Cologne Consumption And Dementia: Is There A Link?

Alcohol-related dementia (ARD) is a form of dementia caused by the long-term, excessive consumption of alcohol, resulting in neurological damage and impaired cognitive function. ARD is characterised by a global deterioration in intellectual function, with memory not being specifically affected, although it may occur with other forms of dementia, resulting in a wide range of symptoms. ARD can cause memory problems, language impairment, and an inability to perform complex motor tasks. It can also produce a variety of psychiatric problems, including psychosis, depression, anxiety, and personality changes.

Excessive alcohol consumption increases the risk of developing dementia by causing shrinkage in areas of the brain involved in memory, affecting the brain's ability to transmit messages, and increasing the risk of high blood pressure, heart disease, and stroke, which can lead to vascular dementia. Additionally, heavy drinking can cause a deficiency of vitamin B1 (thiamine) in the body, leading to alcohol-related brain damage.

While there is strong evidence that drinking too much alcohol increases the risk of dementia, the evidence linking dementia with moderate drinking is less conclusive. Some studies suggest that abstaining from alcohol may lower the likelihood of developing dementia, but it is generally accepted that staying within the recommended limits is unlikely to increase the risk. A few inconclusive studies have suggested that drinking alcohol in moderation may have a protective effect against dementia, but the evidence is limited.

Alcohol-related brain damage (ARBD)

ARBD is associated with several types of damage to the brain:

• Damage to nerve cells: Regularly drinking too much alcohol can be toxic to nerve cells, causing brain cells to die and brain tissue to shrink. This results in fewer cells to carry messages within the brain.
• Damage to blood vessels: Excessive alcohol consumption damages blood vessels in the brain and can lead to high blood pressure, increasing the risk of a stroke.
• Low levels of thiamine (vitamin B1): Alcohol prevents the body from getting enough thiamine, which is essential for the brain to work properly. Alcohol misuse also often results in a poor diet, further increasing the risk of malnutrition and thiamine deficiency.
• Increased risk of head injuries: Regularly drinking too much alcohol increases the risk of repeated head injuries, as drunk individuals are more likely to fall, receive blows to the head, or be the victim of violence.

ARBD is typically diagnosed in people aged between 40 and 50, which is younger than the typical age of onset for common types of dementia, such as Alzheimer's disease. It is more common in men than women, and women who do develop ARBD tend to be younger than men and have a shorter history of alcohol misuse.

While moderate alcohol consumption (1-14 units per week for women and 1-21 units per week for men) has not been conclusively linked to an increased risk of dementia, excessive alcohol consumption is a clear risk factor. Heavy drinking and binge drinking are associated with a higher likelihood of developing dementia.

ARBD symptoms

Alcohol-related brain damage (ARBD) is a brain disorder caused by regularly drinking too much alcohol or binge drinking over several years. The symptoms of ARBD vary, but they can include problems with cognitive functioning, memory, and physical symptoms. Most people with ARBD experience some, rather than all, of these symptoms, and their severity can range from mild to severe.

Cognitive and memory problems

• Memory loss: Forgetting directions to familiar places, trouble remembering appointments, or recalling recent activities.
• Difficulty with familiar tasks: Struggling with everyday tasks like using a phone, confusion about the layout of their home, or how to prepare a meal.
• Difficulty processing new information: Inability to recall times, dates, or appointments, or to remember newly met people.

Behavioural and mood problems

• Depression and irritability: This can also include apathy, a lack of interest in people or events, and a lack of spontaneity or motivation.
• Poor judgement and loss of inhibition: Being too trusting of strangers or responding inappropriately, e.g., removing clothes in public.
• Problems with language: Difficulty remembering words or names, or forgetting the end of a sentence halfway through.
• Erratic behaviour: Rapid mood swings, aggression, or violence, which can be challenging for carers to manage. The person may have no insight into their behaviour and its impact, appearing harsh and uncaring.
• Difficulty concentrating: Inability to focus on a task for more than a few minutes, making everyday tasks difficult.
• Poor choices and decision-making: Denial about their drinking problem, resistance to seeking or accepting help, vulnerability to manipulation, and difficulty making sensible decisions.

In addition to these cognitive and behavioural symptoms, ARBD can also cause physical symptoms, such as:

• Damage to the liver, stomach, and pancreas, which can further affect brain function.
• Pins and needles, numbness, or a burning sensation in the arms and legs, increasing the risk of falls and accidents.
• Slow, wide, stumbling gait (ataxia), making walking and balancing difficult.
• Poor temperature control, muscle weakness, and disturbed sleep patterns caused by brain shrinkage and tissue damage.

The symptoms of ARBD can develop gradually and may be noticeable to family and friends before the affected person realises there is an issue. In other cases, such as Wernicke-Korsakoff's Syndrome or after a severe brain injury, symptoms may appear suddenly and be quite severe. Symptoms may also manifest during alcohol withdrawal.

