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Alcohol-related cognitive impairment

Many people with alcohol problems experience alcohol-related cognitive impairment (ARCI). This includes difficulties with:

This can be due to dementia, stroke or traumatic brain injury. But in people attending alcohol services, alcohol is usually the cause.

In this guide, you can find out about:

Why older adults are more at risk

Older adults with alcohol problems are more likely to have alcohol-related cognitive impairment than younger people with alcohol problems.

This is because older adults are more likely to:

Cognitive impairment caused by thiamine deficiency or the direct toxic effect of alcohol is often reversible if the person stops or greatly reduces their drinking.

This is not the case for cognitive impairment caused by traumatic brain injury or vascular damage. But people with these conditions can still benefit from harm-reduction strategies.

Barriers to treatment

People with cognitive impairment often experience barriers to alcohol treatment.

This may be because they find it difficult to:

In fact, at Drink Wise Age Well, people with cognitive impairment are just as likely to be treated successfully as people without cognitive impairment.

But this can only happen if people are screened for cognitive impairment when they enter services. You may also need to adapt the kind of support they get.

NICE, Public Health England and the Scottish Government all recommend routine screening for cognitive impairment in alcohol services.

One option is a validated screening tool called the Montreal Cognitive Assessment (MoCA).

MoCA is available for free, but you’ll need to complete a paid-for online training course before you can use it.

Find out more about the MoCA cognitive screening tool

When discussing this with a patient, you should reassure them that:

If screening suggests that someone has a cognitive impairment when they enter treatment, they should be screened again if they stop or greatly reduce their drinking.

If this shows that their cognitive function has improved, it can encourage them to maintain a lower level of drinking.

If there’s no improvement, they can be referred for a specialist assessment through their GP, community mental health service or specialist addiction service.

Adapting support for people with cognitive impairment

Once you’ve identified someone with cognitive impairment, here are some practical steps you can take to make sure you’re meeting their needs.

Thiamine (vitamin B1) is an essential nutrient. The body can not produce it, so people have to get it from food or a supplement.

People with alcohol problems are more at risk of thiamine deficiency due to:

Thiamine deficiency is a common cause of alcohol-related brain damage and cognitive impairment. You should assess anyone attending alcohol services for thiamine deficiency. [

Thiamine deficiency can cause a form of brain damage called Wernicke’s Encephalopathy (WE). WE is a life-threatening medical emergency, and the symptoms are often mistaken for drunkenness.

Symptoms of WE include:

People with WE symptoms should be given thiamine through a drip or injection as soon as possible to prevent death or permanent brain damage.

You should also offer thiamine to people who:

Cognitive impairment and mental capacity

Older adults with cognitive impairment do not necessarily lack the capacity to make informed choices.

They may have the mental capacity to decide some things (like what to wear) but not others (like how to manage their finances). Their capacity may also vary over time.

If somebody has capacity and refuses treatment, the law says their decision must be respected. But it’s worth asking them again at other times, as they may change their answer.

Always start by assuming that someone does have the capacity to make decisions. A GP or other health professional can give someone a full assessment of their mental capacity.

When someone has been abstinent for a while, it’s important that they receive another capacity assessment as their mental capacity may have changed.

If somebody does lack capacity, they can still benefit from alcohol treatment. But this might have to be given as part of a multi-agency care package in line with legal frameworks.

Where to go for more information

Find out more about alcohol, dementia and cognitive impairment from: