Alcohol intake in the elderly affects risk of cognitive decline and dementia

Alzheimer's disease (AD) and other types of dementia are most common in the very elderly, and are associated with huge health costs. With a rapidly ageing population throughout the world, factors that affect the risk of cognitive decline and dementia are of great importance. A review paper by Kim JW et al published in Psychiatry Investig 2012;9:8-16 on the association between alcohol consumption and cognition in the elderly provides an excellent summary of the potential ways in which alcohol may affect cognitive function and the risk of dementia, both adversely and favourably as alcohol may have both a neuro toxic and neuro protective effect, depending on the dose and drinking pattern. Longitudinal and brain imaging studies in the elderly show that excessive alcohol consumption may increase the risk of cognitive dysfunction and dementia, but regular low to moderate alcohol intake may protect against cognitive decline and dementia and provide cardiovascular benefits.

Studies published from 1971 to 2011 related to alcohol and cognition in the elderly were reviewed using a PubMed search. At present, there are no proven agents to prevent cognitive decline or dementia, although a number of prospective epidemiologic studies have shown a lower risk of such conditions among light to moderate drinkers in comparison with non-drinkers. Other studies have found that beneficial effects are seen only among certain sub-groups of subjects. A recent meta-analysis by Peters et al of subjects over the age of 65 in longitudinal studies concluded that light-to-moderate alcohol consumption, in comparison with abstinence, was associated with approximately 35-45% lower risk of cognitive decline or dementia.

This paper provides a summary of what is known about the mechanisms by which alcohol consumption, especially heavy drinking, can be neurotoxic, and how light-to-moderate drinking may help protect against cognitive decline and dementia. The authors state that their intent is to determine if there is an "optimal pattern of drinking" that may protect the elderly against such conditions.

At present, the mechanisms by which the moderate intake of wine and other alcoholic beverages reduces the risk of cardiovascular diseases are much better defined than they are for cognition. Forum members agree with the authors that further research is needed to evaluate a potential role that alcohol may play in reducing the risk of dementia.

Forum members also agree that, at present, the specific mechanisms of such putative protection are not well defined, and it would be premature to recommend light-to-moderate drinking for reducing the risk of dementia. On the other hand, current biomedical data supports the concept that regular, moderate intake of ethanol is not simply less dangerous for cognitive function, but is positively protective. This is the same conclusion reached by epidemiologic studies."

Reference: Kim JW, Lee DY, Lee BC, Jung MH, Kim H, Choi YS, Choi I-G. Alcohol and Cognition in the Elderly: A Review. Psychiatry Investig 2012;9:8-16;

On-line: http://dx.doi.org/10.4306/pi.2012.9.1.8

Comments on the present paper were provided by the following members of the International Scientific Forum on Alcohol Research:

Harvey Finkel, MD, Hematology/Oncology, Boston University Medical Center, Boston, MA, USA

Creina Stockley, MSc, MBA, Clinical Pharmacology, Health and Regulatory Information Manager, AWRI, Glen Osmond, South Australia, Australia

Andrew L. Waterhouse, PhD, Marvin Sands Professor, University of California, Davis; Davis, CA, USA

David Vauzour, PhD, Senior Research Associate, Department of Nutrition, Norwich Medical School, University of East Anglia, Norwich, UK

R. Curtis Ellison, MD, Section of Preventive Medicine & Epidemiology, Boston University School of Medicine, Boston, MA, USA

Erik Skovenborg, MD, Scandinavian Medical Alcohol Board, Practitioner, Aarhus, Denmark

Pierre-Louis Teissedre, PhD,, University Victor Segalen Bordeaux 2, Bordeaux, France

Arne Svilaas, MD, PhD, general practice and lipidology, Oslo University Hospital, Oslo, Norway

Fulvio Ursini, MD, Dept. of Biological Chemistry, University of Padova, Padova, Italy

For the detailed critique of this paper by the International Scientific Forum on Alcohol Research and a listing of references , go to http://www.bu.edu/alcohol-forum, click on http://www.bu.edu/alcohol-forum/critique-081-alcohol-intake-in-the-elderly-affects-risk-of-cognitive-decline-and-dementia-22-may-2012/

The specialists who are members of the Forum are happy to respond to questions from Health Editors regarding emerging research on alcohol and health and will offer an independent opinion in context with other research on the subject.

Critique 081: Alcohol intake in the elderly affects risk of cognitive decline and dementia -- 22 May 2012 Read the full critique here: http://www.bu.edu/alcohol-forum/critique-081-alcohol-intake-in-the-elderly-affects-risk-of-cognitive-decline-and-dementia-22-may-2012/

Contacts for Editors

Professor R Curtis Ellison:
ellison@bu.edu

Helena Conibear:
helena@alcohol-forum4profs.org
Tel: +44 1300 320665 or +44 7876 593 345