Cognitive functioning in late life: the impact of moderate alcohol consumption

A Review of Nutritional Requirements of Adults Aged ≥65 Years in the UK

Appropriate dietary choices in later life may reduce the risk of chronic diseases and rate of functional decline, however, there is little well-evidenced age-specific nutritional guidance in the UK for older adults, making it challenging to provide nutritional advice. Therefore, the aim of this critical review was to propose evidence-based nutritional recommendations for older adults (aged ≥65 y). Nutrients with important physiological functions in older adults were selected for inclusion in the recommendations. For these nutrients: 1) recommendations from the UK Scientific Advisory Committee for Nutrition (SACN) reports were reviewed and guidance retained if recent and age-specific, and 2) a literature search conducted where SACN guidance was not sufficient to set or confirm recommendations for older adults, searching Web of Science up to March 2020. Data extracted from a total of 190 selected publications provided evidence to support age-specific UK recommendations for protein (1.2 g·kg-1·d-1), calcium (1000 mg·d-1), folate (400 μg·d-1), vitamin B-12 (2.4 μg·d-1), and fluid (1.6 L·d-1 women, 2.0 L·d-1 men) for those ≥65 y. UK recommendations for carbohydrates, free sugars, dietary fiber, dietary fat and fatty acids, sodium, and alcohol for the general population are likely appropriate for older adults. Insufficient evidence was identified to confirm or change recommendations for all other selected nutrients. In general, significant gaps in current nutritional research among older adults existed, which should be addressed to support delivery of tailored nutritional guidance to this age group to promote healthy aging.

Long-term effects of alcohol consumption on cognitive function: a systematic review and dose-response analysis of evidence published between 2007 and 2018

BACKGROUND

Understanding the long-term health effects of low to moderate alcohol consumption is important for establishing thresholds for minimising the lifetime risk of harm. Recent research has elucidated the dose-response relationship between alcohol and cardiovascular outcomes, showing an increased risk of harm at levels of intake previously thought to be protective. The primary objective of this review was to examine (1) whether there is a dose-response relationship between levels of alcohol consumption and long-term cognitive effects, and (2) what the effects are of different levels of consumption.

METHODS

The review was conducted according to a pre-specified protocol. Eligible studies were those published 2007 onwards that compared cognitive function among people with different levels of alcohol consumption (measured ≥ 6 months prior to first follow-up of cognition). Major cognitive impairment was excluded. Searches were limited to MEDLINE, Embase and PsycINFO (January 2007 to April 2018). Screening, data extraction, and risk of bias assessment (ROBINS-I) were piloted by three authors, then completed by a single author and checked by a second. Analyses were undertaken to identify and characterise dose-response relationships between levels of alcohol consumption and cognition. Certainty of evidence was assessed using GRADE.

RESULTS

We included 27 cohort studies (from 4786 citations). Eighteen studies examined the effects of alcohol consumption at different levels (risk of bias 16 serious, 2 critical). Ten studies provided data for dose-response analysis. The pooled dose-response relationship showed a maximum standardised mean difference (SMD) indicating slightly better cognition among women with moderate alcohol consumption compared to current non-drinkers (SMD 0.18, 95%CI 0.02 to 0.34, at 14.4 grams/day; 5 studies, very low certainty evidence), and a trivial difference for men (SMD 0.05, 95% CI 0.00 to 0.10, at 19.4 grams/day; 6 studies, very low certainty evidence).

CONCLUSIONS

Major limitations in the design and reporting of included studies made it impossible to discern if the effects of 'lower' levels of alcohol intake are due to bias. Further review of the evidence is unlikely to resolve this issue without meta-analysis of individual patient data from cohort studies that address biases in the selection of participants and classification of alcohol consumption.

Association of moderate alcohol intake with in vivo amyloid-beta deposition in human brain: A cross-sectional study

BACKGROUND

An emerging body of literature has indicated that moderate alcohol intake may be protective against Alzheimer disease (AD) dementia. However, little information is available regarding whether moderate alcohol intake is related to reductions in amyloid-beta (Aβ) deposition, or is protective via amyloid-independent mechanisms in the living human brain. Here we examined the associations of moderate alcohol intake with in vivo AD pathologies, including cerebral Aβ deposition, neurodegeneration of AD-signature regions, and cerebral white matter hyperintensities (WMHs) in the living human brain.

METHODS AND FINDINGS

The present study was part of the Korean Brain Aging Study for Early Diagnosis and Prediction of Alzheimer's Disease (KBASE), an ongoing prospective cohort study that started in 2014. As of November 2016, 414 community-dwelling individuals with neither dementia nor alcohol-related disorders (280 cognitively normal [CN] individuals and 134 individuals with mild cognitive impairment [MCI]) between 56 and 90 years of age (mean age 70.9 years ± standard deviation 7.8; male, n [%] = 180 [43.5]) were recruited from 4 sites (i.e., 2 university hospitals and 2 public centers for dementia prevention and management) around Seoul, South Korea. All the participants underwent comprehensive clinical assessments comprising lifetime and current histories of alcohol intake and multimodal brain imaging, including [11C] Pittsburgh compound B positron emission tomography (PET), [18F] fluorodeoxyglucose (FDG) PET, and magnetic resonance imaging (MRI) scans. Lifetime and current alcohol intake were categorized as follows: no drinking, <1 standard drink (SD)/week, 1-13 SDs/week, and 14+ SDs/week. A moderate lifetime alcohol intake (1-13 SDs/week) was significantly associated with a lower Aβ positivity rate compared to the no drinking group, even after controlling for potential confounders (odds ratio 0.341, 95% confidence interval 0.163-0.714, p = 0.004). In contrast, current alcohol intake was not associated with amyloid deposition. Additionally, alcohol intake was not related to neurodegeneration of AD-signature regions or cerebral WMH volume. The present study had some limitations in that it had a cross-sectional design and depended on retrospective recall for alcohol drinking history.

