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THE RENAUD SOCIETY MEMBER BULLETIN BOARD
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| Subject: RE: Journal Watch: Alcohol & Health |
Author: R. Curtis Ellison, MD
Date: 11/23/2008 7:32 am MST
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Review of Recent Publication November 22, 2008
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Article: Peters R, Peters J, Warner J, Beckett N, Bulpitt C.
Alcohol, dementia and cognitive decline in the elderly: a systematic review. Age & Ageing 2008;37:505–512.
Summary: The authors state that dementia and cognitive decline have been linked to cardiovascular risk. Alcohol has known negative effects in large quantities but may be protective for the cardiovascular system in smaller amounts. Effect of alcohol intake may be greater in the elderly and may impact on cognition. To evaluate the evidence for any relationship between incident cognitive decline or dementia in the elderly and alcohol consumption, a systematic review and meta-analyses were carried out. Criteria for inclusion were longitudinal studies of subjects aged ≥65, with primary outcomes of incident dementia/cognitive decline.
The authors report that 23 studies were identified (20 epidemiological cohort, three retrospective matched case-control nested in a cohort). Meta-analyses suggest that small amounts of alcohol may be protective against dementia (random effects model, risk ratio [RR] 0.63; 95% CI 0.53–0.75) and Alzheimer’s disease (RR 0.57; 0.44–0.74) but not for vascular dementia (RR 0.82; 0.50–1.35) or cognitive decline (RR 0.89; 0.67–1.17). However, studies varied, with differing lengths of follow up, measurement of alcohol intake, inclusion of true abstainers and assessment of potential confounders. The authors conclude that because of the heterogeneity in the data these findings should be interpreted with caution. However, there is some evidence to suggest that limited alcohol intake in earlier adult life may be protective against incident dementia later.
Comments: The majority of prospective epidemiologic studies have shown that rates of developing dementia, as well as the degree of cognitive decline with ageing, are lower among moderate drinkers than among abstainers. Overall, the present analysis supports a protective effect of moderate drinking.
Because of diversity among studies, it proved difficult to provide precise estimates of effect for certain types of dementia. For example, vascular dementia is generally shown to have a marked inverse association with moderate alcohol intake (similar to the relation between alcohol and coronary artery disease). However, only 3 studies were included in the meta-analysis of alcohol and vascular dementia; two from Europe suggested a decrease in risk while one from Japan showed an increase in risk, and the meta-analysis indicated a statistically insignificant protective effect of alcohol.
The analyses apparently included all levels of consumption (from drinking monthly to consuming several drinks/day) in the same model. Types of beverage and pattern of drinking may not have been adequately adjusted for. These problems limit the ability of a meta-analysis to provide more valid information than individual large studies. Nevertheless, moderate drinking, especially of wine, was associated with less dementia in this meta-analysis.
Lay Summary: This meta-analysis concluded that moderate drinkers, especially wine drinkers, were at lower risk than were abstainers for developing Alzheimer’s Disease or other dementia. Since the studies that were reviewed varied markedly in terms of amounts of alcohol consumed, control of potential confounders, and information on pattern of drinking, this meta-analysis is limited as to being able to provide precise estimates of effect.
R. Curtis Ellison, MD
Yuqing Zhang, MD, DSc
Institute on Lifestyle & Health
Boston University School of Medicine |
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R. Curtis Ellison, MD |
11/23/2008 7:29 am MST |
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R. Curtis Ellison, MD |
11/23/2008 7:30 am MST |
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RE: Journal Watch: Alcohol & Health |
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R. Curtis Ellison, MD |
11/23/2008 7:32 am MST |
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R. Curtis Ellison, MD |
12/12/2008 4:07 pm MST |
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R. Curtis Ellison, MD |
1/11/2009 7:27 am MST |
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R. Curtis Ellison, MD |
1/11/2009 7:13 am MST |
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