#128- Alcohol + Dementia: Does moderate drinking increase dementia risk?

If you’ve ever been told that “a little wine is good for you,” you might want to hear what the latest science says—especially when it comes to the aging brain.

In this episode, I share compelling new research showing that even moderate alcohol use in midlife and later life may significantly increase the risk of dementia. I’ll walk you through why alcohol use in older adults often goes undetected, how it impacts brain health, and the exact screening tools and questions I use—and that you can use too—to spot red flags early.

This isn’t about scare tactics. It’s about equipping you with the facts, the tools, and the confidence to support safer, healthier aging. Whether you’re a therapist, care manager, or simply someone who wants to protect your own brain health, you’ll come away knowing why there may be no safe level of alcohol when it comes to dementia prevention.

What You’ll Learn in This Episode:

1⃣ The brain changes alcohol accelerates—from memory loss to neurotransmitter disruption.
2⃣ Why “invisible” alcohol misuse often goes undetected in later life—and how to spot it.
3⃣ Three screening tools every clinician should know: SMAST-G, AUDIT-C, and CAGE Questionnaire.
4⃣The good news: Older adults can recover—and often have better treatment outcomes than younger adults when care is tailored to them.

Click here to get all of the resources mentioned in this episode here

If you enjoyed this episode, please subscribe, leave a review, and share it with a colleague or friend. Together, we’re building a movement for mental health and aging—because there is no expiration date on healing, transformation, and growth.

PROFESSIONALS: Grab your free guide to working with older adults here


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Transcript

128- Does moderate drinking increase the risk for dementia? In today's video, I'm gonna share what the science says in answering this question.

I'm Dr. Regina Koepp. I'm a board certified clinical psychologist and Gero psychologist, and I founded the Center for Mental Health and Aging.

There's emerging evidence that shows that moderate drinking increases the risk for dementia in midlife and later life.

And yet, alcohol use among older adults is rarely screened for or misunderstood or dismissed entirely, creating a vulnerability for many older adults as it relates to brain health and mental health in later life. So if you're working with older adults or simply wanna support a healthier, safer aging process, it's time we take a closer look at alcohol use through the lens of brain health.

Alcohol use is the most commonly used substance among older adults or people 65 and older. the rates of binge drinking are on the rise.

 Here's why this is such an important topic. New studies are emerging showing that even moderate alcohol use among middle aged and older adults increase the risk for dementia, and I'm gonna review some of that research now.

You've heard me say this in other videos especially the videos around the link between certain mental health conditions and dementia disorders and alcohol use is no exception.

On the Lancet 2024 list of modifiable dementia risk factors. The Lancet Commission identified excessive alcohol use as being a modifiable risk factor for dementia later in life, and this even starts in middle age, so excessive alcohol use in middle age increases the risk for dementia down the road.

I'm gonna share some other research as well. Looking at the risk between moderate, not necessarily excessive, but moderate alcohol use and dementia disorders.

In a longitudinal study of over 300,000 individuals followed for 13 years, researchers found a linear relationship between alcohol consumption and dementia.

They found that the more the person drank, the greater the risk for dementia, and the less a person drank the lower their risk for dementia.

They concluded that when it comes to dementia, there is no safe level of alcohol consumption.

And so what does this mean for our work with older adults? It means we have to stop separating alcohol use and substance use from brain health. It's all connected.

I did a longer video on this. It's perhaps my most popular video on YouTube has more than 60,000 views on alcohol use and aging . some of the data that I shared then is a little outdated. However, when it comes to the aging brain, the thought is that if you want the healthiest brain, there is no alcohol consumption, that's the best chance at optimal brain health as it relates to alcohol use.

And when it comes to people with mild cognitive impairment who are also engaging in alcohol use or consumption, even moderate or less than, it actually increases brain vulnerability.

 And so let's talk about how alcohol affects the aging brain.

Dr. Regina Koepp: So as we age, our bodies become more sensitive to alcohol.

We metabolize alcohol differently. Our levels of dehydration and hydration are different than in earlier stages of our life. Alcohol consumption also contributes to faster brain shrinkage including in areas like the hippocampus that have to do with memory. Other ways that alcohol affects the brain are with neurotransmitter disruption resulting in emotion dysregulation.

