Alcohol and dementia among the elderly

December 16, 2001

For many people, enjoying a fine glass of wine with a well-prepared meal is one of life's simple pleasures. There is less agreement about alcohol's health merits, however, than there is about its gastronomical qualities. Considerable research has documented many potentially negative effects of alcohol consumption, yet more recent research has found that moderate alcohol consumption may have positive health benefits for cardiovascular and cerebrovascular functioning. A study in the December issue of Alcoholism: Clinical & Experimental Research assesses the association between alcohol consumption and cognitive function among elderly Italian patients.

"The prevalence of dementia increases with advancing age, becoming as high as 38 percent among subjects aged 85 years or older," explained Giuseppe Zuccalà, chair of gerontology at the Catholic University of the Sacred Heart in Rome and lead author of the study. "All currently available treatments for dementia have only limited effects on the severity and progression of this condition. Hence, prevention of dementia becomes key. However, knowledge about the determinants and protective factors for cognitive impairment among geriatric populations is scanty. Various studies have identified alcohol consumption as either a risk factor for dementia or as a protective factor. Regular wine consumption during meals is widespread among older Italian subjects; whether this habit might represent a risk factor for dementia or a protection was the aim of our study."

Researchers analyzed data gathered from 15,807 patients (65 years of age or older) by the Gruppo Italiano di Farmacoepidemiologia nell'Anziano, a study of adverse drug reactions in hospitalized patients. Wine was the alcoholic beverage of choice; each liter of wine was assumed to contain 80 grams of alcohol. Study authors found signs of cognitive derangement in 19 percent of the participants who reported regular alcohol consumption, and in 29% of those who abstained from alcohol. Statistical methods ruled out concurrent factors such as age, gender, education, disease, or medication as influential on this "protective" effect of alcohol. Researchers did, however, find that the quantity of daily alcohol consumption was an important factor.

"The risk of cognitive impairment was reduced, as compared with abstainers," said Zuccalà, "among women whose daily alcohol consumption was less than 40 grams and among men who drank less than 80 grams. On the other hand, subjects who reported higher levels of alcohol consumption showed an increased risk of cognitive impairment when compared with both abstainers and moderate drinkers."

"This study shows that among older persons," said co-author Graziano Onder, currently a research associate in the department of geriatrics at Wake Forest University, "moderate alcohol intake protects from the development of cognitive impairment. However, alcohol abuse - more than one bottle of wine per day for a man or half a bottle for a woman - is associated with an increased risk of cognitive dysfunction. These findings add to a body of hard scientific information developed in the last decade which suggests that alcohol confers clear health benefits on those who consume it in moderation." Onder, who was with the Catholic University of the Sacred Heart at the time of the research, cautions against "prescribing" alcohol for the elderly, notwithstanding its emerging health benefits.

"Physicians and politicians are at present divided on how we should react to this growing body of knowledge," he said. "The risk of alcohol abuse is elevated among older adults, roughly four percent meet criteria for alcohol abuse and dependence, and elderly people frequently use medications, which may interact with alcohol. For these reasons, alcohol consumption should not be encouraged among older adults as a 'preventive treatment,' and should be monitored by physicians." However, he added, "people who enjoy one drink or two should be reassured that this practice is consistent with a healthy life style."

Both Zuccalà and Onder noted that future research on the beneficial effects of moderate alcohol consumption will need to focus on the specific mechanisms and properties that contribute to these effects.

"Most cases of dementia in advanced age are due to cerebrovascular disease," said Zuccalà. "It would seem that moderate alcohol consumption might 'help' cognitive function by protecting against myocardial infarction and stroke. In addition, the antioxidant compounds of wine might account for the observed protection against Alzheimer disease."

"Identification of constituents in alcoholic beverages which are responsible for this and other beneficial effects," added Onder, "could have important clinical and therapeutic implications. Of course, if wine really contains a specific beneficial constituent, some might consider it 'almost a sacrilege' to isolate the effective constituent, as the medicine is already in a highly palatable form."
Co-authors of the Alcoholism: Clinical & Experimental Research paper included: Claudio Pedone of the Center for Gerontology and Health Care Research at Brown University; and Matteo Cesari; Francesco Landi; Roberto Bernabei; and Alberto Cocchi at the Catholic University of the Sacred Heart. The study was partly funded by the National Research Council.

Alcoholism: Clinical & Experimental Research

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