The story usually arrives the same way. A man in his seventies starts repeating himself. He cannot hold on to a conversation from one hour to the next. He mislays things, then fills the gap with a confident explanation that turns out not to be true. His daughter books a GP appointment, braces herself, and waits for the word she already expects to hear.
Sometimes that word is the right one. But there is another condition that produces almost exactly this picture, arrives at roughly the same age, and is treated completely differently. It is called alcohol-related brain injury, and the most important thing about it is this: a good proportion of people who have it get better.
Ireland knows remarkably little about how many of its older adults are living with it.
TL;DR
- Alcohol-related brain injury (ARBI) causes memory loss, confusion and personality change that can look almost identical to dementia, but unlike most dementias it can partially or fully reverse with abstinence, thiamine and the right support.
- Ireland records a mean of 314 hospital discharges a year with an ARBI diagnosis code (HIPE, 2015 to 2023). That national count is published by year and by sex, and not by age.
- Drinking is falling across almost every age group in Ireland. The only age group where frequent drinking rose between 2015 and 2025 is people aged 75 and over, up 5 points.
- Wernicke encephalopathy, the acute emergency that precedes Korsakoff syndrome, is a medical emergency. A 2026 scoping review found it is still routinely missed and undertreated, often with oral thiamine where injected thiamine is needed.
- Ireland has no lead service for ARBI. The Alcohol Forum in Letterkenny runs a specialist case coordination service and publishes free guides for families and professionals.
What alcohol-related brain injury actually is
ARBI is an umbrella term rather than a single disease. It covers the range of lasting changes that heavy, prolonged drinking can produce in the brain, and the two best known are Wernicke encephalopathy and Korsakoff syndrome. Both come down to a shortage of thiamine, which is vitamin B1.
The mechanism is straightforward and, once you have heard it, hard to forget. Someone drinking heavily over years often eats badly, and may substitute drink for meals altogether. Alcohol then interferes with how the body absorbs and uses what little thiamine does arrive. The brain runs short of a vitamin it cannot function without, and cells begin to die.
The HSE’s own guidance is blunt about the acute stage. Wernicke encephalopathy is described as short-lived but life-threatening, with symptoms including trembling legs or a wide-based walk, eyes that flick rapidly from side to side, and confusion or disorientation. The HSE advises calling 112 or 999, or going to an emergency department, if those signs appear. Untreated, people die from it. Those who survive it untreated often go on to develop Korsakoff syndrome.
Korsakoff is the long-lasting form, and it is the one families describe to a GP. Memory loss. An inability to lay down new memories. Difficulty learning anything new. And the symptom that unsettles relatives most of all: filling the gaps in memory with made-up stories, told with complete sincerity. The clinical word is confabulation. It is not lying. The person genuinely does not know the memory is missing.
The Alcohol Forum, the Donegal-based charity that has done more work on this in Ireland than anyone, puts it plainly: ARBI “can remain hidden for many years before it is noticed by family or professionals”. Nobody wakes up with it. It accumulates quietly behind a reputation for being a bit forgetful, a bit unsteady, a bit difficult.
The number Ireland publishes, and the number it does not
In the Winter 2025 issue of Drugnet Ireland, the Health Research Board published the only national count of ARBI we have. Using Hospital In-Patient Enquiry data and three diagnosis codes, it found a mean of 314 ARBI hospitalisations a year between 2015 and 2023. The highest year was 2016, with 346. The lowest was 2023, with 289. Such hospitalisations were consistently more than twice as common among men.
Because ARBI is difficult to diagnose and easily missed, the HRB also ran a looser proxy analysis, counting discharges where a brain injury code and an alcohol-related code both appeared on the same record. That produced a mean of 969 discharges a year, peaking at 1,164 in 2017, and falling 15.6 per cent across the period.
Read the article closely and something is missing. The figures are broken down by year. They are broken down by sex. They are not broken down by age, anywhere. The HRB is scrupulous about the reason for the wider limitation: HIPE counts episodes of care rather than people, and the records carry no individual health identifier, so it is not possible to establish incidence at all. But the absence of an age split is not a technical impossibility. It is simply not reported.
So for the question a family actually has, which is roughly “how common is this in people my mother’s age”, Ireland’s national dataset is silent.
The prevalence estimate is in worse shape. The figure that circulates in Irish policy discussion is that ARBI affects somewhere between 18,200 and 128,000 people here. That range comes from the Alcohol Forum’s Alcohol-Related Brain Injury: A Guide for Professionals, and two things are worth knowing about it. The first is that the guide carries a copyright line of January 2015, so the estimate is eleven years old. The second is that the same document prints the range twice, in two different forms: 18,200 to 128,000 on one page, and 18,320 to 128,240 on another. It is extrapolated from international autopsy studies, not from Irish measurement. A range that spans a factor of seven, derived from other countries’ post-mortems, is what Ireland currently has in place of a count.
