Department of Psychiatry, University of California, San Francisco, Veterans Affairs Medical Center, San Francisco, CA, USA.
Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
J Gen Intern Med. 2022 Apr;37(5):1023-1030. doi: 10.1007/s11606-020-06450-5. Epub 2021 Jan 26.
Smoking starts in early adulthood and persists throughout the life course, but the association between these trajectories and midlife cognition remains unclear.
Determine the association between early to midlife smoking trajectories and midlife cognition.
Prospective cohort study.
Participants were 3364 adults (mean age = 50.1 ± 3.6, 56% female, 46% Black) from the Coronary Artery Risk Development in Young Adults (CARDIA) study: 1638 ever smokers and 1726 never smokers.
Smoking trajectories were identified in latent class analysis among 1638 ever smokers using smoking measures every 2-5 years from baseline (age 18-30 in 1985-1986) through year 25 (2010-2011). Poor cognition was based on cognitive domain scores ≥ 1 SD below the mean on tests of processing speed (Digit Symbol Substitution Test), executive function (Stroop), and memory (Rey Auditory Verbal Learning Test) at year 25.
Five smoking trajectories emerged over 25 years: quitters (19%), and minimal stable (40%), moderate stable (20%), heavy stable (15%), and heavy declining smokers (5%). Heavy stable smokers showed poor cognition on all 3 domains compared to never smoking (processing speed AOR = 2.22 95% CI 1.53-3.22; executive function AOR = 1.58 95% CI 1.05-2.36; memory AOR = 1.48 95% CI 1.05-2.10). Compared to never smoking, both heavy declining (AOR = 1.95 95% CI 1.06-3.68) and moderate stable smokers (AOR = 1.56 95% CI 1.11-2.19) exhibited slower processing speed, and heavy declining smokers additionally had poor executive function. For minimal stable smokers (processing speed AOR = 1.12 95% CI 0.85-1.51; executive function AOR = 0.97 95% CI 0.71-1.31; memory AOR = 1.21 95% CI 0.94-1.55) and quitters (processing speed AOR = 0.96 95% CI 0.63-1.48; executive function AOR = 0.98 95% CI 0.63-1.52; memory AOR = 0.97 95% CI 0.67-1.39), no association was observed.
The association between early to midlife smoking trajectories and midlife cognition was dose-dependent. Results underscore the cognitive health risk of moderate and heavy smoking and the potential benefits of quitting on cognition, even in midlife.
吸烟始于成年早期，并贯穿整个生命周期，但这些轨迹与中年认知之间的关联仍不清楚。
确定早至中年吸烟轨迹与中年认知之间的关联。
前瞻性队列研究。
来自冠状动脉风险发展在年轻人（CARDIA）研究的 3364 名成年人（平均年龄= 50.1±3.6，56%女性，46%黑人）：1638 名曾经吸烟者和 1726 名从不吸烟者。
使用从基线（1985-1986 年 18-30 岁）到第 25 年（2010-2011 年）每隔 2-5 年进行的吸烟测量，在 1638 名曾经吸烟者中使用潜在类别分析确定吸烟轨迹。认知能力差是指在第 25 年进行的加工速度（数字符号替代测试）、执行功能（Stroop）和记忆（Rey 听觉言语学习测试）测试中，认知域得分≥1 个标准差低于平均值。
在 25 年的时间里出现了 5 种吸烟轨迹：戒烟者（19%），最低稳定（40%），中度稳定（20%），重度稳定（15%）和重度下降吸烟者（5%）。与从不吸烟相比，重度稳定吸烟者在所有 3 个领域的认知能力都较差（加工速度 AOR=2.22，95%CI 1.53-3.22；执行功能 AOR=1.58，95%CI 1.05-2.36；记忆 AOR=1.48，95%CI 1.05-2.10）。与从不吸烟相比，重度下降吸烟者（AOR=1.95，95%CI 1.06-3.68）和中度稳定吸烟者（AOR=1.56，95%CI 1.11-2.19）的加工速度均较慢，重度下降吸烟者的执行功能也较差。对于最低稳定吸烟者（加工速度 AOR=1.12，95%CI 0.85-1.51；执行功能 AOR=0.97，95%CI 0.71-1.31；记忆 AOR=1.21，95%CI 0.94-1.55）和戒烟者（加工速度 AOR=0.96，95%CI 0.63-1.48；执行功能 AOR=0.98，95%CI 0.63-1.52；记忆 AOR=0.97，95%CI 0.67-1.39），未观察到关联。
早至中年的吸烟轨迹与中年认知之间的关联是剂量依赖性的。结果强调了中度和重度吸烟对认知健康的风险，以及即使在中年戒烟对认知的潜在益处。
