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HHS — Elder Justice Roadmap Project Report

July 10, 2014 Comments off

Elder Justice Roadmap Project Report (PDF)
Source: U.S. Department of Health and Human Services (National Center on Elder Abuse)

The Top Five Priorities critical to understanding and reducing elder abuse and to promoting health, independence, and justice for older adults, are:
1. Awareness: Increase public awareness of elder abuse, a multi-faceted problem that requires a holistic, well-coordinated response in services, education, policy, and research.
2. Brain health: Conduct research and enhance focus on cognitive (in)capacity and mental health – critical factors both for victims and perpetrators.
3. Caregiving: Provide better support and training for the tens of millions of paid and unpaid caregivers who play a critical role in preventing elder abuse.
4. Economics: Quantify the costs of elder abuse, which is often entwined with financial incentives and comes with huge fiscal costs to victims, families and society.
5. Resources: Strategically invest more resources in services, education, research, and expanding knowledge to reduce elder abuse.

Hat tip: PW

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Geographical variation in dementia: systematic review with meta-analysis

June 27, 2014 Comments off

Geographical variation in dementia: systematic review with meta-analysis
Source: International Journal of Epidemiology

Background
Geographical variation in dementia prevalence and incidence may indicate important socio-environmental contributions to dementia aetiology. However, previous comparisons have been hampered by combining studies with different methodologies. This review systematically collates and synthesizes studies examining geographical variation in the prevalence and incidence of dementia based on comparisons of studies using identical methodologies.

Methods
Papers were identified by a comprehensive electronic search of relevant databases, scrutinising the reference sections of identified publications, contacting experts in the field and re-examining papers already known to us. Identified articles were independently reviewed against inclusion/exclusion criteria and considered according to geographical scale. Rural/urban comparisons were meta-analysed.

Results
Twelve thousand five hundred and eighty records were reviewed and 51 articles were included. Dementia prevalence and incidence varies at a number of scales from the national down to small areas, including some evidence of an effect of rural living [prevalence odds ratio (OR) = 1.11, 90% confidence interval (CI) 0.79–1.57; incidence OR = 1.20, 90% CI 0.84–1.71]. However, this association of rurality was stronger for Alzheimer disease, particularly when early life rural living was captured (prevalence OR = 2.22, 90% CI 1.19–4.16; incidence OR = 1.64, 90% CI 1.08–2.50).

Conclusions
There is evidence of geographical variation in rates of dementia in affluent countries at a variety of geographical scales. Rural living is associated with an increased risk of Alzheimer disease, and there is a suggestion that early life rural living further increases this risk. However, the fact that few studies have been conducted in resource-poor countries limits conclusions.

SAGE – A Test to Measure Thinking Abilities

June 26, 2014 Comments off

SAGE – A Test to Measure Thinking Abilities
Source: Ohio State University (Wexner Medical Center)

The Self-Administered Gerocognitive Exam (SAGE) is designed to detect early signs of cognitive, memory or thinking impairments. It evaluates your thinking abilities and helps physicians to know how well your brain is working.

You may want to take SAGE if you are concerned that you might have cognitive issues. Or you may wish to have your family or friends take the test if they are having memory or thinking problems. The difficulties listed can be early signs of cognitive and brain dysfunction. While dementia or Alzheimer’s disease can lead to these symptoms, there are many other treatable disorders that also may cause these signs.

It is normal to experience some memory loss and to take longer to recall events as you age. But if the changes you are experiencing are worrying you or others around you, SAGE can be a helpful tool to assess if further evaluation is necessary.

See: A Test for the Early Detection of Alzheimer’s Disease (New York Times)

Improving Dementia Long-Term Care: A Policy Blueprint

June 25, 2014 Comments off

Improving Dementia Long-Term Care: A Policy Blueprint
Source: RAND Corporation

In 2010, 15 percent of Americans older than age 70 had dementia, and the number of new dementia cases among those 65 and older is expected to double by the year 2050. As the baby boomer generation ages, many older adults will require dementia-related long-term services and supports (LTSS). This blueprint is the only national document to date that engages local, state, and national stakeholders to specifically focus on policy options at the intersection of dementia and LTSS.

