Alcohol use and cognitive loss among employed men and women

Alcohol and cognition in the elderly: a review

Consumption of large amounts of alcohol is known to have negative effects, but consumption in smaller amounts may be protective. The effect of alcohol may be greater in the elderly than in younger adults, particularly with regard to cognition. However, the drinking pattern that will provide optimal protection against dementia and cognitive decline in the elderly has not been systematically investigated. The present paper is a critical review of research on the effect of alcohol on cognitive function and dementia in the elderly. Studies published from 1971 to 2011 related to alcohol and cognition in the elderly were reviewed using a PubMed search. Alcohol may have both a neurotoxic and neuroprotective effect. Longitudinal and brain imaging studies in the elderly show that excessive alcohol consumption may increase the risk of cognitive dysfunction and dementia, but low to moderate alcohol intake may protect against cognitive decline and dementia and provide cardiovascular benefits. Evidence suggesting that low to moderate alcohol consumption in the elderly protects against cognitive decline and dementia exists; however, because of varying methodology and a lack of standardized definitions, these findings should be interpreted with caution. It is important to conduct more, well-designed studies to identify the alcohol drinking pattern that will optimally protect the elderly against cognitive decline and dementia.

Similar profile of cognitive impairment and recovery for Aboriginal Australians in treatment for episodic or chronic alcohol use

AIMS

The cognitive impairment and recovery associated with chronic alcohol abuse and subsequent abstinence is well understood. However, the recovery profile following heavy episodic or 'binge' use, which is common among some Australian Aboriginal users, has not been investigated thoroughly and no empirical studies have examined chronic use in this population. The aim of this study was to identify and compare cognitive impairment and recovery associated with chronic and episodic alcohol use among Aboriginal Australians.

DESIGN

Longitudinal case-control design.

SETTING

Residential alcohol treatment programmes in northern Australia.

PARTICIPANTS

Forty chronic alcohol users, 24 episodic users and 41 healthy controls [mean age = 34.24; standard deviation (SD) = 9.73].

MEASUREMENTS

Cognitive assessments of visual motor, attention, memory, learning and executive functions at baseline (start of treatment), then 4 weeks and 8 weeks later. Reassessment of 31% of participants an average of 11 months later (SD = 4.4) comparing those who remained abstinent (n = 5), those who relapsed (n = 11) and healthy controls (n = 19).

FINDINGS

At baseline, chronic and episodic alcohol users showed impaired visual motor, learning, memory and executive functions. With the exception of visual motor impairment, all deficits had improved to normal levels within 4 weeks. Visual motor deficits had normalized within 11 months. Performances did not differ at any time between chronic and episodic alcohol groups.

CONCLUSIONS

In Aboriginal Australians, episodic drinking is associated with similar patterns of impairment and recovery as chronic alcohol use. Most cognitive deficits appear to recover within the first month of abstinence, while persisting visual motor problems recover within 1 year.

Moderate alcohol consumption and cognitive risk

We reviewed 143 papers that described the relationship between moderate drinking of alcohol and some aspect of cognition. Two types of papers were found: (1) those that provided ratios of risk between drinkers and nondrinkers (74 papers in total) and (2) those that, although they did not provide such ratios, allowed cognition in drinkers to be rated as "better," "no different," or "worse" than cognition in nondrinkers (69 papers in total). The history of research on moderate drinking and cognition can be divided into two eras: 1977-1997 and 1998-present. Phase I (1977-1997) was the era of neuropsychological evaluation involving mostly young to middle-aged (18-50 years old) subjects. Although initial studies indicated moderate drinking impaired cognition, many later studies failed to confirm this, instead finding no difference in cognition between drinkers and nondrinkers. Phase II (1998-present) was and is the era of mental status exam evaluation involving mostly older (≥55 years old) subjects. These studies overwhelmingly found that moderate drinking either reduced or had no effect on the risk of dementia or cognitive impairment. When all the ratios of risk from all the studies in phase II providing such ratios are entered into a comprehensive meta-analysis, the average ratio of risk for cognitive risk (dementia or cognitive impairment/decline) associated with moderate "social" (not alcoholic) drinking of alcohol is 0.77, with nondrinkers as the reference group. The benefit of moderate drinking applied to all forms of dementia (dementia unspecified, Alzheimer's disease, and vascular dementia) and to cognitive impairment (low test scores), but no significant benefit against cognitive decline (rate of decline in test scores) was found. Both light and moderate drinking provided a similar benefit, but heavy drinking was associated with nonsignificantly higher cognitive risk for dementia and cognitive impairment. Although the meta-analysis also indicated that wine was better than beer or spirits, this was based on a relatively small number of studies because most studies did not distinguish among these different types of alcohol. Furthermore, a number of the studies that did make the distinction reported no difference among the effects of these different types of alcohol. Therefore, at present this question remains unanswered. Analysis also showed that the presence of the apolipoprotein E epsilon 4 allele eliminated the benefit of moderate drinking. However, this was based on a relatively small number of studies and several other studies have found a beneficial effect of the epsilon e4 allele. Further studies are necessary to settle this question. The benefit of moderate alcohol for cognition was seen in both men and women, although the amount and pattern of drinking is very different between the two sexes. Lastly, the finding of unaffected or significantly reduced cognitive risk in light to moderate drinkers was seen in 14/19 countries for which country-specific ratio data were available, with three of the five remaining countries showing nonsignificant reductions as well. Overall, light to moderate drinking does not appear to impair cognition in younger subjects and actually seems to reduce the risk of dementia and cognitive decline in older subjects.

