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Alcohol & Brain Volume in Older Adults: Cortical Thinning & White Matter Loss in Heavy Drinkers (250g/Week) (2023 Study)

Alcohol’s effects on the brain, especially among the elderly, have long been a subject of scientific inquiry.

A recent study from Gothenburg, Sweden, provides new insights into how varying levels of alcohol consumption impact brain structure in individuals aged 70 and over.

This research sheds light on the relationship between alcohol intake and the aging brain, offering valuable information for healthcare professionals and the general public alike.


  1. Significant Brain Changes Above 250g/week: Consumption of more than 250 grams of alcohol per week is associated with cortical thinning and white matter changes.
  2. Frontal Lobe Vulnerability: The frontal lobe, particularly in the right hemisphere, is predominantly affected by higher levels of alcohol consumption.
  3. Non-linear Relationship: The study suggests a non-linear relationship between alcohol consumption and brain structure changes, with significant alterations occurring at higher consumption levels.
  4. Population-Based Sample: Data were derived from 676 participants in the Gothenburg H70 Birth Cohort Study, providing a comprehensive look at alcohol’s effects on the elderly brain in a general population setting.

Source: European Archives of Psychiatry & Clinical Neuroscience (2023)

Effects of Alcohol on the Brain in the Short-Term (Mechanisms)

The immediate effects of alcohol on the brain are varied and depend on the amount consumed, individual tolerance levels, and physiological factors.

Short-term effects range from changes in mood and behavior to impaired cognitive and motor functions.

Short-Term Effects of Alcohol on the Brain

  • Impaired Cognitive Functions: Even low to moderate amounts of alcohol can impair judgment, attention, and reflexes, making activities such as driving dangerous.
  • Mood Alterations: Alcohol consumption can lead to changes in mood, including feelings of relaxation or euphoria at lower doses. However, higher doses may cause negative emotions, aggression, or depression.
  • Memory Impairment: Alcohol can interfere with the ability to form new memories, a phenomenon known as “blackouts,” especially at high levels of consumption.

Mechanisms of Action

  • Neurotransmitter Alterations: Alcohol affects various neurotransmitter systems in the brain, including GABA (gamma-aminobutyric acid) and glutamate. By increasing GABA activity, alcohol promotes sedation and relaxation, while inhibiting glutamate activity, leading to cognitive impairments.
  • Dopamine Release: Alcohol stimulates the release of dopamine in the brain’s reward centers, contributing to its addictive properties and mood-altering effects.
  • Neurotoxic Effects: High levels of alcohol consumption can be directly toxic to neurons, leading to cell damage or death in certain brain regions over time.

Why Research Alcohol Use on Elderly Brain Volume & Structure?

Understanding the effect of regular alcohol use on brain volume and structure in the elderly is of paramount importance for several reasons.

  • Aging & Vulnerability: The aging brain is more vulnerable to the neurotoxic effects of alcohol. Changes in metabolism, increased sensitivity to alcohol, and the presence of comorbidities can exacerbate alcohol’s impact on the elderly brain.
  • Risk of Cognitive Decline: Regular alcohol consumption, especially above moderate levels, has been associated with an increased risk of cognitive decline and the development of dementia-related disorders in the elderly. Understanding these effects can help in developing strategies to mitigate risks.
  • Brain Plasticity: The brain’s ability to adapt and reorganize itself decreases with age. Regular alcohol use can further impair this plasticity, affecting the brain’s capacity to recover from injury and adapt to age-related changes.
  • Preventive Measures & Public Health: By understanding the specific effects of alcohol on brain volume and structure, healthcare professionals can better advise the elderly on safe consumption levels.

Major Findings: Effects of Alcohol Intake on Brain Structure in 70-Year-Olds (2024)

Olof Lindberg et al. evaluated the effect of alcohol consumption on brain structure in a sample of 70-year-olds in Gothenburg, Sweden – below are the major findings.

1. Threshold for Brain Structure Changes

The study identified a non-linear relationship between alcohol consumption and structural brain changes.

It was observed that self-reported consumption above 250 grams per week is associated with significant cortical thinning in various regions of the brain and widespread changes in white matter integrity.

In individuals consuming more than 250 grams of alcohol per week, thinning was noted in the bilateral superior frontal gyrus, the right precentral gyrus, and the right lateral occipital cortex.

This suggests that these brain regions are particularly vulnerable to alcohol-related damage.

2. Cortical Thinning

The areas where cortical thinning was observed indicate a pattern of damage that aligns with previous research on alcohol’s effects on the brain.

The superior frontal gyrus, involved in higher cognitive functions such as decision-making and social behavior, shows susceptibility to alcohol-related damage.