The authors undertook five major tasks that resulted in a prioritized list of policy options and research directions to help decisionmakers improve the dementia LTSS delivery system, workforce, and financing. These were to (1) identify weaknesses in the LTSS system that may be particularly severe for persons with dementia; (2) review national and state strategies addressing dementia or LTSS policy; (3) identify policy options from the perspective of a diverse group of stakeholders; (4) evaluate the policy options; and (5) prioritize policy options by impact and feasibility.

Stakeholders identified 38 policy options. RAND researchers independently evaluated these options against prespecified criteria, settling on 25 priority options. These policy options can be summarized into five objectives for the dementia LTSS system: (1) increase public awareness of dementia to reduce stigma and promote earlier detection; (2) improve access to and use of LTSS; (3) promote high-quality, person- and caregiver-centered care; (4) provide better support for family caregivers of people with dementia; and (5) reduce the burden of dementia LTSS costs on individuals and families.

This policy blueprint provides a foundation upon which to build consensus among a larger set of stakeholders to set priorities and the sequencing of policy recommendations.

Dementia’s Mounting Toll on the U.S. Economy

June 11, 2014 Comments off

Dementia’s Mounting Toll on the U.S. Economy
Source: RAND Corporation

Dementia costs Americans hundreds of billions of dollars per year, and the annual cost could top half a trillion by 2040 due to the “graying” of the U.S. population. This infographic shows the soaring economic costs and caseload of dementia.

Lost and Found: Understanding Technologies Used to Locate Missing Persons with Alzheimer’s or Dementia

April 14, 2014 Comments off

Lost and Found: Understanding Technologies Used to Locate Missing Persons with Alzheimer’s or Dementia (PDF)
Source: Bureau of Justice Assistance

Alzheimer’s disease and other forms of dementia affect not only those who are living with the disease; these afflictions also impact the caregivers, law enforcement, and even neighbors. As the disease progresses, physical and mental capabilities are negatively impacted, short-term memory loss increases, and a person with Alzheimer’s might begin living in the past. As the person attempts to return to former places of employment or residences, they often get lost and need assistance returning to where they are currently residing. It is never possible to predict if or when a person with Alzheimer’s will wander or be unable to navigate familiar routes. Initiating a search for a person with Alzheimer’s can never be delayed, and conducting such searches can prove to be costly and consume extreme amounts of agency resources. It is crucial for law enforcement officers and other first responders to be familiar with and understand the signs of dementia and be aware of passive identification products used to identify persons with Alzheimer’s. In addition to passive identification techniques, there are technologies and products available that can be used to actively locate an individual who is lost.

Cellular location techniques and Global Positioning System devices are examples of proven methods for aiding law enforcement in a search for a missing person with dementia. This document will provide a technical description of these technologies and outline some of the advantages and disadvantages when employing these products. It will also provide comprehensive lists of locating devices that are currently available. Provided in each section is a short technical description of the technology and its advantages and the disadvantages. Appendix I and Appendix II provide a list of passive and active locating devices currently available.

Dementia Special Care Units in Residential Care Communities: United States, 2010

December 2, 2013 Comments off

Dementia Special Care Units in Residential Care Communities: United States, 2010
Source: National Center for Health Statistics

Key findings

  • In 2010, 17% of residential care communities had dementia special care units.
  • Beds in dementia special care units accounted for 13% of all residential care beds.
  • Residential care communities with dementia special care units were more likely than those without to have more beds, be chain-affiliated, and be purposely built as a residential care community, and less likely to be certified or registered to participate in Medicaid.
  • Residential care communities with dementia special care units were more likely than those without to be located in the Northeast and in a metropolitan statistical area, and less likely to be in the West.

