- Chronic heavy drinking leads to serious risk of dementia, study warns
- The Surprising Truth About How Alcohol Affects Your Dementia Risk
- Heavy Alcohol Use May Triple Dementia Risk
- Alcohol is the number one modifiable risk factor for dementia
- Primary exposure
- Discharge diagnosis
- Primary outcome
- Excessive alcohol use linked to early-onset dementia risk
- How alcohol might damage the brain
- Results differed by sex
- Largest study of its kind finds alcohol use biggest risk factor for dementia
- Medscape Log In
Chronic heavy drinking leads to serious risk of dementia, study warns
Heavy drinkers are putting themselves at risk of dementia, according to the largest study of its kind ever conducted.
Research published in the Lancet Public Health journal provides powerful evidence that people who drink enough to end up in hospital are putting themselves at serious risk of vascular dementia and Alzheimer’s disease. It will also raise questions for moderate drinkers about the possible long-term consequences of their social habit.
The study, which used the French National Hospital Discharge database, looked at more than a million people diagnosed with dementia between 2008 and 2013.
More than a third – 38% of the 57,000 cases of early-onset dementia – were directly alcohol-related and 18% had an additional diagnosis of alcohol use disorders. Overall, alcohol use disorders were associated with a three times greater risk of all types of dementia.
Dr Sara Imarisio, head of research at Alzheimer’s Research UK, said: “As this study only looked at the people who had been admitted to hospital due to chronic heavy drinking, it doesn’t reveal the full extent of the link between alcohol use and dementia risk. Previous research has indicated that even moderate drinking may have a negative impact on brain health and people shouldn’t be under the impression that only drinking to the point of hospitalisation carries a risk.”
Experts said the new research should change attitudes. “What is most surprising about this paper is that it has taken us so long to recognise that alcohol misuse and dependence are such potent risk factors for the development of dementia,” said Robert Howard, professor of old age psychiatry at University College London.
“We have long known that alcohol is directly neurotoxic, thiamine deficiency in alcoholics devastates memory, alcohol-related conditions such as cirrhosis and epilepsy can damage the brain and that vascular brain damage is accelerated by alcohol. Surprisingly, we’ve not traditionally considered alcohol and its misuse as an important risk factor for dementia and we were clearly wrong not to have done so.”
The study was not set up to look at the effects of moderate drinking on people’s dementia risk. But the lead author, Dr Michaël Schwarzinger of the Translational Health Economics Network in France, warned that the research showed damage done to the brain by alcohol is never repaired.
Heavy drinkers who had given up alcohol for a time did not reduce their dementia risk, even though they were less ly to die early.
“It is very striking that for people who were heavy drinkers and had at least a period of abstinence, the level of risk of dementia is about the same,” he told the Guardian.
That is in line with imaging studies that have shown even moderate drinking has a permanent effect. A study published in the British Medical Journal last year found that those who drank 14-21 units a week had three times the normal odds of damage to that part of the brain concerned with memory. Guidance in the UK is not to drink more than 14 units a week.
Advice on alcohol and dementia has been confusing. Some studies have suggested that one or two units a day – perhaps a small glass of wine – could be protective. But Schwarzinger said they were small studies and he personally would question whether that can be so.
“Alcohol is a devastating problem, whatever the organ. Now we can add the brain to the list of liver, kidney and heart,” he said.
“A variety of measures are needed, such as reducing availability, increasing taxation, and banning advertising and marketing of alcohol, alongside early detection and treatment of alcohol use disorders.”
Prof Clive Ballard of the University of Exeter Medical School, UK, writing a commentary for the journal, said: “Their study is immensely important and highlights the potential of alcohol use disorders, and possibly alcohol consumption, as modifiable risk factors for dementia prevention … In our view, this evidence is robust and we should move forward with clear public health messages about the relationship between both alcohol use disorders and alcohol consumption, respectively, and dementia.”
Dr James Nicholls, director of policy and research development at Alcohol Research UK, said the concerns raised by the study were very serious.
“If heavy alcohol use increases the risk of dementia then there are enormous social and economic implications,” he said.
“We must recognise that good quality, widely accessible alcohol treatment has important long-term benefits, including reducing the levels of dementia in society. And we must invest in these services, reversing the trend of recent years.”
