{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:53:20Z","timestamp":1791075200330,"version":"4.1.0"},"posted":{"date-parts":[[2026,9,29]]},"group-title":"Public and Global Health","reference-count":26,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Wellcome Trust Career Development Award","award":["306069\/Z\/23\/Z"],"award-info":[{"award-number":["306069\/Z\/23\/Z"]}],"id":[{"id":"https:\/\/ror.org\/02xjhr934","id-type":"ROR","asserted-by":"crossref"}]},{"name":"NIH grants","award":["P50AA012870"],"award-info":[{"award-number":["P50AA012870"]}]},{"name":"NIH grants","award":["R01DA054869"],"award-info":[{"award-number":["R01DA054869"]}]},{"name":"Medical Research Council","award":["UKRI1464"],"award-info":[{"award-number":["UKRI1464"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,9,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Alcohol use disorder (AUD) is associated with increased dementia risk, but its long-term relationship with dementia, variation by age and subtype, and how this risk compares with that associated with alcohol consumption remain poorly characterised. We investigated these questions in a large prospective cohort of UK women.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We analysed Million Women Study participants recruited aged 50\u201364 years and followed for more than 20 years through linked health records. Women with hospital-recorded AUD were matched to up to five controls. Cox models estimated associations between time-varying AUD and incident dementia overall, by subtype, attained age, with exposure lags of up to 15 years and competing-risk analyses. Self-reported alcohol consumption was analysed separately.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Findings<\/jats:title>\n                  <jats:p>Among 1,288,359 women, 20,070 with AUD were matched to 100,339 controls. Dementia occurred in 3,774 women with AUD and 8,239 matched controls. AUD was associated with all-cause dementia (HR=3\u00b773[95% CI 3\u00b752\u20133\u00b795]), with strongest associations for mixed (5\u00b703[3\u00b788\u20136\u00b751]), unspecified (4\u00b729[3\u00b792\u20134\u00b770]), and vascular dementia (3\u00b796[3\u00b744\u20134\u00b756]). Associations were substantially stronger before age 70 years (10\u00b768[9\u00b702\u201312\u00b763]) than at ages 70-79 (3\u00b775[3\u00b747\u20134\u00b704]) or \u226580 years (2\u00b734[2\u00b711\u20132\u00b760]). Risk remained elevated with a 15-year lag (2\u00b716[1\u00b781\u20132\u00b758]) and after accounting for competing mortality. Associations with self-reported alcohol consumption were substantially weaker.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Interpretation<\/jats:title>\n                  <jats:p>Clinically recognised AUD identifies women at markedly increased and prolonged dementia risk, particularly at younger ages and for vascular and mixed dementia, not captured by drinking quantity alone. People with AUD should be considered a priority population for earlier dementia prevention and risk reduction.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Funding<\/jats:title>\n                  <jats:p>Wellcome Trust Career Development Award to AT (306069\/Z\/23\/Z); NIH grants P50AA012870 and R01DA054869 (JG). The Million Women Study is supported by the UK Medical Research Council (grant number UKRI1464)<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.09.23.26363779","type":"posted-content","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T23:25:11Z","timestamp":1790724311000},"source":"Crossref","is-referenced-by-count":0,"title":["Clinically Recognised Alcohol Use Disorder and Risk of Dementia Subtypes in 1.3 Million Women: A Prospective Cohort Study"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8327-2866","authenticated-orcid":false,"given":"Nasri G","family":"Fatih","sequence":"first","affiliation":[{"name":"Nuffield Department of Population Health, Big Data Institute,\u25a1University of Oxford,\u25a1Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Hippisley-Cox","sequence":"additional","affiliation":[{"name":"Nuffield Department