CONCLUSIONS

In this study, we observed in middle- and old-aged individuals with neither dementia nor alcohol-related disorders that moderate lifetime alcohol intake was associated with lower cerebral Aβ deposition compared to a lifetime history of not drinking. Moderate lifetime alcohol intake may have a beneficial influence on AD by reducing pathological amyloid deposition rather than amyloid-independent neurodegeneration or cerebrovascular injury.

Clarifying the neurobehavioral sequelae of moderate drinking lifestyles and acute alcohol effects with aging

Epidemiological estimates indicate not only an increase in the proportion of older adults, but also an increase in those who continue moderate alcohol consumption. Substantial literatures have attempted to characterize health benefits/risks of moderate drinking lifestyles. Not uncommonly, reports address outcomes in a single outcome, such as cardiovascular function or cognitive decline, rather than providing a broader overview of systems. In this narrative review, retaining focus on neurobiological considerations, we summarize key findings regarding moderate drinking and three health domains, cardiovascular health, Type 2 diabetes (T2D), and cognition. Interestingly, few investigators have studied bouts of low/moderate doses of alcohol consumption, a pattern consistent with moderate drinking lifestyles. Here, we address both moderate drinking as a lifestyle and as an acute event. Review of health-related correlates illustrates continuing inconsistencies. Although substantive reductions in risk for cardiovascular and T2D events are reported, robust conclusions remain elusive. Similarly, whereas moderate drinking is often associated with enhanced cognition and lower dementia risk, few benefits are noted in rates of decline or alterations in brain structure. The effect of sex/gender varies across health domains and by consumption levels. For example, women appear to differentially benefit from alcohol use in terms of T2D, but experience greater risk when considering aspects of cardiovascular function. Finally, we observe that socially relevant alcohol doses do not consistently impair performance in older adults. Rather, older drinkers demonstrate divergent, but not necessarily detrimental, patterns in neural activation and some behavioral measures relative to younger drinkers. Taken together, the epidemiological and laboratory studies reinforce the need for greater attention to key individual differences and for the conduct of systematic studies sensitive to age-related shifts in neurobiological systems.

Alcohol consumption and incident dementia in older Japanese adults: The Okayama Study

AIM

To evaluate the association between the amount and frequency of alcohol consumption and incident dementia in older Japanese adults using large sample size data over a long follow-up period.

METHODS

This was a retrospective cohort study carried out in Japan. A total of 53 311 older adults were followed from 2008 to 2014. A health checkup questionnaire was used to assess the amount and frequency of alcohol consumption. The Dementia Scale of long-term care insurance was used as a measure of incident dementia. Cox proportional hazards models were used to calculate adjusted hazard ratios, with their 95% confidence intervals, for the incidence of dementia across the categories of alcohol consumption by sex.

RESULTS

During a 7-year follow-up period, 14 479 participants were regarded as having incident dementia. Compared with non-drinkers, the multivariate adjusted hazard ratios for participants with alcohol consumption ≤2 units per day, occasionally (0.88, 95% CI 0.81-0.96 in men and 0.84, 95% 0.79-0.90 in women) and daily (0.79, 95% 0.73-0.85 in men and 0.87, 95% 0.78-0.97 in women) were statistically significant, and the difference between occasional and daily consumption was only statistically significant in men; however, for participants with alcohol consumption >2 units per day, occasionally (0.91, 95% 0.71-1.16 in men and 1.09, 95% 0.72-1.67 in women) and daily (0.89, 95% 0.81-1.00 in men and 1.16, 95% 0.84-1.81 in women) were not significant.

CONCLUSIONS

Alcohol consumption of ≤2 units per day, occasionally or daily, could reduce the risk of incident dementia, with greater benefit for men with such daily consumption. Geriatr Gerontol Int 2019; 19: 740-746.

Alcohol Use and Frailty Risk among Older Adults over 12 Years: The Health and Retirement Study

OBJECTIVES

The primary goal was to examine the relationship between alcohol use and frailty, a variable characterizing late-life decline, in a national, longitudinal survey of older adults living in the United States.

METHODS

The sample drawn from the Health and Retirement Study included 9,499 stroke-free participants over age 65 in 2000. The sample was 59.1% female, and had a mean age of 74.25 years (SD = 6.99). Follow-up data was from 2004, 2008, and 2012. Frailty was defined phenotypically using the Paulson-Lichtenberg Frailty Index (PLFI). Alcohol use was measured via self-report. Control variables included age, race, education, socio-economic status (SES), depressive symptomatology, medical burden score, body mass index (BMI), and partner status. With abstinent participants as the reference group, logistic regressions were conducted to determine prevalent frailty at 2000, and Cox's proportional hazard models were utilized to determine time to incident frailty over a 12-year period.

