European Journal of Epidemiology

, Volume 28, Issue 10, pp 823–831 | Cite as

History of lifetime smoking, smoking cessation and cognitive function in the elderly population

  • Ute MonsEmail author
  • Ben Schöttker
  • Heiko Müller
  • Matthias Kliegel
  • Hermann Brenner


To examine potential associations of the history of lifetime smoking and smoking cessation with cognitive function in the elderly. In a population-based cohort study of older adults in Saarland, Germany, a detailed lifetime history of smoking was obtained using standardised questionnaires. Cognitive function was assessed with a validated telephone-based instrument (COGTEL) at the five-year follow-up in a subsample of n = 1,697 participants with a baseline age >65 years. Multiple linear regression models were employed to predict cognitive performance, adjusting for potential confounding factors. Ever-smokers with a higher cumulative dose of smoking in pack-years scored lower in the cognitive assessment than never-smokers, with the association being more pronounced in current smokers than in former smokers. In fully adjusted models, current smokers with 21–40 pack-years scored 4.06 points lower (95 % CI −7.18 to −0.94) than never-smokers. In former smokers, a longer time since smoking cessation was associated with higher scores in the cognitive test with reference to current smokers, even after adjustment for pack-years. Former smokers who had quit for more than 30 years scored 4.23 points higher (95 % CI 1.75 to 6.71) than current smokers. Dose–response-relationships of cognitive function with cumulative dose of smoking as well as with time since smoking cessation were substantiated by restricted cubic splines regression. Our results support suggestions that smokers are at an increased risk for cognitive impairment in older age; that the risk increases with duration and intensity of smoking, and subsides with time after smoking cessation.


Smoking Smoking cessation Cognitive function Elderly 



The ESTHER study was funded by grants from the Baden-Württemberg Ministry of Science, Research and Arts, the German Federal Ministry of Education and Research, and the German Federal Ministry of Family, Senior Citizens, Women and Youth. This study was conducted in the context of the CHANCES project funded in the FP7 framework programme of DG-RESEARCH in the European Commission. The CHANCES project is coordinated by the Hellenic Health Foundation, Greece. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Conflict of interest

The authors declare that no competing interests exist.

Supplementary material

10654_2013_9840_MOESM1_ESM.pdf (140 kb)
Supplementary material 1 (PDF 140 kb)


