Brain has partial recovery of white matter volume and improved choline and NAA levels when alcoholics quit drinking early in illness.

Brain, Oxford University Press - As people embark on the festive season’s usual round of drinking they should spare a thought for the damage they are doing to their brains. In particular, new research has revealed that while the brain is able to recover from some of the damage caused by alcohol abuse, the longer alcoholics postpone sobriety the less likely their brains may be to regenerate.

The findings, published 18 December 2006 in the online edition of the journal Brain, used sophisticated scanning technology and computer software to measure how brain volume, form and function changed over six to seven weeks of abstinence from alcohol in 15 alcohol dependent patients (ten men, five women) who were otherwise healthy and free of psychotropic medications or excessive cigarette use.

The researchers from Germany, the UK, Switzerland and Italy measured the patients’ brain volume at the beginning of the study and again after about 38 days of sobriety, and they found that it had increased by an average of nearly two per cent during this time. In addition, levels of two chemicals, which are indicators for how well the brain’s nerve cells and nerve sheaths are constituted, rose significantly. The increase of the nerve cell marker NAA correlated with the patients performing better in a test of attention and concentration. Only one patient seemed to continue to lose some brain volume, and this was also the patient who had been an alcoholic for the longest time.

The leader of the research, Dr Andreas Bartsch from the University of Wuerzburg, Germany, said: “The core message from this study is that, for alcoholics, abstinence pays off and enables the brain to regain some substance and to perform better. However, our research also provides evidence that the longer you drink excessively, the more you risk losing this capacity for regeneration. Therefore, alcoholics must not put off the time when they decide to seek help and stop drinking; the sooner they do it, the better.”

The technology enabled the researchers to measure how levels of various chemicals, including N-acetylaspartate (NAA) and choline, changed between the two time points. NAA can indicate how intact the brain’s nerve cells are (i.e. it is a metabolic marker of neuronal integrity), while choline provides hints at how cell membranes are being broken down and repaired.

Dr Bartsch said: “After short-term sobriety of less than two months, we found that brain volume had increased by an average of nearly two per cent (1.82%), with a range of -0.19 to 4.32%. Only the one patient with the longest history of alcohol dependence (25 years) had a slightly reduced brain volume (-0.19%), but that value is within the margin of measurement error.

“In addition, on average across all the patients, cerebellar choline levels increased by about 20%, while levels of NAA in the cerebellar and frontal region of the brain and frontal choline significantly increased by about 10%. Brain volume regeneration correlated with the percentages increase in choline, indicating that volume regain is driven primarily by rising choline levels, while the more the NAA recovered, the better the patients performed on the test” for attention and concentration.

Dr Bartsch and his colleagues were confident that the increase in brain volume and form was not simply due to rehydration of the brain, as concentrations of choline and NAA increased even when water levels and other metabolites did not change significantly.

“Our results indicate that early brain recovery through abstinence does not simply reflect rehydration. Instead, the adult human brain, and particularly its white matter, seems to possess genuine capabilities for re-growth. Our findings show the ways that the brain can recover from the toxic insults of chronic alcoholism and substantiate the early measurable benefits of therapeutic sobriety. However, they also suggest that prolonged dependence on alcohol may limit rapid recovery from white matter brain injury.

In an accompanying commentary, Professor Graeme Mason wrote that the study was important not just because it unified several previously separate lines of research but because it might give doctors the tools to motivate their alcohol-dependent patients to stay sober.

“Doctors treating or studying alcoholism should be made aware of the research of Dr Bartsch because it may provide a motivational tool that is a broad set of concrete, tangible, and rapid benefits of sobriety: cognition, chemistry and brain volume,” wrote the associate professor of diagnostic radiology and psychiatry at Yale University. Professor Mason believed this was a particularly valuable contribution of the study because “patients often become discouraged from the physical and cognitive difficulties of achieving and maintaining sobriety.”

The paper “Manifestations of early brain recovery associated with abstinence from alcoholism” is available as a PDF download here:

Partial brain recovery from alcoholic damage possible with abstinence from alcohol.

Editorial note:  This study also supports the practice of many psychiatrists of delaying any definitive diagnoses of anxiety or depression (and delaying any prescribing of psychotropic medication except for acamprosate or detoxification medication) until an alcoholic patient has been sober at least 30 days.  We now see that after about a month of sobriety the alcohol dependent person can have a substantial improvement in neurologic biomarkers and brain growth that can correlate with improved cognitive status and a decrease in acute mood or anxiety symptoms, as long as the alcoholic continues to abstain from alcohol and embarks on the path of recovery (and brain regeneration!) - Dr. Z.