Alcohol consumption and risk of dementia: the Rotterdam Study

doi:10.1016/S0140-6736(02)07493-7

The Lancet

Volume 359, Issue 9303, 26 January 2002, Pages 281-286

https://doi.org/10.1016/S0140-6736(02)07493-7 Get rights and content

Summary

Background

Light-to-moderate alcohol consumption reduces the risk of coronary heart disease and stroke. Because vascular disease is associated with cognitive impairment and dementia, we hypothesised that alcohol consumption might also affect the risk of dementia.

Methods

We examined the relation between alcohol consumption and risk of dementia in individuals taking part in the Rotterdam Study—a prospective population-based study of 7983 individuals aged 55 years and older. We studied all participants who did not have dementia at baseline (1990–93) and who had complete data on alcohol consumption (n=5395). Through follow-up examinations in 1993–94 and 1997–99 and an extensive monitoring system, we obtained nearly complete follow-up (99·7%) until the end of 1999. We used proportional hazards regression analysis, adjusted for age, sex, systolic blood pressure, education, smoking, and body-mass index, to compare the risk of developing dementia between individuals who regularly consumed alcohol and individuals who did not consume alcohol.

Findings

The average follow-up was 6·0 years. During this period, 197 individuals developed dementia (146 Alzheimer's disease, 29 vascular dementia, 22 other dementia). The median alcohol consumption was 0·29 drinks per day. Light-to-moderate drinking (one to three drinks per day) was significantly associated with a lower risk of any dementia (hazard ratio 0·58 [95% CI 0·38–0·90]) and vascular dementia (hazard ratio 0·29 [0·09–0·93]). We found no evidence that the relation between alcohol and dementia varied by type of alcoholic beverage.

Interpretation

These findings suggest that light-to-moderate alcohol consumption is associated with a reduced risk of dementia in individuals aged 55 years or older. The effect seems to be unchanged by the source of alcohol.

Introduction

Light-to-moderate alcohol consumption is associated with lower risks of coronary heart disease, ischaemic stroke, and total mortality in elderly men and women.1, 2, 3 Since evidence is increasing that vascular disease is associated with cognitive impairment and dementia,4, 5 light-to-moderate alcohol intake might also reduce the risk of dementia and Alzheimer's disease. Conversely, several studies suggested a neurotoxic effect of high amounts of alcohol intake.6, 7, 8 Previously, a population-based prospective study in Bordeaux, France, reported an inverse association between wine consumption and the risk of dementia.⁹ We hypothesised that light-to-moderate alcohol intake was associated with a lower risk of dementia, and aimed to quantify the relation between alcohol consumption and the risk of dementia and subtypes of dementia; specifically, we examined whether the effect varied by type of alcoholic beverage.

Section snippets

Study population

This study was done as part of the Rotterdam Study—a population-based prospective cohort study for which residents aged 55 years and older of a suburb of Rotterdam, Netherlands, including those living in institutions, were asked to participate.¹⁰ The study was approved by the Medical Ethics Committee of the Erasmus Medical Centre Rotterdam. Participants gave written informed consent and permission to retrieve information from treating physicians.

During the baseline examination (1990–93),

Results

During 32 341 person-years of follow-up (mean follow-up 6·0 years), 197 participants developed dementia (incidence rate 6·1/1000 person-years). Alzheimer's disease was diagnosed in 146 (74%) patients (134 without and 12 with cerebrovascular disease), vascular dementia was diagnosed in 29 (15%) patients, and 22 (11%) were diagnosed with other types of dementia (including eight with Parkinson's disease dementia).

Table 1 shows the baseline characteristics of the study population according to

Discussion

We found that, in this population of individuals aged 55 years or older, those who consumed up to three glasses of alcohol per day had a lower risk of dementia and vascular dementia than those who never drank alcohol.