Neurocognitive effects of alcohol hangover

Alcohol hangover is characterized by adverse physical and mental effects that occur the next morning after the intake of toxic doses of alcohol. One of the more relevant functional consequences of hangover is the cognitive and subjective impairment, which could be related to the high socioeconomic costs of alcohol consumption. Nevertheless, few studies have addressed the study of neurocognitive and subjective effects of hangover. The systematic and exhaustive study of neurocognitive and subjective effects has not been done. In the present work we briefly review the hangover impact, not only in the objective execution of attention, psychomotricity and memory tasks, but in the subjective state of the subjects as well. Moreover, we also highlight the methodology difficulties to study neurocognitive effects of hangover and suggest several aspects to take into account in future investigations.

Cognitive function in drinkers compared to abstainers in the New Mexico elder health survey

BACKGROUND

Recent epidemiological studies have shown that individuals who ingest alcohol regularly have a higher level of cognitive function and are less likely to develop dementia than those who abstain. The purpose of this study was to compare nine measures of cognitive function in drinkers compared to abstainers.

METHODS

A cross-sectional community survey was conducted of 883 randomly selected Hispanic and non-Hispanic white men and women, age >or=65 years of age, undergoing a paid home interview and 4-hour interview/examination in a senior health clinic (The New Mexico Elder Health Survey). The interviews included questions on frequency and quantity of alcohol ingested.

RESULTS

Participants who consumed alcohol had significantly better mean scores on 7 of 9 cognitive function tests and less frequently had scores below selected "cut points" compared to those who abstained from all alcohol intake. Scoring used multivariate linear and logistic regression models adjusted for sex, ethnicity, age, level of education, and evidence of depression.

CONCLUSIONS

Participants in the New Mexico Elder Health Survey (nearly equal numbers of Hispanic and non-Hispanic white men and women) who consumed alcohol had better scores on their cognitive tests than did those participants who abstained.

Non-linear relationships between cognitive function and alcohol consumption in young, middle-aged and older adults: the PATH Through Life Project

AIMS

To investigate associations, including non-linear relationships, between cognitive function and alcohol consumption, testing for moderating effects of age and gender and for differences across outcome measures. Design Cross-sectional general population samples of three age cohorts. Setting Canberra and Queanbeyan, Australia.

PARTICIPANTS

The total sample of 7485 consisted of 2404 men and women aged 20-24 years, 2530 aged 40-44 years, and 2551 aged 60-64 years, selected from the electoral rolls. Measurements Self-report data using hand-held computers provided weekly alcohol consumption from the Alcohol Use Disorders Identification Test (AUDIT) frequency, quantity and binge-drinking items, and socio-demographic factors. Spot-the-Word, digits backwards, the Symbol-Digit Modalities Test (SDMT), immediate recall and reaction-time tests were conducted by trained interviewers.

FINDINGS

Findings varied across dependent variables, but there was a general tendency for light drinkers (up to 20/10 g alcohol per day in men/women, respectively) to perform better than abstainers, occasional drinkers or those drinking at hazardous/harmful levels (>40/20 g per day in men/women). Poorer performance of hazardous/harmful drinkers was seen only in men, whereas that of abstainers was evident in both sexes but was stronger in women. After adjustment for education and race, male hazardous/harmful drinkers no longer performed significantly less well than light drinkers, whereas male and female abstainers and occasional drinkers still did so.

CONCLUSIONS

Abstainers have poorer cognitive function than light drinkers and further investigation is needed to determine what factors contribute to this.

