Alcohol and Dementia Risk: New Study Challenges Previous Assumptions. Proper Dementia Care Ensures Quality of Life
A recent study published in the journal eClinicalMedicine investigated whether increasing alcohol consumption raises the risk of developing dementia among current drinkers. The study's findings suggest that as alcohol consumption—particularly when driven by genetic predispositions—increases, so does the risk of dementia. This research challenges the previously held belief that light-to-moderate alcohol consumption might offer protective benefits. Instead, it proposes that no amount of alcohol may be safe when it comes to dementia prevention.
Dementia is a growing global concern, with the number of people affected expected to rise from 57 million in 2019 to nearly 153 million by 2050, according to the World Health Organization (WHO).
Longevity is the number one risk factor for dementia. In the United States, approximately 6.7 million people live with dementia, with that number expected to rise sharply as the population ages.
In the United Kingdom, around 944,000 people are currently living with dementia, with projections suggesting this could increase to over 1.6 million by 2050.
In Canada, more than 597,000 people live with dementia, and this number is expected to nearly double by 2030.
Australia also faces a significant rise in dementia cases, with more than 400,000 individuals currently living with the condition. This number is projected to exceed 800,000 by 2058 as life expectancy increases.
The growing number of people developing dementia worldwide is increasing the number of people who require long-term care services and supervision, often placing financial strain on families and finances.
Alcohol Consumption and Dementia Risk
While heavy alcohol consumption has long been identified as a risk factor for dementia, the effects of light-to-moderate drinking have been debated.
For example, a recent study led by Harvard T.H. Chan School of Public Health researchers showed that those age 72 and older with mild cognitive impairment (MCI) who drank more than 14 alcoholic drinks a week were 72% more likely to progress to dementia over an eight-year period than those who drank less than one drink a week.
In another study, Shannon Macauley, Ph.D., associate professor of physiology and pharmacology at Wake Forest University School of Medicine, notes that scientists at Wake Forest University School of Medicine showed that even modest amounts of alcohol can accelerate brain atrophy, which is the loss of brain cells, and increase the number of amyloid plaques, which are the accumulation of toxic proteins in Alzheimer's disease.
These findings suggest alcohol might accelerate the pathological cascade of Alzheimer's disease in its early stages.
However, some past studies may have been biased by the "abstainer effect," where individuals who quit drinking due to poor health are compared to regular drinkers. This can skew the results, making it seem like moderate alcohol consumption has a protective effect against dementia.
Additionally, these studies often overlook early-life cognitive declines or interactions with other health issues, contributing to inconsistent conclusions.
About the Study
In this study, researchers used data from the U.K. Biobank, analyzing over 300,000 white British adults who currently consume alcohol. The participants provided information about their drinking habits and genetic data, allowing researchers to use a method called Mendelian Randomization (MR) to examine whether genes linked to alcohol consumption could directly increase the risk of dementia.
The study excluded participants who were non-drinkers or had dementia at the outset. Alcohol intake was calculated based on weekly consumption, and dementia cases were tracked through hospital and death records over approximately 13 years.
Findings
Researchers followed 313,958 current drinkers, of whom 1.7% (5,394 participants) were diagnosed with dementia during the study period. The average weekly alcohol consumption was 13.6 units, with nearly half of participants exceeding the U.K.'s recommended 14 units per week.
Interestingly, a "J-shaped" pattern emerged: those who consumed around 11.9 units of alcohol per week had the lowest dementia risk, while higher consumption significantly increased the risk. For men, the lowest dementia risk was at 16.8 units per week, but no clear trend was observed for women.
The genetic analysis provided even more compelling evidence. It revealed that individuals with genes linked to higher alcohol consumption were more likely to develop dementia, particularly women, suggesting a direct causal relationship between alcohol intake and dementia risk.
Alcohol Use Disorder (AUD) and Dementia
Another recent study has reinforced the connection between alcohol use disorder (AUD) and dementia, particularly Alzheimer's disease.
Researchers from Washington University School of Medicine in St. Louis, led by Professor Sarah Hartz, found that alcohol use can lead to significant changes in brain tissue, impacting cognitive function. The study identified biomarkers like amyloid and tau proteins, which are associated with Alzheimer's, linking them to excessive alcohol consumption. These findings were presented at the 47th annual meeting of the Research Society on Alcohol (RSA) in June 2024.
