Alcohol - PowerPoint Presentation

Slide1

Alcohol

Intake & Cognitive Decline

Rebeckah Roberts

Photo: Baylor.eduSlide2

Background: Impact of DementiaNormal c

ognitive decline  dementiaDementia: cognitive impairments that are severe enough to cause significant decline in everyday

functioningPrecursor to Alzheimer’s diseaseHealth care costs are 3X that of those without dementia in the United States

Prevalence of Alzheimer's disease is expected to increase

by 50%

5.1

million to 7.7 million by

2030

Maintaining cognitive function before reaching late adulthood is likely important in overall health and in the reduction of health care costs Slide3

Background: Impact of AlcoholHeavy alcohol consumption can greatly impair cognitive functioning  dementia

In 2012, alcohol accounted for 5.1% of disability adjusted life years (DALYs) worldwide (WHO, 2014). Possible protective effect of alcohol on cognitive decline with low-to-moderate intake.Slide4

USDA GuidelinesModerate alcohol consumption:1 drink per day for women 2 drinks per day for

menOne drink is defined as:12 fluid ounces of regular beer 5 fluid ounces of wine or

1.5 fluid ounces of 80-proof distilled spirits Slide5

Purpose The purpose of this review is to synthesize the most recent and

relevant studies on alcohol intake in middle-late adulthood, and seek to determine whether or not low-to-moderate alcohol intake is a risk factor

for cognitive decline.Slide6

MethodsSimmons Library DatabaseKey Words:

Alcohol Intake/Abuse, Cognitive Decline/Impairment/Change/Function, AND AgeInclusion Criteria:

English, Peer-Reviewed, 2009-2014, Original Research Study, Humans, Adults Aged 18+ Slide7

Simmons Library Search: n=

10

Citation Indexes of Initial Articles:

n=

6

EBSCOhost Research Database Interface (Thesaurus MeSh):

n=5

Citation Indexes of Additional

Articles:

n=4

Criteria:

original research study, outcome measure of cognition, humans, adults aged 18 and

older, appropriate

design, recruitment, data analysis and outcome measures. Reviews were used only as background material, while case studies, and editorials were not included.

Articles Excluded: n= 7

18 articles for use in this reviewSlide8

AbbreviationsMMSE: Mini Mental State ExaminationAD: Alzheimer’s DiseaseMCI: Mild Cognitive ImpairmentMCD: Mild Cognitive DiseaseTCBV: Total Brain Volume/Cranium SizeTIC-m: Alcohol Intake telephone Interview

NART: National Adult Reading TestAUDIT: Alcohol Use Disorders Identification TestHAS: History & Aeitology ScheduleSlide9

Effect# of Studies

DesignAuthorProtective15

Case-ControlCross-Sectional(12) Prospective Cohorts

Garcia

Chan & Lopes

Arntzen, Cherbuin, Gross, Nooyens, Park, Sabia

(2009), Sabia (2010), Sun, Virta, Weyerer, Xu, Zanjani

Harmful

1

(1) Cross-Sectional

Paul

No Association

2

Cross- Sectional

(1) Prospective Cohort

Cooper

Lobo

Study EffectsSlide10

Protective Effect

Theme# of StudiesDesign

AuthorsBroad

3

(1) Cross-Sectional

(2) Prospective Cohorts

Chan

Gross

& Virta

Gender

6

(1) Case-Control

(1)

Cross-Sectional

(4) Prospective Cohorts

Garcia

Lopes

Nooyens, Park, Sun, & Zanjani

Health Behaviors2(2) Prospective CohortsCherbuin & Sabia (2009)Type of Alcohol2(2) Prospective Cohorts

Artnzen & NooyensDementia4

(1) Case-Control(3) Prospective Cohorts

GarciaCherbuin,Weyerer & Xu

Socioeconomic Status1

(1) Prospective CohortSabia (2010)Slide11

Broad

# of StudiesDesignAuthors

Results3(1)

Cross-Sectional

Chan

Light-to-Moderate drinkers had higher MMSE scores (p<0.001)

Non-drinker:

