The impact of smoking cessation on prospective memory.

1. The impact of smoking cessation on prospective memory. UKNSCC, Manchester, June 2015 Dr Thomas Heffernan Department of Psychology, Northumbria University, Newcastle Upon Tyne. NE1 8ST. Tel. 0191 227 4037 Email: tom.heffernan@northumbria.ac.uk

2. Introduction (1) Tobacco smoking ~ global health concern associated with a range of deleterious long-term outcomes. Including ~ increased incidence of array of cancers, respiratory complications, coronary heart disease (World Health Organisation). Last fewdecades ~ greater understanding of impact persistent tobacco smoking upon the brainand associated cognitive function. Smoking-relatedmemory decline linked with increased accelerated cerebral degeneration,structural deficits several cortical and subcortical regions that mediate memory. Memory deficits include working memory andattention (Gallinat et al. 2006; Nooyens et al. 2008; Durazzoet al. 2012). Much less is known about impact smoking has upon everyday memory.

3. Introduction (2) Prospective memory (PM) ~ cognitive ability to remember to carry out activity at some future point in time (Brandimonte et al., 1996). PM important aspect of day-to-day memory, e.g. remembering to meet with friends, to pay a bill on time, or take an important medication on time. PM is important because the successful management of everyday tasks is crucial to independent living. Research has shown PM may be impaired by persistent smoking (e.g., Heffernan et al., 2005, 2012, 2013; Rash, 2007). Much less is known about what impact smoking cessations has upon PM. Does smoking cessation lead to improved PM performance? Aim of Study Presented Here.

4. Method Sample: 100 HE students (18-30yrs) canvassed; 43 omitted following screening, leaving 57: 21 active (current) smokers (the AS group) 20 never-smokers (the NS group) 16 previous smokers (the PS group) Measures: Drug-Use Questionnaire ~ measures smoking indices/other drug use. Prospective and Retrospective Memory Questionnaire (PRMQ) measured long and short-term PM lapses (Crawford et al., 2003) ~ higher score = more PM lapses. Cambridge Prospective Memory Test ~ time & event-based PM (Wilson et al., 2005) ~ higher scores = more proficient their PM. Hospital Anxiety & Depression Scale ~ general mood (Zigmond& Snaith, 1983). National Adult Reading Test ~ short measure of verbal IQ (Nelson 1982). Age, alcohol indices, mood and IQ included as covariates in analysis.

5. Results Table 1: Means for age, units/week, Table 2: Means for LTPM & STPM, CAMPROMPT anxiety and depression scores. Time-based, Event-based & Total scores. Series of ANCOVAs (controlling for age, units/week, mood and IQ) revealed: No significant impact of group on LTPM (F(2,49)=.220, p=.819) or STPM (F(2,49)=.040, p=.961). Was a significant impact of group on Time-based (F(2,49)=20.8, p<.001) and Event-based (F(2,49)=37.7, p<.001) CAMPROMPT scores. Comparisons revealed NS group recalled sig. more Time-based items than PS and AS groups (p<.05), with PS group sig. more items than AS groups (p<.05). Also, sig. more Event-based items for NS and PS groups compared with AS (p<.05), with no sig. difference between NS and PS groups.

6. Conclusions: Self-reported PM lapses (STPM/LTPM) ~ no sig differences between groups. On objective measure of CAMPROMPT: Active Smokers ~ greater time/event deficits ~ supports previous evidence on effects of chronic smoking on memory. Smoking cessation ~ improvements in both time and event based PM when compared with AS ~ suggests everyday memory improvements with cessation. Discrepancy between self-reported lapses and objective PM findings? Explanations: ~ tobacco smoke >50 toxic chemicals ~ damage structures? ~ such as hippocampus (Ghosh et al., 2009). ~ long-term smoking associated with cortical thinning (Karama et al., 2015). ~ including medial temporal and prefrontal cortices – supporting cognition.

7. Wider Implications & Future Research Everyday cognitive consequences persistent smoking used in health campaigns about dangers of smoking beyond health indices! Improvements in everyday PM also used in smoking-cessation campaigns. Impact of everyday task performance should be assessed. Do specific cessation methods work more effectively (e-cigs) over others? Future Research: ~ Length of cessation and improvements in PM in larger cohort needed. ~ Synergistic effect of smoking and drinking upon health and cognition. ~ Smoking and smoking cessation in children ~ neuro-cognitive development still occurring at this stage (Spear, 2013). ~ impact of second-hand smoking on health/cognition explored further.

8. Planned Research • Does the type of smoking pattern (‘social’ Vs ‘daily’) matter when it comes to cognitive deficits? • A long, hard look at the efficacy of e-cigarettes. • Why do some people persist and some relapse when it some to smoking cessation ~ a qualitative approach. • The impact of SHS on health and cognition (including PM) in adults and adolescents. • “Double Whammy” effects ~ mixing tobacco smoking with other substances.

9. Cross disciplinary research could pursue a myriad of potential projects stemming from this initial research. Thank You! Any Questions?

10. References Brandimonte M, Einstein GO, McDaniel MA. (1996). Prospective Memory: Theory and Applications. Lawrence Erlbaum Associates: USA. Crawford J, Smith G., Maylor E, et al. (2003). The Prospective and Retrospective Memory Questionnaire (PRMQ): Normative data and latent structure in a large non-clinical sample. Memory, 11(3), 261-275. Durazzo TC, Insel PS, Weiner MW. (2012). Greater regional brain atrophy rate in healthy elderly subjects with a history of cigarette smoking. Alzheimer and Dementia, 8, 513–519. Gallinat J, Meisenzahl E, Jacobsen LK, et al., (2006). Smoking and structural brain deficits: a volumetric MR investigation. European Journal of Neuroscience, 24, 1744–1750. Ghosh D, Mishra MK, Das S, Kaushil DK, Basu A. (2009). Tobacco carcinogen induces microglial activation and subsequent neuronal damage. Journal of Neurochemistry 110, 1070–1081 Heffernan TM, Ling J, Parrott AC, et al. (2005). Self-rated every day and prospective memory abilities of cigarette smokers and non smokers: a web based study. Drug and Alcohol Dependence, 78: 235-41. Heffernan TM, O’Neill T, Moss M. (2012). Does persistent smoking impair real world everyday prospective memory? Drug and Alcohol Dependence, 120, 1–6.

11. References Heffernan T.M. O'Neill, T.S, Moss M. (2013). Smoking-related prospective memory deficits observed on naturalistic everyday memory task. Irish Journal of Psychological Medicine, 30(01), 21-27. Karama S, Ducharme S, Corley J, et al. (2015). Cigarette smoking and thinning of the brain’s cortex. Molecular Psychiatry. Nelson, H.E. (1982). The National Adult Reading Test (NART): test manual. NFER-Nelson. Nooyens ACJ, van Gelder BM, Verschuren WMM. (2008). Smoking and cognitive decline among middle-aged men and women: the Doetinchen cohort study. American Journal of Public Health, 98, 1–7. Rash CJ. (2007). The effects of smoking and nicotine withdrawal on prospective memory. Unpublished PhD Dissertation. USA, Louisiana State University. Spear L. (2013). The Teenage Brain Adolescents and Alcohol. Current Directions in Psychological Science, 22(2), 152-157. Wilson BA, Emslie H, Foley J, et al. (2005). The Cambridge Prospective Memory Test. Harcourt-Assessment: London. Zigmond AS, Snaith RP. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavia, 67(6), 361-370.