RESULTS

Results revealed that age, depressive symptomatology, and medical burden score were significant positive correlates of prevalent and incident frailty (p < .05) for both males and females. Logistic regressions revealed that consumption of 1-7 alcoholic drinks per week was associated with reduced prevalent frailty (OR = .49, p < .001) for females. Survival analysis results reveal that compared with nondrinkers, males and females who reportedly consumed 1-7 drinks per week had a decreased probability of incident frailty (HR = .78-081, p < .05).

CONCLUSIONS

Findings suggest that moderate alcohol use confers reduced frailty risk for both older men and women. Future research should examine the mechanism(s) relating alcohol consumption and frailty.

CLINICAL IMPLICATIONS

Findings support extant literature suggesting some healthcare benefits may be associated with moderate drinking.

Moderate alcohol consumption as risk factor for adverse brain outcomes and cognitive decline: longitudinal cohort study

Objectives To investigate whether moderate alcohol consumption has a favourable or adverse association or no association with brain structure and function.Design Observational cohort study with weekly alcohol intake and cognitive performance measured repeatedly over 30 years (1985-2015). Multimodal magnetic resonance imaging (MRI) was performed at study endpoint (2012-15).Setting Community dwelling adults enrolled in the Whitehall II cohort based in the UK (the Whitehall II imaging substudy).Participants 550 men and women with mean age 43.0 (SD 5.4) at study baseline, none were "alcohol dependent" according to the CAGE screening questionnaire, and all safe to undergo MRI of the brain at follow-up. Twenty three were excluded because of incomplete or poor quality imaging data or gross structural abnormality (such as a brain cyst) or incomplete alcohol use, sociodemographic, health, or cognitive data.Main outcome measures Structural brain measures included hippocampal atrophy, grey matter density, and white matter microstructure. Functional measures included cognitive decline over the study and cross sectional cognitive performance at the time of scanning.Results Higher alcohol consumption over the 30 year follow-up was associated with increased odds of hippocampal atrophy in a dose dependent fashion. While those consuming over 30 units a week were at the highest risk compared with abstainers (odds ratio 5.8, 95% confidence interval 1.8 to 18.6; P≤0.001), even those drinking moderately (14-21 units/week) had three times the odds of right sided hippocampal atrophy (3.4, 1.4 to 8.1; P=0.007). There was no protective effect of light drinking (1-<7 units/week) over abstinence. Higher alcohol use was also associated with differences in corpus callosum microstructure and faster decline in lexical fluency. No association was found with cross sectional cognitive performance or longitudinal changes in semantic fluency or word recall.Conclusions Alcohol consumption, even at moderate levels, is associated with adverse brain outcomes including hippocampal atrophy. These results support the recent reduction in alcohol guidance in the UK and question the current limits recommended in the US.

Dietary patterns are associated with cognitive function in the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort

Identifying factors that contribute to the preservation of cognitive function is imperative to maintaining quality of life in advanced years. Of modifiable risk factors, diet quality has emerged as a promising candidate to make an impact on cognition. The objective of this study was to evaluate associations between empirically derived dietary patterns and cognitive function. This study included 18 080 black and white participants aged 45 years and older from the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort. Principal component analysis on data from the Block98 FFQ yielded five dietary patterns: convenience, plant-based, sweets/fats, Southern, and alcohol/salads. Incident cognitive impairment was defined as shifting from intact cognitive status (score >4) at first assessment to impaired cognitive status (score ≤4) at latest assessment, measured by the Six-Item Screener. Learning, memory and executive function were evaluated with the Word List Learning, Word List Delayed Recall, and animal fluency assessments. In fully adjusted models, greater consumption of the alcohol/salads pattern was associated with lower odds of incident cognitive impairment (highest quintile (Q5) v. lowest quintile (Q1): OR 0·68; 95 % CI 0·56, 0·84; P for trend 0·0005). Greater consumption of the alcohol/salads pattern was associated with higher scores on all domain-specific assessments and greater consumption of the plant-based pattern was associated with higher scores in learning and memory. Greater consumption of the Southern pattern was associated with lower scores on each domain-specific assessment (all P < 0·05). In conclusion, dietary patterns including plant-based foods and alcohol intake were associated with higher cognitive scores, and a pattern including fried food and processed meat typical of a Southern diet was associated with lower scores.

Relationship of moderate alcohol intake and type of beverage with health behaviors and quality of life in elderly subjects

PURPOSE

This work was aimed to study the relationships of moderate alcohol intake and the type of beverages consumed with health behaviors and quality of life in elderly people.

METHODS

In this observational study, 231 subjects (55-85 years) voluntarily answering to advertisements were enrolled and divided in three study groups: abstainers and occasional consumers (ABS; n = 98), moderate drinkers of beer (BEER; n = 63) and moderate drinkers of all sorts of alcoholic beverages (MIXED; n = 70). Variables assessed included physical activity, activities of daily living, Mediterranean diet-adherence score, tobacco consumption, quality of sleep, body composition, medication and perception of health through the SF-36 questionnaire. Their relationship with alcohol consumption was assessed through general linear models including confounding variables (age, sex, chronic disease prevalence and socioeconomic status). ABS were also compared to moderate drinkers (MOD = BEER + MIXED).

