Traffic-Related Air Pollution and Dementia Incidence in Northern Sweden: A Longitudinal Study

Particulate matter 2.5 (PM2.5) - associated cognitive impairment and morbidity in humans and animal models: a systematic review

Particulate matter with an aerodynamic diameter of less than 2.5 µm (PM2.5) is one of the criteria air pollutants that (1) serve as an essential carrier of airborne toxicants arising from combustion-related events including emissions from industries, automobiles, and wildfires and (2) play an important role in transient to long-lasting cognitive dysfunction as well as several other neurological disorders. A systematic review was conducted to address differences in study design and various biochemical and molecular markers employed to elucidate neurological disorders in PM2.5 -exposed humans and animal models. Out of 340,068 scientific publications screened from 7 databases, 312 studies were identified that targeted the relationship between exposure to PM2.5 and cognitive dysfunction. Equivocal evidence was identified from pre-clinical (animal model) and human studies that PM2.5 exposure contributes to dementia, Parkinson disease, multiple sclerosis, stroke, depression, autism spectrum disorder, attention deficit hyperactivity disorder, and neurodevelopment. In addition, there was substantial evidence from human studies that PM2.5 also was associated with Alzheimer's disease, anxiety, neuropathy, and brain tumors. The role of exposome in characterizing neurobehavioral anomalies and opportunities available to leverage the neuroexposome initiative for conducting longitudinal studies is discussed. Our review also provided some areas that warrant consideration, one of which is unraveling the role of microbiome, and the other role of climate change in PM2.5 exposure-induced neurological disorders.

Modification effect of healthy lifestyle among solid fuels and mild cognitive impairment in middle-aged and older adults: A prospective cohort study

To explore the association between solid fuels and mild cognitive impairment (MCI) and the role of the healthy lifestyle score (HLS) in the association between solid fuels and MCI. Data were obtained from CHARLS from 2011 to 2020. A logistic regression model which assessed the impact of solid fuel use on MCI was applied. A full HLS was constructed to evaluate the interaction and joint effects of HLS with solid fuels. 11054 people were enclosed in this study and the proportion of the population using solid fuels is as high as 74.05 % for heating fuels and 56.53 % for cooking fuels. Results showed that solid fuel use was positively associated with the risk of MCI during cooking and heating, with 95 % confidence intervals (95 % CI) of 1.11 (1.00, 1.23) for cooking and 1.14 (1.00, 1.31) for heating. Further, a healthy BMI was beneficial in reducing the harmful effects of solid fuels. Solid fuel use was significantly associated with MCI among middle-aged and older Chinese adults. Our results also suggested that higher HLS is beneficial in reducing the risk of MCI from solid fuels. In this study, we are prompted to use cleaner fuels and ventilation equipment along with the need to develop effective HLS measures for interventions.

The Association of Ambient Air Pollution With Dynamic Transitions of Cataract and Dementia: A UK Biobank Study

BACKGROUND AND OBJECTIVES

Air pollution has a detrimental effect on the risk of dementia and cataract. This study aimed to investigate the association of air pollution with the dynamic transitions of cataract and dementia.

RESEARCH DESIGN AND METHODS

We enrolled 409,608 participants (mean age: 56.4 years; 45.9% male) free of cataract and dementia at baseline from the UK Biobank with follow-up until 30 September 2023. We estimated the annual average concentrations of particulate matter (PM) with aerodynamic diameter ≤ 2.5 μm (PM2.5), ≤ 10 μm (PM10), nitrogen dioxide (NO2), and nitrogen oxides (NOx) at 2010. We employed multi-state models to assess the association between air pollution and the dynamic transitions of cataract and dementia after adjusting for potential confounders.

RESULTS

During a median follow-up of 14.5 years, 51,786 participants were diagnosed with cataracts, and 6068 with dementia. PM2.5 showed the strongest association with the transitions from healthy to cataract (hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.04-1.06; p < 0.001), from healthy to dementia (HR, 1.05; 95% CI, 1.02-1.09; p = 0.002), from cataract to comorbidity (HR, 1.07; 95% CI, 1.00-1.15; p = 0.048), from healthy to death (HR, 1.03; 95% CI, 1.01-1.05; p < 0.001), and from cataract to death (HR, 1.06; 95% CI, 1.02-1.10; p = 0.007).

CONCLUSION AND IMPLICATIONS

Our study suggested that the long-term exposure to air pollution was associated an increased risk of the transitions from health to incident cataract, dementia or the progression of both conditions. This implied the importance of implementing air pollution control strategies to prevent cataract and dementia.