Some limitations of this study have to be considered. Alcohol consumption was based on a semiquantitative food-frequency questionnaire. Although assessment of alcohol intake embedded in a food-frequency questionnaire shows high reproducibility,20, 21 underreporting and

References (34)

WenhamPR et al.
Apolipoprotein E genotyping by one-stage PCR
Lancet
(1991)
PerryE et al.
Acetylcholine in mind: a neurotransmitter correlate of consciousness?
Trends Neurosci
(1999)
GoldbergDM et al.
Beyond alcohol: beverage consumption and cardiovascular mortality
Clin Chim Acta
(1995)
RimmEB et al.
Review of moderate alcohol consumption and reduced risk of coronary heart disease: is the effect due to beer, wine, or spirits?
BMJ
(1996)
BergerK et al.
Light-to-moderate alcohol consumption and risk of stroke among US male physicians
N Engl J Med
(1999)
DollR et al.
Mortality in relation to consumption of alcohol: 13 years' observations on male British doctors
BMJ
(1994)
SkoogI
Status of risk factors for vascular dementia
Neuroepidemiology
(1998)
BretelerMMB et al.
Cardiovascular disease and distribution of cognitive function in elderly people: the Rotterdam Study
BMJ
(1994)
SaundersPA et al.
Heavy drinking as a risk factor for depression and dementia in elderly men: findings from the Liverpool longitudinal community study
Br J Psychiatry
(1991)
JoyceEM
Aetiology of alcoholic brain damage: alcoholic neurotoxicity or thiamine malnutrition?
Br Med Bull
(1994)

FratiglioniL et al.

Risk factors for late-onset Alzheimer's disease: a population-based, case-control study

Ann Neurol

(1993)

OrgogozoJM et al.

Wine consumption and dementia in the elderly: a prospective community study in the Bordeaux area

Rev Neurol (Paris)

(1997)

HofmanA et al.

Determinants of disease and disability in the elderly: the Rotterdam Elderly Study

Eur J Epidemiol

(1991)

RothM et al.

CAMDEX: a standardised instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia

Br J Psychiatry

(1986)

GoldbohmRA et al.

Validation of a dietary questionnaire used in a large-scale prospective cohort study on diet and cancer

Eur J Clin Nutr

(1994)

Klipstein-GrobuschK et al.

Dietary assessment in the elderly: validation of a semiquantitative food frequency questionnaire

Eur J Clin Nutr

(1998)

NEVO-table. Dutch food composition table, 1993. The Hague: Voorlichtingsbureau voor de Voeding,...

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ArticlesAlcohol consumption and risk of dementia: the Rotterdam Study

Summary

Background

Methods

Findings

Interpretation

Introduction

Section snippets

Study population

Results

Discussion

Lancet

Trends Neurosci

Clin Chim Acta

Review of moderate alcohol consumption and reduced risk of coronary heart disease: is the effect due to beer, wine, or spirits?

BMJ

Light-to-moderate alcohol consumption and risk of stroke among US male physicians

N Engl J Med

Mortality in relation to consumption of alcohol: 13 years' observations on male British doctors

BMJ

Status of risk factors for vascular dementia

Neuroepidemiology

Cardiovascular disease and distribution of cognitive function in elderly people: the Rotterdam Study

BMJ

Heavy drinking as a risk factor for depression and dementia in elderly men: findings from the Liverpool longitudinal community study

Br J Psychiatry

Aetiology of alcoholic brain damage: alcoholic neurotoxicity or thiamine malnutrition?

Br Med Bull

Risk factors for late-onset Alzheimer's disease: a population-based, case-control study

Ann Neurol

Wine consumption and dementia in the elderly: a prospective community study in the Bordeaux area

Rev Neurol (Paris)

Determinants of disease and disability in the elderly: the Rotterdam Elderly Study

Eur J Epidemiol

CAMDEX: a standardised instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia

Br J Psychiatry

Validation of a dietary questionnaire used in a large-scale prospective cohort study on diet and cancer

Eur J Clin Nutr

Dietary assessment in the elderly: validation of a semiquantitative food frequency questionnaire

Eur J Clin Nutr

Articles
Alcohol consumption and risk of dementia: the Rotterdam Study