Alcohol abuse and dementia/delusions - questions

General health and lifestyle
1

All, 

6 days ago, my cousin was taken to the emergency room because she was out of her head and couldn't walk. She's always been a drinker, but she lost her job last summer and I believe the idle time and depression caused her to hit the bottle harder and harder. According to her "boyfriend", the week before he took her to hospital she was drinking from the time she woke up till she fell asleep. She ate nothing for 4-5 days. She lost feeling in her feet and he caught her walking by grabbing hold of furniture to assist her. A couple of days later, she was butt-walking across the floor because she couldn't stand. A day later, she was unable to move at all.

He finally took her to the ER and they found her potassium had bottomed out and her blood count was extremely low. They gave her 2 units of blood and put her on a potassium drip and also gave her something called a rally pack IV. She remained in the hospital until yesterday and was then relocated to a physical rehab center. Medical tests on her came back pretty clean. She has a fatty liver but her enzyme levels are not at a dangerous level. Here's what I'm trying to understand and what has the family concerned. She's been talking out of her head since she went in and it's not getting better. She knows who I am, who she is, where she is, what day it is, etc, but then she'll say something completely bizzarre, like ask how my fishing trip with the Kardashians went or tell me Marilyn Monroe stopped by last night. At first, they told us the potassium deficiency caused the mental problems, then we were told it was withdrawal symptoms. I can understand both things, but she doesn't have any other 'withdrawal' symptoms and she's not getting better. The past 2 days it's been hard to get her to wake up and she's not on any medication. She can talk to you with perfect sense and even makes jokes. They told her she could take anything in the hospital room with her when she left and she cracked that they should be careful telling her that, because they might come back and find the television missing! The next minute she's wondering what happened to the kitten that's been in her room keeping her feet warm. She's weak and slurs her words like she's drunk or drugged but she's not. Today, we discussed her condition with a nurse who is also a little puzzled by by her seeming lucidity and delusion. After we told her the circumstances, she said it could be alcohol induced dementia. I looked that up but it doesn't seem to really fit her particular symptoms either. We know she's in trouble and no one is taking this alcohol abuse lightly, but I'm concerned about her mind right now. She's not craving alcohol or even talking about it, (except to ask if she'd be able to have a drink at the new place) and she's not in any physical discomfort except for her tingly feet. Has anyone had any experience like this? Is it common? Is it simply withdrawal? Any help or answers is greatly appreciated. -- Polly

2

It sounds like a thiamine deficiency was involved and I wouldn't be surprised to see it in someone who drank all day long. Presumbably, she took some time to get to that level. If that is the main problem, I don't know how long it will take to resolve. They may have her on benzos to ease withdrawal (and the craving), they might make her loopy, cause her to slur, etc. This is all from my memory about the subject and I'm only a lay person. Perhaps someone with better info will jump in and give you more to go on. 

If alcohol was at the root of this, then she really needs to stop drinking. If she can't stop, then she should see an addiction specialist about Medication Assited Treatment. This is one such treatment, there are indeed others:

http://patient.info/health/sinclair-method-for-alcohol-use-disorder

I'll open the floor for others to give you their take on things. 

3

I, along with most members of this forum are not medically trained. To try and diagnose what your cousin is suffering from, could be quite dangerous.

It does sound is if she is suffering from of ARBD (alcohol related brain disease). I would agree with the previous poster, that thiamine deficiency could cause some of the symptoms she's suffering with.

Korsacoffs syndrome could be a possibility and would account for memory problems.

You mentioned having some form of assessment with a nurse. Maybe talking about your concerns to the nurse would be a good starting place. If necessary you could also talk to her gp prior to making an appointment with her dr.

There are too many possible reasons for her behaviour to speculate, but it certainly sounds like it needs a professional input.

 

4

It's always difficult to diagnose from a distance, without all the hospital reports and tests to hand and not being able to speak to the patient.

So, at a guess (emphasis on the word guess), it would be one of the following.

Hepatic encephaopathy

Korsakoff's syndrome

Wernicke's encephalopathy

When looking them up, be careful to avoid 'Wernicke–Korsakoff syndrome', because so many websites instantly combine #2 and #3 which is different to them as individual conditions.