Association between air quality and neurodegenerative diseases in River Sacco Valley: A retrospective cohort study in Latium, central Italy

Research on the relationship between air pollution and neurodegenerative diseases is growing. However, few studies focus on this association in contaminated sites. We investigated the association between long-term air pollution exposure and dementia/Parkinson's disease (PD) incidence in the River Sacco Valley, a contaminated site in central Italy. Through a retrospective cohort study, we enrolled 298,919 40+ years-old residents in 95 municipalities across the study area from 2007 to 2018. Residential exposure to benzene (C6H6), NO2, O3, PM10, PM2.5 and SO2 was estimated through FARM dispersion models with 1-4 km2 resolution. Risks were computed for interquartile range (IQR) increases of each pollutant. Incidence of dementia and PD was determined combining electronic health records. We used Cox proportional hazard regression with age as time axis and sex, socio-economic position (SEP) and municipality of residence as covariates. Study population was formed by 53 % females, 65 % 40-64 years old, 32 % medium-low SEP. Among 40+ years-old individuals, increased risks (HR; 95 % CIs) of dementia resulted from IQR increases of C6H6 (1.15; 1.11-1.18), NO2 (1.17; 1.14-1.21), PM10 (1.08; 1.04-1.11) and PM2.5 (1.10; 1.07-1.13). Increased risks of PD resulted from IQR increases of O3 (1.17; 1.14-1.21) and PM2.5 (1.02; 1.00-1.05). Vascular dementia's risk increases resulted from IQR increases of NO2 and PM2.5. Results for dementia and PD varied based on the pollutant analyzed. Our results concord with previous literature and the biological mechanisms that link air pollution to neurodegeneration. Air pollution might be a risk factor for dementia and PD.

Neurometabolomic impacts of wood smoke and protective benefits of anti-aging therapeutics in aged female C57BL/6J mice

Background

Wildland fires have become progressively more extensive over the past 30 years in the United States, routinely generating smoke that deteriorates air quality for most of the country. We explored the neurometabolomic impact of biomass-derived smoke on older (18 months) female C57BL/6J mice, both acutely and after 10 weeks of recovery from exposures.

Methods

Mice were exposed to wood smoke (WS) 4 hours/day, every other day, for 2 weeks (7 exposures total) to an average concentration of 448 μg particulate matter (PM)/m3 per exposure. One group was euthanized 24 hours after the last exposure. Other groups were then placed on 1 of 4 treatment regimens for 10 weeks after wood smoke exposures: vehicle; resveratrol in chow plus nicotinamide mononucleotide in water (RNMN); senolytics via gavage (dasatanib + quercetin; DQ); or both RNMN with DQ (RNDQ).

Results

Among the findings, the aging from 18 months to 21 months was associated with the greatest metabolic shift, including changes in nicotinamide metabolism, with WS exposure effects that were relatively modest. WS caused a reduction in NAD + within the prefrontal cortex immediately after exposure and a long-term reduction in serotonin that persisted for 10 weeks. The serotonin reductions were corroborated by behavioral changes, including increased immobility in a forced swim test, and neuroinflammatory markers that persisted for 10 weeks. RNMN had the most beneficial effects after WS exposure, while RNDQ caused markers of brain aging to be upregulated within WS-exposed mice.

Discussion

Taken together, these findings highlight the persistent neurometabolomic and behavioral effects of woodsmoke exposure in an aged mouse model. Further examination is necessary to determine the age-specific and species-determinant response pathways and duration before complete resolution occurs.

The Role of Air Pollution and Olfactory Dysfunction in Alzheimer's Disease Pathogenesis

The escalating issue of air pollution contributes to an alarming number of premature fatalities each year, thereby posing a significant threat to global health. The focus of recent research has shifted towards understanding its potential association with neurodegenerative diseases, specifically Alzheimer's disease (AD). AD is recognised for its characteristic deposition of toxic proteins within the brain, leading to a steady deterioration of cognitive capabilities, memory failure, and, ultimately, death. There is burgeoning evidence implying that air pollution may be a contributing factor to this protein build up, thereby intensifying the course of AD. It has been demonstrated that the olfactory system, responsible for smell perception and processing, acts as a potential gateway for airborne pollutants to inflict brain damage. This review aims to elucidate the relationship between air pollution, olfactory deterioration, and AD. Additionally, this review aims to highlight the potential mechanisms through which pollutants might instigate the development of AD and the role of the olfactory system in disease pathogenesis. Moreover, the diverse model systems employed in exploring the correlation, public health policy ramifications, and prospective directions for future research will be discussed.

The Role of the Neural Exposome as a Novel Strategy to Identify and Mitigate Health Inequities in Alzheimer's Disease and Related Dementias

With the continuous increase of the elderly population, there is an urgency to understand and develop relevant treatments for Alzheimer's disease and related dementias (ADRD). In tandem with this, the prevalence of health inequities continues to rise as disadvantaged communities fail to be included in mainstream research. The neural exposome poses as a relevant mechanistic approach and tool for investigating ADRD onset, progression, and pathology as it accounts for several different factors: exogenous, endogenous, and behavioral. Consequently, through the neural exposome, health inequities can be addressed in ADRD research. In this paper, we address how the neural exposome relates to ADRD by contributing to the discourse through defining how the neural exposome can be developed as a tool in accordance with machine learning. Through this, machine learning can allow for developing a greater insight into the application of transferring and making sense of experimental mouse models exposed to health inequities and potentially relate it to humans. The overall goal moving beyond this paper is to define a multitude of potential factors that can increase the risk of ADRD onset and integrate them to create an interdisciplinary approach to the study of ADRD and subsequently translate the findings to clinical research.

