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The relationship between alcohol and judgement impairment

Nonetheless, one of the most intriguing aspects of this topic from a neurological perspective is the cognitive impact of chronic mild to moderate continuous alcohol use and binge drinking. This topic has become more important because a significant number of patients over 65 are developing cognitive decline and experts in addiction medicine are beginning to realize that cognitive function is important in management of these individuals.

According to various studies, 50 to 80 percent of these individuals present with impaired cognitive function. On the contrary, a good deal of information exists regarding cognitive function and alcohol use by itself.

In an article published in Neurology last year, authors concluded that regular and episodic drinking were not consistently associated with cognitive function.

International Journal of High Risk Behaviors and Addiction

This certainly challenges the notion that mild to moderate drinking is healthy for your heart and brain. Ahead is a brief survey of literature on the topic. Alcohol and Cognition One of the most comprehensive studies on alcohol is a meta-analysis of 143 papers from 250 countries covering 1997-2011. It describes the relationship between moderate drinking of alcohol and aspects of cognition.

They also determined that cognitive testing varied between two different eras: In studies in which no ratios and standard neuropsychological testing was used in 111,709 subjects younger than 55 years old, heavy drinking of four to six drinks per day was associated with cognitive impairment and higher risk for dementia. Notably, no significant difference in cognition was observed between light to moderate drinkers and non-drinkers.

Defining Cognitive Impairment in Heavy Drinkers There are four profiles of cognitive impairment in heavy drinkers1: No cognitive impairment 2. Isolated executive deficits with normal memory and global cognitive efficiency 3. Mild executive dysfunction with memory impairment and preserved global cognitive efficiency 4.

  1. Ahead is a brief survey of literature on the topic. Et al, Reported alcohol consumption and cognitive decline.
  2. Of note, the follow-up period of 25 years was considered longer than most other studies.
  3. There was also no difference in outcome between longitudinal or cross sectional studies.

Global impairment executive function, memory and impaired cognitive efficiency. These impairments can generally affect working memory, mental flexibility, attention, decision making, problem solving, processing speed, and planning. Encoding and retrieval tend to be affected most, while memory storage was normal.

The Cognitive Consequences Of Alcohol Use

Visual spatial impairment is also predominantly affected, as studies have shown impaired visual spatial processing, visual learning, and visual spatial construction tasks.

Ihara H et al, Group and case study of the dysexecutive syndrome in alcoholism without amnesia. Pitel AL et al, Genuine Episodic memory deficits and executive dysfunction in alcohol subjects early in abstinence.

Alcohol Clinical Experimental Research. Neuropsychological review 2007 17: Acta Neurol Scand 2002; 105 276-81.

International Journal of High Risk Behaviors and Addiction

In studies with ratios of risk in patients older than 55 years of age, 87 percent used MMSE. Eighty percent of these studies took place since 1998 in multiple countries. These studies showed a decreased risk of dementia and cognitive impairment in light to moderate drinkers in older adults by 20 percent, but no significant benefit against rate of cognitive decline. It is worth noting that this analysis was subject to criticism because some of the studies it used included previous drinkers that quit, which can bias the results.

Nineteen of the ratio studies excluded these former drinkers. The meta-analysis showed that most studies did not distinguish the relationship between alcohol and judgement impairment type of alcohol used. Some studies said wine was better, whereas others found no difference between beer or spirits. Of course, another inherent criticism is that male and female drinkers were combined for analysis and it is known the two sexes have different drinking patterns, which may mask a genuine difference among types of alcohol.

In this meta-analysis, 23 ratios in the worse cognitively impaired group were carefully reviewed to see why mild to moderate drinking was associated with worse cognitive impairment.

Alcohol and Your Brain

Another notable aspect about the meta-analysis is that accounting for age, education, sex, and smoking produced no change in the alcohol effects. There was also no difference in outcome between longitudinal the relationship between alcohol and judgement impairment cross sectional studies. Mental status exams were more often associated with finding better cognition in drinkers while neuropsychological tests were more often associated with no difference in cognition between drinkers and non- drinkers.

Importantly, the findings suggested that moderate drinking had no impact on dementia in general, AD, or vascular dementia. Other meta-analyses have failed to find a significant benefit of alcohol use against cognitive decline, as well.

As for why the MMSE test results were positive in reducing cognitive risk of decline compared to neuropsychological testing group in light to moderate drinkers, the authors pointed out that because many studies used MMSE to increase the validity of the results, while 60 percent of the studies used additional measures of cognition, the judgement of dementia and cognitive impairment were more reliable. The authors also stated that heavy drinking i.

Light to moderate drinking of two drinks per day or less in adult men and one drink or less in adult women, does not increase risk of cognitive decline, cognitive impairment, or dementia. These results were echoed by findings from another comprehensive review evaluating the same factors. Participants completed a self-administered questionnaire followed by clinical exams over future years from 1991 to 2009 four assessments. Mean alcohol consumption was calculated for each participant via questions on frequency and amount of alcohol use and which source of alcohol consumed.

