PROJECT SUMMARY/ABSTRACT Currently, among Americans 65 years and older, about 20-25% have mild cognitive impairment and about 10% have dementia. Smoking has been linked with an increased risk of dementia development and progression. Quitting smoking can slow the progression of dementia by decreasing many of the risk factors for dementia progression such as cardiovascular disease, hypertension, atherosclerosis, atrial fibrillation, and stroke. In addition to the risk factors of disease progression, smokers with dementia represent a particularly high risk smoking population due to an elevated risk of accidents, residential fires and injury. Unfortunately, cognitive impairment often precludes smokers with dementia from participating in trials of most cessation treatments. While most people with dementia do not smoke, there are a significant number that still do. Interventions are needed in this challenging but high-risk population, particularly since smoking cessation is one of the few interventions that actually affects the rate of dementia progression. However, no smoking cessation programs currently exist for people with dementia. Financial incentives for motivating changes in health behavior, particularly for smoking and other morbid habits, are increasingly being tested by health insurers, employers, and government agencies. However, a key unanswered question is how to structure these incentive programs to maximize their effectiveness in patients with dementia. The goal of this supplement is to leverage the resources of an ongoing financial incentive smoking cessation trial in hospitalized patients to adapt and test the financial incentive smoking cessation interventions for smokers with dementia. We propose a 1-year administrative supplement to use the financial incentive smoking cessation interventions from the Financial Incentives for Smoking Cessation Treatment II (FIESTA II) trial and adapt it for patients with dementia (Aim 1). The intervention will be adapted for dementia patients by consulting with people living with cognitive impairment and care partners and pilot tested. The effectiveness of the dementia-specific financial incentive interventions will then be tested in a 3-arm randomized controlled study comparing 1) goal-directed financial incentives and 2) outcome-based financial incentives versus 3) enhanced usual care for achieving smoking cessation (Aim 2). For this supplement, we will focus on hospitalized smokers that screen positive for cognitive impairment, but would normally be excluded from FIESTA II study of financial incentives for hospitalized smokers.