In addition to claiming lives, marriages, homes and careers, alcoholism has a greedy way of robbing its victims of brainpower, as well. Over time, alcohol dependence literally shrinks the brain and several of its components. And in so doing, it erodes an alcoholic's ability to learn new tasks, remember things and organize for action. Even regular, heavy drinking can take a cognitive toll, researchers have found.
But a new study published in the journal Brain details the remarkable ability of the thinking organ to regenerate itself and regain function when its host chooses the path of sobriety. The research also underscores a key warning -- quit now, or risk damage that could be harder to reverse.
A team of European researchers used magnetic resonance imaging to assess the brains of 15 alcohol-dependent and 10 healthy subjects and tracked the volume of two key brain chemicals that are indicators of cell health and activity. The subjects were given a battery of tests of cognitive function at the beginning and end of the study. As the 10 male and five female alcoholics embarked on a journey of sobriety, the team of radiologists plotted a remarkable story of comeback.
In less than two months without alcohol consumption, the brain volume of alcoholic subjects increased, on average, 1.85%. Cerebellar choline levels -- indicators of how well brain cells are able to relay messages -- increased 20%. Levels of another brain chemical that indicates proper function of the brain cells went up 10%. The more dramatic those changes, the greater the improvement in a subject's performance on tests of cognitive function.
The study is among the first to show where regeneration occurs most robustly in the early days of an alcoholic's recovery -- in the brain's ventricles and in the white matter that helps brain cells and brain regions coordinate and communicate more smoothly with one another.
By comparison, the brains of healthy subjects, who also were asked to abstain from alcohol during the study period -- did not change.
Dr. Andreas Bartsch of the University of Wurzburg, Germany, said the study, when added to several that have shown similar resilience on the part of the brain under assault by alcohol, holds a hopeful message for drinkers beset by lapses of memory, motivation and judgment.
"Abstinence pays off and enables the brain to regain some substance and perform better," Bartsch said. "The adult human brain, and particularly its white matter, seems to possess genuine capabilities for regrowth," he added.
The study is the latest and most detailed of a mounting body of research showing how alcohol -- even heavy drinking that falls short of dependence -- can impair cognition, and how abstinence can prompt at least a partial reversal of intellectual deficits.
Those studies have established that alcoholism can cause significant loss of short-term memory skills and of higher-order functions such as reasoning, planning and prioritizing. In adults as well as adolescents, alcohol abuse was associated with changes in the brain -- in particular in the prefrontal cortex, the seat of higher reasoning.
The most well-documented alcohol-related impairments occur in a drinker's visual-spatial skills -- those that allow us to drive, read a map and orient ourselves in three-dimensional space. A Stanford University study published in August found that although middle-aged alcoholics who had been abstinent for as little as six months regained virtually all lost function on measures of abstraction, attention, memory, reaction time and verbal skills, the damage to their visual-spatial skills was not so easily undone.
Studies have found that women are particularly vulnerable to the cognitive effects of alcoholism, and that smoking tobacco during recovery can significantly hamper the brain's process of self-repair.
The length of a person's descent into alcoholism is also key, a point that Bartsch's study underscores. Bartsch says that among the 15 alcohol-dependent patients who participated in his study, the degree to which a subject showed return of lost brain volume and function correlated with the duration of their alcoholism. Those who had been dependent longest showed more modest, and in one case, no recovery, he said. That's why, he said, it's important for alcoholics to quit as soon as possible, before secondary medical or psychiatric disorders make recovery harder and cognitive deficits more difficult to reverse.
To Clancy Imislund, a recovering alcoholic who is managing director of Los Angeles' Midnight Mission, research that details the comeback of cognitive function hits home but also misses a key point.
"It's a funny thing: The brain of an alcoholic is really a dried-out brain," said Imislund, referring to research suggesting that alcohol cripples and kills brain cells, in part, by dehydrating them. "As the alcohol goes out of your system and the synapses get to working better, if you stay sober for a while, it's been my experience they come back pretty well."
But Imislund added that, with abstinence, alcoholics must face the outside world again, and the challenge of doing so reinvigorates the brain -- a dynamic that research, he acknowledges, may never capture.
"When you straighten out, you get going again and you get some focus outside of yourself," Imislund said. Alcoholics, he added, may "appear to be mentally retarded. They're not, they're just mentally self-obsessed. They need to be pulled out of themselves. And that's when your cognitive abilities return, I believe."
In a commentary accompanying Bartsch's study, Yale University psychiatrist Graeme Mason wrote that physicians treating alcoholics in recovery could use the latest research to encourage those patients by holding out the prospect that abstinence will pay off with real gain in intellectual function. The study and the commentary appear in the Dec. 18 online edition of the journal Brain.