The one age group where Irish drinking is going up
Here is where this stops being an abstract data problem.
The Healthy Ireland Survey 2025, published in November 2025, is the most recent national picture of how Ireland drinks. The headline is a good-news story: 71 per cent of people aged 15 and over drank in the previous 12 months, down from 73 per cent in 2024 and 76 per cent in 2015. Weekly drinking is down. Drinking multiple times a week is down, from 24 per cent to 20 per cent.
Then you open the age table.
Drinking multiple times a week fell in almost every band since 2015. It fell 9 points among people aged 25 to 34, 10 points among those aged 35 to 44, 6 points among those aged 45 to 54, and 2 points among those aged 55 to 64. It was unchanged among 15 to 24 year olds and among 65 to 74 year olds.
There is exactly one age group where it rose. Among people aged 75 and over, drinking multiple times a week went from 19 per cent in 2015 to 24 per cent in 2025, an increase of 5 points. The same group is the only one where drinking at all in the past 12 months rose, from 53 per cent to 57 per cent.
Break it down by sex and the picture sharpens further. Among men aged 75 and over, drinking multiple times a week went from 26 per cent to 32 per cent, a 6-point rise, and the proportion who drank at all rose 5 points. Among women aged 55 to 64, both measures rose. And on binge drinking, the survey states it directly: men aged 65 to 74 saw the largest increase of any male age group since 2015, from 28 per cent to 31 per cent.
None of this makes anyone an alcoholic, and it is not meant to. The point is narrower and more awkward. The pattern of drinking that produces ARBI is heavy use sustained over decades combined with poor nutrition, and the demographic in which Ireland’s drinking is holding steady or rising is the one that has had the most decades to accumulate it. That is also the demographic whose memory problems get attributed to age.
Why it gets mistaken for dementia
The HSE publishes a page called “Alcohol and older adults”, and it contains a list of signs that drinking is causing harm to an older person. Read it with a dementia assessment in mind: problems sleeping, problems with memory, thinking or concentration, frequent falls and unexplained bruising, low mood or anxiety, incontinence, poor hygiene and self-neglect, changes in eating habits, confusion, tremors and poor coordination.
Almost every item on that list would also appear on a checklist for early dementia, for vitamin B12 deficiency, or in a falls assessment. The HSE acknowledges the overlap in the same breath, noting that it can be easy to miss the signs that alcohol is causing harm because “you may mistake them for other problems”.
There is a second reason the diagnosis gets missed, and it is about embarrassment. Families do not always volunteer the drinking. Older adults do not always disclose it. The HSE’s list of common reasons an older person drinks is a quietly devastating piece of writing: trying to cope with loss or grief, with the loss of a career or social status, with isolation, loneliness and boredom, with getting older, with losing independence or self-esteem, with caring for someone else, with moving into residential care. These are not the circumstances in which people are forthcoming about units per week.
The practical consequence is that the one piece of history that would change the diagnosis, and the treatment, is the piece least likely to be offered.
The part that matters most: it can get better
This is the detail that justifies the whole conversation, and it is the detail most people do not know.
The Mental Welfare Commission for Scotland, which has examined this more closely than any equivalent body in Ireland, states it directly in its September 2021 report: if a person with alcohol-related brain damage stops drinking and receives good support, “they may be able to make a partial or even full recovery”. They may regain much of their memory and thinking skills, and much of their ability to manage independently. The Commission draws the conclusion explicitly, because clinicians get it wrong: alcohol-related brain damage “does not, therefore, always get worse over time”.
The Alcohol Forum puts a figure on it. Over 75 per cent of people with ARBI can recover to some degree. Spotting it early and getting the right treatment improves those odds.
The HSE says the same thing in gentler language on its page about alcohol and the brain: even after heavy drinking over a long period, the body begins to repair itself as soon as you stop, and if you stop and stay stopped, the brain “may recover or make improvements over time”.
Where Irish care currently falls down
Two gaps are worth naming honestly.
The first is acute treatment. A scoping review published in Addiction Science and Clinical Practice on 1 October 2026 mapped how Wernicke encephalopathy is diagnosed and managed internationally. Its opening description of the condition is the one to hold on to: “a potentially reversible neurological emergency that remains frequently missed and undertreated”. Across 26 included studies the authors found only two randomised controlled trials of thiamine regimens, no consensus on dosing, wildly inconsistent use of formal diagnostic criteria, and undertreatment reported consistently, including delayed starts and “frequent use of oral thiamine in high-risk scenarios”. Oral thiamine is not reliably absorbed in someone drinking heavily. That is the entire reason injected thiamine exists. Where care was protocolised, treatment started earlier and the right form was used more often.
