Late-onset alcohol abuse can be a presenting symptom of dementia

Date:
April 5, 2022
Source:
The Mount Sinai Hospital / Mount Sinai School of Medicine
Summary:
Clinical awareness of connection between alcohol and dementia is
paramount to providing the best patient care management.



FULL STORY ========================================================================== Patients who start abusing alcohol later in life -- after age 40 --
may be doing so secondary to an underlying neurologic condition, such as frontotemporal dementia, according to findings by a team of researchers
from the Icahn School of Medicine at Mount Sinai and the University of California, San Francisco. The results are reported in the April 4 issue
of the Journal of Alzheimer's Disease.


========================================================================== Overall alcohol abuse -- classified as when alcohol consumption negatively impacts work or social life or leads to legal ramifications -- is present
in 1.7 percent of older adults in the United States. Previous research has identified lifelong alcohol abuse as a risk factor for dementia. However,
it has been unknown whether older adults who begin abusing acohol late in
life have an underlying neurodegenerative disease. Particularly concerning
is that people who begin abusing alcohol because of an underlying
neurological condition may be misdiagnosed with primary alcohol abuse
and referred to traditional addiction treatment programs, a process
that may delay correct diagnosis and appropriate behavioral treatment,
expend family resources, and add to patient and caregiver burden.

"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,"
said Georges Nassan, MD, Associate Professor of Neurology, and Medical
Director for the Division of Behavioral Neurology and Neuropsychiatry,
at the Icahn School of Medicine at Mount Sinai and senior author of the
paper. "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 percent (nearly 1 in 15) of patients with frontotemporal
dementia started abusing alcohol late in life, and 5 percent (1 in 20)
did so as the first symptom of the disease. 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." The research team conducted a cross-sectional, retrospective study of patients evaluated at an academic referral center between 1999 and 2017 who had a clinical diagnosis of behavioral variant frontotemporal dementia (bvFTD), Alzheimer's-type
dementia, or semantic variant primary progressive aphasia. The presence
of alcohol abuse was screened using the National Alzheimer's Coordinating Center UDS questionnaire completed by clinicians during patient research visits. 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.

Among the 1,518 participants screened, late-onset alcohol abuse affected
2.2 percent, higher than the 1.7 percent for older adults overall. The
research 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. They also found that alcohol abuse
as a first symptom occurred in 1.4 percent 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.

"Because patients who begin using alcohol late in life are usually
first seen by psychiatrists, primary care providers, and rehabilitation specialists, these professionals should be aware of the possibility
that a neurodegenerative disease might be underlying the onset of
alcohol abuse late in life in people who historically didn't abuse
alcohol. Therefore, a specific evaluation including checking for
other frontal lobe symptoms should be performed, and patients at risk
should be referred to a neurologist," said Dr. Nassan. "An early and appropriate diagnosis in those patients is paramount for providing the
best management, improving patients' and families' quality of life,
and channeling patients to appropriate care facilities." Funding for
this research was provided by the National Institutes of Health, The
National Institute on Aging, and the Larry L. Hillblom Network Grant
for the Prevention of Age-Associated Cognitive Declince.


========================================================================== Story Source: Materials provided by The_Mount_Sinai_Hospital_/_Mount_Sinai_School_of Medicine. Note: Content
may be edited for style and length.


========================================================================== Journal Reference:
1. Elisa de Paula Franc,a Resende, Robin Ketelle, Anna Karydas, Isabel
Allen, Lea T. Grinberg, Salvatore Spina, William W. Seeley, David C.

Perry, Bruce Miller, Georges Naasan. Late-Onset Alcohol Abuse as
a Presenting Symptom of Neurodegenerative Diseases. Journal of
Alzheimer's Disease, 2022; 86 (3): 1073 DOI: 10.3233/JAD-215369 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2022/04/220405102900.htm

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