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PREFACE

Assalamu’alaikum Wr Wb, I would like to thank God for his blessing all though my works so I could finish this paper in time. This paper would not been possible without the continued interest and enthusiasm of my family, my incredible friends and so many lecturer whom most grateful. Thanks to lecturer Prof. DR. dr. Adi Hidayat, MS for his guidance and help on this paper. This paper titled “The association with secondhand smoke and mild cognitive disorder in eldery” that I arranged in order to complete my English assignment for subject Medical English 3rd in the Faculty of Medicine Trisakti University. And thanks to my friends for their helps, without their helps and support I would not be able to finish this paper. I apologize for all mistakes that I made in this paper. I hope this paper could be useful for its reader.

Jakarta, January 2011

Mohd Rodzi Bin Rashid 030.08.279

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1 Key Word : Mild Cognitive Impairment. and self reported long term exposure to secondhand tobacco smoke (living with a smoker for 30 years or more) were about 30% more likely to develop dementia over a six year period than those who were not exposed. participants with subclinical carotid artery disease who lived with a smoker for 30 years or more were more likely to develop dementia. cardiovascular disease.ABSTRACT Cognitive impairment and dementia can be related with active smoking as a risk factor. and death. diabetes. The health effects of high levels of exposure to secondhand smoke may be close to those of active smoking. Cardiovascular Disease 2 . In the same study. had no history of cardiovascular disease or dementia. including an increased risk of lung cancer. hypertension. stroke. Dementia. although it is not clear whether exposure to secondhand smoke is also a risk factor. Participants who had never smoked. suggesting a potential interaction between exposure to secondhand smoke and subclinical cardiovascular disease. A preliminary analysis of patients from the Cardiovascular Health Study was carried out and has been widely reported. Secondhand Smoke. Previous findings also suggest that exposure to secondhand smoke may be associated with poor cognitive performance in children and adolescents.

elevated cholesterol. Cigarette smoke contains more than 4. it contains higher concentrations of many of the toxins found in cigarette smoke.000 chemical compounds. Symptoms of MCI may remain stable for years. . language.4 million people (22.1 3 .INTRODUCTION Mild cognitive impairment (MCI) has been diagnosed estimately 5. So. It involves problems with memory. it relatively caused by a few factors such as smoking. When nonsmokers are exposed to secondhand smoke. Secondhand smoke contains more than 50 cancer-causing chemicals. depression. The National Toxicology Program estimates that at least 250 chemicals in secondhand smoke are known to be toxic or carcinogenic. Secondhand smoke is composed of sidestream smoke (the smoke released from the burning end of a cigarette) and exhaled mainstream smoke (the smoke exhaled by the smoker). MCI is an intermediate stage between the expected cognitive decline of normal aging and the more pronounced decline of dementia. Because sidestream smoke is generated at lower temperatures and under different conditions than mainstream smoke.2%) in the United States. progress to Alzheimer's disease or another type of dementia. hypertension. just as there's no single outcome for the disorder. diabetes. they inhale many of the same cancer-causing chemicals that smokers inhale. thinking and judgment that are greater than typical age-related changes. or improve over time. There's no single cause of MCI. this paper will discuss about the correlation of MCI with secondhand smoke as a risk factor. infrequency participant in mentally or socially stimulating activities and lack of physical activities. Even MCI is normal aging processes.

which are described in detail elsewhere.DISCUSSION The survey has been made which the core sample of the English Longitudinal Study of Ageing is limited to adults aged 50 years or more in 2002 and is drawn from the Health Survey for England sample by postcode sector (geographical area). As the scoring of each individual test varied. Non-stimulated saliva samples were collected according to the Health Survey for England’s protocol. but the remaining 4809 participants formed the sample for our analyses because a number of participants were excluded upon particular reasons including a self-reported diagnosis of dementia. Briefly.2 Based on their research.1 4 . to obtain a global cognitive function score was by summing the standardised scores on each neuropsychological test. Immediate and Delayed Verbal Memory. 1 Cognitive impairment was assessed using neuropsychological tests incorporated in the English Longitudinal Study of Ageing. Of 11 234 people who took part in both the Health Survey for England and the English Longitudinal Study of Ageing. non-smokers but were nicotine products users and those who had missing values on one or more of the neuropsychological measures used to assess cognitive impairment. The metode that has been used are MiniMental State Examination. attention and processing speed were assessed using the letter cancellation task from the Medical Research Council National Study of Health and Development. they use levels of salivary cotinine (ng/ml) measured in the Health Survey for England as a biomarker for recent exposure to secondhand smoke (cotinine is a metabolite of nicotine that has a half life of around 16-25 hours).

48) 1. Exposure to secondhand smoke is associated with an increased risk of cardiovascular disease.78-1. atherogenesis. participants with cognitive impairment may metabolise nicotine differently from those without cognitive impairment.12 (0. as observed by (59th annual meeting of the American Academy of Neurology). Table 1.35 Basic model 1.56) 1.79-1. Exposure to secondhand smoke is also a risk factor for incident stroke.54) 1. and no interaction between cotinine levels and a history of cardiovascular disease was observed. and thrombosis and may therefore compromise the blood supply to the brain.13 (0.72) 1. While additional adjustment for medical history made little difference to the fully adjusted model. Odds of cognitive impairment in 4809 non-smokers by salivary continine levels1 Variable salivary cotinine (ng/ml) Lowest 0.13 (0.8-1.44 (1. Reverse causality is also possible—for example.92-1.56) 1.81-1.07-1.4-0.93) 5 . Another study discovered that short term exposure to secondhand smoke adversely affects endothelial function in ways that immediately compromise the cardiovascular system.27-2.94) adjusted Fully adjust model Fully adjusted model plus medical history 1. Dysfunctional endothelial cells contribute to vasoconstriction.3. it is possible that exposure to secondhand smoke may interact with subclinical cardiovascular disease. and differences in subclinical cerebrovascular disease may help to explain the noticeable individual differences in cognitive function observed during late adulthood.08 (0.07-1.2-0.22) 1.7 Highest 0.08 (0.3 Second 0.8-1.44 (1.The pathophysiology MCI that caused by secondhand smoke is not clearly understand but several mechanisms have been proposed to explain why exposure to secondhand smoke may increase the odds of cognitive impairment.48) 1. and cardiovascular disease may in turn be associated with an increased risk of cognitive impairment and dementia.81-1.4.26 (0.68 (1.

