# The Impact of Chronic Alcohol Consumption on Cognitive Function in Older People

## TL;DR

Chronic alcohol use in older people is linked to cognitive decline, with rural patients starting at a disadvantage and higher liver enzyme levels correlating with worse cognition.

## Contribution

This study identifies rural-urban disparities and the link between hepatic dysfunction and cognitive impairment in older alcohol consumers in Romania.

## Key findings

- 94% of patients had MMSE scores <24 at admission, indicating significant cognitive deficiency.
- Rural patients had lower MMSE scores at admission compared to urban patients (22.6 vs. 24.8).
- GGT levels were inversely correlated with MMSE scores (r = −0.41), linking liver dysfunction to cognitive decline.

## Abstract

Background/Objectives: Cognitive deficiency associated with chronic alcohol consumption in older people remains an under-investigated public health issue in Romania, particularly concerning rural–urban disparities and the impact of reversible hepatic dysfunction on cognitive performance. To evaluate cognitive function at hospital admission and discharge using the Mini-Mental State Examination (MMSE); to identify rural–urban disparities; and to analyze the relationship between hepatic markers and MMSE scores in older people with chronic alcohol consumption. Methods: This retrospective, single-center observational study was conducted on 152 patients aged ≥55 years, hospitalized between January 2021 and December 2023 at the “Elisabeta Doamna” Psychiatric Hospital, Galați. Demographic variables, MMSE scores (at admission and discharge), and hepatic parameters (AST, ALT, GGT, total bilirubin, and ammonia) were collected. Statistical analysis included descriptive statistics, chi-square tests for categorical variables, paired t-tests or ANOVA for MMSE scores, and Pearson correlations between MMSE and hepatic markers (α = 0.05). Results: At admission, 94% of patients had an MMSE score < 24. The mean MMSE score increased from 23.4 ± 4.1 to 25.0 ± 3.7 at discharge (Δ = +1.6; p < 0.001). Patients from rural areas (63.8% of the sample) had significantly lower MMSE scores at admission compared to urban patients (22.6 ± 3.9 vs. 24.8 ± 4.2; p = 0.02). However, no statistically significant difference was observed between rural and urban patients regarding cognitive improvement during hospitalization (p = 0.88), indicating that the initial gap persisted at discharge. GGT levels were inversely correlated with MMSE scores (r = −0.41; p < 0.001), suggesting a contribution of hepatic dysfunction to cognitive decline. Conclusions: Alcohol-related cognitive impairment is highly prevalent among older patients hospitalized for withdrawal, with partial reversibility observed through inpatient management. The observed rural disparities and the association between hepatic dysfunction and cognitive performance highlight the need of concurrent MMSE and hepatic screening, with prioritized interventions in rural settings. Prospective, multicenter studies are warranted to validate these findings and to identify additional prognostic biomarkers.