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

Sufferers who begin abusing alcohol later in life — after age 40 — could also be doing so secondary to an underlying neurologic situation, comparable to frontotemporal dementia, based on findings by a workforce of researchers from the Icahn College of Drugs at Mount Sinai and the College of California, San Francisco. The outcomes are reported within the April 4 problem of the Journal of Alzheimer’s Illness.

Total alcohol abuse — labeled as when alcohol consumption negatively impacts work or social life or results in authorized ramifications — is current in 1.7 p.c of older adults in the USA. Earlier analysis has recognized lifelong alcohol abuse as a danger issue for dementia. Nonetheless, it has been unknown whether or not older adults who start abusing acohol late in life have an underlying neurodegenerative illness. Significantly regarding is that individuals who start abusing alcohol due to an underlying neurological situation could also be misdiagnosed with main alcohol abuse and referred to conventional dependancy therapy packages, a course of that will delay right prognosis and acceptable behavioral therapy, expend household assets, and add to affected person and caregiver burden.

“Our examine aimed to establish and evaluate the frequencies of lifetime alcohol abuse, late-onset alcohol abuse, and alcohol abuse as a primary symptom of dementia in a gaggle of sufferers residing with a number of types of dementia, together with Alzheimer’s illness and frontotemporal dementia,” mentioned Georges Nassan, MD, Affiliate Professor of Neurology, and Medical Director for the Division of Behavioral Neurology and Neuropsychiatry, on the Icahn College of Drugs at Mount Sinai and senior writer of the paper. “What we discovered is that alcohol abuse often is the first signal of an underlying neurological situation when it presents late in life. In truth, as much as 7 p.c (practically 1 in 15) of sufferers with frontotemporal dementia began abusing alcohol late in life, and 5 p.c (1 in 20) did in order the primary symptom of the illness. Whereas it is very important establish social components that will result in alcohol abuse, comparable to retirement, loneliness, or lack of revenue/family members/housing, our knowledge ought to implore well being care staff to keep away from systematically attributing alcohol abuse to those points and immediate clinicians to research the opportunity of frontal lobe dysfunction.”

The analysis workforce performed a cross-sectional, retrospective examine of sufferers evaluated at a tutorial referral heart between 1999 and 2017 who had a scientific prognosis of behavioral variant frontotemporal dementia (bvFTD), Alzheimer’s-type dementia, or semantic variant main progressive aphasia. The presence of alcohol abuse was screened utilizing the Nationwide Alzheimer’s Coordinating Middle UDS questionnaire accomplished by clinicians throughout affected person analysis visits. Lifelong alcohol abuse was outlined as alcohol abuse that started earlier than the affected person was 40 years previous, late-onset alcohol abuse as abuse that started at age 40 or above, and alcohol abuse as a primary symptom of dementia as abuse that began throughout the first three years, both earlier than or after symptom onset.

Among the many 1,518 contributors screened, late-onset alcohol abuse affected 2.2 p.c, larger than the 1.7 p.c for older adults total. The analysis workforce discovered that late-onset alcohol abuse was considerably extra frequent in sufferers with bvFTD than these with Alzheimer’s-type dementia, whereas there was no distinction between the frequency of lifelong alcohol abuse throughout the three dementia teams. In addition they discovered that alcohol abuse as a primary symptom occurred in 1.4 p.c of all sufferers, 5 occasions extra continuously in sufferers with bvFTD than these with Alzheimer’s-type dementia. The outcomes point out not solely that late-onset alcohol abuse is rather more frequent in bvFTD than Alzheimer’s-type dementia, but in addition the probability that the organic mechanisms underlying late-onset and lifelong alcohol abuse are totally different.

“As a result of sufferers who start utilizing alcohol late in life are often first seen by psychiatrists, main care suppliers, and rehabilitation specialists, these professionals ought to concentrate on the likelihood {that a} neurodegenerative illness is likely to be underlying the onset of alcohol abuse late in life in individuals who traditionally did not abuse alcohol. Subsequently, a particular analysis together with checking for different frontal lobe signs must be carried out, and sufferers in danger must be referred to a neurologist,” mentioned Dr. Nassan. “An early and acceptable prognosis in these sufferers is paramount for offering one of the best administration, bettering sufferers’ and households’ high quality of life, and channeling sufferers to acceptable care services.”

Funding for this analysis was supplied by the Nationwide Institutes of Well being, The Nationwide Institute on Growing old, and the Larry L. Hillblom Community Grant for the Prevention of Age-Related Cognitive Declince.