Diagnosis: ARBD and alcohol-related ‘dementia’

ARBD is caused by a person regularly drinking much more alcohol than the recommended limit. Alcohol damages the brain in several ways.

• Damage to nerve cells: Regularly drinking too much alcohol is toxic to cells in the brain. Over time, it destroys so many of these cells that the person’s brain starts to shrink. This means there are fewer cells to do all the complex tasks that the brain needs to do to work properly.
   
• Damage to blood vessels: Alcohol may also damage the blood vessels that supply the brain. It causes them to stiffen, narrow, clot or bleed. This can lead to strokes, which can damage the brain and cause problems with memory and thinking. Strokes are also a common cause of death for people with ARBD.
   

• Low levels of vitamins: Drinking a lot of alcohol stops the body from getting enough vitamins – particularly thiamine (vitamin B1). Without thiamine, parts of the brain become starved of energy and are damaged – sometimes permanently.

  People who drink heavily lose a lot of vitamins in their urine and often eat a poor diet. This means that over time they can become increasingly malnourished. 

  Developing other health conditions: People who are dependent on alcohol are much more likely to develop epilepsy and severe liver disease. 

There are other aspects of behaviour that can also contribute to damage to the brain.

• Repeated withdrawals from drinking alcohol (without medical help): People who drink very heavily for a long time and then stop suddenly may be more likely to have brain damage – particularly if they do this many times. This is because stopping suddenly can be dangerous when the brain is used to high levels of alcohol. It can cause severe withdrawal symptoms, such as seizures and delirium. 

  If someone is dependent on alcohol, they need medical help to keep their brain safe if they stop drinking suddenly. 

• Falls and incidents: Drinking heavily can lead to head injuries from falls or violent incidents. This can damage the brain and cause problems with memory, thinking and behaviour. 

This can be very difficult to assess. It can only be done accurately when a person has stopped drinking alcohol for several weeks. Until then, it’s not clear if their problems with memory and thinking are being caused by being intoxicated, or by the effects of recent withdrawal.

However, a person with possible ARBD can still get medical attention and support even if they’ve not given up drinking by themselves. In fact, it’s very important that they don’t suddenly stop drinking without medical help, as this can make their symptoms worse.

A doctor can still assess a person’s memory and thinking while they are still drinking. This is, as long as they have not yet had an alcoholic drink on the day of testing. This assessment can help to provide a rough guide to whether they might have ARBD. This makes access to support easier. However, a diagnosis can’t be confirmed until they have remained sober for several weeks.

When someone gets ARBD, they have normally been drinking heavily for around three years or more. They are generally dependent on alcohol. This is when a person has a strong desire to drink and feels that they are not able cope without it.

It can be difficult for doctors to know how much someone is drinking and how long they’ve been doing it for. They would normally rely on being told by the person, a family member or friend. Getting accurate information is sometimes very difficult . It’s very common for people who are addicted to alcohol to think that they are drinking a lot less than they actually do.

There are lots of other reasons why a heavy drinker might have long-term problems with memory and thinking. A doctor needs to exclude these other causes first before they make a diagnosis of ARBD. 

In general, if a person’s symptoms get worse even after they’ve stopped drinking for several months, then it’s unlikely that they have ARBD. 

Clinical assessments in the community are normally done by a GP or community mental health nurse. This will involve: 

• taking a detailed history of a person’s symptoms and how these symptoms affect their life
• asking about problems with mood, such as anxiety or depression
• doing a physical examination.

They may also ask the person to do a paper-based test that checks for problems with memory and thinking.

It can be very helpful to have an account from a family member or friend. This can help fill in any gaps and provide another point-of-view. 

It is likely that a person will need a brain scan to rule out other causes, such as stroke or head injury. There may be a wait of several weeks for this to happen, unless it is an emergency.

Most people get a diagnosis of ARBD in hospital. This is because they get very ill and need urgent care. Common reasons include:

• a condition called Wernicke’s encephalopathy that needs urgent medical treatment
• needing to be supported to stop drinking safely to avoid the harm caused by a sudden withdrawal
• another health problem related to heavy drinking, such as a fall, head injury or liver disease. 

A diagnosis of ARBD in hospital is most likely to be made by a liaison psychiatrist. This is a type of psychiatrist who works with patients in general hospital wards, rather than in a mental health unit. 

In hospital, the psychiatrist will have access to specialists, blood tests and brain scans. But, it’s still important for family or friends to provide information. This information should include the person’s level of drinking, how long they’ve been drinking for, and anything else that might help to make a more accurate diagnosis. The person themselves may not remember or understand these details.

A person being treated in hospital can be helped safely through their withdrawal and treated for other medical conditions. This process normally takes at least 1–2 weeks. Once they have come through this they will be fully sober. This means they can get a more reliable diagnosis of ARBD, which will allow them to be referred for support and rehabilitation, if available.