The study utilized data from the Collaborative Study on the Genetics of Alcoholism (COGA) to explore how alcohol consumption, particularly AUD, correlates with cognitive decline and Alzheimer's biomarkers in older adults.
Sarah Hartz, a professor of psychiatry at the Washington University School of Medicine in St. Louis, said they knew that AUD is associated with problems with memory and thinking.
Our preliminary analyses show strong relationships between alcohol use disorder, cognitive decline in older adults, and high rates of these Alzheimer disease biomarkers.
Hartz and her team highlighted that even moderate alcohol use could have negative effects on brain health. However, further research is needed to confirm this.
Implications
The study challenges the notion that light-to-moderate alcohol consumption is harmless, especially for dementia prevention. The results suggest that alcohol may play a direct role in increasing the risk of dementia, particularly for those genetically predisposed to drink more.
As the global population ages and dementia cases continue to rise, these findings underscore the importance of re-evaluating public health guidelines around alcohol consumption. This research also highlights the need for further studies to examine the long-term cognitive impacts of alcohol, even at lower levels of consumption.
By drawing attention to the potential risks, this study emphasizes the importance of making informed decisions about alcohol use, particularly for individuals with a family history of dementia or genetic factors that may increase their vulnerability.
Long-Term Care Has Limited Insurance Coverage
Longevity itself is a risk for long-term care needs, one of which is memory loss. In the United States, health insurance and Medicare only pay for short-term skilled care, not dementia care or other types of long-term care services that many people require due to aging, chronic health issues, and dementia.
Medicaid is means-tested, meaning a care recipient must have limited financial resources to qualify for long-term care benefits. Long-Term Care Insurance will cover memory care and other long-term care services, but someone must have the policy in place before they require care because of medical underwriting.
In the U.K., the National Health Service (NHS) covers medical care for individuals with dementia but does not cover long-term care services, such as assistance with daily activities. Dementia care, including nursing homes or in-home care, is typically means-tested, meaning individuals with assets above a certain threshold must contribute to or fully cover their care costs.
The NHS does offer some care for those with severe health needs through a program called NHS Continuing Healthcare (CHC), which provides fully funded care if the primary need is medical.
In Canada, the public healthcare system covers medical treatments related to dementia, including doctor visits, hospital stays, and diagnostics. However, long-term care services, such as nursing homes or personal care assistance at home, are not fully covered and may require out-of-pocket payments or long-term care insurance.
Some provinces offer subsidized long-term care, but it is means-tested, and many families must cover a significant portion of the costs. Private Long-Term Care Insurance, which is available in Canada, can help cover these expenses.
Long-Term Care Costs Exploding
The greater demand for long-term care services, labor shortages, and rising labor costs place more financial strain on families. According to research by LTC NEWS, long-term care services are expensive, and those long-term care costs are predicted to increase dramatically in the decades ahead.
Imagine you or your spouse needing long-term care for any reason, much less something more dramatic like dementia; who would provide the care?
If you answer a loved one, is that realistic? If you think your spouse will provide care, how would that work, and how would that alter your life? If you're 77 and your spouse is similar in age, how would an older person physically and emotionally be a caregiver?
Adult children, perhaps they will step in and become caregivers? If you have made no other plans what other choice could they make? Granted, they have careers, families, and responsibilities in addition to perhaps being a caregiver.
Professional care is usually the answer, and unless you have Long-Term Care Insurance, the cost will come from your income and assets.
Have a Plan
You need to have a plan for future dementia or other long-term care needs before the crisis starts. Crisis planning is never the best planning.
Consider Long-Term Care Insurance as part of your retirement plan. Generally, an LTC policy is purchased before retirement. However, LTC Insurance premiums vary substantially between insurance companies, and policies are priced, in part, by your age and health when you apply for coverage.
Underwriting rules also vary between insurance companies, so find a qualified, independent Long-Term Care Insurance expert to help you navigate options.
However, don't leave it at that. Be sure to have a conversation about your plan with your family. Explain how an LTC policy will give you access to quality care options when you need it so they can remain family instead of becoming caregivers. Plus, the asset protection provided by a policy will maintain your lifestyle and legacy.
In addition, discuss your preferences. If you want to stay in your home, let your family know. LTC Insurance will pay for in-home care; however, some people like the idea of assisted living. Either way, communicating with loved ones will help you maintain more independence and give them peace of mind.
Dealing with a Loved One With Dementia Now?
If your loved one has dementia now, it can be an overwhelming experience for both them and the family. Taking the proper steps can significantly improve their quality of life and your ability to provide effective support.
