Association of Tobacco Cessation With Cognitive Decline: A Multi-State Analysis.

backgroundMild cognitive decline and a faster reduction of entorhinal cortex volume are found to be more prevalent in individuals with a history of smoking, as shown in longitudinal and neuroimaging-based studies. Early screening of high-risk demographics may reduce cognitive decline progression.  Objective: The objective of this study is to understand the association between tobacco cessation and cognitive decline in the United States of America when adjusted for age, race, sex, education, and income, based on population-level survey data.  Methods: The data for this study were derived from the 2023 Behavioral Risk Factor Surveillance System (BRFSS), a population-based telephone survey that collects self-reported health information from non-institutionalized adults aged 18 years or older. Participants under 45 years old were excluded, as they were not administered questions from the BRFSS Cognitive Decline (CD) Module. Individuals from Florida, Maine, Rhode Island, Utah, Vermont, Wisconsin, Nevada, and Indiana participated in the CD module. Frequencies and percentages were computed for categorical demographic variables and the category of time since the individual stopped smoking. Bivariate analysis was used to determine whether the category of time since tobacco cessation and the demographic characteristics were independently associated with cognitive decline. Variables independently associated with CD (p≤0.10) were entered into a multivariable binary logistic model to determine the risk of CD for length of time category since smoking cessation when adjusted for age, race, sex, income, and education.  Results: This study identified a significant association between smoking cessation duration and cognitive decline (CD). Individuals who quit smoking 10 or more years prior had 3.648 times higher odds (95% CI 3.495, 3.807) of reporting CD compared to those who had never smoked regularly. Moreover, a general trend was observed, indicating greater CD with shorter durations since smoking cessation. The highest odds were observed among individuals who quit smoking between 1 month and less than 3 months prior, with an odds ratio of 5.466 (95% CI 5.197, 5.748) relative to the reference group. All analyses were adjusted for age, race, sex, income, and education.  Conclusion: This study concludes that individuals who have never smoked or quit at least 10 years ago are less likely to experience cognitive decline. A limitation is that the data is self-reported, which may introduce bias. The literature suggests smoking cessation is not linked to episodic memory loss, while smoking is associated with memory impairment. The effects of tobacco use on cognitive functioning may be reversed or halted with smoking cessation. Early intervention, including cognitive testing and smoking cessation counseling, may help reduce cognitive decline in smokers.