Authors

1 Neurology Division, Los Angeles Biomedical Research Institute

2 Neurology Division, Los Angeles Biomedical Research Institute,Neurology

3 Psychiatry Division, Los Angeles Biomedical Research Institute, Departments of Psychiatry, Harbor‑UCLA Medical Center, Torrance, Departments of Psychiatry, David Geffen School of Medicine, UCLA, Los Angeles, CA 90509, USA

Abstract

BACKGROUND: The relationship between cigarette smoking and development of Alzheimer’s
disease (AD) is not fully determined, and previous reports disagree, with some studies suggesting
an increased relative risk and others a decreased odds ratio. Consequently, we wanted to determine
if the prevalence of past cigarette smoking observed in a community‑based clinic sample of patients
with AD would be more consistent with the expected value obtained from a model using either an
increased relative risk or a decreased odds ratio to estimate the effect of smoking on development
of AD.
MATERIALS AND METHODS: Retrospective cross‑sectional analysis of all patients treated for AD
in a community‑based Neurology Clinic during a 2‑year period. Estimates of expected past smoking
prevalence were calculated based on published values for either an increased relative risk or a
decreased odds ratio and compared to the past smoking prevalence observed in the clinic sample.
RESULTS: The observed past smoking prevalence in the clinic population was 29.17%.
The expected past smoking prevalence calculated using the increased relative risk was
30.07% (95% confidence interval [CI] = 27.67–32.32%), and using the decreased odds ratio was
12.54% (95% CI = 6.32–24.81%).
CONCLUSION: The observed past smoking prevalence among the patients being treated for AD
in a community‑based clinic falls within the expected 95% CI for the increased relative risk model
and outside of the expected 95% CI for the decreased odds ratio model. These results support
the contention that the relationship between cigarette smoking and development of AD is the best
characterized by an increased relative risk.

Keywords

1. Alzheimer’s Association. 2014 Alzheimer’s disease facts and
figures. Alzheimers Dement 2014;10:e47‑92.
2. Brookmeyer R, Johnson E, Ziegler‑Graham K, Arrighi HM.
Forecasting the global burden of Alzheimer’s disease. Alzheimers
Dement 2007;3:186‑91.
3. Ockene IS, Miller NH. Cigarette smoking, cardiovascular disease,
and stroke: A statement for healthcare professionals from the
American Heart Association. American Heart Association Task
Force on Risk Reduction. Circulation 1997;96:3243‑7.
4. Cataldo JK, Prochaska JJ, Glantz SA. Cigarette smoking is a risk
factor for Alzheimer’s disease: An analysis controlling for tobacco
industry affiliation. J Alzheimers Dis 2010;19:465‑80.
5. Centers for Disease Control and Prevention. Current cigarette
smoking among adults – United States, 2005‑2013. Morb Mortal
Wkly Rep 2014;63:1108‑12.
6. Johnson NB, Hayes LD, Brown K, Hoo EC, Ethier KA, Centers
for Disease Control and Prevention (CDC). CDC National Health
Report: Leading causes of morbidity and mortality and associated
behavioral risk and protective factors – United States, 2005‑2013.
MMWR Surveill Summ 2014;63 Suppl 4:3‑27.
7. IBM Corp. Released 2013. IBM SPSS Statistics for Windows.
Ver. 22.0. Armonk, NY: IBM Corp.; 2013.
8. Graves AB, van Duijn CM, Chandra V, Fratiglioni L, Heyman A,
Jorm AF, et al. Alcohol and tobacco consumption as risk factors for
Alzheimer’s disease: A collaborative re‑analysis of case‑control
studies. EURODEM Risk Factors Research Group. Int J Epidemiol
1991;20 Suppl 2:S48‑57.
9. Lee PN. Smoking and Alzheimer’s disease: A review of the
epidemiological evidence. Neuroepidemiology 1994;13:131‑44.
10. Van Duijn CM, Clayton DG, Chandra V, Fratiglioni L, Graves AB,
Heyman A, et al. Interaction between genetic and environmental
risk factors for Alzheimer’s disease: A reanalysis of case‑control
studies. Genet Epidemiol 1994;11:539‑51.
11. Rusanen M, Kivipelto M, Quesenberry CP Jr, Zhou J, WhitmerRA.
Heavy smoking in midlife and long‑term risk of Alzheimer
disease and vascular dementia. Arch Intern Med 2011;171:333‑9.
12. Llewellyn DJ, Lang IA, Langa KM, Naughton F, Matthews FE.
Exposure to secondhand smoke and cognitive impairment
in non‑smokers: National cross sectional study with cotinine
measurement. BMJ 2009;338:b462.
13. Barnes DE, Haight TJ, Mehta KM, Carlson MC, Kuller LH,
Tager IB. Secondhand smoke, vascular disease, and dementia
incidence: Findings from the cardiovascular health cognition
study. Am J Epidemiol 2010;171:292‑302.