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Cloudy Thoughts: Vaping and Brain Health

Smoking has been associated with cognitive decline and an increased risk of dementia in later age (1). While vaping can help with quitting smoking and reducing the health risk associated with it, the practice is not harmless (2), and its popularity and uptake among non-smokers raises concerns about its potential impact on brain health.  


The addictive nature of nicotine raises concerns, especially with the increasing popularity of vaping among non-smokers, particularly adolescents, who are nearly three times more likely to transition to traditional smoking if they engage in vaping (4,5,6).   


Emerging research suggests a troubling correlation between e-cigarette use and mental health issues, including depression. Adolescents, with their vulnerable, developing brains, are particularly at risk. Nicotine poses harm to their developing brains, impacting attention, learning, mood, impulse control, and cognition (8).


Studies on tobacco have demonstrated the harmful impact of nicotine on the cardiovascular system, a critical component of overall brain health. Among nonsmokers that uptake vaping the increasing risk of cardiovascular disease has been shown, although the evidence is still insufficient, and more long-term studies are needed (10).   


Electronic Non-Nicotine Delivery Systems (ENNDS) are less regulated in the UK compared to nicotine systems, and certain products labeled as nicotine-free ENNDS have been discovered to contain nicotine (1). Furthermore, the aerosols they emit, rich in particulate matter and potentially toxic substances, paint a worrying picture of indoor air quality and its impact on our health (3,10). 


Nicotine's impact on adult cognition is a complex interplay that seems to be influenced by several factors. However, it's important to note that while some studies hint at potential cognitive benefits, more research is needed to fully elucidate the role of nicotine, especially in the context of older age and conditions like dementia (11,12). The complex nature of nicotine's impact on cognition underscores the necessity for comprehensive studies to guide any potential therapeutic applications or interventions.  

As we navigate this foggy landscape, one thing remains clear: the need for a deeper understanding of the complex interplay between vaping and brain health.


  1. Livingston G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet. 2020;396(10248): 413–446. 

  2. McNeill, A, Simonavičius, E, Brose, LS, Taylor, E, East, K, Zuikova, E, Calder, R and Robson, D (2022). Nicotine vaping in England: an evidence update including health risks and perceptions, September 2022. A report commissioned by the Office for Health Improvement and Disparities. London: Office for Health Improvement and Disparities. 

  3. World Health Organization. Tobacco: e-cigarettes. 2024 Available at 

  4. Soneji S, Barrington-Trimis JL, Wills TA, et al. Association between initial use of e-cigarettes and subsequent cigarette smoking among adolescents and young adults: a systematic review and meta-analysis.  JAMA Pediatr. 2017;171(8):788-797. doi:10.1001/jamapediatrics.2017.1488 

  5. Watkins SL, Glantz SA, Chaffee BW.  Association of noncigarette tobacco product use with future cigarette smoking among youth in the population assessment of tobacco and health (PATH) study, 2013-2015.  JAMA Pediatr. 2018;172(2):181-187. doi:10.1001/jamapediatrics.2017.4173 

  6. Lechner WV, Janssen T, Kahler CW, Audrain-McGovern J, Leventhal AM. Bi-directional associations of electronic and combustible cigarette use onset patterns with depressive symptoms in adolescents. Preventive Medicine 2017; 96:73-78. 

  7. Obisesan OH, Mirbolouk M, Osei AD, et al. 2019. Association Between e-Cigarette Use and Depression in the Behavioral Risk Factor Surveillance System, 2016-2017. JAMA Network Open. 2019;2(12): e1916800. 

  8. U.S. Department of Health and Human Services. E-Cigarette Use Among Youth and Young Adults. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2016. Available at 

  9. Becker TD, Arnold MK, Ro V, Martin L, Rice TR. Systematic Review of Electronic Cigarette Use (Vaping) and Mental Health Comorbidity Among Adolescents and Young Adults. Nicotine & tobacco research: official journal of the Society for Research on Nicotine and Tobacco. 2020;23(3): 415–425. 

  10. Banks AM, E. et al. Electronic cigarettes and health outcomes: umbrella and systematic review of the global evidence. 2023. 

  11. Nop O, Senft Miller A, Culver H, Makarewicz J, Dumas JA. Nicotine and Cognition in Cognitively Normal Older Adults. Frontiers in aging neuroscience. 2021;13: 640674. 

  12. Wang Q, Du W, Wang H, Geng P, Sun Y, Zhang J, et al. Nicotine’s effect on cognition, a friend or foe? Progress in neuro-psychopharmacology & biological psychiatry. 2023;124: 110723. 



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