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Risk Factor:
  (Ethanol, Drinking, Alcohol consumption, Alcohol intake, Alcoholic beverage)
Risk Factor Type: Behavior, Nutrition and supplements
Current Understanding:
The tables below present a modest number of reports whose results, taken collectively, suggest an association between moderate alcohol consumption and reduced risk of both clinical Alzheimer disease (AD) and total dementia. Overall, these data suggest that moderate alcohol consumption is a modifiable protective factor, while heavy alcohol consumption may promote dementia. Results from other lines of research corroborate the value of moderate alcohol consumption in relation to cognitive decline in older adults, as well as better cardiovascular health. This research also documents the neurotoxic effect and other negative health consequences of heavy use, particularly among older individuals. Thus, starting or increasing alcohol consumption in late life for prevention of Alzheimer’s disease is not recommended. Specific aspects of the relationship between alcohol and cognitive outcomes still remain unclear, including the optimal quantity, timing, and type of alcohol consumption to reduce the risk of AD and cognitive decline; whether the observed protective effect is directly causal or mediated through the effect on cardiovascular health; and the active biological agents and mechanism of action. For a review of the putative mechanisms by which alcohol consumption may influence AD risk and a more detailed commentary on interpreting the findings below in a broader context, please view the Discussion.
Literature Extraction: Search strategy  * New *
Last Search Completed: 28 April 2013 - Last content update released on 11 Nov 2013.


Table 1:   Alcohol consumption - categorical
Notes The reports shown in this table examine alcohol consumption in relation to AD risk. The studies vary in the levels of consumption they evaluate. All studies use non-drinkers as referents for comparison, but some further distinguished former drinkers from never drinkers, and used the latter group as the referent.  
  Alzheimer Disease Total Dementia  
Paper Cohort Study Type # Subjects
(% Female)		 Average Follow-up Time Exposure Distribution
# of Cases Effect Size 95% CI P-value # of Cases Effect Size 95% CI P-value Ethnicity Age at Start of Follow-up:
Mean (SD)
(Range)		 Diagnostic Assessment Covariates & Analysis Comment Paper
Deng, 2006 Chongqing Cohort study reporting odds ratios (ORs) 2632
(56%)		 2.0 y
(detail)
Nondrinker: 41%
Light-to-moderate drinker: 52%
Excessive drinker: 6%
(detail)		 -
-
-
Total: 84		 1.00
0.63
1.35		 Ref.
0.55-0.72
0.35-5.21		 Ref.
< 0.0001
0.66
*		 -
-
-
Total: 121		 1.00
0.52
1.45		 Ref.
0.32-0.85
0.43-4.89		 Ref.
0.01
0.55
*		 Chinese
(detail)		 67 (-)
(60 - )
(detail)		 Screening: MMSE

AD Diagnosis: DSM IIIR, NINDS-AIREN, NINCDS ADRDA
(detail)		 A, E, G, MMSE, DBP, SM, SH, SBP‡
(detail)		 Deng, 2006
Hebert, 1992 East Boston EPESE Cohort study reporting odds ratios (ORs) 513
(56%)		 4.7 y
(detail)
Alcohol consumption in past year
Nondrinker: 26%
Drinker: 74%
23
53
Total: 76
1.00
0.70
Ref.
0.30-1.50
Ref.
0.3
 
 
 
 
 		  (detail) - (-)
(65 - )
(detail)		 AD Diagnosis: NINCDS ADRDA
(detail)		 A, E, G, SM‡
(detail)		 Hebert, 1992
Huang, 2002 Kungsholmen Project Incidence study reporting hazard ratios (HRs) 402
(82%)		 -
(detail)
Nondrinker: 43%
Light-to-moderate drinker: 51%
(detail)		 51
33
Total: 84		 1.00
0.50		 Ref.
0.30-0.70		 Ref.
0.001
*		 66
46
Total: 112		 1.00
0.50		 Ref.
0.30-0.70		 Ref.
0.001
*		 Caucasian
(detail)		 - (-)
(75 - ≥ 90)
(detail)		 AD Diagnosis: NINCDS ADRDA
(detail)		 A, E, G, MMSE, INST, SM‡
(detail)		 Huang, 2002
Lindsay, 2002 CSHA Cumulative incidence study reporting odds ratios (ORs) 4088
(61%)		 5.0 y
*
(detail)
Drinks per week
Low consumption (< 1): 59%
Regular consumption (1+): 41%
(detail)
135
51
Total: 186
1.00
0.68
Ref.
0.47-1.00
Ref.
0.05
*
 
