Alcohol consumption and cognitive decline: the elephant in the room?
Authors: Alain Braillon
Journal: The Lancet Public Health (2018)

I read with interest the cohort study by Michaël Schwarzinger and colleagues,1Schwarzinger M Pollock BG Hasan OSM et al.Contribution of alcohol use disorders to the burden of dementia in France 2008–13: a nationwide retrospective cohort study.Lancet Public Health. 2018; 3: e124-e132Summary Full Text Full Text PDF PubMed Scopus (94) Google Scholar showing an association between alcohol use disorders in French hospitalised patients and dementia, which deserved some comments. First, it is important to note that there is a dose-response and that so-called moderate use of alcohol is associated with cognitive decline.2Topiwala A Allan CL Valkanova V et al.Moderate alcohol consumption as risk factor for adverse brain outcomes and cognitive decline: longitudinal cohort study.BMJ. 2017; 357: j2353Crossref PubMed Scopus (1) Google Scholar Second, alcohol is a risk factor for cognitive decline that is too often omitted. In particular, alcohol was not included as a risk factor in the 2017 Lancet Commission on dementia,3Livingston G Sommerlad A Orgeta V et al.Dementia prevention, intervention, and care.Lancet. 2017; 390: 2673-2734Summary Full Text Full Text PDF PubMed Scopus (2072) Google Scholar which noted that “drinking only a moderate amount of alcohol [can] increase life expectancy and health in ageing”—this assertion is unacceptable and the authors ignore that alcohol is a carcinogen beginning at a rate of one drink (10–20 g of alcohol) per day.4Rehm J Shield K Alcohol consumption.in: Stewart BW Wild CB World Cancer Report 2014. International Agency for Research on Cancer, Lyon, France2014: 96-104Google Scholar Third, the policy regarding alcohol in France deserves scrutiny. The French health-care scheme reimburses neither the use of psychotherapy (a cornerstone of treating addiction)5National Institute for Health and Care ExcellenceAlcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence.https://www.nice.org.uk/guidance/cg115/chapter/1-GuidanceDate: February, 2011Date accessed: March 26, 2018Google Scholar nor thiamine (a deficiency of which promotes serious neurological damages).6Frankenburg FR Alcohol use, thiamine deficiency, and cognitive impairment.JAMA. 2008; 299: 2854Crossref PubMed Scopus (4) Google Scholar Importantly, when examining prevention, French Governments' actions seem to favour economical interests over public health. Repealing of the ban on advertising alcohol by the previous Government, and the President's hiring of a wine lobbyist as a special advisor for agriculture are concerning.7Anson J President Macron appoints wine lobbyist as adviser.http://www.decanter.com/wine-news/president-macron-wine-adviser-bourolleau-369584/Date: May 24, 2017Date accessed: February 21, 2018Google Scholar Alcohol is France's second biggest export sector after the aerospace industry and a wealthy internal market is certainly key for exportation. Finally, Schwarzinger and colleagues' conclusion1Schwarzinger M Pollock BG Hasan OSM et al.Contribution of alcohol use disorders to the burden of dementia in France 2008–13: a nationwide retrospective cohort study.Lancet Public Health. 2018; 3: e124-e132Summary Full Text Full Text PDF PubMed Scopus (94) Google Scholar that alcohol policies should be considered to reduce heavy drinking in the general population overlooked the fact that low consumption can also cause damage. I declare no competing interests. Contribution of alcohol use disorders to the burden of dementia in France 2008–13: a nationwide retrospective cohort studyAlcohol use disorders were a major risk factor for onset of all types of dementia, and especially early-onset dementia. Thus, screening for heavy drinking should be part of regular medical care, with intervention or treatment being offered when necessary. Additionally, other alcohol policies should be considered to reduce heavy drinking in the general population. Full-Text PDF Open Access