Neuro(b)log for Patients

Smoking is a well-known habit that measurably damages the lungs and dramatically increases the risk of cancer—whether it involves lung, oral cavity, or tongue carcinomas. However, few laypeople realize how deeply smoking, and nicotine itself, affects our brain.The brain is the organ reached by nicotine faster than any other. Within just a few seconds after a single puff from a cigarette, a cascade of neurochemical reactions is triggered, instantly altering our mood, attention, memory, and stress-coping abilities. While short-term effects may seem pleasant to the smoker, the long-term consequences are devastating to the nervous system.

How Does Nicotine Affect the Brain?

Nicotine is a drug, much like alcohol, marijuana, kratom, or other addictive substances. Its molecules have the ability to bind to what are known as nicotinic acetylcholine receptors in the brain.This binding immediately triggers a rapid release of dopamin in the reward center, inducing a feeling of satisfaction. Simultaneously, levels of noradrenaline rise, leading to increased alertness and mental tension. Nicotine further influences levels of serotonin (responsible for mood) and glutamate, which is key for creating memory traces and learning. All of these neurotransmitters, released at the ends of nerve pathways, are directly involved in the swift development of a powerful addiction. 

Short-Term Effects: The Illusion of Well-Being

A short-term increase in noradrenaline concentration temporarily improves the smoker's focus. However, the feeling of relaxation that follows lighting a cigarette is actually just the suppression of onsetting withdrawal symptoms, which the smoker was not even aware of beforehand. The dopamine-boosted mood is the primary reason why smokers derive pleasure from their habit. Furthermore, smoking suppresses appetite, activates the sympathetic nervous system, and accelerates the heart rate. This entire effect lasts approximately 20 to 40 minutes. Once nicotine levels drop, the brain begins demanding another dose. 

Long-Term Effects: Structural Changes in the Brain

Our brain is capable of learning and adapting from childhood into old age. The foundation of this process is neuroplasticity—the ability to form new neural connections and circuits. Long-term nicotine use, however, fundamentally disrupts this capability.

The brain defends itself against being flooded with nicotine by creating an increasingly higher number of nicotinic receptors within cells. This elevated count then demands higher and more regular doses of nicotine. Without it, mood deteriorates dramatically, anxiety sets in, and the ability to experience natural joy declines. 

A faster depletion of brain gray matter has been clinically proven in smokers. This leads to a decline in working memory and a significant slowdown in information processing. Consequently, long-term smoking is a major risk factor for developing Alzheimer's and vascular dementia. 

Nicotine and toxins from cigarette smoke cause vasoconstriction (narrowing of blood vessels) and chronic elevation of blood pressure. Additionally, they contribute to rising cholesterol levels, leading to the accumulation of atherosclerotic plaques and further narrowing of the vessels. Through this mechanism, the risk of a cerebrovascular accident (stroke) increases drastically. 

Multiplication of Risks: When Nicotine Meets Contraception or a Cancer Diagnosis

A cerebrovascular accident (stroke) or the onset of dementia are not threats that arrive in isolation. Nicotine acts as a powerful accelerator of other hidden risks within the body. The combination of nicotine use and hormonal contraception (HC) in women, or in patients with inherited thrombophilic states (e.g., Factor V Leiden mutation), is extremely dangerous. While contraception alone increases stroke risk slightly, when combined with nicotine use, this risk escalates up to ninefold!

Furthermore, nicotine directly raises levels of "bad" LDL cholesterol and free fatty acids in the blood, thereby dramatically accelerating the process of atherosclerosis (hardening of the arteries). As a result, the vessel walls of smokers clog with atherosclerotic plaques much more rapidly, even at a relatively young age. This multiplication effect becomes critical in cancer diagnoses, which inherently increase blood hypercoagulability and susceptibility to thrombosis. If vessel narrowing (vasoconstriction), advanced hardening due to cholesterol, and oncologically elevated clotting meet in the body, the risk of a fatal vascular catastrophe in the brain grows exponentially. 

