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The relation of alcohol consumption to the development of dementia, with very extensive evaluations of the latter

This study was designed to assess the association between alcohol consumption and dementia and the roles of mild cognitive impairment (MCI) and apolipoproteinEε4 (APOEE4) genotype in modifying this association.  It was based on data from the Ginkgo Evaluation of Memory Study, conducted from 2000 to 2008 among US community-dwelling participants (which did not demonstrate beneficial effects of ginkgo). The study analyzed 3,021 participants aged 72 years and older who were free of dementia at baseline.

The assessment of alcohol consumption included both the amount and frequency of intake, and the authors had a very broad assessment of potential confounders, including cardiovascular and other diseases, depression, race, ethnicity, educational level, social activity, medication use, and genotype for APOE-E4.  There was a very complete and careful attention to the assessment of cognitive function, as subjects underwent numerous and repeated cognitive assessments.  For example, if there was any suggestion of cognitive impairment, cerebral magnetic resonance imaging and referral to an expert panel of clinicians, who reviewed and validated presence of dementia, was carried out.  No previous studies have had such an extensive assessment of cognition.

The main results include a finding that for the large majority of participants (the 2,548 without mild cognitive impairment at baseline), complete abstention from alcohol was associated with a slightly higher risk of dementia than seen in any of the groups consuming alcohol.  For 473 subjects with MCI at baseline, there was no effect on risk of dementia for up to about 10 drinks/week, then a slight but insignificant increase in risk with greater intake.  Daily low-quantity drinking was associated with more than 50% lower dementia risk than infrequent higher alcohol consumption.  Many of the associations shown had a consistent pattern (a decrease in risk with light drinking) but did not reach statistical significance.  The association was similar for all sub-groups, and was not modified by APOEE4 genotype.

The analyses seem well done, and Forum members agreed that, while some of the associations did not reach statistical significance, the data support most previous studies that show a J-shaped or U-shaped association for the relation of alcohol consumption to the risk of dementia.  As has been shown in most previous studies, regular (even daily) light drinking was found to be preferable to infrequent higher levels of alcohol consumption in terms of the effect on the risk of dementia.

Reference:  Koch M, Fitzpatrick AL, Rapp SR, Nahin RL, Williamson JD, Lopez OL, et al.  Alcohol Consumption and Risk of Dementia and Cognitive Decline Among Older Adults With or Without Mild Cognitive Impairment.   JAMA Network Open 2019:2(9):e1910319.                                                                                       doi.org/10.1001/jamanetworkopen.2019.10319

For the full critique of this paper by the International Scientific Forum on Alcohol Research, please click here.
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