Alcohol and Cognitive Function in Older Women
http://www.100md.com
《新英格兰医药杂志》
To the Editor: Stampfer et al. (Jan. 20 issue)1 suggest that "women who consume up to one drink per day have less cognitive impairment . . . than nondrinkers," on the basis of the authors' data from the Nurses' Health Study and findings reported in the literature. A significant limitation of the study by Stampfer et al. is its low generalizability. On the basis of their exclusion criteria, the findings are applicable only to relatively well educated women with very stable drinking patterns who have no history of antidepressant use. Furthermore, a major threat to the study's external validity appears to be its nonrandom selection of subjects. We agree with the point made by Evans and Bienias in their accompanying editorial2 that older adults in good mental and physical health may be more likely than their less healthy peers to consume alcohol in social situations. Thus, cognitive and health characteristics of the participating women may be determining the study's alcohol-intake groups. Finally, caution is necessary when recommending any amount of alcohol to older adults, since the toxic effects of alcohol can be exacerbated with age as a result of changes in body composition (e.g., decreased lean body mass and total body water).
Kara S. Schmidt, Ph.D.
David J. Libon, Ph.D.
University of Medicine and Dentistry of New Jersey
School of Osteopathic Medicine
Stratford, NJ 08084
schmidka@umdnj.edu
References
Stampfer MJ, Kang JH, Chen J, Cherry R, Grodstein F. Effects of moderate alcohol consumption on cognitive function in women. N Engl J Med 2005;352:245-253.
Evans DA, Bienias JL. Alcohol consumption and cognition. N Engl J Med 2005;352:289-290.
To the Editor: Stampfer et al. report that women who consume a moderate amount of alcohol have less cognitive impairment and better cognitive function than nondrinkers. However, the antiinflammatory action of alcohol is not clearly mentioned among the plausible explanations for this effect.
Moderate alcohol consumption has been shown to be related to a decrease in markers of systemic inflammation.1,2 Since inflammatory mechanisms are hypothesized to be involved in the pathogenesis of cognitive impairment,3,4,5 the beneficial action of moderate alcohol intake on cognitive function could also be related to its antiinflammatory activity.
Francesca Pezzetta, M.D.
Presidio Ospedaliero di San Vito al Tagliamento
33078 San Vito al Tagliamento, Italy
Luca Mascitelli, M.D.
Comando Brigata Alpina Julia
33100 Udine, Italy
lumasci@libero.it
References
Albert MA, Glynn RJ, Ridker PM. Alcohol consumption and plasma concentration of C-reactive protein. Circulation 2003;107:443-447.
Imhof A, Woodward M, Doering A, et al. Overall alcohol intake, beer, wine, and systemic markers of inflammation in western Europe: results from three MONICA samples (Augsburg, Glasgow, Lille). Eur Heart J 2004;25:2092-2100.
McGeer EG, McGeer PL. Brain inflammation in Alzheimer disease and the therapeutic implications. Curr Pharm Des 1999;5:821-836.
Teunissen CE, van Boxtel MP, Bosma H, et al. Inflammation markers in relation to cognition in a healthy aging population. J Neuroimmunol 2003;134:142-150.
Yaffe K, Lindquist K, Penninx BW, et al. Inflammatory markers and cognition in well-functioning African-American and white elders. Neurology 2003;61:76-80.
To the Editor: Stampfer and colleagues report that older women who consumed less than 15 g of alcohol per day had better cognitive scores and a lower risk of cognitive decline than nondrinkers. No significant associations were found for higher levels of alcohol consumption (15 to 30 g per day), and no differences were found according to the type of beverage. These conclusions may underscore the potential effects of wine consumption as a constituent of the Mediterranean diet. For instance, among 13,462 women enrolled in an Italian collaborative pharmacoepidemiologic study, Gruppo Italiano di Farmacovigilanza nell'Anziano (GIFA),1 all levels of alcohol consumption up to 39 g per day were associated with a lower probability of cognitive impairment (odds ratio as compared with no alcohol consumption, 0.69; 95 percent confidence interval, 0.62 to 0.76), after adjustment for age, coexisting conditions, and medications. This result is in keeping with the observed benefits of up to 29 g of alcohol per day in older populations adhering to a Mediterranean diet.2 The question of whether such dose–effect differences among studies should be ascribed to consumption of red wine or to increased rates of alcohol elimination associated with regular drinking during meals3 deserves further investigation.