UK — Independent report: Peer support networks and dementia advisers: evaluation

October 10, 2013 Comments off

Independent report: Peer support networks and dementia advisers: evaluation
Source: Department of Health

This report, commissioned by the Department of Health, provides evidence on the importance of post diagnostic support for people with dementia and their carers, and the role that dementia advisers and peer support networks can provide in this.

Important messages from the report are:

  • people with dementia and carers saw dementia advisers and peer support networks as having a positive impact on their wellbeing and quality of life
  • demonstrator sites provided evidence of both dementia advisers and peer support networks filling a gap in service provision that often occurs after diagnosis but before
  • there is a need for more intensive support
  • both initiatives were seen as having resource saving implications for the local health and social care economy

Hygiene and the world distribution of Alzheimer’s disease; Epidemiological evidence for a relationship between microbial environment and age-adjusted disease burden

September 25, 2013 Comments off

Hygiene and the world distribution of Alzheimer’s disease; Epidemiological evidence for a relationship between microbial environment and age-adjusted disease burden
Source: Evolution, Medicine, and Public Health

Background and objectives:
Alzheimer’s disease (AD) shares certain etiological features with autoimmunity. Prevalence of autoimmunity varies between populations in accordance with variation in environmental microbial diversity. Exposure to microorganisms may improve individuals’ immunoregulation in ways that protect against autoimmunity, and we suggest that this may also be the case for AD. Here, we investigate whether differences in microbial diversity can explain patterns of age-adjusted AD rates between countries.

Methodology:
We use regression models to test whether pathogen prevalence, as a proxy for microbial diversity, across 192 countries can explain a significant amount of the variation in age-standardized AD disability-adjusted life-year (DALY) rates. We also review and assess the relationship between pathogen prevalence and AD rates in different world populations.

Results:
Based on our analyses, it appears that hygiene is positively associated with AD risk. Countries with greater degree of sanitation and lower degree of pathogen prevalence have higher age-adjusted AD DALY rates. Countries with greater degree of urbanization and wealth exhibit higher age-adjusted AD DALY rates.

Conclusions and implications:
Variation in hygiene may partly explain global patterns in AD rates. Microorganism exposure may be inversely related to AD risk. These results may help predict AD burden in developing countries where microbial diversity is rapidly diminishing. Epidemiological forecasting is important for preparing for future healthcare needs and research prioritization.

Political drive to screen for pre-dementia: not evidence based and ignores the harms of diagnosis

September 11, 2013 Comments off

Political drive to screen for pre-dementia: not evidence based and ignores the harms of diagnosis
Source: British Medical Journal

Clinical context
Dementia is age related and with an ageing global population is predicted to become an overwhelming and costly problem.

Diagnostic change
Introduction of broader diagnostic criteria for mild cognitive impairment and pre-dementia based on new cognitive screening tests coupled with cerebrospinal fluid biomarkers and neuroimaging.

Rationale for change
Past neglect of services and research in dementia has fuelled international calls for action and earlier treatment.

Leap of faith
People with mild symptoms will eventually develop dementia and interventions are more likely to be effective at an early stage.

Impact on prevalence
The current prevalence of dementia is thought to be 10-30% in people over the age of 80, but the adoption of new diagnostic criteria will result in up to 65% of this age group having Alzheimer’s disease diagnosed and up to 23% of non-demented older people being diagnosed with dementia.

Evidence of overdiagnosis
Screening for cognitive impairment and measurement of biomarkers and neuroimaging are increasing the diagnosis of mild cognitive impairment, which in many people will improve spontaneously.

Harms from overdiagnosis
Unnecessary investigation and treatments with side effects; adverse psychological and social outcomes; and distraction of resources and support from those with manifest dementia in whom need is greatest.

Limitations
Current case identification and screening policy relies mostly on anecdotal and observational data from potentially biased sources, including those with vested commercial interests, rather than evidence from clinical trials. There is a lack of research focused on older people, in whom dementia is most prevalent.

Conclusions
Current policy is rolling out untested and uncontrolled experiments in the frailest people in society without a rigorous evaluation of its benefits and harms to individuals, families, service settings, and professionals.

