There is evidence from short-term studies, such as those performed over one day, that nicotine has a positive effect on some aspects of cognitive performance.1,2 However, as described below, despite these effects, people who smoke in the long term are more likely to have certain cognitive deficits compared to non-smokers. The significance of any short-term cognitive benefits to the lives of people who smoke or use e-cigarettes is therefore uncertain.2
The effects of acute nicotine exposure on cognitive performance have been studied for decades using nicotine replacement therapies, nicotine injections and the use of cigarettes or chewing tobacco1,2 and more recently, the use of e-cigarettes.3 These studies usually test the effects of one dose of nicotine stimulation on measurable aspects of cognitive performance such as attention, memory, motor sensory skills or reasoning.1,2 A meta-analysis has found positive effects of nicotine or smoking on fine motor skills, various measures of response time, and short-term episodic memory-accuracy. A strength of this particular meta-analysis was that it minimised the effects of nicotine withdrawal on cognitive benefit of nicotine exposure. Nicotine withdrawal in people who have temporarily abstained is associated with reduced attention and increased distraction, which can be alleviated by nicotine exposure, thus appearing to provide a cognitive benefit. By selecting studies that did not include people who smoke, or that used very short abstinence periods, this meta-analysis minimised the effects of withdrawal relief, to reduce false positive findings.
A more recent systematic review has examined the industry links of the authors of studies of the effects of nicotine on cognitive performance. Most of the reviewed studies concluded that nicotine enhanced cognitive performance, but many had financial conflicts of interest with the tobacco industry or pharmaceutical industry. Only five studies were independent; two of these found mixed effects on attention, two found positive effects on attention and one found positive effects on long-term memory. This review concluded that nicotine does not appear to be associated with consistent cognitive performance effects.1
Some studies have tested the effects of e-cigarette use on cognitive performance, mostly in people who smoke tobacco but have temporarily abstained. An improvement in cognitive performance in these people may come from stabilisation of their mood after relief from nicotine withdrawal, allowing for better concentration on cognitive tasks.3 A review of these studies found only minimal effects of e-cigarette use on cognitive performance in people who smoke. The review did not find evidence for the long-term effects of e-cigarette use on cognitive function in people who do not smoke tobacco.3
Chronic tobacco smoking is associated with decrements in cognitive functioning, including an increased risk of cognitive impairment,4 decreased processing capacity,5 higher impulsivity, and an external locus of control.6 Cardiovascular disease—which is often caused by smoking—is associated with lower memory performance.7 People who use e-cigarettes are more likely to have cognitive deficiencies such as poor academic performance, greater mind-wandering tendencies,8,9 difficulty concentrating, remembering or making decisions,10 compared to non-users.
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References
1. Pasetes SV, Ling PM, and Apollonio DE. Cognitive performance effects of nicotine and industry affiliation: a systematic review. Substance Abuse, 2020; 14:1178221820926545. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32547048
2. Heishman SJ, Kleykamp BA, and Singleton EG. Meta-analysis of the acute effects of nicotine and smoking on human performance. Psychopharmacology, 2010; 210(4):453-69. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20414766
3. Novak ML and Wang GY. The effect of e-cigarettes on cognitive function: a scoping review. Psychopharmacology, 2024; 241(7):1287-97. Available from: https://www.ncbi.nlm.nih.gov/pubmed/38724716
4. Galanis D, Petrovich H, Launer L, Harris T, Foley D, et al. Smoking history in middle-aged and subsequent cognitive performance in elderly Japanese-American men. The Honolulu-Asia aging study. American Journal of Epidemiology, 1997; 145:507–15. Available from: https://www.ncbi.nlm.nih.gov/pubmed/9063340
5. Aleman A, Muller M, de Haan EH, and van der Schouw YT. Vascular risk factors and cognitive function in a sample of independently living men. Neurobiology of Aging, 2005; 26(4):485-90. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15653177
6. Sheffer C, Mackillop J, McGeary J, Landes R, Carter L, et al. Delay discounting, locus of control, and cognitive impulsiveness independently predict tobacco dependence treatment outcomes in a highly dependent, lower socioeconomic group of smokers. American Journal on Addictions, 2012; 21(3):221-32. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22494224
7. Muller M, Grobbee DE, Aleman A, Bots M, and van der Schouw YT. Cardiovascular disease and cognitive performance in middle-aged and elderly men. Atherosclerosis, 2007; 190(1):143-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16488420
8. Augenstein JA, Smaldone AM, Usseglio J, and Bruzzese JM. Electronic Cigarette Use and Academic Performance Among Adolescents and Young Adults: A Scoping Review. Academic Pediatrics, 2024; 24(2):228-42. Available from: https://www.ncbi.nlm.nih.gov/pubmed/37748535
9. Novak ML, Gyawali P, and Wang GY. Association Between E-Cigarettes, Cognition and Mood in Adolescents. Substance Use and Misuse, 2024; 59(12):1820-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/39054646
10. Xie Z, Ossip DJ, Rahman I, O'Connor RJ, and Li D. Electronic cigarette use and subjective cognitive complaints in adults. PLoS One, 2020; 15(11):e0241599. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33137145