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February brain health tip: Smoking
Research shows that brain health is promoted by reducing and stopping smoking cigarettes.
Smoking in New Zealand
The 2018 national census generated estimates that 6% of New Zealanders aged 65 and over are regular smokers, 34% have improved their health by becoming ex-smokers, and 60% never smoked. .
Unfortunately, Māori rates are worse than this average, with 15% of our kaumātua still smoking regularly. Around 10% of Pasifika Elders in New Zealand still smoke.
Smoking cigarettes is linked to cognitive decline
The scientific papers reviewed by the Lancet Commission enabled them to estimate that people who smoke in later life have a 60% higher risk of developing a dementia compared with people who do not smoke at this stage of life. This is even though smoking reduces life expectancy so that some smokers don’t live long enough to develop a dementia if they were going to!
Second-hand smoking has also been linked to increased risk of cognitive decline, as has being exposed to air pollution.
The more a person is exposed to cigarette smoke, the higher the risk of cognitive impairment and the more rapid the decline (this is called a “dose effect”).
What about nicotine?
Nicotine is a highly addictive component of cigarette smoke. All cigarettes contain large quantities of harmful chemicals in them in addition to nicotine.
Although there may be some benefit to cognitive ability from the nicotine part of cigarettes, the benefit seems to be short-term (hours).
Nicotine drugs have not been shown to provide benefits for people with dementia, and there are no studies showing that nicotine prevents dementia.
Why is smoking harmful for the brain?
Smoking is strongly linked to impaired blood flow to the brain because of damage to the heart and to blood vessels. Reduced brain blood flow is known to be a key driving force for all of the common diseases that cause dementia in New Zealand, including Alzheimer’s Disease, various vascular dementias, Lewy Body Dementia, and fronto-temporal dementias.
In addition, toxins in cigarette smoke increase inflammation and oxidative stress, two pathological processes known to be implicated in many of the causes of dementia.
Smoking is also strongly linked to strokes of all kinds, and stroke is strongly linked to dementia.
Smoking also raises the risk of brain cancer and of other cancers that can spread to the brain.
Smoking interacts with other risk factors for poor blood supply to the brain such as high blood pressure, high cholesterol, being overweight, and having diabetes.
Is stopping smoking helpful?
Stopping smoking, even when smokers are older, significantly reduces their risk of dementia.
Even if completely stopping smoking is a goal a person does not feel ready to embrace, reducing the number of cigarettes they smoke may be a helpful first step for brain health.
Health professionals should always do their ABCs!
We should routinely
people we work with whether they smoke, no matter how old they are, and document this in our notes.
We should always give
to smokers, encouraging them to stop because this will help them to be healthier, including lowering their risk of dementia in later life.
We should strongly encourage all smokers to use
. A combination of support of some kind plus a stop-smoking medication such as a reducing course of nicotine is the most effective way. You can refer anyone to Quitline on 0800 778 778. They will call people to explain their local support and medication options to them.
Just because a person has tried stopping before does not mean they won’t succeed now. Sometimes all that is needed is a different approach, and sometimes it is having the persistence to try again that helps people quit. You can find out more about helping people to stop smoking
People living with dementia
People living with dementia may also benefit from reducing and stopping smoking because of the many benefits for health, including improved fitness, improved exercise tolerance and reduced susceptibility to lung infections, not to mention having more money to spend on other things.
Perhaps the idea that people with dementia “should be allowed to smoke because it’s the last thing left they can enjoy” says more about how poor an environment such a person is living in than it does about how much true enjoyment they get from continuing to service their addiction.
Pursuing smoking cessation is sometimes important during a health emergency such as being admitted to hospital, but it may be more likely to be successful without causing any harm to a person with dementia if it is done gradually in a period of being well rather than suddenly during a period of stress.