Heavy Drinking Increases Dementia Risk

Many people enjoy having an occasional cocktail, beer or glass of wine—and light drinking isn’t likely to take a major toll on your health. But regular and heavy drinking are starting to ring alarm bells for researchers. Back in 2020, the World Health Organization released a statement recommending that people drink less alcohol. And in January 2025, the U.S. Surgeon General issued a pressing warning ranking alcohol as the third leading cause of cancer, right after tobacco and obesity.

There are a few reasons behind those warnings. For starters, alcohol contributes to 2.6 million deaths worldwide each year, and overall, alcohol is responsible for 4.7% of the global burden of disease. In the U.S., about 178,000 deaths can be attributed to excessive alcohol use every year. In addition to those deaths, 32 people in the U.S. are killed every day in vehicle crashes involving a driver who is impaired by alcohol—that’s one death every 45 minutes.

Regarding disease risk, research is becoming clearer—even moderate drinking can increase your risk of cancer, heart disease, depression, anxiety, liver disease and more. Drinking has also been linked to cognitive decline and diseases of the brain. And this is what researchers in Brazil and the University of California, San Francisco, wanted to take a closer look at. They published their findings in the American Academy of Neurology’s publication, Neurology. Let’s break down what they found.

How Was This Study Conducted?

This study is different from typical studies in that much of the information was gathered from autopsies and next of kin who had at least weekly contact with the deceased for a minimum of six months preceding death. There were 1,781 participants with an average age of 75 at death. About half of the participants were women, and 64% were white, 34% Black and 2% Asian.

Demographic information was collected from the Brazilian Institute of Geography and Statistics and official government documents. Alcohol consumption related to the previous three months before the death of the deceased was gathered from detailed questionnaires administered to the deceased’s next of kin. The medical history of the deceased was also gathered from next of kin through a semistructured interview while they waited for the autopsy to be performed. 

Included in the next of kin interview was a questionnaire called the Clinical Dementia Rating (CDR) scale, which evaluates six domains to detect the presence and severity of dementia: memory, orientation, judgment and problem-solving, community affairs, home and hobbies and personal care. Each domain is scored on a scale of 0 to 3, reflecting the degree of impairment and then summed to compute the CDR Sum of Boxed (CDR-SOB). The CDR-SOB ranges from 0 to 18, with higher scores indicating poorer cognitive abilities.

For this study, researchers defined one dose of alcohol as being equivalent to 14 grams of alcohol, or 350 mL of beer, 150 mL of wine or 45 mL of distilled spirits. Participants were then categorized as: 

• “never” for those who did not consume alcohol at all 
• “moderate” for those consuming up to 7 doses per week 
• “heavy” for those consuming 8 or more doses per week 
• “former heavy” for those who previously engaged in heavy drinking but had stopped their consumption up to 3 months before death

After the brains were removed from the skulls, they were weighed. In previous studies, smaller brains have been connected with brain disorders, including dementia, which is why this measurement was included. The brains were also analyzed for various signs of disease, including occluded brain vessels and specific lesions connected to dementia, including Alzheimer’s. 

What Did This Study Show?

After adjusting for demographics that can affect brain health, including smoking status, age at death and physical activity, researchers found that, compared to those who never drank:

• Heavy drinkers had 133% higher odds of having vascular brain lesions.
• Former heavy drinkers had 89% higher odds and moderate drinkers had 60% higher odds of having vascular brain lesions.
• Heavy drinkers had 41% higher odds and former heavy drinkers 31% higher odds of developing tau tangles, a biomarker associated with Alzheimer’s disease.
• Heavy drinkers died an average of 13 years earlier.
• Former heavy drinking was associated with a lower brain mass ratio and worse cognitive abilities.

Interestingly, no link was found between moderate or heavy drinking and brain mass ratio or cognitive abilities. Researchers note that this may be due to heavy drinkers dying 13 years earlier. In other words, they may have died before the signs of dementia showed up. 

There are several limitations to this study. For starters, it is not a longitudinal (long-term) study and did not look at participants before death. Instead, they relied on next of kin’s perception of their loved ones’ alcohol intake and cognitive abilities. These autopsies also only included people with unknown causes of death, not those with traumatic causes of death, such as auto accidents. Researchers note that due to this, the sample of heavy drinkers might be underrepresented to reflect the health risks associated with excessive alcohol intake. 

Lastly, researchers did not evaluate the presence of vitamin deficiencies, which many heavy drinkers experience and which can affect brain health. For example, a thiamine deficiency influences specific regions of the brain related to cognitive decline.

How Does This Apply to Real Life?

The evidence is stacking up toward alcohol having more negative health consequences than positive, especially for heavy drinkers. While it’s common to have an occasional drink at dinner or grab a beer to catch up with friends, if you’re drinking more than a drink per night, it may be time to cut back.

Alcohol use is an individual decision. If you do drink, take an honest look at how much, how often and why. Sometimes, we drink because everyone else is. But if you don’t like the taste of it or how it makes you feel—or you’re noticing sneaky side effects—those may be signs that it’s time to give it up. Assessing why you’re drinking and how it’s affecting your life—including financially and with your relationships—are important questions to ask now and then.

If you feel your body has become dependent on alcohol and are ready to quit, it’s imperative to get help. That could mean seeking the support of friends and family, speaking with your doctor or seeking out a nearby support group. If you’re worried about experiencing withdrawals, getting in touch with your doctor is a good first step.

The Bottom Line

This study suggests that heavy drinkers and former heavy drinkers have much higher odds of brain damage related to brain diseases compared to those who don’t drink. While research is mixed regarding the effects of alcohol on health, it is leaning more and more toward alcohol creating negative health consequences more often than positive ones.

Alcohol isn’t the only thing that affects brain health, though. Diet, physical activity, stress, sleep and socialization also influence how healthy your brain is. The MIND diet is loaded with brain-healthy foods. EatingWell’s registered dietitians put together a 30-day MIND diet meal plan to make it easy to get started. Combine healthy eating with regular exercise, good sleep and time with friends or family, and you’ll be supporting your cognitive health one step at a time.