Cigarettes are cool again? How docs are responding to the MAHA-affiliated trend pushing nicotine as an anti-dementia ‘hack’
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This is something that comes up occasionally during clinic visits and during lay fora, especially in the online sphere, where there is a rise of online discussions framing nicotine as a ‘cognitive enhancer.’ ... The idea is appealing, [because] people are always trying to preserve brain health.
—Jon Stewart Hao Dy, MD, FPNA
Nicotine is back in the wellness feed. Not cigarettes, at least not openly. The pitch centers on pouches, gum, and patches, framed as cognitive enhancers, longevity aids, and even Alzheimer’s workarounds.
The trend has picked up steam from MAHA-aligned influencers and wellness figures. [] The claims include better cognition, reduced dementia risk, and improved longevity.
USC addiction researcher Adam Leventhal, PhD, put the clinical problem plainly: “If there really was a health benefit for nicotine, then the medical community would be recommending it to their patients.”
When asked if questions from patients about using nicotine for cognitive enhancement or dementia prevention have increased, Jon Stewart Hao Dy, MD, FPNA, a board-certified adult neurologist, said, “This is something that comes up occasionally during clinic visits and during lay fora, especially in the online sphere, where there is a rise of online discussions framing nicotine as a ‘cognitive enhancer.’”
The evidence is shaky
However, the evidence base does not support nicotine as an anti-dementia intervention. A 2012 pilot trial of transdermal nicotine in 74 nonsmoking adults with mild cognitive impairment showed some cognitive test improvements over 6 months, including a signal in long-term memory. []
Lead investigator Paul Newhouse, MD, warned at the time: “People with mild memory loss should not start smoking or using nicotine patches by themselves, because there are harmful effects of smoking and a medication, such as nicotine should only be used with a doctor's supervision.” []
Top-line results from the larger, follow-up trial, however, called the MIND study, published in December 2025, undercut the favorable interpretation of the pilot study circulating on the Internet. [][] In MIND, 2 years of nicotine patch therapy did not slow memory loss vs placebo in adults with mild cognitive impairment or mild memory loss. The MIND findings, therefore, are more pertinent for patient counseling.
Dr. Hao Dy says, “While the idea is appealing (especially nicotine being extremely accessible and people are always trying to protect and preserve brain health), the long-term risks outweigh the perceived short-term benefits.”
And the risks are well-established
CDC clearly states, “There are no safe tobacco products, including nicotine pouches.” []
According to the CDC, nicotine is highly addictive, with harms for fetal and adolescent brain development. Nicotine pouches are also not FDA-approved smoking cessation products. FDA-authorized cessation medications exist, and pairing medication with counseling more than doubles quit success.
Cardiovascular risk
The American Heart Association notes nicotine raises blood pressure, increases heart rate, narrows arteries, and is linked with arterial hardening and heart attack risk. []
Newer products also deliver high nicotine concentrations without smoke, which makes “clean nicotine” a misleading clinical conception. []
Wilfred van Gorp, PhD, a board-certified neuropsychologist and Director of the Cognitive Assessment Group, states, “The risk factor is something that cannot be neglected when calculating the risks and benefits of nicotine use. The stimulation of the sympathetic nervous system by nicotine is immediate—within minutes, heart rate and blood pressure levels increase. Repeated stimulation of the sympathetic nervous system causes sustained stress on the vascular system, causing damage to the endothelial lining of blood vessels, thus impairing the vascular regulation of blood flow.”
Cognitive decline
The dementia story has also moved in the opposite direction, away from nicotine. University of Chicago researchers reported a nicotine-triggered lung-brain signaling pathway in Science Advances. [][]
Joyce Chen, PhD, one of the authors, described the lung as “a dynamic, active signaling organ,” not a passive exposure site. Their model links inhaled nicotine exposure to exosomes from pulmonary neuroendocrine cells and downstream brain iron dysregulation.
Dr. van Gorp says, “The vascular system is the most well-known cause of cognitive decline, so using nicotine to achieve cognitive improvement is counterproductive.”
In a clinician-heavy r/medicine discussion of the trend, one commenter reacted to influencer claims with: “Gross. In my clinical opinion.” []
Dr. Hao Dy elaborated on the issue. “Nicotine acts on nicotinic acetylcholine receptors in the brain, which can transiently enhance attention and working memory. However, this comes at the cost of well-established risks, including cerebrovascular and cardiovascular effects and dependence. The increased risk of stroke, ischemic heart disease, cancer, and many others cannot be overstated in this scenario. There is currently no strong research evidence supporting nicotine as a safe nor is it an effective strategy for long-term brain health or dementia prevention.”
How to counsel patients
Dr. Hao Dy offers an approach to patients. “I clarify to my patients and to my audience that while nicotine can have short-term effects on temporarily improving attention and alertness, these do not translate into meaningful long-term cognitive benefit or dementia prevention," he says.
He further adds, “When patients understand the risks involved in their decisions, it helps maintain the trust in the physician-patient relationship, all while redirecting them towards evidence-based strategies such as regular exercise (30 minutes/day for at least 5 days/week), quality sleep, and vascular risk factor control (controlling their blood pressure, blood sugar level, cholesterol levels, maintaining the ideal body mass index, etc.)."