Alcohol-Related Brain Damage: – even people who ‘seem normal’

There are two main types of alcohol brain damage, both very important, and both very prevalent in Australia.

Alcohol damages brain: now unable to learn from mistakes

It was only about ten years ago that research started to show that frontal ‘lobe damage’ is not only extremely common in alcoholics, but can also occur in social drinkers.

… So what are the symptoms? Basically they show problems with organizing and planning; with flexibility of thought; with forming concepts; with coding and classifying information; and with recognizing that you have made an error, and working out how to avoid making the same mistake next time. Most of these symptoms, unfortunately, are much more likely to be noticed as problems by family and work-mates rather than the person him or herself…

… block design, a subtest of the Weschler Adult Intelligence Scale. This is the only part of that standard intelligence test that showed up this kind of damage — a major reason why it went unrecognized for so long. In part of the test, the subject has to reproduce patterns, shown in pictures, using coloured blocks, red on two sides, white on two, and diagonally half and half on two. In some patterns, it is obvious where the blocks begin and end; in others the pattern doesn’t make this clear. People with frontal damage have no trouble doing the former, but can’t do the latter unless someone supplies a grid over the design that shows where the blocks go.

Another test for people of high intelligence and minor damage, is the Austin Maze… a panel of 100 buttons, arranged in rows of ten, with a path marked underneath, invisible to the subject, from the bottom left-hand corner to the top right-hand one. The subject has to find the path, getting a green light for a correct hit, and a buzzer for a wrong one, over a number of trials. The first, with no way of knowing which is the correct path, will contain many errors, which should be progressively eliminated. People with ‘frontal’ damage are unable to eliminate the last few errors, even over a large number of trials. They are quite unable to learn from their mistakes. The above tests show up fairly minor damage, but ‘frontal’ damage can be of any degree of severity.

In a severe case, the subject is given a set of twelve counters, four of each of three shapes, each shape having one of four colours. The subject is asked to sort them into groups ‘any way you like’. Most five-year-old children would be able to sort them easily into groups of shapes, then groups of colours. A severely ‘frontal’ ARBD client can’t. After some hesitation he may sort them into shapes, or into colours, unable without prompting to verbalise what he has done; but when asked to sort them another way, will remain stuck on the way he started with. When the tester sorts out one group for him the other way, he will usually say ‘They’re different.’

It is a very sobering experience to see someone floundering in such tests. Someone, that is, who is to all appearances, in normal conversation, and on basic bedside testing, completely intact. Someone who is likely, because they seem OK, to be expected to pull themselves together and go out and organise a new lifestyle without alcohol — something it is clear, from specific testing, they have completely lost the ability to do.

Frontal lobe damage seems to be extremely common in Australia.

the boss of the company, who has to deal with constantly changing circumstances… is likely to be severely incapacitated by even a mild degree of damage. An experienced and able secretary can cover up for such a person for a long time, acting in effect as their frontal lobes. This works until the secretary leaves, or the job is restructured, when the problem suddenly becomes all too obvious.

Alcohol damages brain: lost medium-term memory

Another type of ARBD is known as the Wernicke-Korsokoff syndrome — “wet brain,” in colloquial terms. It is very definitely related to nutrition, and is equally definitely much commoner in Australia than in any other country in the world … It is most unfortunate that Australians, especially males, drink beer to quench thirst, which in a hot climate means a lot of beer.

The reason we can be so sure about how often it occurs, is that it produces typical changes in the brain, which can be seen at autopsy. In a series of autopsies done on patients who had died in hospital, those changes were present in nearly 3 percent. However, only one in five had been diagnosed before death. A very common problem, alarmingly under-recognised.

No matter how severe the memory defect is, they will still be able to ‘parrot’ information back if they are asked to do so immediately — to repeat a telephone number, for example. This may mislead people into thinking their memory is in fact alright. A short while later, though, that information will have gone. The frustrating and tragic thing about the defect is that memories and skills from the past are relatively intact. Someone who could play the piano well from memory, for example, will still be able to do so. Problems can however arise because they don’t remember that they have already played a particular piece.

Prevention is essential, for both kinds of brain damage. Once you’ve got severe damage, the chance of getting back to normal or nearly normal is virtually nil. With any degree of damage, if you stop drinking altogether, you will not get any worse. [Chances of actually improving are slim if you put off quitting until after forty.] If you continue drinking you will get steadily worse.

The implications of ARBD for this country are mind-boggling. We can assume that somewhere around 10 percent of drinkers may be affected, mostly only mildly … one interesting suggestion is that the Aussie male stereotype, rigid in his thinking, intolerant of change, unable to relate emotionally, could owe something to widespread ARBD.

Dr. Jean Lennane, 1992, ‘Alcohol: The National Hangover’, pp. 115-117.