Smoking Is Associated with an Increased Risk of Dementia: A Meta-Analysis of Prospective Cohort Studies with Investigation of Potential Effect Modifiers
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{"title"=>"Smoking is associated with an increased risk of dementia: A meta-analysis of prospective cohort studies with investigation of potential effect modifiers", "type"=>"journal", "authors"=>[{"first_name"=>"Guochao", "last_name"=>"Zhong", "scopus_author_id"=>"56498524200"}, {"first_name"=>"Yi", "last_name"=>"Wang", "scopus_author_id"=>"56623226300"}, {"first_name"=>"Yong", "last_name"=>"Zhang", "scopus_author_id"=>"55883675200"}, {"first_name"=>"Jeff Jianfei", "last_name"=>"Guo", "scopus_author_id"=>"7404489124"}, {"first_name"=>"Yong", "last_name"=>"Zhao", "scopus_author_id"=>"55726042300"}], "year"=>2015, "source"=>"PLoS ONE", "identifiers"=>{"issn"=>"19326203", "scopus"=>"2-s2.0-84928905831", "pui"=>"604166288", "doi"=>"10.1371/journal.pone.0118333", "isbn"=>"1932-6203", "sgr"=>"84928905831", "pmid"=>"25763939"}, "id"=>"4e87aa4e-3633-311c-805d-6039b1c9b32a", "abstract"=>"Background Previous studies showed inconsistent results on the association of smoking with all-cause dementia and vascular dementia (VaD), and are limited by inclusion of a small number of studies and unexplained heterogeneity. Our review aimed to assess the risk of all-cause de- mentia, Alzheimer’s disease (AD) and VaD associated with smoking, and to identify poten- tial effect modifiers. Methods and Findings The PubMed,Embase, Cochrane Library and Psychinfo databases were searched to identify studies that provided risk estimates on smoking and incidence of dementia. A random-effects model was used to yield pooled results. Thirty-seven studies were included.Comparedwith never smokers, current smokers showed an increased risk of all-cause dementia (risk ratio (RR) 1.30, 95%confidence interval (CI) 1.18–1.45), AD(RR1.40, 95%CI 1.13–1.73) and VaD(RR1.38, 95%CI 1.15–1.66). For all-cause dementia, the risk increased by 34%for every 20 cigarettes per day (RR1.34, 95%CI 1.25–1.43). Former smokers did not showan increased risk of all-cause dementia (RR1.01, 95%CI 0.96–1.06),AD(RR1.04, 95%CI 0.96–1.13) and VaD(RR0.97, 95%CI 0.83–1.13). Subgroup analyses indicated that (1) the significantly increased risk ofADfrom current smoking was seen only in apolipoprotein E ε4 noncarriers; (2) current smokers aged 65 to 75 years at baseline showed increased risk of all- cause dementia and ADcompared to those aged over 75 or under 65 years; and (3) sex, race, study location and diagnostic criteria difference in risk of dementiawas not found. PLOS Conclusions Smokers show an increased risk of dementia, and smoking cessation decreases the risk to that of never smokers. The increased risk of AD from smoking is more pronounced in apoli- poprotein E ε4 noncarriers. Survival bias and competing risk reduce the risk of dementia from smoking at extreme age. Introduction", "link"=>"http://www.mendeley.com/research/smoking-associated-increased-risk-dementia-metaanalysis-prospective-cohort-studies-investigation-pot-1", "reader_count"=>74, "reader_count_by_academic_status"=>{"Unspecified"=>3, "Librarian"=>2, "Researcher"=>12, "Student > Doctoral Student"=>9, "Student > Ph. D. Student"=>9, "Student > Postgraduate"=>2, "Student > Master"=>18, "Other"=>4, "Student > Bachelor"=>14, "Lecturer > Senior Lecturer"=>1}, "reader_count_by_user_role"=>{"Unspecified"=>3, "Librarian"=>2, "Researcher"=>12, "Student > Doctoral Student"=>9, "Student > Ph. D. Student"=>9, "Student > Postgraduate"=>2, "Student > Master"=>18, "Other"=>4, "Student > Bachelor"=>14, "Lecturer > Senior Lecturer"=>1}, "reader_count_by_subject_area"=>{"Unspecified"=>5, "Agricultural and Biological Sciences"=>5, "Environmental Science"=>2, "Nursing and Health Professions"=>7, "Biochemistry, Genetics and Molecular Biology"=>1, "Mathematics"=>3, "Medicine and Dentistry"=>26, "Neuroscience"=>7, "Pharmacology, Toxicology and Pharmaceutical Science"=>1, "Sports and Recreations"=>1, "Psychology"=>10, "Social Sciences"=>4, "Immunology and Microbiology"=>2}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>26}, "Social