Effects of moderate alcohol consumption on the central nervous system

The concept of moderate consumption of ethanol (beverage alcohol) has evolved over time from considering this level of intake to be nonintoxicating and noninjurious, to encompassing levels defined as "statistically" normal in particular populations, and the public health-driven concepts that define moderate drinking as the level corresponding to the lowest overall rate of morbidity or mortality in a population. The various approaches to defining moderate consumption of ethanol provide for a range of intakes that can result in blood ethanol concentrations ranging from 5 to 6 mg/dl, to levels of over 90 mg/dl (i.e., approximately 20 mM). This review summarizes available information regarding the effects of moderate consumption of ethanol on the adult and the developing nervous systems. The metabolism of ethanol in the human is reviewed to allow for proper appreciation of the important variables that interact to influence the level of exposure of the brain to ethanol once ethanol is orally consumed. At the neurochemical level, the moderate consumption of ethanol selectively affects the function of GABA, glutamatergic, serotonergic, dopaminergic, cholinergic, and opioid neuronal systems. Ethanol can affect these systems directly, and/or the interactions between and among these systems become important in the expression of ethanol's actions. The behavioral consequences of ethanol's actions on brain neurochemistry, and the neurochemical effects themselves, are very much dose- and time-related, and the collage of ethanol's actions can change significantly even on the rising and falling phases of the blood ethanol curve. The behavioral effects of moderate ethanol intake can encompass events that the human or other animal can perceive as reinforcing through either positive (e.g., pleasurable, activating) or negative (e.g., anxiolysis, stress reduction) reinforcement mechanisms. Genetic factors and gender play an important role in the metabolism and behavioral actions of ethanol, and doses of ethanol producing pleasurable feelings, activation, and reduction of anxiety in some humans/animals can have aversive, sedative, or no effect in others. Research on the cognitive effects of acute and chronic moderate intake of ethanol is reviewed, and although a number of studies have noted a measurable diminution in neuropsychologic parameters in habitual consumers of moderate amounts of ethanol, others have not found such changes. Recent studies have also noted some positive effects of moderate ethanol consumption on cognitive performance in the aging human. The moderate consumption of ethanol by pregnant women can have significant consequences on the developing nervous system of the fetus. Consumption of ethanol during pregnancy at levels considered to be in the moderate range can generate fetal alcohol effects (behavioral, cognitive anomalies) in the offspring. A number of factors--including gestational period, the periodicity of the mother's drinking, genetic factors, etc.--play important roles in determining the effect of ethanol on the developing central nervous system. A series of recommendations for future research endeavors, at all levels, is included with this review as part of the assessment of the effects of moderate ethanol consumption on the central nervous system.

Alcohol related dementia: proposed clinical criteria

Current diagnostic criteria for Alcohol Related Dementia (ARD) are based almost exclusively on clinical judgment. Moreover, there are no guidelines available to assist the clinician or the researcher in distinguishing Alcohol Related Dementia from other causes of dementia such as Alzheimer's Disease (AD). However, this distinction may have implications for the prognosis and treatment of patients. In this article, provisional diagnostic criteria for establishing a diagnosis of Alcohol Related Dementia are proposed for further study. The criteria are based on the available literature on the relationship between alcohol consumption and dementia and were modeled after existing diagnostic criteria for AD and Vascular Dementia. Validity of these criteria for distinguishing AD from ARD will require further study.

Sleep-disordered breathing and neuropsychological deficits. A population-based study

The relationship of sleep-disordered breathing (SOB) to neuropsychological deficits was investigated with cross-sectional data from the Wisconsin Sleep Cohort Study, a population-based study of the natural history of SDB. A sample of 841 employed men and women ages 30 to 60 yr was studied by overnight polysomnography to assess the frequency of apneas and hypopneas per hour of sleep (apnea-hypopnea index, AHI). Prior to overnight polysomnography, the participants were given a battery of neuropsychological tests for functionally important capacities including motor skills, attention, concentration, information processing, and memory. Principal factor analysis of all the neuro-psychological test data revealed a psychomotor efficiency and a memory factor. Multiple regression analysis showed a significant negative association between logarithmically transformed AHI (LogAHI) and psychomotor efficiency score independent of age, gender, and educational status (p = 0.017). The relationship was not explained by self-reported sleepiness. No significant relationship was seen between LogAHI and memory score. In assessing the clinical significance of mild SDB, we estimate that an AHI of 15 is equivalent to the decrement in psychomotor efficiency associated with 5 additional yr of age, or to 50% of the decrement associated with hypnosedative use.

The relationship between alcohol consumption, cognitive performance, and daily functioning in an urban sample of older black Americans

OBJECTIVE

To report on moderate alcohol consumption and measurements of cognitive function and activities of daily living in an older, urban, community-dwelling sample of black Americans.

DESIGN

As part of a community prevalence study of dementia, information on alcohol consumption and cognitive performance was collected on 2040 randomly selected black subjects living in Indianapolis.

MEASUREMENTS

From questions in the screening interview, alcohol consumption was grouped into four categories: lifetime abstainers, regular drinkers less than 4 drinks per week, 4 to 10 drinks per week, and more than 10 drinks per week. Current and past drinkers were analyzed separately. Three measurements were used: (1) a total cognitive score; (2) the delayed recall score from the East Boston Memory Test; (3) a score for daily functioning based upon information from the informant. Multiple regression models were fitted with drinking variables as the major predictor, including covariates of age, gender, education, history of stroke, hypertension, being treated for depression, and a family history of dementia.