“,”author”:”Sarah Boseley Health editor”,”date_published”:”2018-02-20T23:30:07.000Z”,”lead_image_url”:”https://i.guim.co.uk/img/media/904f7eeaa7eab9466bb239312b422a98624bb209/112_350_4634_2781/master/4634.jpg?width=1200&height=630&quality=85&auto=format&fit=crop&overlay-align=bottom%2Cleft&overlay-width=100p&overlay-base64=L2ltZy9zdGF0aWMvb3ZlcmxheXMvdGctYWdlLTIwMTgucG5n&enable=upscale&s=b8f32296f71b57defa826dc1bc543feb”,”dek”:null,”next_page_url”:null,”url”:”https://www.theguardian.com/society/2018/feb/20/chronic-heavy-drinking-leads-to-serious-risk-of-dementia-study-warns”,”domain”:”www.theguardian.com”,”excerpt”:”Questions also raised for moderate drinkers of alcohol about their social habit”,”word_count”:752,”direction”:”ltr”,”total_pages”:1,”rendered_pages”:1}
The Surprising Truth About How Alcohol Affects Your Dementia Risk
Alcohol drinks are frequently cited in medical news, both for their benefits as well as for the harm that alcohol misuse and addiction causes. So, what do those reports say about your mind on alcohol? Does alcohol impact the functioning of your brain? Does it affect your risk of developing Alzheimer's disease?
In a word, yes. But how? The answer depends on several factors, but two of the more researched factors include the amount of alcohol consumed and whether someone is an APOE ε4 gene carrier.
Multiple research and observational studies have demonstrated that people who drink high amounts of alcohol are at an increased risk of developing dementia. Alcohol-related brain damage may account for approximately 10% of all dementia cases.
Cognitive impairments among excessive alcohol drinkers include:
These cognitive impairments may develop over time, but alcohol can also cause immediate memory loss, known as blackouts.
According to one study conducted on the risk factors for younger-onset dementia, alcohol intoxication as a late teenager is one of the highest predictors of men who will develop it. Additionally, a second study found that 57% of young-onset dementia was related to chronic heavy alcohol use.
Moderate alcohol drinking is classified as drinking one alcoholic drink a day for women and two a day for men. Light drinking describes those who drink less than moderate drinkers but more than those who totally abstain from alcohol.
In a study that involved over 3000 adults over the age of 75, light to moderate drinking was associated with a 42% lower risk of Alzheimer's disease and a 29% lower risk of all types of dementia.
One study found that among women who were over the age of 90, a decrease in alcohol consumption was associated with an increase in the development of mild cognitive impairment and dementia.
Another study considered how alcohol consumption affected people with a diagnosis of mild cognitive impairment (MCI). (MCI sometimes, but not always, progresses to dementia.
) This study demonstrated that light to moderate alcohol consumption was associated with a decreased chance of mild cognitive impairment progressing into full dementia.
Participants who never drank alcohol had a higher chance of developing dementia than those who were light to moderate drinkers, while heavy drinkers were the most ly to progress to dementia.
Of interest, researchers in one study identified the participants who were APOE-ε4 carriers and those who did not carry this gene. (APOE-ε4 is a gene that is associated with an increased risk of Alzheimer's disease.
) Study participants who were light to moderate alcohol drinkers and who carried the APOE-ε4 gene were at an increased risk of cognitive decline and memory loss, while light to moderate drinkers who did not carry the APOE-ε4 gene demonstrated improved learning ability and memory.
It depends on whom you ask. Research has come to different conclusions about this question. Multiple studies have cited wine as specifically having protective effects on people's memory and cognitive ability. Other studies, however, have concluded that wine, beer, and liquor all have similar effects on cognition.
There are some people that should not drink alcohol.
This group includes but is not limited to alcoholics, people with Wernicke-Korakoff syndrome, those taking certain medications that could negatively interact with alcohol, people with certain medical conditions such as liver disease and pancreatitis, those who are under the legal age to drink, women who are (or are attempting to become) pregnant and those who are operating a vehicle or performing other complex tasks.
