Moderate alcohol consumption as risk factor for adverse brain outcomes and cognitive decline: longitudinal cohort study

• Published in: BMJ (Online) 2017-06, Vol.357, p.j2353
• Main Authors: Topiwala, Anya, Allan, Charlotte L, Valkanova, Vyara, Zsoldos, Enikő, Filippini, Nicola, Sexton, Claire, Mahmood, Abda, Fooks, Peggy, Singh-Manoux, Archana, Mackay, Clare E, Kivimäki, Mika, Ebmeier, Klaus P
• Format: Article
• Language: English
• Subjects: Adult; Aging; Alcohol Drinking - adverse effects; Alcohol use; Anniversaries; Atrophy; Automation; Brain Diseases - chemically induced; Brain Diseases - diagnostic imaging; Brain Diseases - physiopathology; Cognition Disorders - chemically induced; Cognition Disorders - diagnostic imaging; Cognition Disorders - physiopathology; Cohort analysis; Corpus Callosum - diagnostic imaging; Corpus Callosum - pathology; Dementia; Education; Executive Function - drug effects; Female; Humans; Longitudinal Studies; Magnetic Resonance Imaging; Male; Medical imaging; Neuroimaging; Older people; Questionnaires; Reaction Time - drug effects; Regression analysis; Risk Factors; Semantics; Sociodemographics; Socioeconomic factors; Statistical analysis; Verbal learning; Womens health
• ISSN: 0959-8138; 1756-1833
• DOI: 10.1136/bmj.j2353

Objectives To investigate whether moderate alcohol consumption has a favourable or adverse association or no association with brain structure and function.Design Observational cohort study with weekly alcohol intake and cognitive performance measured repeatedly over 30 years (1985-2015). Multimodal magnetic resonance imaging (MRI) was performed at study endpoint (2012-15).Setting Community dwelling adults enrolled in the Whitehall II cohort based in the UK (the Whitehall II imaging substudy).Participants 550 men and women with mean age 43.0 (SD 5.4) at study baseline, none were “alcohol dependent” according to the CAGE screening questionnaire, and all safe to undergo MRI of the brain at follow-up. Twenty three were excluded because of incomplete or poor quality imaging data or gross structural abnormality (such as a brain cyst) or incomplete alcohol use, sociodemographic, health, or cognitive data.Main outcome measures Structural brain measures included hippocampal atrophy, grey matter density, and white matter microstructure. Functional measures included cognitive decline over the study and cross sectional cognitive performance at the time of scanning.Results Higher alcohol consumption over the 30 year follow-up was associated with increased odds of hippocampal atrophy in a dose dependent fashion. While those consuming over 30 units a week were at the highest risk compared with abstainers (odds ratio 5.8, 95% confidence interval 1.8 to 18.6; P≤0.001), even those drinking moderately (14-21 units/week) had three times the odds of right sided hippocampal atrophy (3.4, 1.4 to 8.1; P=0.007). There was no protective effect of light drinking (1-