Ott A, Andersen K, Dewey M E, Letenneur L, Brayne C, Copeland J R M, Dartigues J F, Kragh-Sorensen P, Lobo A, Martinez-Lage J M, Stijnen T, Hofman A, Launer L J
Department of Epidemiology and Biostatistics (Drs. Hofman, Launer, Ott, and Stijnen), Erasmus University Medical Centre, the Netherlands.
Neurology. 2004 Mar 23;62(6):920-4. doi: 10.1212/01.wnl.0000115110.35610.80.
Contrary to early case-control studies that suggested smoking protects against Alzheimer disease (AD), recent prospective studies have shown that elderly who smoke may be at increased risk for dementia.
To examine prospectively the effect of smoking on cognition in nondemented elderly.
In a multicenter cohort, the European Community Concerted Action Epidemiology of Dementia (EURODEM), including the Odense, Personnes Agées Quid (Paquid), Rotterdam, and Medical Research Council: Ageing in Liverpool Project-Health Aspects (MRC ALPHA) Studies, 17,610 persons aged 65 and over were screened and examined for dementia. After an average 2.3 years of follow-up, 11,003 nondemented participants were retested. Excluding incident dementia cases and those without baseline information on smoking gave an analytical sample of 9,209 persons. Average yearly decline in Mini-Mental State Examination (MMSE) score was compared among groups, adjusting for age, sex, baseline MMSE, education, type of residence, and history of myocardial infarction or stroke.
MMSE score of persons who never smoked on average declined 0.03 point/year. The adjusted decline of former smokers was 0.03 point greater and of current smokers 0.13 point greater than never smokers (p < 0.001). Higher rates of decline by smoking were found in men and women, persons with and without family history of dementia, and in three of four participating studies. Higher cigarette pack-year exposure was correlated with a significantly higher rate of decline.
Smoking may accelerate cognitive decline in nondemented elderly.
早期病例对照研究表明吸烟可预防阿尔茨海默病（AD），但近期前瞻性研究显示，吸烟的老年人患痴呆症的风险可能更高。
前瞻性研究吸烟对非痴呆老年人认知功能的影响。
在一个多中心队列研究中，即欧洲共同体痴呆症流行病学协同行动（EURODEM），包括欧登塞、老年人健康状况研究（Paquid）、鹿特丹以及医学研究委员会：利物浦衰老项目-健康方面（MRC ALPHA）研究，对17610名65岁及以上的人群进行了痴呆症筛查和检查。经过平均2.3年的随访，对11003名非痴呆参与者进行了重新测试。排除新发痴呆病例以及那些没有吸烟基线信息的人后，得到了一个包含9209人的分析样本。在对年龄、性别、基线简易精神状态检查表（MMSE）、教育程度、居住类型以及心肌梗死或中风病史进行调整后，比较了各组MMSE评分的年均下降情况。
从不吸烟的人的MMSE评分平均每年下降0.03分。已戒烟者经调整后的下降幅度比从不吸烟者大0.03分，而目前仍吸烟者的下降幅度比从不吸烟者大0.13分（p<0.001）。在男性和女性、有和没有痴呆家族史的人群中，以及在四项参与研究中的三项研究中，均发现吸烟导致的下降率更高。吸烟包年数越高，下降率显著越高。
吸烟可能会加速非痴呆老年人的认知衰退。
