Alcohol intake and its relationship to the risk of dementia in the elderly

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  • Matsui Toshifumi
    Department of Geriatric Medicine, Kyorin University School of Medicine
  • Kozaki Koichi
    Department of Geriatric Medicine, Kyorin University School of Medicine
  • Matsushita Sachio
    National Hospital Organization, Kurihama Medical & Addiction Center
  • Higuchi Susumu
    National Hospital Organization, Kurihama Medical & Addiction Center

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Other Title
  • 高齢者における飲酒コントロールと認知症予防
  • イブニングセミナー 高齢者における飲酒コントロールと認知症予防
  • イブニングセミナー コウレイシャ ニ オケル インシュ コントロール ト ニンチショウ ヨボウ

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Abstract

Excessive alcohol use is the third leading cause of preventable deaths after smoking and obesity and is implicated in many physical and mental complications. One such complication, alcohol-related dementia(ARD)is brought about by direct or indirect ethanol intoxication, and coexisting nutritional deficiency, liver disease, cerebrovascular disease and traumatic brain injury. While the concept of ARD is multifactorial and includes all cognitive deficits in alcoholics, the central clinical manifestations are exemplified by Korsakoff's syndrome(KS), a persistent neuropsychiatric syndrome characterized by amnesia and disorientation that is caused by thiamine deficiency along with excessive alcohol consumption. A 3-dimensional MRI method for voxel-based morphometry demonstrates that the parahippocampal/ hippocampal atrophy is specific to KS and the thalamus atrophy and the third ventricle enlargement were more severe in patients with KS than in cognitively normal alcoholics. This review also shows late-onset ARD which occurs in alcoholics over 60 years old, and which has been underestimated and underdiagnosed. These older alcoholics have high prevalence of lacunar infarcts and deep white matter lesions on the brain, which is associated not only with their cognitive decline, but also with their frailty, leading to high morbidity and mortality ratio. ARD is potentially reversible. However, the severity of alcohol dependence, age, and concomitant nutritional, physical and environmental factors can all have an impact on the outcome. Therefore, people with ARD benefit from comprehensive approach to lifestyle factors so that they can minimizes preventable risks, maintains health status and overcomes chronic diseases. Nursing home placement may be an appropriate treatment option for some refractory, long-term alcoholics with dementia.

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