Extent of Cigarette Consumption

study฀in฀women.฀These฀women฀smokers฀showed฀a฀better฀improvement฀rate฀in฀various฀ psychiatric฀ categories฀ than฀ the฀ other฀ women฀ patients฀ who฀ did฀ not฀ smoke฀ [80] ,฀ while฀ smoking฀was฀considered฀a฀mood฀elevator฀and฀a฀supportive฀element฀in฀resolving฀daily฀ tasks.฀Tobacco฀consumption฀is฀seen฀to฀correlate฀with฀the฀extent฀of฀dyskinesias,฀commonly฀ affecting฀the฀neck฀and฀upper฀body฀and฀possibly฀triggered฀by฀the฀nicotine-induced฀dop- amine฀secretion฀ [115] .฀In฀more฀severe,฀therapy-resistant฀forms฀of฀schizophrenia,฀which฀ were฀treated฀episode-wise฀with฀antipsychotics,฀smoking฀appears฀to฀be฀associated฀with฀ more฀ pronounced฀ psychopathological฀ symptoms฀ as฀ shown฀ by฀ scores฀ for฀ “Verbal฀ Positive”,฀“Paranoia”฀and฀“Loss฀of฀Function”฀than฀non-smoking฀is฀ [104] .฀However,฀this฀ effect฀is฀no฀longer฀detectable฀30฀days฀after฀discontinuation฀of฀treatment฀with฀antipsychot- ics.฀ On฀ the฀ other฀ hand,฀ neuroleptic-induced฀ parkinsonism฀ is฀ seen฀ less฀ frequently฀ in฀ schizophrenic฀smokers฀and฀can฀also฀be฀rendered฀milder฀by฀high-level฀tobacco฀฀consumption฀ [7,฀13] . Schizophrenic฀patients฀have฀deicits฀in฀neuropsychological฀performance.฀These฀patients฀ also฀ have฀ high฀ rates฀ of฀ smoking฀ and฀ resistance฀ to฀ smoking฀ cessation฀ interventions.฀ Therefore,฀Dolan฀et฀al.฀examined฀whether฀the฀presence฀of฀neuropsychological฀deicits฀prior฀ to฀smoking฀cessation฀treatment฀was฀associated฀with฀smoking฀cessation฀treatment฀failure฀in฀ schizophrenic฀as฀compared฀to฀non-psychiatric฀control฀smokers.฀They฀used฀neuropsycho- logical฀assessments฀which฀were฀performed฀prior฀to฀treatment฀with฀pharmacological฀agents฀ during฀the฀course฀of฀placebo-controlled฀trials฀in฀schizophrenic฀and฀non-psychiatric฀control฀ smokers,฀and฀included฀the฀Wisconsin฀Card฀Sorting฀Test฀WCST,฀a฀Visuospatial฀Working฀ Memory฀ VSWM฀ task,฀ the฀ Stroop฀ Color-Word฀ Test฀ SCWT฀ and฀ the฀ Continuous฀ Performance฀Test฀CPT฀ [116] .฀They฀found฀that฀in฀schizophrenics฀n฀=฀32,฀subjects฀who฀ had฀greater฀deicits฀in฀VSWM฀and฀WCST฀performance฀were฀signiicantly฀less฀likely฀to฀ quit฀ smoking,฀ but฀ this฀ association฀ was฀ not฀ observed฀ in฀ controls฀ n฀ =฀ 40.฀ Differences฀ between฀quitters฀and฀non-quitters฀were฀not฀likely฀related฀to฀atypical฀antipsychotic฀treat- ment฀ or฀ differences฀ in฀ depressive฀ symptoms.฀ No฀ associations฀ between฀ baseline฀ perfor- mance฀on฀CPT฀or฀SCWT฀and฀quit฀status฀were฀found฀in฀either฀group.฀The฀data฀indicate฀that฀ in฀schizophrenics,฀neuropsychological฀deicits฀are฀associated฀with฀smoking฀cessation฀treat- ment฀failure฀ [116] .

