Alcohol consumption and cognitive function: A systematic review and dose-response meta-analysis of 20 cohort studies

Amid ongoing debate on whether low-to-moderate alcohol consumption reduces cardiovascular risk, studies examining the association between alcohol consumption and cognitive function have reported inconsistent results. To quantitatively assess this association, we conducted a dose-response meta-analysis of cohort studies, including stratified analyses by potential modifiers and study-level characteristics.

Eligible studies were identified by searching PubMed, Embase and Web of Science for articles published through 13 June 2025. Studies investigating major cognitive impairment were excluded. Pooled standardized mean differences (SMDs) were calculated using a random-effects model.

We identified 20 studies including 78 657 participants. A weak inverted J-shaped association between alcohol consumption and cognitive function was observed, but the test for nonlinearity did not reach statistical significance (P for nonlinearity = 0.06). Compared with no alcohol consumption, heavy alcohol consumption (≥67 g/day) was inversely associated with cognitive function [SMD at 67 g/day = -0.18, 95% confidence interval (CI) = -0.36 to -0.00; 20 studies, 78 657 participants], while the evidence for a protective effect of low-to-moderate alcohol intake remained uncertain. In studies that accounted for baseline cognition, alcohol consumption of ≥28 g/day was associated with lower cognitive function (SMD at 28 g/day = -0.08, 95% CI = -0.15 to -0.01; 9 studies, 23 385 participants), whereas the association remained uncertain in studies that did not account for baseline cognition (SMD at 28 g/day = 0.13, 95% CI = -0.05 to 0.32; 11 studies, 55 272 participants) (P for interaction < 0.01). By region, alcohol consumption of ≥33 g/day was associated with lower cognitive function in studies conducted in the United States (SMD at 33 g/day = -0.11, 95% CI = -0.22 to -0.01; 7 studies, 25 538 participants), whereas the association remained uncertain in studies conducted in Europe (SMD at 33 g/day = 0.07, 95% CI = -0.08 to 0.22; 10 studies, 44 235 participants) (P for interaction = 0.02).

A review of current evidence shows that heavy alcohol consumption (≥67 g/day) is inversely associated with cognitive function, while the evidence for a protective effect of low-to-moderate alcohol intake remains uncertain. The inverse association is stronger in studies that accounted for baseline cognition, with the alcohol intake threshold (~28 g/day) for lower cognitive function close to the drinking guideline limits, although these findings should be interpreted cautiously because of the limited number of studies.