Addressing common biases in the evaluation of lifetime alcohol consumption patterns and dementia risk

Alcohol consumption has been described to exhibit a J-shaped relationship with dementia risk, but previous observations may be partly biased due to “sick-quitters” and competing risks of death. A study examined the association between baseline and lifetime alcohol consumption and the risk of dementia and subtypes in a large Mediterranean cohort, accounting for lifetime drinking patterns, potential confounding, and competing risks of death.
The prospective study involved 30,211 participants aged 29–69 years at recruitment (1992–1996), from the EPIC-Spain dementia cohort. Alcohol consumption was evaluated using a validated dietary history and retrospective questionnaires covering ages 20, 30, and 40 years. Dementia cases (n = 1,114) were identified through linkage with healthcare and mortality databases, as well as individual medical record review, over a mean follow-up of 22.8 years.
Mean lifetime alcohol consumption was 41.9 and 4.4 g/d in men and women, respectively. No significant associations were observed between baseline or lifetime alcohol consumption and the risk of overall dementia, Alzheimer’s disease, or non-Alzheimer’s subtypes. These null results remained consistent across different sexes, BMI groups, smoking categories, and beverage types. Sensitivity analyses excluding misreporters of energy intake or low-quality diagnoses produced similar findings.
This large prospective cohort study with over 1,100 dementia cases and long-term follow-up found no significant link between alcohol consumption and dementia risk. These results challenge the idea that moderate drinking offers protection and highlight the need for further research using methodologically rigorous methods to explore how alcohol dose, timing, and pattern influence dementia risk.
Source: Huerta José M., Colorado-Yohar Sandra M., Andreu-Reinón M. Encarnación et al. (2025). Addressing common biases in the evaluation of lifetime alcohol consumption patterns and dementia risk: the EPIC-Spain dementia cohort. Frontiers in Nutrition, 12.