7.1.7 Effects of Smoking in Forms of Dementia

Findings฀regarding฀the฀effects฀of฀nicotine฀on฀the฀central฀nervous฀system฀CNS฀are฀in฀some฀ cases฀contradictory,฀with฀smoking฀nicotine฀acting฀as฀both฀an฀anxiolytic฀and฀a฀psycho- stimulant.฀Nicotine฀improves฀the฀number฀of฀words฀recalled฀from฀a฀32-item฀list,฀a฀result฀ which฀is฀consistent฀with฀the฀hypothesis฀that฀the฀alkaloid฀was฀supplying฀additional฀process- ing฀resources฀and฀that฀deployment฀of฀these฀is฀under฀the฀strategic฀control฀of฀the฀subject฀ [117] .฀Additionally,฀nicotine฀may฀improve฀the฀intensity฀feature฀of฀attention฀and฀the฀cogni- tive฀and฀psychomotor฀function฀ [118,฀119] .฀These฀speculations฀are฀supported฀by฀the฀proven฀ fact฀that฀Alzheimer’s฀patients฀show฀a฀loss฀of฀ACh N ฀receptors฀as฀well฀as,฀albeit฀post฀mor- tem,฀reduction฀of฀nicotine฀binding฀to฀cortical฀ACh N ฀receptors฀ [120–122] .฀Loss฀of฀cortical฀ a 4-subunit฀appears฀to฀be฀a฀characteristic฀feature฀of฀neurodegenerative฀dementia฀but฀not฀ dementia฀of฀vascular฀origin฀ [123] .฀The฀cholinergic฀effects฀of฀nicotine฀would฀lead฀one฀to฀ expect฀an฀effect฀in฀Alzheimer’s฀disease.฀The฀assumption฀that฀smoking฀has฀an฀Alzheimer- protective฀effect฀received฀due฀attention฀from฀the฀tobacco฀industry.฀These฀results฀were฀not฀ conirmed฀by฀other฀groups฀ [17,฀124] .฀A฀study฀published฀several฀years฀ago฀revealed฀only฀ negative฀effects,฀so฀that฀the฀question฀of฀whether฀nicotine฀has฀an฀effect฀on฀Alzheimer’s฀ disease฀ remains฀ unanswered฀ [125–127] .฀ Also,฀ in฀ a฀ study฀ in฀ 238฀ Alzheimer’s฀ disease฀ patients,฀no฀signiicant฀association฀was฀found฀between฀smoker฀status฀and฀cognitive฀status฀ [128] .฀ A฀ small฀ number฀ of฀ retrospective฀ studies฀ have฀ reported฀ an฀ inverse฀ relationship฀ between฀Alzheimer’s฀disease฀and฀smoking,฀although฀artefacts฀may฀have฀inluenced฀these฀ evaluations฀ [129] .฀The฀neuroprotective฀effects฀of฀smoking฀recorded฀in฀animal฀experiments฀ are฀thus฀not฀transferable฀to฀humans฀ [130] . Smoking฀nicotine฀is฀also฀claimed฀to฀have฀an฀anti-dementia฀effect,฀although฀no฀evi- dence฀has฀been฀found฀to฀support฀this฀claim฀ [28,฀131] .฀Conversely,฀smoking฀increases฀the฀ risk฀of฀stroke฀based฀on฀microcirculatory฀and฀vasoactive฀reactions฀ [132] ,฀so฀that฀dementia฀ from฀vascular฀aetiologies฀may฀also฀result฀from฀long-term฀smoking฀ [129,฀133] .฀The฀pro- spective฀EURODEM฀study฀involving฀male฀British฀doctors฀over฀the฀age฀of฀65฀is฀based฀on฀ this฀thesis฀and฀early฀results฀are฀available฀ [53,฀129] .฀It฀can฀be฀assumed฀that฀smoking฀tends฀ to฀lead฀to฀premature฀rather฀than฀late-onset฀dementia,฀thus฀exacerbating฀and฀complicating฀a฀ primary฀psychotic฀illness.฀According฀to฀the฀Doll฀study฀ [129] ,฀there฀is฀no฀signiicant฀rela- tionship฀between฀smoking฀and฀any฀form฀of฀dementia฀RR฀0.86;฀95฀CI:฀0.55–1.34.฀The฀ prospective฀ studies฀ summarised฀ in฀ Table฀ 7.3 ฀ clearly฀ show฀ that฀ no฀ protective฀ effects฀ of฀ smoking฀against฀developing฀dementia฀have฀been฀demonstrated,฀to฀date,฀in฀humans.฀Instead,฀ it฀must฀be฀assumed฀that฀smoking฀leads฀to฀the฀accelerated฀outbreak฀of฀dementia.

7.1.8 Smoking and Parkinson’s Disease

Various฀epidemiological฀studies฀have฀suggested฀a฀negative฀association฀between฀cigarette฀ smoking฀and฀the฀risk฀of฀Parkinson’s฀disease฀ [134-137] .฀In฀one฀study฀conducted฀over฀a฀total฀ 30-year฀period,฀the฀rate฀ratios฀95฀conidence฀intervals฀for฀Parkinson’s฀disease฀relative฀ Smoking฀ habits Years฀of฀ observation฀ [n] Alzheimer’s฀disease฀ Different฀forms฀of฀dementia References Cases฀ n฀ OR฀95,฀CI Cases฀ n฀ OR฀95,฀CI S a ฀vs.฀NS 3 34 1.1฀0.5–2.4 46 1.4฀0.8–2.7 [26] S฀vs.฀NS 3 76 0.7฀0.3–1.4 – – [138] S฀vs.฀NS 2 277 1.74฀ 1.21–2.50 400 1.39฀1.03–1.89 [51] Curr฀S฀vs.฀ NS 47 370 0.99฀ 0.78–1.25 473 0.96฀0.78–1.18 [125] b Table 7.3 ฀฀฀Smoking฀and฀inluences฀on฀dementia:฀results฀of฀four฀studies a Not฀including฀smokers฀who฀smoked฀5฀cigarettes฀a฀day฀and฀who฀quit฀1–2฀decades฀ago b Study฀involving฀British฀physicians฀and฀based฀on฀smoker฀status฀during฀the฀last฀10–15฀years฀of฀life฀ Curr฀current