Geriatric medicine

Dr Linda Calabresi
Clinical Articles iconClinical Articles

Want to preserve your brain function into old age? Cut down on the booze. That’s the conclusion of a large, longitudinal study just published in JAMA Psychiatry. After comparing more than 200 alcohol dependent adults with a similar number of healthy adults, over a 14 year period, the US researchers concluded alcohol-dependence accelerated the cortical ageing process even if the alcohol habit developed later in life. They found, through a series of MRIs that alcohol dependence (as per the DSM-IV criteria) resulted in more rapid frontal lobe deterioration than that which just occurred with age, regardless of gender. As part of the study the researchers also looked at whether comorbidities such as drug use or hepatitis C infection made a difference to the decline in cognitive function. And while they found they compounded the shrinkage of the frontal lobe, the actual deficits in the frontal cortex seemed to be associated chiefly with the alcohol. “We observed a selectivity of frontal cortex to age-alcoholism interaction beyond normal aging effects and independent of deficits related to drug dependence,” they said. Also, the researchers found that the deterioration was more associated with current drinking habits  than the cumulative effect of many years of alcohol abuse. People who had become alcohol dependent later in life were just as vulnerable as people whose alcohol use disorder started when they were younger. “The accelerated volume deficits in the older alcohol-dependent participants could not readily be attributed to more years of heavy drinking, given that many had a late onset of their disorder and lower lifetime alcohol consumption estimates than their early-onset counterparts,” the study authors said. So, it appears the frontal cortex, which is that part of brain that helps people plan, reason, modify behaviours and problem solve is the most vulnerable to damage in people with alcohol use disorder. Add this to the fact the frontal cortex deterioration associated with aging, is fundamentally responsible for the deterioration in executive function that limits an elderly person’s ability to function and live independently, and you have a recipe for disaster for those older people who drink to excess. What does this all mean? An accompanying editorial makes the take home message quite clear. “Given the rapidly growing aging population… it is critical that we improve and implement strategies to address alcohol misuse among older drinkers. As Yoda might say, “Protect their brains, we must.” Ref: JAMA Psychiatry. Published online March 14, 2018. doi:10.1001/jamapsychiatry.2018.002 JAMA Psychiatry. Published online March 14, 2018. doi:10.1001/jamapsychiatry.2018.0009