I am wondering if she is taking lactulose for condition one? The Rally pack, is a liquid solution of vitamins that her body will be missing. Some like thiamine for her brain function and others to help her central and peripheral nervous system - which was cauing her unsteadiness and then inability to walk.

I don't believe the heavy drinking over 4-5 days caused this, there will have been heavy drinking over a longer period, it will just have been kept out of sight. Only when the person became unsteady, could they no longer hide it.

The problem with daily heavy drinkers is:

A. They don't eat, because they get all their calories from alcohol and are not hungry. Therefore their body is depleted of the necessary and vitally important function of vitamins.

B. The body is dehydrated, because the person does not feel very thirsty, because they are always drinking, but they are not retaining any fluid.

C. The body cannot retain or absorb/use any of the vitamins, because the alcohol inflames the stomach lining (leading to gastritis) which stops the vitamins being absorbed and they are excreted straight out by the kidneys - hence the reason hospitals always IV vitamins rather than give them orally.

D. The liver is taking such a hammering from the alcohol, it is not able to process and use these vitamins.

The result of lacks of vitamins, manifests itself in two way. Brain function, usually confusion. Bodily function, the central nervous system where limbs such as arms and legs, start to stop functioning or functioning properly. Peripheral nervous system, whereby the fingers and toes will start tingling, itching, onis & needles, go numb etc.

In answer to your final question, it is not a symptom of withdrawal. It would be a sysmptom of long term alcohol abuse. Although it is not documented, or not well, their does seem to be some correlation, that when alcohol is removed from the equation, it does unbalance some people. Their body has become so dependent, that without alcohol, the body goes into a bit of a meltdown.

Hopefully, as the patient continues to be given IV vitamins, lactulose (ask if she is given that) and is eating plus not drinking, she should start to return to normal. It is unusual for permanent brain damage. It takes long term heavy daily drinking to do that.

5

good reply and much more technical and in depth that I can offer. Well done and food for thought. Robin

6

Thank you for taking the time to reply. They don't have her on any medication at all. Nothing for withdrawal or pain. Only something for the neuropathy in her feet and I don't *think* that would make her loopy. Alcohol is definitely at the root of this and we know that she needs help with that.

7

Thanks for your input, vickylou. I've been doing some research on ARBD (only on the internet, of course) but her particular symptoms don't seem to fit anything I've found, although she does have some issues with memory. Sometimes she can recount an event like yesterday and others are lost to her. No one has done any kind of real cognitive exam on her. Just the typical name, date, day of the week, etc. and she's good at all that. If she doesn't start to improve soon, we're going to have to do something else. 

8

Thank you so much for your in depth, thoughtful response, RHGB! We are also certain this didn't happen over 4-5 days. She's been drinking much too heavily probably since last summer, but apparently over that particular 5 day period, she did nothing BUT drink and didn't eat a bite. I will definitely ask about the lactulose and I really appreciate your explanation on how daily heavy drinking affects the body. One thing I wondered about was how she got so completely depleted of vitamins when I know that the ONE thing (besides drinking) she's always been diligent about is taking vitamins every day. Of course, she may have slacked off, but if her body can't absorb them, that explains things. I'm just so afraid she's done some permanent damage to herself. She only weighs 90 lbs (40.8 kg). She's a little thing, anyway, but she's underweight by 9kg. It's good to hear that permanent brain damage is rare. I guess we just have to be patient and give it more time, but today she was excited to ask how I enjoyed the carnival this morning and what rides I rode. It's unsettling, to say the least, and downright scary at worst. Thanks so much for all your time and attention. :-)

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And also thanks for the link to the sinclair method, too! :-)

10

For the brain confusion, make sure she keeps being given thiamine. Also try to make sure she is having lactulose. She sould also be on vitamin B compound strong/complex for her body and her central/peripheral nervous system and folic acid.

For her weight, she will gain weight, if she eats. I don't know about food in the US, but in the UK, hospital food is not brilliant, in fact prison food has to be made to higher standards. So people tend to give up on eating.