MAIN RESULTS

In all analyses, there was a very consistent pattern for both current and past drinkers. There was a small but significant dose effect of drinking for the drinkers, with subjects in the heaviest drinking category scoring poorest, i.e., lowest scores in cognitive tests and highest scores in scales of daily functioning indicating more impairment. The scores of abstainers were worse than those of subjects in the lightest drinking category. The pattern of scores for cognitive performance and daily functioning was similar between current and past drinkers. These patterns remained the same even after potential confounders were included.

CONCLUSIONS

Previous research on effects of alcohol on health indices have suggested a J-shaped relationship between amounts of alcohol consumption and measurements of heart disease, stroke, and mortality rates. Our study provides some support for the concept of a similar J-shaped relationship between cognitive performance and alcohol consumption, but the differences between drinking categories were modest and the clinical significance of these findings uncertain.

Medical manifestations of alcoholism in the elderly

Alcoholism may lead to a great many physical and mental problems in individuals of any age. Elderly alcoholics often have additional problems resulting from the interaction of age related changes in physiology and "heavy" alcohol intake. Some of the more important problems are: Impairment of the immune system with decreased ability to deal with infection or cancer. Increased incidence of hypertension, cardiac arrhythmia, myocardial infarction, and cardiomyopathy. Increased incidence of stroke. Alcohol dementia. Increased incidence of esophageal and other cancers. Cirrhosis and other liver disease. Malnutrition. There seems to be no area in which even moderate alcohol intake is of definite benefit, and some areas in which even small amounts are detrimental.

Is aluminium an etiologic contributor to alcoholic amnesia and dementia?

Neurotoxicity from excess brain exposure to aluminium (Al) is well-documented, from both clinical observations and animal experiments, to impair learning, memory and cognition. The etiology of the cognitive impairment in chronic abusers of ethanol--alcoholic amnesia or dementia--is not known, but it is likely to be multifactorial. We hypothesize that a slowly-progressive accumulation of Al in the brain, so as to reach functionally-toxic levels, may be one such factor. This could occur because of an increased permeability of intestinal mucosa to entry of Al, arising from sustained exposure of the gastrointestinal tract to alcoholic beverages, plus a trend for more frequent ingestion of antacids based on Al salts for treating gastritis or ulcers caused by such exposure. If this be true, use of Al-containing medications, as well as all avoidable exposures to Al, should be contra-indicated for chronic heavy drinkers.

Discriminating neuropsychological sequelae of head injury from alcohol-abuse-induced deficits: a review and analysis

Alcohol abuse is linked strongly with neuropsychological deficits that may resemble deficits seen in head-injured individuals. Heavy daily drinking appears more damaging than episodic abusive consumption. Cognitive deficits associated with alcohol include abstraction, perceptuospatial, and problem-solving skills. Verbal abilities are spared. For alcoholics younger than 40, abstinence is associated with improved functioning. For those over 40, deficits may be permanent. Intelligence tests are unlikely to pick up alcohol-induced deficits. Points for neuropsychologists to consider in differentiating between head injury and alcohol-induced deficits include abstinence from drinking prior to testing, intactness of remote memory and verbal functions, and changes in tolerance for alcohol.

Gender-role attitudes, job competition and alcohol consumption among women and men

Attempting to account for greater alcohol consumption among women, social scientists have argued that traditional gender roles and gender-role attitudes concerning the division of labor in the family have provided women with a moral or cultural protection against heavier drinking but that the "breakdown" of this protection has allowed for greater alcohol use. This paper assesses the breakdown argument using data from two representative samples: a sample of 12,069 young adults in the United States and a sample of 1,367 employed men and women in metropolitan Detroit. Our analysis indicates that among young women the nontraditional role of employment and nontraditional gender-role attitudes concerning responsibilities for household labor and child care are associated with greater alcohol consumption. However, among the employed, our analysis indicates that it is not nontraditional women and traditional men but rather traditional women and nontraditional men who have greater alcohol use--it is the women and men who believe that they have substantial obligations at home and who have intense competition at the workplace that consume a greater quantity of alcohol.

The role of cirrhosis in memory functioning of alcoholics

The effects of alcoholism and liver disease on memory functioning in alcoholics were studied by comparing four groups: normal healthy controls, alcoholics without liver disease, alcoholics with biopsy-confirmed cirrhosis, and nonalcoholics with postnecrotic cirrhosis. Memory capacity was evaluated employing the Benton Visual Retention Test (BVRT), the Rey-Osterreith Complex Figure Test, Digit Span, and the Brown Peterson four-word short-term memory test. A 2 x 2 ANOVA revealed significant main effects for both alcohol and cirrhosis on Digits Forward and the total score on the Brown Peterson test. Additionally, there were significant main effects for cirrhosis on the BVRT. The Brown Peterson test was analyzed using a repeated measures 2 x 2 ANOVA. Significant effects for cirrhosis were observed at all three interpolation periods. The effects for alcohol approached significance at the 30-sec (most difficult) interpolation period. Analysis of error patterns on the Brown Peterson test indicated that overall omission errors were most commonly made among all groups. Significant effects were found for alcohol on omissions and intrusion, while the cirrhosis factor yielded significant effects for phonemic, perseverative, and omission errors. This study demonstrates the importance of liver disease underlying the etiology of memory impairments in alcoholics. The results confirm our earlier findings that neuropsychologic deficits seen in alcoholics may be the result of the combination of alcohol abuse and liver disease.