Metabolomic profiling identifies signatures and biomarkers linking air pollution to dementia risk: A prospective cohort study

Exposure to air pollution has been associated with increased dementia. However, it remains unknown what specific metabolic mechanisms play a role in this relationship. We included 192,300 dementia-free participants from the UK Biobank cohort study. Annual concentrations of air pollution were assessed based on the residential address. Elastic net regression was performed to identify air pollution-related metabolites, and metabolic score was constructed. Cox regression models and covariate balancing generalized propensity scores (CBGPS) regression models were conducted to explore the longitudinal associations between air pollution/metabolic signatures and dementia risk. The underlying mechanisms between air pollution and dementia driven by metabolic signature or specific metabolites were also investigated. A total of 2592 incident dementia cases were documented. We identified the metabolite profiles in response to air pollution exposure, including 87 metabolites for PM2.5, 65 metabolites for PM10, 76 metabolites for NO2, and 71 metabolites for NOx. The air pollution-related metabolic signatures were associated with increased risk of dementia, with hazard ratios (HR) of 1.17 (95 % CI: 1.12, 1.22), 1.06 (95 % CI: 1.02, 1.11), 1.16 (95 % CI: 1.10, 1.21), and 1.17 (95 % CI: 1.12, 1.22) for PM2.5, PM10, NO2 and NOx, respectively. The associations persisted using causal models. Metabolic signatures mediated the associations between air pollution exposure and dementia risk, with mediation proportions ranging from 6.57 % to 12.71 %. Additionally, we observed that a metabolite known as free cholesterol in medium VLDL (M-VLDL-FC) played a crucial mediating role. Our study provides novel insights into the metabolic mechanisms linking air pollution exposure to dementia risk.

The role of leukocytes in cognitive impairment due to long-term exposure to fine particulate matter: A large population-based mediation analysis

INTRODUCTION

Our understanding of how fine particulate matter (PM2.5) impacts cognitive functioning is limited. Systemic inflammation processes may play a role in mediating this effect.

METHODS

This prospective cohort study used data from 66,254 participants aged 18+ between 2006 and 2015 from the Dutch Lifelines Cohort Study and Biobank. Causal mediation analysis was conducted to examine the impact of ambient PM2.5 exposure on cognitive processing time (CPT), using the change in white blood cell (WBC) count and its subtypes as potential mediators.

RESULTS

Heightened PM2.5 exposure was associated with slower CPT (total effect = 81.76 × 10-3, 95% confidence interval [CI] 59.51 × 10-3-105.31 × 10-3). The effect was partially mediated via increased WBC count (indirect effect [IE] = 0.42 × 10-3, 95% CI 0.07 × 10-3-0.90 × 10-3), particularly driven by an increase in monocytes (IE = 0.73 × 10-3, 95% CI 0.24 × 10-3-1.31 × 10-3).

DISCUSSION

Systemic inflammation processes may partially explain the harmful effects of PM2.5 on cognitive functioning, why lower levels of systemic inflammation may help contain its neurotoxic effects.

HIGHLIGHTS

The pathways leading to the neurotoxic effects of fine particulate matter (PM2.5) are poorly understood. We analyzed data from over 66,000 participants using causal pathway analysis. Increased white blood cell (WBC) count mediates the effect of PM2.5 on cognitive functioning. Monocyte count played a crucial role in this low-pollution setting. Systemic inflammation may contribute to the neurotoxic effects of PM2.5.

Comparison of the neurotoxic potency of different ultrafine particle fractions from diesel engine exhaust following direct and simulated inhalation exposure

Exposure to traffic-related air pollution and ultrafine particles (<100 nm; UFP) is linked with neurodegeneration. However, the impact of the aromatic content in fuels and the contribution of different fractions of UFP, i.e., solid UFP vs SVOC UFP, on neuronal function is unknown. We therefore studied effects on neuronal activity and viability in rat primary cortical cells exposed for up to 120 h to copper oxide particles (CuO) or UFP (solid and SVOC) emitted from a heavy-duty diesel engine fueled with petroleum diesel (A20; 20 % aromatics) or Hydrotreated Vegetable Oil-type fuel (A0; 0.1 % aromatics), or solid UFP emitted from a non-road Kubota engine fueled with A20. Moreover, effects of UFP and CuO upon simulated inhalation exposure were studied by exposing an lung model (Calu-3 and THP-1 cells) for 48 h and subsequently exposing the cortical cells to the medium collected from the basal compartment of the lung model. Additionally, cell viability, cytotoxicity, barrier function, inflammation, and oxidative and cell stress were studied in the lung model after 48 h exposure to UFP and CuO. Compared to control, direct exposure to CuO and SVOC UFP decreased neuronal activity, which was partly associated with cytotoxicity. Effects on neuronal activity upon direct exposure to solid UFP were limited. A20-derived UFP (solid and SVOC) were more potent in altering neuronal function and viability than A0 counterparts. Effects on neuronal activity from simulated inhalation exposure were minor compared to direct exposures. In the lung model, CuO and A20-derived UFP increased cytokine release compared to control, whereas CuO and SVOC A20 altered gene expression indicative for oxidative stress. Our data indicate that SVOC UFP exhibit higher (neuro)toxic potency for altering neuronal activity in rat primary cortical cells than the solid fraction. Moreover, our data suggest that reducing the aromatic content in fuel decreases the (neuro)toxic potency of emitted UFP.

