Smoking as a risk factor for dementia and cognitive decline: a meta-analysis of prospective studies

The authors assessed the association of smoking with dementia and cognitive decline in a meta-analysis of 19 prospective studies with at least 12 months of follow-up. Studies included a total of 26,374 participants followed for dementia for 2-30 years and 17,023 participants followed up for 2-7 years to assess cognitive decline. Mean study age was 74 years. Current smokers at baseline, relative to never smokers, had risks of 1.79 (95% confidence interval (Cl): 1.43, 2.23) for incident Alzheimer's disease, 1.78 (95% Cl: 1.28, 2.47) for incident vascular dementia, and 1.27 (95% Cl: 1.02, 1.60) for any dementia. Compared with those who never smoked, current smokers at baseline also showed greater yearly declines in Mini-Mental State Examination scores over the follow-up period (effect size (beta) = -0.13, 95% Cl: -0.18, -0.08). Compared with former smokers, current smokers at baseline showed an increased risk of Alzheimer's disease (relative risk = 1.70, 95% Cl: 1.25,2.31)and an increased decline in cognitive abilities (effect size (beta) = -0.07, 95% Cl: -0.11, -0.03), but the groups were not different regarding risk of vascular dementia or any dementia. The authors concluded that elderly smokers have increased risks of dementia and cognitive decline.