Use of computerized test batteries for quantifying neurobehavioral outcomes

Neurobehavioral testing provides for noninvasive assessment of the functional integrity of the nervous system. Neurobehavioral tests have been used as quantitative outcome measures in a number of epidemiologic investigations of the potential effects on the nervous system from exposure to organic solvents, heavy metals, and pesticides. Because of the functional complexity of the nervous system, sets of tests assessing a range of functions have been used, with inconsistency from one study to another. Although there has been recent progress in standardizing a core set of tests for use in occupational epidemiology, major consensus on testing methods has not emerged. Standardization of test methods is essential to provide a consistent database for risk analysis. Automation of data collection provides not only standardization, but also improved time efficiency, of data collection and analysis. The computerized Neurobehavioral Evaluation System (NES) has been developed to address the need for standardized, efficient data acquisition of a range of neurobehavioral variables. Examples of application of NES in epidemiologic studies of workers exposed to solvents are summarized. The need for use of NES as a tool for surveillance and in prospective epidemiologic investigations is emphasized.

Use of computerized test batteries for quantifying neurobehavioral outcomes

Neurobehavioral testing provides for noninvasive assessment of the functional integrity of the nervous system. Neurobehavioral tests have been used as quantitative outcome measures in a number of epidemiologic investigations of the potential effects on the nervous system from exposure to organic solvents, heavy metals, and pesticides. Because of the functional complexity of the nervous system, sets of tests assessing a range of functions have been used, with inconsistency from one study to another. Although there has been recent progress in standardizing a core set of tests for use in occupational epidemiology, major consensus on testing methods has not emerged. Standardization of test methods is essential to provide a consistent database for risk analysis. Automation of data collection provides not only standardization, but also improved time efficiency, of data collection and analysis. The computerized Neurobehavioral Evaluation System (NES) has been developed to address the need for standardized, efficient data acquisition of a range of neurobehavioral variables. Examples of application of NES in epidemiologic studies of workers exposed to solvents are summarized. The need for use of NES as a tool for surveillance and in prospective epidemiologic investigations is emphasized.

Effects of social drinking and familial alcoholism risk on cognitive functioning: null findings

The effects of both heavy social drinking and high familial alcoholism risk status on the cognitive performance of college men were examined in this study. A two by three factorial design was employed represented by two social drinking groups (heavy/nonheavy) and three familial risk groups (high, middle, and low). The cognitive performance tasks employed--group embedded figures, revised Beta mazes, mirror tracing, and symbol-digit paired associate learning--had all been previously shown to present difficulties to male alcoholics. No evidence was obtained of a relationship between heavy drinking or familial risk and cognitive functioning, nor a meaningful interaction of these two independent variables. Little evidence was revealed for the "hangover hypothesis" as evidenced by a relationship between drinking behavior within the past week and cognitive performance. The findings are discussed in the context of previous findings in these areas and the general difficulties of interpretation posed in nonexperimental research based on subject variables.

High alcohol consumption, liver toxic drugs and brain damage--a population study

Computed tomography (CT) of the brain was performed in a random sample of 195 men to investigate the relationship between alcohol drinking and brain damage. This sample from the general population was divided into subsamples on the basis of their self-reported loss of control over drinking, morning drinks and blackouts. Three groups with different degrees of alcohol consumption were distinguished and the only differences in CT findings were a significantly higher frequency of frontal lobe atrophy with increasing alcohol consumption. The consumption of hepatotoxic drugs was also investigated and the following were the types of drug used: antiarrhythmics, antiepileptics, antibiotics, antiphlogistics, mixed analgetics, sulphonamides, benzodiazepines and derivatives of phenothiazines, all of which are metabolized by way of the liver. The material was divided into four groups with regard to both alcohol consumption and use of hepatotoxic drugs: Group IA, low or moderate alcohol consumption and no use of such drugs; IB, low or moderate alcohol consumption with use of such drugs; IIA, high alcohol consumption with no use of such drugs; and IIB, high alcohol consumption with use of such drugs. Group IIB was found to have a higher incidence of cortical and subcortical changes than group IA. The results indicate that drug use influences the incidence of cortical and subcortical aberrations. It is concluded that there is a typical frontal lobe atrophy associated with alcohol abuse; thus with increasing alcohol ingestion there is accelerated shrinkage of the brain, the frontal lobe being the first part affected. The groups with alcohol abuse who used hepatotoxic drugs show a picture of cortical changes and also of subcortical aberrations, expressed as an increased anterior horn index and widening of the third ventricle.