Create a Safe and Supportive Environment
Andrew Duxbury, M.D., a geriatrician in the Division of Gerontology, Geriatrics, and Palliative Care at the University of Alabama at Birmingham, says you should maintain a safe and supportive living environment while also providing solutions for caregivers to use when caring for the care recipient.
When approaching dementia families, I follow the safe and sane rule. Everything we do needs to make the patient safe and the family sane. In terms of safety, it boils down into the big four: meals, wheels, bills and pills.
The first step is to ensure their home or living space is safe and dementia-friendly. This includes removing tripping hazards, installing bathroom grab bars, and securing sharp objects or chemicals.
You may also consider adding visual cues like labels on cabinets or colored tape on steps to aid with memory and navigation. Reducing noise and clutter can also help reduce confusion and anxiety, which are common in people with dementia.
Establish a Daily Routine
Routine is crucial for someone with dementia. Setting a daily schedule provides a sense of security and reduces anxiety. Include regular times for meals, activities, and rest. Try to keep tasks simple and consistent. For example, involve your loved one in household chores like folding laundry or setting the table—activities they are familiar with—so they feel productive without being overwhelmed.
Foster Social Engagement
Social interaction can help maintain cognitive function and emotional health. Encourage activities that involve others, whether it's a family meal, attending a support group, or participating in community programs designed for people with dementia. Music therapy, art activities, and gentle exercise can stimulate their minds and lift their spirits. Try reminiscing about past events, as long-term memories often remain intact longer than short-term memories in people with dementia.
Meals - Make Sure They are Eating
"You need to consider whether the person is capable of preparing food, eating healthy and appropriate amounts of food, and has the awareness that they need to eat," Duxbury said. "If any link in that chain breaks, the person may not eat."
Every individual's experience with Alzheimer's or dementia is unique, but there are several strategies caregivers can implement to help maintain their loved one's independence in the kitchen while ensuring safety.
Taking precautions such as simplifying tasks, using visual aids like labels or pictures, and keeping frequently used items within easy reach can allow for a sense of autonomy.
At the same time, ensuring safety measures—such as installing stove shut-off devices, removing sharp objects, and monitoring cooking activities—can help prevent accidents and create a safe environment for the person with Alzheimer's to remain engaged in everyday activities.
Other Concerns
Losing independence is one of the hardest challenges for a person with dementia, especially when it comes to driving. Taking away someone's keys can be emotional, but a simple step like giving a loved one a set of keys that doesn't include the car key can provide comfort without compromising safety.
Additionally, reducing the need to drive by arranging deliveries or scheduling transportation for appointments can help ease the transition.
Caring for a loved one with dementia also involves managing their finances. To prevent elder financial abuse, have a conversation with your loved one, and remember that they don't live in the same reality as everyone else.
One of the top mistakes made by families is that they try to use adult rationality and logic with people with dementia, and these people's brains don't work that way. All it does is frustrate them because it doesn't make any sense.
One approach is giving them outdated checks so they feel involved without managing actual finances.
Managing their medication is also a major concern. Setting up a pillbox or timers to help them manage medications can help ensure their safety without taking away their independence.
Seek Professional Support
At some point, probably sooner than later, the family caregivers will need professional help. Professional caregivers can provide quality care to help them maintain a better quality of life, easing the burden on the family.
Your loved one may be able to remain at home with professional care or be better off with assisted living or memory care. Use the LTC NEWS Caregiver Directory to search for homecare providers, home health agencies, adult day care centers, assisted living, memory care, and nursing homes. With a few clicks, you can narrow down the options.
If your loved one has a Long-Term Care Insurance policy, be sure you don't hesitate to use the benefits right away -- Filing a Long-Term Care Insurance Claim.
Manage Medical Needs and Plan Ahead
Ensure that your loved one has regular medical checkups to monitor their health. Discuss with their doctor about medications that could help manage symptoms such as memory loss, mood swings, or agitation. Early legal and financial planning is also crucial. Ensure that they have up-to-date wills, healthcare proxies, and powers of attorney. Planning for future care, including long-term care options, is essential to make transitions smoother down the line.
By creating a supportive environment, engaging them socially, and working with professionals, you can ensure that your loved one with dementia is cared for in a way that maximizes their comfort and well-being.
Meanwhile, start thinking about whether you are prepared for the consequences of aging. Planning should, ideally, start in your 40s or 50s when you have the most affordable options.