Current pharmacophore based approaches for the development of new anti-Alzheimer's agents

Amyloid beta peptide (Aβ) and hyperphosphorylated neuronal tau proteins accumulate in neurofibrillary tangles in Alzheimer's disease (AD), a chronic neurodegenerative illness. Chronic inflammation in the brain, which promotes disease progression, is another feature of the Alzheimer's disease pathogenesis. Approximately 60-70 % of dementia cases are caused by AD. The development of effective therapies for the treatment of AD is urgently needed given the severity of the condition and its rapidly rising prevalence. Cholinesterase inhibitors, beta-amyloid (A-beta), tau inhibitors, and many other medications are currently used as preventive medicine for AD. These medications can temporarily suppress dementia symptoms but cannot halt or reverse the disease's progression. Many international pharmaceutical companies have tried numerous times to develop an amyloid clearing medication based on the amyloid hypothesis, but without success. Therefore, the amyloid theory may not be entirely plausible. This review mainly covers the recent and important reported pharmacophores as the starting point to discuss already known targets like tau, butyrylcholinesterase, amyloid beta, and acetylcholinesterase and covers the literature between years 2019-2024.

Frontiers and hotspots evolution between air pollution and Alzheimer's disease: A bibliometric analysis from 2013 to 2023

In recent years, the study of air pollution has received increasing attention from researchers, but a summary of Alzheimer's disease (AD) and air pollution is missed. Through combing the documents in the core dataset of Web of Science, this study analyzes current research based on specific keywords. CiteSpace and VOSviewer perform statistical analysis of measurement metrics to visualize a network of relevant content elements. The research devotes discussion to the relationship between air pollution and AD. Keyword hotspots include AD, children, oxidative stress, and system inflammation. Overall, 304 documents on air pollution and AD from 2013 to 2023 were retrieved from Web of Science. One hundred twenty-two journals published relevant articles, and the number of articles has increased gradually since the past decade. Research and development in AD and air pollution are progressing rapidly, but there is still a need for more connections with multidisciplinary technologies to explore cutting-edge hotspots.

Exposure to air pollution and cognitive function based on the minimum mental state examination: a systematic review and meta-analysis

Evidence regarding the cognitive effects of air pollution is inconsistent. This study aimed to quantitatively analyze the relationship between air pollutants and cognitive abilities using the Mini-Mental State Examination (MMSE). We systematically searched for studies published until July 1, 2023, and assessed heterogeneity with Cochran's Q test and I² statistics, while publication bias was evaluated using Funnel plots and Egger's test. Out of 380 studies, 17 were included in the meta-analysis. Results demonstrated significant relationship among long-term exposure to PM2.5, O3, and cognitive decline. The pooled RR of cognitive impairment per 10μg/m3 increase were 1.17 for PM2.5 and 1.07 for PM10. Furthermore, there was a significant association between cognitive decline and long-term exposure to PM2.5 (β = -0.30; I2 = 95.30%) and PM10 (β = -0.15; I2 = 87.50%). Our research suggests that long-term exposure to air pollution, especially PM2.5, is a risk factor for cognitive impairment.

Association of ambient air pollution with cognitive functioning and markers of structural brain damage: The Maastricht study

INTRODUCTION

Given the absence of curative interventions and the rising global incidence of dementia, research is increasingly focusing on lifestyle factors for prevention. However, identifying shared environmental risk for dementia, next to individual factors, is crucial for optimal risk reduction strategies. Therefore, in the present study we investigated the association between air pollution, cognitive functioning, and markers of structural brain damage.

METHODS

We used cross-sectional data from 4,002 participants of The Maastricht Study on volumetric markers of brain integrity (white and grey matter volume, cerebrospinal fluid volume, white matter hyperintensities volume, presence of cerebral small vessel disease) and cognitive functioning (memory, executive functioning and attention, processing speed, overall cognition). Individuals were matched by postal code of residence to nationwide data on air pollution exposure (particulate matter < 2.5 μm (PM2.5), particulate matter <10 μm (PM10), nitrogen dioxide (NO2), soot). Potentia linear and non-linear associations were investigated with linear, logistic, and restricted cubic splines regression. All analyses were adjusted for demographic characteristics and a compound score of modifiable dementia risk and protective factors.

RESULTS

Exposure to air pollutants was not related to cognitive functioning and most brain markers. We found curvilinear relationships between high PM2.5 exposures and grey matter and cerebrospinal fluid volume. Participants in the low and high range of exposure had lower grey matter volume. Higher cerebrospinal fluid volumes were only associated with high range of exposure, independent of demographic and individual modifiable dementia risk factors. After additional post hoc analyses, controlling for urbanicity, the associations for grey matter volume became non-significant. In men only, higher exposure to all air pollutants was associated with lower white matter volumes. No significant associations with white matter hyperintensities volume or cerebral small vessel disease were observed.