of Population Health, Big Data Institute,\u25a1University of Oxford,\u25a1Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus P","family":"Ebmeier","sequence":"additional","affiliation":[{"name":"Department of Psychiatry,\u25a1University of Oxford,\u25a1Oxford,\u25a1Oxfordshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel","family":"Gelernter","sequence":"additional","affiliation":[{"name":"Veterans Affairs Connecticut Healthcare System, Department of Psychiatry; Yale University School of Medicine, Departments of Psychiatry, Genetics, and Neuroscience, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gillian K.","family":"Reeves","sequence":"additional","affiliation":[{"name":"Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Floud","sequence":"additional","affiliation":[{"name":"Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5190-5908","authenticated-orcid":false,"given":"Maria D.","family":"Christodoulou","sequence":"additional","affiliation":[{"name":"Department of Statistics,\u25a1University of Oxford,\u25a1Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8408-0372","authenticated-orcid":false,"given":"Anya","family":"Topiwala","sequence":"additional","affiliation":[{"name":"Nuffield Department of Population Health, Big Data Institute,\u25a1University of Oxford,\u25a1Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026100317300610000_2026.09.23.26363779v1.1","doi-asserted-by":"crossref","first-page":"e124","DOI":"10.1016\/S2468-2667(18)30022-7","article-title":"Contribution of alcohol use disorders to the burden of dementia in France 2008\u201313: a nationwide retrospective cohort study","volume":"3","year":"2018","journal-title":"The Lancet Public Health"},{"key":"2026100317300610000_2026.09.23.26363779v1.2","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1136\/bmjebm-2025-113913","article-title":"Alcohol use and risk of dementia in diverse populations: evidence from cohort, case\u2013control and Mendelian randomisation approaches","volume":"31","year":"2026","journal-title":"BMJ EBM"},{"key":"2026100317300610000_2026.09.23.26363779v1.3","unstructured":"World Health Organization. Risk reduction of cognitive decline and dementia: WHO guidelines. Geneva: World Health Organization, 2026 https:\/\/iris.who.int\/server\/api\/core\/bitstreams\/ea44b7f6-b09f-4e6f-b8c7-2e5b0fcc9a99\/content."},{"key":"2026100317300610000_2026.09.23.26363779v1.4","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1186\/s12877-023-03972-5","article-title":"Alcohol use, dementia risk, and sex: a systematic review and assessment of alcohol-attributable dementia cases in Europe","volume":"23","year":"2023","journal-title":"BMC Geriatr"},{"key":"2026100317300610000_2026.09.23.26363779v1.5","doi-asserted-by":"crossref","first-page":"1831","DOI":"10.1016\/S0140-6736(18)31772-0","article-title":"Conventional and genetic evidence on alcohol and vascular disease aetiology: a prospective study of 500000 men and women in China","volume":"393","year":"2019","journal-title":"The Lancet"},{"key":"2026100317300610000_2026.09.23.26363779v1.6","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001341"},{"key":"2026100317300610000_2026.09.23.26363779v1.7","doi-asserted-by":"publisher","DOI":"10.1093\/alcalc\/agw092"},{"key":"2026100317300610000_2026.09.23.26363779v1.8","doi-asserted-by":"crossref","first-page":"03","DOI":"10.35946\/arcr.v44.1.03","article-title":"Alcohol Use Disorder and Dementia: A Review","volume":"44","year":"2024","journal-title":"ARCR"},{"key":"2026100317300610000_2026.09.23.26363779v1.9","doi-asserted-by":"crossref","first-page":"100831","DOI":"10.1016\/j.lanhl.2026.100831","article-title":"Risk factors for early-onset and late-onset dementia: a prospective cohort study","volume":"7","year":"2026","journal-title":"The Lancet Healthy Longevity"},{"key":"2026100317300610000_2026.09.23.26363779v1.10","doi-asserted-by":"crossref","first-page":"1671047","DOI":"10.3389\/fnut.2025.1671047","article-title":"Addressing common biases in the evaluation of lifetime alcohol consumption patterns and dementia risk: the EPIC-Spain dementia