Journal of Alzheimer’s Disease 17 (2009) 7–31 7 DOI 10.3233/JAD-2009-1009 IOS Press Review Article Alcohol Drinking, Cognitive Functions in Older Age, Predementia, and Dementia Syndromes Francesco Panza a , Cristiano Capurso b , Alessia D’Introno a , Anna M Colacicco a , Vincenza Frisardi a , Maria Lorusso a , Andrea Santamato c , Davide Seripa d , Alberto Pilotto e , Emanuele Scafato f , Gianluigi Vendemiale b,g , Antonio Capurso a and Vincenzo Solfrizzi a,* a Department of Geriatrics, Center for Aging Brain, Memory Unit, University of Bari, Bari, Italy b Department of Geriatrics, University of Foggia, Foggia, Italy c Physical Medicine and Rehabilitation, University of Foggia, Foggia, Italy d Laboratory of Gerontology & Geriatrics, Department of Research, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy e Geriatric Unit, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy f National Center on Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanit ` a, Rome, Italy g Internal Medicine Unit, IRCSS Casa Sollievo dalla Sofferenza. San Giovanni Rotondo, Foggia, Italy Abstract. Among lifestyle-related factors, low to moderate alcohol drinking has been proposed as a protective factor against the development of age-related changes in cognitive function, predementia syndromes, and cognitive decline of degenerative (Alzheimer’s disease, AD) or vascular origin (vascular dementia, VaD) in several longitudinal studies, but contrasting findings also exist. Furthermore, many of these studies were limited by cross-sectional design, restriction by age or sex, or incomplete ascertainment. Different outcomes, beverages, drinking patterns, or follow-up periods, or possible interactions with other lifestyle-related (i.e., smoking) or genetic factors [i.e., apolipoprotein E (APOE) genotyping] may be sources of great variability. Light to moderate alcohol use may be associated with a reduced risk of unspecified incident dementia and AD, while for VaD, cognitive decline, and predementia syndromes, the current evidence is only suggestive of a protective effect. In conclusion, as intervention studies are not feasible in this area, the best evidence comes from an overview of epidemiological studies, suggesting that the protective effects are more likely with wine consumption and the absence of an APOE e4 allele. At present, there is no indication that light to moderate alcohol drinking would be harmful to cognition and dementia, and it is not possible to define a specific beneficial level of alcohol intake. Keywords: Alcohol, Alzheimer’s disease, dementia, mild cognitive impairment, predementia syndromes, vascular dementia, vascular risk factors * Corresponding author: Vincenzo Solfrizzi, MD, PhD, Depart- ment of Geriatrics, Center for Aging Brain, Memory Unit, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy. Tel.: +39 080 5473685; Fax: +39 080 5478860; E-mail: v.solfrizzi@ geriatria.uniba.it. INTRODUCTION The boundaries of normal cognitive aging are indef- inite, and the clinical pictures of predementia and de- mentia syndromes are, at present, in progress. Demen- tia is a syndrome defined by impairments in memory ISSN 1387-2877/09/$17.00  2009 – IOS Press and the authors. All rights reserved