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Alcohol Related Dementia

The price of alcohol relative to UK average income has halved since the 1960's, whilst the personal consumption of alcohol has more than doubled in some age groups Alcohol misuse in the elderly is underestimated and under-diagnosed and if the present trend continues, the UK will rise to the top in Europe. The DOH 'sensible drinking' policy is 3-4 units a day for men and 2-3 units for women. Long term alcohol consumption above these limits is generally considered harmful. The concurrent use of 'recreational' drugs may well contribute to later onset cognitive problems. Consequently future generations may see a disproportionate increase in alcohol-related dementia. It is worth noting that the current prevalence of alcohol consumption in the elderly was manifest in levels of less than half the level of today's younger and middle-aged generations. Chronic alcohol misuse is associated with early death but given that fact , alcohol-related dementia rates would be a lot higher if the life span of heavy drinkers was similar to the general population.

There is increased occurrence of all types of dementia, except Alzheimer’s disease, in elderly people with alcohol use disorders. The reasons for this have yet to be fully explained, as the relationship between alcohol use and dementias is complex. Also, it can be difficult to differentiate Alzheimer’s disease from alcohol-related dementia. Although rates of alcohol-related dementia in late life differ depending on the diagnostic criteria used and the nature of the population studied, there is consensus that alcohol contributes to the acquisition of cognitive deficits in late life. Among participants over the age of 55 in the USA, the prevalence of alcohol use disorders was 1.5 times greater among people with mild and severe cognitive impairment than those with no impairment.

Britain has the largest number of very high risk drinkers in Europe, according to a 2018 study. Nearly 1.2 million - or just under 3 per cent of those aged 15 to 64 - are drinking at levels that are knocking two to three decades off their lives. A 'very high' level of drinking is defined as consuming the equivalent of 1.2-1.5 bottles of wine every day. This group are 'the most severely affected population of alcohol users', 'chronically intoxicated' to the extent that their organs are being poisoned and their cognitive abilities are damaged.

Supporting documentation on Alcohol Related Dementia can be found HERE

Drug Abuse and Dementia

There are 2 aspects to this, firstly the damaging effects on the brain produced by recreational drugs, mainly in younger people, and secondly the increased dementia risks of some prescribed medications in the older generation. However, this is a big area to cover and the effects are not always positive although evidence may well point in one direction but no certainty of a conclusion. And of course, as in the case of moderate alcohol use, it may well be that some drugs are beneficial for dementia prevention. In the case of recreational drugs, the fact that they clearly cross the brain/blood barrier to produce an effect means the risk potential is very much there. There is evidence that some drugs contribute to the causal pathway that leads to the development of cognitive impairment and perhaps dementia in later life. Currently there is no separate diagnostic category of drug-induced dementia but in any case, recreational drug useage will develop into a major health care problem for the future.

Documentation on Recreational Drugs and Dementia risk can be found HERE

The second aspect of this is the drugs given to elderly people to control their behaviour, chemical sedation. This does not include the cholinesterase inhibitors such as aricept etc. given to slow memory loss in dementia patients. What we are mainly concerned with here is the administring of antipsychotic drugs, benzodiazipines drugs and buprenorphine drugs. The problem is that whilst these drugs may serve a purpose if administerd and monitored properly, ths rarely happens since doctors do not have the time or inclination, consequently drugs are used for far too long on repeat prescriptions and side effects kick-in big time. The management of dementia symptoms can be difficult. Current systems have grown by chance rather than by active planning or commissioning. They deliver a largely drug-based response that is likely to do considerable harm as well as failing to address many of the behavioural problems in dementia.

Information on Drug Abuse and Misuse in the Elderly can be found HERE