Cognitive Functioning in Late Life: The Impact of Moderate Alcohol Consumption

doi:10.1016/j.annepidem.2006.06.005

Annals of Epidemiology

Volume 17, Issue 2, February 2007, Pages 93-99

https://doi.org/10.1016/j.annepidem.2006.06.005 Get rights and content

Purpose

Sex differences in the association between moderate alcohol consumption and cognitive functioning were examined during 4 years.

Methods

Participants were 2716 US older adults 70 years and older (mean age, = 76.02 years) who were free of cognitive impairment from the Second Longitudinal Study of Aging (1994 to 2000). Multiple logistic regression models were used to predict cognitive functioning (adapted Telephone Interview for Cognitive Status) from average daily alcohol intake (no drink, one drink or less daily, and more than one drink daily) during 4 years after controlling for covariates.

Results

Sex differences in the association between alcohol consumption and cognitive functioning were found (p < 0.01). Older adults with alcohol consumption of one drink or less per day had a lower odds of low cognitive functioning compared with abstainers for women (adjusted odds ratio [AOR], 0.67; 95% confidence interval [CI], 0.55–0.83), but not men (AOR, 0.96; 95% CI, 0.69–1.34).

Conclusions

For older adults with a level of cognitive functioning within normal ranges, moderate amounts of alcohol, an average of one drink or less daily, was protective for women, but not men. Caution should be used in suggesting moderate alcohol consumption to maintain cognitive functioning because of the risks of consuming alcohol.

Introduction

Moderate alcohol consumption in middle-aged and older adults is associated with reduced all-cause mortality and lower risk for coronary heart disease (1). In addition, moderate drinking in older adults was reported to stimulate appetite, promote regular bowel functioning, and improve mood (2). However, adults older than 65 years had fewer alcohol-related problems than younger persons (3) and consumed fewer alcoholic beverages (41.4%) than younger adults aged 45 to 64 years (63%) in 2002 (4).

Recently, several prospective studies reported that older women who consumed moderate amounts of alcohol had higher levels of cognitive functioning 5, 6. However, there is little consistent prospective evidence examining both men and women in late life 7, 8, 9, 10, 11, 12, 13, 14, 15. These inconsistent findings might be attributable to several method issues, including weak statistical power and variability in operational definitions of alcohol consumption. The objective was to examine whether there were sex differences in the association between moderate alcohol consumption and cognitive functioning by using data from a sample of US older adults free from mild to severe cognitive impairment in the Second Longitudinal Study of Aging (LSOA II) (16).

Section snippets

Participants

Data for the present investigation came from the LSOA II, a nationally representative sample with a multistage complex sampling design. The baseline of the LSOA II is the 1994 National Health Interview Survey, Second Supplement on Aging II, conducted by the Centers for Disease Control and Prevention. The Second Supplement on Aging II was composed of 9447 community-dwelling civilian men and women who were at least 70 years of age (mean, = 77.82 ± 0.08 [SE] years) and completed 11.13 ± 0.06 [SE]

Results

Of the 9447 participants in the Second Supplement on Aging II, 4995 people were eligible and participated in the first and second follow-ups. Of 4995 participants, 3406 had complete cognitive information at both the first and second follow-ups and 3204 reported their alcohol consumption. Participants were excluded for potential cognitive impairment (n = 164) or incomplete information for covariate variables (n = 324). Those not included in the final sample were older (p ≤ 0.01), had less

Discussion

Results suggest that moderate alcohol consumption, an average of one drink or less daily, is protective for cognitive functioning of women, but not men, for people with cognitive functioning within the normal range. This study not only addresses the method issues from previous studies by having greater statistical power, but also uses nationally recognized definitions of moderate alcohol consumption for older adults. In addition, it examines the relationship between alcohol consumption and