Event-related brain potentials in individuals at high and low risk for developing alcoholism: failure to replicate

Event-related brain potentials (ERPs) were used to compare young men having a positive paternal family history for alcoholism (FHP) with carefully matched control subjects having no family history for alcoholism (FHN). The P300 ERP component was obtained from all subjects (n = 10/group) with a complex auditory paradigm before and on two occasions after they received a placebo drink which they were told might contain alcohol. The procedures employed replicated those of a previous study in which FHP subjects showed diminished P300 potentials compared to FHN subjects under the placebo as well as ethanol consumption conditions--a finding which raised the possibility that the P300 ERP component might be a biological marker for subjects at high risk to develop alcoholism. No differences between the family history groups were obtained for the P300 or any other ERP component using the replication procedures. Both groups demonstrated a decrease in P300 amplitude across trial blocks in a similar fashion suggesting that habituation effects may have diminished the ERP response.

P300 and the risk for alcoholism: family history, task difficulty, and gender

P300 event-related brain potentials (ERPs) were obtained from 20 pairs of male and 20 pairs of female undergraduate subjects. One member of each pair reported having a father who was alcoholic (FHP), the other reported no known alcoholic biological relative (FHN). Pair members were matched on age, height, weight, grade point average, and personal drinking history. Three auditory tasks which differed in stimulus discrimination difficulty were presented to each subject. All tasks employed 20% target and 80% standard tones with the subject required to move their index finger whenever a target stimulus was detected. No significant differences in P300 amplitude or latency were obtained between the family history subject groups, although female FHP subjects tended to have smaller P300 amplitudes than their FHN counterparts. P300 amplitude decreased with increases in the amount of self-reported alcohol consumed for FHP subjects but significantly so only for the most difficult task situation. The results suggest that the relationship between the P300 ERP and the inheritability of alcoholism is not yet clear and may be subject to modulation by task requirements, population differences, and subject sex.

The hangover hypothesis and the influence of moderate social drinking on mental ability

The "hangover" hypothesis proposes that there is some residual effect of low to moderate alcohol intake on the nervous system after the blood alcohol level has returned to zero. This notion has been invoked to explain the putative effects of moderate alcohol consumption on mental ability. We evaluated the hangover hypothesis by attempting to predict cognitive performance from self-reports of alcohol consumed during the week prior to testing. We found no meaningful evidence to support the notion that moderate alcohol ingestion produces a measurable toxic effect on brain function after the period of acute intoxication.

Assessment of neuropsychological dysfunction in the workplace: normative data from the Pittsburgh Occupational Exposures Test Battery

Neuropsychologists are being increasingly called upon to assess the neurobehavioral status of adults who have been exposed to toxic chemicals or heavy metals in the workplace. Unfortunately, the evaluation of blue-collar workers has been hampered by the absence of a brief yet comprehensive battery of sensitive neuropsychological tests that have been administered to a large cohort of demographically similar adults with no prior history of occupational exposure. In this paper we describe the development of the Pittsburgh Occupational Exposures Test Battery. We detail the procedures used to collect appropriate age-scaled norms from 182 blue-collar males, and delineate the factor structure of the test battery. We also examine the interrelationships among test scores and certain demographic variables, and discuss the epidemiologic and clinical relevance of these data.

Brain impairment in social drinkers? No cause for concern

Correlations between measures of alcohol consumption and cognitive test scores have been interpreted to reflect a chronic toxic effect of ethanol on brain function in light to moderate social drinkers. However, the data indicate that there is little support across research groups for any specific relationship and, at best, the effect of alcohol consumption accounts for only a small proportion of variance. Consideration of test validity suggests that the principal measure of ability used in this research is not capable of elucidating cerebral deficit. Further, the pattern of observed correlations is not consistent with the assumption that the putative effects of social drinking involve deficits less severe but similar in type to those seen in chronic alcoholics. Instead, an association between innate ability, demographic variables, and drinking behavior in the general population is the most parsimonious explanation of all the data.

P300 from normals and adult children of alcoholics

The P300 event-related brain potential (ERP) was obtained from 24 pairs of undergraduate male subjects. One member of each pair reported having a father who was alcoholic (FH+), the other reported no alcoholic family member (FH-). Pairs were matched on height, weight, academic performance, and personal drinking history. Three auditory task situations were employed which manipulated stimulus discrimination difficulty. All tasks employed 20% target and 80% standard tones randomly presented with the subjects required to move their index finger whenever a target tone was detected. No differences in P300 amplitude or latency were obtained between the groups. FH+ subjects tended to demonstrate decreased amplitudes with increased amounts of reported alcohol consumption but only for the most difficult task. The results of the present study suggest that the relationship between the P300 and the heritability for alcoholism is not yet clear and may be modulated by differences in task requirements, subject populations, and personal drinking history.