RESULTS

The mean daily alcohol consumption in each group was (mean ± SD): ABS: 0.7 ± 1.1; BEER: 12.7 ± 8.1; MIXED: 13.9 ± 10.2 g/day. MOD and MIXED showed significantly higher physical activity (metabolic standard units; METs) than ABS (p = 0.023 and p = 0.004, respectively). MOD spent significantly less time doing housework activities than ABS (p = 0.032). Daily grams of alcohol consumption were significantly associated with METs (B = 21.727, p = 0.023). Specifically, wine consumption (g/day) was associated with METs (B = 46.196, p = <0.001) and showed borderline significant relationships with mental health (B = 0.245, p = 0.062) and vitality perception (B = 0.266, p = 0.054).

CONCLUSION

Moderate alcohol consumption, and in particular wine consumption, is associated with a more active lifestyle and better perception of own health in the Spanish elderly subjects studied.

Alcohol consumption and cognitive impairment among Korean older adults: does gender matter?

BACKGROUND

This study investigated gender differences in the relationship between alcohol consumption and cognitive impairment among older adults in South Korea.

METHODS

Using data from the Korean Longitudinal Study of Ageing, 2,471 females and 1,657 males were analyzed separately. Cognitive impairment was measured based on the Korean version of the Mini-Mental State Exam score. Logistic regression was conducted to examine the relationship between alcohol consumption and cognitive impairment among Korean older adults.

RESULTS

Multivariate analysis showed that compared to moderate drinkers, past drinkers were more likely to be cognitively impaired for women, while heavy drinkers were more likely to be cognitively impaired for men.

CONCLUSIONS

Findings suggest that the relationship between alcohol consumption and cognition varies with gender. Clinicians and service providers should consider gender differences when developing strategies for the prevention and treatment of alcohol-related cognitive decline among older adults.

Late-life alcohol consumption and cognitive function in elderly men

Moderate alcohol consumption (one to two drinks per day) has been associated with better cognitive function and lower risk of developing dementia in the elderly. In light of alcohol's well-known neurotoxic properties, more evidence from well-controlled population-based studies is required. The objective of this study was to examine whether self-reported alcohol intake at age 70 is linked to cognitive function (assessed by trail making tests (TMTs) A and B, which are measures of attention, mental speed, and flexibility) in a population-based cohort consisting of 652 cognitively healthy elderly men. Linear regression models were used to assess both cross-sectional (i.e., age 70) and prospective (i.e., age 77) associations between alcohol intake and cognitive function. The analyses were adjusted for education, body mass index, energy intake, self-reported physical activity, smoking, a history of hypertension or diabetes, apolipoprotein E ε4 status, and cholesterol levels at the age of 70. Baseline data were obtained from 1990 to 1996. Self-reported alcohol intake (mean 6.9 ± 7.1 g/day) was associated with better performance on TMT-B at ages 70 and 77 (β = -0.87, p < 0.001). In contrast, alcohol intake was not predictive of the difference in performance on these tests between ages 70 and 77. Despite cross-sectional associations with performance in a test of executive functioning, moderate intake of alcohol was not linked to differences in cognitive performance between ages 70 and 77 in the present study. Thus, our findings do not support the view that daily moderate alcohol consumption is a recommendable strategy to slow cognitive aging in elderly populations.

The association between alcohol use and long-term care placement among older Canadians: a 14-year population-based study

Studies have shown that moderate alcohol use confers protection against some of the dominant predictors of long-term care placement, including diminished cognitive functioning, physical disability, and injury. But little is known about the association between alcohol use and the likelihood of placement in long-term care facilities. A nationally representative sample of 5404 community-dwelling Canadians ages 50 years and older at baseline (1994/95) was obtained from the longitudinal National Population Health Survey. Alcohol use categories were developed based on the quantity and frequency of use in the 12 months before the interview. Cox proportional hazards models were used to estimate the association between alcohol use at baseline and subsequent placement in long-term care facilities after adjusting for covariates measured at baseline. During the 14-year follow-up period, 14% of lifetime abstainers, 10% of former drinkers, 7% of infrequent drinkers, 4% of moderate drinkers, and 3% of heavy drinkers were placed in long-term care facilities. Furthermore, the multivariate analysis revealed that abstainers, former drinkers, and infrequent drinkers were more than twice as likely to be placed in long-term care as moderate drinkers. Moderate drinking was protective against placement in long-term care facilities even after adjusting for an array of well-known confounders. The strong protective effect of moderate alcohol use on long-term care entry is likely due to a complex mix of physical, cognitive and psychosocial health factors.

A self-administered questionnaire to screen the risk of dementia: a pilot study and the results of a comparison with the mini-mental state examination (MMSE)

Cognitive impairment is an age-related condition as the rate of cognitive decline rapidly increases with aging. The aim of this study was to screen the risk of cognitive decline in people over 60 years from 16 different Italian cities, by comparing the results of a self-administered questionnaire with the MMSE. We analyzed data from 203 persons aged 60 years and over, who voluntarily accepted to participate during the "Second Prevention Day for AD". A self-administered questionnaire, developed by clinicians of our Department of Aging, was distributed to all participants, in order to easily screen the risk of cognitive impairment. Then, all subjects underwent cognitive assessment by MMSE. We esteemed the risk of cognitive impairment of all participants basing on MMSE scores (no risk, mild and moderate risk) and we compared this assessment with the results obtained by the self-administered questionnaire. The comparison between the risk of cognitive impairment revealed by our questionnaire and the risk esteemed by MMSE resulted in a discrepancy in 43.96% of cases in no risk class. In mild risk group there was a discrepancy of results in 70.53% of subjects. In moderate risk class there was a discrepancy of results in 38.46% of individuals. Our questionnaire resulted to be accurate for the evaluation of patients with moderate risk of cognitive impairment. It showed a lower accuracy for the mild risk class, often overestimating the risk of cognitive decline.