 
 
 
 		  (detail) 73 (-)
(65 - 100)
(detail)		 Screening: 3MSE

AD Diagnosis: NINCDS ADRDA
(detail)		 A, E, G‡ Lindsay, 2002
Luchsinger, 2004 WHICAP Incidence study reporting hazard ratios (HRs) 981
(67%)		 4.1 y
Servings of beer, wine or liquor
Nondrinker (0): 70%
Light-moderate (1/mo to 1-3/day): 29%
Heavy drinker (>3/day): 1%
(detail)
-
-
-
Total: 199
1.00
0.97
-
Ref.
0.69-1.35
-
Ref.
0.85
-
-
-
-
Total: 260
1.00
-
-
Ref.
-
-
Ref.
-
-		 Caucasian, Hispanic, African-American (Black)
 73 (6)
(65 - )		 AD Diagnosis: NINCDS ADRDA
(detail)		 A, E, G, APOE4‡
(detail)		 Luchsinger, 2004
Mukamal, 2003 CHCS Nested case control study with cumulative incidence sampling reporting odds ratios (ORs) 746
(58%)		 6.1 y
(detail)
Long-term consumption pattern
0 drinks/wk (not former or quitter): 37%
<1 drink/wk: 17%
1-6 drinks/wk: 14%
7-13 drinks/wk: 8%
>14 drinks/wk: 6%
Former: 8%
Quitter (since baseline): 11%
(detail)
130
44
28
22
19
28
41
Total: 312
1.00
0.59
0.43
0.65
0.95
1.47
1.18
Ref.
0.37-0.94
0.25-0.72
0.35-1.23
0.46-1.96
0.77-2.82
0.68-2.04
Ref.
0.03
< 0.0001
0.18
0.89
0.24
0.55
*
151
53
33
25
24
35
52
Total: 373
1.00
0.65
0.46
0.69
1.22
1.52
1.38
Ref.
0.41-1.02
0.27-0.77
0.37-1.31
0.60-2.49
0.81-2.83
0.81-2.35
Ref.
0.06
< 0.0001
0.25
0.58
0.19
0.24
*		 Caucasian, African-American (Black)
(detail)		 - (-)
(65 - )
(detail)		 Screening: 3MSE

AD Diagnosis: DSM IV, IQ-CODE, Medical History, NINDS-AIREN, NINCDS ADRDA, Neurologic examination, Neuropsychological examination
(detail)		 A, G, APOE4, DM, RE, SH‡§
(detail)		 Mukamal, 2003
Ogunniyi, 2006 Indianapolis-Ibadan Dementia Project - Indianapolis Cohort Cohort study reporting odds ratios (ORs) 470
(69%)		 4.7 y
(detail)
>10 drinks/wk: 31%
<10 drinks/wk: 69%		 -
-
Total: 89		 0.49
1.00		 0.25-0.90
Ref.		 0.03
Ref.
*		  
 		       African-American (Black)
(detail)		 77 (6)
( - )
(detail)		 Screening: CSID

AD Diagnosis: NINCDS ADRDA
(detail)		 A, G‡ Ogunniyi, 2006
Ogunniyi, 2006 Indianapolis-Ibadan Dementia Project - Ibadan Cohort Cohort study reporting odds ratios (ORs) 523
(69%)		 5.1 y
(detail)
>10 drinks/wk: 23%
<10 drinks/wk: 77%		 -
-
Total: 62		 0.82
1.00		 0.35-1.78
Ref.		 0.63
Ref.
*		  
 		       African
(detail)		 76 (7)
( - )
(detail)		 Screening: CSID

