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Even moderate alcohol consumption increases risk of cognitive decline

30 Jun

This month The British Medical Journal published a paper titled : “Moderate alcohol consumption as risk factor for adverse brain outcomes and cognitive decline: longitudinal cohort study.” Here is the abstract:

Objectives To investigate whether moderate alcohol consumption has a favourable or adverse association or no association with brain structure and function.

Design Observational cohort study with weekly alcohol intake and cognitive performance measured repeatedly over 30 years (1985-2015). Multimodal magnetic resonance imaging (MRI) was performed at study endpoint (2012-15).

Setting Community dwelling adults enrolled in the Whitehall II cohort based in the UK (the Whitehall II imaging substudy).

Participants 550 men and women with mean age 43.0 (SD 5.4) at study baseline, none were “alcohol dependent” according to the CAGE screening questionnaire, and all safe to undergo MRI of the brain at follow-up. Twenty three were excluded because of incomplete or poor quality imaging data or gross structural abnormality (such as a brain cyst) or incomplete alcohol use, sociodemographic, health, or cognitive data.

Main outcome measures Structural brain measures included hippocampal atrophy, grey matter density, and white matter microstructure. Functional measures included cognitive decline over the study and cross sectional cognitive performance at the time of scanning.

Results Higher alcohol consumption over the 30 year follow-up was associated with increased odds of hippocampal atrophy in a dose dependent fashion. While those consuming over 30 units a week were at the highest risk compared with abstainers (odds ratio 5.8, 95% confidence interval 1.8 to 18.6; P≤0.001), even those drinking moderately (14-21 units/week) had three times the odds of right sided hippocampal atrophy (3.4, 1.4 to 8.1; P=0.007). There was no protective effect of light drinking (1-<7 units/week) over abstinence. Higher alcohol use was also associated with differences in corpus callosum microstructure and faster decline in lexical fluency. No association was found with cross sectional cognitive performance or longitudinal changes in semantic fluency or word recall.

Conclusions Alcohol consumption, even at moderate levels, is associated with adverse brain outcomes including hippocampal atrophy. These results support the recent reduction in alcohol guidance in the UK and question the current limits recommended in the US.

There is a good account in The Washington Post

The Alcohol Harm Paradox

15 May

I had not heard of this relationship before and thought my readers might be interested. The alcohol harm paradox refers to the fact that “that people with low individual or neighbourhood socioeconomic status (SES) show a greater susceptibility to the harmful effects of alcohol”

For example, in England:

Lower SES is associated with an almost two fold greater risk of alcohol related death compared with individuals in higher SES classifications.
Relative to high SES, low SES is associated with an increased risk of head and neck cancers, strokes, hypertension, liver disease and pre-term birth. These findings are independent of a number of other known risk factors for these conditions such as diet and smoking.

Here is a large study of the effect. It concludes:

Different SES measures appear to influence whether the Alcohol Harm Paradox is observed as a linear trend across SES groups or a phenomenon associated particularly with the most disadvantaged. The paradox also appears more concentrated in men and younger age groups

It would not surprise anyone that greater wealth affords greater protection from the vicissitudes of life, but other variables may play a role, such as class differences in the patterns of drinking behavior and the beverages consumed.

Testing a hypothesis: Over 21 edition

24 Apr

Tonight, I am going to lecture about hypothesis testing. I plan to show my students this video I found on BoingBoing:

The question for the students: was this a fair test?

Alcohol Has No Health Benefits

7 Sep

The Times recently republished this piece  on longevity. Most of the advise is reasonably sound, but it does include this:

It’s O.K. to drink red wine. “A glass of wine is better than a glass of water with a Mediterranean meal.”

If only it were true. Unfortunately, there is good reason to doubt this much promoted advice. See for example, this recent article by Dr. Mirkin:

A study from New Zealand shows that 30 per cent of alcohol–related deaths are from cancer, and 60 per cent of those deaths are from breast cancer. One third of these deaths were associated with an average of fewer than two drinks a day (Drug Alcohol Rev, June 16, 2016). However, the more you drink, the more likely you are to develop certain cancers. Alcohol increases risk for cancers of the oropharynx, larynx, esophagus, liver, colon, rectum, breast, cervix, vulva, vagina, skin, bladder, lung, stomach, skin, prostate and pancreas, and for leukemia and multiple myeloma.

For many years it was claimed that low levels of alcohol consumption had health benefits. More recently, we have learned that the harm of alcohol is dose dependent, the more you drink, the greater the risk to your health. It is quite possible that low levels of exposure pose very little risk, but the optimal level of consumption appears to be zero.

 

“Do ‘Moderate’ Drinkers Have Reduced Mortality Risk?”

30 Mar

Not according to this meta-analysis published in  The Journal of Studies on Alcohol and Drugs.

“In summary, analyses of groups of higher quality studies free from abstainer biases were less likely to find evidence of reduced risk of mortality (i.e., health benefits) at low levels of alcohol consumption. Rather, the pattern of results is more consistent with a linear dose response than a J-shaped curve describing the risk relationships between level of alcohol consumption and all-cause mortality.”

 

Alcohol and the adolescent brain

29 Jan

A paper in Neuroscience and Neuroeconomics:

“Alcohol drinking is a significant risk factor for morbidity and mortality in adolescents worldwide. Adolescents frequently binge drink, and this pattern of use is associated with poor school performance, injuries, violence, drug use, and a variety of poor psychosocial outcomes in adulthood. These associations have raised concerns that alcohol drinking may damage the adolescent brain and lead to impaired cognition and behavior. Similar to the neurotoxicity seen in adult alcoholics, magnetic resonance imaging studies of brain anatomy in adolescent drinkers have shown that alcohol disrupts the development of temporal and frontal cortices and myelinated fiber tracts throughout the brain. Although adult brains show some recovery with abstinence, at present, no studies have examined brain recovery in adolescents. Studies of neuropsychological function have found deficits in attention and visuospatial ability that show dose-dependent correlations with alcohol exposure and withdrawal symptoms, but visuospatial performance recovers with short-term abstinence. Differences in executive function and decision-making have also been found, but the available evidence suggests that these are not primarily the result of alcohol exposure; instead, they reflect premorbid factors that increase risk-taking and substance use. Nevertheless, alcohol drinking by adolescents remains an important concern because of the potential for brain injury in addition to the many negative consequences associated with acute intoxication.”

 

The cost of drinking

21 Oct

Alcohol is the world’s most popular neurotoxicin. Its effects on the brain are well documented. A recent article in The Washington Post reviews the hidden costs of drinking.

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Prohibition was a failure, but the article makes a good case for increasing taxes on alcohol.

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