A state-by-state guide to: Missing Senior/Adult Public Alert Systems

July 24, 2013 Comments off

A state-by-state guide to: Missing Senior/Adult Public Alert Systems
Source: International Association of Chiefs of Police

With more than 5 million Americans currently living with Alzheimer’s disease and approximately 500,000 new cases of this disease emerging each year, projections pronounce that there could be as many as 16 million Americans that will have Alzheimer’s by 2050. To help law enforcement protect this special population, IACP’s Alzheimer’s Initiatives program is committed to helping first responders improve their knowledge and skills to safeguard this special population.

This interactive map displays a state-by-state guide to the systems used to alert the public regarding missing persons with Alzheimer’s disease or other form of dementia. programs available throughout the 50 states. Also, once you click on a state, you will be able to see more in-depth state specific statistics and resources.

Evaluation of Excess Significance Bias in Animal Studies of Neurological Diseases

July 19, 2013 Comments off

Evaluation of Excess Significance Bias in Animal Studies of Neurological Diseases
Source: PLoS Biology

Animal studies generate valuable hypotheses that lead to the conduct of preventive or therapeutic clinical trials. We assessed whether there is evidence for excess statistical significance in results of animal studies on neurological disorders, suggesting biases. We used data from meta-analyses of interventions deposited in Collaborative Approach to Meta-Analysis and Review of Animal Data in Experimental Studies (CAMARADES). The number of observed studies with statistically significant results (O) was compared with the expected number (E), based on the statistical power of each study under different assumptions for the plausible effect size. We assessed 4,445 datasets synthesized in 160 meta-analyses on Alzheimer disease (n = 2), experimental autoimmune encephalomyelitis (n = 34), focal ischemia (n = 16), intracerebral hemorrhage (n = 61), Parkinson disease (n = 45), and spinal cord injury (n = 2). 112 meta-analyses (70%) found nominally (p≤0.05) statistically significant summary fixed effects. Assuming the effect size in the most precise study to be a plausible effect, 919 out of 4,445 nominally significant results were expected versus 1,719 observed (p<10−9). Excess significance was present across all neurological disorders, in all subgroups defined by methodological characteristics, and also according to alternative plausible effects. Asymmetry tests also showed evidence of small-study effects in 74 (46%) meta-analyses. Significantly effective interventions with more than 500 animals, and no hints of bias were seen in eight (5%) meta-analyses. Overall, there are too many animal studies with statistically significant results in the literature of neurological disorders. This observation suggests strong biases, with selective analysis and outcome reporting biases being plausible explanations, and provides novel evidence on how these biases might influence the whole research domain of neurological animal literature.

Self-Reported Increased Confusion or Memory Loss and Associated Functional Difficulties Among Adults Aged ≥60 Years — 21 States, 2011

May 14, 2013 Comments off

Self-Reported Increased Confusion or Memory Loss and Associated Functional Difficulties Among Adults Aged ≥60 Years — 21 States, 2011

Source: Morbidity and Mortality Weekly Report (CDC)

Declines in cognitive function vary among persons and can include changes in attention, memory, learning, executive function, and language capabilities that negatively affect quality of life, personal relationships, and the capacity for making informed decisions about health care and other matters (1). Memory problems typically are one of the first warning signs of cognitive decline, and mild cognitive impairment might be present when memory problems are greater than normal for a person’s age but not as severe as problems experienced with Alzheimer’s disease (2,3). Some, but not all, persons with mild cognitive impairment develop Alzheimer’s disease; others can recover from mild cognitive impairment if certain causes (e.g., medication side effects or depression) are detected and treated (3). In 2012, the U.S. Department of Health and Human Services published the National Plan to Address Alzheimer’s Disease, calling for expanding data collection and surveillance efforts to track the prevalence and impact of Alzheimer’s and other types of dementia (4). To estimate the prevalence of self-reported increased confusion or memory loss and associated functional difficulties among adults aged ≥60 years, CDC analyzed data from 21 states that administered an optional module in the 2011 Behavioral Risk Factor Surveillance System (BRFSS) survey. The results indicated that 12.7% of respondents reported increased confusion or memory loss in the preceding 12 months. Among those reporting increased confusion or memory loss, 35.2% reported experiencing functional difficulties. These results provide baseline information about the number of noninstitutionalized older adults with increased confusion or memory loss that is causing functional difficulties and might require services and supports now or in the future.

