When a person struggles with alcohol use disorder for a long time, they are at risk of developing several chronic conditions. One of these is colloquially referred to as wet brain, a type of dementia or cognitive impairment caused by a lack of thiamine, or vitamin B1. Wet brain is actually a combination of two related conditions: Wernicke encephalopathy and Korsakoff’s syndrome (more extreme forms are called Korsakoff’s psychosis). The overall medical condition is called Wernicke-Korsakoff syndrome.

Most people consume enough thiamine to prevent the development of this condition. However, people who struggle with alcohol use disorder may focus on consuming alcohol instead of eating a balanced diet, with whole grains and lean proteins. In other cases, alcohol can upset the stomach and the person may experience loss of appetite, or vomiting, which can reduce sources of thiamine. The liver stores some thiamine, although not very much, and damage to the liver from long-term alcohol abuse can prevent storage and release of this vitamin nutrient into the body.

Mental Health

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Wet brain can progress in a specific pattern, or both Wernicke encephalopathy and Korsakoff’s syndrome can develop together. Sometimes, Korsakoff’s syndrome develops first. However, the typical pattern that constitutes wet brain is the development of Wernicke encephalopathy followed by Korsakoff’s psychosis. Among people who develop wet brain, 20 percent experience progression of symptoms until death; 10 percent spontaneously recovery with little or no medical intervention; and 70 percent do not die from the condition but require long-term care.

The signs that wet brain is developing are outlined below.

  • Early Symptoms

    The early stages of wet brain include:

    • Rapid weight loss in the past year
    • Reduced body mass index
    • Reduced nutrition due to other reasons
    • High carbohydrate intake, not from complex carbohydrates like whole grains
    • Consistent vomiting over the course of one month
    • Anemia or co-occurrence of other nutritional deficiencies

    Very early symptoms of Wernicke-Korsakoff syndrome include:

    • Loss of appetite
    • Vomiting and consistent nausea
    • Exhaustion, fatigue, or weakness
    • Unexplained giddiness
    • Insomnia
    • Trouble concentrating
    • Memory loss
  • Wernicke Encephalopathy

    In most cases of wet brain, the beginning of the condition is the formation of Wernicke encephalopathy. Initial stages can appear similar to drunkenness or alcohol withdrawal. Signs include:

    • Confusion
    • Amnesia
    • Impaired short-term memory
    • Eyelid drooping
    • Uncontrollable leg twitches or spasms

    About 80 percent of people who develop Wernicke encephalopathy experience a progression of the disease into more serious symptoms. These include:

    • Extreme confusion
    • Loss of memory (dementia)
    • Ataxia, or loss of muscle coordination
    • Abnormal eye movements

    Initial stages of ataxia can cause loss of coordination or stumbling, which can make the person appear drunk even when they are not; however, as muscle tone continues to decrease, the symptoms will get worse until the individual is no longer able to stand or walk without assistance.

    Changes in vision begin with eyelid drooping and double vision, which are also similar to signs of alcohol intoxication. However, these vision changes do not improve during periods of sobriety, and the person is likely to experience worsening of vision problems, which lead to nystagmus, a rapid back-and-forth movement of the eyes.

    Many symptoms of Wernicke encephalopathy appear before Korsakoff’s syndrome; however, it is possible for a person to develop Korsakoff’s syndrome without developing Wernicke encephalopathy, to develop Korsakoff’s first, or to only develop Wernicke encephalopathy due to alcohol use disorder.

  • Korsakoff’s Psychosis

    The primary symptoms of Korsakoff’s psychosis are memory impairment and loss. The person is no longer able to form new memories in the later stages of the condition; they lose memories progressively as brain tissue is damaged over the course of the illness.

    Symptoms of Korsakoff’s include:

    • Short-term memory problems: The person is not able to form new memories so they do not recall recent events.
    • Confabulation: Fictitious memories are created to bridge gaps in existing memories. A person with this symptom likely does not know they are making up memories.
    • Personality changes: The individual may react apathetically to their environment or express a lack of concern for things that happen to them.
    • Increased talkativeness: The person may talk a great deal, say things repeatedly, or perform repetitive behaviors, including attempts at conversation.
  • Other Symptoms

    When a person develops Wernicke-Korsakoff syndrome, they experience loss of mental capacity, motor function, and eye movement or vision.

    There are other symptoms associated with physical changes to the brain as well, including:

    • Polyneuropathy: problems affecting many nerves throughout the body
    • Peripheral neuropathy: damage to the nerves outside the central nervous system, especially extremities like hands and feet
    • Tachycardia: rapid heartbeat
    • Postural hypotension: low blood pressure when standing since the heart cannot circulate blood well
    • Syncope: loss of consciousness
    • Cachexia: extreme malnutrition, appearing as physical “wasting away”

Diagnosis and Treatment for Wernicke-Korsakoff Syndrome

A brain scan may show evidence of wet brain, due to brain swelling from Wernicke encephalopathy; however, most doctors diagnose the condition by examining the list of symptoms. Treatment typically involves ingesting thiamine, either intravenously, intramuscularly, or orally, depending on how the person will best tolerate the vitamin. Although treatment will not change brain damage or memory loss that occurs from Korsakoff’s psychosis, it can prevent or delay any further progression of wet brain.

Treatment for Alcohol Use Disorder

It is very important for a person to get help overcoming alcohol use disorder, especially before they develop chronic conditions like Wernicke-Korsakoff syndrome. The best process for most people is to get professional help to safely detox from alcohol and then progress into a complete rehabilitation program.

Rehabilitation programs provide individual and group therapy, and sometimes family therapy. These therapies help the person understand the sources of their alcohol addiction and develop better coping mechanisms to deal with cravings and stress. Group therapy helps the person develop a network of peers that can support the individual’s focus on maintaining sobriety. Group and family therapy help to build new relationships and rebuild existing relationships, so the individual has additional support once they leave the program.

While some effects of Wernicke-Korsakoff syndrome may be permanent, the best way to avoid further damage is to stop drinking safely, with professional help, and to embrace a life in recovery.