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P4‐637: EXAMINING THE ROLE OF CIGARETTE SMOKING AND CESSATION ON COMBINED RISK OF INCIDENT DEMENTIA, NURSING HOME PLACEMENT, AND DEATH IN COGNITIVELY HEALTHY AND MILD COGNITIVELY IMPAIRED ADULTS
Author(s) -
Johnson Adrienne L.,
Nystrom Naomi C.,
Piper Megan E.,
Cook Jessica,
Norton Derek L.,
Zuelsdorff Megan,
Wyman Mary F.,
Benton Susan Flowers,
Lambrou Nickolas H.,
O'Hara John,
Chin Nathaniel A.,
Asthana Sanjay,
Carlsson Cynthia,
Gleason Carey E.
Publication year - 2019
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2019.08.186
Subject(s) - medicine , abstinence , dementia , smoking cessation , hazard ratio , proportional hazards model , demography , gerontology , psychiatry , confidence interval , disease , pathology , sociology
Text: Background: Cigarette smoking directly and indirectly accounts for a 70% increased risk of ADRD onset with smoking cessation lowering this risk. However, this risk may be underestimated due to challenges disentangling key outcomes (i.e. death or nursing home placement prior to dementia diagnosis). Further, the magnitude of these risks remains unexplored in smokers with mild cognitive impairment (MCI). We sought to examine the impact of smoking status, duration of smoke exposure, and duration of abstinence on key outcomes of diagnosis of dementia, nursing home placement, or death (Dem/NH/Death). Method: We conducted three Cox-regression proportional hazard analyses to model conversion to event (Dem/NH/Death) using the NACC dataset, stratified by baseline cognitive status (cognitively healthy [CH; N = 10852; Mage = 72.0; 64.6% Female; 81.4% Caucasian] vs. MCI [N = 4931; Mage = 73.4; 49.1% Female; 81.5% Caucasian]). Time delayed entry methods accounted for varying age of entry. Model 1: smoking status (former vs. current smoker). Model 2: pack years (PY) comparing never (0 PY) smokers to low (>0 <20 PY), moderate (20 <40 PY), and heavy (≥ 40 PY) users. Model 3: duration of abstinence (i.e., not quit, >0->10 years, 10->20 years, 20->30 years, ≥ 30 years) compared to never smokers. Result: (1) CH current smokers had higher rate of conversion (HR = 2.18; 95% CI 1.74-2.75; p < 0.001). (2) CH heavy use smokers had higher rate of conversion (HR = 1.36; 95% CI 1.16-1.59; p < 0.001). (3) CH current smokers had increased rate of conversion than never smokers (HR = 2.14; 95% CI 1.71-2.67; p < 0.001). After 10 years of quitting, former smokers did not differ from never smokers in rates of Dem/NH/Death (HR = 1.65; 95% CI 1.25-2.18; p < 0.001). None of the results from the MCI group were significant (p’s > .05). Conclusion: Using a more comprehensive outcome suggests an even greater negative impact of smoking on dementia and highlights the benefit of quitting on these risks. The lack of significant findings in the MCI group may be related to diagnostic confounders (e.g., race, socioeconomic status). Future research is needed among this group of smokers. Tables and Figures: Figure 1.png (38.8KB) Figure 2.png (45.0KB) Figure 3.png (51.9KB)