Heavy Drinking and Early-onset Dementia

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A new study suggests heavy alcohol consumption is a major risk factor for all types of dementia, but particularly early-onset dementia.

The retrospective analysis involving 30 million people in France shows that those with a history of alcohol use disorders had a threefold increased risk for dementia and that over half those with early-onset dementia had a history of alcohol problems.

“Our results suggest that heavy drinking is the strongest potentially modifiable risk factor for dementia that we have ever seen,” lead author, Michaël Schwarzinger, MD, Translational Health Economics Network, Paris, France, said.

Their data make a strong argument for lower consumption of alcohol generally, he added. “If people are consuming more than a couple of alcoholic drinks a day, they could be putting themselves at increased risk of dementia. Our results suggest that one of the best things you can do for your brain health is to cut down your alcohol intake.”

The study is published online in Lancet Public Health on February 20.

In an accompanying Comment, Clive Ballard, MD, and Iain Lang, MD, University of Exeter Medical School, United Kingdom, say the study is “immensely important and highlights the potential of alcohol use disorders, and possibly alcohol consumption, as modifiable risk factors for dementia prevention.”

“This study used a phenomenally large database, and the result showing that half the cases of early-onset dementia were associated with alcohol use disorders is truly staggering,” Ballard told Medscape Medical News.

“This has flagged something that has long been neglected, so it is a very important contribution to our knowledge,” he added. “It does suggest that heavy drinking increases the risk for dementia and could be a significant contributing factor to early-onset dementia. That is important to know as we can potentially do something about it.”

In the paper, the researchers call for screening and interventions for heavy drinking and treatment for alcohol use disorders to reduce the alcohol-attributable burden of dementia.

“In our view, this evidence is robust and we should move forward with clear public health messages about the relationship between both alcohol use disorders and alcohol consumption, respectively, and dementia,” Ballard and Lang add. “We might want to consider the extent to which the growing prevalence of dementia worldwide might be curbed by reductions in population-level alcohol consumption.”

Quite a lot of work has looked at the effects of light drinking, with several cohort studies suggesting health benefits, including a possible reduction in dementia. But there has been very little research on the effects of heavy drinking, Schwarzinger noted, “so we wanted to look at this.”

For the study, they analyzed a database covering all hospital admissions in France. “We had data on around 30 million people over a 6-year period, including 80% of the French population more than 60 years of age,” Schwarzinger reported.

The researchers used diagnostic codes on hospital records to identify patients with dementia and those who had a history of alcohol use disorders. They found over a million cases of dementia, after excluding people with diseases that can lead to rare types of dementia and those with early-life mental disorders that can increase or confound dementia diagnosis. There were also 945,000 people with alcohol use disorders.
Results showed a strong association between a history of alcohol problems and dementia. This was especially noticeable in early-onset dementia, with 57% of the 57,000 patients who had developed dementia under the age of 65 years having a history of alcohol use disorders (66% of men and 37% of women).

In an analysis of just those patients in whom the first record of dementia occurred in 2011-2013 and adjusted for other risk factors found in the medical records, the risk for dementia was three times greater if the patient had a history of alcohol use disorders. The hazard ratio was 3.36 for men and 3.34 for women.

Is There a J-shaped Curve?

“We have very little information on the effects of heavy drinking as these people don’t generally participate in studies and if they do they frequently drop out,” Schwarzinger explained. “So this is the first solid data we have on this issue.”

But he pointed out that some small neuroimaging studies have shown a relationship between alcohol use and gray matter damage. “This association appears to be linear — the more alcohol is consumed the more gray matter damage — right down to very low levels.”

Because the current study used diagnostic codes to identify people with alcohol use disorders, it doesn’t give a level of alcohol consumption considered to be hazardous for dementia risk.

“We don’t know how much they were actually drinking, but usually anyone with an alcohol use disorder would be drinking more than 5 units of alcohol a day,” he said.

The World Health Organization defines chronic heavy drinking as consuming more than 60 g of pure alcohol a day for men (around six or more standard drinks per day on average) and more than 40 g per day for women (around four or more standard drinks per day), the study authors note.

“Cohort studies suggest a J-shaped curve for the alcohol and dementia relationship, with low and moderate levels of drinking possibly having a benefit, but our study shows a clear harmful effect of heavy levels of drinking,” Schwarzinger said. “We don’t know where the threshold is. We cannot discern that information from this study.”

He himself is not convinced about a J-shaped curve. “Personally I doubt there is a J-curve for the relationship between alcohol and brain health — the suggestion of benefit with low alcohol consumption has been seen in cohort studies in healthy people, which can have many biases, and the neuroimaging studies show brain damage with even low doses of alcohol.”

