Alcohol use and dementia: a systematic scoping review

Heavy alcohol use is known to increase the risk of acute lung injury and the acute respiratory distress syndrome. This is in part due to increased production of reactive oxygen species. We hypothesized that recipients of lungs from heavy drinkers would be more susceptible to lung injury following transplantation. In this retrospective cohort study, donor histories and transplant outcomes were reviewed in 192 consecutive lung transplant recipients. Donors were classified as No Alcohol Use, Moderate Alcohol Use, or Heavy Alcohol Use based on documented donor histories. Freedom from mechanical ventilation took longer in the lung transplant recipients whose donors had Heavy Alcohol Use, compared with those whose donors had No Alcohol Use or Moderate Alcohol Use (p=0.01). At admission to the intensive care unit, the Heavy Alcohol Use group had median PaO2 /FiO2 ratio 219 (interquartile range [IQR]: 162 to 382), compared with 305 (IQR: 232 to 400) in the Moderate Alcohol Use group and 314 (IQR: 249 to 418) in the No Alcohol Use group (p=0.005). The odds of developing severe primary graft dysfunction (PGD) in the Heavy Alcohol Use group versus the No Alcohol Use group were 8.7 times greater (95% confidence interval 1.427 to 53.404, p=0.019) after controlling for factors known to be associated with PGD. Recipients of donors with a heavy alcohol use history had an over 8 times greater risk of developing severe PGD following lung transplant. The increase in PGD resulted in poorer gas exchange in the recipients of donor lungs from heavy alcohol users, and these recipients subsequently required mechanical ventilation for a longer time following transplant. Further investigation into lung donors with heavy alcohol use histories is necessary to determine those at highest risk for PGD following transplant.

Background: Heavy alcohol use has been hypothesized to accelerate disease progression to end-stage liver disease in patients with hepatitis C virus (HCV) infection. In this study, we estimated the relative influences of heavy alcohol use and HCV in decompensated chronic liver disease (CLD). Methods: Retrospectively, 904 patients with cirrhotic disease admitted to our hospitals during January 2010–December 2012 were identified based on ICD9 codes. A thorough chart review captured information on demographics, viral hepatitis status, alcohol use and progression of liver disease (i.e. decompensation). Decompensation was defined as the presence of ascites due to portal hypertension, bleeding esophageal varices, hepatic encephalopathy or hepatorenal syndrome. Heavy alcohol use was defined as a chart entry of greater than six daily units of alcohol or its equivalent. Results: 347 patients were included based on our selection criteria of documented heavy alcohol use (n = 215; 62.0%), hepatitis titers (HCV: n = 182; 52.5%) and radiological evidence of CLD with or without decompensation (decompensation: n = 225; 64.8%). Independent of HCV infection, heavy alcohol use significantly increased the risk of decompensation (OR = 1.75, 95% CI 1.11–2.75, p < 0.02) relative to no heavy alcohol use. No significance was seen with age, sex, race, HIV, viral hepatitis and moderate alcohol use for risk for decompensation. Additionally, dose-relationship regression analysis revealed that heavy, but not moderate alcohol use, resulted in a three-fold increase (p = 0.013) in the risk of decompensation relative to abstinence. Conclusions: While both heavy alcohol use and HCV infection are associated with risk of developing CLD, our data suggest that heavy, but not moderate, alcohol consumption is associated with a greater risk for hepatic decompensation in patients with cirrhosis than does HCV infection.

