Midlife Alcohol Abuse Linked to Severe Memory Impairment

Caroline Cassels

July 30, 2014

Problem drinking in middle age appears to significantly increase the risk for severe memory loss in later life, new research shows.

Dr. Iain Lang

Investigators at the University of Exeter Medical School in the United Kingdom found that middle-aged adults with alcohol use disorders (AUDs) had more than double the risk of developing severe memory impairment almost 20 years later.

"Our results suggest odds of late-life severe memory impairment are substantially increased in middle-aged adults with a history of AUDs. There was little evidence that this relationship is mediated by history of hypertension, cardiovascular disease, or head injury," the authors, led by Iain A. Lang, PhD, write.

The study was published online July 30 in the American Journal of Geriatric Psychiatry.

New Puzzle Piece

Previous evidence suggests there is a relationship between AUDs and dementia, the investigators note. However, they add, no previous study has looked at the long-term relationship between a history of AUDs and dementia-related outcomes.

"We already know there is an association between dementia risk and levels of current alcohol consumption ― that understanding is based on asking older people how much they drink and then observing whether they develop problems. But this is only one part of the puzzle, and we know little about the consequences of alcohol consumption earlier in life," Dr. Lang said in a statement.

"What we did here is investigate the relatively unknown association between having a drinking problem at any point in life and experiencing problems with memory later in life," Dr. Lang added.

The study included 6542 middle-aged adults born from 1931 through 1941 who participated in the Health and Retirement Study, a prospective, nationally representative US cohort.

Participants were assessed at baseline in 1992, and follow-up cognitive assessments were conducted biannually from 1996 through 2010.

A history of AUDs was identified using the 4-item modified Cut down, Annoyed, Guilty, Eye-opener (CAGE) questionnaire, which includes the following questions:

  • Have you ever felt you should cut down on your drinking?

  • Have people annoyed you by criticizing your drinking?

  • Have you ever felt bad or guilty about your drinking?

  • Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (eye-opener)?

Cognitive outcomes were assessed using the 35-item modified Telephone Interview for Cognitive Status at last follow-up, with incident severe cognitive impairment defined as a score of less than 8, and incident severe memory impairment defined as a score of less than 1 on a 20-item memory subscale.

Practical Screening Tool

During a period of up to 19 years of follow-up (mean: 16.7 years; standard deviation: 3.0; range: 3.5 - 19.1 years), 90 participants experienced severe cognitive impairment, and 74 participants experienced severe memory impairment.

The investigators found that a history of AUDs more than doubled the odds of severe memory impairment (odds ratio [OR], 2.21; 95% confidence interval [CI], 1.27 - 3.85; P = .01). They note that although the association between AUDs and severe cognitive impairment was statistically nonsignificant, it was trending in the same direction (OR, 1.80; 95% CI, 0.97 - 3.33; P = .06).

"This finding ― that middle-aged people with a history of problem drinking more than double their chances of memory impairment when they are older ― suggests 3 things: that this is a public health issue that needs to be addressed; that more research is required to investigate the potential harms associated with alcohol consumption throughout life; and that the CAGE questionnaire may offer doctors a practical way to identify those at risk of memory/cognitive impairment and who may benefit from help to tackle their relationship with alcohol," said Dr. Lang.

Commenting on the findings, Doug Brown, PhD, director of research and development at the Alzheimer's Society in the United Kingdom, said the media often focuses on the hazards of heavy drinking among young people but noted that this study underscores the fact that alcohol abuse at any age is associated with risk.

"This isn't to say that people need to abstain from alcohol altogether. As well as eating a healthy diet, not smoking, and maintaining a healthy weight, the odd glass of red wine could even help reduce your risk of developing dementia," Dr. Brown said in a statement.

The authors and Dr. Brown report no relevant financial relationships.

Am J Geriatr Psychiatry. Published online July 30, 2014. Full text

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