Ballard added: “There is a fair amount of evidence that modest alcohol consumption may be protective against dementia, and this study now suggests strongly that heavy drinking is harmful. We don’t know the specifics and we need to do a lot more work to find where the threshold may be, but possibly one or two drinks a day could be protective while five or more could be harmful.”

He further pointed out that there were almost certainly confounding factors that could have contributed to the current results.

“People with alcohol use disorders often also have many other risk factors for dementia, such as depression, social isolation, and poor nutrition, that may not have shown up in this study,” he said. “But having said that, the very high hazard ratio in this study is certainly a big push for further research on heavy drinking.”

Drugs, Alcohol, Suicide: Deaths of Despair killing Americans at Record Rates

“Despair deaths” from drugs, alcohol and suicide have reached new peaks in the U.S. and are not just killing whites, but spiking in communities of color, as well, according to a new report released Thursday.

More than 142,000 Americans died from drug or alcohol overdoses and from suicide in 2016, an 11 percent increase over 2015, the report from the Trust for America’s Health and the Well Being Trust finds.

“These 142,000 ‘despair deaths’ in 2016 add to the more than one million Americans who died from drugs, alcohol or suicide in the previous decade,” the report reads.

While the increased deaths from opioid overdoses and suicide are well documented, the team that wrote the report say their analysis shows some troubling differences.

“We had been seeing increases in these trends among these individuals who are dying from drugs, alcohol and suicide,” said Ben Miller, a clinical psychologist at the Well Being Trust.

“But between 2015 and 2016 the racial differences popped out. We saw literally a 39 percent increase in deaths of people of color due to drug overdose,” added Miller, formerly of the Department of Family Medicine at the University of Colorado School of Medicine.

“That is unheard of. This stood out like, holy cow what is going on?”

“The substantial rise in deaths in 2016 puts the country past the ‘worst case scenario’ projection trajectory.”

“The substantial rise in deaths in 2016 puts the country past the ‘worst case scenario’ projection trajectory.”
The report found that suicide rates went up 10 percent among blacks from 2015 to 2016 and rose 9 percent among Latinos.

“While drug overdoses were still highest among whites in 2016, there were disproportionally large increases in drug deaths among racial/ethnic minority groups, particularly among black Americans,” the report reads.

“In the previous decade, blacks had relatively low drug overdose rates — averaging 35 percent lower than whites between 2006 and 2015. However, between 2015 and 2016, blacks experienced an alarming increase — of 39 percent — in drug-related deaths.”

The opioid abuse epidemic is so bad that it has hit overall U.S. life expectancy. Life expectancy falls when people start dying at younger ages, and that’s what’s happening in the U.S. with opioid overdoses.

The National Center for Health Statistics has found that 63,600 people died of drug overdoses in 2016, and that in turn drove down overall U.S. life expectancy for the second year in a row.

Teen drug overdoses double in U.S.
Suicide rates have also soared. Sometimes, the causes are clear: just this week Puerto Rico health authorities reported that at least 103 people have committed suicide in the aftermath of Hurricane Maria, which devastated the island territory on Sept. 20.

The trends are related, Miller said.

“When we talk about deaths from alcohol, drugs and suicide, we recognize that there is a relationship there — that we can’t just look at the issue of suicide in isolation without tackling drugs and alcohol because the data show that they are related,” he said.

And now the epidemic has engulfed Latinos and other minorities across the U.S., the new report finds.

“Latinos and Asian Americans also historically have had relatively low rates of opioid and synthetic opioid drug overdoses and saw disproportionately large increases between 2015 and 2016,” it reads.

Suicide rates soar
“Latinos saw opioid death rates increase 35 percent and synthetic opioids death rates increase 183 percent between 2015 and 2016. Asians saw opioid deaths rates increase 41 percent and synthetic opioids death rates increase 140 percent between 2015 and 2016.”

If deaths continue to increase at the same rate, more than 2 million people could be dying from drug overdoses, suicide and alcohol abuse over the next decade, the report projects.

“The substantial rise in deaths in 2016 puts the country past the ‘worst case scenario’ projection trajectory,” it says. “This would mean more than 287,700 individuals could die from these three causes in the year 2025, double the current number who died in 2016.”

Miller says the country needs a comprehensive approach to treating pain — both physical pain and mental distress.

Alcohol kills six Americans a day
“People will continue to die until we come up with a systematic approach to take care of them,” he said.

“We talk about creating a national resilience strategy. How can we go into communities and see so much more than presence or absence of disease, but begin to take into account the social factors, to actually take care of people’s pain in more comprehensive ways instead of just treating them like a diagnosis or just labeling them as having some problem.”

Mental health reform is an obvious place to start, Miller said, but better strategies are also needed for treating acute and chronic pain.

“There is acute pain, there is chronic pain and sometimes there is this more emotional pain,” Miller said.

“They might be medicating the pain they feel from their family, from their community, from the trauma they suffered.”

