Sex-Related Vulnerability to Alcohol in Older Drinkers: A Narrative Review

An integrated literature focusing on alcohol’s impact on cognitive aging processes among older women has yet to emerge. Incorporating epidemiological studies probing community drinking patterns and laboratory data interrogating the effects of alcohol use disorder (AUD), the current narrative review seeks to address this gap.

Population-based studies reveal outcomes ranging from beneficial to detrimental. Sex differences are often modest, do not consistently reflect differential vulnerability in women, and vary by assessment instrument and the analytic model applied. Other data, obtained from individuals with AUD, indicate that AUD substantially increases risk for early-onset and other dementias in women and men. There are relatively few laboratory studies sufficiently powered to explore both age and sex effects in individuals with AUD. Across those available, there is little support for sex-specific vulnerability to either cognitive impairment or decline.

Existing literature on the impact of moderate alcohol consumption in older women and men on cognition and risk for dementia onset is marked by heterogeneity, with few data indicating robust sex differences. Studies of AUD also provide little support for hypotheses of sex-related vulnerability and fail to resolve questions as to whether cognitive decline in AUD reflects accelerated aging or reflects the risk for dementia onset. Numerous factors likely contribute to these inconsistencies, meriting attention in future research. Notable examples include variable operational definitions for drinking classifications, under-representation of women, constrained range of drinking levels among women, and insufficient consideration of the temporal dynamics of alcohol use across adulthood.