Alcohol Use Disorders in Cognitively Impaired Patients Referred for Geriatric Assessment

Abstract

Alcohol Use Disorders are thought to be underdiagnosed in the geriatric population. A retrospective medical record review was performed on 383 patients who presented for outpatient geriatric assessment from 1985-1990. The record review included data on the alcohol consumption history, age, sex, presence of alcoholic beverages in the home, geriatric psychiatry evaluation, and alcohol-related diagnoses. Alcohol Use Disorders were recognized as contributing to medical problems in 10% of patients having a mean age of 78 years. All except one patient were found to be cognitively impaired. In addition, 9% of patients consumed alcohol on a regular basis and this consumption was not considered in the diagnosis, despite the presence of cognitive impairment. Twenty-five percent of cognitively impaired patients were consuming alcohol at the time of evaluation. These results indicate that alcohol consumption and AUD are common in cognitively impaired patients presenting for geriatric assessment. Recognition of Alcohol Use Disorders is essential, as chronic alcohol toxicity represents one cause of potentially reversible dementia. Because there are no validated instruments for alcoholism screening in cognitively impaired elderly patients, evaluation should include a past and present consumption history, a search for alcoholic beverages at the home visit, and possible psychiatric referral.

Substance use history in behavioral-variant frontotemporal dementia versus primary progressive aphasia

“…Clinical treatment providers working with patients diagnosed with either FTD subtype may need to continue screening for and monitoring substance use patterns even after a FTD diagnosis is made – not assuming that substance use will remit with increased age and risk underdiagnosing a substance use disorder in an older adult 2, 44–48 . The one significant finding of a greater percentage of participants smoked in the last 30 days in the bvFTD subtype compared to the PPAPH subtype is consistent with the characteristic behavioral disinhibition of the bvFTD subtype.…”

The Subjective Effects of Cocaine: Relationship to Years of Cocaine Use and Current Age

“…For example, because cocaine continues to result in pleasurable subjective effects as age increases, the motivation to stop cocaine use may not decrease for cocaine users as they grow older. Rather than assuming that cocaine use will remit as age increases and underdiagnosing substance abuse in older adult populations (24–29), clinical treatment providers may need to continue screening for cocaine use in cocaine users as they grow older and, if present, discuss the risk–benefit ratio of continued cocaine use in later life. In addition, as cocaine’s subjective effects appear to be unaltered by age or years of cocaine use, these data suggest that increasing rates of cocaine abuse in older populations may be mediated by the same factors relevant to younger initiates to cocaine use.…”

Alcohol related dementia: proposed clinical criteria

“…Three recent clinical studies have examined the prevalence of heavy alcohol use among patients who present for evaluation of dementia. Rains and Ditzler studied 383 men and women, 9% of whom had a history of heavy alcohol use (Rains, 1993). More recently, studies by King and by Smith and Atkinson both found the prevalence of heavy alcohol use to be 22% in patients presenting to a dementia clinic (King, 1986;Smith, 1994a).…”