Association of Alcohol Consumption with Cognition in Older Population: The A4 Study

Background: Alcohol use disorders have been categorized as a 'strongly modifiable' risk factor for dementia. Objective: To investigate the cross-sectional association between alcohol consumption and cognition in older adults and if it is different across sexes or depends on amyloid-beta (A beta) accumulation in the brain. Methods: Cognitively unimpaired older adults (N = 4387) with objective and subjective cognitive assessments and amyloid positron emission tomography (PET) imaging were classified into four categories based on their average daily alcohol use. Multivariable linear regression was then used to test the main effects and interactions with sex and A beta levels. Results: Individuals who reported no alcohol consumption had lower scores on the Preclinical Alzheimer Cognitive Composite (PACC) compared to those consuming one or two drinks/day. In sex-stratified analysis, the association between alcohol consumption and cognition was more prominent in females. Female participants who consumed two drinks/day had better performance on PACC and Cognitive Function Index (CFI) than those who reported no alcohol consumption. In an A beta- stratified sample, the association between alcohol consumption and cognition was present only in the A beta- subgroup. The interaction between A beta status and alcohol consumption on cognition was not significant. Conclusion: Low or moderate consumption of alcohol was associated with better objective cognitive performance and better subjective report of daily functioning in cognitively unimpaired individuals. The association was present only in A beta- individuals, suggesting that the pathophysiologic mechanism underlying the effect of alcohol on cognition is independent of A beta pathology. Further investigation is required with larger samples consuming three or more drinks/day.