ARTICLE: Relation between alcohol consumption in midlife and dementia in late life

AUTHOR: Sevil Yasar

JOURNAL: BMJ. 2018 Aug 1;362:k3164. doi: 10.1136/bmj.k3164.

Alzheimer’s disease is a rapidly growing clinical and public health problem with currently no disease modifying therapies to treat or prevent the disease.1 Research suggests that pathological changes precede clinical symptoms by decades,2 resulting in an increased interest in modifiable lifestyle and health related risk factors in midlife.3

Interest in the health effects of alcohol, including risk of dementia, has been ongoing for a long time. Epidemiological studies reported a J-shaped relation, in which abstaining from alcohol (<1 unit/week) or consuming large amounts (>21-28 units/week) was associated with an increased risk of dementia compared with light to moderate (7-21 units/week) consumption.4 However, these studies had relatively short follow-ups of 2-9 years.4 Only a few studies had longer follow-up or assessed the role of ethnicity or sex or types of alcohol consumed, and none evaluated the effects of change in consumption behaviour. Light to moderate alcohol use has also been associated with a cardioprotective effect through anti-inflammatory or antioxidant pathways, or both,5 and a reduction in mortality.6

In a linked article, Sabia and colleagues (doi:10.1136/bmj.k2927) attempt to tackle some of these issues.7 They evaluated the effects of midlife alcohol consumption on risk of dementia in 9087 participants of the Whitehall II study over a mean follow-up of 23 years. Participants were stratified as abstainers; moderate alcohol drinkers, consuming 1-14 units/week (this group also served as the reference group); or excessive drinkers consuming 14 units/week or more—a definition based on recently revised UK guidelines.8

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