A-86: Auto Brewery Syndrome Vs. Neurodegenerative Disease Case Study

Abstract

Objective: Objective: Auto-brewery syndrome (ABS) is an extremely rare (~100 cases) and likely underdiagnosed condition characterized by the microbial fermentation of carbohydrates in the gastrointestinal tracts, resulting in endogenous production of ethanol in the absence of alcohol consumption. Patients present as drunk especially after high carbohydrate meals. Risk factors include use of antibiotics, gastric issues, diabetes, liver disease, and high carbohydrate diet. Diagnosis is often made based carbohydrate challenge and fecal analysis. Treatment involves a restricted carbohydrate diet, alcohol cessation, antifungal treatment, and/or antimicrobial therapy with resistant cases requiring fecal microbiota transplant. The neuropsychological profile of ABS remains poorly characterized and thus we present the cognitive profile of a gentleman with suspected ABS. Method/Data Selection: Method: Retrospective review of the neuropsychological report. Results/Data Synthesis: Results: 78-year-old brilliant man (SS=128) with hypertension, diabetes and gastric problems followed by a 3-year history of multiple ER visits due to abrupt onset of cognitive and motor changes with work up revealing elevated alcohol levels out of proportion to alcohol consumption. This was followed by poor compliance with low carb diet and alcohol cessation. 2025 fecal transplant done with no further episodes 2026 MRI noted progressive neurovascular disease. Amyloid PET and P-tau negative. MOCA=18/30. Assessment revealed impaired learning, memory, semantic fluency, and executive deficits. Conclusions: Conclusion: The patient demonstrated notable learning, memory, executive and semantic fluency deficits yet negative biomarkers. ABS vs other degenerative disease will be discussed. Neuropsychologists should be familiar with this disorder given the high societal and at times legal issues.