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NEUROLOGY 2007;69:998-1005
© 2007 American Academy of Neurology

Relation between smoking and risk of dementia and Alzheimer disease

The Rotterdam Study

C. Reitz, MD, PhD, T. den Heijer, MD, PhD, C. van Duijn, PhD, A. Hofman, MD, PhD and M.M.B. Breteler, MD, PhD

From the Departments of Epidemiology & Biostatistics (C.R., T.d.H., C.v.D., A.H., M.M.B.B.) and Neurology (T.d.H.), Erasmus Medical Center, Rotterdam, The Netherlands.

Address correspondence and reprint requests to DrB. Breteler, Department of Epidemiology & Biostatistics, Erasmus Medical Center, PO Box 1738, 3000DR Rotterdam, The Netherlands m.breteler{at}erasmusmc.nl

Background and Objective: Previous studies relating smoking with the risk of dementia have been inconsistent and limited in their validity by short follow-up times, large intervals between baseline and follow-up assessments, and unspecific determination of dementia diagnosis. We re-assessed after longer follow-up time in the large population-based cohort of the Rotterdam Study whether smoking habits and pack-years of smoking are associated with the risk of dementia, Alzheimer disease (AD), and vascular dementia (VaD).

Methods: Prospective population-based cohort study in 6,868 participants, 55 years or older and free of dementia at baseline. First, Cox proportional hazard models were used to relate smoking status at baseline with the risks of incident dementia, VaD, and AD, using never smokers as the reference category in all analyses. Then Cox proportional hazard models were used to relate pack-years of smoking with the risks of incident dementia, VaD, and AD. To explore the impact of the APOE{varepsilon}4 allele, sex, and age on the association between smoking status and dementia, we repeated all analyses stratifying, in separate models, by APOE{varepsilon}4 genotype, sex, and median of age.

Results: After a mean follow-up time of 7.1 years, current smoking at baseline was associated with an increased risk of dementia (HR 1.47, 95% CI 1.18 to 1.86) and AD (HR 1.56, 95% CI 1.21 to 2.02). This increase in disease risk was restricted to persons without the APOE{varepsilon}4 allele. There was no association between current smoking and risk of VaD, and there was no association between past smoking and risk of dementia, AD, or VaD.

Conclusion: Current smoking increases the risk of dementia. This effect is more pronounced in persons without the APOE{varepsilon}4 allele than APOE{varepsilon}4 carriers.

Supported by the Erasmus Medical Center and Erasmus University Rotterdam, the Netherlands Organization for Scientific Research (NWO), the Netherlands Organization for Health Research and Development (ZonMW), the Research Institute for Diseases in the Elderly (RIDE), the Ministry of Education, Culture and Science, the Ministry of Health, Welfare and Sports, the European Commission (DG XII), the Municipality of Rotterdam, and the Lise-Meitner-Stipend provided by the Ministry of Innovation, Science, Research and Technology of the State of North Rhine-Westphalia, Federal Republic of Germany (Ministerium für Innovation, Wissenschaft, Forschung und Technologie des Landes Nordrhein-Westfalen, Bundesrepublik Deutschland).

Disclosure: The authors report no conflicts of interest.

Received January 3, 2007. Accepted in final form April 5, 2007.




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[Abstract] [Full Text] [PDF]


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