 Which affects mood, learning, attention and emotion regulation.

Another significant way that alcohol affects the brain is that when people are drinking even moderate amounts, the risk of falling increases leading to head trauma, broken bones, and other injuries- falls can be detrimental to many older people

Further, alcohol consumption increases the risk for anxiety and depression. In the last two videos I did, I reviewed the link between depression and anxiety and dementia, and so we know that those are risk factors for dementia. Depression is on that lancet list of modifiable risk factors, and in the video on anxiety, researchers identified anxiety as being as risky for developing dementia as diabetes, and so it's really important that we're managing mental health and reducing, or if possible, eliminating alcohol consumption. There are also harmful drug interactions that can happen between alcohol and medications prescribed for many older adults.

Alcohol use can also increase risk for other medical problems and so on. There are a lot of contraindications for alcohol use among older adults, not only in how it affects the aging brain, but how it affects the body overall.

 Another thing to consider as we're talking about alcohol use in later life is that alcohol misuse often goes undetected later in life. And in fact, among geriatricians and geropsychologists like myself, it's often called the invisible illness.

Dr. Regina Koepp: And that's because we so often overlook alcohol misuse among older adults. And here's why. First is that symptoms can often mimic what is often considered, even though erroneously as normal aging, which can be memory lapses, mood swings, inattention, fatigue. Of course, mood swings, fatigue. Not normal with aging, but if we think that they're normal with aging, we'll overlook them for what they may really be, which could be depression, anxiety, insomnia, or alcohol misuse, or other substance misuse.

Another reason that alcohol misuse often goes undetected and untreated is that. Clients themselves may under report their use. Like on a screener, they might say, no, I'm not using problematically, or, no, I'm not craving when. In fact they may be. And the reason for this is stigma, shame, and I've heard many older adults describe alcohol misuse as a habit.

So may not see it as problematic, but see it as a habit, something that I just do every day that's been consistent for several years.

Another reason that alcohol misuse goes undetected and untreated is that often professionals, health providers, mental health providers, medical providers, aging services providers are not asking about it. We look at a person who walks into our office and we don't assume that we need to be screening for alcohol misuse or other substances, when in fact we may need to be. Professionals may also just assume it's just one drink when it may not be.

So an example of this: I was having a conversation with a psychologist a couple of years ago who took her father to see a neuropsychologist, and the neuropsychologist did not ask about the father's substance use and the psychologist knew that the father was misusing substances, which was one of the reasons that she was concerned about his brain health.

And so she took, her father had a first clinical interview with the neuropsychologist. The neuropsychologist overlooked the substance use component in a clinical interview, and this was really concerning to the psychologist who was bringing her father in, and they did not go back to that neuropsychologist because the key ingredient for the concerns that were happening for this person's father was alcohol misuse and consistent long-term alcohol misuse, and her concern about how it was affecting his brain health professionals from every discipline overlook this. Our assumptions persuade the questions that we ask. And so this is my invitation to you and to myself as a reminder to continue to challenge our assumptions and to keep an open mind and clinical curiosity about the people walking into our office.

And when it comes to families, especially when there are longstanding patterns of substance use, families may minimize or fear bringing up their concerns about alcohol misuse. Maybe they don't wanna rock the boat. Maybe they fear that at this stage in the person's life, what's the point? They're not gonna change anyway or have so many other barriers enabling, codependence that may be preventing them from bringing up the topic as a result, problematic alcohol use could be slipping through the cracks and often does. Leading again to what many clinicians call the invisible problem or invisible illness in older adulthood.

So the good news here is that we can screen and refer or provide treatment. So you don't need to be a substance use specialist to begin to screen for alcohol use and then refer to treatment or if you're a licensed mental health provider to provide that treatment. Some of the screening tools that are normed for use with older adults are the short Michigan Alcohol Screening test, geriatric version, which is the SMAST-G, the audit C, which is the three item questionnaire, the cage questionnaire, which is an acronym, which is four questions, and so I'll link to these three assessment tools in the show notes below, but you can simply ask these three questions as well.

Has your drinking changed in the last three years?

