Five days before an intellectual US magazine asked if boozing is a prerequisite for inspired male writing—since many Great American Novels have come from male alcoholics—an unusually thorough scientific study found that even moderately heavy drinking impairs cognition in middle-aged men.

Middle-aged men imbibing more than 2.5 drinks a day saw faster decline in all cognitive areas of their brains over a decade. Indeed, middle-aged men putting back 2.5-plus daily, accumulated almost six (5.7) years of extra cognitive aging.

“A 55-year-old man after that kind of drinking has the brain of a 61-year-old,” Wake Forest Medical College neuroscientist David Friedman tells Bioscience Technology. Friedman was not involved in the work. “And this is a very good, rich study, with a well-defined study population asked at multiple points about alcohol consumption. It is far more reliable than usual.”

Furthermore, while earlier studies found excessive drinking leads to both short and long term cognitive defects, fewer studies have looked at moderately excessive levels. “In this study it was not possible to detect the specific level at which alcohol becomes detrimental for cognitive aging, as the category of heavy drinkers included individuals drinking 2.5 to 8 drinks per day, with a mean of 3.5 drinks per day,” lead author Severine Sabia of University College London tells Bioscience Technology.

Séverine Sabia, PhDBut from 2.5 on up, a definite decline was found. “That is the strength of this study.”

Another strength, agrees Sabia and Friedman: many prior studies looked at the effect of alcohol on the elderly, who do less drinking (health woes). Ages in this study started much younger, at 44-69, and ended at 54-79.

Published in Neurology, the recent paper looks at 7,153 participants in the Whitehall II Study (the British equivalent of the Framingham study). The 67 percent male population includes British civil servants. It began in the mid 1980’s.

The reference category for men was .1 to 19.9 grams per day; in women, .1 to 9.9 grams per day. A typical US drink is .6 fluid ounces (14 grams).

Four tests (one short-term verbal memory test, and three tests of executive function) were offered starting in 1997-1999, when the study enrollees ranged from 44 to 69 years old. The tests were repeated twice over the following decade.

Men drinking 36 or more grams of alcohol a day showed faster deterioration on all cognitive measures, in contrast to those consuming .1 to 19.9 grams a day.

The 2.5-plus daily drinkers experienced 2.4 extra years of cognitive decline in global cognition; 1.5 extra years of cognitive decline for executive function; and 5.7 extra years of cognitive decline in memory.

There was no difference in effects of beer vs. wine.

The study did not include enough heavy-drinking women, so it wasn’t possible to properly test them. Otherwise, in women there was a slight link between 19 grams of daily drinks and a faster deterioration of executive function of 2.4 extra years.

Abstention did not have an effect on cognitive decline in men. But it did affect women. Compared with women drinking .1 to 9.9 grams per day, ten-year abstainers underwent faster decline in the global cognitive score and executive functions. This resulted in approximately ten extra years of cognitive decline.

But all told, the pool of abstainers was too small to determine abstention effects.

Alcohol’s mechanism of action is complex. It is believed cognition is affected because too much alcohol is toxic to both the brain, and the cerebrovascular and cardiovascular pathways feeding it.

But more moderate amounts of alcohol can have a protective effect on the brain, also partly due to effects on cerebrovascular and cardiovascular systems (if a recent review by Columbia University neuroscientist John Brust illustrates a plethora of potential reasons on both sides). “In the present study, we did not find differences between abstainers and moderate drinkers in men,” says Sabia, “but the number of abstainers was very small so it is difficult to conclude.”

The bottom line is that Sabia’s study agrees with earlier work showing light to moderate alcohol consumption is not deleterious to middle-aged male cognition. And it offers strong new data that drinking on the slightly more excessive end of the moderate scale—on up—harms cognition in middle-aged men.

Says Brust to Bioscience Technology, "Although not surprising, the study qualifies as a valuable contribution to the literature on cognition and alcohol. It is well recognized that mild-to-moderate consumption of alcohol reduces risk of cognitive impairment compared to abstention and heavy consumption, but earlier studies (as the authors note) were usually case-control, not longitudinal. and did not specifically address drinking in middle age." Brust was also uninvolved with the new study.

Says Friedman: "These things are good to know. A pretty compelling study."

The above (New Republic) magazine article asking if heavy drinking fuels a specific kind of cognition—creativity--offered the example of six celebrated US novelist/drinkers: Raymond Carver, John Cheever, F. Scott Fitzgerald, John Berryman, Ernest Hemingway, and Tennessee Williams. The article took issue with the way a recent book—“The Trip to Echo Spring: On Writers and Drinking”—often portrays writers’ drinking as detrimental to their craft. The article cites a few studies finding moderate drinking can fuel creativity.

Friedman says the key word is “moderate.” “You need to ask how much the writers were drinking when producing those great books,” he says. “When alcohol is absorbed, it at first releases inhibitions, so it is easy to imagine an early period of creativity. But as it declines in the blood, it sedates. After a one-hour binge, we’re toast. It is more likely these brilliant men produced their work despite their drinking, not because of it.”

Shakespeare, the West’s most celebrated writer, apparently agreed. “What three things does drink especially provoke?” he posited in “MacBeth.”

His professional diagnosis: “Nose painting, sleep, and urine.”