Alcohol, insulin resistance (IR), and hepatitis C (HCV) are all significant contributors to adverse outcomes of chronic liver disease. Latinos are disproportionately affected by these risk factors. We investigated the relationship between alcohol use and insulin action in a prospective cohort of Latino individuals with and without HCV. One hundred fifty-three nondiabetic Latino individuals (60 HCV+, 93 HCV-) underwent clinical evaluation and metabolic testing; 56 had repeat testing over a median follow-up of 1.5years. Peripheral IR and hepatic IR were measured via steady-state plasma glucose (SSPG) and endogenous glucose production during a two-step, 240-min insulin suppression test. Insulin secretion (IS) was measured using the graded glucose infusion test. Alcohol use was categorized as none, moderate (≤1drink/day for women and ≤2drinks/day for men), and heavy (>moderate). Multivariable models including HCV status assessed associations of alcohol use with baseline SSPG, hepatic IR and IS, and changes in these parameters over time. Overall, the median age was 44years, 63.4% were male, 66.7% overweight/ obese, and 31.9% had heavy lifetime alcohol use while 60.4% had moderate lifetime alcohol use. SSPG and IS were similar by levels of alcohol use at baseline and alcohol use was not statistically significantly associated with change in these measures over time. However, lifetime daily heavy alcohol use (vs. not heavy, coef 2.4μU-mg/kg-min-ml, p=0.04) and HCV status (coef 4.4μU-mg/kg-min-ml, p=0.0003) were independently associated with higher baseline hepatic IR, and current heavy alcohol use was associated with greater change in hepatic IR in follow-up (coef 5.8μU-mg/kg-min-ml, p=0.03). In this cohort of Latino individuals, lifetime and current heavy alcohol use influenced hepatic IR and its change over time. Strategies to decrease rates of heavy alcohol use or increase abstinence along with lifestyle modification and anti-HCV therapy to reduce metabolic risk are critical to prevent adverse liver and metabolic outcomes in Latino individuals.

Overlapping epidemics of alcohol and illicit drug use among HCV-infected persons who inject drugs

Characterizing the effects of alcohol and marijuana use on adolescent brain development is important for understanding potential alterations in neurodevelopment. Several cross sectional studies have identified group differences in white matter integrity after initiation of heavy alcohol and marijuana use, however none have explored white matter trajectories in adolescents pre- and post initiation of use, particularly for marijuana users. This study followed 16 adolescents with minimal alcohol and marijuana use at ages 16–18 over three years. At follow-up, teens were 19–22 years old; half of the participants initiated heavy alcohol use and half initiated heavy alcohol and marijuana use. Repeated-measures ANOVA revealed 20 clusters in association and projection fibers tracts (p < 0.01) in which a group by time interaction was found. Most consistently, white matter integrity (i.e., fractional anisotropy) decreased for those who initiated both heavy alcohol and marijuana use over the follow-up interval. No effect of time or change in white matter integrity was seen for those who initiated alcohol use only in the majority of clusters. In most regions, at the baseline time point, teens who would later initiate both alcohol and marijuana use demonstrated white matter integrity greater than or equal to teens that initiated alcohol use only. Findings suggest poorer tissue integrity associated with combined initiation of heavy alcohol and marijuana use in late adolescence. While OPEN ACCESS pre-existing differences may also be related to likelihood of substance use, the present data suggest an effect on tissue integrity for these teens transitioning to combined alcohol and marijuana use in later adolescence.

ABSTRACTCorrelates of heavy episodic alcohol and alcohol reduction intervention preferences were examined among lesbian, gay, bisexual, and queer (LGBQ) adults in romantic relationships. Anonymous data were collected online; analyses included logistic and multinomial regression models. One-fourth of participants reported recent heavy episodic alcohol use. Perceptions of partners' engaging in heavy alcohol use was associated with an increased odds of engaging in heavy alcohol use. Perceptions of partners' heavy alcohol use was associated with an increased odds of preferring a couples-based alcohol intervention compared to preferring no intervention. Findings highlight the need to consider partners in alcohol interventions for LGBQ couples.

Higher rates of alcohol use have been reported in HIV+ individuals compared to the general population. Both heavy alcohol use and HIV infection are associated with increased risk of neuropsychological (NP) impairment. We examined effects of heavy active alcohol use and HIV on NP functioning in a large sample of community-residing HIV+ individuals and HIV- controls. The four main study groups included 72 HIV- light/non-drinkers, 70 HIV- heavy drinkers (>100 drinks per month), 70 HIV+ light/non-drinkers, and 56 HIV+ heavy drinkers. The heavy drinking group was further subdivided to assess effects of the heaviest levels of active alcohol use (>6 drinks per day) on NP functioning. A comprehensive NP battery was administered. Multivariate analysis of covariance was employed to examine the effect of HIV and alcohol on NP functioning after adjusting for group differences in age and estimated premorbid verbal intellectual functioning. The analyses identified main effects of heavy drinking and HIV on NP function, with greatest effects involving the contrast of HIV+ heavy drinkers and the HIV- light drinkers. Synergistic effects of heaviest current drinking and HIV infection were identified in analyses of motor and visuomotor speed. Supplementary analyses also revealed better NP function in the HIV+ group with antiretroviral treatment (ART) and lower level of viral burden, a finding that was consistent across levels of alcohol consumption. Finally, heavy alcohol use and executive functioning difficulties were associated with lower levels of self-reported medication adherence in the HIV+ group. The findings suggest that active heavy alcohol use and HIV infection have additive adverse effects on NP function, that they may show synergistic effects in circumstances of very heavy active alcohol use, and that heavy drinking and executive functioning may mediate health-related behaviors in HIV disease.