Alcohol consumption in mild cognitive impairment and dementia: harmful or neuroprotective?

OBJECTIVE

In several longitudinal studies, light-to-moderate drinking of alcoholic beverages has been proposed as being protective against the development of age-related changes in cognitive function, predementia syndromes, and cognitive decline of degenerative (Alzheimer's disease, AD) or vascular origin (vascular dementia). However, contrasting findings also exist.

METHOD

The English literature published in this area before September 2011 was evaluated, and information relating to the various factors that may impact upon the relationship between alcohol consumption and dementia or predementia syndromes is presented in the succeeding texts.

RESULTS

Light-to-moderate alcohol consumption may be associated with a reduced risk of incident overall dementia and AD; however, protective benefits afforded to vascular dementia, cognitive decline, and predementia syndromes are less clear. The equivocal findings may relate to many of the studies being limited to cross-sectional designs, restrictions by age or gender, or incomplete ascertainment. Different outcomes, beverages, drinking patterns, and study follow-up periods or possible interactions with other lifestyle-related (e.g., smoking) or genetic factors (e.g., apolipoprotein E gene variation) may all contribute to the variability of findings.

CONCLUSION

Protective effects of moderate alcohol consumption against cognitive decline are suggested to be more likely in the absence of the AD-associated apolipoprotein E ε4 allele and where wine is the beverage. At present, there is no indication that light-to-moderate alcohol drinking would be harmful to cognition and dementia, and attempts to define what might be deemed beneficial levels of alcohol intake in terms of cognitive performance would be highly problematic and contentious.

Gender differences in the link between excessive drinking and domain-specific cognitive functioning among older adults

OBJECTIVE

This study investigated gender differences in the relationship between excessive drinking and two cognitive domains among older adults.

METHOD

Using data from the Health and Retirement Study, 3,888 females and 2,350 males were analyzed separately. Multivariate regression was used to analyze the association between excessive drinking and fluid intelligence score. Logistic regression was conducted to examine the relationship between excessive drinking and crystallized intelligence.

RESULTS

Multivariate analysis showed that compared to non-excessive drinking, excessive drinking did not have a significant impact on fluid intelligence for either women or men, but it had a significantly negative association with a high crystallized intelligence score for women.

DISCUSSION

Findings suggest that the relationship between excessive drinking and cognition varies with gender when crystallized intelligence is measured. Clinicians and service providers should consider gender differences when developing strategies for the prevention and treatment of alcohol-related cognitive decline among older adults.

Alcohol effects on cognitive change in middle-aged and older adults

OBJECTIVES

This study examines cognitive outcomes for alcohol drinking status over time, across cognitive ability and age groups.

METHODS

Data (1998-2005) from n = 571 Seattle Longitudinal Study participants aged 45+years (middle-aged: 45-64, young-old: 65-75, old-old: 75+) were analyzed to examine the alcohol drinking status effect (e.g., abstinent, moderate (less than seven drinks/week), at-risk (more than eight drinks/week)) on cognitive ability (e.g., memory, reasoning, spatial, verbal number, speed abilities).

RESULTS

Findings indicated that alcohol drinking status was associated with change in verbal ability, spatial ability, and perceptual speed. Decline in verbal ability was seen among alcohol abstainers and moderate alcohol consumers, but at-risk drinkers displayed relative stability. At-risk old-old adults and middle-aged adults (regardless of drinking status), displayed relative stability in spatial ability. Decline in spatial ability was however present among young-old adults across drinking status, and among abstaining and moderate drinking old-old adults. At-risk drinkers showed the most positive spatial ability trajectory. A gender effect in perceptual speed was detected, with women who abstained from drinking displaying the most decline in perceptual speed compared with women that regularly consumed alcohol, and men displaying decline in perceptual speed across drinking status.

DISCUSSION

In this study, consuming alcohol is indicative of cognitive stability. This conclusion should be considered cautiously, due to study bias created from survivor effects, analyzing two time points, health/medication change status, and overrepresentation of higher socioeconomic status and white populations in this study. Future research needs to design studies that can make concrete recommendations about the relationship between drinking status and cognition.

Alcohol and cognition in the elderly: a review

Consumption of large amounts of alcohol is known to have negative effects, but consumption in smaller amounts may be protective. The effect of alcohol may be greater in the elderly than in younger adults, particularly with regard to cognition. However, the drinking pattern that will provide optimal protection against dementia and cognitive decline in the elderly has not been systematically investigated. The present paper is a critical review of research on the effect of alcohol on cognitive function and dementia in the elderly. Studies published from 1971 to 2011 related to alcohol and cognition in the elderly were reviewed using a PubMed search. Alcohol may have both a neurotoxic and neuroprotective effect. Longitudinal and brain imaging studies in the elderly show that excessive alcohol consumption may increase the risk of cognitive dysfunction and dementia, but low to moderate alcohol intake may protect against cognitive decline and dementia and provide cardiovascular benefits. Evidence suggesting that low to moderate alcohol consumption in the elderly protects against cognitive decline and dementia exists; however, because of varying methodology and a lack of standardized definitions, these findings should be interpreted with caution. It is important to conduct more, well-designed studies to identify the alcohol drinking pattern that will optimally protect the elderly against cognitive decline and dementia.

