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Association between serum cotinine levels and cognitive function in Americans aged 60 and older: A cross-sectional
Jieqiong Zhang1, Guanxun Zhang1, Ciai Yan1
1Department of First Clinical School, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang Province, PR China.
Medicine
|May 23, 2026
Summary
Higher cotinine levels, a marker of tobacco exposure, are linked to poorer cognitive function in older US adults. This inverse association appears to have a threshold, with effects diminishing above a certain exposure level.
Area of Science:
- Gerontology and Public Health
- Neuroscience and Toxicology
Background:
- Cognitive decline is a significant public health issue for aging populations.
- Identifying modifiable risk factors for cognitive decline is crucial.
- Cotinine, a nicotine metabolite and biomarker of tobacco exposure, has plausible links to cognitive function.
Purpose of the Study:
- To examine the association between serum cotinine levels and cognitive function in US adults aged 60 years and older.
- To investigate potential nonlinear relationships and thresholds in this association.
Main Methods:
- Cross-sectional study using data from 2781 US adults aged ≥60 years (2011-2014 NHANES).
- Multivariable linear regression, stratified analyses, and restricted cubic splines were employed.
- Sampling weights ensured national representativeness; analyses accounted for complex survey design.
Main Results:
- A significant inverse association was found between serum cotinine levels and cognitive function (β = -0.85, P = 0.034).
- Subgroup and sensitivity analyses confirmed the robustness of these findings.
- An L-shaped relationship was identified, with a threshold at log2cotinine = -0.16, below which the inverse association was significant.
Conclusions:
- Serum cotinine levels are inversely associated with cognitive function in older US adults.
- The association appears to be threshold-dependent, with significant effects below log2cotinine = -0.16.
- Findings contribute to understanding tobacco exposure's impact on cognitive aging.
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