1. 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

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

3. 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%

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

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

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

7. 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

8. 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%

9. 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

10. 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

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

12. 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

13. Alcohol Co-morbid with Dementia
Diagnostic Categories
Dementia
(N = 35,612)
Age 50+ %
OR; 95% CI
Alcohol Disorder
0.7
5.05;
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

14. 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

15. 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

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