Enlargement of perivascular spaces associated with habitual sake (Japanese rice wine) consumption in participants of brain health checkups

The prevalence of cerebral small vessel disease (SVD) among individuals who consume moderate amounts of alcohol remains unclear. This study aimed to evaluate the association between alcohol consumption and the severity of SVD markers. This cross-sectional study included participants who underwent brain health checkups at a single facility. Drinkers were categorized as occasional (three or fewer times per week) and frequent (four or more times per week). Alcohol intake was assessed in units of one glass of sake, a traditional Japanese alcoholic beverage. The severity of periventricular hyperintensity (PVH), deep subcortical white matter hyperintensity (DWMH), cerebral microbleeds (CMB), and enlargement of perivascular spaces in the basal ganglia (PVS-BG) and perivascular spaces in the centrum semiovale (PVS-CSO) were evaluated as SVD indicators. A total of 64,659 participants were included in this study. In multivariable ordinal logistic regression analysis, frequent drinkers had higher odds of PVS-BG enlargement (odds ratio [OR] = 1.09, 95% confidence interval [CI]: 1.02–1.15, p = 0.006) and PVS-CSO (OR = 1.23, 95% CI: 1.16–1.31, p < 0.001) compared with non-current drinkers. Occasional drinkers also had higher odds of PVS-CSO enlargement (OR = 1.08, 95% CI: 1.02–1.14, p = 0.007). Moreover, the consumption of one glass of sake per day (equivalent to 20 g of pure alcohol) was associated with greater severity of PVS-BG and PVS-CSO enlargement. PVS enlargement, particularly PVS-CSO, showed a moderate association with habitual alcohol consumption. These findings suggest that PVS may serve as a potential imaging biomarker reflecting subtle structural brain alterations associated with alcohol exposure.