cohort","volume":"12","year":"2025","journal-title":"Front Nutr"},{"key":"2026100317300610000_2026.09.23.26363779v1.11","doi-asserted-by":"crossref","first-page":"e2254771","DOI":"10.1001\/jamanetworkopen.2022.54771","article-title":"Changes in Alcohol Consumption and Risk of Dementia in a Nationwide Cohort in South Korea","volume":"6","year":"2023","journal-title":"JAMA Network Open"},{"key":"2026100317300610000_2026.09.23.26363779v1.12","doi-asserted-by":"crossref","unstructured":"Sabia S , Fayosse A , Dumurgier J , et al. Alcohol consumption and risk of dementia: 23 year follow-up of Whitehall II cohort study. BMJ 2018;: k2927.","DOI":"10.1136\/bmj.k2927"},{"key":"2026100317300610000_2026.09.23.26363779v1.13","doi-asserted-by":"publisher","DOI":"10.15288\/jsad.2015.76.158"},{"key":"2026100317300610000_2026.09.23.26363779v1.14","doi-asserted-by":"crossref","unstructured":"Sabia S , Fayosse A , Dumurgier J , et al. Association of ideal cardiovascular health at age 50 with incidence of dementia: 25 year follow-up of Whitehall II cohort study. BMJ 2019;4414.","DOI":"10.1136\/bmj.l4414"},{"key":"2026100317300610000_2026.09.23.26363779v1.15","first-page":"1","article-title":"Alcohol use and dementia: a systematic scoping review","volume":"11","year":"2019","journal-title":"Alz Res Therapy"},{"key":"2026100317300610000_2026.09.23.26363779v1.16","first-page":"e12370","article-title":"Alcohol use disorder is associated with higher risks of Alzheimer\u2019s and Parkinson\u2019s diseases: A study of US insurance claims data","volume":"14","year":"2022","journal-title":"Alzheimer\u2019s & Dementia: Diagnosis, Assessment & Disease Monitoring"},{"key":"2026100317300610000_2026.09.23.26363779v1.17","unstructured":"Cancer Epidemiology Unit. Million Women Study. 1996."},{"key":"2026100317300610000_2026.09.23.26363779v1.18","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyy065"},{"key":"2026100317300610000_2026.09.23.26363779v1.19","doi-asserted-by":"publisher","DOI":"10.1093\/biomet\/81.3.515"},{"key":"2026100317300610000_2026.09.23.26363779v1.20","doi-asserted-by":"crossref","first-page":"1504","DOI":"10.1093\/aje\/kwae361","article-title":"Why use methods that require proportional hazards?","volume":"194","year":"2025","journal-title":"American Journal of Epidemiology"},{"key":"2026100317300610000_2026.09.23.26363779v1.21","doi-asserted-by":"publisher","DOI":"10.2307\/2670170"},{"key":"2026100317300610000_2026.09.23.26363779v1.22","first-page":"141","article-title":"An Empirical Transition Matrix for Nonhomogeneous Markov Chains Based on Censored Observations","volume":"5","year":"1978","journal-title":"Scandinavian Journal of Statistics"},{"key":"2026100317300610000_2026.09.23.26363779v1.23","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1111\/add.16395","article-title":"Disentangling the contributions of alcohol use disorder and alcohol[related liver disease towards dementia: A population[based cohort study","volume":"119","year":"2024","journal-title":"Addiction"},{"key":"2026100317300610000_2026.09.23.26363779v1.24","doi-asserted-by":"crossref","first-page":"e115","DOI":"10.1016\/S2666-7568(23)00019-3","article-title":"The prevalence, correlation, and co-occurrence of neuropathology in old age: harmonisation of 12 measures across six community-based autopsy studies of dementia","volume":"4","year":"2023","journal-title":"The Lancet Healthy Longevity"},{"key":"2026100317300610000_2026.09.23.26363779v1.25","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000271090.28148.24"},{"key":"2026100317300610000_2026.09.23.26363779v1.26","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajgp.11.4.441"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.64898\/2026.09.23.26363779","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:30:15Z","timestamp":1791073815000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.64898\/2026.09.23.26363779"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,29]]},"references-count":26,"URL":"https:\/\/doi.org\/10.64898\/2026.09.23.26363779","relation":{},"subject":[],"published":{"date-parts":[[2026,9,29]]},"subtype":"preprint"}}