Other studies have found that drinking alcohol has other health risks; thus, your decision to drink alcohol should be discussed with your doctor.
For many people, research suggests that light to moderate drinking of alcohol seems to have a protective benefit on dementia risk. However, it's important to remember that alcohol use can lead to dependence and abuse, so caution is warranted.
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- Dementia Collaborative Research Center. Your Brain Matters. Alcohol- Evidence.
- Downer B, Zanjani F, Fardo DW. The relationship between midlife and late life alcohol consumption, APOE e4 and the decline in learning and memory among older adults. Alcohol Alcohol. 2014;49(1):17-22. doi:10.1093/alcalc/agt144
- Hoang TD, Byers AL, Barnes DE, Yaffe K. Alcohol consumption patterns and cognitive impairment in older women. Am J Geriatr Psychiatry. 2014;22(12):1663-7.
- Michaël Schwarzinger, Bruce G Pollock, Omer S M Hasan, Carole Dufouil, Prof Jürgen Rehm, QalyDays Study Group.Contribution of alcohol use disorders to the burden of dementia in France 2008–13: a nationwide retrospective cohort study.The Lancet Public Health, 2018;3(3). doi:10.1016/S2468-2667(18)30022-7
- Nordström P, Nordström A, Eriksson M, Wahlund LO, Gustafson Y. Risk factors in late adolescence for young-onset dementia in men: a nationwide cohort study. JAMA Intern Med. 2013;173(17):1612-8.
- Weyerer S, Schäufele M, Wiese B, et al. Current alcohol consumption and its relationship to incident dementia: results from a 3-year follow-up study among primary care attenders aged 75 years and older. Age Ageing. 2011;40(4):456-63. doi:10.1093/ageing/afr007
- Xu G, Liu X, Yin Q, Zhu W, Zhang R, Fan X. Alcohol consumption and transition of mild cognitive impairment to dementia. Psychiatry Clin Neurosci. 2009;63(1):43-9.
Heavy Alcohol Use May Triple Dementia Risk
LOS ANGELES — Older female veterans who have alcohol use disorder (AUD) are at a threefold increased risk of developing dementia compared to their counterparts without AUD, new research shows.
Although AUD is a growing concern in all veterans, it has been unclear if this disorder raises dementia risk in female veterans.
Dr Amber Bahorik
“Nobody has looked at this before. Female veterans are a unique group because they are increasing in numbers, and it is a population that is getting older,” study investigator Amber L. Bahorik, PhD, research project coordinator in psychiatry, University of California, San Francisco (UCSF), told Medscape Medical News.
The results have implications for screening and prevention, she added.
The findings were presented here at the Alzheimer's Association International Conference (AAIC) 2019.
Research shows that the impact of alcohol consumption on the risk for various diseases depends on the amount consumed. For example, statistically, alcohol consumption has a J-shaped effect on the relative risk for heart disease, stroke, and diabetes. Moderate consumption reduces risk, and excess use markedly increases risk.
The same may apply to the effects of alcohol consumption regarding dementia.
“If you drink moderately, that might have a protective effect on dementia risk, but excessive alcohol consumption might have a bad effect — although this area is controversial,” said Bahorik.
The study included 2207 women aged 55 years or older (mean age, 60 years) who had current AUD and 2207 age-matched control persons who did not have AUD. The participants attended Veterans Affairs (VA) centers in the United States from October 2004 to September 2015.
AUD was diagnosed using the International Classification of Diseases 9th Revision Clinical Modification Codes (ICD-9). The condition, which is defined as a problematic pattern of drinking accompanied by clinical impairment or distress, is a growing concern among older veterans, especially women.
Hazardous drinking has a “slightly lower threshold,” said Bahorik. Women who consume more than four alcoholic drinks per day “would be flagged as a hazardous or problematic drinker.” For men, the threshold is more than five drinks per day, she said.
The outcome of the study was incident dementia diagnosed using ICD-9 codes during 7 years of follow-up.
The study showed that female veterans with AUD were more than three times more ly to develop dementia than female veterans who did not have AUD (hazard ratio, 3.06; 95% confidence interval, 1.83 – 5.13).