Medical Device Helps Heroin Addicts Detox

The US Food and Drug Administration (FDA) has just approved
a “percutaneous nerve field simulator” for use in treating those
addicted to heroin and other opioid drugs.
The United States is currently in the grip of an opioid addiction
epidemic, caused largely by over-prescription of painkillers such
as Oxycontin and Vicodin. As a result, drug overdoses are now the
leading cause of death among under-50s in the US, having overtaken
car accidents and shootings. One reason this problem has proven so
intractable is that for those addicted to opiates, withdrawal symptoms
can be crippling.
The NSS-2 Bridge from Innovative Health Solutions is designed
to make coming off such drugs easier, by vastly reducing those
.ymptoms. The electrical nerve stimulator is placed behind the
t1>atient’s ear, and contains a battery-powered chip that emits
/ electrical pulses to stimulate branches of certain cranial nerves via
diodes that attach to the skin. These pulses are said to offer relief
from withdrawal symptoms such as sweating, gastrointestinal upset,
agitation, insomnia and joint pain. The device, which will only be
available on prescription, can be worn for up to five days, which is
about how long acute physical symptoms of withdrawal usually last.
FDA commissioner Dr Scott Gottlieb said: “The FDA is committed
to supporting the development of novel treatments, both drugs and
devices, that can be used to address opioid dependence or addiction,
as well as new, non-addictive treatments for pain that can serve as
alternatives to opioids.”

Moderate Alcohol Consumption as Risk Factor for Adverse Brain Outcomes and Cognitive Decline: Longitudinal Cohort Study

The reported health effects of drinking alcohol are varied, with clear deleterious effects of heavy drinking on the brain, liver, and other organ systems, and some suggestion of benefit at low levels of consumption.

Little previous research has targeted the impact of moderate drinking on the brain, and findings have been inconsistent. The goal of this observational cohort study was to examine the association of moderate alcohol consumption with brain structure and function.
From 1985 to 2015, 550 community dwelling adult participants in the UK Whitehall II cohort imaging substudy underwent repeated measurements of cognitive performance and weekly alcohol intake, as well as multimodal MRI at study endpoint. At baseline, mean age was 43.0 ± 5.4 years, and no participants were alcohol-dependent, on the basis of the CAGE screening questionnaire. Incomplete or poor-quality MRI or clinical data or gross structural abnormality led to exclusion of 23 participants.
In a dose-dependent manner, higher alcohol consumption was associated with increased risk for hippocampal atrophy during the 30-year follow-up, after adjustment for confounding factors that included age, sex, education, social class, physical and social activity, smoking, stroke risk, and medical history.
Compared with abstainers, participants who drank more than 30 units/week had the highest risk (odds ratio [OR], 5.8; 95% confidence interval, 1.8 to 18.6; P ≤ .001). Even moderate drinkers (14 to < 21 units/week in men; 14 units was equivalent to four pints of strong beer or five large glasses of wine) had more than threefold the risk for right-sided hippocampal atrophy compared with abstainers (OR, 3.4; 95% CI, 1.4 to 8.1; P = .007), Light drinking (1 to < 7 units/week) did not protect against hippocampal atrophy. Other risks associated with higher alcohol consumption were differences in corpus callosum microstructure, reduced gray-matter density, reduced white-matter microstructural integrity, and faster decline in lexical fluency, but there were no associations with cross-sectional cognitive performance at the time of MRI or longitudinal changes in semantic fluency or word recall. study limitations include the observational design, which precludes causal inferences; a possible lack of generalizability; and possible bias. However, these limitations are offset by major strengths, including long-term data on alcohol intake, detailed information on confounding variables, a large amount of MRI data, and advanced methods of imaging analysis. The findings suggest that even moderate alcohol drinking is associated with threefold risk for atrophy in the hippocampus (a key region for memory and spatial navigation) and other adverse brain outcomes. Moderate alcohol drinking has not previously been linked to hippocampal atrophy. Associations of alcohol intake with compromised white-matter integrity in this study also suggest potential threats to cognitive efficiency. These findings have important potential public health implications, supporting recent UK guidelines recommending lower alcohol intake and raising concerns regarding current limits recommended in US guidelines. The latter suggest that up to 24.5 units/week is safe for men, but this study showed a threefold increase in risk for hippocampal atrophy at only 14-21 units/week. In this study, nearly one half of the men and one quarter of the women were "moderate" drinkers. This study showed no protective effect of light drinking over abstinence. Earlier reports claiming such a protective effect might have been limited by confounding if light drinking was associated with higher social class or IQ. As life span increases, preserving quality of life will depend on maintaining cognitive function, which declines with increasing age. Alcohol drinking may be a modifiable risk factor for cognitive impairment, if primary prevention efforts begin in early adulthood or sooner. In light of these findings, justifying drinking habits that are regarded as normal or even as beneficial may no longer be rational.

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