TOBACCO AND NEURODEGENERATIVE DISEASES

1. TOBACCO AND NEURODEGENERATIVE DISEASES Mini-Lecture 3 Module :Tobacco and the Nervous System

2. Objectives of the Mini Lecture Goals of Mini Lecture: Provide students with knowledge about the effect of smoking on risk of developing neurodegenerative diseases. Learning Objectives of Mini Lecture: Students will be able to: • Describe the effect of smoking on the risk of developing multiple sclerosis and its progression. • Describe the effect of smoking on Alzheimer’s disease. • Describe the effect of smoking on Parkinson’s disease. • Explain why smoking cessation is important.

3. Contents Core Slides: • Smoking and Multiple Sclerosis Risk • Smoking and MS Progression • Secondhand Smoke and MS • Smoking and Alzheimer’s Disease • Smoking and Parkinson’s Disease • Discussion: Smoking vs. Quitting Optional Slides: • Smoking and MS: Mechanisms (1–2)

4. CORE SLIDES Tobacco and Neurodegenerative Disease Mini Lecture 3 Module: Tobacco and The Nervous System

5. Smoking and MultipleSclerosis Risk • Increased risk of developing multiple sclerosis (MS)1,2 • Increased risk among active smokers2 • Incidence of MS increased with cumulative exposure to smoking2 http://www.elements4health.com/images/stories/conditions/multiple-sclerosis.jpg 1. Hawkes 2007; 2. Mikaeloff 2007

6. Smoking and MS Progression • Relapsing-remitting MS patients continuing to smoke: increased risk of entering secondary progressive phase of disease1 • Increased risk of severe disease 2 http://www.knowledgebase-script.com/demo/admin/attachments/multiple-sclerosis.jpg 1. Hawkes 2007; 2. Mikaeloff 2007

7. Secondhand Smoke and MS • Parental smoking at home: increased risk of first episode of MS in children (2.12 times).1 • Significantly associated with prolonged duration of exposure in older cases. http://www.elements4health.com/images/stories/conditions/myelin-sheath.jpg 1. Mikaeloff 2007

8. Smoking and Alzheimer’s Disease • Most studies show inverse association between smoking and Alzheimer's disease (AD), i.e. protective.1 • However, Rotterdam study shows twice the risk of AD among smokers.2 • Protective association restricted to patients with family history of dementia.1 1. van Duijn et al. 1991; 2. Merchant et al. 1999

9. Smoking and Parkinson’s Disease1 • Patients with Parkinson's disease (PD) observed to smoke less than control subjects • Most studies of cigarette smoking and PD have reported a protective effect of smoking http://www.about-dementia.com/images/ParkinsonsDopamine.jpg 1. van Duijn et al. 1991

10. Discussion: Smoking vs. Quitting • Data on protective effect of smoking on AD and PD is inconclusive. • Moreover, smoking is a known risk factor for many major diseases like stroke, heart disease, etc. • No overall advantage in smoking.

11. OPTIONAL SLIDES Tobacco and Neurodegenerative Disease Mini Lecture 3 Module: Tobacco and The Nervous System

12. Smoking and MS:Mechanisms (1) • Immune stimulation or suppression1 • Direct effect of cigarette smoke components1,2: increased blood-brain permeability • Induces deficiency of interferon gamma producing cells in adenoids of children2 http://2getherwewill.com/yahoo_site_admin/assets/images/mscleros.32502053_std.gif 1. Hawkes 2007; 2. Mikaeloff et al. 2007

13. Smoking and MS:Mechanisms (2) Direct toxic effects on the central nervous system1: • Demyelination by cyanide (cigarette smoke)1 • Axonal degeneration due to nitric oxide2 http://repairstemcell.files.wordpress.com/2009/02/ww5r308_big.jpg 1. Mikaeloff et al. 2007; 2. Hawkes 2007

14. The most important health message a doctor can give to patients is to quit smoking.