The findings were adjusted for demographics as well as for depression, anxiety, posttraumatic stress disorder, smoking, hypertension, diabetes, stroke, chronic obstructive pulmonary disease, and traumatic brain injury.
Bahorik presented data that showed that women veterans with AUD developed dementia at a faster rate than those without AUD.
Other research has found that the rate of AUD is higher in male veterans than in female veterans. “I don't know what the dementia risk is in male vets with AUD, but presumably that would be higher, too,” said Bahorik.
It is important for clinicians to ask patients about their drinking habits as well as smoking and other unhealthy behaviors, the study's principal investigator, Kristine Yaffe, MD, professor of neurology, psychiatry, and epidemiology, UCSF, told Medscape Medical News.
“If you're concerned about someone having an alcohol use disorder or risky behavior, there are some pretty good treatment programs, particularly at the VA, so you can refer patients there,” she said.
Commenting on the study for Medscape Medical News, Heather Snyder, PhD, senior director of medical and scientific operations, the Alzheimer's Association, said the work is “interesting” and “very important” in that it investigated how behaviors or habits in “a defined population” of female veterans may influence later-life risk for dementia.
“To my knowledge, this is one of the first studies of its kind that we have seen in this specific population,” she said.
The results could help with targeting interventions, said Snyder.
Bahorik, Jaffe, and Snyder have disclosed no relevant financial relationships.
Alzheimer's Association International Conference (AAIC) 2019: Abstract 32612. Presented July 14, 2019.
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Cite this: Heavy Alcohol Use May Triple Dementia Risk – Medscape – Jul 18, 2019.
Alcohol is the number one modifiable risk factor for dementia
There is an ongoing interest in the relationship between alcohol use, cognitive health, and dementia specifically.
Previous research has presented inconsistent results with some evidence suggesting that light-to-moderate drinking has a positive effect on cognition, while moderate drinking can cause damage to brain structure (Rehm et al, 2017; Verbaten, 2009).
Heavy drinking, on the other hand, has been associated with functional brain damage caused by ethanol, thiamine deficiency and vascular problems (high blood pressure, stroke, heart failure).
Mental Elf blogger, Josephine Neale, blogged about the World Alzheimer’s Report on evidence for protective and risk factors for dementia (Neale, J. 2014). It was suggested that heavy or excessive drinkers had similar risks to non-drinkers and those who only drank wine had similar risks to non-drinkers. So surely, the French have nothing to worry about, right?
This blog summarises the findings of a recent retrospective study examining the association between alcohol use disorders and dementia risk, in a retrospective cohort in France between 2008 and 2013 (Schwarzinger et al, 2018).
Red wine is often portrayed in the media as the ‘healthy’ alcoholic drink, so surely, the French have nothing to worry about, right?
Data was extracted retrospectively from the French National Hospital Discharge database. This database included standardised discharge summaries of demographics, primary and associated discharge diagnoses using WHO ICD-10, medical procedures, length of stay and discharge modes.
The authors searched discharge summaries for all adults aged 20 or over living in metropolitan France who were discharged between 2008 and 2013. They applied exclusion criteria according to ICD-10 taxonomy.
- Individuals with diseases leading to rare types of dementia (F02): infectious diseases, HIV/AIDS, hereditary metabolic disorders, hereditary neurological disorders such as Huntington’s disease, other neurological disorders such as Parkinson’s disease and systemic connective tissue disorders
- Individuals with early-life mental disorders, that could increase or confound dementia diagnosis: cerebral palsy, Down’s syndrome, learning disabilities and schizophrenia. (A full coding dictionary was included in the appendices).
Alcohol use disorders defined, using ICD-10, as the chronic and harmful use of alcohol or alcohol dependence.
Two categories of discharge diagnosis (applying ICD-10 codes):
- Mental and behavioral disorders due to former or current chronic harmful use of alcohol including alcohol abstinence
- Chronic disease attributable to alcohol use disorders (Wernicke-Korsakoff syndrome, end stage liver disease and other forms of liver cirrhosis, epilepsy and head injury).
Dementia, defined by any primary or associated discharge diagnosis (ICD-10) codes labelling dementia or related to dementia.
Dementia onset was reported as the age at first dementia diagnosis between 2008 and 2013. Diagnoses made before age 65 were classified at early-onset diagnosis.
