Tobacco use and cognitive impairment: A bibliometric analysis of research trends and knowledge structure

Smoking is recognized as a key preventable risk factor for dementia and has therefore received extensive research attention. However, the relationship between smoking and cognitive impairment is complex, involving methodological controversies such as residual confounding, the nicotine paradox, and selective survival bias. Despite the growing body of evidence, this interdisciplinary field still lacks systematic bibliometric analysis. The purpose of this study is to use bibliometric methods to map the knowledge structure, thematic evolution, and emerging frontiers in smoking and cognitive impairment research.

Using the Web of Science core collection as the data source, 811 relevant English-language articles and reviews published from 1985 to 2026 were analyzed by bibliometrics. This article uses VOSviewer and CiteSpace to conduct co-occurrence and cluster analyses, burst detection, and thematic evolution analysis. It systematically examines the publication trends, collaboration networks, disciplinary distribution, keyword co-occurrence patterns, and research frontiers in this field.

Neuroscience and Public Health constitute the two core hub disciplines. The United States (293 publications), China (213), and England (131) dominate global research output. Keyword co-occurrence analysis revealed a four-dimensional research structure centered on disease outcome, tobacco exposure, epidemiological association, and preventive intervention. Burst detection identifies a three-stage evolution path from disease subtyping and population characteristics to prevention and intervention through mechanism exploration and exposure expansion. Prevention (burst strength = 4.20) and Intervention (3.85) are the keywords with the highest intensity after 2020. Observational studies predominated, while evidence from interventions and participation by low- and middle-income countries remained limited.

The research on tobacco use and cognitive impairment has shifted from risk identification toward intervention validation, but observational research still dominates, and intervention evidence remains limited. Low- and middle-income countries remain under-represented in global evidence production.