Monetary Costs of Dementia in the United States

April 5, 2013 Comments off

Monetary Costs of Dementia in the United States
Source: New England Journal of Medicine

We used nationally representative data to document comprehensively the incremental increase in costs attributable to dementia that arise from market transactions for goods and services as well as the costs of unpaid caregiving. We found that dementia leads to total annual societal costs of $41,000 to $56,000 per case, with a total cost of $159 billion to $215 billion nationwide in 2010. Our calculations suggest that the aging of the U.S. population will result in an increase of nearly 80% in total societal costs per adult by 2040.

The main component of the costs attributable to dementia is the cost for institutional and home-based long-term care rather than the costs of medical services — the sum of the costs for nursing home care and formal and informal home care represent 75 to 84% of attributable costs. Our estimate places dementia among the diseases that are the most costly to society. The cost for dementia care purchased in the marketplace ($109 billion) was similar to estimates of the direct health care expenditures for heart disease ($96 billion in 2008, or $102 billion in 2010 dollars) and significantly higher than the direct health care expenditures for cancer ($72 billion in 2008, or $77 billion in 2010 dollars). These costs do not include the costs of informal care, which are likely to be larger for dementia than for heart disease or cancer.

Although the costs attributable to dementia reported here are large, they are considerably smaller than those reported by the Alzheimer’s Association, which has estimated that in 2010 the monetary costs alone were $172 billion (2010 dollars) as compared with our estimate of $109 billion. There are several reasons for this higher estimate. It is likely that the cost per case reported by the Alzheimer’s Association is higher because it was estimated on the basis of a sample from a more severely impaired population (persons identified in the Medicare Current Beneficiary Survey as having dementia). The higher cost is also based on a significantly larger estimate of the prevalence of dementia. The national prevalence of dementia used by the Alzheimer’s Association is derived from a study of three Chicago neighborhoods. The diagnostic criteria for dementia used in that study did not require the presence of a limitation in ADLs or IADLs (a criterion that was used in ADAMS), a factor that probably led to the substantially higher estimate of the prevalence of dementia in the Chicago study. Finally, the cost estimate from the Alzheimer’s Association was not adjusted for the costs of coexisting conditions.

Proxy Consent to Research: The Legal Landscape

March 12, 2013 Comments off

Proxy Consent to Research: The Legal Landscape (PDF)

Source: Yale Journal of Health Policy, Law, and Ethics

When an adult suffers from a disorder that impairs his or her capacity to consent, may another person enroll that individual in research? The answer, it appears, is not a simple "yes" or "no," but rather "it depends."

The conduct of important research on disorders that affect many individuals. A growing population in our country suffers from illnesses that may affect decision-making, such as dementia, mental retardation, or, in certain instances, severe neuropsychiatric disorders. To illustrate this point, consider Alzheimer’s disease ("AD"). As the most common cause of dementia, the current and projected impact of AD is immense. An estimated four to fifteen million people are expected to suffer from Alzheimer’s disease by the year 2047. Beyond the quantitative impact of AD, the personal and relational costs of the disease are staggering. Patients in later stages may not recognize family members and often lose many of their core human traits and abilities. Many patients face institutionalization because of the common, yet extremely challenging, behavioral and psychiatric expressions of the disease. The financial costs are also significant. Current annual costs, both direct and indirect, approach $100 billion in the United States alone. It is urgent that research on this disease be strongly encouraged and facilitated.

