Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022;86(3):1073-1080.
doi: 10.3233/JAD-215369.

Late-Onset Alcohol Abuse as a Presenting Symptom of Neurodegenerative Diseases

Elisa de Paula França Resende  1   2 , Robin Ketelle  3 , Anna Karydas  3 , Isabel Allen  2   4 , Lea T Grinberg  2   3 , Salvatore Spina  2   3 , William W Seeley  3 , David C Perry  3 , Bruce Miller  2   3 , Georges Naasan  2   5
Affiliations

Late-Onset Alcohol Abuse as a Presenting Symptom of Neurodegenerative Diseases

Elisa de Paula França Resende et al. J Alzheimers Dis. 2022.

Abstract

Background: The association between lifetime alcohol abuse and a higher risk to develop dementia is well known. However, it is unknown whether older adults who begin abusing alcohol late in life have an underlying neurodegenerative disease.

Objective: Identify the frequency of lifelong alcohol abuse (L-AA), late-onset alcohol abuse (LO-AA), and alcohol abuse as a first symptom of dementia (AA-FS) in patients with neurodegenerative diseases.

Methods: Cross-sectional retrospective study of patients evaluated at an academic referral center with a clinical diagnosis of behavioral variant frontotemporal dementia (bvFTD), Alzheimer-type dementia (AD), and semantic variant primary progressive aphasia (svPPA) (n = 1,518). The presence of alcohol abuse was screened with the National Alzheimer's Coordinating Center questionnaire. L-AA was defined as onset < 40 years, LO-AA as onset ≥40 years, and AA-FS was defined when the abuse started within the first three years from symptom onset.

Results: The frequency of LO-AA was 2.2% (n = 33/1,518). LO-AA was significantly more frequent in patients with bvFTD than AD (7.5%, n = 13/173 versus 1.3%, n = 16/1,254, CI:1.0;11.4%), but not svPPA (4.4%, n = 4/91, CI: -4.4;10.7%). Similarly, AA-FS was more frequent in bvFTD patients than AD (5.7%, n = 10/173 versus 0.7%, n = 9/1,254, CI:0.5%;9.5%), but not svPPA (2.2%, n = 2/91, CI:-2.4;9.1%).

Conclusion: LO-AA can be a presenting symptom of dementia, especially bvFTD. Alcohol abuse onset later in life should prompt a clinical investigation into the possibility of an underlying neurodegenerative process because delay in diagnosis and treatment may increase patient and caregiver burden. The results need to be interpreted with caution due to the limitations of the study.

Keywords: Alcohol-related problems; Alzheimer’s dementia; dementia; frontotemporal dementia.

PubMed Disclaimer

Figures

Fig. 1.
Fig. 1.
Frequency of late-onset alcohol abuse and alcohol abuse as one of the first symptoms of dementia, per diagnosis. The first panel shows the comparisons of the proportions of late-onset alcohol abuse across the cognitive diagnosis: Alzheimer’s disease dementia (AD), semantic variant primary progressive aphasia (svPPA), and behavioral variant frontotemporal dementia (bvFTD). The second panel shows the proportions of alcohol as the first symptom (subgroup analyses) across the cognitive diagnosis. The third panel shows the frequency of lifelong alcohol abuse per diagnosis. The Confidence Intervals (CI) refer to the comparisons of the proportions between groups. The error bars depict the 95% CI of the proportions within each cognitive group.
Fig. 2.
Fig. 2.
Distribution of pathological diagnosis per alcohol status. The proportion of patients with frontotemporal lobar degeneration (FTLD) pathology in the late-onset alcohol abuse was higher than in the lifelong alcohol abuse, where the proportion between FTDL pathology and Alzheimer’s disease was similar.
See this image and copyright information in PMC

References

    1. Rascovsky K, Hodges JR, Knopman D, Mendez MF, Kramer JH, Neuhaus J, van Swieten JC, Seelaar H, Dopper EG, Onyike CU, Hillis AE, Josephs KA, Boeve BF, Kertesz A, Seeley WW, Rankin KP, Johnson JK, Gorno-Tempini ML, Rosen H, Prioleau-Latham CE, Lee A, Kipps CM, Lillo P, Piguet O, Rohrer JD, Rossor MN, Warren JD, Fox NC, Galasko D, Salmon DP, Black SE, Mesulam M, Weintraub S, Dickerson BC, Diehl-Schmid J, Pasquier F, Deramecourt V, Lebert F, Pijnenburg Y, Chow TW, Manes F, Grafman J, Cappa SF, Freedman M, Grossman M, Miller BL (2011) Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. Brain 134, 2456–2477. - PMC - PubMed
    1. Mendez MF, Perryman KM, Miller BL, Swartz JR, Cummings JL (1997) Compulsive behaviors as presenting symptoms of frontotemporal dementia. J Geriatr Psychiatry Neurol 10, 154–157. - PubMed
    1. Perry DC, Sturm VE, Seeley WW, Miller BL, Kramer JH, Rosen HJ (2014) Anatomical correlates of reward-seeking behaviours in behavioural variant frontotemporal dementia. Brain 137, 1621–1626. - PMC - PubMed
    1. Gorno-Tempini ML, Hillis AE, Weintraub S, Kertesz A, Mendez M, Cappa SF, Ogar JM, Rohrer JD, Black S, Boeve BF, Manes F, Dronkers NF, Vandenberghe R, Rascovsky K, Patterson K, Miller BL, Knopman DS, Hodges JR, Mesulam MM, Grossman M (2011) Classification of primary progressive aphasia and its variants. Neurology 76, 1006–1014. - PMC - PubMed
    1. Hodges JR, Patterson K, Ward R, Garrard P, Bak T, Perry R, Gregory C (1999) The differentiation of semantic dementia and frontal lobe dementia (temporal and frontal variants of frontotemporal dementia) from early Alzheimer’s disease: A comparative neuropsychological study. Neuropsychology 13, 31–40. - PubMed

Publication types

MeSH terms