Giuseppe Zuccala, M.D.
Emanuele Marzetti, M.D.
Roberto Bernabei, M.D.
Catholic University
00168 Rome, Italy
giuseppe_zuccala@rm.unicatt.it
References
Carosella L, Pahor M, Pedone C, et al. Pharmacosurveillance in hospitalized patients in Italy: study design of the `Gruppo Italiano di Farmacovigilanza nell'Anziano' (GIFA). Pharmacol Res 1999;40:287-295.
Knoops KT, de Groot LC, Kromhout D, et al. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the Hale Project. JAMA 2004;292:1433-1439.
Ramchandani VA, Kwo PY, Li TK. Effect of food and food consumption on alcohol elimination rates in healthy men and women. J Clin Pharmacol 2001;41:1345-1350.
The authors reply: Drs. Schmidt and Libon note that our finding of an inverse relation between moderate alcohol consumption and cognitive decline may not be generalizable. We agree; taken by themselves, our findings (and those of any single study) may have limited generalizability. However, generalizability is best addressed by determining whether other studies of alcohol and cognitive function in populations with different characteristics have similar results. As we describe in the Discussion section of our article, similar inverse associations were observed among U.S. blacks, French and Dutch populations, Japanese Americans, and other populations with varying educational backgrounds and drinking patterns. Since we submitted our manuscript, two other articles have been published: a report of the Women's Health Initiative Memory Study1 and a report on a study of Japanese Americans and white Americans2; both studies show an apparent benefit of moderate alcohol consumption. Moreover, a relation between moderate alcohol consumption and better cognition has biologic support. Thus, we believe our findings are generalizable to groups other than the specific population in our study.
Drs. Schmidt and Libon also mention the possibility of confounding. Although no observational study can be free of confounding by unknown factors, we took into account a wide range of physical, mental, and social variables (including depression), and adjustment for these variables had little effect on the results. We chose specifically to select women with long-term stable drinking patterns in order to minimize the possibility of reverse causation (i.e., that the level of cognitive function predetermined the drinking patterns).
Drs. Schmidt and Libon express concern about alcohol consumption by older adults. Nobody would argue against caution in recommending alcohol, as we repeatedly emphasize in our article. However, total abstinence has been consistently linked with higher rates of coronary disease and overall mortality in many studies3,4,5; thus, the potential health benefits of moderate alcohol might be considered, too.
We fully agree with Drs. Pezzetta and Mascitelli that an antiinflammatory mechanism is plausible; space constraints limited our discussion of this issue. Finally, we were unaware of the GIFA data provided by Zuccala et al., which add further support to the overall hypothesis that there may be an inverse relation between moderate alcohol consumption and cognitive decline. Clearly, further study is needed to define the optimal levels of intake.
Meir J. Stampfer, M.D.
Jae Hee Kang, Sc.D.
Francine Grodstein, Sc.D.
Brigham and Women's Hospital
Boston, MA 02115
References
Espeland MA, Gu L, Masaki KH, et al. Association between reported alcohol intake and cognition: results from the Women's Health Initiative Memory Study. Am J Epidemiol 2005;161:228-238.
Bond GE, Burr R, McCurry SM, et al. Alcohol, gender, and cognitive performance: a longitudinal study comparing older Japanese and non-Hispanic white Americans. J Aging Health 2004;16:615-640.
