Mukamal Kenneth J, Kuller Lewis H, Fitzpatrick Annette L, Longstreth W T, Mittleman Murray A, Siscovick David S
Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Ave, RO-114, Boston, Mass 02215, USA.
JAMA. 2003 Mar 19;289(11):1405-13. doi: 10.1001/jama.289.11.1405.
Alcohol consumption has been associated with complex changes in cerebral vasculature and structure in older adults. How alcohol consumption affects the incidence of dementia is less clear.
To determine the prospective relationship of alcohol consumption and risk of dementia among older adults.
DESIGN, SETTING, AND PARTICIPANTS: Nested case-control study of 373 cases with incident dementia and 373 controls who were among 5888 adults aged 65 years and older who participated in the Cardiovascular Health Study, a prospective, population-based cohort study in 4 US communities. The controls were frequency-matched on age, death before 1999, and their attendance of a 1998-1999 clinic. Participants in this study underwent magnetic resonance imaging (MRI) of the brain and cognitive testing between 1992 and 1994 and were followed up until 1999.
Odds of incident dementia, ascertained by detailed neurological and neuropsychological examinations according to average alcohol consumption, assessed by self-reported intake of beer, wine, and liquor at 2 visits prior to the date of the MRI.
Compared with abstention, the adjusted odds for dementia among those whose weekly alcohol consumption was less than 1 drink were 0.65 (95% confidence interval [CI], 0.41-1.02); 1 to 6 drinks, 0.46 (95% CI, 0.27-0.77); 7 to 13 drinks, 0.69 (95% CI, 0.37-1.31); and 14 or more drinks, 1.22 (95% CI, 0.60-2.49; P for quadratic term =.001). A trend toward greater odds of dementia associated with heavier alcohol consumption was most apparent among men and participants with an apolipoprotein E epsilon4 allele. We found generally similar relationships of alcohol use with Alzheimer disease and vascular dementia.
Compared with abstention, consumption of 1 to 6 drinks weekly is associated with a lower risk of incident dementia among older adults.
饮酒与老年人脑血管和结构的复杂变化有关。饮酒如何影响痴呆症的发病率尚不清楚。
确定老年人饮酒与痴呆症风险之间的前瞻性关系。
设计、地点和参与者：对373例新发痴呆症患者和373例对照进行巢式病例对照研究，这些患者和对照来自5888名65岁及以上的成年人，他们参与了心血管健康研究，这是一项在美国4个社区进行的基于人群的前瞻性队列研究。对照在年龄、1999年前死亡情况以及1998 - 1999年诊所就诊情况方面进行频率匹配。本研究的参与者在1992年至1994年间接受了脑部磁共振成像（MRI）和认知测试，并随访至1999年。
新发痴呆症的几率，通过详细的神经学和神经心理学检查确定，根据平均饮酒量进行评估，平均饮酒量通过MRI检查日期前两次就诊时自我报告的啤酒、葡萄酒和烈酒摄入量来评估。
与戒酒者相比，每周饮酒量少于1杯者患痴呆症的校正几率为0.65（95%置信区间[CI]，0.41 - 1.02）；1至6杯者为0.46（95%CI，0.27 - 0.77）；7至13杯者为0.69（95%CI，0.37 - 1.31）；14杯及以上者为1.22（95%CI，0.60 - 2.49；二次项P = 0.001）。与饮酒量增加相关的痴呆症几率增加的趋势在男性和携带载脂蛋白Eε4等位基因的参与者中最为明显。我们发现饮酒与阿尔茨海默病和血管性痴呆的关系总体相似。
与戒酒相比，老年人每周饮用1至6杯酒与较低的新发痴呆症风险相关。
