Smoking Impairs Womens Verbal Learning and Memory Performance More than Mens: An International Web-Cohort Study of 70,000 Participants
Background: Vascular contributions to cognitive impairment and dementia (VCID) include structural and functional blood vessel injuries linked to poor neurocognitive outcomes. Smoking might indirectly increase the likelihood of cognitive impairment by exacerbating the risks associated with underlying vascular disease. Sex disparities in VCID have been reported, however, few studies have assessed the sex-specific impact of smoking on cognitive function and with contradictory results. This is an important topic since smoking and cardiovascular disease negatively impact health and possibly women have the greater lifetime risk of stroke and dementia than men. In this study, we sought to investigate the effect-modification of sex on the relationship between smoking, cardiovascular disease and verbal learning and memory function. Methods: Using MindCrowd, a web-based cohort of over 70,000 people aged 18 - 85, we investigated whether sex modifies the impact of smoking and cardiovascular disease on verbal memory performance on a paired-associate learning task using both multiple regression and propensity matching approaches. Artificial error introduction and permutation testing underscored the stability of our results. To demonstrate the necessity of large sample sizes to detect an interaction of sex and smoking, we performed down sampling analyses. Findings: We found significant interactions in that smoking impacts verbal learning performance more in women and cardiovascular disease more in men across a wide age range. Interpretation: These results suggest that smoking and cardiovascular disease impact verbal learning and memory throughout adulthood. Smoking particularly affects learning and memory in women and cardiovascular disease has a larger effect in men. Although the reasons for these sex-modification effects are not entirely understood, our findings highlight the importance of considering biological sex in VCID.