AD Diagnosis: NINCDS ADRDA
(detail)		 A, G‡ Ogunniyi, 2006
Ruitenberg, 2002 Rotterdam Study Incidence study reporting hazard ratios (HRs) 5395
(59%)		 6.0 y
No alcohol: 21%
<1 drink /week: 21%
>1 drink /week but <1 /day: 28%
1-3 drinks /day: 27%
> 4 drinks /day: 3%
(detail)		 -
-
-
-
-
Total: 146		 1.00
0.91
0.91
0.72
1.17		 Ref.
0.58-1.44
0.58-1.44
0.43-1.20
0.35-3.55		 Ref.
0.68
0.68
0.21
0.79
*		 62
44
48
38
5
Total: 197		 1.00
0.82
0.75
0.58
1.00†		 Ref.
0.56-1.22
0.51-1.11
0.38-0.90
0.39-2.59		 Ref.
0.32
0.15
0.01
1.0
*		  (detail) 68 (8)
(55 - )		 Screening: GMS, MMSE

AD Diagnosis: DSM IIIR, NINDS-AIREN, NINCDS ADRDA
(detail)		 A, E, G, BMI, DM, SM, SBP‡
(detail)		 Ruitenberg, 2002
Weyerer, 2011 German AgeCoDe Study Incidence study reporting hazard ratios (HRs) 3180
(65%)		 3.0 y
(detail)
Weekly consumption (days/week)
Abstainer: 50%
Drinker (1 or more): 50%
(detail)
-
-
Total: 111
1.00
0.58
Ref.
0.38-0.89
Ref.
0.01
-
-
Total: 217
1.00
0.71
Ref.
0.53-0.96
Ref.
0.03		  (detail) - (-)
(75 - )
(detail)		 Screening: DSM IIIR - dementia, Other

AD Diagnosis: DSM IIIR, DSM IV, Other
(detail)		 A, E, G, APOE4, CI, DEP, IADLI, ALON, MCI, SM‡ Weyerer, 2011
Weyerer, 2011 German AgeCoDe Study Incidence study reporting hazard ratios (HRs) 3180
(65%)		 3.0 y
(detail)
Grams consumed per day
Abstainer: 50%
1-9: 25%
10-19: 13%
20-29:         
30-39:         
40+:         
(detail)
-
-
-
-
-
-
Total: 111
1.00
0.61
0.72
0.13
0.33
0.68
Ref.
0.36-1.01
0.37-1.39
0.02-0.95
0.05-2.41
0.16-2.90
Ref.
0.06
0.33
0.05
0.27
0.61
-
-
-
-
-
-
Total: 217
1.00
0.76
0.78
0.40
0.72
0.51
Ref.
0.53-1.07
0.49-1.25
0.17-0.94
0.26-1.97
0.16-1.64
Ref.
0.12
0.3
0.03
0.52
0.26		  (detail) - (-)
(75 - )
(detail)		 Screening: Other

AD Diagnosis: DSM IIIR, DSM IV, Other
(detail)		 A, E, G, APOE4, CI, DEP, IADLI, ALON, MCI, SM‡ Weyerer, 2011
* Derived value.
 † Five or fewer cases exist.
 ‡ Covariates: "A" (age), "E" (education), "G" (gender), "APOE4" (APOE e4 genotype), "MMSE" (baseline MMSE), "BMI" (body mass index), "CI" (comorbidity index), "DEP" (depression), "DM" (diabetes mellitus), "DBP" (diastolic blood pressure), "INST" (institutionalization), "IADLI" (instrumental activities of daily living impairment), "ALON" (living alone), "MCI" (mild cognitive impairment), "RE" (race/ethnicity), "SM" (smoking status), "SH" (stroke history), "SBP" (systolic blood pressure)
 § Covariates for total dementia are different.
 