Galactic Cosmic Radiation Leads to Cognitive Impairment and Increased Aβ Plaque Accumulation in a Mouse Model o f Alzheimer’s Disease

January 2, 2013 Comments off

Galactic Cosmic Radiation Leads to Cognitive Impairment and Increased Aβ Plaque Accumulation in a Mouse Model of Alzheimer’s Disease

Source: PLoS ONE

Galactic Cosmic Radiation consisting of high-energy, high-charged (HZE) particles poses a significant threat to future astronauts in deep space. Aside from cancer, concerns have been raised about late degenerative risks, including effects on the brain. In this study we examined the effects of 56Fe particle irradiation in an APP/PS1 mouse model of Alzheimer’s disease (AD). We demonstrated 6 months after exposure to 10 and 100 cGy 56Fe radiation at 1 GeV/µ, that APP/PS1 mice show decreased cognitive abilities measured by contextual fear conditioning and novel object recognition tests. Furthermore, in male mice we saw acceleration of Aβ plaque pathology using Congo red and 6E10 staining, which was further confirmed by ELISA measures of Aβ isoforms. Increases were not due to higher levels of amyloid precursor protein (APP) or increased cleavage as measured by levels of the β C-terminal fragment of APP. Additionally, we saw no change in microglial activation levels judging by CD68 and Iba-1 immunoreactivities in and around Aβ plaques or insulin degrading enzyme, which has been shown to degrade Aβ. However, immunohistochemical analysis of ICAM-1 showed evidence of endothelial activation after 100 cGy irradiation in male mice, suggesting possible alterations in Aβ trafficking through the blood brain barrier as a possible cause of plaque increase. Overall, our results show for the first time that HZE particle radiation can increase Aβ plaque pathology in an APP/PS1 mouse model of AD.

See: Space Travel May Be Harmful to the Brain, Study Suggests; Prolonged Cosmic Radiation Exposure Could Hasten Alzheimer’s (Science Daily)

Categories: dementia, PLoS ONE, science

Design and dementia: A case of garments designed to prevent undressing

August 14, 2012 Comments off

Design and dementia: A case of garments designed to prevent undressing

Source: Dementia

This article focuses on garments used in care environments. We investigate a patient overall, developed for the care of people with severe memory problems, severe learning difficulties and brain injuries. The aim of the use of a patient overall is to prevent undressing in socially inappropriate situations and/or to stop the user from removing an incontinence pad. This article is based on interviews of designers of medical textiles and patients and family carers in Finland. Both designers and patients found patient overalls to be infantilizing and stigmatizing for the user but accepted the basic functions of the product. We report results of a design project aimed at designing a new type of garment that takes into account the technical requirements but provides a more dignified look and opportunities for activity. We discuss the ethical issues concerning the use of this kind of product in the care of people with dementia.

Informant-reported cognitive symptoms that predict amnestic mild cognitive impairment

February 8, 2012 Comments off
Source:  BMC Geriatrics
Background
Differentiating amnestic mild cognitive impairment (aMCI) from normal cognition is difficult in clinical settings. Self-reported and informant-reported memory complaints occur often in both clinical groups, which then necessitates the use of a comprehensive neuropsychological examination to make a differential diagnosis. However, the ability to identify cognitive symptoms that are predictive of aMCI through informant-based information may provide some clinical utility in accurately identifying individuals who are at risk for developing Alzheimer’s disease (AD).
Methods
The current study utilized a case-control design using data from an ongoing validation study of the Alzheimer’s Questionnaire (AQ), an informant-based dementia assessment. Data from 51 cognitively normal (CN) individuals participating in a brain donation program and 47 aMCI individuals seen in a neurology practice at the same institute were analyzed to determine which AQ items differentiated aMCI from CN individuals.
Results
Forward stepwise multiple logistic regression analysis which controlled for age and education showed that 4 AQ items were strong indicators of aMCI which included: repetition of statements and/or questions [OR 13.20 (3.02, 57.66)]; trouble knowing the day, date, month, year, and time [OR 17.97 (2.63, 122.77)]; difficulty managing finances [OR 11.60 (2.10, 63.99)]; and decreased sense of direction [OR 5.84 (1.09, 31.30)].
Conclusions
Overall, these data indicate that certain informant-reported cognitive symptoms may help clinicians differentiate individuals with aMCI from those with normal cognition. Items pertaining to repetition of statements, orientation, ability to manage finances, and visuospatial disorientation had high discriminatory power.