Sciences"=>{"Social Sciences"=>4}, "Sports and Recreations"=>{"Sports and Recreations"=>1}, "Psychology"=>{"Psychology"=>10}, "Mathematics"=>{"Mathematics"=>3}, "Unspecified"=>{"Unspecified"=>5}, "Environmental Science"=>{"Environmental Science"=>2}, "Pharmacology, Toxicology and Pharmaceutical Science"=>{"Pharmacology, Toxicology and Pharmaceutical Science"=>1}, "Neuroscience"=>{"Neuroscience"=>7}, "Immunology and Microbiology"=>{"Immunology and Microbiology"=>2}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>5}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>7}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>1}}, "reader_count_by_country"=>{"Greece"=>1, "Netherlands"=>1, "Japan"=>1, "United Kingdom"=>1}, "group_count"=>6}

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/1946157"], "description"=>"<p>Meta-analysis for ever smoking and risk of A) all-cause dementia, B) Alzheimer’s disease and C) vascular dementia.</p>", "links"=>[], "tags"=>["Potential Effect Modifiers BackgroundPrevious studies", "20 cigarettes", "rr", "smoking cessation decreases", "survival bias", "risk estimates", "study location", "FindingsThe PubMed", "criteria difference", "found.ConclusionsSmokers show", "Psychinfo databases", "ci", "75 years", "risk ratio", "Cochrane library", "65 years", "dementia", "Prospective cohort studies", "ad", "effect modifiers.Methods", "smoker"], "article_id"=>1333805, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Guochao Zhong", "Yi Wang", "Yong Zhang", "Jeff Jianfei Guo", "Yong Zhao"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0118333.g004", "stats"=>{"downloads"=>0, "page_views"=>11, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Meta_analysis_for_ever_smoking_and_risk_of_A_all_cause_dementia_B_Alzheimer_8217_s_disease_and_C_vascular_dementia_/1333805", "title"=>"Meta-analysis for ever smoking and risk of A) all-cause dementia, B) Alzheimer’s disease and C) vascular dementia.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-03-12 02:54:55"}
  • {"files"=>["https://ndownloader.figshare.com/files/1946153"], "description"=>"<p>Meta-analysis for current smoking and risk of A) all-cause dementia, B) Alzheimer’s disease and C) vascular dementia.</p>", "links"=>[], "tags"=>["Potential Effect Modifiers BackgroundPrevious studies", "20 cigarettes", "rr", "smoking cessation decreases", "survival bias", "risk estimates", "study location", "FindingsThe PubMed", "criteria difference", "found.ConclusionsSmokers show", "Psychinfo databases", "ci", "75 years", "risk ratio", "Cochrane library", "65 years", "dementia", "Prospective cohort studies", "ad", "effect modifiers.Methods", "smoker"], "article_id"=>1333801, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Guochao Zhong", "Yi Wang", "Yong Zhang", "Jeff Jianfei Guo", "Yong Zhao"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0118333.g002", "stats"=>{"downloads"=>5, "page_views"=>11, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Meta_analysis_for_current_smoking_and_risk_of_A_all_cause_dementia_B_Alzheimer_8217_s_disease_and_C_vascular_dementia_/1333801", "title"=>"Meta-analysis for current smoking and risk of A) all-cause dementia, B) Alzheimer’s disease and C) vascular dementia.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-03-12 02:54:55"}
  • {"files"=>["https://ndownloader.figshare.com/files/1946152"], "description"=>"<p>The flowchart of identifying relevant studies.</p>", "links"=>[], "tags"=>["Potential Effect Modifiers BackgroundPrevious studies", "20 cigarettes", "rr", "smoking cessation decreases", "survival bias", "risk estimates", "study location", "FindingsThe PubMed", "criteria difference", "found.ConclusionsSmokers show", "Psychinfo databases", "ci", "75 years", "risk ratio", "Cochrane library", "65 years", "dementia", "Prospective cohort studies", "ad", "effect modifiers.Methods", "smoker"], "article_id"=>1333800, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Guochao Zhong", "Yi Wang", "Yong Zhang", "Jeff Jianfei Guo", "Yong Zhao"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0118333.g001", "stats"=>{"downloads"=>0, "page_views"=>8, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_The_flowchart_of_identifying_relevant_studies_/1333800", "title"=>"The flowchart of identifying relevant studies.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-03-12 02:54:55"}
