You are leaving Medscape Education
Cancel Continue
Log in to save activities Your saved activities will show here so that you can easily access them whenever you're ready. Log in here CME & Education Log in to keep track of your credits.
 

CME

Moderate Alcohol Use May Slow Progression to Dementia

  • Authors: News Author: Caroline Cassels
    CME Author: Laurie Barclay, MD
  • CME Released: 5/21/2007; Reviewed and Renewed: 5/20/2008
  • THIS ACTIVITY HAS EXPIRED FOR CREDIT
  • Valid for credit through: 5/20/2009
Start Activity


Target Audience and Goal Statement

This article is intended for primary care clinicians, geriatricians, neurologists, and other specialists who care for patients with mild cognitive impairment.

The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.

Upon completion of this activity, participants will be able to:

  • Describe the effect of moderate alcohol consumption (≤ 1 drink/day) on development of mild cognitive impairment, based on the Italian Longitudinal Study on Aging.
  • Describe the association of moderate alcohol consumption (≤ 1 drink/day) on progression to dementia in individuals with mild cognitive impairment.


Disclosures

As an organization accredited by the ACCME, Medscape, LLC requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


Author(s)

  • Caroline Cassels

    Caroline Cassels is a Senior Journalist for Medscape Neurology & Neurosurgery. A medical and health journalist for 20 years, Caroline has written extensively for both physician and consumer audiences. She helped launch and was the editor of Health Digest, an award-winning Canadian consumer health publication. She was also national editor of the Heart & Stroke Foundation of Canada's Web site before joining Medscape Neurology & Neurosurgery in 2005. She is the recipient of the 2008 American Academy of Neurology Journalism Fellowship Award. She can be contacted at [email protected]

    Disclosures

    Disclosure: Caroline Cassels has disclosed no relevant financial relationships.

CME Author(s)

  • Laurie Barclay, MD

    Laurie Barclay is a freelance reviewer and writer for Medscape.

    Disclosures

    Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.


Accreditation Statements

    For Physicians

  • Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

    Medscape, LLC designates this educational activity for a maximum of 0.25 AMA PRA Category 1 Credit(s) . Physicians should only claim credit commensurate with the extent of their participation in the activity. Medscape Medical News has been reviewed and is acceptable for up to 200 Prescribed credits by the American Academy of Family Physicians. AAFP accreditation begins 09/01/06. Term of approval is for 1 year from this date. This activity is approved for 0.25 Prescribed credits. Credit may be claimed for 1 year from the date of this activity. AAFP credit is subject to change based on topic selection throughout the accreditation year.


    AAFP Accreditation Questions

    Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]


Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page.

Follow these steps to earn CME/CE credit*:

  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. Medscape encourages you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 5 years; at any point within this time period you can print out the tally as well as the certificates by accessing "Edit Your Profile" at the top of your Medscape homepage.

*The credit that you receive is based on your user profile.

CME

Moderate Alcohol Use May Slow Progression to Dementia

Authors: News Author: Caroline Cassels CME Author: Laurie Barclay, MDFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME Released: 5/21/2007; Reviewed and Renewed: 5/20/2008

Valid for credit through: 5/20/2009

processing....

May 21, 2007 -- A single alcoholic drink every day or less may significantly delay progression to dementia in individuals with mild cognitive impairment (MCI), a study published in the May 22, 2007, issue of Neurology suggests.

Investigators at the University of Bari in Italy found patients with MCI who had up to 1 drink per day - mostly wine - developed dementia at an 85% slower rate than their abstemious counterparts.

According to study authors Vincenzo Solfrizzi, MD, PhD, and Francesco Panza, MD, PhD, whereas many studies have assessed alcohol consumption and cognitive function in the elderly population, this is the first to examine how alcohol consumption affects the rate of progression from MCI to dementia.

Lifetime Alcohol Exposure

Study subjects were participants in the Italian Longitudinal Study on Aging (ILSA) and included 1445 individuals aged 65 to 84 years who were cognitively healthy at study outset and evaluated for MCI risk factors. Of these subjects, a group of 121 who subsequently developed the condition were evaluated for progression to dementia.

Participants underwent clinical and laboratory evaluations that included screenings for coronary artery disease, hypertension, type 2 diabetes, and stroke.

In addition, all subjects completed a questionnaire that gathered information on demographic characteristics, body weight and weight history, smoking habits, and current medication use. In addition, blood samples were taken to determine serum total cholesterol levels.

Study subjects underwent the Mini-Mental State Examination to evaluate global cognitive function. Episodic memory was tested with the Babcock Story Recall Test, and the Activities of Daily Living scale was used to determine functional status.

Beer or wine consumption was assessed according to daily consumption in the previous year and quantified according to 3 categories: half a glass (0.125 L), 2 glasses (0.25 L), and 4 glasses (0.50 L).