Rimm EB, Stampfer MJ. Alcohol abstinence: a risk factor for coronary heart disease. Heart Dis Updates 2000;2:1-9.
Thun MJ, Peto R, Lopez AD, et al. Alcohol consumption and mortality among middle-aged and elderly U.S. adults. N Engl J Med 1997;337:1705-1714.
Gmel G, Gutjahr E, Rehm J. How stable is the risk curve between alcohol and all-cause mortality and what factors influence the shape? A precision-weighted hierarchical meta-analysis. Eur J Epidemiol 2003;18:631-642.
Kara S. Schmidt, Ph.D.
David J. Libon, Ph.D.
University of Medicine and Dentistry of New Jersey
School of Osteopathic Medicine
Stratford, NJ 08084
schmidka@umdnj.edu
References
Stampfer MJ, Kang JH, Chen J, Cherry R, Grodstein F. Effects of moderate alcohol consumption on cognitive function in women. N Engl J Med 2005;352:245-253.
Evans DA, Bienias JL. Alcohol consumption and cognition. N Engl J Med 2005;352:289-290.
To the Editor: Stampfer et al. report that women who consume a moderate amount of alcohol have less cognitive impairment and better cognitive function than nondrinkers. However, the antiinflammatory action of alcohol is not clearly mentioned among the plausible explanations for this effect.
Moderate alcohol consumption has been shown to be related to a decrease in markers of systemic inflammation.1,2 Since inflammatory mechanisms are hypothesized to be involved in the pathogenesis of cognitive impairment,3,4,5 the beneficial action of moderate alcohol intake on cognitive function could also be related to its antiinflammatory activity.
Francesca Pezzetta, M.D.
Presidio Ospedaliero di San Vito al Tagliamento
33078 San Vito al Tagliamento, Italy
Luca Mascitelli, M.D.
Comando Brigata Alpina Julia
33100 Udine, Italy
lumasci@libero.it
References
Albert MA, Glynn RJ, Ridker PM. Alcohol consumption and plasma concentration of C-reactive protein. Circulation 2003;107:443-447.
Imhof A, Woodward M, Doering A, et al. Overall alcohol intake, beer, wine, and systemic markers of inflammation in western Europe: results from three MONICA samples (Augsburg, Glasgow, Lille). Eur Heart J 2004;25:2092-2100.
McGeer EG, McGeer PL. Brain inflammation in Alzheimer disease and the therapeutic implications. Curr Pharm Des 1999;5:821-836.
Teunissen CE, van Boxtel MP, Bosma H, et al. Inflammation markers in relation to cognition in a healthy aging population. J Neuroimmunol 2003;134:142-150.
Yaffe K, Lindquist K, Penninx BW, et al. Inflammatory markers and cognition in well-functioning African-American and white elders. Neurology 2003;61:76-80.
To the Editor: Stampfer and colleagues report that older women who consumed less than 15 g of alcohol per day had better cognitive scores and a lower risk of cognitive decline than nondrinkers. No significant associations were found for higher levels of alcohol consumption (15 to 30 g per day), and no differences were found according to the type of beverage. These conclusions may underscore the potential effects of wine consumption as a constituent of the Mediterranean diet. For instance, among 13,462 women enrolled in an Italian collaborative pharmacoepidemiologic study, Gruppo Italiano di Farmacovigilanza nell'Anziano (GIFA),1 all levels of alcohol consumption up to 39 g per day were associated with a lower probability of cognitive impairment (odds ratio as compared with no alcohol consumption, 0.69; 95 percent confidence interval, 0.62 to 0.76), after adjustment for age, coexisting conditions, and medications. This result is in keeping with the observed benefits of up to 29 g of alcohol per day in older populations adhering to a Mediterranean diet.2 The question of whether such dose–effect differences among studies should be ascribed to consumption of red wine or to increased rates of alcohol elimination associated with regular drinking during meals3 deserves further investigation.