  1. 1.
    Ferri CP, Prince M, Brayne C, et al. Global prevalence of dementia: a delphi consensus study. Lancet. 2005;366:2112–7. doi: 10.1016/S0140-6736(05)67889-0.PubMedCrossRefGoogle Scholar
  2. 2.
    DeCarli C. Mild cognitive impairment: prevalence, prognosis, aetiology, and treatment. Lancet Neurol. 2003;2:15–21.PubMedCrossRefGoogle Scholar
  3. 3.
    Stephan BC, Brayne C. Vascular factors and prevention of dementia. Int Rev Psychiatry. 2008;20:344–56. doi: 10.1080/09540260802094456.PubMedCrossRefGoogle Scholar
  4. 4.
    Etgen T, Sander D, Bickel H, Forstl H. Mild cognitive impairment and dementia: the importance of modifiable risk factors. Dtsch Arztebl Int. 2011;108:743–50. doi: 10.3238/arztebl.2011.0743.PubMedGoogle Scholar
  5. 5.
    Flicker L. Life style interventions to reduce the risk of dementia. Maturitas. 2009;63:319–22. doi: 10.1016/j.maturitas.2009.06.008.PubMedCrossRefGoogle Scholar
  6. 6.
    Picciotto MR, Zoli M. Nicotinic receptors in aging and dementia. J Neurobiol. 2002;53:641–55. doi: 10.1002/neu.10102.PubMedCrossRefGoogle Scholar
  7. 7.
    Anstey KJ, von Sanden C, Salim A, O’Kearney R. Smoking as a risk factor for dementia and cognitive decline: a meta-analysis of prospective studies. Am J Epidemiol. 2007;166:367–78. doi: 10.1093/aje/kwm116.PubMedCrossRefGoogle Scholar
  8. 8.
    Peters R, Poulter R, Warner J, Beckett N, Burch L, Bulpitt C. Smoking, dementia and cognitive decline in the elderly, a systematic review. BMC Geriatr. 2008;8:36. doi: 10.1186/1471-2318-8-36.PubMedCrossRefGoogle Scholar
  9. 9.
    O’Brien JT, Erkinjuntti T, Reisberg B, et al. Vascular cognitive impairment. Lancet Neurol. 2003;2:89–98.PubMedCrossRefGoogle Scholar
  10. 10.
    Almeida OP, Garrido GJ, Alfonso H, et al. 24-month effect of smoking cessation on cognitive function and brain structure in later life. Neuroimage. 2011;55:1480–9. doi: 10.1016/j.neuroimage.2011.01.063.PubMedCrossRefGoogle Scholar
  11. 11.
    Almeida OP, Garrido GJ, Lautenschlager NT, Hulse GK, Jamrozik K, Flicker L. Smoking is associated with reduced cortical regional gray matter density in brain regions associated with incipient Alzheimer disease. Am J Geriatr Psychiatry. 2008;16:92–8. doi: 10.1097/JGP.0b013e318157cad2.PubMedCrossRefGoogle Scholar
  12. 12.
    Gallinat J, Meisenzahl E, Jacobsen LK, et al. Smoking and structural brain deficits: a volumetric MR investigation. Eur J Neurosci. 2006;24:1744–50. doi: 10.1111/j.1460-9568.2006.05050.x.PubMedCrossRefGoogle Scholar
  13. 13.
    Sabia S, Marmot M, Dufouil C, Singh-Manoux A. Smoking history and cognitive function in middle age from the Whitehall II study. Arch Intern Med. 2008;168:1165–73. doi: 10.1001/archinte.168.11.1165.PubMedCrossRefGoogle Scholar
  14. 14.
    Stewart MC, Deary IJ, Fowkes FG, Price JF. Relationship between lifetime smoking, smoking status at older age and human cognitive function. Neuroepidemiology. 2006;26:83–92. doi: 10.1159/000090253.PubMedCrossRefGoogle Scholar
  15. 15.
    Nooyens AC, van Gelder BM, Verschuren WM. Smoking and cognitive decline among middle-aged men and women: the Doetinchem cohort study. Am J Public Health. 2008;98:2244–50. doi: 10.2105/AJPH.2007.130294.PubMedCrossRefGoogle Scholar
  16. 16.
    Ott A, Andersen K, Dewey ME, et al. Effect of smoking on global cognitive function in nondemented elderly. Neurology. 2004;62:920–4.PubMedCrossRefGoogle Scholar
  17. 17.
    Sabia S, Elbaz A, Dugravot A, et al. Impact of smoking on cognitive decline in early old age: the Whitehall II cohort study. Arch Gen Psychiatry. 2012. doi: 10.1001/archgenpsychiatry.2011.2016.
  18. 18.
    Galanis DJ, Petrovitch H, Launer LJ, Harris TB, Foley DJ, White LR. Smoking history in middle age and subsequent cognitive performance in elderly Japanese-American men. The Honolulu-Asia aging study. Am J Epidemiol. 1997;145:507–15.PubMedCrossRefGoogle Scholar
  19. 19.
    Löw M, Stegmaier C, Ziegler H, Rothenbacher D, Brenner H. Epidemiological investigations of the chances of preventing, recognizing early and optimally treating chronic diseases in an elderly population (ESTHER study). Dtsch Med Wochenschr. 2004;129:2643–7. doi: 10.1055/s-2004-836089.PubMedCrossRefGoogle Scholar