The study found a predilection for the right hemisphere, supporting the “right hemisphere hypothesis” which posits that the right side of the brain is more affected by alcohol use than the left.

This hypothesis is grounded in observations of cognitive deficits that are typically associated with right hemisphere functions in individuals with alcohol use disorders.

3. White Matter Integrity

Participants consuming above the identified threshold exhibited reduced FA (Fractional Anisotropy) and increased MD (Mean Diffusivity) spread across many tracts in the brain.

This indicates a degradation of white matter integrity, affecting the brain’s communication pathways.

Although the study did not directly measure cognitive outcomes, the observed changes in white matter integrity suggest potential impacts on cognitive and functional capabilities, given the role of white matter in facilitating brain communication.

4. No Effect on Subcortical Structures

Interestingly, the study found no significant changes in subcortical gray matter structures across different levels of alcohol consumption.

This finding suggests that alcohol’s impact at the examined consumption levels predominantly affects cortical thickness and white matter, rather than subcortical volumes.

Alcohol Use & Brain Volume in Elderly (2023 Study)

The primary objective of the Gothenburg H70 Birth Cohort Study was to investigate the association between current alcohol use and brain structure in a large, population-based sample of 70-year-olds living in Gothenburg, Sweden.

Specifically, the study aimed to understand how different amounts of weekly alcohol consumption impact cortical thickness, subcortical volumes, and white matter integrity in the elderly.


  • Participants: The study included 676 participants from the Gothenburg H70 Birth Cohort Study 2014–16, all aged 70 years, with a response rate of 72.2%. Participants were systematically selected based on birth dates obtained from the Swedish Tax Agency.
  • Assessment of Alcohol Consumption: Alcohol consumption was assessed through face-to-face interviews, where participants reported their weekly intake of beer, wine, and spirits in grams. Consumption was categorized into seven groups ranging from 0–50 g/week to more than 300 g/week.
  • MRI Acquisition & Analysis: Brain structures were assessed using T1-weighted structural magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) techniques. Cortical reconstruction, volumetric segmentation, and white matter integrity analysis were performed using FreeSurfer 5.3 and FSL tools, respectively.
  • Statistical Analysis: General linear models were employed to estimate associations between alcohol consumption and brain structure changes, adjusting for relevant confounders like sex and intracranial volume.


  • Cortical Thinning: Participants consuming more than 250 grams of alcohol per week exhibited significant cortical thinning in several brain regions, including the bilateral superior frontal gyrus, right precentral gyrus, and right lateral occipital cortex.
  • White Matter Integrity: High alcohol consumption was associated with reduced fractional anisotropy (FA) and increased mean diffusivity (MD) in many white matter tracts throughout the brain, indicating compromised white matter integrity.
  • Non-linear Relationship: The study found a non-linear relationship between alcohol consumption and brain structure changes, with significant alterations only occurring in participants who consumed more than 250 grams of alcohol per week.
  • No Subcortical Volume Changes: There were no observed changes in subcortical gray matter structures across different levels of alcohol consumption.


  • Cross-sectional Design: The study’s cross-sectional nature limits the ability to infer causality between alcohol consumption and brain changes.
  • Self-reported Alcohol Consumption: Alcohol intake was self-reported, which could introduce reporting bias and inaccuracies in consumption data.
  • Lack of Detailed Drinking Patterns: The study did not account for variations in drinking patterns, such as binge drinking versus regular consumption, which could differentially impact brain structure.
  • Age Specificity: Since all participants were 70 years old, the findings may not be generalizable to other age groups or to the broader process of aging across the lifespan.
  • Statistical Power: Dividing the sample into seven groups based on alcohol consumption levels may have reduced statistical power for detecting subtle changes, especially in higher consumption categories.

The 250g Weekly Alcohol Threshold & Its Non-Linear Impact

When assessing the significance of the 250 grams per week alcohol consumption threshold, it’s crucial to contextualize what this amount represents in terms of everyday alcoholic beverages, and to consider the non-linear relationship between alcohol consumption and its effects on the brain.

Contextualizing the Threshold

  • Standard Drink Comparison: A standard drink typically contains about 14 grams of pure alcohol. This translates to approximately 12 ounces of beer (5% alcohol content), 5 ounces of wine (about 12% alcohol content), or 1.5 ounces of distilled spirits (40% alcohol content).
  • Weekly Consumption Equivalence: Exceeding 250 grams of alcohol weekly amounts to consuming over 18 standard drinks, substantially above the moderate drinking guidelines of up to one drink per day for women and two for men.

Individual Variability in Alcohol’s Effects

Factors influencing the impact of alcohol, even at levels below the 250g threshold, include genetics, body size, age, sex, and overall health.

