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Late-life alcohol abuse shown to be a possible symptom of dementia

People over 40 years old who develop alcohol abuse behaviors may be doing so in response to underlying brain disorders, such as early-onset dementia.

According to a new study, adults who begin abusing alcohol later in life — after the age of 40 — may be doing so as a result of an underlying neurologic condition such as frontotemporal dementia. The findings were published by a research team from the Icahn School of Medicine at Mount Sinai and the University of California, San Francisco in the Journal of Alzheimer’s Disease on April 4th.

In the United States, 1.7% of older Americans suffer from alcohol abuse, which is defined as drinking that has a detrimental impact on job or social life or results in legal consequences. Lifelong alcohol misuse has been established as a risk factor for dementia in previous studies. However, it’s unclear if older persons who start consuming alcohol later in life have a neurodegenerative condition.

People who begin abusing alcohol as a result of an underlying neurological condition may be initially diagnosed with primary alcohol abuse and referred to conventional rehabilitation programs, a methodology that can delay proper diagnosis and behavioral treatment, drain resources, and increase patient and caregiver burden.The researchers conducted a cross-sectional, retrospective investigation of individuals diagnosed with behavioral variant frontotemporal dementia (bvFTD),

Georges Nassan, MD, an Associate Professor of Neurology at the Icahn School of Medicine at Mount Sinai and co-author of the paper, stated in a Mount Sinai news release, “Our study aimed to identify and compare the frequencies of lifetime alcohol abuse, late-onset alcohol abuse, and alcohol abuse as a first symptom of dementia in a group of patients living with several forms of dementia, including Alzheimer’s disease and frontotemporal dementia.”

He continued, “What we found is that alcohol abuse may be the first sign of an underlying neurological condition when it presents late in life. In fact, up to 7% (nearly 1 in 15) of patients with frontotemporal dementia started abusing alcohol late in life, and 5% (1 in 20) did so as the first symptom of the disease. While it is important to identify social factors that may lead to alcohol abuse, such as retirement, loneliness, or loss of income/loved ones/housing, our data should implore health care workers to avoid systematically attributing alcohol abuse to these aspects and prompt clinicians to investigate the possibility of frontal lobe dysfunction.”

The researchers conducted a cross-sectional, retrospective investigation of individuals diagnosed with behavioral variant frontotemporal dementia (bvFTD). BvFTD is the most common type of frontotemporal degeneration. During patient research visits, physicians completed the National Alzheimer’s Coordinating Center UDS questionnaire to check for alcohol consumption. Dementia-related alcohol abuse was defined as abuse that started within the first three years, either before or after symptom onset.

Late-onset alcohol misuse impacted 2.2% of the 1,518 persons evaluated in 2017, which is higher than the general rate of 1.7% for older adults. The researchers discovered that individuals with bvFTD were substantially more likely than those with Alzheimer’s-type dementia to develop late-onset alcohol consumption.

They also found that alcohol abuse was a first symptom in 1.4% of all patients with bvFTD, which was five times higher than Alzheimer’s-type dementia patients. The findings suggest that not only is late-onset alcohol abuse far more common in bvFTD than Alzheimer’s-type dementia, but also the molecular processes driving late-onset and lifelong alcohol consumption are likely to be distinct.

The study was published in Journal of Alzheimer’s Disease on April 5th, 2022.

Abstract. Background:The association between lifetime alcohol abuse and a higher risk to develop dementia is well known. However, it is unknown whether older adults who begin abusing alcohol late in life have an underlying neurodegenerative disease. Objective:Identify the frequency of lifelong alcohol abuse (L-AA), late-onset alcohol abuse (LO-AA), and alcohol abuse as a first symptom of dementia (AA-FS) in patients with neurodegenerative diseases. Methods:Cross-sectional retrospective study of patients evaluated at an academic referral center with a clinical diagnosis of behavioral variant frontotemporal dementia (bvFTD), Alzheimer-type dementia (AD), and semantic variant primary progressive aphasia (svPPA) (n = 1,518). The presence of alcohol abuse was screened with the National Alzheimer’s Coordinating Center questionnaire. L-AA was defined as onset < 40 years, LO-AA as onset ≥40 years, and AA-FS was defined when the abuse started within the first three years from symptom onset. Results:The frequency of LO-AA was 2.2% (n = 33/1,518). LO-AA was significantly more frequent in patients with bvFTD than AD (7.5%, n = 13/173 versus 1.3%, n = 16/1,254, CI:1.0;11.4%), but not svPPA (4.4%, n = 4/91, CI: –4.4;10.7%). Similarly, AA-FS was more frequent in bvFTD patients than AD (5.7%, n = 10/173 versus 0.7%, n = 9/1,254, CI:0.5%;9.5%), but not svPPA (2.2%, n = 2/91, CI:–2.4;9.1%). Conclusion:LO-AA can be a presenting symptom of dementia, especially bvFTD. Alcohol abuse onset later in life should prompt a clinical investigation into the possibility of an underlying neurodegenerative process because delay in diagnosis and treatment may increase patient and caregiver burden. The results need to be interpreted with caution due to the limitations of the study.

de Paula França Resende E, Ketelle R, Karydas A, Allen I, Grinberg LT, Spina S, Seeley WW, Perry DC, Miller B, Naasan G. Late-Onset Alcohol Abuse as a Presenting Symptom of Neurodegenerative Diseases. J Alzheimers Dis. 2022 Feb 9. doi: 10.3233/JAD-215369. Epub ahead of print. PMID: 35180118.

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