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In contrast, lower levels of drinking (< 10 g/day) in women was associated with slower rates of decline relative to non-drinking women. These findings are consistent with a number of investigations identifying stronger protective effects of moderate drinking on cognitive function in women than in men (e.g., Dufouil, Ducimetiere, & Alperovitch, 1997; McGuire, Ajani, & Ford, 2007; Stott et al., 2008), and highlight both the import and complexity of considering sex as a critical covariate in neurobehavioral analyses of alcohol effects. Topiwala et al. (2017) analyzed both structural (MRI) and behavioral measures collected over ~ 30 years of follow-ups from the Whitehall II cohort in the United Kingdom.
Epidemiological estimates indicate not only an increase in the proportion of older adults, but also an increase in those who continue moderate alcohol consumption. Substantial literatures have attempted to characterize health benefits/risks of moderate drinking lifestyles. Not uncommonly, reports address outcomes in a single outcome, such as cardiovascular function or cognitive decline, rather than providing a broader overview of systems. In this narrative review, retaining focus on neurobiological considerations, we summarize key findings regarding moderate drinking and three health domains, cardiovascular health, Type 2 diabetes (T2D), and cognition. Interestingly, few investigators have studied bouts of low/moderate doses of alcohol consumption, a pattern consistent with moderate drinking lifestyles. Here, we address both moderate drinking as a lifestyle and as an acute event.
Review of health-related correlates illustrates continuing inconsistencies. Although substantive reductions in risk for cardiovascular and T2D events are reported, robust conclusions remain elusive. Similarly, whereas moderate drinking is often associated with enhanced cognition and lower dementia risk, few benefits are noted in rates of decline or alterations in brain structure. The effect of sex/gender varies across health domains and by consumption levels. For example, women appear to differentially benefit from alcohol use in terms of T2D, but experience greater risk when considering aspects of cardiovascular function. Finally, we observe that socially relevant alcohol doses do not consistently impair performance in older adults. Rather, older drinkers demonstrate divergent, but not necessarily detrimental, patterns in neural activation and some behavioral measures relative to younger drinkers. Taken together, the epidemiological and laboratory studies reinforce the need for greater attention to key individual differences and for the conduct of systematic studies sensitive to age-related shifts in neurobiological systems.
The association between alcohol use and long-term care placement among older Canadians: A 14-year population-based study
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Studies have shown that moderate alcohol use confers protection against some of the dominant predictors of long-term care placement, including diminished cognitive functioning, physical disability, and injury. But little is known about the association between alcohol use and the likelihood of placement in long-term care facilities. A nationally representative sample of 5404 community-dwelling Canadians ages 50 years and older at baseline (1994/95) was obtained from the longitudinal National Population Health Survey. Alcohol use categories were developed based on the quantity and frequency of use in the 12 months before the interview. Cox proportional hazards models were used to estimate the association between alcohol use at baseline and subsequent placement in long-term care facilities after adjusting for covariates measured at baseline. During the 14-year follow-up period, 14% of lifetime abstainers, 10% of former drinkers, 7% of infrequent drinkers, 4% of moderate drinkers, and 3% of heavy drinkers were placed in long-term care facilities. Furthermore, the multivariate analysis revealed that abstainers, former drinkers, and infrequent drinkers were more than twice as likely to be placed in long-term care as moderate drinkers. Moderate drinking was protective against placement in long-term care facilities even after adjusting for an array of well-known confounders. The strong protective effect of moderate alcohol use on long-term care entry is likely due to a complex mix of physical, cognitive and psychosocial health factors.
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Nevertheless, socioeconomic conditions as well as biological and life style factors may accelerate cognitive aging and increase the risk for dementia (Van der Flier and Scheltens, 2005; Anderson et al., 2007). Studies have reported that besides age, educational level, sex, alcohol consumption, sedentary life and smoking represent important risk factors for cognitive decline and dementia (Hogan, 2005; Anderson et al., 2007; Anstey et al., 2007; McGuire et al., 2007; Wu et al., 2011). In addition, aging is characterized by a higher prevalence of chronic diseases and they may amplify the risk of cognitive impairment (Alves et al., 2007; Hung et al., 2011).
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In our study, moderate alcohol use was less consistently positively associated with cognitive function among women. Sex-specific associations of alcohol use with cognitive function have been found before (30), but not always as less evident among women (11, 31). Moderate alcohol use may benefit the cardiovascular system (32–36); cardiovascular disease is associated with cognitive impairment (37, 38).
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: Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

View full text

Cognitive Functioning in Late Life: The Impact of Moderate Alcohol Consumption

Purpose

Methods

Results

Conclusions

Introduction

Section snippets

Participants

Results

Discussion

Am J Prev Med

Aust N Z J Public Health

Lancet

Trends Neurosci

J Am Coll Cardiol

Am J Clin Nutr

Am J Prev Med

Ann Epidemiol

Am J Prev Med

Drug Alcohol Depend

Alcohol and the elderly

Clin Geriatr Med

Alcohol Alert No. 40: Alcohol and Aging

Health, United States, 2004 With Chartbook on Trends in the Health of Americans

Association between reported alcohol intake and cognition: Results from the Women's Health Initiative Memory Study

Am J Epidemiol

Effects of moderate alcohol consumption on cognitive function in women

N Engl J Med

Alcohol consumption and cognitive function in the Whitehall II Study

Am J Epidemiol

Smoking, drinking, and thinking. The Zutphen Elderly Study

Am J Epidemiol

Smoking, drinking, and incident cognitive impairment: A cohort community based study included in the Gospel Oak project

J Neurol Neurosurg Psychiatry

Alcohol intake in a healthy elderly population

Am J Public Health

Prospective association of smoking and alcohol use with cognitive function in an elderly cohort

J Womens Health

Cognitive function after 11.5 years of alcohol use: Relation to alcohol use

Am J Epidemiol

Alcohol drinking in middle age and subsequent risk of mild cognitive impairment and dementia in old age: A prospective population based study

BMJ