Table 2:   Alcohol consumption - continuous, per ounce/day increment
Notes The reports shown in this table examine alcohol consumption as a continuous variable (ounces of alcohol consumed per day) in relation to AD risk.  
  Alzheimer Disease Total Dementia  
Paper Cohort Study Type # Subjects
(% Female)		 Average Follow-up Time oz/day
Mean (SD)
(Range)
# of Cases Effect Size 95% CI P-value # of Cases Effect Size 95% CI P-value Ethnicity Age at Start of Follow-up:
Mean (SD)
(Range)		 Diagnostic Assessment Covariates & Analysis Comment Paper
Hebert, 1992 East Boston EPESE Cohort study reporting odds ratios (ORs) 513
(56%)		 4.7 y
(detail)
- (-)
( - )
(detail)		 76 1.10 0.80-1.50 0.4          (detail) - (-)
(65 - )
(detail)		 AD Diagnosis: NINCDS ADRDA
(detail)		 A, E, G, SM‡
(detail)		 Hebert, 1992
‡ Covariates: "A" (age), "E" (education), "G" (gender), "SM" (smoking status)
 
Table 3:   Wine consumption - categorical
Notes The reports shown in this table examine wine consumption in relation to AD risk. The studies vary in the levels of wine consumption they evaluate. All studies use non-drinkers (of wine) as referents for comparison. In most of these studies, wine was the predominant form of alcohol consumed in the study population (e.g., living in regions of France), and thus consumption of other forms of alcohol was comparatively rare and therefore ignored.  
  Alzheimer Disease Total Dementia  
Paper Cohort Study Type # Subjects
(% Female)		 Average Follow-up Time Exposure Distribution
# of Cases Effect Size 95% CI P-value # of Cases Effect Size 95% CI P-value Ethnicity Age at Start of Follow-up:
Mean (SD)
(Range)		 Diagnostic Assessment Covariates & Analysis Comment Paper
Larrieu 2004 PAQUID Incidence study reporting hazard ratios (HRs) 2950
(-)		 -
(detail)
Glasses
Nondrinker (< 1/wk): 43%
Mild drinker (2/wk-2/day): 41%
Moderate drinker (3-4/day): 13%
Heavy drinker (>5/day): 3%
(detail)
-
-
-
-
1.00
0.88
0.53
-
Ref.
0.66-1.18
0.30-0.95
-
Ref.
0.39
0.03
-
*
-
-
-
-
1.00
0.89
0.56
-
Ref.
0.70-1.15
0.36-0.92
-
Ref.
0.36
0.02
-
*		  (detail) - (-)
(65 - )
(detail)		 Screening: DSM IIIR - dementia

AD Diagnosis: DSM IIIR, Hachinski's Ischemic Scale (Hachinski, 1975), NINCDS ADRDA
(detail)		 A, E, G‡
(detail)		 Larrieu 2004
Leibovici, 1999 Eugeria Cohort study reporting odds ratios (ORs) 225
(-)		 3.0 y
(detail)
Daily consumption
Non-drinkers (< 1/4 litre): 51%
Drinkers (> 1/4 litre): 49%
(detail)
-
-
1.00
0.13
Ref.
0.04-1.20
Ref.
0.08
 
 
 
 
 		  (detail) - (-)
(60 - )
(detail)		 Screening: DSM IIIR - dementia, Other

AD Diagnosis: Brain Imaging, DSM IIIR, Neurologic examination
(detail)		 A, E‡
(detail)		 Leibovici, 1999
Lindsay, 2002 CSHA Cumulative incidence study reporting odds ratios (ORs) 4088
(61%)		 5.0 y
*
(detail)
Drinks per week
No wine consumption (0): 83%
Regular consumption (1+): 17%
(detail)
171
15
Total: 186
1.00
0.49
Ref.
0.28-0.88
Ref.
0.01
*
 
 
 