Have you noticed any changes to sleep, memory or mood as a result of alcohol use? Do you ever drink to cope with stress or sleep problems or loneliness? And you'll see I added sleep problems in there because insomnia is more common among older adults than any other age group. And next week I'll be sharing a video on the link between sleep and dementia, so stay tuned for that.

Okay, but here is, the good news is that treatment works, and even some studies show that older adults actually have better treatment completion and outcomes related to substance use treatment than any other age group. And so this idea that older adults can't change. Is wrong. Older adults benefit from substance use treatment even more than other age groups and treatment works.

And so when you screen and you identify substance use concerns, either provide that treatment if you have the training to do so or refer for treatment.

This is one of the most hopeful findings both clinically and in the research, is that older adults do benefit from treatment for problematic alcohol use. They're more likely to stay in treatment and complete the full treatment protocol. And like I mentioned earlier, they tend to have better outcomes and especially if that program is tailored to meet the unique needs of older adults, which is why I founded the Center for Mental Health and Aging, so that you have the tools to meet the mental health needs of older adults.

Some ways to tailor alcohol use treatment or substance use treatment to older adults have to do with the conversations that are started around isolation and loneliness, life transitions, loss, dignity, et cetera. And even practical things like the length of where the group rooms or the meeting rooms are from the waiting room if the person uses assistive devices for walking or the size of the print on the materials, like large print materials or the pacing of the programs themselves.

 But of course, what works best is a nonjudgmental relationship and human centered approach,

and I think especially when it comes to working with older adults to begin to challenge some of the ageism that keeps older adults out of care, or even believing in their ability to change the idea that people are stuck in their ways or are rigid when in fact that is not true. Older adults , as you've seen, have great treatment outcomes with substance use treatment, and so for clinicians to hold hope that change is possible, and indeed that is one of the common ingredients for what makes therapy and mental health treatment work in the first place. Along with unconditional positive regard, there's hope and belief in the person's ability to heal. And as it relates to older adults, this is really important because I like to say there is no expiration date on healing, transformation, and growth, and the research proves it.

It also helps to provide clear education on alcohol use and brain health so people can make informed decisions about their health as they age, related to what they're putting into their bodies and their willingness to engage in treatment.

Support groups and therapists trained in aging and substance use are key, as well as integrated care that addresses social isolation and loneliness, trauma, other mental health conditions like depression, anxiety, grief and loss.

So as a mental health provider or medical provider, aging services provider, you have a really important role in optimizing not only brain health, but mental health all throughout older adulthood.

So here's what you can do. One is to screen gently, openly, and routinely. Two is to include alcohol use, misuse, consistent use in your understanding of brain health and psychological health.

Three is to refer when needed, but don't underestimate the influence that you have and the importance of your role, even if you're not the one providing treatment. , if you screen and you identify alcohol use and the person is not yet ready to be referred, maybe they need time to think about this, to come to terms, to make sense to take stock.

Give the person some space and grace to come around and make this a conversation, not necessarily a one and done if you're working with that person going forward. Let them know that the door is always open to change their mind. I have had incredible success with that strategy. When a person's not ready now, I say no problem.

My door is always open to you. When you're ready, reach out to me and let me know. Or we can talk about other things that are concerning you in your life, and then down the road with trust, with exposure to the therapeutic process. Sometimes they come around.

And this leads me to my last point- to normalize conversations around brain health, substance use, mental health and autonomy. Often later in life, we as clinicians, and I've seen this with very well-meaning, clinicians can fragilize older adults and not ask about substance use because we worry that it's one intrusive when we would be willing to ask other age groups, but two:

we worry that the person can't handle the hard conversations when in fact that is an ageist thought in and of itself- this fragilizing older people. When we catch these concerns early and refer people to treatment and help to pave the road to treatment, even if they're not ready at the first conversation, this helps older adults live a fuller, clearer, and more connected life for years to come, with even more autonomy likely down the road because the risk for dementia will be decreased. I'm Dr. Regina Koepp, and this is your weekly mental health and aging tip. If you found value here today, will you like, subscribe and share? This will help other people to find this content so we can bring more accurate evidence-based information to people around mental health and aging because there is a lot of misinformation out there about what's typical with aging, and we can change that together.

So thank you for liking, subscribing, and sharing. I'll see you next week.