International Journal of Epidemiology, Vol 20, S48-S57, Copyright © 1991 by International Epidemiological Association
AB Graves, CM van Duijn, V Chandra, L Fratiglioni, A Heyman, AF Jorm, E Kokmen, K Kondo, JA Mortimer and WA Rocca
A meta-analysis, involving the secondary analysis of original data from 11
case-control studies of Alzheimer's disease, is presented for alcohol
consumption and cigarette smoking. Five studies included in the
meta-analysis of alcohol consumption. Alcohol consumption was computed in
terms of average weekly intake, measured in ounces of 'pure alcohol'. This
variable was categorized into tertiles to represent low, medium and high
intake. Analyses showed no excess estimated risk of Alzheimer's disease for
any level of alcohol intake. Smoking was analysed in three different
manners: (1) lifetime prevalence of smoking (ever/never)--this included
eight studies; (2) amount smoked (less than or equal to one pack per day
versus more than one pack per day)--this included seven studies; and (3)
pack-years--including four studies. A statistically significant inverse
association between smoking and Alzheimer's disease was observed at all
levels of analysis, with a trend towards decreasing risk with increasing
consumption (p(trend) = 0.0003). A propensity towards a stronger inverse
relation was observed among patients with a positive family history of
dementia, but the difference between this group and the group with no such
history was not statistically significant. Although the observed
disturbance in nicotinic receptor function in Alzheimer's disease may
provide an explanation for these findings, possible biases related to the
selection or survival of study subjects cannot be fully ruled out at this
time. Prospective, community-based studies of incident cases of Alzheimer's
disease are needed to document in detail the smoking history, age of onset
of disease and survival of patients and cognitively intact people by
smoking status.
ARTICLES
Alcohol and tobacco consumption as risk factors for Alzheimer's disease: a collaborative re-analysis of case-control studies. EURODEM Risk Factors Research Group
Health and Population Research Center, Battelle Seattle Research Center, Seattle, WA 98105.
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