Dementia onset was separated into three categories:
- Alcohol-related brain damage
- Vascular dementia
- Other dementia including Alzheimer Disease.
Other risk factors extracted from the database included vascular risk factors (tobacco, smoking, obesity, high blood pressure, hyperlipidemia and diabetes), cardiovascular risk factors (hemorrhagic stroke, ischaemic stroke, history of stroke, history of IA and CC disease.), depression and hearing loss.
Other diseases (i.e. visual impairment, sleep apnoea) that might lead to rare cases of dementia were also controlled for.
Educational level was estimated using 5645 postal codes of residency as a proxy of educational level for each geographical area.
- 31.6 million adults were discharged from French hospitals during 2008-2013. Approximately 1 million (3.4%) were excluded exclusion criteria noted above
- 1.1 million adults included in the study had a diagnosis of dementia of which 64.9% were women. This proportion was different for the early onset (aged
Excessive alcohol use linked to early-onset dementia risk
- Research involved more than 1 million adult patients released from hospitals in France
- Alcohol abuse was also associated with vascular risk factors, including high blood pressure
(CNN)Excessive alcohol use could increase your risk for all types of dementia, particularly early-onset dementia, according to a new study.
The study, published Tuesday in the journal Lancet Public Health, looked at over 1 million adults released from French hospitals between 2008 and 2013 who were diagnosed with dementia, a clinical syndrome characterized by a progressive deterioration in cognitive ability.
Using data from the French National Hospital Discharge database, the researchers found that alcohol-use disorders were diagnosed in 16.5% of the men with dementia and 4% of the women with dementia — over twice as much as in those without dementia for both sexes.
Alcohol-use disorders refer to “the chronic harmful use of alcohol or alcohol dependence,” the researchers wrote.
In order to isolate the role of alcohol use, patients with neurological disorders such as Parkinson's and Huntington's, which can also lead to dementia, were excluded from the study.
“The most novel result is the large contribution of alcohol-use disorders to the burden of dementia over the lifespan,” said Dr. Michael Schwarzinger, a researcher at the Transitional Health Economics Network in Paris and a leading author of the study.
The association was particularly strong for those with early-onset dementia, diagnosed when the patient is younger than 65. Over half of the individuals in the early-onset group had alcohol-related dementia or an additional diagnosis of alcohol-use disorder.
“Given the strength of the association, what is the most surprising to me is that alcohol-use disorders had received so little interest in dementia research and public health policies,” Schwarzinger said.
How alcohol might damage the brain
Although many studies have shown a strong association between excessive alcohol use and dementia, this study is unique in its findings about early-onset dementia, according to Dr. Kostas Lyketsos, a neuropsychiatry professor and director of the Johns Hopkins Memory and Alzheimer's Treatment Center who was not involved in the study.
“That is rather unique,” Lyketsos said. “It does remind us that alcoholics have shorter life expectancies.”
The study was also among the largest of its kind. But, according to Lyketsos, the large size could leave the study open to selection bias.
“There's a tradeoff between size and precision of the variables,” he said. “The more people you have, the less confidence you have in the elements that go into the diagnosis of dementia.
“I also want to point out that this was really a sample of hospitalized individuals. It's very unusual for people with dementia, at least in the milder stages, to be hospitalized,” he added.
Researchsuggests multiple ways heavy alcohol use can lead to dementia. First, ethanol and its byproduct acetaldehyde are known to have a toxic effect on the brain that can lead to long-term structural and functional brain damage, Schwarzinger says.
Heavy alcohol use can also lead to a condition called hepatic encephalopathy, characterized by a loss in brain function due to increases of ammonia in the blood caused by liver damage.
“Heavy drinking is also strongly associated with vascular risk factors such as high blood pressure or diabetes mellitus as well as cardiovascular diseases,” Schwarzinger added.
“Lastly, heavy drinking clusters (in) people with less education, smoking habits, and/or depression. All of these factors were found to be independent risk factors for dementia onset.”
Though heavy alcohol use increased the risk of dementia in general, the association was shown to be stronger in men.
