Alcohol induced dementia/ alcoholic neurodegeneration

Continuing with the effects of alcohol on the brain, in this post I shall dicuss a frequently asked question by people who consume alcohol, does it cause neurodegeneration? Does alcohol kill neurons/ brain cells?

Let us discuss the entity called alcoholic cerebellar and cerebral degeneration. We now sufficient data to suggest that excessive consumption of alcohol does damage the brain.  Some parts of the brain are more specifically affected, these include the cerebellum. The cerebellum is the part of the brain which controls coordination, balance, gait as well has motor memory (memory for common motor actions performed by the brain). In the cerebellum are cells called the Purkinje cells which are selectively destroyed by alcohol ( the part of the cerebellum most commonly affected is the midline of the cerebellum between the two cerebellar hemispheres. This part is called the vermis of the cerebellum). So in alcoholic cerebellar degeneration we see vermian cerebellar atrophy in CT scan and MRI scans and also grossly if an autopsy is carried out).

So how does vermian atrophy present clinically?

Patients with alcoholic cerebellar degeneration have problems with gait and balance. Their coordination is off and they are prone to frequent falls (we have all seen the walk of a drunkard. While the clinical signs may not be so overt, on clinical examination we can usually pick up the signs of cerebellar dysfunction). Since these patients are prone to falls, they frequently land up in the ERs with head injuries (intracerebral hematoma, epidural and subdural hematoma). See my post on neurotrauma

Alcohol induced dementia: while this entity is not so well defined as alcoholic cerebellar degeneration, there is ample evidence to suggest that too much alcohol damages the cerebrum and can cause cognitive and memory problems. The thinking is that this is not entirely due to alcohol only. When someone abuses alcohol, he or she also does not consume a good diet and soon becomes deficient in essential nutrients and vitamins such as vitamin  B12 and folic acid. So alcohol induced cerebral degeneration is likely due to nutritional deficiencies.

No one quite knows the answer that if you supplement your diet with vitamins and essential nutrients even in the face of heavy and chronic alcohol consumption, would that prevent the development of alcoholic cerebral and cerebellar degeration. Infact in certain countries of the world a plan was put forward to fortify all alcoholic beverages with vitamins and essential nutrients. One of the problems with this proposal is that it alters the taste of the alcohol. Your rum does not taste like rum anymore!!!

In any case I advise my patients to always drink in moderation and to take 1to 2 tablets of a good multivitamin every day apart from a wholesome and nutritious diet.

Nitin Sethi, MD

One thought on “Alcohol induced dementia/ alcoholic neurodegeneration

  1. Sure one of the best monologues on the effects of alcohol abuse on the human brain was written many years ago by a smart neurologist by the name of Maurice Victor. If you can lay your hands on that, you shall have the ultimate resource for this topic. Makes for a tough read but well worth the effort.

    Personal Regards,
    Nitin Sethi, MD

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