Alcohol use patterns and cognitive impairment: A cross‐country comparison

Abstract

Background Alcohol use is shown to be a risk and protective factor for cognitive impairment. Alcohol use patterns differ across cultures; it is possible inconsistent findings may be partially explained by different drinking patterns across countries. We analyzed datasets from international studies housed in the Global Alzheimer’s Association Interactive Network to examine the association between alcohol use and cognitive performance. Method We used baseline data from two countries: a) the United States (National Alzheimer’s Coordinating Center Uniform Dataset; NACC), and b) Taiwan (Taiwan Initiative for Geriatric Epidemiological Research; TIGER), focusing on participants age 65+ years, not currently taking Alzheimer’s disease medications, and who had complete data for cognitive performance (NACC: N=4,443; TIGER: N=605). In both studies, participants self‐reported alcohol use and completed a cognitive battery. We characterized alcohol use patterns by recent use (yes vs. no), and frequency (never, <once a week, 1‐4 times/week, daily/almost daily), and focused on Trail Making A and B and Verbal Fluency tests. Mixed effects models assessed the relationship between alcohol use and cognitive performance including the study (NACC vs. TIGER) as a random effect, and controlling for participant age, sex, and education in main effects. We also tested interactions for associations between studies. Result Two‐thirds of the combined sample reported alcohol use (18% <once a week, 25% 1‐4 times/week, and 19% daily/almost daily). In mixed effects models, those reporting recent alcohol use showed better cognitive performance than those reporting no use (Trail Making A: 46.4 [SD=10.1] vs. 51.7 [SD=10.1]; Trail Making B: 122.1 [SD=18.0] vs. 144.6 [SD=18.0]; Verbal Fluency: 29.7 [SD=3.4] vs. 27.3 [SD=3.4]; all p’s<0.001), and greater frequency was associated with better cognitive performance (all p’s<0.001). There were differences across studies in the association between alcohol use and Trail Making B (interaction p=0.003) and Verbal Fluency (interaction p=0.007); driven by positive associations observed within the NACC dataset. No interactions by study were observed for drinking frequency with cognition. Conclusion Both recent and more frequent alcohol use were associated with better cognitive performance; although this association appeared more prominently in the US vs. Taiwan. Identification of specific cultural factors driving associations observed will be explored.