Giuseppe Zuccala, M.D.
Emanuele Marzetti, M.D.
Roberto Bernabei, M.D.
Catholic University
00168 Rome, Italy
giuseppe_zuccala@rm.unicatt.it
References
Carosella L, Pahor M, Pedone C, et al. Pharmacosurveillance in hospitalized patients in Italy: study design of the `Gruppo Italiano di Farmacovigilanza nell'Anziano' (GIFA). Pharmacol Res 1999;40:287-295.
Knoops KT, de Groot LC, Kromhout D, et al. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the Hale Project. JAMA 2004;292:1433-1439.
Ramchandani VA, Kwo PY, Li TK. Effect of food and food consumption on alcohol elimination rates in healthy men and women. J Clin Pharmacol 2001;41:1345-1350.
The authors reply: Drs. Schmidt and Libon note that our finding of an inverse relation between moderate alcohol consumption and cognitive decline may not be generalizable. We agree; taken by themselves, our findings (and those of any single study) may have limited generalizability. However, generalizability is best addressed by determining whether other studies of alcohol and cognitive function in populations with different characteristics have similar results. As we describe in the Discussion section of our article, similar inverse associations were observed among U.S. blacks, French and Dutch populations, Japanese Americans, and other populations with varying educational backgrounds and drinking patterns. Since we submitted our manuscript, two other articles have been published: a report of the Women's Health Initiative Memory Study1 and a report on a study of Japanese Americans and white Americans2; both studies show an apparent benefit of moderate alcohol consumption. Moreover, a relation between moderate alcohol consumption and better cognition has biologic support. Thus, we believe our findings are generalizable to groups other than the specific population in our study.
Drs. Schmidt and Libon also mention the possibility of confounding. Although no observational study can be free of confounding by unknown factors, we took into account a wide range of physical, mental, and social variables (including depression), and adjustment for these variables had little effect on the results. We chose specifically to select women with long-term stable drinking patterns in order to minimize the possibility of reverse causation (i.e., that the level of cognitive function predetermined the drinking patterns).
Drs. Schmidt and Libon express concern about alcohol consumption by older adults. Nobody would argue against caution in recommending alcohol, as we repeatedly emphasize in our article. However, total abstinence has been consistently linked with higher rates of coronary disease and overall mortality in many studies3,4,5; thus, the potential health benefits of moderate alcohol might be considered, too.
We fully agree with Drs. Pezzetta and Mascitelli that an antiinflammatory mechanism is plausible; space constraints limited our discussion of this issue. Finally, we were unaware of the GIFA data provided by Zuccala et al., which add further support to the overall hypothesis that there may be an inverse relation between moderate alcohol consumption and cognitive decline. Clearly, further study is needed to define the optimal levels of intake.
Meir J. Stampfer, M.D.
Jae Hee Kang, Sc.D.
Francine Grodstein, Sc.D.
Brigham and Women's Hospital
Boston, MA 02115
References
Espeland MA, Gu L, Masaki KH, et al. Association between reported alcohol intake and cognition: results from the Women's Health Initiative Memory Study. Am J Epidemiol 2005;161:228-238.
Bond GE, Burr R, McCurry SM, et al. Alcohol, gender, and cognitive performance: a longitudinal study comparing older Japanese and non-Hispanic white Americans. J Aging Health 2004;16:615-640.
Rimm EB, Stampfer MJ. Alcohol abstinence: a risk factor for coronary heart disease. Heart Dis Updates 2000;2:1-9.
Thun MJ, Peto R, Lopez AD, et al. Alcohol consumption and mortality among middle-aged and elderly U.S. adults. N Engl J Med 1997;337:1705-1714.
Gmel G, Gutjahr E, Rehm J. How stable is the risk curve between alcohol and all-cause mortality and what factors influence the shape? A precision-weighted hierarchical meta-analysis. Eur J Epidemiol 2003;18:631-642.