  • {"files"=>["https://ndownloader.figshare.com/files/1946164", "https://ndownloader.figshare.com/files/1946165", "https://ndownloader.figshare.com/files/1946166", "https://ndownloader.figshare.com/files/1946167"], "description"=>"<div><p>Background</p><p>Previous studies showed inconsistent results on the association of smoking with all-cause dementia and vascular dementia (VaD), and are limited by inclusion of a small number of studies and unexplained heterogeneity. Our review aimed to assess the risk of all-cause dementia, Alzheimer’s disease (AD) and VaD associated with smoking, and to identify potential effect modifiers.</p><p>Methods and Findings</p><p>The PubMed, Embase, Cochrane Library and Psychinfo databases were searched to identify studies that provided risk estimates on smoking and incidence of dementia. A random-effects model was used to yield pooled results. Thirty-seven studies were included. Compared with never smokers, current smokers showed an increased risk of all-cause dementia (risk ratio (RR) 1.30, 95% confidence interval (CI) 1.18–1.45), AD (RR 1.40, 95% CI 1.13–1.73) and VaD (RR 1.38, 95% CI 1.15–1.66). For all-cause dementia, the risk increased by 34% for every 20 cigarettes per day (RR 1.34, 95% CI 1.25–1.43). Former smokers did not show an increased risk of all-cause dementia (RR 1.01, 95% CI 0.96–1.06), AD (RR 1.04, 95% CI 0.96–1.13) and VaD (RR 0.97, 95% CI 0.83–1.13). Subgroup analyses indicated that (1) the significantly increased risk of AD from current smoking was seen only in apolipoprotein E ε4 noncarriers; (2) current smokers aged 65 to 75 years at baseline showed increased risk of all-cause dementia and AD compared to those aged over 75 or under 65 years; and (3) sex, race, study location and diagnostic criteria difference in risk of dementia was not found.</p><p>Conclusions</p><p>Smokers show an increased risk of dementia, and smoking cessation decreases the risk to that of never smokers. The increased risk of AD from smoking is more pronounced in apolipoprotein E ε4 noncarriers. Survival bias and competing risk reduce the risk of dementia from smoking at extreme age.</p></div>", "links"=>[], "tags"=>["Potential Effect Modifiers BackgroundPrevious studies", "20 cigarettes", "rr", "smoking cessation decreases", "survival bias", "risk estimates", "study location", "FindingsThe PubMed", "criteria difference", "found.ConclusionsSmokers show", "Psychinfo databases", "ci", "75 years", "risk ratio", "Cochrane library", "65 years", "dementia", "Prospective cohort studies", "ad", "effect modifiers.Methods", "smoker"], "article_id"=>1333812, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Guochao Zhong", "Yi Wang", "Yong Zhang", "Jeff Jianfei Guo", "Yong Zhao"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0118333.s001", "https://dx.doi.org/10.1371/journal.pone.0118333.s002", "https://dx.doi.org/10.1371/journal.pone.0118333.s003", "https://dx.doi.org/10.1371/journal.pone.0118333.s004"], "stats"=>{"downloads"=>2, "page_views"=>11, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Smoking_Is_Associated_with_an_Increased_Risk_of_Dementia_A_Meta_Analysis_of_Prospective_Cohort_Studies_with_Investigation_of_Potential_Effect_Modifiers_/1333812", "title"=>"Smoking Is Associated with an Increased Risk of Dementia: A Meta-Analysis of Prospective Cohort Studies with Investigation of Potential Effect Modifiers", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2015-03-12 02:54:55"}
