Alcohol and Dementia: Can You Reverse Drinking’s Damage to Your Brain? Here’s an Expert Neurology Doctor’s Answer

In a July 2023 Gallup survey, 62% of US adults reported drinking alcohol, while just under 20% of that group reported sometimes drinking more than they should. The link between alcohol consumption and brain health is a growing concern, especially considering projections that dementia rates could triple by 2050. Is alcohol part of the growing dementia problem—and if so, is the damage to your brain too far gone to try to correct?

Speaking to these concerns is director of the Cleveland Clinic’s Lou Ruvo Center for Brain Health, Dylan Wint, MD, a superlatively qualified brain expert who is quadruple-board-certified in neurology, psychiatry, behavioral neurology, and neuropsychiatry. Dr. Wint says that while “moderate” alcohol consumption (no more than one drink per day for women and two drinks per day for men) does not cause neurological damage on average, “people with neurologic conditions or at risk for neurologic conditions should probably abstain from alcohol altogether.” Echoing the World Health Organization’s January 2023 statement on alcohol, Dr. Wint states: “There is no level of drinking that is guaranteed safe for everyone.”

Still, the discourse has been confusing. Some studies have suggested that low to moderate alcohol use might actually reduce dementia risk, while others indicate there are no health benefits to drinking alcohol. What all experts can agree on, though, is that exceeding moderate drinking levels should be avoided. Alcohol consumption plays against other demonstrated health factors like nutrition, exercise, mental activity, sleep, and social relationships that have significant roles in brain health.

Below, we lay out the effects of alcohol on the brain and identify the specific drinking behaviors that research says put individuals at the greatest dementia risk.

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Can alcohol cause dementia?

The answer to this question is yes, in several ways and often linked to chronic, heavy alcohol use. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines heavy alcohol use as the following:

• Men: Consuming five or more drinks on any single day, or 15 or more drinks per week
• Women: Consuming four or more drinks on any single day, or eight or more drinks per week

One primary mechanism that alcohol can contribute to dementia is through Alcohol-Related Brain Injury (ARBI). According to Dr. Wint, ARBI happens when alcohol directly damages the brain by excessively stimulating nerve cells and harming the brain’s white matter. White matter is composed of nerve fibers essential for transmitting messages throughout the brain.

The damage doesn’t stop there: Alcohol also diminishes blood flow and triggers the loss of nerve cells, especially in critical areas such as the frontal lobes—responsible for decision-making and emotional control—and the cerebellum, which coordinates movement.

Another dementia type often linked to alcohol consumption is Korsakoff syndrome, which frequently accompanies Wernicke encephalopathy. This condition arises from the destruction of neural pathways involved in memory due to a deficiency in thiamine (vitamin B1). Thiamine is an essential nutrient that supports brain function and overall nerve health. Dr. Wint explains the underlying issue: “Heavy alcohol use leads to poor nutrition (less thiamine intake), poor absorption (of thiamine), and lower liver storage of thiamine.” This can result in severe memory loss.

Marchiafava-Bignami disease is another outcome linked to alcohol, predominantly affecting malnourished, heavy drinkers. It involves the deterioration of the corpus callosum, the major fiber tract that connects the brain’s two hemispheres. The resulting damage can cause a range of severe symptoms, including cognitive decline, inability to walk, slurred speech and muscle spasms.

As Dr. Wint points out, other negative effects on brain health include:

• Formation of amyloid plaques, similar to those found in Alzheimer’s disease

• Liver damage, which leads to increased circulation of toxins in the blood

• Head injuries resulting from falls or altercations

• Cognitive issues stemming from heart disease

What are some other long-term neurological effects of alcohol?

One of the significant impacts of alcohol is on mental health, specifically through its disruption of neurotransmitters—the chemicals essential for communication between brain cells. This disruption can cause mood swings, depression and anxiety, notes Dr. Wint.

Physically, the effects of alcohol are equally concerning. Regular consumption can lead to issues with movement and balance as well as muscle weakness. Alcohol can also cause neuropathy, characterized by numbness, tingling, and functional impairments, primarily in the toes and feet. This occurs because alcohol damages peripheral nerves, harming their ability to transmit signals.

It’s important to note that the risk of stroke and internal bleeding in the brain escalates with regular alcohol use, too. Alcohol-induced hypertension and other cardiovascular complications can significantly increase the likelihood of strokes.

Can brain damage from alcohol be reversed?

While the changes to the brain caused by alcohol are generally seen as irreversible, Dr. Wint notes, “Functional improvement may be possible with rehabilitation and preventing further damage from alcohol and other toxic lifestyle habits.”

This means that through dedicated alcohol rehabilitation programs, which often include therapy and support groups, individuals can work toward improving their brain function. Complementing this with healthier lifestyle choices—such as a balanced diet, regular exercise, avoiding harmful substances, and managing stress—can also help mitigate further damage and potentially enhance brain recovery.

What is the life expectancy of someone with brain injuries related to alcohol?

Dr. Wint explains that the life expectancy for individuals with alcohol-related brain injuries is “quite variable, depending upon the type and severity of brain damage—anywhere from a normal lifespan to imminent death from severe, acute alcohol toxicity.”

There are cases when people may not have to cut out alcohol completely. For those for whom it’s still appropriate to occasionally relax with a drink, a low-risk level is defined as one-half to one drink per day for women and one to one and a half drinks per day for men. Dr. Wint adds that these recommendations should be lower for individuals over age 65.

To clarify, one drink equates to:

• 12 ounces of regular beer (5% alcohol)
• eight ounces of malt liquor (7% alcohol)
• five ounces of wine (12% alcohol)
• one and a half ounces of liquor (40% alcohol)

“Alcohol dependency and seeking treatment are highly stigmatized, causing people to avoid expressing concerns or seeking help,” shares Dr. Wint. If concerns about alcohol use are affecting you or someone close to you, don’t hesitate to reach out. It’s important to consult trusted healthcare professionals experienced in substance use recovery. For immediate assistance, consider contacting the Substance Abuse and Mental Health Services Administration (SAMHSA) at their free crisis hotline: 1-800-662-4357. This resource can provide support and guidance when you need it most.

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