<![CDATA[Background: Smoking is a changeable risk factor for cognitive decline, working through harmful effects on the brain and inflammation. Although many people in Indonesia still smoke, there is little detailed information on how long-term tobacco use, measured by the Brinkman Index, relates to specific cognitive impairments. Methods: A descriptive study was done at the Neurology Outpatient Clinic of Dr Saiful Anwar General Hospital, Malang, from July to August 2025. Eighty-eight adult current and former smokers were included sequentially. Cognitive function was assessed using the Indonesian Montreal Cognitive Assessment (MoCA-INA; impairment defined as a score below 26), and total tobacco use was measured with the Brinkman Index, categorised as mild (<200), moderate (200–600), or severe (>600). Results: All participants were men, with an average age of 52.9 years. More than half (71.6%) were former smokers. On average, they started smoking at 18.7 years old, smoked for about 29.3 years, and smoked 12.2 cigarettes daily. Most (72.3%) had moderate-to-high Brinkman Index scores. Cognitive problems were found in 65 people (73.9%), with an average MoCA-INA score of 20.7; all with problems had smoked before. Memory was the most affected area (98.4%), followed by thinking skills (75.4%), visual and planning skills (61.5%), attention (53.8%), language (50.1%), and awareness of surroundings (18.5%). Conclusion: Long-term heavy tobacco use is linked to lower cognitive function, especially in memory, thinking, visual skills, and attention. These results support early cognitive testing for people who have smoked for a long time.]]>
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