Investigators used cognitive testing in the middle of the study ages 44-69 and repeated in 2002-04, and 2007-09 age range 55-80. Short-term memory and executive function fluency and inductive reasoning, Math, etc. At inception, roughly 7,500 out of 10,000 participants participated at least one of three cognitive assessments and constituted the analytic sample. Thirteen percent participated in the first wave of cognitive studies, 22.

This was more evident in men than women. Abstinence from drinking was associated with faster decline in global cognitive score and executive function.

The number of abstinence drinkers, however, was small and included more women and non-white individuals, which may have altered the data. Alcohol consumption of 36 grams per day heavy or greater was associated with faster cognitive decline in all cognitive domains compared with consumption of 0.

In women, however, compared with those drinking 0. Of note, the data were not driven by a single type of alcohol.

While heavy drinking has been associated with cognitive impairments in addition to other detriments to health, there is some evidence to suggest that moderate alcohol consumption may have a positive impact.

For example, one study found that low to moderate drinking reduced the risk of Myocardial Infarction 0.

The main theory focuses on cerebral and cardio-pathways that play out over extended period of time. Britton A et al, Who benefits most from the cardioprotective properties of alcohol consumption: Journal Epidemiology and community health. Epidemiological considerations and mechanistic studies.

Alcohol clinical experimental research 2009; 33: Association of alcohol consumption with selected cardiovascular disease outcomes: A systemic review and Met-analysis. Et al, Dementia after stroke: Panza F et al, Alcohol consumption in Mild cognitive impairment and dementia: International journal of geriatric society. Et al, Reported alcohol consumption and cognitive decline: The northern Manhatten study. National Review of Neurology 2011; 7: The investigators looked at 28,947 men and women aged 45-69 years old.

Re-exam was done in 2006-08 63 percent response rate. The cognitive testing included ten-word recall, verbal fluency, letter cancellation test to measure attention, mental speed, and concentration. They had complete cognitive data in 17,022 at the end of the study in 2008. Women who were non-drinkers had lower cognitive scores than light drinkers. Better cognitive scores in moderate drinkers was attenuated adjusting for social, economic, and lifestyle factors. Quantity and frequency of drinking were not associated with cognitive performance in men.

First, the analytic sample was restricted to participants with cognitive measures at follow-up. Attrition was higher in participants with lower cognitive scores, non-drinkers, and frequent drinkers at baseline, which could possibly bias the results of the study. Also, self-reported alcohol measures typically underestimate actual consumption. In this study, heavy drinkers had lower participation rates and higher likelihood of cognitive impairment, suggesting that heavy drinking and cognitive function were underestimated.

The other concern about this study is that the follow-up period was only three years, which may not have been a long enough time to examine trajectories of cognitive decline. Not specifically addressed in the majority of these studies was binge drinking. This topic was specifically evaluated in a 2005 study in which investigators studied 554 Finnish Twins who provided data on alcohol consumption in questionnaires in 1975 and 1981 and were followed for 25 years.

The assessments were done by telephone the relationship between alcohol and judgement impairment, which have shown a strong correlation with mental assessment face to face. By the end of the follow-up, 103 participants developed dementia, however, the cause of dementia could not be determined from the telephone interview.

The Cognitive Consequences Of Alcohol Use

The study considered binge drinking as five bottles of beer or one bottle of wine on one occasion at least monthly. This was associated with a relative risk of 3. Also, blacking out during the heavy drinking periods at least twice during the previous year as reported in 1981 was associated with a with a higher risk for dementia in drinkers. The study found that binge drinking and passing out were risk factors even after controlling for alcohol consumption or after excluding from the analysis that were heavy drinkers.

Of note, the follow-up period of 25 years was considered longer than most other studies.

The Cognitive Consequences Of Alcohol Use

Participants in studies such as this frequently misreport their drinking habits for 25 years due to perhaps memory problems. Of note, a large proportion of the study population was composed of abstainers 24 percent. It did not appear that abstainers were less healthy than the other study members.

Interestingly, another study found that light to moderate drinkers with occasional binge drinking had a higher mortality than those light to moderate drinkers with such occasions. These data suggest that binge drinking in midlife is associated with increased risk of dementia. The Effect of Alcohol Overuse and Abstinence on the Brain When it comes to the exactly how alcohol use affects the brain, the severity of brain lesions depends on various factors including the extent of alcohol consumption, age, gender, and neuropsychological comorbidities.

The limbic system, especially the hippocampus, which is involved in episodic memory, is also impaired. The cerebellum shows reduction of white matter volume in the vermis and cerebellar hemisphere, and connections between cerebellum and frontal lobe via pons and thalamus are impaired.

  1. Increased cardiovascular morbidity plays a big role in its negative affect.
  2. An increase in brain volume characterized by increased white matter and gray matter volumes and a reduction in size of the size of the sulci and ventricles is observed right from the first month of abstinence. Binge drinking has been studied less but drinking greater than five beers or one bottle of wine at one time, a minimum of one time a month, has been shown to increase cognitive decline and dementia.
  3. When this happens, a person has gone beyond heavy drinking into a new area. More importantly, episodic memory and executive impairment did not appear reliable predictors of treatment outcome over a six-month period.