  • {"files"=>["https://ndownloader.figshare.com/files/1946161"], "description"=>"<p>APOE ε4, apolipoprotein E ε4; NA, not available; BMI, body mass index; IGT, impaired glucose tolerance; NINCDS-ADRDA, DSM-III-R, Diagnostic and Statistical Manual of Mental Disorders, third edition Revised; DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, fourth edition; NINDS-AIREN, National Institute of Neurological Disorders and Stroke-Association Internationale pour la Recherche et l'Enseignement en Neurosciences; GMS-AGECAT, Geriatric Mental State-the Automated Geriatric Examination for Computer Assisted Taxonomy; ICD-8, International Classification of Diseases, Eighth Revision; ADDTC core criteria, Alzheimer’s Disease Diagnostic and Treatment Centers core criteria.</p><p><sup>1</sup> Value refers to mean age of participants at baseline.</p><p><sup>2</sup> Value is expressed as maximum.</p><p><sup>3</sup> Dementia was determined by a battery of neuropsychological measures and a standardized neurological examination.</p><p><sup>4</sup> The term “other” in the “Adjustment factors” column refers to all the confounders except age, sex, education, APOE ε4, BMI, diabetes, alcohol and hypertension.</p><p><sup>5</sup> Value refers to sample size at baseline.</p><p><sup>6</sup> The risk estimates were available just for former smoking and the risk of all-cause dementia and AD.</p><p>Characteristics of 37 included studies regarding smoking and risk of dementia.</p>", "links"=>[], "tags"=>["Potential Effect Modifiers BackgroundPrevious studies", "20 cigarettes", "rr", "smoking cessation decreases", "survival bias", "risk estimates", "study location", "FindingsThe PubMed", "criteria difference", "found.ConclusionsSmokers show", "Psychinfo databases", "ci", "75 years", "risk ratio", "Cochrane library", "65 years", "dementia", "Prospective cohort studies", "ad", "effect modifiers.Methods", "smoker"], "article_id"=>1333809, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Guochao Zhong", "Yi Wang", "Yong Zhang", "Jeff Jianfei Guo", "Yong Zhao"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0118333.t001", "stats"=>{"downloads"=>4, "page_views"=>66, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Characteristics_of_37_included_studies_regarding_smoking_and_risk_of_dementia_/1333809", "title"=>"Characteristics of 37 included studies regarding smoking and risk of dementia.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2015-03-12 02:54:55"}
  • {"files"=>["https://ndownloader.figshare.com/files/1946159"], "description"=>"<p>Each circle represents an individual study. The area of circle is proportional to the inverse variance of logrr. RR, risk ratio.</p>", "links"=>[], "tags"=>["Potential Effect Modifiers BackgroundPrevious studies", "20 cigarettes", "rr", "smoking cessation decreases", "survival bias", "risk estimates", "study location", "FindingsThe PubMed", "criteria difference", "found.ConclusionsSmokers show", "Psychinfo databases", "ci", "75 years", "risk ratio", "Cochrane library", "65 years", "dementia", "Prospective cohort studies", "ad", "effect modifiers.Methods", "smoker"], "article_id"=>1333807, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Guochao Zhong", "Yi Wang", "Yong Zhang", "Jeff Jianfei Guo", "Yong Zhao"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0118333.g005", "stats"=>{"downloads"=>0, "page_views"=>16, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_LogRR_of_A_all_cause_dementia_and_B_Alzheimer_8217_s_disease_by_the_mean_age_at_baseline_/1333807", "title"=>"LogRR of A) all-cause dementia and B) Alzheimer’s disease by the mean age at baseline.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-03-12 02:54:55"}
  • {"files"=>["https://ndownloader.figshare.com/files/1946160"], "description"=>"<p>The solid line represents the linear trend and lines with short dashes represent its’ 95% confidence interval.</p>", "links"=>[], "tags"=>["Potential Effect Modifiers BackgroundPrevious studies", "20 cigarettes", "rr", "smoking cessation decreases", "survival bias", "risk estimates", "study location", "FindingsThe PubMed", "criteria difference", "found.ConclusionsSmokers show", "Psychinfo databases", "ci", "75 years", "risk ratio", "Cochrane library", "65 years", "dementia", "Prospective cohort studies", "ad", "effect modifiers.Methods", "smoker"], "article_id"=>1333808, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Guochao Zhong", "Yi Wang", "Yong Zhang", "Jeff Jianfei Guo", "Yong Zhao"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0118333.g006", "stats"=>{"downloads"=>1, "page_views"=>16, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_The_linear_dose_8211_response_relationship_plot_between_current_smoking_and_all_cause_dementia_/1333808", "title"=>"The linear dose–response relationship plot between current smoking and all-cause dementia.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-03-12 02:54:55"}
