Purpose <p>According to a WHO statement, it has been asserted that there is no safe level of alcohol consumption regarding human health. Nevertheless, the relationship between alcohol consumption and Alzheimer’s disease (AD) pathology remains unclear. Therefore, we examined whether the frequency and patterns of alcohol consumption could predict neurodegeneration biomarkers in a cohort of middle-aged adults without dementia.</p> Methods <p>A total of 195 participants without dementia were included from the ALBION study. Multivariate logistic regression analyses were conducted using drinking frequency subgroups (abstainers, occasional drinkers, and light-to-moderate drinkers) and Mediterranean-Alcohol Dietary Pattern (MADP) adherence subgroups along with cerebrospinal fluid (CSF) AD biomarkers (Tau, phosphorylated tau (PTau) and amyloid beta (Aβ). In these analyses, the abstinence was used as the reference category.</p> Results <p>Of the 195 individuals without dementia, 66% were female, with an average age of 65 ± 9.4 years, and they had 13.8 ± 3.6 years of education. Logistic regression analyses revealed that light-to-moderate drinkers (<i>n</i> = 51) were associated with higher Aβ positivity [OR: 2.98 (1.29–6.90)] compared to the abstinence (<i>n</i> = 117). Additionally, high adherence to the MADP was significantly associated with higher Aβ, Tau/Aβ_42, and PTau/Aβ₄₂ ratios positivity compared to the abstinence.</p> Conclusion <p>Light-to-moderate alcohol intake was associated with higher Aβ deposition in middle-aged individuals without dementia, compared to abstinence. High adherence to the MADP, which indicates low-to-moderate red wine consumption distributing over the week with meals, was associated with a higher Aβ and Tau/Aβ and PTau/Aβ positivity. Therefore, the management of alcohol consumption may help improve AD outcomes even at the preclinical stage.</p>