Try to get her to eat. If she isn't eating hospital food, then bring her whatever she will eat. people recovering from alcohol, aren't usually interested in healthy things like fruit. If there is anything she likes, that she will eat, bring her that, even if it is cake.

Give it time. I was in hospital for suspected alcohol liver failure and a related brain haemorrhage, for almost two months. I'm still here, three years later. I lost an awful lot of weight in hospital, it wasn't until I left, that I started to put it back on. Look on the bright side, my wife had to visit me, whilst I was jaundiced, a horrible yellow colour. I had a completely red eye (subconjunctival haemorrhage) and tubes coming out of me, where they did an ascites drain and I was in ICU for about 9-10 days.

It gets better, give it time. Your main problem, is when she is better, is stopping her from doing it all over again - believe me, it is hard.

11

Thanks again, RHGB. They booted her out of the hospital and she's now in a physical rehab facility. I'll be sure to check what kind of vitamins they have her on. If they don't have her on what you suggest, I'll suggest it. Can't hurt, but I also can't make them give her anything.

The food at this facility is 'not bad', but she can eat anything and I brought her a very unhealthy, fatty, salty, carb filled meal that she loves and she ate that today. I think her appetite is starting to very slowly pick up, but boy are you right about her not wanting healthy foods! She wants nothing to do with fruits or salads or healthy cereals. The dietician said she can have anything, though, and everything she eats is a step in the right direction. 

She'll start PT in ernest tomorrow and she is not going to be happy about that. I'm hoping that will help not only her body but help with her clarity. Right now she's like a little child and it's heartbreaking. 

It certainly sounds like you've been through the mill yourself, as have a lot of you here. I've read a lot of your collective posts and you are a great source of information and inspiration to others. Thank you for that. :-) I'm glad you're recovered! 

I greatly fear she will do this again. I've already explored the naltrexone, but we're so backward here in the U.S. it's difficult to find a practitioner. Fortunately, there's always the internet! Don't worry. I'm not jumping into anything, but that Sinclair method really sounds like something that could work for her. It's definitely worth a look if she decides to not change her habits. 

12

seems very postive now!! You are a great support. Robin (UK)

13

"We're so backward here in the U.S. It's difficult to find a practitioner "

​I was under the impression from US posters, it was the other way round! A lot of our gps seem to be unaware of AUD and medications. Well the ones I've seen and read about.

14

Vickylou, not sure what AUD (alcohol use disorder?) is, sorry, but I looked for doctors that were aware of The Sinclair Method, and found none in the 3 surrounding states and only 1 in my state, but when I looked him up, his site indicates he doesn't want to treat alcoholics. 

I'm definitely no expert, not even close, but I've been close to one other alcoholic and several people addicted to drugs. It seems all anyone talks about or recommends is AA or the like. AA worked for my crack cocaine addicted friend, but not for anyone else. The alcoholic died of liver disease, the heroin addict actually got through her addiction by force of prison and has stayed clean, and the opiate addicted friend is still battling. None of them received any help from doctors in the way of pharmaceuticals and the only therapy or treatment anyone suggested was AA or NA. Everything is so steeped in religion here. It can be extremely cloying. 

Maybe if we lived somewhere more progressive, like California, it would be easier but, unfortunately, we live in Kentucky. 

We'll definitely explore every possibility available to us, but she has to cooperate and I know without a shadow of a doubt AA is not the answer for her. 

If you know of any other medications or treatments to explore, please share them. I'm open to any suggestions. Right now, though, she's still completely out of her head. She called me last night screaming that everyone was there with her and then just left her. Where did we all go? Then she called me five more times in the middle of the night. Today she's still looking for Rob Kardashian, convinced he's there with her. I'm worried the rehab place may kick her out if she doesn't snap of this soon. It's beyond distressing. :-(

Thanks again, vickylou! :-)

15

Thank you, Robin2015. She's like a sister to me and I'm committed to doing anything and everything within my power to get her past this. 

