Can thiamine substitution restore cognitive function in alcohol use disorder?

Area of Science:

• Neuroscience
• Clinical Medicine
• Nutritional Psychiatry

Background:

• Thiamine deficiency is common and severe in alcohol use disorder (AUD).
• Evidence-based recommendations for thiamine substitution (TS) dosage, administration, and target levels are lacking.
• Clinical consequences of thiamine deficiency in AUD necessitate optimized treatment strategies.

Purpose of the Study:

• To compare the effects of two best-practice thiamine substitution (TS) regimens on thiamine pyrophosphate (TPP) blood levels.
• To evaluate the impact of TS on cognitive function in patients with AUD.
• To determine if preceding intravenous TS offers advantages over oral TS alone.

Main Methods:

• Fifty patients undergoing inpatient alcohol-withdrawal treatment were studied.
• Thiamine pyrophosphate (TPP) levels were measured at baseline and weeks 1, 2, and 8.
• Patients received either oral TS or intravenous followed by oral TS; cognitive function and depressive symptoms were assessed.

Main Results:

• All patients showed significant increases in TPP blood levels by weeks 1 and 2.
• No significant difference in TPP level increases was observed between the intravenous and oral TS groups.
• Improved cognitive function, particularly in memory tasks, was associated with the extent of TPP level response to TS.

Conclusions:

• Thiamine substitution (TS) improves cognitive function in patients with AUD, regardless of the administration regimen.
• Oral TS may be sufficient to prevent cognitive decline in AUD patients, especially when Wernicke-Korsakoff Syndrome is absent.
• This study supports the use of oral TS as an essential medication for managing cognitive deficits in AUD.