For those who enjoy the occasional adult beverage, the end stage plight of the falling down drunk seems afar off. For those of us who see alcoholics in the ER setting, the long term negative impact of the habit on cognitive function is as clear as day…or night, as is more commonly the case. The most severe version of alcohol induced dementia is known as Wernicke-Korsakoff syndrome, and impaired memory and confusion are leading symptoms. The main cause of this dementia is thiamine (Vitamin B-1) deficiency. If identified early enough, brain injury in these individuals can be resuscitated with thiamine supplementation.
It turns out that you don’t need to be an alcoholic to have thiamine deficiency induced cognitive dysfunction. Studies from back as early as the 90’s have shown that thiamine deficiency can be associated with and even predictive of milder forms of cognitive impairment. In one study over 50% of patients with cognitive decline had low plasma thiamine levels. 1
Unfortunately, all of us will experience some degree of cognitive decline as we pass through the midlife years. Those who use alcohol socially, even in modest amounts can accumulate thiamine deficiency over time. Using diuretics, acid blockers or having had gastric bypass surgery can accentuate this potential deficiency. Because thiamine is water soluble, one could become deficient in as little as two weeks of deficit or increased demand.
A 12-week trial of thiamine support at a very reasonable dosage of 100 mg/day has shown benefit in early dementia patients. 2 If you are a social drinker, and feel that you are having minimal but persisting problems with word recall, remembering names, short term memory-such as details of recent events, multitasking, or learning new tasks…when not drinking, of course ; – )… you may want to consider reducing your alcohol intake, and trying a 12-week thiamine repletion trial at 100 mg/day. I have worked with a number of patients over the years who have noticed a meaningful improvement of mental acuity with these two measures. As an aside, a form of thiamine called benfotiamine is used at times to give an enhanced benefit for peripheral neuropathy or liver repair, and may be superior to thiamine in this regard as a form of Vitamin B-1. However, it may not enhance central nervous system levels as well, and for the purposes of this discussion, thiamine, not benfotiamine, would be the better choice.
Keep in mind that other reasons for ‘senior moments’ for those in the mid 40’s to 60’s can also include:
–sleep deprivation, or loss of deep restorative sleep. This can be aggravated by hormonal imbalance (in both men and women), sleep apnea and urinary or prostate problems, among others.
–vascular problems, including long term hypertension, plaque in arteries or hyperviscosity of blood. This can be accentuated by diabetes or smoking.
–depression and anxiety disorders
If the factors we’ve discussed above have been addressed or controlled and you have persisting symptoms of cognitive loss, consider asking your primary physician about neuropsychiatric testing. This is a series of tests administered by a psychologist. It can help to define early problems with brain aging and suggest additional therapeutic measures. While age will take some edge off even the sharpest knife in the box, attending to the little things that can promote cognitive decline will help keep your wits close at hand as the years go by.
1 Kanofsky, et.al. J Am College Nutrition 1996:15, 197-198
2 Mimori, Y, et.al. Metabolic Brain Disease 1996:11. 89-94
