The authors matched 1,758 varenicline initiators to 1,758 nicotine replacement users aged 50 or older in All of Us, on demographics, comorbidities, BMI and prior medications, over 2006 to 2023. Varenicline was associated with a hazard ratio of 0.52 (95% CI 0.35-0.75) for incident dementia and 0.66 (0.50-0.86) for dementia or death combined. The drug was picked out by a medication-wide association screen rather than a prior hypothesis, so this is a signal to test rather than an established effect.
Why it is interesting: An existing cessation drug, not an amyloid agent, tracks with lower dementia incidence in a population defined by its smoking history.