Could alcohol be the cause and how do you know if it is?

@wilkins57 said:

I’m wondering if alcohol is the cause of his dementia. When I’ve read about that type of dementia it seemed like the person would be drinking all day long every day for it to cause dementia. Am I getting the wrong impression on that?

If it is WKS, the window in which one drinks is less important than the number of standard drinks consumed as well as his nutritional status. Another piece is that there seems to be a genetic piece WKS. There's a lot of alcohol use disorder and addiction issues in dad's family. His nephew was also diagnosed with WKS. In retrospect, I believe my late sister had it in the last 6 months of her life before dying from AIDS. Dad has a couple of uncles who also might have based on family stories. A lot of the research done on WKS comes out of the UK and Australia which would track with dad's family.

On one hand, if it is the alcohol, from what I’ve read, there would be a better possibility of stopping the progression. But of course the alcohol battle isn’t easy either.

When dad was treated with IV Thiamine and remained abstinent, he did improve considerably from a baseline of complete psychosis. I'm told his nephew did stay sober with support of the son who took him in but he did still progress and died before he was 60. Dad's neurologist said sobriety would give the best chance of maintaining the improvements over time but it wasn't a guarantee.

I would say dad went from a stage 6 dementia with extreme delusions to about a stage 4-ish. Mom had left undiagnosed dad for a week to attend a funeral with dear friends checking on him and returned to what looked like a crime scene with all the art off the walls, broken glass everywhere, dad covered in blood and convinced he'd killed the bad man. This resulted in a weeklong hospital stay and then 7 weeks in a SNF during which time he had little access (weekly happy hour with one small glass of ghastly wine) to alcohol.

But as you say, being the alcohol police is not easy. One downside to dad's "improvement" was that it gave him more capacity to be difficult. Since dad had mixed dementia— both Alz and WKS, the battle over drinking became more nuanced. We considered a 28-Day inpatient program designed specifically for older alcoholics who have memory issues, but the director felt dad was unlikely to benefit long term because he wasn't interested in stopping and his current level of impairment meant he wouldn't be able to learn strategies for sobriety or even recognize that he needed to. We also tried the usual suggestions of trying alcohol-free versions or even watering down his wine/beer but he could always tell. Any suggestion to limit drinking resulted in him drinking more in retaliation.

As he progressed into stage 6-ish he did seem to drink less. It is possible that the addition of Wellbutrin to his meds helped dull his craving as its used for smoking and overeating. GLP-1s are being looked at for this use as well, fyi.

He is in the very early stages of this disease so he still drives and is able to find his way around areas that he is very familiar with. He goes to our local Walmart to buy groceries so he buys alcohol along with the groceries.

This is difficult. Driving is an issue. Be certain you have contacted your insurance agent regarding his diagnosis. Dad's policy was void the minute the diagnosis was entered into his medical record. If he had an accident, you could be sued even if it's not his fault. I went through a lawsuit with my mom after an accident (no dementia— vision issues); that process takes time and a concern I would have given the progressive nature of dementia is that by the time he went to court he would not be the same person who had the accident. One thing that might be useful around the driving is to have him assessed by a specially trained OT. Some of the specific losses associated with WKS— especially around spatial reasoning would make driving unsafe. My dad once got angry with me because I said he couldn't put the cars in the garage. He didn't understand how I couldn't fit 3 vehicles into his one car garage. He also wanted to remodel a 6 x10' storage space into a Jack and Jill suite with a shared bath.

We have an appointment with a neurologist in February and they will be doing an MRI—will that help determine the cause as to whether or not it is the alcohol?

The neuropsych might have suggested WKS in the pattern of areas where he did relatively well vs poorly. Dad's diagnostic process was a little unusual in that it started in the ED and then completed outpatient. The resident thought his symptoms lined up with WKS based on the history/symptoms I gave. The attending neurologist thought it was "just garden variety Alzheimer's". The new neurologist at the memory center gave him the dual diagnosis based on interviews, history, and tests. The test that confirmed the WKS was a special PET scan than looked at how certain parts of the brain use glucose.

Sorry to be so lengthy in my post, but I wanted to give some additional background. Thanks!

More information is a good thing. The article that @JulietteBee shared is a good overview of what you might be seeing if this is WKS. Aside from the gait, the 2 most striking symptoms for me were dad always being cold (setting the heat to 85F in July in coastal MD) and conflating stories. Before he was diagnosed, this felt like he was rewriting family history.

HB

@wilkins57

Dad's Thiamine can back low normal but neurologist agreed to test further based on specific symptoms and his improvement on IV Thiamine/abstinence.

YMMV.
HB