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Age-Alcoholism Interactions May Harm the Brain’s Frontal Cortex

March 26, 2018

By Marilynn Larkin

NEW YORK—Older alcohol-dependent individuals may be at increased risk for gray matter loss and functional compromise, even if excessive drinking starts late in life, researchers say.

The consequences could be exacerbated by drug dependence and HCV infection, they add.

Dr. Edith Sullivan of Stanford University School of Medicine in California and colleagues analyzed structural MRIs, HCV status and substance abuse data on 222 alcohol-dependent individuals, ages 25 to 75 (mean age, 48; 70% men), and 199 age-matched controls (53% men).

As reported online March 14 in JAMA Psychiatry, examination of the six major cortical volumes identified five regions showing volume deficits in participants with alcoholism compared with the control group: the frontal, temporal, parietal, cingulate, and insular cortices.

“Volume deficits were prominent in frontal, parietal, and insular cortices and were less so but still significant in temporal and cingulate regions,” the authors reported.

When the effect of age was examined independently, accelerated aging (i.e., volume loss) was seen in the frontal cortex and precentral and superior gyri in the alcoholism group. These changes could not be attributed to the amount of alcohol consumed, which was greater in patients with younger age at alcoholism onset.

Given the high incidence (54.5%) of drug dependence in the alcoholism group, the team compared longitudinal data on drug subgroups (cocaine, cannabis, amphetamines, opiates) among 116 participants with alcoholism and 96 control participants.

The alcohol-plus-cocaine and alcohol-plus-opiate groups had smaller frontal volumes than the drug-dependence–free alcoholism group. However, deficits in precentral, supplementary motor, and medial volumes endured in drug-dependence-free participants with alcoholism compared with controls.

Additional longitudinal analyses showed that those with HCV infection had greater deficits in frontal, precentral, superior, and orbital volumes than those without HCV. However, total frontal, insular, parietal, temporal, and precentral volume deficits persisted in the uninfected participants with alcoholism compared with control participants with HCV.

“We speculate that age-alcohol interactions notable in frontal cortex put older adults at heightened risk for age-associated neurocompromise even if alcohol misuse is initiated later in life,” the authors conclude.

Although the National Institute on Alcohol Abuse and Alcoholism (NIAAA) has guidelines and definitions for “low-risk” drinking, Dr. Sullivan said by email, “It is important to recognize that some people should refrain from drinking or drink even less than the maximum depending on their medical conditions.”

“Aging comes with additional medications, which sometimes can interact with alcohol having negative consequences,” she told Reuters Health.

“Physicians should be confident to ask patients of all ages how much they drink and how often they drink that amount,” she continued. “If alcohol consumption exceeds the NIAAA guidelines (, patients should be informed about the risks of unsafe drinking.”

“Such knowledge is also important for physicians to take seriously given the potential interaction of alcohol and medications especially in their older patients,” Dr. Sullivan noted. “Older age is not protective against the adverse consequences of alcohol consumption.”

Dr. George Koob of NIAAA, author of a related editorial, told Reuters Health by email, “Alcohol misuse in older adults can accelerate the decline in the volume of the frontal cortex, the area of the brain responsible for executive function, including cognitive processes. An accelerated frontal cortex decline can lead to accelerated impairments in cognitive function observed in aging.”

“There is no evidence that moderate levels of consumption accelerate cognitive decline during aging,” he added.

“The NIAAA recommends that both female and male adults 65+ who are healthy and do not take medications consume no more than seven . . . drinks per week, with no more than three drinks on any one day, as higher levels of alcohol consumption may increase the risk of alcohol-related problems in this population,” he said.

“For individuals with a history of alcohol use disorder, major psychiatric disorder, liver disease, or who take over-the-counter or prescription medications,” he added, “no alcohol may be advisable regardless of age.”


JAMA Psychiatry 2018.

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