A New Trap for the Young Brain: Nicotine Pouches

Recently, in my neurological practice, I have been encountering more and more young people between the ages of 20 and 30 struggling with a massive addiction to nicotine. Many of them have switched to nicotine pouches, which they mistakenly view as a "healthier" alternative to smoking because they contain no tar or tobacco smoke. The opposite is true. While the body absorbs roughly 1 to 2 mg of nicotine from a single standard cigarette, a stronger nicotine pouch can rapidly release 10 to 50 mg of nicotine into the system.This massive and abrupt nicotine spike floods brain receptors with such force that dependency develops much more rapidly and aggressively than with classic cigarettes. Young people then find themselves in a trap from which they cannot escape without professional help, despite making repeated attempts. 

The most common neurological and somatic side effects of using nicotine pouches include: 

(caused by sudden changes in cerebral blood vessel tone)

(due to a permanently stimulated sympathetic nervous system)

In Conclusion

The human brain possesses neuroplasticity—the capacity to learn, adapt, and form new memory traces. For this process to function optimally, nerve cells require not only a sufficient supply of nutrients but also the lowest possible burden of toxic substances that disrupt their metabolism. 

How does reading affect neuroplasticity and learning? Find out more in my article:

• Neural Pathways in Books: A Story about Neuroplasticity

However, there are risk factors that increase the likelihood of developing a stroke or neurodegenerative conditions, such as dementia. Smoking and nicotine are prominent among these factors. I often tell my patients that quitting smoking is one of the few risk factors they can control entirely by themselves. By doing so, they can significantly improve their quality of life and lower the risk of numerous serious illnesses. If you notice memory lapses, impaired concentration, or a long-term decline in mood, it is always crucial to rule out organic or vascular causes in the brain in a timely manner.

What Can You Do for Your Cognitive Health Right Now?

If you are battling an addiction to nicotine (whether in the form of cigarettes or pouches) and want to protect your brain from premature aging, vascular events, and the onset of dementia, I recommend these key steps:

1. Quitting an addiction pays off at any age: The human brain has an immense capacity for regeneration. Just a few months after stopping nicotine use, the natural balance of neurotransmitters begins to restore, and blood flow to brain tissue improves. 
2. Have your risk factors checked regularly: If you smoke or use nicotine pouches, have your cholesterol levels and blood pressure checked by your general practitioner. If you are a woman using hormonal contraception, ask to be tested for hidden thrombophilic states (blood clotting disorders).
3. Do not ignore warning signs: If you experience frequent forgetfulness, concentration troubles, unexplained headaches, dizziness, or a prolonged dip in mood, do not delay visiting a specialist.

Where to Find Help for Quitting?

Nicotine addiction is a recognized medical disease, and seeking professional help is nothing to be ashamed of. On the contrary, it significantly boosts your chances of success. If you want to end your dependence (on both cigarettes and pouches), you can reach out to these specialized resources: 

• National Quitting Helpline (Národní linka pro odvykání): Toll-free telephone support at 800 350 000 (available every weekday from 10:00 AM to 6:00 PM). They will help you build an individualized plan and manage withdrawal symptoms. 
• Online Support: Practical advice, mobile applications, and a map of all specialized counseling centers in the Czech Republic can be found on the portal www.chciodvykat.cz. 

Read also: Nicotine is not the only substance that accelerates brain aging. See how alcohol impacts our memory and dementia risk in the article Alcohol and the Brain: How Alcohol Affects Short-Term Memory, Sleep, and Dementia Risk. 

Ordinary forgetfulness, or is it already the first sign of dementia? Find the answers in my article titled Memory: Normal Aging vs. Warning Signs 

At our neurological clinic, we focus on comprehensive clinical examinations and modern electrophysiological diagnostics (including EEG), which can detect functional changes in the nervous system early. These tools assist not only with the diagnosis of epilepsy but also with dementia screening, such as within our basic comprehensive examination program.  

MUDr. Petra Mištríková, MBA