Alcohol and cognition in the elderly: a review

Consumption of large amounts of alcohol is known to have negative effects, but consumption in smaller amounts may be protective. The effect of alcohol may be greater in the elderly than in younger adults, particularly with regard to cognition. However, the drinking pattern that will provide optimal protection against dementia and cognitive decline in the elderly has not been systematically investigated. The present paper is a critical review of research on the effect of alcohol on cognitive function and dementia in the elderly. Studies published from 1971 to 2011 related to alcohol and cognition in the elderly were reviewed using a PubMed search. Alcohol may have both a neurotoxic and neuroprotective effect. Longitudinal and brain imaging studies in the elderly show that excessive alcohol consumption may increase the risk of cognitive dysfunction and dementia, but low to moderate alcohol intake may protect against cognitive decline and dementia and provide cardiovascular benefits. Evidence suggesting that low to moderate alcohol consumption in the elderly protects against cognitive decline and dementia exists; however, because of varying methodology and a lack of standardized definitions, these findings should be interpreted with caution. It is important to conduct more, well-designed studies to identify the alcohol drinking pattern that will optimally protect the elderly against cognitive decline and dementia.     

Alcohol dependence among elderly French inpatients.

OBJECTIVE/METHODS: The authors compared groups of heavier and lighter drinkers in a geriatric hospital inpatient unit in France, using questionnaire measures of alcohol dependence, sociodemographic characteristics, and cognitive status. RESULTS: Alcohol consumption is more frequent in men than in women; 9% of the geriatric patients (3% of women and 18% of men) show symptoms of alcohol dependence. Alcohol dependence is also associated with benzodiazepine treatment and nicotine dependence. CONCLUSION: Elderly male patients hospitalized in the geriatric unit and receiving benzodiazepines should thus be identified as a population at risk for alcohol dependence, and medical practitioners should be alert to the possibility of overprescribing benzodiazepines past the acute withdrawal stage.     

Alcohol withdrawal delirium manifested by manic symptoms in an elderly patient

Alcohol withdrawal syndrome is a commonly seen problem in psychiatric practice. Alcohol withdrawal delirium is associated with significant morbidity and mortality. Withdrawal symptoms usually include tremulousness, psychotic and perceptual symptoms, seizures, and consciousness disturbance. Herein, we report a case involving a 63‐year‐old man who had alcohol withdrawal delirium that was manifested mainly by manic symptoms.     

Alcohol use and abuse in the elderly: Findings from the liverpool longitudinal study of continuing health in the community

Problem drinking and patterns of alcohol consumption are examined as part of a follow-up study of 1070 elderly subjects randomly selected from Liverpool general practitioner lists. Using a community version of the Geriatric Mental State Examination, the prevalence of current drinking problems was found to be 9.4/1000 subjects aged 65 and over. At follow-up three years later, one-third were drinking moderately and a similar proportion whose health had seriously deteriorated were abstinent. Detailed examination of drinking patterns reveals a decline with age in the number of subjects drinking regularly. This decline is accompanied by a trend towards reduction in alcohol consumption with age which is less marked for women. Nearly one-fifth of both males and females who are drinking regularly are exceeding recommended sensible limits of alcohol consumption.     

Alcohol abuse in an inner city elderly population: The gospel oak survey

One hundred and seventy-nine men and 335 women over the age of 65 years, ascertained in a community survey, completed the CAGE questionnaire to detect possible alcohol abuse. Only three subjects were CAGE positive and thus at risk for alcohol abuse. It is concluded that current alcohol abuse does not underlie neuropsychiatric conditions in the elderly and fears of significant rates of abuse in this population are probably unfounded. Further research is necessary.     