DISCUSSION

Our findings suggest that higher PM2.5 exposure is associated with more brain atrophy.

Associations between toxicity-weighted concentrations and dementia risk: Results from the Cardiovascular Health Cognition Study

BACKGROUND

Air pollution is a modifiable risk factor for dementia. Yet, studies on specific sources of air pollution (i.e., toxic chemical emissions from industrial facilities) and dementia risk are scarce. We examined associations between toxicity-weighted concentrations of industrial pollution and dementia outcomes among a large, multi-site cohort of older adults.

METHODS

Participants (n = 2770) were ≥ 65 years old (Mean = 75.3, SD = 5.1 years) from the Cardiovascular Health Cognition Study (1992-1999). Toxicity-weighted concentrations were estimated using the Risk Screening Environmental Indicator (RSEI) model which incorporates total reported chemical emissions with toxicity, fate, and transport models. Estimates were aggregated to participants' baseline census tract, averaged across 1988-1992, and log2-transformed. Dementia status was clinically adjudicated in 1998-1999 and categorized by subtype (Alzheimer's, vascular, mixed). We assessed whether RSEI-estimated toxicity-weighted concentrations were associated with 1) odds of prevalent dementia and 2) incident dementia risk by subtype.

RESULTS

After adjusting for individual and census-tract level covariates, a doubling in toxicity-weighted concentrations was associated with 9 % higher odds of prevalent dementia (OR = 1.09, 95 % CI: 1.00, 1.19). In discrete-time survival models, each doubling in toxicity-weighted concentrations was associated with a 16 % greater hazard of vascular dementia (HR = 1.16, 95 % CI: 1.01, 1.34) but was not significantly associated with all-cause, Alzheimer's disease, or mixed dementia (p's > 0.05).

DISCUSSION

Living in regions with higher toxicity-weighted concentrations was associated with higher odds of prevalent dementia and a higher risk of incident vascular dementia in this large, community-based cohort of older adults. These findings support the need for additional studies to examine whether toxic chemical emissions from industrial and federal facilities may be a modifiable target for dementia prevention.

Air pollution: a latent key driving force of dementia

Many researchers have studied the role of air pollutants on cognitive function, changes in brain structure, and occurrence of dementia. Due to the wide range of studies and often contradictory results, the present systematic review was conducted to try and clarify the relationship between air pollutants and dementia. To identify studies for this review, a systematic search was conducted in Scopus, PubMed, and Web of Science databases (without historical restrictions) until May 22, 2023. The PECO statement was created to clarify the research question, and articles that did not meet the criteria of this statement were excluded. In this review, animal studies, laboratory studies, books, review articles, conference papers and letters to the editors were avoided. Also, studies focused on the effect of air pollutants on cellular and biochemical changes (without investigating dementia) were also excluded. A quality assessment was done according to the type of design of each article, using the checklist developed by the Joanna Briggs Institute (JBI). Finally, selected studies were reviewed and discussed in terms of Alzheimer's dementia and non-Alzheimer's dementia. We identified 14,924 articles through a systematic search in databases, and after comprehensive reviews, 53 articles were found to be eligible for inclusion in the current systematic review. The results showed that chronic exposure to higher levels of air pollutants was associated with adverse effects on cognitive abilities and the presence of dementia. Studies strongly supported the negative effects of PM2.5 and then NO2 on the brain and the development of neurodegenerative disorders in old age. Because the onset of brain structural changes due to dementia begins decades before the onset of disease symptoms, and that exposure to air pollution is considered a modifiable risk factor, taking preventive measures to reduce air pollution and introducing behavioral interventions to reduce people's exposure to pollutants is advisable.

Investigating Modifiable Risk Factors Across Dementia Subtypes: Insights from the UK Biobank

This study investigates the relationship between modifiable risk factors and dementia subtypes using data from 460,799 participants in the UK Biobank. Utilizing univariate Cox proportional hazards regression models, we examined the associations between 83 modifiable risk factors and the risks of all-cause dementia (ACD), Alzheimer's disease (AD), and vascular dementia (VD). Composite scores for different domains were generated by aggregating risk factors associated with ACD, AD, and VD, respectively, and their joint associations were assessed in multivariable Cox models. Additionally, population attributable fractions (PAF) were utilized to estimate the potential impact of eliminating adverse characteristics of the risk domains. Our findings revealed that an unfavorable medical history significantly increased the risk of ACD, AD, and VD (hazard ratios (HR) = 1.88, 95% confidence interval (95% CI): 1.74-2.03, p < 0.001; HR = 1.80, 95% CI: 1.54-2.10, p < 0.001; HR = 2.39, 95% CI: 2.10-2.71, p < 0.001, respectively). Blood markers (PAF = 12.1%; 17.4%) emerged as the most important risk domain for preventing ACD and VD, while psychiatric factors (PAF = 18.3%) were the most important for preventing AD. This study underscores the potential for preventing dementia and its subtypes through targeted interventions for modifiable risk factors. The distinct insights provided by HR and PAF emphasize the importance of considering both the strength of the associations and the population-level impact of dementia prevention strategies. Our research provides valuable guidance for developing effective public health interventions aimed at reducing the burden of dementia, representing a significant advancement in the field.