  • Genetics: Genetic differences may enhance susceptibility to alcohol’s harmful effects, leading to more significant brain structure changes at lower consumption levels.
  • Body Size & Composition: Smaller body size can result in higher blood alcohol concentrations from less alcohol, increasing sensitivity to its effects.
  • Age: The elderly metabolize alcohol more slowly, heightening their vulnerability to its impacts.

The Non-Linear Relationship

  • Beyond Predictability: The study highlighted a non-linear relationship between alcohol consumption and brain structure changes. This implies that the effects on the brain don’t incrementally increase with consumption but rather, significant changes become pronounced past the 250 grams per week mark.
  • Implications for Moderation & Risk Assessment: This non-linearity suggests that while some individuals may not notice adverse effects from moderate alcohol use, others could be at risk with even lower consumption levels. It stresses the necessity of tailored advice on alcohol use, particularly for sensitive or at-risk populations like the elderly.

The findings underscore the importance of a cautious and personalized approach to alcohol consumption, especially given the stakes for maintaining brain health and cognitive functions in older age.

Recognizing the non-linear relationship between alcohol intake and its potential brain impacts is crucial for informed decision-making and effective health advisories.

Applications & Implications of the Findings (Alcohol Intake in Elderly)

The study’s findings on the impact of alcohol consumption on brain structure in the elderly have significant applications and implications for individuals, healthcare professionals, and policymakers.


  • Informed Decision-Making: The clear delineation of a threshold (250 grams/week) beyond which alcohol consumption is associated with adverse brain structure changes empowers individuals, especially the elderly, to make informed decisions about their drinking habits.
  • Lifestyle Adjustments: Individuals may use these findings as a motivation to monitor and possibly reduce their alcohol intake as part of a broader strategy for maintaining brain health and cognitive function in later life.

Healthcare Professionals

  • Guidance and Counseling: The study provides healthcare professionals with concrete evidence to guide conversations with patients about the risks associated with excessive alcohol consumption. This can help in developing personalized advice and interventions for elderly patients.
  • Early Detection & Intervention: Knowledge of specific brain regions affected by higher alcohol consumption levels can aid in the early detection of alcohol-related brain changes, allowing for timely intervention and support strategies to prevent further damage.

Potential for Reversibility of Effects Through Decreased Alcohol Intake?

The question of whether decreasing alcohol intake can reverse the observed effects on brain structure in the elderly is of significant interest to both the scientific community and the general public.

While the study in Gothenburg provides critical insights into the impact of alcohol consumption on brain health in the elderly, the reversibility of these effects through decreased alcohol intake warrants further exploration.

Brain Plasticity & Recovery

  • Brain Plasticity: The brain’s ability to change and adapt in response to new experiences, known as plasticity, is a key factor in its potential to recover from damage, including that caused by alcohol.
  • Age-Related Factors: Although plasticity exists throughout the lifespan, its capacity diminishes with age. However, there is evidence to suggest that lifestyle changes, including reduced alcohol consumption, can promote brain health and potentially reverse some negative effects.

Evidence from Previous Studies

  • Recovery in Younger Populations: Studies in younger populations have shown that abstaining from alcohol can lead to improvements in certain brain functions and partial recovery of brain structure, particularly in white matter integrity.
  • Limited Research in Elderly Populations: There is less research on brain recovery following reduced alcohol intake in the elderly, making it difficult to draw definitive conclusions. However, the principle that reducing exposure to harmful substances can halt or slow damage provides a basis for optimism.

Potential Areas for Recovery

  • Cognitive Function: Improvements in cognitive function, such as memory, attention, and executive functions, are among the most promising areas for recovery following reduced alcohol consumption.
  • White Matter Integrity: Given the diffuse impact of alcohol on white matter, reductions in consumption may lead to improvements in white matter integrity, enhancing cognitive connectivity and function.

Conclusion: Alcohol Intake & Brain Structure in Elderly Adults

The study conducted on the impact of alcohol consumption on brain structure in 70-year-olds in Gothenburg, Sweden, provides pivotal insights into how alcohol affects the aging brain.

It establishes a clear threshold for alcohol consumption—250 grams per week—beyond which significant structural changes in the brain, including cortical thinning and alterations in white matter integrity, are observed.

These findings underscore the importance of moderation in alcohol intake, particularly as individuals age, to preserve brain health and cognitive function.

While the study does not explicitly address whether reducing alcohol intake can reverse the observed effects, it highlights the need for further research into the potential for brain recovery with decreased consumption.

Importantly, this research serves as a critical reminder for healthcare professionals to discuss alcohol use with elderly patients and for policymakers to consider these findings in public health strategies.

Overall, the study emphasizes the critical role of lifestyle choices in influencing brain health and the potential to mitigate risks associated with alcohol consumption in the elderly.


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