Alcohol-Related Brain Damage (ARBD) - Signs and Symptoms

There are a number of different symptoms of ARBD but with the right support and treatment many of these can improve.

What are the symptoms of ARBD?

The symptoms of ARBD vary, but include problems with cognitive functioning (thinking and understanding) and memory, alongside physical symptoms. It’s important to remember that these symptoms can vary from mild to severe, and most people with ARBD will experience some rather than all of them, depending on which part of the brain is damaged and how badly it has been affected. Many of these symptoms can improve or even disappear over time with proper care and treatment.

Cognitive and memory problems

  • Memory loss – a person is unable to remember directions to familiar places or has trouble remembering appointments or recalling what they've just done or should be doing.
  • Difficulty with familiar tasks – a person may struggle with an everyday task like using their phone, or be confused about the layout of their home or how to prepare a meal.
  • Difficulty in processing new information – not being able to recall times, dates, appointments they’ve recently been given, or to remember people they’ve just met.
  • 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 – a person may be too trusting of strangers or respond inappropriately, for example by removing their clothes in public.
  • Problems with language – there may be difficulties in remembering words or the names of friends and family, or problems like forgetting the end of a sentence halfway through.
  • Erratic behaviour – carers of people with ARBD often find this the most difficult thing to cope with. A person may have rapid mood swings, become aggressive or even violent, or otherwise behave out of character. They may also have no insight into how they’re behaving and the effect it is having on themselves or others, making them appear harsh and uncaring.
  • Difficulty concentrating – it can be hard for people with ARBD to focus on one thing for more than a few minutes, which can make everyday tasks difficult.
  • Poor choices and decision-making – a person may not see any reason to think about changing their drinking and may not seek or accept help. They may have difficulty in weighing up options or making sensible decisions. They may also be vulnerable to manipulation, coercion and abuse by others.

Physical problems

There may also be physical signs of the damage to the body and its control systems, such as:

  • Damage to the liver, stomach and pancreas – all of which can affect brain function.
  • Pins and needles and numbness or burning sensation in arms and legs – this can increase the risk of falls and accidents.
  • Slow, wide, stumbling gait (ataxia) – this can make it difficult for someone to walk, and they may find balancing difficult.
  • Poor temperature control, muscle weakness and disturbed sleep patterns – these are all caused by shrinkage of the brain and by tissue damage.

Sometimes, these symptoms will build gradually and could be noticeable to family and friends long before the person with ARBD realises that something is wrong.

Symptoms may be misunderstood as effects of stress or growing older, or even that the person is just drunk – indeed, one reason ARBD may not be diagnosed in a drinker is that its symptoms can appear very much like drunkenness.

In other cases, such as Wernicke-Korsakoff’s Syndrome, or after a severe brain injury, the symptoms will appear suddenly and may be quite severe. Symptoms may also appear when someone is withdrawing from alcohol.

The story below, from Chris, a lady with ARBD, gives just one example of what it’s like to live with one form of this condition:

"I didn’t think I drank that much, the odd glass in an evening with my husband, but I didn’t notice my consumption gradually increasing and I definitely didn’t know the damage it would do to my mind and body. I had always been fit and healthy; I had no reason to be concerned.

It started gradually at first, stumbling occasionally, forgetting things and then all of a sudden it felt like I lost control of my left side. I couldn’t walk properly; my leg wouldn’t listen to what I wanted it to do, no matter how hard I tried. It felt like I’d had a stroke: in the end it was so bad that I resorted to crawling on all fours at home. I looked up my symptoms and thought I may even have Parkinson’s. I didn’t even know that Alcohol-Related Brain Damage existed until somebody said I had it.

Eventually I was diagnosed with Cerebellar Disease after a severe B12 deficiency, and was told the extent of my recovery would depend on the length of time this had been going on. It has taken me seven long years to get nearly back to normal. I still go to physiotherapy now, but only I know what’s happened to me."

Wernicke-Korsakoff’s Syndrome

The most severe form of ARBD is known as Wernicke-Korsakoff’s Syndrome (WKS), and was named after the two doctors who first recognised it. It is caused by a lack of vitamin B1 (thiamine) in the body, which in turn is a result of long-term heavy drinking.

In the past, Wernicke-Korsakoff’s Syndrome (WKS) was used as an umbrella term to describe all types of ARBD and alcohol-related dementias. However, the term Alcohol-Related Brain Damage (or Alcohol-Related Brain Impairment) is a much more useful term, as WKS is actually a very specific form of ARBD. WKS is made up of two separate elements: Wernicke’s Encephalopathy and Korsakoff’s Psychosis.

Wernicke’s Encephalopathy is a deterioration of brain tissue, and the symptoms include confusion and disorientation, numbness in the hands and feet, rapid random eye movements (sometimes called ‘dancing eyes’), blurred vision, and poor balance and gait (walking unsteadily). It should be treated as a medical emergency and can be effectively treated with large doses of thiamine, if caught early. People with Wernicke’s Encephalopathy often appear drunk, even if they’ve had very little to drink.

Many patients who experience Wernicke’s Encephalopathy go on to develop Korsakoff’s Psychosis. The symptoms of this include memory loss, apathy, and confusion about where they are and about the passage of time. A swift diagnosis and early treatment can often reverse these symptoms.

For advice on living with someone with ARBD, see our handbook for carers: Road to Recovery.

If you’re a professional working with people with the condition, download our Quick Guide for Professionals.

For more detailed information on all aspects of ARBD, download Alcohol Concern’s report All in the mind – Meeting the challenge of alcohol-related brain damage.

Please note: Our publications do not look at the damage to the brain caused in the womb by heavy drinking during pregnancy, known as Foetal Alcohol Spectrum Disorder or Foetal Alcohol Syndrome. More information on these conditions can be found on the website of the National Organisation for Foetal Alcohol Syndrome: www.nofas-uk.org.

This fact sheet was written by our predecessor organisation Alcohol Concern with the support of Garfield Weston Foundation.

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