Population-based study of alcoholic cerebellar degeneration: The Atahualpa Project

Background There are no population studies estimating the burden of alcoholic cerebellar degeneration (ACD). We aimed to assess prevalence and correlates of ACD among chronic alcohol drinkers living in rural Ecuador. Methods Characteristics of alcohol intake were evaluated in community-dwelling men aged ≥ 40 years enrolled in the Atahualpa Project. Cerebellar dysfunction evaluation used the Brief Ataxia Rating Scale (BARS). Association between alcohol intake and the BARS was assessed in generalized linear models adjusted for relevant confounders. In subjects who had CT, the relationship between cerebellar atrophy and the BARS was evaluated. Results Of the 313 men identified during a door-to-door survey, 246 (79%) were enrolled. All admitted continuous drinking for ≥ 10 years. Of these, 41% started drinking below legal age (18 years), 72% were current drinkers, and 83% engaged in binge drinking. Average alcohol intake was 330 ± 351 g/week. Mean BARS score was 1.4 ± 2 points, with 14.6% (95% C.I.: 10.8%-19.6%) of individuals having ≥ 4 points and considered to have clinically relevant ACD. The BARS was associated with years of drinking (p = 0.036), amount of alcohol intake (p < 0.0001), and binge drinking (p = 0.026). Predictive models showed significant relationships between BARS score margins and years of drinking and the amount of alcohol intake, independent of other variables. There was no association between cerebellar atrophy on CT and the BARS in 214 participants. Conclusions Prevalence of clinically relevant ACD in this population is low. There are both independent and synergistic effects of years of drinking, amount of alcohol intake and binge drinking in the severity of cerebellar dysfunction.