 
 		  (detail) 73 (-)
(65 - 100)
(detail)		 Screening: 3MSE

AD Diagnosis: NINDS-AIREN
(detail)		 A, E, G‡
(detail)		 Lindsay, 2002
Luchsinger, 2004 WHICAP Incidence study reporting hazard ratios (HRs) 981
(67%)		 4.1 y
(detail)
Servings
Nondrinker: 86%
Light-moderate (1/mo to 1-3/day): 14%
Heavy drinker (> 3/day): 0%
(detail)
-
-
-
Total: 199
1.00
0.69
-
Ref.
0.45-1.09
-
Ref.
0.1
-
*
-
-
-
Total: 260
1.00
0.64
-
Ref.
0.43-0.96
-
Ref.
0.03
-
*		 Caucasian, Hispanic, African-American (Black)
(detail)		 73 (6)
(65 - )		 AD Diagnosis: NINCDS ADRDA
(detail)		 A, E, G, APOE4‡
(detail)		 Luchsinger, 2004
Orgogozo, 1997 PAQUID Case-cohort study reporting odds ratios (ORs) 2273
(57%)		 3.0 y
(detail)
Glasses
Nondrinker (< 1/wk): 43%
Mild drinker (2/wk to 2/day): 41%
Moderate drinker (3-4/day): 14%
Heavy drinker (5+/day): 3%
(detail)
36
26
3
1
Total: 66
1.00
0.55
0.28†
0.48†
Ref.
0.31-0.99
0.08-0.99
0.06-3.92
Ref.
0.04
0.05
0.49
*
48
47
3
1
Total: 99
1.00
0.81
0.19†
0.31†
Ref.
0.50-1.30
0.05-0.66
0.04-2.42
Ref.
0.39
0.01
0.26
*		   74 (-)
(65 - )
(detail)		 AD Diagnosis: NINCDS ADRDA
(detail)		 A, E, G, MMSE, OS‡
(detail)		 Orgogozo, 1997
Weyerer, 2011 German AgeCoDe Study Incidence study reporting hazard ratios (HRs) 3180
(65%)		 3.0 y
(detail)
Wine consumption (only)
Abstainer:         
Wine consumption (only) > 1/wk:         
(detail)
-
-
Total: 111
1.00
0.76
Ref.
0.46-1.23
Ref.
0.26
-
-
Total: 217
1.00
0.79
Ref.
0.55-1.13
Ref.
0.2		  (detail) - (-)
(75 - )
(detail)		 Screening: Other

AD Diagnosis: DSM IIIR, DSM IV, Other
(detail)		 A, E, G, APOE4, CI, DEP, IADLI, ALON, MCI, SM‡ Weyerer, 2011
* Derived value.
 † Five or fewer cases exist.
 ‡ Covariates: "A" (age), "E" (education), "G" (gender), "APOE4" (APOE e4 genotype), "MMSE" (baseline MMSE), "CI" (comorbidity index), "DEP" (depression), "IADLI" (instrumental activities of daily living impairment), "ALON" (living alone), "MCI" (mild cognitive impairment), "OS" (Occupational status), "SM" (smoking status)
 
Table 4:   Beer consumption - categorical
Notes These reports shown in this table examine beer consumption in relation to AD risk. Persons who do not drink beer are the referents for comparison. Some reports in this table are not clear about whether the persons in the reference group do not drink at all or merely abstain from beer. The latter is presumed for all reports in this table.  
  Alzheimer Disease Total Dementia  
Paper Cohort Study Type # Subjects
(% Female)		 Average Follow-up Time Exposure Distribution
# of Cases Effect Size 95% CI P-value # of Cases Effect Size 95% CI P-value Ethnicity Age at Start of Follow-up:
Mean (SD)
(Range)		 Diagnostic Assessment Covariates & Analysis Comment Paper
Lindsay, 2002 CSHA Cumulative incidence study reporting odds ratios (ORs) 4088
(61%)		 5.0 y
*
(detail)
Drinks per week
No beer consumption (0): 81%
Regular consumption (1+): 19%
(detail)
162
25
Total: 187
1.00
0.84
Ref.
0.51-1.41
Ref.
0.5
*
 
 
 
