Moderate alcohol consumption and cognitive risk.
Moderate alcohol consumption and cognitive risk.
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DOI：
10.2147/ndt.s23159
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发表时间：
2011
影响因子：
3.2
通讯作者：
Collins MA
中科院分区：
文献类型：
--
作者：
Neafsey EJ;Collins MA
我们回顾了143篇描述适度饮酒与认知某些方面之间关系的论文。研究人员发现了两类论文：（1）提供饮酒者和不饮酒者之间的风险比的论文（共74篇）和（2）虽然没有提供这样的比例，但允许饮酒者的认知能力被评为“比不饮酒者的认知能力更好”、“没有区别”或“更差”的论文（共69篇）。适度饮酒与认知的研究历史可以分为两个时代：1977-1997年和1998年至今。第一阶段（1977-1997）是神经心理学评估的时代，主要涉及年轻到中年（18-50岁）的受试者。虽然最初的研究表明适度饮酒会损害认知，但后来的许多研究都未能证实这一点，反而发现饮酒者和不饮酒者之间的认知没有差异。II期（1998年至今）是精神状态检查评估的时代，主要涉及老年（≥55岁）受试者。这些研究压倒性地发现，适度饮酒可以降低或不影响痴呆症或认知障碍的风险。当第二阶段所有研究的所有风险比都进入综合荟萃分析时，与中度“社交”（非酒精性）饮酒相关的认知风险（痴呆或认知障碍/下降）的平均风险比为0.77，不饮酒者作为参考组。适度饮酒适用于所有形式的痴呆症（未指明的痴呆、阿尔茨海默病和血管性痴呆）和认知障碍（低测试分数），但对认知能力下降没有显著益处轻度和中度饮酒都提供了类似的益处，但重度饮酒与痴呆和认知障碍的认知风险无关。虽然荟萃分析也表明葡萄酒比啤酒或烈酒更好，但这是基于相对较少的研究，因为大多数研究并没有区分这些不同类型的酒精。此外，一些确实做出区分的研究报告说，这些不同类型的酒精的影响没有差异。因此，目前这个问题仍然没有答案。分析还表明，载脂蛋白E等位基因的存在消除了适度饮酒的好处。然而，这是基于相对较少的研究，其他几项研究发现了E4等位基因的有益作用。要解决这一问题还需要进一步的研究。适量饮酒对认知的好处在男性和女性中都有体现，尽管饮酒的数量和模式在两性之间有很大差异。最后，在19个国家中，有14个国家的特定比率数据显示，轻度至中度饮酒者的认知风险未受影响或显著降低，其余5个国家中有3个也显示出非显著降低。总体而言，轻度至中度饮酒似乎不会损害年轻受试者的认知能力，实际上似乎可以降低老年受试者患痴呆症和认知能力下降的风险。
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.