The relationship between co-use of tobacco and alcohol and cognitive decline in middle-aged and older Chinese males: A cross-lagged panel network analysis.

Abstract

The co-use of tobacco and alcohol can impair cognitive function, but whether the frequency of this co-use interacts with cognitive decline in middle-aged and elderly Chinese men remains unclear. We analyzed three waves of the China Health and Retirement Longitudinal Study (CHARLS) data (2015, 2018, and 2020). The analytic sample included 2044 individuals who co-used tobacco and alcohol, 1339 who smoked only, and 1714 who drank alcohol only. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) subscale, and smoking and drinking frequencies were calculated separately. Two directed networks were constructed using the cross-lagged panel network (CLPN) model to explore reciprocal relationships between cognitive function and smoking and drinking frequencies, with network centrality metrics identifying key bridging variables. From 2015-2018, higher smoking frequency was associated with poorer memory, and greater alcohol consumption with worse memory and orientation. From 2018-2020, increased alcohol consumption led to declines in attention/calculation and memory, while higher smoking frequency decreased attention/calculation. Additionally, poorer memory was associated with reduced alcohol consumption. Network indices ranked alcohol consumption as the strongest cross-domain driver, and memory as the most affected cognitive node. For middle-aged and older Chinese men who co-use tobacco and alcohol, cognitive abilities-especially memory and attention-are significantly impaired. Some cognitive functions, such as memory, are linked to subsequent alcohol use frequency. Combining smoking and alcohol cessation with cognitive support for memory may help alleviate cognitive aging in this high-risk group.