Alcohol consumption and cognitive function in late life A longitudinal community study M. Ganguli, MD, MPH; J. Vander Bilt, MPH; J.A. Saxton, PhD; C. Shen, PhD; and H.H. Dodge, PhD Abstract—Objective: To examine the association between alcohol use and cognitive decline in a longitudinal study of a representative elderly community sample free of dementia at baseline. Methods: Cognitive functions and self-reported drinking habits were assessed at 2-year intervals over an average of 7 years of follow-up. Cognitive measures, grouped into composites, were examined in association with alcohol consumption. Trajectory analyses identified latent homoge- neous groups with respect to alcohol use frequency over time, and their association with average decline over the same period in each cognitive domain. Models controlled for age, sex, education, depression, smoking, general mental status (Mini-Mental State Examination [MMSE]), performance on the given test at baseline, and subsequent new-onset dementia during follow-up. Results: The authors found three homogeneous trajectories that they characterized as no drinking, minimal drinking, and moderate drinking. Few heavy drinkers were identified in this elderly cohort. Compared to no drinking, both minimal and moderate drinking were associated with lesser decline on the MMSE and Trailmaking tests. Minimal drinking was also associated with lesser decline on tests of learning and naming. These associations were more pronounced when comparing current drinkers to former drinkers (quitters) than to lifelong abstainers. Conclusion: In a representative elderly cohort over an average of 7 years, a pattern of mild-to-moderate drinking, compared to not drinking, was associated with lesser average decline in cognitive domains over the same period. NEUROLOGY 2005;65:1210–1217 Current clinical wisdom regarding alcohol and the brain is based largely on the deleterious effects of excessive alcohol consumption such as Wernicke- Korsakoff syndrome, alcohol dementia, 1-4 and hemor- rhagic stroke 5 . Acute alcohol consumption adversely affects cognitive task performance in laboratory settings, 6-9 and heavy alcohol consumption impairs cognitive processing in older individuals. 10-12 In con- trast, a growing literature suggests that a chronic pattern of light-to-moderate drinking, variously de- fined, may have a protective effect against dementia 13-28 and on cognitive function, 19-22 particu- larly among women. 23-26 These findings parallel con- temporary reports of the beneficial effects of moderate alcohol use on cardiovascular health. 27,28 Many previous studies examined either cognitive performance or alcohol use at a single measurement point. 10,14,29,30 Others examined only a general mental status test. 21,31 Some accounted for changes in drink- ing patterns over time by repeating the analyses ex- cluding those with such changes. 17,18,25 In the present study, we used the method of trajectory analysis to examine the associations between changes in cogni- tive functioning over time and the patterns or trajec- tories of self-reported drinking over the same period, in a large community-based elderly sample of older adults. Methods. The data reported here were collected as part of the Monongahela Valley Independent Elders Survey (MoVIES project), a prospective epidemiologic study of dementia in a largely rural, blue-collar community in Southwestern Pennsylvania. De- tails of the background, cohort, and methods of the study have been reported earlier. 32-34 Briefly, a total of 1,681 individuals aged 65 years or older were recruited during 1987–1989, fluent in En- glish with at least sixth-grade education, and living in the commu- nity (i.e., not in long-term-care institutions). Of these, 1,422 study participants were recruited by random sampling from the voter registration lists for the selected area, and 259 subjects were volunteers from the same area. A covariate “recruitment status,” representing original random vs volunteer selection, is always included in our analytic models. At approximately 2-year intervals, surviving consenting sub- jects were reassessed in a series of data collection “waves” until 2002. Data on alcohol consumption were first collected at wave 2 (1989-1991), which therefore serves as the baseline for the current analyses. At wave 2, the MoVIES cohort consisted of 1,341 adults with mean (SD) age 74.9 (5.5) years. After excluding 64 partici- pants with prevalent dementia (see below) with onset before base- line, data from the remaining 1,277 participants were available for the present analysis; further exclusions occurred where data were missing or not relevant for specific analyses, as will be de- scribed later. Screening assessment. Informed consent was obtained accord- ing to procedures approved annually by the University of Pitts- burgh Institutional Review Board. The standardized interview From the Division of Geriatrics and Neuropsychiatry, Department of Psychiatry (Dr. Ganguli and J. Vander Bilt), Department of Neurology (Dr. Saxton), University of Pittsburgh School of Medicine, and Department of Epidemiology (Drs. Ganguli and Dodge), University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; and the Division of Biostatistics (Dr. Shen), School of Medicine, Indiana University, Indianapolis, IN. Supported by Grants R01AG07562, K24AG023014, and K01AG023014 from the National Institute on Aging. Disclosure: The authors report no conflicts of interest. Received April 27, 2005. Accepted in final form July 5, 2005. Address correspondence and reprint requests to Dr. Mary Ganguli, Western Psychiatric Institute and Clinic, 3811 O’Hara Street, Pittsburgh, PA 15213-2593; e-mail: gangulim@upmc.edu 1210 Copyright © 2005 by AAN Enterprises, Inc.