  • {"files"=>["https://ndownloader.figshare.com/files/1946155"], "description"=>"<p>Meta-analysis for former smoking and risk of A) all-cause dementia, B) Alzheimer’s disease and C) vascular dementia.</p>", "links"=>[], "tags"=>["Potential Effect Modifiers BackgroundPrevious studies", "20 cigarettes", "rr", "smoking cessation decreases", "survival bias", "risk estimates", "study location", "FindingsThe PubMed", "criteria difference", "found.ConclusionsSmokers show", "Psychinfo databases", "ci", "75 years", "risk ratio", "Cochrane library", "65 years", "dementia", "Prospective cohort studies", "ad", "effect modifiers.Methods", "smoker"], "article_id"=>1333803, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Guochao Zhong", "Yi Wang", "Yong Zhang", "Jeff Jianfei Guo", "Yong Zhao"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0118333.g003", "stats"=>{"downloads"=>0, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Meta_analysis_for_former_smoking_and_risk_of_A_all_cause_dementia_B_Alzheimer_8217_s_disease_and_C_vascular_dementia_/1333803", "title"=>"Meta-analysis for former smoking and risk of A) all-cause dementia, B) Alzheimer’s disease and C) vascular dementia.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-03-12 02:54:55"}

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  • {"unique-ip"=>"129", "full-text"=>"161", "pdf"=>"22", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"1", "supp-data"=>"7", "cited-by"=>"1", "year"=>"2019", "month"=>"5"}
  • {"unique-ip"=>"225", "full-text"=>"241", "pdf"=>"15", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"8"}
  • {"unique-ip"=>"260", "full-text"=>"292", "pdf"=>"14", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"1", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"9"}
  • {"unique-ip"=>"143", "full-text"=>"201", "pdf"=>"28", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"7", "supp-data"=>"6", "cited-by"=>"0", "year"=>"2019", "month"=>"10"}
  • {"unique-ip"=>"130", "full-text"=>"167", "pdf"=>"20", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"6", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"12"}
  • {"unique-ip"=>"128", "full-text"=>"152", "pdf"=>"13", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"1", "cited-by"=>"0", "year"=>"2020", "month"=>"2"}
  • {"unique-ip"=>"158", "full-text"=>"208", "pdf"=>"17", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"5", "supp-data"=>"2", "cited-by"=>"0", "year"=>"2020", "month"=>"3"}
  • {"unique-ip"=>"138", "full-text"=>"182", "pdf"=>"13", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"5", "supp-data"=>"0", "cited-by"=>"2", "year"=>"2020", "month"=>"4"}
  • {"unique-ip"=>"306", "full-text"=>"381", "pdf"=>"24", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"5", "supp-data"=>"5", "cited-by"=>"2", "year"=>"2020", "month"=>"5"}
  • {"unique-ip"=>"140", "full-text"=>"167", "pdf"=>"17", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"1", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2020", "month"=>"6"}
  • {"unique-ip"=>"177", "full-text"=>"203", "pdf"=>"11", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"8", "cited-by"=>"0", "year"=>"2020", "month"=>"7"}
  • {"unique-ip"=>"335", "full-text"=>"371", "pdf"=>"15", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"22", "supp-data"=>"4", "cited-by"=>"0", "year"=>"2020", "month"=>"8"}
  • {"unique-ip"=>"126", "full-text"=>"160", "pdf"=>"13", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"5", "supp-data"=>"2", "cited-by"=>"2", "year"=>"2020", "month"=>"9"}
  • {"unique-ip"=>"111", "full-text"=>"169", "pdf"=>"14", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"4", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2020", "month"=>"10"}

Relative Metric

{"start_date"=>"2015-01-01T00:00:00Z", "end_date"=>"2015-12-31T00:00:00Z", "subject_areas"=>[]}
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