Determinants of cognitive performance among community dwelling older adults in an impoverished sub-district of São Paulo in Brazil

Determinants of cognitive performance in old age have received limited attention in Latin America. We investigated the association of socio-demographic and health-related variables with cognitive performance in a sample of older adults with limited educational experience living in a poor sub-district of the city of São Paulo. This was a cross-sectional population-based study which included a sample of 384 seniors 65 years and older. Cognition was assessed by the Mini-Mental State Examination (MMSE) and the Brief Cognitive Screening Battery (BCSB) (episodic memory test with 10 pictures, verbal fluency (VF), Clock Drawing Test (CDT)). Results indicated that age, sex, schooling, depressive symptoms, and systolic blood pressure (SBP) level had a significant impact on the cognitive performance of the sample. Therefore, pharmacological and psychosocial interventions with a focus on improving mood and controlling hypertension may have beneficial effects on cognition among seniors with similar socio-demographic characteristics.

Socio-demographic and health-related factors associated with cognitive impairment in the elderly in Taiwan

Background

Cognitive impairment is an age-related condition as the rate of cognitive decline rapidly increases with aging. It is especially important to better understand factors involving in cognitive decline for the countries where the older population is growing rapidly. The aim of this study was to examine the association between socio-demographic and health-related factors and cognitive impairment in the elderly in Taiwan.

Methods

We analysed data from 2119 persons aged 65 years and over who participated in the 2005 National Health Interview Survey. Cognitive impairment was defined as having the score of the Mini Mental State Examination lower than 24. The χ² test and multiple logistic regression models were used to evaluate the association between cognitive impairment and variables of socio-demography, chronic diseases, geriatric conditions, lifestyle, and dietary factors.

Results

The prevalence of cognitive impairment was 22.2%. Results of multivariate analysis indicated that low education, being single, low social support, lower lipid level, history of stroke, physical inactivity, non-coffee drinking and poor physical function were associated with a higher risk of cognitive impairment.

Conclusion

Most of the characteristics in relation to cognitive impairment identified in our analysis are potentially modifiable. These results suggest that improving lifestyle behaviours such as regular exercise and increased social participation could help prevent or decrease the risk of cognitive impairment. Further investigations using longitudinal data are needed to clarify our findings.

Moderate alcohol consumption and cognitive risk

We reviewed 143 papers that described the relationship between moderate drinking of alcohol and some aspect of cognition. Two types of papers were found: (1) those that provided ratios of risk between drinkers and nondrinkers (74 papers in total) and (2) those that, although they did not provide such ratios, allowed cognition in drinkers to be rated as "better," "no different," or "worse" than cognition in nondrinkers (69 papers in total). The history of research on moderate drinking and cognition can be divided into two eras: 1977-1997 and 1998-present. Phase I (1977-1997) was the era of neuropsychological evaluation involving mostly young to middle-aged (18-50 years old) subjects. Although initial studies indicated moderate drinking impaired cognition, many later studies failed to confirm this, instead finding no difference in cognition between drinkers and nondrinkers. Phase II (1998-present) was and is the era of mental status exam evaluation involving mostly older (≥55 years old) subjects. These studies overwhelmingly found that moderate drinking either reduced or had no effect on the risk of dementia or cognitive impairment. When all the ratios of risk from all the studies in phase II providing such ratios are entered into a comprehensive meta-analysis, the average ratio of risk for cognitive risk (dementia or cognitive impairment/decline) associated with moderate "social" (not alcoholic) drinking of alcohol is 0.77, with nondrinkers as the reference group. The benefit of moderate drinking applied to all forms of dementia (dementia unspecified, Alzheimer's disease, and vascular dementia) and to cognitive impairment (low test scores), but no significant benefit against cognitive decline (rate of decline in test scores) was found. Both light and moderate drinking provided a similar benefit, but heavy drinking was associated with nonsignificantly higher cognitive risk for dementia and cognitive impairment. Although the meta-analysis also indicated that wine was better than beer or spirits, this was based on a relatively small number of studies because most studies did not distinguish among these different types of alcohol. Furthermore, a number of the studies that did make the distinction reported no difference among the effects of these different types of alcohol. Therefore, at present this question remains unanswered. Analysis also showed that the presence of the apolipoprotein E epsilon 4 allele eliminated the benefit of moderate drinking. However, this was based on a relatively small number of studies and several other studies have found a beneficial effect of the epsilon e4 allele. Further studies are necessary to settle this question. The benefit of moderate alcohol for cognition was seen in both men and women, although the amount and pattern of drinking is very different between the two sexes. Lastly, the finding of unaffected or significantly reduced cognitive risk in light to moderate drinkers was seen in 14/19 countries for which country-specific ratio data were available, with three of the five remaining countries showing nonsignificant reductions as well. Overall, light to moderate drinking does not appear to impair cognition in younger subjects and actually seems to reduce the risk of dementia and cognitive decline in older subjects.

Association between alcohol consumption and cognitive impairment in Southern Chinese older adults

BACKGROUND

There is limited data on the effects of alcohol consumption on cognitive impairment in Chinese populations.

OBJECTIVES

To investigate the association between alcohol consumption and the risk of cognitive impairment in Southern Chinese older adults in Hong Kong.