Alcohol use and depression symptoms among employed men and women

A representative sample of 1,367 employed men and women in Detroit responded to questions about drinking practices and symptoms of depression. After controlling for age, education, family income, marital status, medication use, fathers' drinking, and other variables, increased quantity of alcohol consumed per drinking occasion was associated with increased depression symptoms in the sober state among men and women. Depression symptoms may be one of a group of not fully identified drug after-effect disorders involving psychological functioning.

Alcohol intake in a healthy elderly population

The relationship between amount of alcohol consumption and social, psychological, and cognitive status was examined in 270 healthy, independently living men and women over age 65. Forty-eight per cent of the sample recorded some alcohol intake during a three-day diet record, with 8 per cent drinking 30 or more grams of alcohol daily. Alcohol intake was positively associated with male gender, income, and amount of education and negatively associated with age. Alcohol intake was not associated with any changes in social or psychological status, but was positively associated with several measurements of cognitive status. These correlations were weak, however, and tended to disappear after controlling for income, education, gender, and age. Past alcohol intake was not associated with any indicators of present social, psychological, or cognitive functioning.

The impact of late adolescent substance use on young adult health status and utilization of health services: a structural-equation model over four years

This study examined the impact of adolescent substance use on young adult health status and health service utilization, while controlling for earlier subjective and objective health problems and seeking medical care. Data were obtained from 654 participants when they were in late adolescence and 4 years later when they were young adults. Latent-variable models were used to determine what effect, if any, adolescent drug use had on later health. A second-order factor of general drug use had a small, but significant, influence on decreasing subjective physical hardiness over the 4-year period. However, general drug use was not directly related to later physical symptomatology, subjective health problems, or health service utilization. General cigarette use and amount of cigarette smoking were significantly related to a range of health outcomes including increased psychosomatic symptoms, respiratory symptoms, reporting trouble with health, nights spent in the hospital, and health service utilization, as well as decreased subjective physical hardiness. Early cannabis use decreased later subjective physical hardiness and increased health problems experienced over the 4 years. Hard drug use was associated with increased emergency physician visits during adolescence and increased perceived trouble with health as young adults. Due to the fact that adolescent general drug use decreased subjective physical hardiness over 4 years, it is possible that continued substance use might lead to more serious objective health consequences later in life (i.e. physical symptoms).

The influence of both drinking and familial risk statuses on cognitive functioning of social drinkers

Problem and nonproblem drinking, college student sons of alcoholics were compared to problem and nonproblem drinking college student sons of nonalcoholic fathers with respect to cognitive functioning. Problem drinkers performed more poorly on two of the four cognitive tasks, Group Embedded Figures and Symbol-Digit Paired Associates Learning Task, thus supporting earlier findings of cognitive deficits in problem drinking nonalcoholics. Additionally, sons of alcoholics tended to perform more poorly than sons of nonalcoholics on the Group Embedded Figures Test. Cognitive performance was not predicted by any of four measures of impulsive/antisocial personality and behavior-preadult antisocial behavior, childhood behavior problems, sensation seeking, and the MacAndrew Alcoholism Scale. The findings of the research pointed to the importance of considering both drinking and familial alcoholism risk statuses in studies of the cognitive performance of nonalcoholics. Further implications and limitations of the findings are discussed.

Drinking practices and neuropsychological test performance in sober male alcoholics and social drinkers

The relationships between alcohol intake (per occasion over time) and performance on neuropsychological tests, as they might be affected by anxiety and depression, were investigated in both an alcoholic (N = 60) and social drinking (N = 43) sample. alcoholics, a Maximum Quantity Frequency (MQF) of alcohol consumed over the previous six months was found to be the best predictor of an impairment index. Neither anxiety nor depression were correlated with test performance. In social drinkers, anxiety was the best predictor of performance on the impairment index; depression was not predictive. Neither MQF nor a commonly used measure of drinking behaviors, weighted quantity per occasion (QPO), significantly predicted performance in the social drinkers once anxiety was accounted for. The results support the assumption that in alcoholics the greater and more frequent the alcohol ingestion, the more the brain's functioning is disrupted, at least as reflected in neuropsychological test performance. Anxiety appears to play a major role in the test performance of social drinkers and should be monitored in future studies in this research area.

P300 and alcohol consumption in normals and individuals at risk for alcoholism. A preliminary report

Pairs of college student subjects (36 male, 36 female) were matched on age, sex, and personal drinking history. One pair member had a parent who met the DSM III criteria of alcoholism, while the other pair member had no close alcoholic relative. The P300 event-related brain potential (ERP) was obtained from each subject with auditory stimuli in an "oddball" paradigm. Target stimuli occurred randomly on 20% of the trials in a frequency discrimination task, a relatively easy intensity discrimination task, and a more difficult intensity discrimination task. Subjects indicated when the target items occurred by moving their index finger. No significant overall effects were obtained for family history for either P300 latency or amplitude. P300 latency increased and amplitude decreased with increases in the reported amount of alcohol consumption in all subjects only for the difficult intensity task but were statistically significant only for individuals with a negative family history for alcoholism.

