Page 107 - The Memory Program How to Prevent Memory Loss and Enhance Memory Power

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deficits in recent memory associated with generalized brain atrophy on MRI scan. These results
strongly suggested Alzheimer's disease. But as I usually do before I drop this diagnostic bombshell, I
spent a little extra time double-checking all aspects of the patient's history.

I recalled that at her first visit, she had responded to the question about alcohol use by stating that
she drank a little every day. After I received her alarming test results, I decided to probe further into
this issue. Mary then revealed that she had four shots of whiskey every evening, a long-standing
habit. Her husband confirmed her report. He also mentioned that she had begun to make up stories to
fill the gaps in her recent memory, a tendency that is called ‘‘confabulation.” Mary said that she had
played with her grandchildren the previous weekend when in fact she hadn't seen them for a month.
Confabulation is common in both Alzheimer's disease and Korsakoff's syndrome, which is the
diagnostic term for a common type of alcohol-induced brain damage and memory loss. Heavy
drinking damages the liver, which in turn causes thiamine (vitamin B1) deficiency. Thiamine is
essential for proper utilization of glucose, which is the brain's main energy source. As a result,
alcohol-induced thiamine deficiency causes damage to nerve cells in the hippocampus and two
nearby structures called the amygdala and mammillary bodies that are also involved in memory
processes. This leads to memory loss for recent events while most other intellectual abilities remain
intact.

The neuropsychologist had concluded that Mary's test performance was consistent with a
diagnosis of Alzheimer's disease, but her history of alcohol consumption made me think otherwise.
So I decided to launch a systematic campaign to get Mary to stop drinking, or at least to reduce her
alcohol consumption. Getting people to stop drinking or smoking is never an easy task, and these
efforts are often doomed to fail. When I broached the subject, Mary fussed that there was nothing
wrong in having a few “tonics” every day. After some thought, I realized that her husband, Sean, was
the key. I spoke to him alone.

“Mary's four or five drinks a day are probably the cause of her memory loss,” I said. “With age,
her brain cannot handle the same amount of alcohol, which didn't create a problem when she was
younger.”

He paused to digest this new information. “I think I understand what you mean, doc,” he ventured.
“To tell you the truth, I was getting a little worried about that. But I can't get her to stop. She won't
admit that she's drinking too much for her age.”