Substance Use
Lifecourse alcohol use profiles and cognitive health among older US adults Jonathan Platt* Jonathan Platt Platt Platt University of Iowa
For many older adults, a lifetime of alcohol consumption may influence cognitive health. Despite substantial lifecourse variability in drinking behavior, research often relies on cross-sectional designs or recent recall periods among older populations, and is thus unable to account for reverse causation, prior drinking history, and other key sources of bias. This analysis aimed to identify distinct lifecourse trajectories of alcohol use behaviors and estimate their longitudinal associations with cognitive health in older adulthood.
The study sample included 14 waves (1982-2018) of the National Longitudinal Survey of Youth 1979 Cohort (n=12,686, ages 18–61). Latent profile analysis of six person-level alcohol use behaviors (i.e., means and linear slopes for binge drinking frequency, drinking days/week, and drinks/day) identified distinct drinking trajectories over time. Cognitive health was measured using the Modified Telephone Interview for Cognitive Status (TICS-M) (range=0-27). Continuous TICS-M scores were regressed on drinking profiles, adjusting for sex, race/ethnicity, and age.
Eight drinking profiles were identified: near abstention (7.4%), stable occasional use (19.8%), declining occasional use (6.9%), stable moderate use (17%), to stable heavy use (9.1%), declining moderate use (23.4%), high-intensity declining use (8.6%), occasional escalating use (7.8%). Compared with the near abstention group, all alcohol use trajectories were associated with significantly lower TICS-M scores. The largest deficits were seen for occasional escalating (β = −2.12, 95% CI: −2.42, −1.81), declining moderate (β = −2.10, 95% CI: −2.36, −1.85), and declining high-intensity use (β = −2.03, 95% CI: −2.33, −1.73).
The cognitive consequences of alcohol use depend on the timing, intensity, and direction of change across the lifecourse. Conceptualizing alcohol use as a dynamic, heterogeneous process will inform prevention efforts to maximize cognitive health in aging populations.
