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Séverine Sabia, MSc; Michael Marmot, PhD, FFPHM, FRCP; Carole Dufouil, PhD; Archana Singh-Manoux, PhD

Arch Intern Med. 2008;168(11):1165-1173.

Background  Studies about the association between smoking and dementia necessarily involve those who have "survived" smoking. We examine the association between smoking history and cognitive function in middle age and estimate the risk of death and of nonparticipation in cognitive tests among smokers.

Methods  Data are from the Whitehall II study of 10 308 participants aged 35 to 55 years at baseline (phase 1 [1985-1988]). Smoking history was assessed at phase 1 and at phase 5 (1997-1999). Cognitive data (memory, reasoning, vocabulary, and semantic and phonemic fluency) were available for 5388 participants at phase 5; 4659 of these were retested 5 years later.

Results  Smokers at phase 1 were at higher risk of death (hazard ratio [HR], 2.00; 95% confidence interval [CI], 1.58-2.52 among men and HR, 2.46; 95% CI, 1.80-3.37 among women) and of nonparticipation in cognitive tests (odds ratio [OR], 1.32; 95% CI, 1.16-1.51 among men and OR, 1.69; 95% CI, 1.41- 2.02 among women). At phase 5 in age- and sex-adjusted analyses, smokers compared with those who never smoked were more likely to be in the lowest quintile of cognitive performance. After adjustment for multiple covariates, this risk remained for memory (OR, 1.37; 95% CI, 1.10-1.73). Ex-smokers at phase 1 had a 30% lower risk of poor vocabulary and low verbal fluency. In longitudinal analysis, the evidence for an association between smoking history and cognitive decline was inconsistent. Stopping smoking during the follow-up period was associated with improvement in other health behaviors.

Conclusions  Smoking was associated with greater risk of poor memory. Middle-aged smokers are more likely to be lost to follow-up by death or through nonparticipation in cognitive tests. Ex-smokers had a lower risk of poor cognition, possibly owing to improvement in other health behaviors.

Author Affiliations: Institut National de la Santé et de la Recherche Médicale (INSERM) Unité 687, Institut Fédératif de Recherche 69, Hôpital Paul Brousse, Villejuif, France (Ms Sabia and Dr Singh-Manoux); INSERM Unité 708 and Université Paris 6 (Dr Dufouil) and Centre de Gérontologie, Hôpital Sainte Perrine, Assistance Publique–Hôpitaux de Paris, Paris, France (Dr Singh-Manoux); and Department of Epidemiology and Public Health, University College London, London, England (Drs Marmot and Singh-Manoux).

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