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Psychiatry

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Psychiatry

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  1. Psychiatry Alcohol and Dementia: A potent cocktail Brian Draper1, Rosemary Karmel2, Diane Gibson3, Ann Peut2, Phil Anderson2, Adrienne Withall1 1School of Psychiatry, University of NSW, Sydney, Australia 2Australian Institute of Health & Welfare, Canberra, Australia 3University of Canberra, Canberra, Australia

  2. Alcohol and Dementia Two relationships to explore: Alcohol as a cause of dementia Alcohol disorders comorbid with another type of dementia

  3. Alcohol as a cause of Young Onset Dementia Harvey et al (2003) (England) 10.3% Panegyres & Frencham (2000) (Australia) 5.4% Fujihara et al (2004) (Brazil) 5.0% McMurtray et al (2006) (USA- LA) 5.4% Kelley et al (2008) (USA – Mid-West) 0.4%

  4. Hospital Dementia Services Dataset 253,000 persons aged at least 50 years on 1 July 2006 had at least one multi-day stay ending between 1 July 2006 and 30 June 2007 in one of the 222 public hospitals in NSW. 20,793 were diagnosed with dementia

  5. Dementia Diagnoses by Age NSW Hospitals 2006/7 ARD = 1.4% dementia diagnoses, 20.8% dementia diagnoses age 50-64

  6. Alcohol Related Dementia and Other Cognitive Disorders – NSW Hospitals 2006/7 0.2% of NSW hospital admissions

  7. Comparison of ARD with Other Dementia(Draper et al, 2011) ALL DEMENTIA (N = 20,793) • 40% Male • Mean age 82.7 years ARD (n = 300) • 82% Male • Mean Age 65.0 years

  8. Comorbid diagnoses in NSW multi-day hospital stays of patients with Alcohol-Related Dementia (N = 881) (Draper et al, 2011)

  9. Alcohol-related Dementia - Discharge Deaths and Transfers by Dementia Status(Draper et al, 2011)

  10. Partner logo here Sydney Young Onset Dementia Case Finding Survey (Withall & Draper, 2009) Similar methodology to Harvey et al. (1998; 2003) GPs, specialists, health professionals, health services & RACFs in Eastern Sydney area Capture-recapture Personalised & deliberately brief 83% response rate (GPs 23%) Case note review to validate diagnosis

  11. Sydney Young Onset Dementia Case Finding Survey (Withall & Draper, 2009)N = 136

  12. ARD in Young Onset Dementia SurveyWithall & Draper, 2009 Mean Age of Onset = 52 years Mean time from onset of cognitive symptoms to diagnosis = 2.2 years 24% were in residential care (consistent with other published data that ~25% cannot live independently) 7% were homeless

  13. Alcohol Co-morbid with Dementia • Alcohol Disorders are 5 times more likely to be present in acute hospital patients with dementia • PWD are admitted due to falls (head injuries, hip fractures), infections and increased confusion

  14. What messages should we be giving about Alcohol & Cognitive Disorders? There is no single clear message but perhaps we need to become more circumspect about the role of alcohol In older people the upper ‘safe limit’ for older people is 1.5 units per day or 11 units per week & binge drinking should be defined as >4.5 units in a single session for men and >3 units for women (Royal College Psychiatrists, 2011) In younger people, significant alcohol use (minimum 35 standard drinks per week for men, and 28 for women) for a period > 5 yearsis sufficient to cause dementia; much less can cause cognitive impairment, particularly frontal

  15. What messages should we be giving about Alcohol & Cognitive Disorders? Moderate alcohol intake in people aged 60+ may reduce their risk of dementia, however, once a cognitive disorder is diagnosed perhaps alcohol intake should be reduced or ceased as it can cause increased confusion, BPSD and require more hospitalisations

  16. Thank You! Brian Draper B.Draper@unsw.edu.au www.med.unsw.edu.au/adfoap