Given alcohol and/or other drug (AOD) use occurs among people with HIV (PWH), we examined its association with falls and fall-related outcomes and whether frailty moderates the association. Northeastern US city. We analyzed an observational cohort of PWH with current or past AOD use. Alcohol measures were any past 14-day heavy use, average alcohol/day, and days with heavy use. Drug use measures were past 30-day illicit use of cocaine, opioids, and sedatives. Repeated cross-sectional associations were estimated with separate multivariable generalized estimating equation regression models for each fall-related outcome. Among PWH (n = 251; mean age 52 [SD = 10]), 35% reported heavy alcohol use, 24% cocaine, 16% illicit opioids, 13% illicit sedatives, and 35% any fall; 27% were frail. Heavy alcohol use was associated with a fall (AOR = 1.49, 95% CI: 1.08 to 2.07), multiple falls (AOR = 1.55 95% CI: 1.10 to 2.19), and fall/fracture-related emergency department visit or hospitalization (AOR = 1.81, 95% CI: 1.10 to 2.97). Higher average alcohol/day and more heavy drinking days were associated with multiple falls. Illicit sedative use was associated with a fall, multiple falls, and emergency department visit/hospitalization and opioid use with fracture. Frailty moderated the association of heavy alcohol use and a fall (AOR = 2.26, 95% CI: 1.28 to 4.01 in those frail) but not in those not frail. The effect of AOD use on falls and fall-related outcomes was most pronounced with alcohol, particularly among frail PWH. Heavy alcohol, illicit sedative, and illicit opioid use are high-priority targets for preventing falls and fall-related consequences for PWH.

Data from birth registries can be studied to assess the prevalence of prenatal alcohol use and associated maternal and neonatal outcomes. Linked maternal and neonatal data (2015-2018) for alcohol-exposed pregnancies were obtained from the Better Outcomes Registry and Network (BORN) Ontario. Descriptive statistics were generated for maternal demographics, prenatal substance use, mental health/substance use history, and neonatal outcomes. Logistic regression models were performed to assess the odds of prenatal heavy (binge or weekly) alcohol and other substance use based on mental health/substance use history and other maternal demographics, and the impacts of heavy alcohol use and other prenatal substance exposures on neonatal outcomes. A total of 10,172 (2.4%) women reported alcohol use during pregnancy. One-third had pre-existing or current mental health and/or substance use problems, which was associated with significantly higher odds of heavy alcohol use during pregnancy. Prenatal exposure to heavy alcohol use was associated with increased odds of neonatal abstinence syndrome (2.5 times); respiratory distress syndrome (2.3 times); neonatal intensive care unit (NICU) admission (58%); and hyperbilirubinemia (57%). Prenatal exposure to one or more substances in addition to alcohol was associated with significantly higher odds of fetal/maternal/placental pregnancy complications; preterm birth; NICU admission; low APGAR scores; one or more confirmed congenital anomalies at birth; respiratory distress syndrome; and intrauterine growth restriction. It is crucial to routinely screen childbearing-age and pregnant women for alcohol and other substance use as well as mental health problems in order to prevent adverse maternal and neonatal outcomes.

