Smoking and the Risk of Cognitive Decline and Dementia: Implications and Prevention Strategies

Abstract Smoking is a well-established risk factor for numerous health problems, including cardiovascular and respiratory diseases. In recent years, a growing body of evidence has demonstrated a strong link between smoking and an increased risk of dementia, including Alzheimer’s disease and vascular dementia. This narrative review synthesizes the epidemiological literature that consistently links tobacco smoking with an elevated risk of dementia, drawing on prospective cohort studies, meta-analyses, and population-based registries to quantify the magnitude of this association across diverse demographic groups. It further evaluates the biological plausibility of smoking-induced cognitive decline by examining vascular injury, oxidative stress, neuroinflammation, and nicotine-mediated disruption of cholinergic pathways as convergent mechanisms that accelerate neurodegeneration. By contextualizing these findings within a public health framework, the review underscores smoking as a uniquely modifiable risk factor whose mitigation could appreciably curb the projected rise in dementia incidence worldwide. Accordingly, it proposes a suite of evidence-based prevention strategies including targeted smoking-cessation programs, integration of cessation counseling into primary care and geriatric services, policy-level interventions such as taxation and smoke-free legislation, and culturally tailored health promotion campaigns to maximize uptake and sustain abstinence, thereby contributing to a measurable reduction in the global dementia burden.