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June 25, 2008

Alcohol Use, Thiamine Deficiency, and Cognitive Impairment—Reply

JAMA. 2008;299(24):2853-2855. doi:10.1001/jama.299.24.2854-b

In Reply: As noted by Dr Panza and colleagues, the findings of the Italian Longitudinal Study on Aging (ILSA)1 support the view that mild to moderate alcohol consumption has beneficial effects on cognition in the elderly. Their data do not persuade me, however, that rather than abstinence from alcohol, “a viable alternative option” for Mr. E would be “moderate drinking.” As their article notes,1 studies addressing alcohol's effects on cognition have produced “inconsistent results.” In one study, benefit disappeared after adjusting for demographic and socioeconomic factors.2 One study found the most favorable effects in participants carrying the apolipoprotein E ε4 allele,3 whereas another found the greatest benefit in participants without the apolipoprotein E ε4 allele.4 One found benefit only for wine,5 whereas another found benefit for wine, beer, or spirits.6 Although ILSA investigators asked abstainers whether they had been drinkers in the past, abstainer subgroups were not separately analyzed. Panza et al acknowledge that abstainers might have had a relatively poor health status, and it is plausible that poor health, including cognitive impairment, would be especially likely among those who became abstainers because of problem drinking.