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| News covering selected sessions related to migraine from 2008 medical conferences. |
| Annual Meeting of the American Academy of Neurology |
Chicago, IL April 15-18, 2008 |
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Alzheimer’s Onset Sooner in Heavy
Drinkers, Smokers |
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BY PATRICE WENDLING
Chicago Bureau |
CHICAGO —
Heavy drinking and smoking are associated with a significantly
earlier age of development of late-onset Alzheimer’s disease,
according to findings presented at the annual meeting of the
American Academy of Neurology.
In a retrospective analysis of 686 patients diagnosed with
possible or probable Alzheimer’s disease, people who were heavy
drinkers, defined as having more than two drinks of wine, beer,
or spirits per day, developed Alzheimer’s 5 years earlier than
those who were not drinkers (onset 71 vs. 76 years).
People who smoked at least a pack of cigarettes per day
developed the disease 2 years sooner than nonsmokers (73 vs. 75
years).
The combination of heavy drinking and smoking reduced the age at
onset by 6 to 7 years, compared with those who did not drink or
smoke heavily, lead investigator Dr. Ranjan Duara, medical
director of the Wien Center for Alzheimer’s Disease and Memory
Disorders, Mount Sinai Medical Center, Miami Beach, and
associates reported in a poster.
Genetic testing revealed that 27% of patients were positive for
the apolipoprotein (APOE) e4 allele, which has long been
considered a risk factor for Alzheimer’s. Patients with APOE e4
developed the disease 3 years sooner than those without the gene
variant. Gender had no significant influence on age of onset.
Identification of heavy smoking and heavy drinking as modifiable
risk factors may potentially reduce the prevalence of
Alzheimer’s disease, especially among those with increased
genetic risk, Dr. Duara said during a press briefing at the
meeting.
Because the prevalence of Alzheimer’s increases with age and
roughly doubles every 5 years from age 65 years onward, a 5-year
delay in disease onset could reduce the prevalence of
Alzheimer’s by almost 50%, he explained. Late-onset Alzheimer’s
is the most common form of the disease, representing roughly 85%
of cases.
The investigators observed an additive, but not synergistic
effect of the three risk factors. The average age at onset was
73 years among patients with the APOE e4 allele who were also
heavy smokers, 74 years for patients with APOE e4 who drank
heavily, and 68.5 years for those with all three risk factors.
In contrast, the average age at onset was 77 years among
patients with none of the three risk factors.
When asked if physicians should be screening patients in midlife
for the APOE e4 genotype, Dr. Duara responded that the general
consensus has been that it is not a useful screening measure for
evaluating overall risk of developing Alzheimer’s. However,
genetic testing for APOE e4 could be of potential use in
patients with a family history of the disease, and may
ultimately be recommended as a risk screener as more information
becomes available on the interaction of APOE e4 with other risk
factors.
In the meantime, Dr. Duara suggested that public health agencies
and hospitals should emphasize to school-age children onwards
the importance of not smoking and limiting alcohol consumption
to two or fewer drinks per day, in combination with regular
exercise, a healthy diet, and an active social life.
At baseline, the mean Mini-Mental Status Examination score was
18, women accounted for 64% of patients, 371 patients never
smoked cigarettes, 129 smoked less than one pack per day, 94
smoked one pack per day, and 92 smoked at least one pack per
day. In all, 340 patients never drank, 218 drank less than one
drink a day, 78 drank one to two drinks a day, and 50 drank two
or more drinks per day.
Dr. Duara acknowledged that the study was limited by its
retrospective design, use of informant-based reports on age of
onset and risk factors, lack of dose-response assessment, and
clinic-based population, which may limit the generalizability of
the findings to the general population.
The study was funded by the Florida Department of Elder Affairs,
and the investigators reported no disclosures. |
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