. Heavy smoking in midlife and long-term risk of Alzheimer disease and vascular dementia. Arch Intern Med. 2011 Feb 28;171(4):333-9. PubMed.


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  1. Evidence has accumulated that cigarette smoking not only increases the risk of developing Alzheimer’s disease, but also is associated with increased numbers of neocortical plaques and earlier death from the disease. These studies have demonstrated that smoking is not protective, as had been suggested by earlier reports that were affected by methodological limitations, such as survival bias and asymmetric reporting (smoking history obtained by self-reports for controls but by proxy reports for Alzheimer’s cases).

    This study by Rusanen et al. contributes to our understanding of this issue by confirming the association between smoking and increased risk of Alzheimer’s disease in a large, ethnically diverse sample. In addition, this study reports an association between smoking and vascular dementia after adjustment for potential confounders, including vascular factors.

    The authors cite limitations of reliance on medical records for dementia diagnosis, the potential for undiagnosed dementia, and limited smoking data. In addition, it is unfortunate that genetic data were not available, given that the association between smoking and Alzheimer’s disease has previously been shown to vary by apolipoprotein E status.

    Cigarette smoking has well-known links to adverse health conditions such as cancer and cardiovascular disease, yet some individuals continue to smoke. Studies such as that by Rusanen and colleagues may provide additional motivation for smoking cessation by showing the adverse consequences of smoking for Alzheimer’s disease, one of the most feared health conditions in later life.

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