping someone with alcohol-induced neurocognitive disorder

If you suspect someone you know has alcohol-induced neurocognitive disorder, you can help them in many ways. Initial steps to take might include:^[11]

• Express concern about your loved one’s drinking in a non-combative and supportive manner
• Provide your loved one with information about sources for help
• Avoid calling your loved one an alcoholic or using other labels with a negative connotation
• Offer your support in seeking treatment (e.g., driving them to therapy or AA)
• Seek a better understanding of their triggers so you can avoid them too
• Refrain from drinking alcohol in the presence of your loved one

An intervention might be in order, too. Interventions bring loved ones together to confront the individual with the negative effects their drinking has on others. It is not an opportunity to pile on the person with the drinking problem but rather a chance for honest communication and an outpouring of love and support.

You can also help your loved one make necessary lifestyle changes to reduce alcohol consumption or address the symptoms of neurocognitive disorder. For example, you can volunteer to help them remove all alcohol from their home or make yourself available to transport them to appointments if they’ve lost the ability to drive safely.

FAQs about alcohol-induced neurocognitive disorder

How does alcohol-induced neurocognitive disorder impact daily life?

This disorder can significantly impact a person’s ability to function normally. With symptoms ranging from motor control issues to personality changes to memory loss, someone with this disorder may not be able to maintain personal relationships, employment, or independently care for themselves.

How common is alcohol-induced neurocognitive disorder?

The incidence of alcohol-induced neurocognitive disorder is unknown at this time. However, neurocognitive impairments are extremely common among specific populations. For example, 30-80 percent of people with a substance use disorder have mild to severe neurocognitive impairment. This is not exclusive of alcohol-induced neurocognitive disorder but represents various cognitive impairments.^[12]

How can I tell if I have alcohol-induced neurocognitive disorder?

Suppose you frequently drink alcohol to the point of intoxication and experience memory loss, mood disturbances, an inability to learn simple tasks or other common symptoms. In that case, you might have alcohol-induced neurocognitive disorder. If you think you might have this disorder - even if you feel it’s highly unlikely - it’s essential to see your healthcare provider.