Alcohol abuse among elderly patients in a general hospital as identified by the Munich Alcoholism Test

The aim of this study was to assess the prevalence of alcohol abuse among elderly patients in a general hospital. Scores on the Dutch version of the Munich Alcoholism Test (MALT) and medical records were obtained from 132 patients aged 65 and over, staying at the University Hospital Leiden. According to the MALT, 9% of the elderly patients (13% of the men and 7% of the women) were classified as alcoholics. In contrast, the discharge diagnosis involved alcohol dependence or abuse for only 0.5% of the patients 65 years and over admitted in 1989. In this study, two thirds of the alcoholic patients were recognized by the attending physician. Vague symptoms as admission diagnosis occurred more frequently in alcoholics than in nonalcoholics. Regarding former medical diagnoses, alcoholics had suffered significantly more often from organic brain diseases. In comparison to nonalcoholics, elderly alcoholics used more psychotropic drugs.     

Alcohol consumption in the elderly and risk of dementia related death - a Norwegian prospective study with a 17-year follow-up

Purpose: The aim of this study was to determine the association between alcohol intake and risk of dementia related death, taking into account relevant confounding and mediating factors. Materials and Methods: Data was obtained from a Norwegian prospective study with a 17-year follow-up. The study population comprised 25,635 participants aged between 60 and 80 years at the time of examination from the Cohort of Norway (CONOR). Cox regression was used to investigate the association between alcohol use and dementia related death. Results: Nearly half (12,139) of the study population died during follow-up, of which 1,224 had a diagnosis of dementia on their death certificate. The risk of dementia related death was significantly higher among abstainers than among individuals that drank alcohol once per month (HR = 1.33, 95% CI = 1.14–1.56, p < 0.001, in a fully adjusted model). Respondents with missing information regarding alcohol consumption (representing 5% of the study population) had the highest risk of dementia related death (HR = 1.60, 95% CI = 1.28–2.00, p < 0.001) and also significantly higher mortality rates due to alcohol-related causes (HR = 1.41, 95% CI = 1.03–1.93, p = 0.031) and other causes (HR = 1.32, 95% CI = 1.21–1.43, p < 0.001), all compared to those drinking alcohol no more than once per month. Conclusion: These findings suggest that the risk of dementia related death is significantly higher among elderly abstainers than among those who drink alcohol, after adjusting for relevant confounders. However, care should be taken in interpretation of data due to missing information on drinking frequency, as this missing-group might have a large share of the heavy drinkers in the study cohort.     

Alcohol and the serotonin system]

There is considerable evidence from animal and human studies that serotonin plays a role in the modulation of alcohol intake and/or alcohol dependence. Biochemical, behavioral and pharmacological studies both in animal and man had verified this hypothesis. Central and peripheral levels of serotonin and of its metabolite 5-hydroxyindoleacetic acid (5-HIAA) are modified by alcoholisation. Moreover, the use of pharmacological drugs modifying specifically serotonin transmission decreases ethanol intake. Our own studies suggest that a dysfunctioning of serotonin uptake system could be implicated in the individual risk of alcohol dependence. Even if other systems, e.g. amino acids, are involved in the regulation of alcohol behavior, all data are in favor of a modulation of alcohol intake by serotonin transmission.     

Alcohol and crime

The role alcohol abuse plays in criminality has been a matter of primary concern for scholars for decades, as indicated by numerous studies and research projects. Most of these studies focus on determining the presence of a relationship between criminal behaviour and alcohol use, and whether criminal inclinations increase with the consumption of alcohol. Research shows that alcohol use indeed increases the risk of criminal behaviour, and that there is an especially strong and consistent correlation between alcohol abuse and violent crimes. However, researchers still disagree on the exact extent to which alcohol use effects criminality, and on the mechanisms causing alcohol to induce violent behaviour. A significant proportion of studies have focused in recent years on aggressive behaviour as a result of drinking alcohol. One of the most important means of measurement is the study of violent behaviour in places where alcohol is on sale. Studying the forms and frequency of violence in pubs and near off-licence stores greatly enables experts to understand the general context of the problem. This is the reason for the increasing interest in the topic throughout the past few decades. The present study focuses mainly on the literature published in English and German in leading journals of criminology since 1980, as well as on the most recent and fundamental publications on the topic, with special regard to results concerning drinking habits, and the relationship between drinking alcohol and violent or criminal behaviour, respectively.