Global Public Health Implications of Traffic Related Air Pollution: Systematic Review

Background

Traffic-related air pollution (TRAP) has significant public health implications and a wide range of adverse health effects, including cardiovascular, respiratory, pulmonary, and other health problems. This study aimed to determine the public health impacts of traffic-related air pollution across the world that can be used as an input for protecting human health.

Methods

This study considered studies conducted across the world and full-text articles written in English. The articles were searched using a combination of Boolean logic operators (AND, OR, and NOT), MeSH, and keywords from the included electronic databases (SCOPUS, PubMed, EMBASE, Web of Science, CINAHL, and Google Scholars). The quality assessment of the articles was done using JBI tools to determine the relevance of each included article to the study.

Results

In this study, 1 282 032 participants ranging from 19 to 452 735 were included in 30 articles published from 2010 to 2022. About 4 (13.3%), 9 (30.0%), 12 (40.0%), 8 (26.7%), 2 (6.7%), 15 (50.0%), 3 (10.0%), 3 (10.0%) 1 (3.3%), and 3 (10.0%) of articles reported the association between human health and exposure to CO, PM10, PM2.5, NOx, NO, NO2, black carbon, O3, PAH, and SO2, respectively. Respiratory diseases, cancer, cognitive function problems, preterm birth, blood pressure and hypertension, diabetes, allergies and sensitization, coronary heart disease, dementia incidence, and hemorrhagic stroke were associated with exposure to TRAP.

Conclusions

Exposure to nitrogen dioxide, nitrogen oxide, sulfur dioxide, and fine particulate matter was associated with various health effects. This revealed that there is a need for the concerned organizations to respond appropriately.

Metabolic profiles associated with exposure to ambient particulate air pollution: findings from the Betula cohort

Introduction

Air pollution is a significant contributor to morbidity and mortality globally and has been linked to an increased risk of dementia. Previous studies within the Betula cohort in Northern Sweden have demonstrated associations between air pollution and dementia, as well as distinctive metabolomic profiles in dementia patients compared to controls. This study aimed to investigate whether air pollution is associated with quantitative changes in metabolite levels within this cohort, and whether future dementia status would modify this association.

Methods

Both short-term and long-term exposure to air pollution were evaluated using high spatial resolution models and measured data. Air pollution from vehicle exhaust and woodsmoke were analyzed separately. Metabolomic profiling was conducted on 321 participants, including 58 serum samples from dementia patients and a control group matched for age, sex, and education level, using nuclear magnetic resonance spectroscopy.

Results

No statistically significant associations were found between any metabolites and any measures of short-term or long-term exposure to air pollution. However, there were trends potentially suggesting associations between both long-term and short-term exposure to air pollution with lactate and glucose metabolites. Notably, these associations were observed despite the lack of correlation between long-term and short-term air pollution exposure in this cohort. There were also tendencies for associations between air pollution from woodsmoke to be more pronounced in participants that would later develop dementia, suggesting a potential effect depending on urban/rural factors.

Discussion

While no significant associations were found, the trends observed in the data suggest potential links between air pollution exposure and changes in lactate and glucose metabolites. These findings provide some new insights into the link between air pollution and metabolic markers in a low-exposure setting. However, addressing existing limitations is crucial to improve the robustness and applicability of future research in this area. The pronounced associations in participants who later developed dementia may indicate an influence of urban/rural factors, warranting further investigation.

Associations of ambient air pollution exposure and lifestyle factors with incident dementia in the elderly: A prospective study in the UK Biobank

OBJECTIVE

Dementia is an important disease burden among the elderly, and its occurrence may be profoundly affected by environmental factors. Evidence of the relationship between air pollution and dementia is emerging, but the extent to which this can be offset by lifestyle factors remains ambiguous.

METHODS

This study comprised 155,828 elder adults aged 60 years and above in the UK Biobank who were dementia-free at baseline. Cox proportional hazard models were conducted to examine the associations of annual average levels of air pollutants in 2010, including nitrogen dioxide (NO2), nitrogen oxides (NOX), particulate matter (PM2.5, PM10, and PMcoarse) and lifestyle factors recorded at baseline [physical activity (PA), sleep patterns, or smoking status] with incident risk of dementia, and their interactions on both multiplicative and additive scales.