18.68

6.3

Light-drinker:

20.596.12

Moderate-drinker:

24.695.40

Heavy-drinker: 15.09 5.39

(2) Prospective Cohorts

Gross1 drink/week greater alcohol intake was associated with lower phonemic fluency: 1986 (p<0.02) 1993 (p<0.004) 2003 (p<0.03)

VirtaHeavy

drinkers & Abstainers had increased risk for cognitive impairment Heavy: OR: 1.94 (1.08-3.44)

Abstainers: OR: 1.44 (1.02-2.10)Slide12

Gender

StudiesDesignAuthors

Results6(1) Case-Control

Garcia

Protective

effect for women who drank moderately

OR: 0.48 (0.27-0.84) p<0.001

Women who drink 40+ years had lower risk for AD

OR:

0.22 (0.08-0.66) p=0.001

(

1)

Cross-Sectional

Lopes

Women

m

ore likely than low-to-moderate drinkers for impaired cognition (p<0.001) Abstainers: OR: 1.8 (1.2-2.7) Heavy: OR: 4.7 (1.8-12.1)(4) Prospective Cohorts

Nooyens, Park, Sun, & ZanjaniTotal consumption inversely associated with global cognitive functioning

p for trend=0.02 Dose response relationship was shown in male subjects (p for trend=0.044)

Infrequent drinking decreased odds of cognitive impairment in women OR: 0.67 (0.42-1.00)

Light-to-moderate alcohol intake was associated with increased odds of successful aging

5.1g – 15g/day: OR: 1.19 (1.01,1.40) 15.1g – 30g/day: OR: 1.28(1.03,1.58)

Women abstainers (p<0.0001) had highest decline in perceptual compared to regular drinkers. Men declined across drinking status (p for trend=0.0001) Slide13

Health BehaviorsAlcohol Abstinence is a predictor for MCIOR: 9.10 (3.02-27.42) p<0.001

Higher risk for MCI for low & high intake categoriesOR: 1.53 (1.18-2.11) p=0.002Abstinence was associated with higher risk Executive Function

OR: 1.71(1.39-2.10)Memory OR: 1.34(1.08-1.66)

# of Studies

Design

Authors

2

(

2) Prospective Cohorts

Cherbuin

& Sabia

(2009)Slide14

Type of AlcoholModerate red wine consumption is protective of cognitive decline

Independently associated with better performance on all cognitive testsP for trend: 0.0003-0.04 (men)P for trend: <0.0001-0.002 (women)Inversely associated with decline in global

cognitive functioning, memory, & flexibilityGlobal Cognitive Functioning (P for trend: <0.01)

Memory (P for trend: <0.01)

Flexibility (P for trend: 0.03)

Theme

# of Studies

Design

Authors

Type of Alcohol

2

(2) Prospective Cohorts

Artnzen & NooyensSlide15

Dementia/ADCompared with abstainers, people who consumed alcohol were 47% less likely to develop AD OR: 0.53 (0.32-0.88) p =0.001

Light-to-moderate drinkers had better MMSE scores 2 years post diagnosis of MCIThan abstainers (p<0.01) & heavy drinkers (p<0.05)

Heavy drinkers had a higher risk of dementiaThan abstainers & low-to-moderate drinkers (p for both: <0.05)Light-to-moderate drinkers had decreased risk of dementia

Light (20g)

OR: 0.04 (0.17-0.94) p<0.034

Moderate (29g)

OR: 0.13 (0.02-0.95) p<0.045

Theme

# of Studies

Design

Authors

Dementia

4

(1) Case-Control

(3)

Prospective Cohorts

Garcia

Cherbuin, Weyerer & XuSlide16

Socioeconomic StatusLow Occupational Group>21 drinks/week (heavy intake) had mean DSST score 2.1 (-3.9, -0.3) points lower than those consuming 14 drinks/week (moderate intake)

Great ↑ or ↓ in alcohol consumption was associated with lower DSSTGreat Increase: -3.9 (-6.1,-1.7) pointsGreat Decrease: -3.5 (-6.2,-0.7) points

