Last week my blog post, I went to therapy and you should too, focused on the importance of psychotherapy for healthcare professionals in stressful workplaces.
This week, for Research Tuesday, I’m writing about alcohol use disorders. While as rehabilitation specialists, we are not mental health or addiction professionals, I believe it is important for us to be aware of mental health and addiction disorders and how they impact our scope of practice. (For more about mental health, I hope you’ll check out one of my convention sessions “Clients at Risk for Suicide: Our Experiences and Responsibilities“.)
This week I read “History of Alcohol Use Disorders and Risk of Severe Cognitive Impairment: A 19-year Prospective Cohort Study“. The paper defines alcohol use disorders (AUDs) as “alcohol dependence or alcohol abuse (recurrent alcohol use associated with a range of problems but not meeting criteria of dependence).”
While previous studies have been completed looking at alcohol use during mid-life and cognitive impairment, this is the first long-term study spanning 19 years. The study was completed with data from the RAND Center for the Study of Aging, including 8663 self respondents. All data is available online.
Baseline memory function was assed using immediate and delayed recall tasks (20 nouns). Abstract reasoning was assessed with a modified similarities test (Wechsler Adult Intelligence Scale – Revised). Follow-up assessment was completed via the Telephone Interview for Cognitive Status (mTICS) with is an adapted version of the MMSE.
In order to focus on the effects of personal history of alcohol consumption (rather than current consumption) participants consuming three or more drinks per day were excluded. With this consideration, findings would reflect the association of a history of heavy alcohol consumption and memory and cognitive function rather than current heavy consumption.
The authors did an admirable job teasing out variables, including but not limited to formal education, race, smoking status, obesity, physical exercise, hypertension, cardiovascular disease, and head injury.
The major limitation of the study was study participants self reported AUDs and people tend to underreport alcohol consumption. Also, those that engage in risky behavior are less likely to participate in survey.
AUD leads to increased risk for severe cognitive impairment
The authors found people with a history of AUDs developed severe memory impairment in later life with 1.84% odds compared to those without history of AUDs at 0.85% odds. While the percentages may seem low over all, AUDs more than doubled the odds of severe memory impairment.
The odds for severe cognitive impairment in later life were nearly doubled in those with a history of AUDs (1.86%) compared to those without a history of AUDs (1.06%).
The results of this study are consistent with previous studies, even though this study had a much larger sample and had follow up over the longer period of time.
How does alcohol impact the brain?
Alcohol use is suspected to be related to dementia as a result of brain damage from toxic effects of alcohol, metabolic brain changes, imbalanced neurotransmitters, and nutritional deficiencies.
Specifically alcohol dependence is linked to:
- Volume reduction in white and gray matter, especially in the frontal lobes limbic system, and cerebellum
- Reduced glucose metabolism in cortical and subcortical structures
- Neurotransmitter imbalances impacting GABA, serotonin, dopamine, and opioid receptors
- Head injuries
- Liver cirrhosis
- Nutritional deficiencies – Severe thiamine deficiency may result in Wernicke encephalopathy
- Cardiovascular system changes including cardiomyopathy, arrhythmias, hypertension, and stroke
What can you do?
This study did not examine on cognitive rehabilitation treatment. The study was focused on building connections between mid-life alcohol use disorders and severe memory impairment in later life. This study offered no help in treating current patients. However, it may offer opportunities for prevention.
If you or someone you know is struggling with an alcohol use disorder, seek help. Alcoholics Anonymous is an excellent place to start. Visit this page to learn more about AA meetings near you. The National Institute for Alcohol Abuse and Alcoholism reported in 2012 approximately 17 million adults had an alcohol use disorder resulting in 5.1% of disability worldwide. Alcohol abuse is considered the fifth leading risk for premature death and disability.
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