RESULTS

During a 12-year period of follow-up, 4,389 incidents of all-cause dementia were identified. For each standarddeviationincrease in ambient NO2, NOX or PM2.5, all-cause dementia risk increases by 1.07-fold [hazard ratio (HR) and 95 % confidence interval (CI) = 1.07 (1.04, 1.10)], 1.05-fold (95 % CI: 1.02, 1.08) and 1.07-fold (95 % CI: 1.04, 1.10), whereas low levels of PA, poor sleep patterns, and smoking are associated with an elevated risk of dementia [HR (95 % CI) = 1.17 (1.09, 1.26), 1.13 (1.00, 1.27), and 1.14 (1.07, 1.21), respectively]. Furthermore, these air pollutants show joint effects with low PA, poor sleep patterns, and smoking on the onset of dementia. The moderate to high levels of PA could significantly or marginally significantly modify the associations between NO2, NOX or PM2.5 (P-int = 0.067, 0.036, and 0.067, respectively) and Alzheimer's disease (AD), but no significant modification effects are found for sleep patterns or smoking status.

CONCLUSION

The increased exposures of NO2, NOX, or PM2.5 are associated with elevated risk of dementia among elderly UK Biobank population. These air pollutants take joint effects with low PA, poor sleep patterns, and smoking on the development of dementia. In addition, moderate to high levels of PA could attenuate the incident risk of AD caused by air pollution. Further prospective researches among other cohort populations are warranted to validate these findings.

Exposure to source-specific air pollution in residential areas and its association with dementia incidence: a cohort study in Northern Sweden

The aim of this study was to investigate the relationship between source-specific ambient particulate air pollution concentrations and the incidence of dementia. The study encompassed 70,057 participants from the Västerbotten intervention program cohort in Northern Sweden with a median age of 40 years at baseline. High-resolution dispersion models were employed to estimate source-specific particulate matter (PM) concentrations, such as PM10 and PM2.5 from traffic, exhaust, and biomass (mainly wood) burning, at the residential addresses of each participant. Cox regression models, adjusted for potential confounding factors, were used for the assessment. Over 884,847 person-years of follow-up, 409 incident dementia cases, identified through national registers, were observed. The study population's average exposure to annual mean total PM10 and PM2.5 lag 1-5 years was 9.50 µg/m3 and 5.61 µg/m3, respectively. Increased risks were identified for PM10-Traffic (35% [95% CI 0-82%]) and PM2.5-Exhaust (33% [95% CI - 2 to 79%]) in the second exposure tertile for lag 1-5 years, although no such risks were observed in the third tertile. Interestingly, a negative association was observed between PM2.5-Wood burning and the risk of dementia. In summary, this register-based study did not conclusively establish a strong association between air pollution exposure and the incidence of dementia. While some evidence indicated elevated risks for PM10-Traffic and PM2.5-Exhaust, and conversely, a negative association for PM2.5-Wood burning, no clear exposure-response relationships were evident.

Association of Gaseous Ambient Air Pollution and Dementia-Related Neuroimaging Markers in the ARIC Cohort, Comparing Exposure Estimation Methods and Confounding by Study Site

BACKGROUND

Evidence linking gaseous air pollution to late-life brain health is mixed.

OBJECTIVE

We explored associations between exposure to gaseous pollutants and brain magnetic resonance imaging (MRI) markers among Atherosclerosis Risk in Communities (ARIC) Study participants, with attention to the influence of exposure estimation method and confounding by site.

METHODS

We considered data from 1,665 eligible ARIC participants recruited from four US sites in the period 1987-1989 with valid brain MRI data from Visit 5 (2011-2013). We estimated 10-y (2001-2010) mean carbon monoxide (CO), nitrogen dioxide (NO 2 ), nitrogen oxides (NO x ), and 8- and 24-h ozone (O 3 ) concentrations at participant addresses, using multiple exposure estimation methods. We estimated site-specific associations between pollutant exposures and brain MRI outcomes (total and regional volumes; presence of microhemorrhages, infarcts, lacunes, and severe white matter hyperintensities), using adjusted linear and logistic regression models. We compared meta-analytically combined site-specific associations to analyses that did not account for site.

RESULTS

Within-site exposure distributions varied across exposure estimation methods. Meta-analytic associations were generally not statistically significant regardless of exposure, outcome, or exposure estimation method; point estimates often suggested associations between higher NO 2   and   NO x and smaller temporal lobe, deep gray, hippocampal, frontal lobe, and Alzheimer disease signature region of interest volumes and between higher CO and smaller temporal and frontal lobe volumes. Analyses that did not account for study site more often yielded significant associations and sometimes different direction of associations.

DISCUSSION

Patterns of local variation in estimated air pollution concentrations differ by estimation method. Although we did not find strong evidence supporting impact of gaseous pollutants on brain changes detectable by MRI, point estimates suggested associations between higher exposure to CO, NO x , and NO 2 and smaller regional brain volumes. Analyses of air pollution and dementia-related outcomes that do not adjust for location likely underestimate uncertainty and may be susceptible to confounding bias. https://doi.org/10.1289/EHP13906.

