Late-onset alcohol abuse can be symptom of dementia

late-onset alcohol abuse
© Kristýna Henkeová

According to new results in the Journal of Alzheimer’s Disease, patients who start abusing alcohol in later life – after age 40 – maybe due to underlying dementia

Researchers from the Icahn School of Medicine at Mount Sinai and the University of California, San Francisco have stated that an underlying neurologic condition, such as frontotemporal dementia, may be influencing patients late-onset alcohol abuse.

What is late-onset alcohol abuse?

Overall alcohol abuse is classified as when alcohol is consumed consistently and begins to negatively impact work or social life or leads to legal ramifications. 1.7% of older adults in the United States struggle with overall alcohol abuse.

Previous research has identified lifelong alcohol abuse as a risk factor for dementia. However, it has been previously unknown whether older adults who begin abusing alcohol later in life have an underlying neurodegenerative disease.

Senior author, Doctor Georges Nassan, Associate Professor of Neurology, and Medical Director for the Division of Behavioural Neurology and Neuropsychiatry stated, “our study aimed to identify and compare the frequencies of lifetime alcohol abuse, late-onset alcohol abuse, and alcohol abuse as a first symptom of dementia in a group of patients living with several forms of dementia, including Alzheimer’s disease and frontotemporal dementia.”

The importance of understanding the connection between late-onset alcohol abuse and dementia

A point of concern that prompted the research is that those who begin abusing alcohol due to an underlying neurological condition may be misdiagnosed with primary alcohol abuse and then referred to traditional addiction treatment programs, a process that may delay correct diagnosis and appropriate behavioural treatment, expend family resources, and add to patient and caregiver burden.

“What we found is that alcohol abuse may be the first sign of an underlying neurological condition when it presents late in life. In fact, up to 7% (nearly 1 in 15) of patients with frontotemporal dementia started abusing alcohol late in life, and 5% (1 in 20) did so as the first symptom of the disease,” said Nassan.

“While it is important to identify social factors that may lead to alcohol abuse, such as retirement, loneliness, or loss of income/loved ones/housing, our data should implore health care workers to avoid systematically attributing alcohol abuse to these aspects and prompt clinicians to investigate the possibility of frontal lobe dysfunction.”

Late-onset alcohol abuse usually happens within first three years of symptoms

The research team conducted a cross-sectional, retrospective study of patients evaluated at an academic referral centre between 1999 and 2017 who had a clinical diagnosis of behavioural variant frontotemporal dementia (bvFTD), Alzheimer’s-type dementia, or semantic variant primary progressive aphasia.

Screened using the National Alzheimer’s Coordinating Center UDS questionnaire completed by clinicians during patient research visits, the presence of alcohol was catalogued.

Lifelong alcohol abuse was defined as alcohol abuse that began before the patient was 40 years old, late-onset alcohol abuse as abuse that began at age 40 or above, and alcohol abuse as a first symptom of dementia as abuse that started within the first three years, either before or after symptom onset.

Within the 1,518 people screened, the researchers found that late-onset alcohol abuse affected 2.2%, higher than the 1.7% for older adults overall. The team found that late-onset alcohol abuse was significantly more frequent in patients with bvFTD than those with Alzheimer’s-type dementia, while there was no difference between the frequency of lifelong alcohol abuse across the three dementia groups.

Alcohol abuse was a first symptom of dementia in 1.4% of patients

They also found that alcohol abuse as a first symptom occurred in 1.4% of all patients, five times more frequently in patients with bvFTD than those with Alzheimer’s-type dementia. The results indicate not only that late-onset alcohol abuse is much more frequent in bvFTD than Alzheimer’s-type dementia, but also the likelihood that the biological mechanisms underlying late-onset and lifelong alcohol abuse are different.

“An early and appropriate diagnosis in those patients is paramount for providing the best management, improving patients’ and families’ quality of life, and channelling patients to appropriate care facilities” said Doctor Nassan.


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