This is how alcohol damages the brain

A person wrapped in cardboard and a brick of wine next to him warns us, at first glance, of the physical and social ravages of alcohol. More difficult is to discover the damage that is not seen and that, however, is part of the causal chain that leads to this situation: the damage inflicted on the brain.

Most people could quickly describe the acute effects of alcohol: lack of coordination, disinhibition, impulsivity... Far fewer could talk about the chronic consequences, which respond to the same neurotoxic effect of alcohol on the brain.

Neuropsychological and neuroimaging studies show that three neural networks are especially vulnerable: the frontocerebellar network, which controls gait and balance; the frontolimbic, involved in memory, motivation and self-awareness; and the frontostriatum, responsible for emotional regulation, inhibition, cognitive flexibility and reward management.

Pay attention to these symptoms
But how do we know if a drinker suffers brain damage? People around you will notice that you are slower, easily distracted, more rigid, have a poor memory, make decisions without assessing the risks, have a hard time regulating your emotions, and interpret those of others less well. And this affects your family, work and social life.

The good news is that if you stop using and maintain abstinence, your brain will show structural and functional improvement. On the other hand, as long as you continue drinking, your brain will age faster than normal.

Furthermore, like the whiting chasing its tail, your cognitive and emotional deficits will compromise your efforts to initiate and maintain abstinence. Healthcare personnel must take into account that brain damage can be an obstacle to following clinical treatment, by limiting emotional self-regulation, motivation for change, interaction with other people, emotional perception and awareness of social dysfunctions.

Even when these difficulties are overcome and abstinence is achieved, it may come too late.

Honest lies and alcohol: Korsakoff syndrome
This is what happens to patients with Korsakoff syndrome. This residual and largely irreversible disorder appears in one in two cases of Wernicke's encephalopathy, a pathology caused by a severe deficiency of vitamin B1 or thiamine and which is more common among malnourished people who abuse alcohol. A prevalence of between 25-50 cases per 100 inhabitants has been estimated, and post-mortem studies suggest that it is underdiagnosed.

In this syndrome, the damage affects a region of the brain called the diencephalon, particularly the mammillary bodies and thalamic nuclei. The deterioration manifests itself above all in memory: patients suffer from an amnestic syndrome that is accompanied, especially in early stages, by confabulations. That is, the affected person has false memories and is convinced that they are real. Called “honest lies,” they arise due to a deficit in access to memory.

Adolescents and binge drinking
And what about the young people? Is it necessary to drink for years for alcohol to cause brain damage? If they only do it on the weekend, nothing will happen to them? No, drinking five or more drinks in a few hours, at least once a month, is associated with a deterioration in memory and executive skills, which allow us to plan, supervise and regulate our behavior according to our objectives and standards. social.

These difficulties respond to structural and functional changes at the brain level. Neuroimaging studies show neurofunctional abnormalities, such as excessive activation of neural networks when a response to an alcoholic beverage must be inhibited. Volume differences have also been observed in the white and gray matter in different regions related to impulse control.

It is necessary to take into account that adolescence is a period of brain vulnerability during which important changes take place in the structure and functional connectivity of neural networks. We should be concerned that alcohol continues to be perceived as the least dangerous drug among 14- to 18-year-olds.

The first involuntary drunk: fetal alcohol syndrome
But brain damage associated with alcohol intake can begin long before adolescence: even before birth. Consuming it during pregnancy is the cause of fetal alcohol syndrome spectrum disorders, a completely avoidable neurodevelopmental disorder.

There is no safe consumption during pregnancy. Drinking alcohol is linked to central nervous system alterations such as small head circumference, structural brain abnormalities, and neuropsychological deficits. All of this will affect the development of intellectual capacity, cognitive functioning and self-regulation of behavior.

Among the especially vulnerable groups that require special attention are children from international adoptions, especially from countries with high alcohol consumption. A recent study indicates that up to 50% of them meet the diagnostic criteria for the disorder. And one in five affected people show the most serious form: fetal alcohol syndrome.

It is necessary to educate the entire population about the risks to the fetus and support pregnant mothers who decide to stop drinking alcohol. And we must not forget to detect and intervene early to guarantee the adequate academic, psychological and social development of these children.

In short, if you want to take care of your brain health, and whatever your age, the less alcohol, the better.

Article written with the advice of the Spanish Society of Epidemiology.

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Source: The Conversation. Authorship:

Montserrat Corral Varela
Professor of Neuropsychology, University of Santiago de Compostela