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Doctors newspaper online, 04.10.2019
Alcohol in old age
People who regularly drink small amounts of alcohol when they are old may be able to prevent dementia – even if they already have initial cognitive limitations. This was the result of a US study.
By Thomas Müller
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The most important facts in brief
Question : Should Older People with First Cognitive Deficits Refrain from Alcohol?
Answer : In the six-year GEM study, the incidence of dementia was lowest with low to moderate alcohol consumption – even among participants with MCI.
Meaning : A glass of wine or a can of beer a day does not seem to increase the risk of dementia in MCI either, but it should not be much more alcohol.
Restriction : Alcohol quantities based on self-reports, study quite small.
BOSTON. On the subject of alcohol raging sometimes a true religious war for the exegesis of scientific literature: some see the glass half full with regard to the risks and advise as possible from any alcohol consumption, the other half see it empty and can for a moderate consumption rather advantages, at least but recognize no disadvantages.
In fact, the U- or J-shaped curves, as they appear quite consistently in epidemiological studies on dementia and cardiovascular risks, allow a variety of interpretations.
The only thing that is clear is that a lot of alcohol harms a lot, and most often starts with two beers a day or an equivalent amount of ethanol from other drinks. So it is hardly surprising that another study has found that moderate alcohol consumption is associated with a reduced risk of dementia – whatever that may be.
Study illuminated benefits of Ginkgo biloba
Health researchers around Dr. Manja Koch from the Chan School of Public Health in Boston evaluated long-term data from the Ginkgo Evaluation of Memory Study (GEMS) (JAMA Netw Open 2019; 2 (9): e1910319) .
The study was primarily intended to compare the benefits of Ginkgo biloba with placebo. Participants were 3069 people aged averaging 78 years. Around 16 percent showed first cognitive deficits (MCI), the rest were cognitively unremarkable. On average, the subjects participated in the study for six years. During this time, 277 in the Ginkgo and 246 in the placebo arm fell ill with dementia – so Ginkgo could not lower the dementia rate.
Koch's team now used the dataset to retrospectively correlate dementia incidence with alcohol consumption. Consumption was determined via questionnaires at the beginning of the study.
Because participants were routinely thoroughly neuropsychiatric in the course of the study, the effects of alcohol consumption on cognition should be clearly visible. However, alcoholics were excluded.
Reduced dementia risk
In the initial interview, attendees should state how much beer, wine, and other alcoholics they consumed per week – as well as how much they drank each time they enjoyed alcohol. The researchers calculated the information in standard drinks, based on a can of beer (350ml) or a glass of wine (180ml). One drink equals about 14 g of pure ethanol.
Researchers divided the GEMS subjects into five groups: 42 percent were abstainers, 15 percent drank almost nothing (less than one drink a week), 23 percent consumed 1 to 7 drinks a week, and 10 percent indulged in 7 to 14 drinks and also 10 percent more than 14 drinks.
For reference, Koch's team chose participants with very low levels of consumption (less than one drink a week), but no abstinence, as abstainers often include former alcoholics, which could distort the outcome.
Taking into account all known concomitant factors such as age, gender, education, comorbidities, and drug prescriptions, the rate of dementia was lowest for those without initial MCI who consumed 7 to 14 drinks per week. They were able to enjoy a 37 percent reduction in the incidence of dementia compared to those who drank very little.
Similar trend among participants with MCI
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Even the group with the highest alcohol consumption shone with a slightly lower rate of dementia. However, all differences were not significant, but there were probably too few subjects and dementia patients in this group.
A similar trend was seen among the participants with MCI at baseline: here the incidence of dementia was lowest in the group with 1 to 7 drinks per week (minus 10 per cent) and slightly lower even with moderate consumption (minus 7 per cent) but significantly increased in the group with the highest consumption (plus 72 percent) – again compared to participants who drank very little or nothing at all, and again all results were not significant.
A statistically reliable result brought the study to light, and in terms of the distribution of alcohol consumption: Who enjoys a drink every day and no longer has, according to these data, only half as high risk of developing dementia, such someone who drinks alcohol much less often, but then needs two or more drinks. Regularly a glass of wine is probably associated with a reduced risk of dementia.
What can be concluded from the data? The basic problem of the study was the low number of participants and thus a low event rate. Barely significant results can be expected in small groups. Nevertheless, the known association between low to moderate alcohol consumption and reduced risk of dementia was shown.
For MCI, however, the threshold for high-risk alcohol consumption may be slightly lower than for cognitively healthy older people, suggesting a more modest alcohol intake in people with incipient dementia, but even for such recommendations, the study data are unlikely.
As always, it remains unclear whether it is alcohol or other factors if elderly people, who like to drink a glass of beer or wine, are less likely to suffer from dementia than those who drink no or almost no alcohol.
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