Background: The relationship between alcohol use and stroke is complex. A U-shaped relationship has been identified for ischemic stroke, while a more linearly increasing risk has been found for hemorrhagic stroke. Previous investigations of alcohol and risk on hemorrhagic stroke have not consistently reported on the separate risk of intracerebral hemorrhage (ICH). We here report on the association of alcohol use and risk of ICH in ERICH. Methods: ERICH is a multi-center, prospective, case-control study of a race-ethnically mixed population with ICH. Controls were identified through random digit dialing to match cases by age (+/- 5 years), sex, race/ethnicity (non-Hispanic white, non-Hispanic black and Hispanic) and geographic area. Records of cases were reviewed for past medical history and data on ICH presentation. All cases and controls underwent a comprehensive interview which includes questions regarding alcohol use. We categorized alcohol use as none, rare (&lt;1 drink a month), moderate ( ≥1 drink per month and ≤2 drinks daily), intermediate (&gt;2 but &lt;5 daily) and heavy (≥ 5 daily). Odds ratios for each category were calculated using the no use alcohol group as a reference. Results: A total of 740 cases were matched with controls. Mean age was 58±12, 55% were male, 44% non-Hispanic black, 31% non-Hispanic white and 25% Hispanic. Cases were more likely to report no (52 vs. 37%) and heavy alcohol use (12% vs. 5.2%). Controls were more likely to report rare (12 vs. 6%), moderate (41 vs. 26%) and intermediate (5 vs. 4%) alcohol use. The odds ratios were 0.47 (CI: 0.27-0.82) for rare, 0.58 (CI: 0.40-0.83) for moderate, 0.57 (CI: 0.27-1.19) for intermediate and 1.54 (CI: 0.87-2.72) for heavy use after adjustment for baseline group differences. Conclusion: These findings demonstrate a protective effect of rare and moderate alcohol use on ICH risk in a multi racial-ethnic population. There was a non-significant trend for heavy alcohol use and increasing ICH risk. The results support previous recommendations on the moderate use of alcohol and cardiovascular disease prevention.

Despite vast group heterogeneity among multiracial individuals, their rates of heavy alcohol use (binge drinking five or more times in a month) tend to be disproportionately high when compared to monoracial individuals. Multiracial individuals also report high rates of perceived racial discrimination compared to monoracial individuals, which is of concern as perceived racial discrimination has a robust relationship with heavy alcohol use. Further, research has identified racial identity affiliation as a protective factor against heavy alcohol use for some minority groups; however, results have been mixed among multiracial individuals. There is also reason to believe that the relationship between racial identity affiliation and heavy alcohol use may vary by sex. Yet there is a dearth of literature examining the relations between racial discrimination, racial identity affiliation, sex, and heavy alcohol use among multiracial individuals. Therefore, the purpose of the present study is to test the following hypotheses: 1) multiracial people will be more likely to report (a) heavy alcohol use than Asian, White, and Black individuals; (b) higher levels of perceived racial discrimination than White and Asian individuals but no significant differences compared to Black individuals; and (c) lower overall scores on racial identity affiliation than Asian, White, and Black individuals; 2) among multiracial individuals, greater perceived racial discrimination and less racial identity affiliation will be related to significantly greater likelihood of reporting heavy alcohol use; 3) racial identity affiliation will moderate the relationship between perceived racial discrimination and heavy alcohol use in multiracial individuals; and 4) there will be a three-way interactive effect of sex, racial identity affiliation, and perceived racial discrimination on heavy alcohol use. Data for the current study was drawn from the National Epidemiologic Survey on Alcohol and Related Conditions-III data (NESARC-III), sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The NESARC-III data consists of a nationally representative sample of adults (n = 36,309; 56.4% female), including 598 multiracial individuals (2.1%). From 2012–2013, participants were administered the Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV, an interview-based assessment of alcohol use and potentially related variables. Logistic regression analysis, controlling for sex, revealed that multiracial individuals were significantly more likely to report heavy alcohol use than White (p = .006, OR = 1.69) and Asian (p < .001, OR = 2.94) individuals, but were not significantly different from Black individuals (p = .950, OR = 0.99). Two linear regression analyses, controlling for sex, compared