The second gap is what happens afterwards. The Alcohol Forum states it without hedging: “There is no lead service for people affected by Alcohol-Related Brain Injury in Ireland.” People with ARBI have limited or no access to standard disability or mental health services, because the condition does not sit neatly inside either remit. The absence of a care pathway has consequences the Forum describes from experience: people blocked in hospital beds for want of community support, or sent home before they are ready.
Scotland offers a useful mirror rather than a scolding, because Scotland has not solved this either. Its Mental Welfare Commission visited 50 people with ARBD under guardianship in 2021 and found 70 per cent living in care homes, and 52 per cent of the sample, 26 people, aged under 65, the youngest in their thirties. Only one of those care homes was registered as a specialist service for brain damage including alcohol-related brain damage. The Commission’s first recommendation was that partnerships should commission “suitable, age appropriate and where possible specialist ARBD services”, and it raised, bluntly, whether placing someone in a setting they would never choose breaches their human rights.
That finding cuts in two directions for an Irish reader. It is a warning about what happens without a pathway. It is also a reminder that ARBI is not only a condition of later life, which is precisely why older adults who have it are the ones most likely to be quietly reclassified as having dementia.
One more detail is worth noticing. Ireland’s own prescribed alcohol health warnings, set out in the Public Health (Alcohol) (Labelling) Regulations 2023, name two harms: “Drinking alcohol causes liver disease” and “There is a direct link between alcohol and fatal cancers”. Both are true and both are important. Neither of them mentions the brain.
What to do if this sounds familiar
If you are reading this about someone you love, a few things are genuinely actionable.
Treat the acute signs as an emergency. Unsteady or wide-based walking, eyes flicking from side to side, and sudden confusion in someone who drinks heavily is not a GP appointment next week. The HSE’s instruction is to call 112 or 999 or go to an emergency department. Wernicke encephalopathy is the stage at which this is most reversible, and the window is short.
Say the word “alcohol” out loud to the doctor. This is the single most useful thing a family member can do, and the hardest. A clinician assessing memory loss in a 74-year-old will reach a very different decision tree if drinking history is on the table. Describe what you have noticed, how it developed over time, and how it differs from how the person usually is.
Ask specifically about thiamine. It is reasonable to ask whether thiamine has been considered and, if there is any suspicion of Wernicke encephalopathy, whether it should be given by injection rather than by tablet. The evidence on undertreatment is strong enough that the question is fair.
Do not accept “it is just their age” as a conclusion. Not because it is never true, but because the alternative is treatable and the default assumption is not.
Get hold of the guides. The Alcohol Forum publishes free ARBI guides for families and for professionals, and runs a specialist case coordination service that links people with ARBI to the supports they need. Given that there is no lead service in Ireland, this is a genuinely important door to know about. The Forum is based in Letterkenny, County Donegal, and works nationally.
Know that stopping helps at any age. The HSE’s position is that it is never too late to cut back or stop, and that health benefits usually begin within weeks. For the brain specifically, abstinence is not merely damage limitation. It is the treatment.
A final thought
The statistics matter because they shape what gets looked for. A national count that does not report age cannot tell a clinician this is worth considering in a 76-year-old, and a prevalence estimate extrapolated from other countries’ autopsies in 2015 cannot tell a service planner how many people need a pathway that does not exist.
But the thing worth carrying away is smaller and more hopeful than any of that. Among the conditions that take memory from older adults, this is one of the few that can give some of it back. It requires someone to think of it, name it, and treat it quickly. In Ireland, that someone is quite often a family member who read about it first.
At Críonna Health we write about ageing because the details matter, and because the difference between a condition that progresses and a condition that reverses is the kind of detail that changes a life. If memory, balance or confusion are worrying you about someone close to you, talk to a GP, and do not leave drinking out of the conversation. You can also read our guides to understanding dementia and to how alcohol affects the body after 50.
Sources: Doyle A, “Alcohol-related brain injury hospitalisations, 2015 to 2023”, Drugnet Ireland Issue 90, Health Research Board, Winter 2025; Healthy Ireland Survey 2025 Summary Report, Department of Health, November 2025; “Undertreatment of Wernicke encephalopathy in alcohol-related clinical contexts: a scoping review”, Addiction Science and Clinical Practice, 1 October 2026; HSE, “How alcohol affects the brain” and “Alcohol and older adults”; Alcohol Forum Ireland, “Alcohol-Related Brain Injury: A Guide for Professionals”, January 2015, and its ARBI service pages; Mental Welfare Commission for Scotland, “Care and treatment for people with alcohol related brain damage in Scotland”, September 2021; S.I. No. 249 of 2023, Public Health (Alcohol) (Labelling) Regulations 2023.
This article is for general information and is not a substitute for individual medical advice. If you are concerned about your own drinking or someone else’s, speak to your GP or contact the HSE drugs and alcohol helpline.
📷 Photo by bahareh moradian on Unsplash