Investigators collected data on "superalcoholic" consumption by asking participants how often they consumed "shots" of spirits in the previous year. A single shot was considered equivalent to 1 standard drink. In addition, investigators calculated subjects' lifetime alcohol exposures.

Among the overall study group, wine accounted for 75% of alcohol intake; beer, 2%; and superalcoholic beverages, 22.1%. In addition, alcohol consumption was higher among men than women.

No Link to Increased MCI Risk

Adjusted analyses showed there was no association between alcohol consumption and increased MCI risk. However, based on previous research, including the Rotterdam Study, which showed light to moderate alcohol consumption was associated with a reduced risk for dementia, the authors speculate that a longer follow-up period in the current study likely would have revealed a similarly positive relationship between moderate alcohol consumption and MCI risk.

At a median follow-up of 3.5 years, 14 subjects with MCI developed dementia. Adjusted analysis showed that light drinking (0.1 - 1 drink/day) was associated with a significantly lower rate of progression to dementia compared with no alcohol consumption (hazard ratio [HR], 0.15; 95% CI, 0.03 - 0.77).

Furthermore, compared with alcohol derived from other sources, alcohol derived from wine was also significantly associated with a lower rate of progression to dementia.

The authors also report there was no significant association between higher levels of drinking, classified as 1 or more drinks per day, and the rate of progression to dementia in patients with MCI compared with nondrinkers.

The mechanism by which low to moderate alcohol consumption may protect against progression of MCI to dementia is not clear. However, the authors speculate it may be through the effects of alcohol consumption on the cerebral vasculature. They point out that some evidence suggests moderate alcohol consumption may be protective against ischemic stroke and vascular dementia via a reduction in vascular risk factors.

This study was supported by ILSA and the Associazione per la Formazione e la Ricerca in Geriatria.

Neurology. 2007;68:1790-1799.

Clinical Context

ILSA showed that vascular risk factors affected incident MCI and the rate of progression to dementia. Risk factors for cerebrovascular disease and vascular dementia have also been shown to increase the risk for Alzheimer's disease.

Previous studies evaluating alcohol intake and cognitive function in elderly people have had inconsistent findings, and epidemiologic studies have suggested that light to moderate alcohol consumption might have a protective effect vs total abstinence or heavy consumption. The current study aimed to evaluate the possible effect of alcohol consumption on the incidence of MCI and its progression to dementia in a large, Italian, population-based sample.

Study Highlights

  • The ILSA study cohort included a sample of 5632 subjects aged 65 to 84 years, independent or institutionalized, randomly selected from the electoral rolls of 8 Italian municipalities, after stratification for age and sex. Data were obtained from the first prevalence survey study (March 1992 - June 1993) and from the second prevalence survey study (September 1995 - October 1996).
  • The investigators evaluated the incidence of MCI in 1445 non–cognitively impaired individuals and its progression to dementia in 121 patients with MCI who were enrolled in ILSA. Median follow-up was 3.5 years.
  • The level of alcohol consumption was determined from food frequency questionnaires completed in the year before the survey. Dementia and MCI were defined by current clinical criteria, based on an extensive risk factor interview, screening test battery, and structured clinical assessment by a neurologist.
  • During 15,341 person-years of follow-up, 105 subjects developed MCI. There was no association between alcohol intake and risk for MCI, nor were there any significant associations between any levels of drinking and the incidence of MCI in non–cognitively impaired individuals vs abstainers.
  • During 8241 person-years of follow-up (median follow-up, 3.5 years), 14 subjects developed dementia. Patients with MCI who were moderate drinkers (≤ 1 drink, or about 15 g of alcohol, daily) had a lower rate of progression to dementia than did abstainers (HR, 0.15; 95% confidence interval [CI], 0.03 - 0.78 in the fully adjusted model).
  • Moderate drinkers with MCI who consumed 1 or fewer drink per day of wine had a significantly lower rate of progression to dementia than did abstainers (HR, 0.15; 95% CI, 0.03 - 0.77).
  • There was no significant association between drinking 1 drink or more per day and rate of progression to dementia in patients with MCI vs abstainers.
  • There was no evidence to support the hypothesis that the rate of progression to dementia varied according to the type of alcoholic beverage consumed. However, most of the alcohol consumption reported in this study derived from wine.
  • Adjustment for many potential confounders had little effect on the results.
  • Study limitations include reliance on self-report of alcohol intake, possible unmeasured confounders, and failure to study the possible risk for MCI and its progression to dementia linked to the apolipoprotein E genotype.

Pearls for Practice

  • In ILSA, there was no association between alcohol intake and risk for MCI, nor were there any significant associations between any levels of drinking vs abstinence and the incidence of MCI in non–cognitively impaired individuals.
  • Patients with MCI who were moderate drinkers (≤ 1 drink, or about 15 g of alcohol, daily), had a lower rate of progression to dementia than did abstainers. Moderate drinkers with MCI who consumed less than 1 drink per day of wine had a significantly lower rate of progression to dementia than did abstainers.

CME/CE Test

  • Print