Psychological correlates of drinking behavior in social drinker college students

Psychological adjustment, cognitive functioning, and drinking behaviors have been shown to discriminate between alcoholic and control populations. Few data exist on the discriminatory power of such measures among social drinkers differing on alcohol intake level. The purpose of this study was to assess the relationship between alcohol consumption and psychological/cognitive functioning in a group of social drinker college students made up of equal numbers of males and females, matched on age and education, and varying on amount of alcohol consumed per drinking episode. Results indicate no relationship between alcohol consumption and cognitive functioning in this group of social drinkers. Drinking and psychological profiles of heavy social drinkers were very similar to those of diagnosed alcoholics and very dissimilar to light social drinkers. Such a finding suggests that these types of profiles may have predictive value for identifying at-risk social drinkers in the general population.

The impact of fathers' drinking on cognitive loss among social drinkers

This chapter examines cognitive loss in social drinkers. The question of concern is whether the relationship between increased levels of alcohol consumption and reduced sober cognitive performance is misspecified. In particular, does reduced abstraction performance in social drinkers result from parental heavy drinking rather than, as we have proposed, from social drinkers' current use of alcohol. Because offspring of alcoholics may be at high risk for cognitive deficits even in childhood, these deficits may be transmitted in alcoholic families. Thus, the relationship between increased drinking and sober cognitive loss might be eliminated if parental drinking is controlled. We report here, however, that the effects of current alcohol use on abstraction performance in a representative sample of employed men and women cannot be accounted for by fathers' drinking. Our findings indicate the need for further research on both the cognitive effects of parental drinking and current alcohol use.

Alcohol use and cognitive functioning in men and women college students

Two studies of the relationship between alcohol consumption and cognitive functioning in men and women college students are presented. Study 1 showed several predicted relationships of decreased cognitive performance on various tests with increased quantity of alcohol per occasion and total lifetime consumption in both women and men. Study 2a was designed to replicate study 1, but the pattern of relationship of cognitive and consumption variables was quite different, e.g., increased cognitive performance was associated with increased quantity per occasion for several tests in males. Study 2b was designed to demonstrate reversibility of the negative effects of consumption on cognition by randomly assigning half of the subjects to abstain for two weeks. Reversibility was not demonstrated. Difficulties in studying these effects in college students are discussed.

Cognitive deficits and morphological cerebral changes in a random sample of social drinkers

A random sample of 200 men and 200 women taken from the general population as well as subsamples of 31 male and 17 female excessive social drinkers were investigated with neuropsychological tests and computed tomography of the brain. Relatively high alcohol intake per drinking occasion did not give evidence of cognitive deficits or morphological cerebral changes. However, in males, mild cognitive deficits and morphological cerebral changes as a result of high recent alcohol intake, particularly during the 24-hr period prior to the investigation, were observed. When excluding acute effects of recent alcohol intake, mild cognitive deficits but not morphological cerebral changes that are apparently due to long-term excessive social drinking were observed in males. In females there was no association between the drinking variables and cognitive deficits or morphological cerebral changes, probably due to their less advanced drinking habits. It is suggested that future risk evaluations and estimations of safe alcohol intake should take into consideration the potential risk for brain damage due to excessive social drinking. However, it is premature to make any definite statements about safe alcohol intake and the risk for brain damage in social drinkers from the general population.

Alcohol and drug use--is there a 'safe' amount?

All human endeavors are associated with quantifiable risks. Knowledge of the risk is essential for personal health maintenance. Nontherapeutic use of psychoactive drugs poses an important danger to individual persons and society. What are the quantitative estimates of these risks? Are they acceptable?Because the basic mechanism of the toxic effect of alcohol or other drugs is unknown, deciding on acceptable risks is difficult. Based on current information, the recreational abuse of inhalants, hallucinogens, stimulants, narcotics and sedative-hypnotic drugs poses unacceptable individual and societal risks. Groups at special risk should not consume alcohol or any drug unless they are under medical supervision. The threshold for increased morbidity from the regular use of alcohol in adults is in the range of three to five drinks per day; this rises sharply after six drinks per day. The apparent "safe" level of alcohol consumption appears to be one to two drinks per day. Further basic studies are required to refine these risk estimates.

Alcohol, lipids and heart disease

The attenuating effect of moderate amounts of alcohol on cardiovascular morbidity and mortality has been reported by several groups of investigators at various geographic locations. At this time, the generally accepted explantation for this cardioprotective effect favors an increase in plasma high-density lipoprotein cholesterol, a factor inversely associated with the development of coronary heart disease (CHD). Other variables potentially influencing the development of CHD such as a reduced tendency for blood coagulation and increased fibrinolytic activity has been enhanced by alcohol and may be considered as possible additional mechanisms for the cardioprotective effects of the agent. Because of its addictive potential, alcohol should not be considered for treatment of CHD.