The Older Brain on Drugs: Substances That May Cause Cognitive Impairment

Jenny Rogers, MD; Bonnie S. Wiese, MD; Kiran Rabheru, MD, CCFP, FRCP

Disclosures

Geriatrics and Aging. 2008;11(5):284-289. 

In This Article

Alcohol-Related Dementia

Moderate to high alcohol consumption is one of the risk factors for development of dementia prior to age 65.[12] Saunders, et al.,[21] found a 4.6 times greater risk of dementia for community-dwelling men over 65 who had a history of heavy drinking. Oslin, et al.,[22] developed criteria for probable alcohol-related dementia (ARD) ( Table 2 ). Typical impairments seen in ARD include deficits in abstracting abilities and short-term memory, and in executive control. These cognitive patterns contrast to those seen in Alzheimer's dementia (AD), where the memory impairment is profound and involves both recognition and recall, and individuals frequently present with word-finding deficits. Among abstinent individuals with ARD neither cognitive nor physical functioning deteriorate, unlike among those with a progressive dementia such as AD. Not all older drinkers with dementia meet criteria for ARD, but alcohol may still contribute to a mixed dementia.[23]

Direct neurotoxicity is a proposed mechanism by which heavy alcohol consumption causes shrinkage detectable by imaging studies in total cortical and subcortical volume.[16] Antilla, et al.,[24] found that APOEɛ-4 allele (a gene that predisposes to AD) carriers who drink any alcohol are three times more likely to develop dementia than APOEɛ-4 carriers who are nondrinkers. APOEɛ-4 carriers do not show benefit from light to moderate drinking as do noncarriers.[25]

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