Air pollution as a risk factor for Cognitive Impairment no Dementia (CIND) and its progression to dementia: A longitudinal study

Environ Int. 2022 Feb:160:107067. doi: 10.1016/j.envint.2021.107067. Epub 2022 Jan 12.

Abstract

Background and aim: Accumulation of evidence has raised concern regarding the harmful effect of air pollution on cognitive function, but results are diverging. We aimed to investigate the longitudinal association of long-term exposure to air pollutants and cognitive impairment and its further progression to dementia in older adults residing in an urban area.

Methods: Data were obtained from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K). Cognitive impairment, no dementia (CIND) was assessed by a comprehensive neuropsychological battery (scoring ≥1.5 standard deviations below age-specific means in ≥1 cognitive domain). We assessed long-term residential exposure to particulate matters (PM2.5 and PM10) and nitrogen oxides (NOx) with dispersion modeling. The association with CIND was estimated using Cox proportional hazards models with 3-year moving average air pollution exposure. We further estimated the effect of long-term air pollution exposure on the progression of CIND to dementia using Cox proportional hazards models.

Results: Among 1987 cognitively intact participants, 301 individuals developed CIND during the 12-year follow-up. A 1-μg/m3 increment in PM2.5 exposure was associated with a 75% increased risk of incident CIND (HR = 1.75, 95 %CI: 1.54, 1.99). Weaker associations were found for PM10 (HR for 1-μg/m3 = 1.08, 95 %CI: 1.03-1.14) and NOx (HR for 10 μg/m3 = 1.18, 95 %CI: 1.04-1.33). Among those with CIND at baseline (n = 607), 118 participants developed dementia during follow-up. Results also show that exposure to air pollution was a risk factor for the conversion from CIND to dementia (PM2.5: HR for 1-μg/m3 = 1.90, 95 %CI: 1.48-2.43; PM10: HR for 1-μg/m3 = 1.14, 95 %CI: 1.03-1.26; and NOx: HR for 10 μg/m3 = 1.34, 95 %CI: 1.07-1.69).

Conclusion: We found evidence of an association between long-term exposure to ambient air pollutants and incidence of CIND. Of special interest is that air pollution also was a risk factor for the progression from CIND to dementia.

Keywords: Air pollution; Cognitive impairment no dementia; Dementia; Nitrogen oxide; Particulate matter; Population-based study.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Air Pollutants* / analysis
  • Air Pollutants* / toxicity
  • Air Pollution* / analysis
  • Air Pollution* / statistics & numerical data
  • Cognitive Dysfunction* / chemically induced
  • Cognitive Dysfunction* / etiology
  • Dementia* / epidemiology
  • Dementia* / etiology
  • Environmental Exposure / analysis
  • Environmental Exposure / statistics & numerical data
  • Humans
  • Longitudinal Studies
  • Particulate Matter / analysis
  • Risk Factors

Substances

  • Air Pollutants
  • Particulate Matter