 
 		  (detail) 73 (-)
(65 - 100)
(detail)		 Screening: 3MSE

AD Diagnosis: NINCDS ADRDA
(detail)		 A, E, G‡
(detail)		 Lindsay, 2002
Luchsinger, 2004 WHICAP Incidence study reporting hazard ratios (HRs) 981
(67%)		 4.1 y
(detail)
Servings
Nondrinker: 86%
Light-moderate (1/mo to 1-3/day): 14%
Heavy drinker (> 3/day): 0%
(detail)
-
-
-
Total: 199
1.00
1.33
-
Ref.
0.91-1.96
-
Ref.
0.14
-
 
 
 
Total: 260
 
 
 		 Caucasian, Hispanic, African-American (Black)
(detail)		 73 (6)
(65 - )		 AD Diagnosis: NINCDS ADRDA
(detail)		 A, E, G, APOE4‡
(detail)		 Luchsinger, 2004
Weyerer, 2011 German AgeCoDe Study Incidence study reporting hazard ratios (HRs) 3180
(65%)		 3.0 y
(detail)
Beer consumption (only)
Abstainer:         
Beer drinker (only) > 1/wk:         
(detail)
-
-
Total: 111
1.00
0.60
Ref.
0.30-1.21
Ref.
0.15
-
-
Total: 217
1.00
0.87
Ref.
0.56-1.35
Ref.
0.53		  (detail) - (-)
(75 - )
(detail)		 Screening: Other

AD Diagnosis: DSM IIIR, DSM IV, Other
(detail)		 A, E, G, APOE4, CI, DEP, IADLI, ALON, MCI, SM‡ Weyerer, 2011
* Derived value.
 ‡ Covariates: "A" (age), "E" (education), "G" (gender), "APOE4" (APOE e4 genotype), "CI" (comorbidity index), "DEP" (depression), "IADLI" (instrumental activities of daily living impairment), "ALON" (living alone), "MCI" (mild cognitive impairment), "SM" (smoking status)
 
Table 5:   Liquor consumption - categorical
Notes These reports shown in this table examine liquor consumption in relation to AD risk. Persons who do not drink liquor are the referents for comparison. Some reports in this table are not clear about whether the persons in the reference group do not drink at all or merely abstain from liquor. The latter is presumed for all reports in this table.  
  Alzheimer Disease Total Dementia  
Paper Cohort Study Type # Subjects
(% Female)		 Average Follow-up Time Exposure Distribution
# of Cases Effect Size 95% CI P-value # of Cases Effect Size 95% CI P-value Ethnicity Age at Start of Follow-up:
Mean (SD)
(Range)		 Diagnostic Assessment Covariates & Analysis Comment Paper
Lindsay, 2002 CSHA Cumulative incidence study reporting odds ratios (ORs) 4088
(61%)		 5.0 y
*
(detail)
Drinks per week
No spirits consumption (0): 73%
Regular consumption (1+): 28%
(detail)
151
35
Total: 186
1.00
0.78
Ref.
0.52-1.19
Ref.
0.24
*
 
 
 
 
 		  (detail) 73 (-)
(65 - 100)
(detail)		 Screening: 3MSE

AD Diagnosis: NINCDS ADRDA
(detail)		 A, E, G‡
(detail)		 Lindsay, 2002
Luchsinger, 2004 WHICAP Incidence study reporting hazard ratios (HRs) 981
(67%)		 4.1 y
(detail)
Servings
Nondrinker: 86%
Light-moderate (1/mo to 1-3/day): 14%
Heavy drinker (> 3/day): 0%
(detail)
-
-
-
Total: 199
1.00
1.34
-
Ref.
0.89-2.00
-
Ref.
0.15
-
 
 
 
Total: 260
 
 
 		 Caucasian, Hispanic, African-American (Black)
(detail)		 73 (6)
(65 - )		 AD Diagnosis: NINCDS ADRDA
(detail)		 A, E, G, APOE4‡
(detail)		 Luchsinger, 2004
* Derived value.
 ‡ Covariates: "A" (age), "E" (education), "G" (gender), "APOE4" (APOE e4 genotype)