Brain - parts vulnerable to damage by alcoholAlcohol Related Brain Impairment (ARBI) is a term used to describe the physical injury to the brain sustained as a result of alcohol consumption. Having ARBI is not the same as having an intellectual disability, nor is it the same as having dementia.

How does Alcohol use Result in Brain Impairment?

  • Alcohol has a toxic effect on the central nervous system
  • It causes changes to metabolism, heart functioning and blood flow
  • It interferes with the body’s use of thiamine (vitamin B1, an important brain food)
  • It is often associated with a poor diet
  • It can cause dehydration which may lead to cell death
  • It can lead to falls that injure the brain.

Cerebellar Atrophy (Brain shrinkage)

Impairment to the part of the brain called the cerebellum causes balance and coordination difficulties which typically affect the lower limbs and results in a wide-based gait (walking with the legs wide apart) called ataxia.

Peripheral Neuropathy

Peripheral neuropathy is a sensory disturbance affecting the hands, feet and legs. It usually begins in the feet with numbness, pins and needles, burning sensations and pain, and may progress to loss of knee and ankle reflexes and muscle wasting.

Disorders associated with ARBI

The degree of brain impairment resulting from excessive alcohol consumption depends on many factors, including the amount and pattern of consumption, age, sex, nutrition and individual differences. ARBI may be mild, moderate, severe or very severe. ARBI is associated with changes in cognition (memory and thinking abilities), difficulties with balance and coordination and a range of medical and neurological disorders. The following are common disorders related to ARBI.

Hepatic Encephalopathy

Hepatic encephalopathy is the neuropsychiatric syndrome seen in patients with liver disease. The syndrome features changes in sleep, mood and personality. Impairment and fluctuation of consciousness is accompanied by confusion, delirium and hallucinations and in the latter stages will progress to coma.

Executive Dysfunction

Impairment to the frontal lobes of the brain results in changes in thinking patterns, behaviour and personality. Executive dysfunction makes it difficult for people to plan and organise, to monitor and control behaviour, to think flexibly, and to adapt to change or unfamiliar situations. Frontal lobe dysfunction is often an early sign of ARBI, while memory function is intact.

Wernicke’s Encephalopathy

Wernicke’s encephalopathy is the acute neurological reaction to severe thiamine (Vitamin B1) deficiency and is characterised by disturbances of vision, ataxia, and global confusion. It may be reversed by large doses of thiamine, but left untreated may progress to coma and death.

Korsakoff’s Amnesic Syndrome

Korsakoff’s amnesic syndrome is a profound impairment of short term memory that results in an almost complete inability to acquire any new information. An associated feature is confabulation, or tendency to fabricate missing memories.

Common Deficits Associated With ARBI

The range of difficulties associated with Acquired Brain Injury is diverse and as individual as the people suffering them. ABI is sometimes referred to as a ‘hidden disability’ and is often undiagnosed especially among people who have a mild disability or where onset has been very gradual. In other cases it is anything but hidden as the person, their family, friends, and support workers struggle to cope with the challenges involved. All ABI’s can, however, result in significant restrictions on an individual’s ability to participate fully in education, employment, relationships and other aspects of life.

People may experience one, or a combination of the following:

SENSORY

  • Visual impairments
  • Hearing loss
  • Loss of Smell
  • Loss of Taste
  • Body Temperature disturbance
  • Chronic Pain

PHYSICAL

  • Paralysis –total or partial
  • Fatigue
  • Limb weakness
  • Visual-motor dis-coordination
  • Tremor
  • Headaches
  • Seizures
  • Balance disturbance

COMMUNICATION

  • Slurred speech
  • Reading/writing difficulties
  • Expressive disorder
  • Word finding difficulties
  • Difficulty understanding

COGNITIVE

  • Mental Fatigue
  • Poor Concentration
  • Memory Loss
  • Planning difficulties
  • Problem solving difficulties
  • Reasoning difficulties
  • Difficulties with learning
  • Initiation difficulties

BEHAVIOURAL/PSYCHOSOCIAL

  • Disinhibition
  • Verbal Abusiveness
  • Physically aggressive
  • Increased Impulsivity
  • Sexually inappropriate
  • Agitation
  • Depression
  • Emotional instability
  • Irritability
  • Inappropriate behaviour
  • Paranoia
  • Loss of self-awareness

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Related Reading:

How to Change Your Drinking: a Harm Reduction Guide to Alcohol (2nd edition)
Stop Drinking Start Living!
Alcohol: A Dangerous and Unnecessary Medicine, How and Why What Medical Writers Say
Drink: A Cultural History of Alcohol
Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 6e