Alcohol and Dementia: A potent cocktail Brian Draper1, Rosemary Karmel2, Diane Gibson3, Ann Peut2, Phil Anderson2, Adrienne Withall1 Psychiatry 1School of Psychiatry, University of NSW, Sydney, Australia 2Australian Institute of Health & Welfare, Canberra, Australia 3University of Canberra, Canberra, Australia

Alcohol and Dementia Two relationships to explore: Alcohol as a cause of dementia Alcohol disorders comorbid with another type of dementia

Alcohol as a cause of Young Onset Dementia Harvey et al (2003) (England) 10.3% Panegyres & Frencham (2000) (Australia) 5.4% Fujihara et al (2004) (Brazil) 5.0% McMurtray et al (2006) (USA- LA) 5.4% Kelley et al (2008) (USA – Mid-West) 0.4%

Hospital Dementia Services Dataset 253,000 persons aged at least 50 years on 1 July 2006 had at least one multi-day stay ending between 1 July 2006 and 30 June 2007 in one of the 222 public hospitals in NSW. 20,793 were diagnosed with dementia

Dementia Diagnoses by Age NSW Hospitals 2006/7 ARD = 1.4% dementia diagnoses, 20.8% dementia diagnoses age 50-64

Alcohol Related Dementia and Other Cognitive Disorders – NSW Hospitals 2006/7 0.2% of NSW hospital admissions

Comparison of ARD with Other Dementia (Draper et al, 2011) 82% Male Mean Age 65.0 years ALL DEMENTIA (N = 20,793) 40% Male Mean age 82.7 years

Selected Diagnostic Categories Comorbid diagnoses in NSW multi-day hospital stays of patients with Alcohol-Related Dementia (N = 881) (Draper et al, 2011) Selected Diagnostic Categories Principal Diagnosis All Diagnoses Liver Disease 11.0% 34.8% Fractures 3.9% 5.6% Epilepsy 2.8% 5.4% Head injury 2.4% 6.0% Lower Respiratory Tract infection 1.9% 6.7% Stroke 1.0% 1.5% UTI 0.9% 7.0% Septicaemia 0.5% 2.3%

Alcohol-related Dementia - Discharge Deaths and Transfers by Dementia Status (Draper et al, 2011) Outcome ARD All Dementia No Dementia Total (%) Transfer to RACF 7.0 19.4 2.2 Transfer to Other Accommodation 2.8 2.7 0.7 Transfer to Usual Accommodation 80.0 69.6 92.5 Discharge at own risk 3.7 0.4 Died 5.0 8.3 4.6

Partner logo here Sydney Young Onset Dementia Case Finding Survey (Withall & Draper, 2009) Similar methodology to Harvey et al. (1998; 2003) GPs, specialists, health professionals, health services & RACFs in Eastern Sydney area Capture-recapture Personalised & deliberately brief 83% response rate (GPs 23%) Case note review to validate diagnosis psychiatrists, neurologists, geriatricians, rehabilitation practitioners (to capture traumatic and post-neurosurgical dementias) and immunologists (to capture HIV-related dementia) Memory clinics ACATs 10

Sydney Young Onset Dementia Case Finding Survey (Withall & Draper, 2009) N = 136

ARD in Young Onset Dementia Survey Withall & Draper, 2009 Mean Age of Onset = 52 years Mean time from onset of cognitive symptoms to diagnosis = 2.2 years 24% were in residential care (consistent with other published data that ~25% cannot live independently) 7% were homeless

Alcohol Co-morbid with Dementia Diagnostic Categories Dementia (N = 35,612) Age 50+ % OR; 95% CI Alcohol Disorder 0.7 5.05; 4.37-5.83 Alcohol Disorders are 5 times more likely to be present in acute hospital patients with dementia PWD are admitted due to falls (head injuries, hip fractures), infections and increased confusion

What messages should we be giving about Alcohol & Cognitive Disorders? There is no single clear message but perhaps we need to become more circumspect about the role of alcohol In older people the upper ‘safe limit’ for older people is 1.5 units per day or 11 units per week & binge drinking should be defined as >4.5 units in a single session for men and >3 units for women (Royal College Psychiatrists, 2011) In younger people, significant alcohol use (minimum 35 standard drinks per week for men, and 28 for women) for a period > 5 years is sufficient to cause dementia; much less can cause cognitive impairment, particularly frontal

What messages should we be giving about Alcohol & Cognitive Disorders? Moderate alcohol intake in people aged 60+ may reduce their risk of dementia, however, once a cognitive disorder is diagnosed perhaps alcohol intake should be reduced or ceased as it can cause increased confusion, BPSD and require more hospitalisations

Thank You! www.med.unsw.edu.au/adfoap Brian Draper B.Draper@unsw.edu.au www.med.unsw.edu.au/adfoap