ARBD treatment

Alcohol-related brain damage (ARBD) is a cluster of different conditions caused by heavy drinking. Treatment for ARBD can be broken down into five phases:

• Physical stabilisation and withdrawal: This involves stabilising any health problems and starting detoxification from alcohol. The person with ARBD should also receive high doses of vitamin B1 (thiamine) via a drip (intravenous) or injection (intramuscular).
• Psycho-social assessment: The purpose of this phase is to make a thorough assessment of the person with ARBD in a safe environment, after they have stopped drinking.
• Therapeutic rehabilitation: During this phase, the person with ARBD is taken through a planned rehabilitation programme. This includes support to remain abstinent from alcohol.
• Adaptive rehabilitation: At this stage, the person with ARBD is helped to find the right level of support and an appropriate place to live in order to move on with their life.
• Social integration and relapse prevention: This final stage aims to help people with ARBD to build relationships and social networks. This can be particularly important if their old social networks were based on drinking and they want to make new non-drinking friends, so as not to undermine their recovery.

Treatment for ARBD is most successful when tailored to the individual's needs. Around 75% of people with ARBD who receive treatment make some form of recovery, with 25% making a complete recovery.

ARBD diagnosis

Alcohol-related brain damage (ARBD) is a brain disorder that can be caused by regularly drinking too much alcohol or binge drinking over several years. ARBD is an umbrella term used to describe the damage that can happen to the brain as a result of long-term heavy drinking. It is not a type of dementia, as it is possible to recover from ARBD. However, it can cause symptoms similar to dementia, such as memory loss and issues with thinking clearly.

ARBD can be difficult to diagnose as many clinicians are not aware of it and it can be misdiagnosed as a form of dementia or mental illness. There is also no single assessment tool that can be used for diagnosis, and screening tools intended for other forms of dementia may not give an accurate diagnosis. It can be hard to distinguish between the long-term effects of alcohol on the brain and the short-term effects of intoxication or withdrawal, so diagnosis is easier once a person has been abstinent for a few weeks.

There are three broad categories of symptoms that professionals can use to help them decide if someone has ARBD:

• Problems with long- and short-term memory, with information rarely retained for more than 20 minutes.
• Reasoning problems interfering with tasks such as weighing up options, understanding the implications of decisions, and learning new information.
• Problems with impulse control, including difficulty managing emotions and aggression, tendencies to disclose personal information inappropriately, and difficulty in coping with even minor stresses.

There are also some factors in a person’s medical history that can indicate ARBD and prompt clinicians to test for it:

• A history of drinking at least 35 units of alcohol a week for women or 50 units a week for men for a period of at least five years.
• Prolonged cognitive impairment – long-term difficulties with thinking and reasoning.
• Vitamin B1 (thiamine) deficiency.

There are several tests that can be used to assess a person's cognitive functioning, including:

• Abbreviated Mental Test Score (AMTS)
• General Practitioner Assessment of Cognition
• Addenbrooke’s Cognitive Examination (ACEIII)
• Mini Mental State Examination (MMSE)
• Montreal Cognitive Assessment (MoCA)

These tests can then be repeated as part of ongoing care to see whether there have been improvements in brain function. Scans such as MRIs can also help confirm the diagnosis of specific elements of ARBD by showing changes in the shape and size of parts of the brain.

Dementia risk factors

While drinking cologne is not advisable, it is unlikely to be a direct cause of dementia. However, excessive alcohol consumption is a well-known risk factor for developing dementia. Here are some key factors that contribute to an increased risk of dementia:

Age

The risk of developing Alzheimer's disease, vascular dementia, and other types of dementia increases significantly with age. The older a person gets, the higher the likelihood of being affected by dementia.

Genetics and Family History

While having a family history of Alzheimer's disease can indicate a higher risk, it is not always a definitive predictor. Many people with relatives suffering from Alzheimer's never develop the disease, and some individuals without a family history do get it. However, specific gene mutations, such as those found in Creutzfeldt-Jakob disease, Gerstmann-Sträussler-Scheinker syndrome, or fatal familial insomnia, significantly increase the risk of developing these forms of dementia.

Abnormal Genes

Abnormal genes have been implicated as risk factors in several types of dementia, including Huntington's disease, FTDP-17, and others. Additionally, people with Down's syndrome often exhibit neurological and behavioural signs of Alzheimer's disease as they reach middle age.

Smoking and Alcohol Use

Smoking is a significant risk factor for mental decline and dementia. It increases the risk of atherosclerosis and vascular disease, which are underlying causes of dementia. Similarly, excessive alcohol consumption (more than 12 drinks per week) is linked to an elevated risk of dementia. However, moderate drinking may have a protective effect, with some studies suggesting lower dementia risk for moderate drinkers compared to heavy drinkers or abstainers.

Atherosclerosis and High Cholesterol

Atherosclerosis, the buildup of plaque in arteries, is a significant risk factor for vascular dementia as it disrupts blood flow to the brain. High levels of low-density lipoprotein (LDL), or "bad" cholesterol, are also associated with an increased risk of vascular dementia and potentially Alzheimer's disease.

Plasma Homocysteine and Diabetes

Higher-than-average blood levels of homocysteine, a type of amino acid, are strongly linked to the development of Alzheimer's and vascular dementia. Additionally, diabetes is a risk factor for both Alzheimer's and vascular dementia, as it contributes to atherosclerosis and stroke, which are risk factors for vascular dementia.

Mild Cognitive Impairment

While not everyone with mild cognitive impairment develops dementia, this condition significantly increases the risk. Studies have shown that approximately 40% of people over 65 with mild cognitive impairment progressed to dementia within three years.

Frequently asked questions