METHOD

This was a cross-sectional study of 314 Chinese older participants, aged 65 years or over. Participants' socio-demographic, co-morbid diseases, alcohol drinking habits, and Mini Mental State Examination (MMSE) for cognitive function were obtained by a face-to-face interview. Participants were categorized into normal cognitive and cognitively impaired groups by education-adjusted MMSE cut-off scores.

RESULT

The mean (SD) age of the participants was 79.9 (6.5) years. The average weekly alcohol consumption in the cognitively impaired group was significantly higher than that of the normal cognition group [mean (SD): 861.89 (673.03) versus 241.21 (276.26) grams per week respectively; p < 0.001, t-test]. Drinkers with light to moderate alcohol consumption were associated with higher MMSE scores than non-drinkers and heavy drinkers. Logistic regression analyses showed that heavy drinkers (> 400 g alcohol for men and > 280 g for women) were associated with an increased risk of cognitive impairment (OR = 4.99, 95%CI = 1.8-13.82), while light drinkers and moderated drinkers (< 400 g for men and < 280 g for women) were associated with reduced risks (OR = 0.32, 95%CI = 0.12-0.86; OR = 0.17, 95%CI = 0.06-0.51, respectively). Exercise and age were independent protective and risk factors respectively.

CONCLUSION

Heavy alcohol consumption is associated with an increased risk of cognitive impairment while light to moderate alcohol consumption is associated with reduced risk among Southern Chinese older adults in Hong Kong.

Alcohol consumption and domain-specific cognitive function in older adults: longitudinal data from the Johns Hopkins Precursors Study

OBJECTIVES

The association of alcohol consumption with performance in different cognitive domains has not been well studied.

METHODS

The Johns Hopkins Precursors Study was used to examine associations between prospectively collected information about alcohol consumption ascertained on multiple occasions starting at age 55 years on average with domain-specific cognition at age 72 years. Cognitive variables measured phonemic and semantic fluency, attention, verbal memory, and global cognition.

RESULTS

Controlling for age, hypertension, smoking status, sex, and other cognitive variables, higher average weekly quantity and frequency of alcohol consumed in midlife were associated with lower phonemic fluency. There were no associations with four other measures of cognitive function. With respect to frequency of alcohol intake, phonemic fluency was significantly better among those who drank three to four alcoholic beverages per week as compared with daily or almost daily drinkers. A measure of global cognition was not associated with alcohol intake at any point over the follow-up.

DISCUSSION

Results suggest that higher alcohol consumption in midlife may impair some components of executive function in late life.

Is there an association between low-to-moderate alcohol consumption and risk of cognitive decline?

The authors evaluated the association of low-to-moderate alcohol consumption with risk of cognitive decline in a census-based cohort study of men and women aged ≥55 years conducted in Zaragoza, Spain (1994-1999). Participants free of dementia at baseline (N = 3,888) were examined after 2.5 and 4.5 years of follow-up. Information on alcohol intake was collected with the EURODEM Risk Factors Questionnaire and the History and Aetiology Schedule. The study endpoint was severe cognitive decline, defined as loss of ≥1 point/year on the Mini-Mental State Examination or a diagnosis of incident dementia (Diagnostic and Statistical Manual of Mental Disorders: DSM-IV, Text Revision criteria). Compared with those for abstainers, the multivariate-adjusted odds ratios for severe cognitive decline for male drinkers of <12 g alcohol/day, drinkers of 12-24 g alcohol/day, and former drinkers were 0.61 (95% confidence interval (CI): 0.31, 1.20), 1.19 (95% CI: 0.61, 2.32), and 1.03 (95% CI: 0.59, 1.82), respectively. The corresponding odds ratios for women were 0.88 (95% CI: 0.45, 1.72), 2.38 (95% CI: 0.98, 5.77), and 1.03 (95% CI: 0.48, 2.23). This study did not support the hypothesis that low-to-moderate alcohol consumption prevents cognitive decline. The inverse association between low-to-moderate alcohol intake and cognitive decline observed in other studies may have been due to inclusion of former drinkers in the abstainers reference category.

Effects of alcohol- and cigarette-use disorders on global and specific measures of cognition in middle-age adults

OBJECTIVE

This study examined the effects of alcohol- and tobacco-use disorders on global and specific cognitive abilities in middle age.

METHOD

The sample consisted of 118 men and 169 women ranging in age from 31 to 60 years (M [SD] = 43.59 [6.58]). Lifetime diagnoses were determined from a semistructured interview. Information about current levels of alcohol and cigarette use was also collected. A comprehensive neurocognitive assessment measuring global cognition, memory, and executive-functioning abilities was administered. Baseline cognition was estimated from average composite scores of the Iowa Test of Basic Skills school-achievement tests administered from third through eighth grade. Repeated-measures analysis of variance was used. Covariates comprised baseline cognition, current depression symptoms, and medication use.

RESULTS

Lifetime alcohol- and tobacco-use disorders were not associated with cognition among men. Women having a diagnosis of tobacco dependence (according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV]) performed less well on measures of global cognition and executive functioning. A lifetime diagnosis of DSM-IV alcohol abuse or dependence was associated with higher working memory among women only.

CONCLUSIONS

These results demonstrate few negative effects of alcohol-use disorders on midlife cognition, especially if current consumption is light. Differential susceptibility to the effects of cigarette use on cognition was found with women showing greater deficits in visuospatial abilities, processing speed, and executive-functioning abilities.

