Association between smoking behavior and cognitive functioning in patients with psychosis, siblings, and healthy control subjects: Results from a prospective 6-year follow-up study

Jentien M. Vermeulen*, Frederike Schirmbeck, Matthijs Blankers, Mirjam Van Tricht, Richard Bruggeman, Wim Van Den Brink, Lieuwe De Haan, Therese Van Amelsvoort, Behrooz Z. Alizadeh, Agna A. Bartels-Velthuis, Nico J. Van Beveren, Wiepke Cahn, Philippe Delespaul, Carin J. Meijer, Inez Myin-Germeys, Rene S. Kahn, Claudia J.P. Simons, Neeltje E. Van Haren, Jim Van Os, Ruud Van Winkel

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Objective: The high prevalence of smoking and cognitive deficits in schizophrenia patients is well known, but findings regarding the association between the two are contradictory, and longitudinal studies are lacking. The authors sought to examine the multi-cross-sectional association between smoking behavior and performance in specific cognitive domains and the longitudinal association between change in smoking behavior and change in cognitive functioning in a large prospective study. Method: The authors conducted a cohort study of patients with nonaffective psychosis (N=1,094), their siblings (N=1,047), and healthy control subjects (N=579). At baseline and at 3-and 6-year follow-ups, smoking behavior was assessed with the Composite International Diagnostic Interview and cognitive functioning with a test battery. Multivariate linear mixed-effects regression analyses were conducted to assess associations between smoking and cognitive domains while adjusting for variation in demographic factors, psychopathology, medication, and substance use. Bonferroni correction for multiple testing was applied. Results: At baseline, 66.6% of the patients smoked, compared with 38.3% of the siblings and 25.2% of the control subjects. Significant multi-cross-sectional associations were found between smoking and lower processing speed in the patient and control groups compared with the nonsmoking patient group (estimate=22.38, SE=0.84) and the nonsmoking control group (estimate=23.13, SE=1.06). In siblings, smoking was significantly associated with lower performance in working memory and reasoning and problem solving compared with nonsmoking. Also, the number of cigarettes smoked per day was negatively associated with these domains. Patients, but not siblings and control subjects, who quit smoking showed a significant improvement in processing speed (estimate=4.90, SE=1.73). Conclusions: The study findings indicate that smoking is associated with poorer cognitive performance in patients, their siblings, and healthy control subjects compared with nonsmoking. Smoking cessation may improve processing speed in patients.

Original languageEnglish
Pages (from-to)1121-1128
Number of pages8
JournalAmerican Journal of Psychiatry
Issue number11
Publication statusPublished - Nov 2018
Externally publishedYes

Bibliographical note

Funding Information:
The infrastructure for the GROUP study is funded through the Geestkracht program of the Dutch Health Research Council (ZonMw, grant number 10-000-1001), and matching funds from participating pharmaceutical companies (Lundbeck, AstraZeneca, Eli Lilly, Janssen-Cilag), universities, and mental health care organizations (Amsterdam: Academic Psychiatric Center of the Academic Medical Center and the mental health institutions GGZ Ingeest, Arkin, Dijk en Duin, GGZ Rivierduinen, Erasmus Medical Center, GGZ Noord Holland Noord. Groningen: University Medical Center Groningen and the mental health institutions Lentis, GGZ Friesland, GGZ Drenthe, Dimence, Mediant, GGNet Warnsveld, Yulius Dordrecht and Parnassia Psycho-Medical Center The Hague. Maastricht: Maastricht University Medical Center and the mental health institutions GGzE, GGZ Breburg, GGZ Oost-Brabant, Vincent van Gogh voor Geestelijke Gezondheid, Mondriaan, Virenze riagg, Zuyderland GGZ, MET ggz, Universitair Centrum Sint-Jozef Kortenberg, CAPRI University of Antwerp, PC Ziekeren Sint-Truiden, PZ Sancta Maria Sint-Truiden, GGZ Overpelt, OPZ Rekem. Utrecht: University Medical Center Utrecht and the mental health institutions Altrecht, GGZ Centraal, and Delta.) The authors thank all the research personnel involved in the GROUP project, and in particular Joyce van Baaren, Erwin Veermans, Ger Driessen, Truda Driesen, Karin Pos, Erna van ’t Hag, Jessica de Nijs, Atiqul Islam, Wendy Beuken, and Debora Op ’t Eijnde. They also thank the participating patients, their families, and the healthy subjects for their time and effort.

Publisher Copyright:
© 2018 American Journal of Psychiatry. All rights reserved.


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