Low Educational Group>21 drinks/week (heavy intake) had mean DSST score 3.6 (-7.1, -0.0) points lower than those consuming 14 drinks/week (moderate intake

)

# of Studies

Design

Authors

1

(1) Prospective Cohort

Sabia (2010)Slide17

Not ProtectiveIncrease in alcohol intake was associated with a decrease in TCBV (p<0.01)

Beta Coefficient: -0.25To verify that there was no protective effect of alcohol intake, the low consumption group was compared to each of the other intake groupsP<0.07 (women)P<0.39 (men)

No significant difference for either sex

# of Studies

Design

Authors

1

(1)

Cross-Sectional

Paul (2009)Slide18

No Association

Does not benefit or harm cognitive healthTIC-m scores were lower in abstainersOR: 22.3 (21.6-23.0)

No stat sign differences in types of abstainersAdjusted odds ratios for severe cognitive decline<12g/day OR: 0.61(0.31,1.20) men & 0.88(0.45,1.72)

women

12-24g/day OR:

1.19 (0.61,2.32)

men &

2.38(0.98, 5.77)

women

# of Studies

Design

Authors

2

(1) Cross-Sectional

(1) Prospective

Cohort

Cooper

, 2009

Lobo, 2010Slide19

DiscussionVariance in Alcohol Intake & Cognitive Measures

All Alcohol Intake was Self-reportedFormer-drinkers included in Abstainers GroupTime at which cognition was measured:PeriodicallyOnly once (change or decline in cognition could not be evaluated

)ConfoundersNon-generalizable Populations:Nurses Health Study, White Males with Medical Degrees, Low-SES, Chinese Men, Low Survival

RateSlide20

Alcohol Intake VarianceMean total Daily Consumptionof Pure

AlcoholNumber of Glasses/DayTotal of AlcoholBeerWineSpirits

Pattern of Alcohol Intake:1-2 days/week3-4days/week5-7

days/week

Category

Abstainers

No alcohol

Former drinkers

Light

<168g m <112g w

0-3drinks/week

1-13 units m

1-7 units w

Moderate

>168<400g m >112<280g w

>3-14drinks/week m

>3-7drinks/week w

14-27 units m

8-13 w

<7drinks/week

Heavy

>400g m >280g w

>14 drinks/week m >7drinks/weeks w

28-42 units m

14-28 w

>7 drinks/week

Hazardous/At Risk

>42 units =6+ drinks/day m

>28 units w

Average Weekly Alcohol

Consumption:

Frequency:

Number of Times/Week

Infrequent: 1-3x/week

Frequent: >

4x/week

<1 glass/14 days

1-2 glasses/14

days

3-4 glasses/14 days

>5 glasses/14 daysSlide21

Cognitive Measure VarianceVerbal memory test Digit-symbol coding test Tapping testMMSE scoresOnset of MCD

Onset of ADPhonemic & Semantic FluencyAttentionGlobal CognitionCFI Screening TestDSST Test “Successful Aging”TIC-m Scores

TCBVNARTSlide22

ConclusionMost studies showed a protective association

Quantity & Frequency affected risk of cognitive declineHeavy Drinking & High Frequency of Drinking: ↑ risk

Increased risk in Abstainers: U-shaped trendAbstainers & Heavy: ↑ riskLow-to-Moderate: ↓risk

Women vs. Men

Type of Alcohol: Red Wine was protective

Antioxidant Qualities?

Low SES:

↑

risk

Cognitive reserve with higher SES?Slide23

ImplicationsNo explicit measurable quantity of alcohol intake can be defined as protective

Future studies should focus on:Generalizable PopulationStandard Categories of Alcohol Intake (USDA)Cognitive Function should be measured at Baseline & Follow-up

Benefits of low-to-moderate alcohol consumption do not outweigh the risks of other ailments

DO NOT

start drinking exclusively to protect against cognitive declineSlide24

Questions?Slide25

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http://www.who.int/substance_abuse/publications/global_alcohol_report/msb_gsr_2014_1.pdf?ua=1

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