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Tuesday, September 2, 2014
Alzheimer's Disease and Alcoholism
My father in law is a lifelong alcoholic. He had a CT scan done after taking yet another fall (from passing out). The doctor compared this CT scan to one done 3 months ago and said the image showed quite a difference in brain shrinkage. The doctor mentioned dementia and/or possibly Alzheimer`s and directed him to a neurologist. He refuses to go. I understand there can be a shortened lifespan. My husband is in a bit of denial. With such progression in such a short amount of time, I would like to know what kind of time frame we might be looking at.
Also, how much does the alcoholism have to do with this? My mother in law is not prepared to handle what is going on and I would like to be sure that we are there effectively to help her cope.
The typical course of progression of atrophy in Alzheimer's disease is gradual. Alcoholism also has been reported to be associated with generalized atrophy, as well as more severe damage to certain areas when adequate nutrition with certain B-vitamins is not maintained. Alcoholism would certainly increase the problems associated with Alzheimer's disease. I do not know why such a major change might have occurred in 3 months on the CT scan. One radiologist personally mentioned to me that he thought alcohol caused an additional acute but transient decrease in apparent brain volume after a binge- so maybe his second scan was after several recent drinks- but I cannot find literature to support this.
That specific question might best be answered by an expert on alcoholism. The typical course of Alzheimer's is about a 10 year course from diagnosis to death. In patients with only memory trouble, 10-15% per year progress to Alzheimer's disease. Without a lot of details of where he is right now and how fast he is progressing, I cannot give a time frame beyond such general numbers. However, he is almost certain to progress and will eventually not be able to care for himself, and later would not be able to be cared for by his wife.
Getting appropriate care is a must, to deal with the growing danger from various safety issues (driving, handling finances and being swindled, accidentally leaving the stove on, access to weapons and toxins, and later things such as wandering away) and other social/environmental problems, to exclude other treatable causes, to deal with psychiatric complications and behavioral problems, and to try current Alzheimer drugs.
You can just tell him he is going to another doctor and not tell him about the Alzheimer's question in order to get him to go. You can also discuss this with his family physician. The local Alzheimer's Association chapter can also sometimes be a helpful resource. If you fear for his safety, Adult Protective Services can be called. If competence is an issue, discuss with the family attorney.
David Q Beversdorf, MD
Assistant Professor of Clinical Neurobehavior and Neurology
College of Medicine
The Ohio State University