Higher free testosterone level is associated with faster visual processing and more flanker interference in older men

The aim of this study was to investigate the relation between free testosterone (FT) level and basic cognitive functions in older men. Three cognitive computer tasks were aimed to measure visual-processing speed, ability to suppress inappropriate responses, and visuospatial cognition, respectively. The tasks employed were a visual backward masking task, the Eriksen flanker task, and a mental rotation task. Participants were 72 older men (mean age=67.2 years, range 57-79). The influence of FT, age, alcohol consumption, and education on task performances was examined by means of multiple linear regression analysis. FT level was positively associated with accuracy on the short intervals (33 and 50ms) of the backward masking task and negatively with response latency on congruent flanker-task trials. These results indicate faster visual-processing speed in older men with higher FT levels. FT level was positively associated with interference elicited by irrelevant incongruent flankers, which implies that older men with higher levels of free testosterone exert less inhibitory control. Consistent with previous research, higher FT levels were associated with faster 'same-different' responses for unrotated mental rotation stimuli, but not with the slopes of the response time rotation functions. Older age was associated with lower backward masking accuracy at 33ms and with lower overall mental rotation accuracy. Higher education level was associated with faster processing speed for congruent flankers and with higher overall mental rotation accuracy. Alcohol consumption did not affect the task performances. Our results suggest that higher FT levels in older men may promote sustained visual-processing speed and visuospatial ability, probably at the expense of some inhibitory functioning.

Light to moderate alcohol consumption is associated with S100beta and amyloid beta levels in healthy older adults

Heavy alcohol consumption has been associated with several adverse neurocognitive outcomes in older adults, though little is known about lower consumption levels. No study has investigated the associations between S100beta and amyloid beta (Abeta) serum levels (biomarkers that provide evidence of neurological pathology) and light to moderate alcohol consumption in healthy older adults without neurological conditions. Thirty-five healthy older adults underwent neuropsychological testing and fasting blood draw with subsequent serum S100beta and Abeta 1-40 level quantification. Increased S100beta levels were associated with increased frequency of alcohol consumption and increased total monthly consumption of alcohol. Increased Abeta levels were associated with increased quantity of alcohol consumption. Further work investigating possible mechanisms is needed, particularly longitudinal studies and studies employing neuroimaging.

One-per-occasion or less: are moderate-drinking postmenopausal women really healthier than their nondrinking and heavier-drinking peers?

BACKGROUND

While some reported benefits of moderate drinking are thought to be the direct results of physiological mechanisms associated with consumption, other effects may be attributable to mediating factors. Both explanations suggest that moderate drinkers may be healthier than nondrinking and heavier-drinking peers. The purpose of this study was to determine whether moderate-drinking postmenopausal women report healthier dietary and exercise patterns, and whether they demonstrate better physiological functioning compared with peers. This study also aimed to describe patterns of relationships between alcohol and measures of general health functioning in postmenopausal women.

METHODS

One-hundred and fifteen women aged 50 to 65 participated. Participants completed alcohol interviews, diet and exercise questionnaires, and bone density examination. Blood pressure, height, and weight were assessed, and blood was collected to conduct basic chemistry and complete blood count tests.

RESULTS

Postmenopausal moderate drinkers failed to demonstrate healthier dietary or exercise habits, and did not exhibit significantly better health-functioning compared with peers. They did evidence positive associations between drinking and healthy behavior, and between drinking and cardiovascular health. Relationships between alcohol and blood analytes differed between drinking groups, some of which suggested possible negative health consequences for higher-end drinkers in both drinking groups.

CONCLUSIONS

These data suggested that moderate-drinking postmenopausal women are not significantly healthier than their non- or heavier-drinking peers, but may drink as part of a larger effort to take care of their health. Despite this, even 1-drink-per-drinking-day moderate drinkers may have tendencies toward unhealthy conditions. Limitations include small sample size, inability to assess specific cardiac risk and socioeconomic status, small number of correlations, and clinical relevance of analyte values.

Alcohol use and older adults: A little goes a long way

We examined the relationships between alcohol use, cognitive and affective variables, and the potential differential benefits of training for older adults drinkers and non-drinkers who participated in a randomized trial implemented between 2001-2006. Participants, who were living independently in the community, were randomly assigned to either twelve hours of memory training or health promotion classes. Outcomes included depression, health, cognition, verbal, visual, memory, and performance-based IADLs. The sample was 79% female, 17% Hispanic and 12% African-American. The typical participant had an average age of 75 years with 13 years of education. In the memory intervention group, there were 135 individuals (63 drinkers, 72 non-drinkers). In the health promotion condition, there were 129 individuals (58 drinkers and 71 non-drinkers). At baseline, drinkers scored higher on cognition, verbal memory, and lower on depression than non-drinkers. Alcohol use was positively related to physical health at baseline as measured by the Physical Component Summary Score of the Medical Outcomes Health Scale (SF-36). We found significant effects for the time*drinking*treatment group interaction in the repeated measures ANCOVA for the Mini Mental Status Examination, the Hopkins Verbal Learning Test, and the SF-36 Mental Health sub-scale. The time*drinking*group interactions were not statistically significant for any of the other outcomes; This study demonstrated that older adults benefited from targeted psychosocial interventions on affective, cognitive and functional outcomes. In addition, the SeniorWISE study provides empirical support to the research evidence emphasizing the health benefits of moderate alcohol consumption in older adults.