Alcohol-related brain injury: An unrecognized problem in acute medicine

Alcohol-related brain injury (ARBI) is an unrecognized and therefore untreated consequence of alcohol use disorder. Here, we explore a 12-month period prevalence of alcohol-related brain injury (ARBI) in alcohol use disorder patients. Inpatients aged ≥18 years reviewed by the Alcohol Care Team's Specialist Nurses between April 1, 2017 and March 31, 2018 were eligible for the study (n = 1276). Screening identified a high-risk subset of patients who matched at least one of the following: 1) more than three alcohol-related admissions in one year; 2) two alcohol-related admissions in any given 30-day period; 3) patient or their significant other had concerns regarding cognition. The high-risk patients were assessed for evidence of ARBI using the Montreal Cognitive Assessment Tool (MoCA). The primary measure of interest was MoCA ≤23. Analysis was conducted between subgroups of the study population to identify prevalence rate ratios for matching the high-risk screening criteria, and MoCA ≤23 in high-risk patients. Two hundred and five patients were identified as high risk for ARBI. The period prevalence rates in this high-risk group for patients with a MoCA ≤23 was 36.1%. Those under the age of 35 years were significantly less likely to match the high-risk criteria. Patients that were homeless or staying in hostels were more likely to match the high-risk criteria and were also at increased risk of MoCA ≤23, compared with those living with family members. In summary, ARBI is common in patients with AUD attending acute hospitals. ARBI is often not diagnosed, and thus further work is required to improve screening for, and identification of, these patients to develop evidence-based clinical pathways that optimize care.