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June 12, 2008 — Smoking is linked to an increased risk for memory deficit and cognitive decline in middle age in an analysis based on data from Whitehall II, a large, prospective cohort study.
The findings by Séverine Sabia, MSc, at the Institut National de la Santé et de la Recherche Médicale, in Villejuif, France, and colleagues, are published in the June 9 issue of the Archives of Internal Medicine.
Compared with study participants who had never smoked, after adjustment for other confounding factors, smokers had a 37% increased risk of having scores in the lowest quintile on a memory test (they were more likely to recall less than 5 of 20 words), Ms. Sabia told Medscape Psychiatry.
Cognitive Decline in Middle Age
"This risk is quite important considering that we are only in middle-age when cognitive decline is just starting," she noted. Evidence of this association at this age could support the hypothesis that smoking is involved in the pathogenesis of preclinical cognitive deficit and decline, which is a risk factor for later dementia, she added.
With the aging population and the projected increases in older adults with dementia, it is important to identify modifiable risk factors, she noted. "Our results suggest that smoking had an adverse effect on cognitive function in midlife, [but] 10 years after smoking cessation, there was little adverse effect of smoking on cognition," she added. "Thus, public health messages should target smokers at all ages."
A recent meta-analysis concluded that smoking is a risk factor for dementia, the group writes, adding that it is problematic to study the link between smoking and cognition (thinking, learning, and memory) in older people because many study participants do not return for follow-up visits, or they die from smoking-related diseases.
At the same time, there is increasing evidence that midlife risk factors play a role in later dementia.
Does Smoking Affect Memory?
The group aimed to investigate the association between smoking history and cognitive function in middle-aged individuals.
They analyzed data from the Whitehall II study, which was designed to examine the socioeconomic gradient in health and disease. Whitehall II enrolled 10,308 London-based civil servants (6895 men and 3413 women) aged 35 to 55 years at baseline (phase 1) from 1985 to 1988.
Cognition was assessed at phase 5, when participants were aged 45 to 68 years (mean age, 55.5 years) and 5 years later, at phase 7, when participants were aged 50 to 74 years (mean age, 61 years), said Ms. Sabia.
Cognitive data from tests of memory, reasoning, vocabulary, and semantic and phonetic fluency were available for 5388 participants at phase 5 and 4659 participants at phase 7.
Smoking was assessed at baseline and at phase 5. At baseline, the smokers smoked an average of 14 cigarettes a day; 25% were light smokers (≤ 5 cigarettes/day) and 25% were heavy smokers (1 - 2 packs/day), but only 27 participants smoked more than 2 packs/day, she noted.
Four Key Findings
The study presented 4 key findings, the group writes.
First, smoking in middle age was associated with memory deficit and decline in reasoning abilities. At phase 5, after adjustment for sex, age, socioeconomic differences, health behaviors, and health measures, current smokers vs participants who had never smoked had a 37% greater risk of being in the lowest quintile of cognitive function (odds ratio, 1.37; 95% confidence interval [CI], 1.10 - 1.73).
Second, compared with smokers, long-term ex-smokers (those who had stopped smoking before the beginning of the study) had a 30% lower risk for poor vocabulary and low verbal fluency.
Third, giving up smoking in midlife was accompanied by improvement in health habits such as drinking less alcohol, being more active, and eating more fruits and vegetables.
Fourth, compared with nonsmokers, smokers were more likely to die by phase 7 (an average 17.1 years of follow-up) or not to participate in cognitive tests, suggesting that nonparticipants had cognitive deficits and that, thus, the association between smoking and cognition in late midlife could be underestimated.
These findings are important because other research suggests that individuals with mild cognitive impairment progress to clinically diagnosed dementia at an accelerated rate, the group writes.
Not Too Late to Stop Smoking
"During the past 20 years, public health messages about smoking have led to changes in smoking behavior," they note. Based on the current study, "public health messages on smoking should continue to target smokers at all ages," they conclude.
This study was supported by the British Medical Research Council, the French Ministry of Research, and the European Science Foundation. The Whitehall II study was supported by the British Medical Research Council; the British Heart Foundation; the British Health and Safety Executive; the British Department of Health; the National Heart, Lung, and Blood Institute; the National Institute on Aging; the Agency for Health Care Policy and Research; and the John D. and Catherine T. MacArthur Foundation Research Networks on Successful Midlife Development and Socioeconomic Status and Health. Two of the study authors have obtained funding. The other study authors have disclosed no relevant financial relationships.
Arch Intern Med. 2008;168:1165-1173.
A meta-analysis by Anstey and colleagues in the August 15, 2007, issue of the American Journal of Epidemiology found that smoking is a risk factor for dementia. However, as noted by Kukull in the February 1, 2001, issue of Biological Psychiatry, the effects of smoking might be difficult to determine because of attrition and smoking-related mortality before the diagnosis of dementia. However, the effects of smoking on cognitive ability before the onset of dementia could be examined.
In the Whitehall II study described by Marmot and colleagues in the June 8, 1991, issue of The Lancet, civil servants were recruited in 1985 to assess the link between socioeconomic factors and health. This study uses the Whitehall II database to examine whether smoking history is associated with cognitive function in middle-aged adults and to assess the risk for death and participation in cognitive tests in those who smoke.
