title: Alcohol, dementia and cognitive decline in the elderly: a systematic review.
abstract: BACKGROUND
  dementia and cognitive decline have been linked to cardiovascular risk. Alcohol has known negative effects in large quantities but may be protective for the cardiovascular system in smaller amounts. Effect of alcohol intake may be greater in the elderly and may impact on cognition.
  
  
  METHODS
  to evaluate the evidence for any relationship between incident cognitive decline or dementia in the elderly and alcohol consumption, a systematic review and meta-analyses were carried out. Criteria for inclusion were longitudinal studies of subjects aged >or=65, with primary outcomes of incident dementia/cognitive decline.
  
  
  RESULTS
  23 studies were identified (20 epidemiological cohort, three retrospective matched case-control nested in a cohort). Meta-analyses suggest that small amounts of alcohol may be protective against dementia (random effects model, risk ratio [RR] 0.63; 95% CI 0.53-0.75) and Alzheimer's disease (RR 0.57; 0.44-0.74) but not for vascular dementia (RR 0.82; 0.50-1.35) or cognitive decline (RR 0.89; 0.67-1.17) However, studies varied, with differing lengths of follow up, measurement of alcohol intake, inclusion of true abstainers and assessment of potential confounders.
  
  
  CONCLUSIONS
  because of the heterogeneity in the data these findings should be interpreted with caution. However, there is some evidence to suggest that limited alcohol intake in earlier adult life may be protective against incident dementia later.
authors.affiliation: Imperial College, London, UK. r.peters@imperial.ac.uk
authors.forename: Ruth
authors.initials: R
authors.lastname: Peters
authors.forename: Jean
authors.initials: J
authors.lastname: Peters
authors.forename: James
authors.initials: J
authors.lastname: Warner
authors.forename: Nigel
authors.initials: N
authors.lastname: Beckett
authors.forename: Christopher
authors.initials: C
authors.lastname: Bulpitt
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000375:Aging; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology; D003071:Cognition / Q000187:drug effects*; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D003704:Dementia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D004305:Dose-Response Relationship, Drug; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018570:Risk Assessment