Hidden risks from smoking now include dementia

CANCER, stroke and heart disease are well documented but not many are aware of the direct links between tobacco and the raised incidence of dementia in an ageing population, writes Valerie Smith

Many people continue to smoke despite knowing the risks of cancer, heart disease and strokes. Picture: AFP/GettyImages

The fact that smoking kills is so deeply embedded in our political, social and cultural landscape that it has largely lost the power to shock. Tobacco may cause more deaths than drugs, alcohol, suicide and road accidents together, but that’s not really news any more.

Less familiar is the frequency with which a smoking-related death only occurs after many years of debilitating illness. That awkward fact doesn’t get so much airtime.

Building the discussion of smoking’s impact on quality of life, and the ability to live well, requires us to consider the links with other areas of public health.

Dementia, on the other hand, is very newsworthy, with around 85,000 people in Scotland currently affected by the condition a number expected to double in the next 25 years. Concerns centre not just on the potentially devastating impact on individuals and families but for the predicted pressures on future health and social care.

Rightly we are concerned to get the best standard of care for people living with dementia. Understandably great effort is devoted to scientific research as to how the condition develops, and thus how it might one day be cured. Yet at the same time dementia prevention remains the poor relation, even though we already have good evidence that it works.

Buried within the projections of increasing dementia rates lies an interesting detail. Increasing age is the main risk factor for dementia, so that the overall number of dementia cases is expected to grow along with the number of older people. At the same time the likelihood of any particular individual of a certain age contracting dementia is going down, due to improvements in other risk factors.

The risk of developing dementia is up to 70 per cent higher in current heavy smokers than in non-smokers but decreases substantially upon stopping smoking. So the ongoing reduction in the smoking rate is already helping to reduce overall dementia rates, and achieving Scotland’s target of a 5 per cent smoking rate by 2034 will make a significant inroad into those additional cases, reduce the number of families affected by dementia and help to save on care costs into the future.

Yet while the connections between smoking and cancer, stroke and heart disease are well known, the general public, including most smokers, are relatively unaware of the link with dementia and the risk that smokers take with every cigarette. Even amongst professionals aware of the connection, there is still work to do to develop the narrative which highlights the avoidable lifestyle risks without allowing any suggestion of blaming people for their illness – a presentation that cancer, stroke and heart disease charities have learned to deliver with ease.

Those of us who want to see smoking restricted to those informed adults who freely choose to do so would have to question whether anyone unaware of the dementia link could properly be described as fully informed of the harm caused by smoking.

Were we to complement the strong laboratory research into dementia with some social research and engagement, we could learn more about how smokers respond to information about the dementia risk. Having seen surveys indicating that people are now more concerned about dementia than cancer, it is reasonable to conclude that awareness of the dementia link would leave many smokers more inclined to quit.

There are other behaviours which impact on an individual’s risk of developing dementia, including diet, exercise and mental activity. Taken together these make a strong case for a joined up approach on dementia prevention – adding to the good work on dementia care and research for dementia cure to finally represent a comprehensive response to dementia.

Every dementia case avoided makes a huge difference to the lives of an individual and their family.

So much so that reducing the overall dementia rate will bring huge benefits to society in the decades to come.

So Ash Scotland is calling for a dementia prevention strategy. This should put dementia prevention on the same level as for cancer, stroke and heart disease, learn from successful campaigns in those areas and make a similar contribution to the ongoing health and well-being of people in Scotland.

• Valerie Smith is senior executive officer at Ash Scotland, www.ashscotland.org.uk