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Smoking, alcohol and your brain

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Two risk factors worth a closer look

Smoking and alcohol use appear on every international list of modifiable dementia risk factors.

Neither is always discussed with much nuance. Smoking advice can become a lecture, while research on alcohol and dementia has produced findings that are easy to overinterpret.

Here is what the evidence actually tells us — and what you can do with it.

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Does smoking affect memory?

Yes. Smoking is named in both the guidance from the World Health Organization (WHO) and list from the Lancet Commission.

The reasons are well understood. Smoking damages blood vessels, including the small vessels that supply the brain, and increases the risk of stroke. It also contributes to inflammation and oxidative stress.

The brain depends on a steady supply of blood and oxygen. Damage to the blood vessels over time can affect how well the brain functions.

Is it too late to quit?

No. There are benefits to quitting at any point.

The health risks associated with smoking begin to decline after you stop. Research suggests that people who quit smoking can move closer to the risk profile of people who never smoked, including those who quit later in life.

That is worth knowing. Quitting is not about undoing every effect of smoking. It is about reducing your risk from this point forward.

It is never too late to quit.

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Where to get help quitting

Most people who quit successfully have tried to quit before. In other words, a previous attempt isn't proof that you can't quit, it's part of practicing and learning what works for you.

Call 1-800-QUIT-NOW (1-800-784-8669) to reach your state's quitline. It's free, and it connects you with a trained counselor, a personalized quit plan and information about medications that help.

Counseling combined with medication can be more effective than either approach alone. Talk with your doctor about using both together.

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How much alcohol is too much?

Heavy drinking is clearly harmful to the brain. This has never been in dispute.

It can damage brain tissue, interfere with vitamin B1 absorption, disrupt sleep, raise blood pressure and increase the risk of falls and head injuries.

Alcohol can also interact with medications, particularly those that cause drowsiness. In older adults, combining alcohol with sleep medications or anti-anxiety medications can increase the risk of confusion, falls and other adverse effects.

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What about moderate drinking?

You have probably read that a glass of red wine protects your brain. That claim deserves a careful answer rather than a confident one in either direction.

The claim came from observational studies that found moderate drinkers had better outcomes than both heavy drinkers and non-drinkers. The problem was the people in the non-drinking group. This group included lifelong abstainers, but it also included people who stopped drinking because they became ill. Comparing drinkers against a group with people who were unwell makes drinking look better than it is.

When researchers account for this, the apparent benefit shrinks considerably.

Guidance has moved accordingly. The position of the World Health Organization is that no level of alcohol consumption is safe for health overall. What does this mean in practice? If you drink moderately and enjoy it, there is no need to be alarmed. However, alcohol is not considered a health measure. Put simply, there is no evidence drinking alcohol will benefit your brain.

What if cutting down is hard?

What if cutting down on alcohol is difficult? Tell someone you trust. Recognizing you need support is a practical step, not a judgment.

If you are physically dependent on alcohol, stopping suddenly can be dangerous. Withdrawal can cause seizures and other serious complications, so medical supervision may be necessary. If you think you may be dependent, talk with a healthcare professional before stopping abruptly.

The Substance Abuse and Mental Health Service (SAMHSA) National Helpline is 1-800-662-4357. It is free, confidential, available 24 hours a day in English and Spanish, and it will connect you with local treatment options.

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A Latina woman in her seventies swimming in the sea at dawn

What should you do next?

If you smoke, the quitline number above is a good place to start.

If you drink and are unsure whether it may be affecting you, try keeping an honest record of what you drink for a week. It can give you a clearer picture without requiring anyone else’s involvement.

And if you want to know where your memory stands today, establishing a baseline gives you something to measure over time. Memory Exam is a 10–15 minute verbal assessment you can take at home.

Memory Exam is a screening tool, not a diagnosis. Results should be discussed with a qualified doctor or healthcare professional when appropriate.

Where this information comes from

  • World Health Organization. Risk Reduction of Cognitive Decline and Dementia: WHO guidelines, Second edition. July 2026.
  • Livingston G, et al. Dementia Prevention, Intervention, and Care: 2024 Report of the Lancet Standing Commission. The Lancet 2024.
  • U.S. Centers for Disease Control and Prevention. National Tobacco Quitline, 1-800-QUIT-NOW.
  • Substance Abuse and Mental Health Services Administration. National Helpline, 1-800-662-HELP (4357).