  20. 20.
    Raum E, Rothenbacher D, Low M, Stegmaier C, Ziegler H, Brenner H. Changes of cardiovascular risk factors and their implications in subsequent birth cohorts of older adults in Germany: a life course approach. Eur J Cardiovasc Prev Rehabil. 2007;14:809–14. doi: 10.1097/HJR.0b013e3282eeb308.PubMedCrossRefGoogle Scholar
  21. 21.
    Breitling LP, Wolf M, Müller H, Raum E, Kliegel M, Brenner H. Large-scale application of a telephone-based test of cognitive functioning in older adults. Dement Geriatr Cogn Disord. 2010;30:309–16. doi: 10.1159/000319896.PubMedCrossRefGoogle Scholar
  22. 22.
    Breitling LP, Perna L, Müller H, Raum E, Kliegel M, Brenner H. Vitamin D and cognitive functioning in the elderly population in Germany. Exp Gerontol. 2012;47:122–7. doi: 10.1016/j.exger.2011.11.004.PubMedCrossRefGoogle Scholar
  23. 23.
    Kliegel M, Martin M, Jager T. Development and validation of the cognitive telephone screening instrument (COGTEL) for the assessment of cognitive function across adulthood. J Psychol. 2007;141:147–70. doi: 10.3200/JRLP.141.2.147-172.PubMedCrossRefGoogle Scholar
  24. 24.
    Burger M, Ziese T. Bundes-Gesundheitssurvey: Alkohol-Konsumverhalten in Deutschland. Berlin: Robert Koch Institut; 2003.Google Scholar
  25. 25.
    Desquilbet L, Mariotti F. Dose-response analyses using restricted cubic spline functions in public health research. Stat Med. 2010;29:1037–57. doi: 10.1002/sim.3841.PubMedGoogle Scholar
  26. 26.
    Euser SM, Schram MT, Hofman A, Westendorp RG, Breteler MM. Measuring cognitive function with age: the influence of selection by health and survival. Epidemiology. 2008;19:440–7. doi: 10.1097/EDE.0b013e31816a1d31.PubMedCrossRefGoogle Scholar
  27. 27.
    Hernan MA, Alonso A, Logroscino G. Cigarette smoking and dementia: potential selection bias in the elderly. Epidemiology. 2008;19:448–50. doi: 10.1097/EDE.0b013e31816bbe14.PubMedCrossRefGoogle Scholar
  28. 28.
    Burns DM. Epidemiology of smoking-induced cardiovascular disease. Prog Cardiovasc Dis. 2003;46:11–29.PubMedCrossRefGoogle Scholar
  29. 29.
    Mitchell AJ. A meta-analysis of the accuracy of the mini-mental state examination in the detection of dementia and mild cognitive impairment. J Psychiatr Res. 2009;43:411–31. doi: 10.1016/j.jpsychires.2008.04.014.PubMedCrossRefGoogle Scholar
  30. 30.
    Buckner RL. Memory and executive function in aging and AD: multiple factors that cause decline and reserve factors that compensate. Neuron. 2004;44:195–208. doi: 10.1016/j.neuron.2004.09.006.PubMedCrossRefGoogle Scholar
  31. 31.
    Goel V, Dolan RJ. Differential involvement of left prefrontal cortex in inductive and deductive reasoning. Cognition. 2004;93:B109–21. doi: 10.1016/j.cognition.2004.03.001.PubMedCrossRefGoogle Scholar
  32. 32.
    Breitling LP, Raum E, Müller H, Rothenbacher D, Brenner H. Synergism between smoking and alcohol consumption with respect to serum gamma-glutamyltransferase. Hepatology. 2009;49:802–8. doi: 10.1002/hep.22727.PubMedCrossRefGoogle Scholar
  33. 33.
    Panza F, Frisardi V, Seripa D, et al. Alcohol consumption in mild cognitive impairment and dementia: harmful or neuroprotective? Int J Geriatr Psychiatry. 2012;27:1218–38. doi: 10.1002/gps.3772.PubMedCrossRefGoogle Scholar
  34. 34.
    Roerecke M, Rehm J. Irregular heavy drinking occasions and risk of ischemic heart disease: a systematic review and meta-analysis. Am J Epidemiol. 2010;171:633–44. doi: 10.1093/aje/kwp451.PubMedCrossRefGoogle Scholar
  35. 35.
    Mariani E, Monastero R, Mecocci P. Mild cognitive impairment: a systematic review. J Alzheimers Dis. 2007;12:23–35.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Ute Mons
    • 1
    Email author
  • Ben Schöttker
    • 1
  • Heiko Müller
    • 1
  • Matthias Kliegel
    • 2
  • Hermann Brenner
    • 1
  1. 1.Division of Clinical Epidemiology and Aging ResearchGerman Cancer Research Center (DKFZ)HeidelbergGermany
  2. 2.Department of PsychologyUniversity of GenevaGenevaSwitzerland

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