When other factors were not controlled for, heavy drinking was associated with a higher risk of dementia among both men and women. In men, the risk was increased by a factor of 4.7, while in women, it increased by a factor of 4.3.
But even when the researchers controlled for factors high blood pressure, obesity and tobacco smoking, heavy alcohol use was still associated with a more than threefold increase in dementia among both sexes.
Results differed by sex
The study also showed that the average age of dementia onset differed between men and women. Men were more ly to develop it a younger age and women at an older age.
“Gender differences on dementia onset have been puzzling for decades,” Schwarzinger said. “Men have a poorer lifestyle than women on average, in particular heavier alcohol consumption. Therefore, it is somewhat unsurprising that early-onset dementia identifies a cluster of men with alcohol use disorders.”
The gender difference could also result from the study's methodology, according to Lyketsos.
“That was one of the reasons I'm a little concerned about selection bias,” he said. “There could be a gender effect on who goes to the hospital with dementia.”
Alcohol use was also not objectively measured in the participants, one of the study's main limitations.
“We have no idea what is the level of drinks they were actually drinking,” Schwarzinger added. “That kind of information you can only get in a cohort study with a questionnaire.”
Though the study had a very large sample size, it looked at individuals in only one country, making it difficult to generalize across cultures. According to a 2014 report from the World Health Organization, each person consumes an average of 12.2 liters of pure alcohol in France versus 9.2 liters in the United States.
But Schwarzinger cautioned that people outside France should still take the findings seriously: “While the rate of alcohol use disorders is lower in the USA, it remains substantial enough to be considered major risk factor for dementia onset.”
Correction: A previous version of this story misstated the title of Dr. Kostas Lyketsos. He is a professor of neuropsychiatry.
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Largest study of its kind finds alcohol use biggest risk factor for dementia
Alcohol use disorders are the most important preventable risk factors for the onset of all types of dementia, especially early-onset dementia. This according to a nationwide observational study, published in The Lancet Public Health journal, of over one million adults diagnosed with dementia in France.
This study looked specifically at the effect of alcohol use disorders, and included people who had been diagnosed with mental and behavioural disorders or chronic diseases that were attributable to chronic harmful use of alcohol.
Of the 57,000 cases of early-onset dementia (before the age of 65), the majority (57%) were related to chronic heavy drinking.
The World Health Organization (WHO) defines chronic heavy drinking as consuming more than 60 grams pure alcohol on average per day for men (4-5 Canadian standard drinks) and 40 grams (about 3 standard drinks) per day for women.
As a result of the strong association found in this study, the authors suggest that screening, brief interventions for heavy drinking, and treatment for alcohol use disorders should be implemented to reduce the alcohol-attributable burden of dementia.
“The findings indicate that heavy drinking and alcohol use disorders are the most important risk factors for dementia, and especially important for those types of dementia which start before age 65, and which lead to premature deaths,” says study co-author and Director of the CAMH Institute for Mental Health Policy Research Dr. Jürgen Rehm. “Alcohol-induced brain damage and dementia are preventable, and known-effective preventive and policy measures can make a dent into premature dementia deaths.”
Dr. Rehm points out that on average, alcohol use disorders shorten life expectancy by more than 20 years, and dementia is one of the leading causes of death for these people.
For early-onset dementia, there was a significant gender split. While the overall majority of dementia patients were women, almost two-thirds of all early-onset dementia patients (64.9%) were men.
Alcohol use disorders were also associated with all other independent risk factors for dementia onset, such as tobacco smoking, high blood pressure, diabetes, lower education, depression, and hearing loss, among modifiable risk factors. It suggests that alcohol use disorders may contribute in many ways to the risk of dementia.
“As a geriatric psychiatrist, I frequently see the effects of alcohol use disorder on dementia, when unfortunately alcohol treatment interventions may be too late to improve cognition,” says CAMH Vice-President of Research Dr. Bruce Pollock.
“Screening for and reduction of problem drinking, and treatment for alcohol use disorders need to start much earlier in primary care.” The authors also noted that only the most severe cases of alcohol use disorder — ones involving hospitalization — were included in the study.
This could mean that, because of ongoing stigma regarding the reporting of alcohol-use disorders, the association between chronic heavy drinking and dementia may be even stronger.
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