57-1. These changes include: Plaques and tangles (which are microscopic protein clumps characteristic of Alzheimer's disease).3ng/ml).88-2.Table 2.4-0.10-2.07 to 1.26 (0.03 to 2.63-1.90-2.32 (0.78) Based on the table 1 shown above.80) Former smokers (n=2795) adjust Basic model 0.75 (1.77-2. Those with high levels of salivary cotinine (0.8-13. and then additional covariables (fully adjusted models) were added.70.5 ng/ml) were more likely to be cognitively impaired (odds ratio 1. although this association was weaker than that observed for never smokers.11 (0. education. adjustments were made for age.8-1.34) 1.08) 1. 95% confidence interval 1.3 ng/ml).45) 1.92 to 1.42 (0.03-2.30) adjusted Fully model 0.5 ng/ml) were more likely to be cognitively impaired (odds ratio 1. Never smokers exposed to the highest levels of secondhand smoke (salivary cotinine concentrations 0.8-13.97) 1.35 model 1.3 Second 0.91) adjust salivary cotinine Basic (ng/ml) Lowest 0.68-1.74-1.31) 1.67) 1.80) than those exposed to little or no secondhand smoke(0. pathologists have observed changes in brain structure.31) 1. 1.1 In some cases studied at autopsy.88 (0. Some of these changes have been identified in autopsy studies of people with MCI. Odds of cognitive impairment in former and never smokers by salivary continine levels1 Variable Never Smokers (n=2014) adjusted Fully model 1.2-0.2-0. 0.91).16 (0.Former smokers exposed to the highest levels of secondhand smoke also had increased odds of cognitive impairment (1.7 Highest 0.44.92-1.32.85-1. Lewy bodies (which are microscopic clumps of another protein associated with 6 .95 (0.86) 1.70 (1.62 (1.44 (0.14-2. sex. and testing interval (basic adjusted mo dels).94) than those exposed to little or no secondhand smoke (0.26 (0.2-0.

But MCI is an active area of research. dementia with Lewy bodies and some cases of Alzheimer's disease)." Depression is common in people with MCI. Other common conditions besides MCI can make you feel forgetful or less mentally sharp than usual. Treatment can improve these symptoms and restore alertness. Small strokes or reduced blood flow through brain blood vessels5 Recently. When you're depressed.Parkinson's disease.6. High blood pressure can worsen these problems and cause memory difficulties.7 7 . Blood pressure will be monitored and steps to lower it will be given. Sleep apnea can make you feel excessively tired during the day. Conditions that can affect memory include high blood pressure. Treating these conditions can help improve your memory and overall mental function. no MCI drugs or other treatments are specifically approved by the Food and Drug Administration (FDA). you often feel forgetful and mentally "foggy. forgetful and unable to concentrate. People with MCI tend to be more likely to have problems with the blood vessels inside their brains. Depression.

in a large diverse sample of non-smoking adults. high levels of cotinine may be associated with increased odds of cognitive impairment. Prospective nationally representative studies of the association between biomarkers of exposure to secondhand smoke and cognitive decline and dementia are therefore warranted to assess the relation between secondhand smoke and cognitive health with greater precision. their results provide new evidence to suggest that exposure to secondhand smoke may be associated with increased odds of cognitive impairment. secondhand smoke may result cardiovascular disease and impotency as a risk a factor. this is a topic of major public health significance. Given the ongoing international policy debate on exposure to secondhand smoke. 8 . they conclude that. In others hand. In the meantime.CONCLUSION Based on the study.

2009. Lang I.com/script/main/art. Smoking as a risk factor for dementia and mild cognitive impairment : a meta-analysis of prospective studies.html#causes. 2006. Exposure to secondhand smoke and cognitive impairment in non-smokers: national cross sectional study with cotinine measurement.com/health/mild-cognitive-impairment/DS00553. 5.mayoclinic. Snyder CA. O’Kearney R. Anstey KJ.asp?articlekey=13423. Chen LC. 7. Surgeon General of the United States. Mayo clinic. Langa K.REFERENCES 1. Ira BT. Available at: http://www. Executive Summary. Thaddeus JH. Secondhand Smoke. 8. The Health Consequences of Involuntary Exposure to Tobacco Smoke. 35-98 6. NYU medical center. 2. Second hand smoke definition. Mild cognitive impairment. Circulation . Accessed on 22nd Sept 2011. Von Sanden C. Penn A.nyu. Michelle CC. BMJ 2009. Lewis HK. Vascular Disease. Retrieved 2009-01-28. Available at: http://www. Medicine. Inhalation of steady-state sidestream smoke from one ciggarete promote arteriosclerotic plaque development. Deborah EB.338:b462. 1994. Accessed on 22nd Sept 2011. Salim A.90:1363-7 4. Kala MM.medterms. Accessed on 22nd Sept 2011 9 .com.166: 367-78 3. Mild Cognitive Impairment.Net. Am I epidomiol 2007 . Available at: http://www.med. and Dementia Incidence: Findings From the Cardiovascular Health Cognition Study.edu/adc/forpatients/cognitiveimpair. Llewellyn D.