Given intersecting social and structural factors, female sex workers (FSW) exhibit elevated risk of HIV and substance use. However, there is limited study of how distinct substance use typologies influence HIV treatment outcomes among FSW. A cross-sectional survey with objective viral load assessments of 1391 FSW enrolled into a treatment optimization-focused trial in Durban, South Africa (2018-2020). We used latent class analysis to uncover discrete patterns in past-month self-reported use of the following substances: heavy alcohol use, cannabis, cocaine, crack, ecstasy, methamphetamine, heroin, and Whoonga . We used Wald tests to identify multilevel predictors of latent class membership and multivariable mixture modeling to quantify associations of substance use classes with HIV viremia (≥50 RNA copies/mL). Substance use (87%) and HIV viremia (62%) were highly prevalent. Latent class analysis uncovered 3 polysubstance use profiles: Heavy Alcohol Use Only (∼54%); Cannabis, Heavy Alcohol, & Crack Use (∼28%); and Whoonga & Crack Use (∼18%). Whoonga & Crack Use was associated with social and structural adversities, including homelessness, outdoor/public sex work, HIV stigma, and violence. Relative to Heavy Alcohol Use Only , HIV viremia was significantly higher in the Whoonga & Crack Use class (adjusted odds ratio 1.97, 95% confidence interval: 1.13 to 3.43), but not in the Cannabis, Heavy Alcohol, & Crack Use class (adjusted odds ratio 1.17, 95% confidence interval: 0.74 to 1.86). HIV viremia differed significantly across identified polysubstance use profiles among South African FSW. Integrating drug treatment and harm reduction services into HIV treatment programs is key to improving virologic outcomes in marginalized communities.

Very few studies have investigated the "real world" prospective, predictive value of behavioral instruments used in laboratory studies to test decision-making abilities or impulse control. The current study examines the degree to which 2 commonly used decision-making/impulse control measures prospectively predict (heavy) alcohol use in a sample of college students. Two hundred healthy young adults (50% women) performed the Iowa Gambling Task (IGT) and a StopSignal inhibition task in the second college year. At testing and at the end of the fourth college year, heavy alcohol use was assessed. Disadvantageous performance on the IGT was associated with higher scores on a heavy drinking measure and higher quantity/frequency of alcohol use 2 years past neurocognitive testing in male students even after controlling for prior drinking. These results were corrected for heavy drinking and alcohol use in the period before neurocognitive testing. Interactions with gender indicated that this general pattern held for male but not for female students. Level of response inhibition was not associated with either of the alcohol use measures prospectively. These findings indicate that a neurocognitive decision-making task is predictive of maladaptive alcohol use. Advantageous decision makers appear to show adaptive real-life decision making, changing their drinking habits to the changing challenges of early adulthood (e.g., finishing college), whereas disadvantageous decision makers do not, and continue to drink heavily. These findings extend earlier findings of neurocognitive predictors of relapse in clinical substance-dependent groups, to subclinical alcohol use and abuse.

Given the fear and stigma surrounding dementia

Studies investigating the association between alcohol use and cognitive disorders in the elderly population have produced divergent results. Moreover, the role of alcohol in cognitive dysfunction is not clear. The aims of this study were to estimate the prevalence of alcohol-related problems in an elderly population from Brazil and to investigate their association with cognitive and functional impairment (CFI) and dementia. A community-based cross-sectional study was performed. A sample of 1,145 elderly people was examined in 2 phases. Several instruments were utilized in the first phase: the CAGE questionnaire was used to identify potential cases of alcohol-related problems, and a screening test for dementia was used to estimate CFI. The CAMDEX interview (Cambridge Examination) and DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) criteria were used for the clinical diagnosis of dementia in the second phase. "Heavy alcohol use" (CAGE > or = 2) was found in 92 subjects (prevalence: 8.2%). It was associated with gender (males, p < 0.001), low education (only in females, p = 0.002), and low socioeconomic level (p = 0.001, in females; p = 0.002, in males). The Mini Mental State Examination exhibited a nonlinear relationship with alcohol-related problems in females; "mild-moderate alcohol use" (CAGE < 2) presented the highest score. A significant association between alcohol-related problems and cognitive dysfunction was found only in females. "Heavy alcohol use" was associated with higher CFI and dementia rates compared to "mild-moderate alcohol use" (p = 0.003 and p < 0.001, respectively). "Mild-moderate alcohol use" had a tendency of association with lower CFI and dementia rates when compared to "no alcohol use" (p = 0.063 and 0.050, respectively). Our findings suggest that alcohol use does not have a linear relationship with cognitive decline.