16

Well, keep feeding her, whatever she will eat. You can worry about the nutrional value when she is better. I always remember a vet saying to me, when my cat was involved in an RTA and had its jaw broken, so it could not eat. He was given liquivite, a sort of protein drink, which they can lap up (my cat would finish off tins of the stuff). He said, I know your cat will survive, the ones with an appetite always do, it's the ones that don't eat, that I worry for. I'm sure humans are the same.

The UK is not a great place for helping people with alcohol problems, it is a fight to get help. Hence those who have got through it, try to help those that are going through it, by posting here. People with alcohol problems are seen to have brought it upon themselves and lack willpower. However, if you are a heroin addict, you will get all the help under the sun.

I have never been to the AA (I am not religious) but I did get coerced once, to go to an alcohol group therapy session. I'll tell you, if you didn't drink before you went, you certainly would after you left, depressive is the only adjective to describe it. Usually the US is quite good with medication for alcohol, maybe because you live in the 'sticks' it is not so good, but nearer the big cities it should be better.

You have two routes to go down, either the naltrexone of Campral, they work completely differently. I wouldn't count on California as being progressive (I have been there), I'd probably go with Kentucky everyday of the week.

As for the phone calls. I found hospital (I know she is not actually in a hospital itself, but that type of environment) very lonely and very hard mentally. I couldn't walk, so I laid there in the bed virtually 24/7. Keep making sure she eats, hopefully she is on the thiamine and lactulose and make sure, someone visits her daily.

17

Perhaps look into the Goodman Center in Tennessee? I was surprised to see that Dr. Cox would rather not treat alcoholics, perhaps a call to his office might clear things up.

18

ADEfree, I will check into the Goodman Center (not literally, lol) to see what it offers. I see you found Dr. Cox and saw the same thing I did. Funny thing is that he's in Lexington, Ky, which is where Debby's (my cousin) sister and father live, so it would be a good location. We will definitely call him if/when we get to that point. He also sounds 'expensive' and doesn't directly accept any insurance, so that could be an issue. There's always a lot to consider. 

Thank you for your time! :-)

19

RHGB, in my experience, Americans feel the same way about alcoholics as the UK. There's no sympathy and often undisguised disgust. I'm sorry to hear it's hard to get treatment there. We have lots of in-patient facilities to treat alcohol and drug addiction, but it's basically AA with bars. All about the higher power. It sounds very like the meeting you went to. I've gone to a couple of AA meetings to 'support' an addict and they are just awful and, as you put it, very depressive. Then you have to end every meeting with the Lord's Prayer. 

I'll continue to proactively look for help for her and I'm pursuing the vitamin supplements. One of the biggest issues is how she'll pay for it. We have to see what her insurance will cover and what facilities will accept her insurance, etc. 

She can't walk right now, either, RHGB, and I don't begrudge the phone calls at ALL. I'm sure what you went through was pure hell and she's lonely and bored too. It's the fact that they're crazy phone calls. I wish I knew the correct psychiatric term for what's wrong with her. Confabulation? Delusion? She doesn't SEE Rob Kardashian, but she's completely sure she was with him just 5 minutes ago and he's probably in the bathroom. She called me this morning thinking she was calling Rob and said she just couldn't seem to remember his number. 

Someone does go to see her every day, but sometimes it's not for very long. I'm her closest family and I have to work every day and I often work 12pm-8pm, so I can only see her for an hour or so in the morning. Her sister and father live 2 hours away, so they only come up every few days. We're all doing the best we can. I try my best to go every day, though and make sure she's clean and fed and her hair and teeth are brushed. 

Thanks again for all your support. :-)

20

No problem, Sweetpolly! 

My own TSM doc didn't take insurance either. that said it was about $500 for the appointments, meds and blood tests for the whole 6 months it took me to go from a 12-pack every night to less than a 6-pack per month. Naltrexone is out of patent and available for about a buck per pill. 

If your cousin agrees, it would be a good thing to have a prescription in place in case she slips back into drinking. Getting that naltrexone blockade into place will help considerably in keeping the booze from taking deep root again, so long as she can remember to take it an hour before drinking. The pill isn't taken on dry days, so as one goes along, fewer pills are taken.