The issues surrounding alcohol have been abundant in my life – I am the adult child of an alcoholic, have several significant alcoholics in my life, and sadly, have lost my best friend, Suzzie, due to alcohol. As I child, I grew up in a family where alcohol was abundant and the risks of drink were never discussed or considered. In my family, the “just one” referred to one bottle, rather than one glass.
The rate of people drinking alcohol has increased over the last ten years with an increase in the availability of cheap alcohol alongside the binge drinking culture. This is despite the constant flow of news reports highlighting the fact that excessive alcohol consumption can increase the risk of developing serious health problems, including dementia. For longer term drinkers and alcoholics, the reality of ‘drying’ out to get a diagnosis can be difficult.
“Pour Me Another One”
Many people drink alcohol to relax or when socialising, but do we really know our limits, and if we do, does it worry us? The NHS states that men and women should not drink more than 14 units of alcohol per week, and to spread those units out over three days, if you drink regularly. There is an average 9 units in a bottle of wine, so for some, it is easy to consume more than the desired weekly amount.
Research over the years has shown links between alcohol and vascular dementia (please see our video about different types of dementia), which is second most common type of dementia in over 65’s in the UK. People who have had a stroke, or mini-strokes – known as transient ischaemic attacks (TIAs) – which cause narrowing of the arteries, or had a heart attack, are at risk of developing vascular dementia because of small blood clots that prevent oxygen circulating to brain tissue.
Regular drinking can lead to a dependency on alcohol. In the UK, there is estimated to be over 586,000 people who are considered “dependant drinkers”. A dependant drinker is someone who regularly consumes more than the safe level, has built up a tolerance to the effects of alcohol and therefore drinks more to achieve the desired effect. They will also continue to drink, even knowing the harmful effects on their bodies. For long term drinkers, there is an increased risk in developing alcohol related dementia, Wernicke’s, and Korsakoff’s syndrome.
“Are you glass half full or half empty?”
The damage that is caused to the brain by long term drinking can cause a thiamine (vitamin B1) deficiency, blood vessel and nerve damage. This can result in symptoms including a lack of ability to plan or make decisions, reduction in emotional control, confusion, short term memory loss, depression, or an inability to concentrate. For long term drinkers who suddenly stop drinking without the correct help and support, there is a risk of them developing ‘Wernicke’s encephalopathy’. The onset of the symptoms can be sudden, and the person may show loss of coordination, balance, and abnormal eye movements. If these symptoms are not treated with a high dose of thiamine, the person can, over a period, develop Korsakoff’s syndrome. People can experience gaps in their memory, problems learning new information, and concentration problems.
I fear for those long-term drinkers in my family and wonder when I might be told that they have an alcohol-related dementia. I see myself as one of the fortunate people, who knows the system and won’t need to trawl the internet to find out what it might mean for my loved ones and what support will need to be put in place.
One of our customers, aged 47, had misused alcohol for 23 years. Now years into sobriety, they face the reality of being an alcoholic and awaiting a diagnosis, having been formally assessed.
For another of our customers, getting a diagnosis of dementia has been difficult. As a long-term drinker, he was consuming 25-30 cans of beer a day, which, over time, he has cut down to just one can a day. He is still dependant on just one can; he feels unable to give up drinking and has been told he is not able to start a formal process. NHS trusts around the country have different criteria for long-term drinkers to achieve to undergo a formal assessment for dementia, making it a postcode lottery for diagnosis. Over time the body becomes used to excessive daily amounts of alcohol, and suddenly stopping drinking could cause alcohol withdrawal syndrome.
“Down the Hatch”
I have worked with people living with dementia who would not consider themselves regular or long term drinkers; however, since their diagnosis, may consume a bottle of wine in an evening because they may have forgotten that they have already had a glass or two, and this risks them consuming more than the recommended 14 units per week. Alcoholics, and long-term drinkers, become clever at hiding the amount they drink. One lady I support thought her Mum was enjoying a morning coffee or two, until one day when she joined her on the decking she realised she was drinking whiskey, and through further investigation, realised her Mum was drinking 3-4 litres of Whiskey in a week.
Further issues linked to alcohol facing a person with dementia, include the risk of dehydration, or alcohol limiting the effectiveness of their dementia drugs.
Alcohol has a diuretic effect on the body, causing a person to urinate more often, and therefore placing them at risk of dehydration. Generally, for people with dementia, there is a risk of dehydration because they are not drinking enough fluids and this reduction could result in an increased risk of urine infections. The presenting symptoms of dehydration include memory impairment, reduction in concentration and reaction times, low blood pressure, and dizziness, all of which could increase the risk of falls.
Additionally, for people living with dementia who are prescribed medication, the use of alcohol can reduce the effectiveness of dementia drugs such as Donepezil, or antibiotics prescribed for urine infections, and it is therefore recommended not to drink alcohol regularly.
“One for the road”
As a nation, drinking alcohol is part of daily life for many. However, research shows the links between alcohol consumption and vascular dementia, and the risks of alcohol related dementia for long term drinkers. For long term drinkers, getting a dementia diagnosis can be made more difficult due to the need to stop drinking, which they might not be able to do.
The additional risks of consuming alcohol regularly for a person diagnosed with dementia can cause dehydration, urine infections and prescribed medications being ineffective.