In plain English
Smoking is causally linked to Vascular Dementia and accelerates Alzheimer's Disease. Stopping at any age substantially reduces risk. UK NHS Stop Smoking Services are free and effective; modern medication including Varenicline doubles the success rate of quit attempts.
Why stopping matters for the brain
Smoking causes vascular damage throughout the body, including the brain. It accelerates Small Vessel Disease, increases stroke risk and contributes to the trajectory of Vascular Dementia and Mixed Alzheimer's and Vascular Dementia. The 2024 Lancet Commission identifies smoking as one of the 14 modifiable dementia risk factors, estimating around 5 per cent of dementia cases worldwide are attributable to smoking.
Stopping at any age substantially reduces vascular risk; cardiovascular risk halves within a year of stopping. Dementia risk reduces over the following 4 to 10 years to approach that of never-smokers in many studies.
How smoking damages the brain
- Vascular damage through atherosclerosis and inflammation;
- Increased blood pressure and heart rate;
- Reduced oxygen delivery to brain tissue;
- Increased risk of stroke (about double in heavy smokers);
- Direct neurotoxicity from carbon monoxide and other constituents;
- Reduced grey matter volume in long-term smokers;
- Worse outcomes after head injury.
The UK Stop Smoking Service
The NHS Stop Smoking Service is free in England, Scotland and Wales. It combines:
- Behavioural support (one-to-one or group sessions);
- Nicotine Replacement Therapy or other medication;
- A structured 12-week programme;
- Follow-up support.
The combination of behavioural support and medication achieves quit rates of 35 to 40 per cent at one year, compared with around 5 per cent unaided.
Medication options
Nicotine Replacement Therapy
Available as patches, gum, lozenges, inhalator, spray and mouth strip. Combining a long-acting patch with a short-acting form (gum or lozenge) is more effective than either alone. Free through the NHS Stop Smoking Service in many areas.
Varenicline
Varenicline (Champix) reduces cravings and the rewarding effect of smoking. The most effective single medication for quitting. Standard course is 12 weeks. Side effects include nausea, vivid dreams and rarely mood changes. Varenicline is back on the UK market after a temporary supply issue.
Bupropion
Bupropion (Zyban) is an alternative to Varenicline. Effective but has more interactions and contraindications.
Cytisine
A newer plant-derived option, increasingly available in the UK.
E-cigarettes
E-cigarettes (vapes) are substantially less harmful than cigarettes and are an effective quit aid. The UK position, supported by Public Health England and NICE, is that adult smokers who switch fully to e-cigarettes substantially reduce their health risks. Some Stop Smoking Services offer e-cigarettes within structured programmes.
E-cigarettes are not risk-free, and the long-term effects are still being studied. The aim is full transition rather than long-term dual use of cigarettes and e-cigarettes.
For people with established dementia
Stopping smoking remains beneficial at any stage. Practical challenges in moderate to severe dementia:
- Forgetting to use Nicotine Replacement Therapy;
- Forgetting that smoking has stopped, leading to renewed attempts;
- Fire safety with continued smoking (cigarettes left burning, falling asleep with cigarettes).
Family support, structured routines and removal of cigarettes from the environment all help. Discuss with your memory clinician and GP for an individualised plan.
Where to get help in the UK
- NHS Smokefree (England): 0300 123 1044 or nhs.uk/smokefree;
- Quit Your Way Scotland: 0800 84 84 84;
- Help Me Quit (Wales): 0800 085 2219;
- Stop Smoking NI: 0808 812 8008;
- Your local pharmacy or GP practice.
Frequently asked questions
Is it worth stopping in my seventies or eighties?
Yes. Cardiovascular benefits accrue within months. Dementia risk reduction takes longer but is real. The earlier the better, but it is never too late.
Are e-cigarettes a good way to stop?
Yes, for adult smokers. UK public health bodies support e-cigarettes as a quit aid, substantially less harmful than cigarettes. Full switching is the aim.
Does Varenicline cause depression?
Initial concerns about mood effects have not been borne out in large trials. People with significant mental health conditions can usually take Varenicline safely under medical supervision.
How long does the urge to smoke last?
Acute urges typically peak in the first 3 to 4 weeks. Cravings reduce substantially over 3 months and largely fade by 6 to 12 months for most people.
Can a person with dementia use Nicotine Replacement Therapy?
Yes, with carer support. Patches are simpler than gum or lozenges, as they do not depend on remembered use through the day.
References
- NICE NG209: Tobacco: preventing uptake, promoting quitting and treating dependence.
- Hartmann-Boyce J et al. E-cigarettes for smoking cessation. Cochrane Database 2024.
- Anstey KJ et al. Smoking as a risk factor for dementia. Am J Epidemiol 2007.
- Public Health England. E-cigarettes: a new foundation for evidence-based policy 2018.