Full Paper (PDF)

2011 Alzheimer’s Disease Facts and Figures

November 2, 2011 Comments off

2011 Alzheimer’s Disease Facts and Figures (PDF)
Source: Alzheimer’s Association

2011 Alzheimer’s Disease Facts and Figures provides a statistical resource for U.S. data related to Alzheimer’s disease, the most common type of dementia, as well as other dementias. Background and context for interpretation of the data are contained in the Overview. This information includes definitions of the types of dementia and a summary of current knowledge about Alzheimer’s disease. Additional sections address prevalence, mortality, caregiving and use and costs of care and services. The Special Report focuses on the benefits and challenges of early detection and diagnosis of Alzheimer’s disease.
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Moderate alcohol consumption and cognitive risk

August 18, 2011 Comments off

Moderate alcohol consumption and cognitive risk (PDF)
Source: Neuropsychiatric Disease and Treatment

We reviewed 143 papers that described the relationship between moderate drinking of alcohol and some aspect of cognition. Two types of papers were found: (1) those that provided ratios of risk between drinkers and nondrinkers (74 papers in total) and (2) those that, although they did not provide such ratios, allowed cognition in drinkers to be rated as “better,” “no different,” or “worse” than cognition in nondrinkers (69 papers in total). The history of research on moderate drinking and cognition can be divided into two eras: 1977–1997 and 1998–present. Phase I (1977–1997) was the era of neuropsychological evaluation involving mostly young to middle-aged (18–50 years old) subjects. Although initial studies indicated moderate drinking impaired cognition, many later studies failed to confirm this, instead finding no difference in cognition between drinkers and nondrinkers. Phase II (1998–present) was and is the era of mental status exam evaluation involving mostly older (≥55 years old) subjects. These studies overwhelmingly found that moderate drinking either reduced or had no effect on the risk of dementia or cognitive impairment. When all the ratios of risk from all the studies in phase II providing such ratios are entered into a comprehensive meta-analysis, the average ratio of risk for cognitive risk (dementia or cognitive impairment/decline) associated with moderate “social” (not alcoholic) drinking of alcohol is 0.77, with nondrinkers as the reference group. The benefit of moderate drinking applied to all forms of dementia (dementia unspecified, Alzheimer’s disease, and vascular dementia) and to cognitive impairment (low test scores), but no significant benefit against cognitive decline (rate of decline in test scores) was found. Both light and moderate drinking provided a similar benefit, but heavy drinking was associated with nonsignificantly higher cognitive risk for dementia and cognitive impairment. Although the meta-analysis also indicated that wine was better than beer or spirits, this was based on a relatively small number of studies because most studies did not distinguish among these different types of alcohol. Furthermore, a number of the studies that did make the distinction reported no difference among the effects of these different types of alcohol. Therefore, at present this question remains unanswered. Analysis also showed that the presence of the apolipoprotein E epsilon 4 allele eliminated the benefit of moderate drinking. However, this was based on a relatively small number of studies and several other studies have found a beneficial effect of the epsilon e4 allele. Further studies are necessary to settle this question. The benefit of moderate alcohol for cognition was seen in both men and women, although the amount and pattern of drinking is very different between the two sexes. Lastly, the finding of unaffected or significantly reduced cognitive risk in light to moderate drinkers was seen in 14/19 countries for which country-specific ratio data were available, with three of the five remaining countries showing nonsignificant reductions as well. Overall, light to moderate drinking does not appear to impair cognition in younger subjects and actually seems to reduce the risk of dementia and cognitive decline in older subjects.

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