Environmental risk factors provoke new thinking for prevention and treatment of dementia with Lewy bodies

In recent years, environmental factors have received attention in the pathogenesis of neurodegenerative diseases. Other than genetic factors, the identification of environmental factors and modifiable risk factors may create opportunities to delay the onset or slow the progression of Lewy body disease. Researchers have made significant progress in understanding environmental and modifiable risk factors over the past 30 years. To date, despite the increasing number of articles assessing risk factors for Lewy body disease, few reviews have focused on their role in its onset. In this review, we reviewed the literature investigating the relationship between Lewy body disease and several environmental and other modifiable factors. We found that some air pollutants, exposure to some metals, and infection with some microorganisms may increase the risk of Lewy body disease. Coffee intake and the Mediterranean diet are protective factors. However, it is puzzling that low educational levels and smoking may have some protective effects. In addition, we proposed specific protocols for subsequent research directions on risk factors for neurodegenerative diseases and improved methods. By conducting additional case-control studies, we could explore the role of these factors in the etiopathogenesis of Lewy body disease, establishing a foundation for strategies aimed at preventing and reducing the onset and burden of the disease.

Long-term exposure to major constituents of fine particulate matter and neurodegenerative diseases: A population-based survey in the Pearl River Delta Region, China

BACKGROUND

Exposure to PM2.5 has been linked to neurodegenerative diseases, with limited understanding of constituent-specific contributions.

OBJECTIVES

To explore the associations between long-term exposure to PM2.5 constituents and neurodegenerative diseases.

METHODS

We recruited 148,274 individuals aged ≥ 60 from four cities in the Pearl River Delta region, China (2020 to 2021). We calculated twenty-year average air pollutant concentrations (PM2.5 mass, black carbon (BC), organic matter (OM), ammonium (NH4+), nitrate (NO3-) and sulfate (SO42-)) at the individuals' home addresses. Neurodegenerative diseases were determined by self-reported doctor-diagnosed Alzheimer's disease (AD) and Parkinson's disease (PD). Generalized linear mixed models were employed to explore associations between pollutants and neurodegenerative disease prevalence.

RESULTS

PM2.5 and all five constituents were significantly associated with a higher prevalence of AD and PD. The observed associations generally exhibited a non-linear pattern. For example, compared with the lowest quartile, higher quartiles of BC were associated with greater odds for AD prevalence (i.e., the adjusted odds ratios were 1.81; 95% CI, 1.45-2.27; 1.78; 95% CI, 1.37-2.32; and 1.99; 95% CI, 1.54-2.57 for the second, third, and fourth quartiles, respectively).

CONCLUSIONS

Long-term exposure to PM2.5 and its constituents, particularly combustion-related BC, OM, and SO42-, was significantly associated with higher prevalence of AD and PD in Chinese individuals.

ENVIRONMENTAL IMPLICATION

PM2.5 is a routinely regulated mixture of multiple hazardous constituents that can lead to diverse adverse health outcomes. However, current evidence on the specific contributions of PM2.5 constituents to health effects is scarce. This study firstly investigated the association between PM2.5 constituents and neurodegenerative diseases in the moderately to highly polluted Pearl River Delta region in China, and identified hazardous constituents within PM2.5 that have significant impacts. This study provides important implications for the development of targeted PM2.5 prevention and control policies to reduce specific hazardous PM2.5 constituents.

Emerging Theories of Allostatic-Interoceptive Overload in Neurodegeneration

Recent integrative multilevel models offer novel insights into the etiology and course of neurodegenerative conditions. The predictive coding of allostatic-interoception theory posits that the brain adapts to environmental demands by modulating internal bodily signals through the allostatic-interoceptive system. Specifically, a domain-general allostatic-interoceptive network exerts adaptive physiological control by fine-tuning initial top-down predictions and bottom-up peripheral signaling. In this context, adequate adaptation implies the minimization of prediction errors thereby optimizing energy expenditure. Abnormalities in top-down interoceptive predictions or peripheral signaling can trigger allostatic overload states, ultimately leading to dysregulated interoceptive and bodily systems (endocrine, immunological, circulatory, etc.). In this context, environmental stress, social determinants of health, and harmful exposomes (i.e., the cumulative life-course exposition to different environmental stressors) may interact with physiological and genetic factors, dysregulating allostatic interoception and precipitating neurodegenerative processes. We review the allostatic-interoceptive overload framework across different neurodegenerative diseases, particularly in the behavioral variant frontotemporal dementia (bvFTD). We describe how concepts of allostasis and interoception could be integrated with principles of predictive coding to explain how the brain optimizes adaptive responses, while maintaining physiological stability through feedback loops with multiple organismic systems. Then, we introduce the model of allostatic-interoceptive overload of bvFTD and discuss its implications for the understanding of pathophysiological and neurocognitive abnormalities in multiple neurodegenerative conditions.

Air pollution, APOE genotype and risk of dementia among individuals with cardiovascular diseases: A population-based longitudinal study

Individuals with cardiovascular disease (CVD) are particularly vulnerable to dementia, but it remains unclear whether air pollution exposure links with higher risk of dementia among those with CVD. The data were derived from the UK Biobank study (UKB). Dementia-free participants with CVD at baseline were included. Air pollution exposure was assessed through land use regression models, including particulate matter (PM2.5, PM2.5-10, and PM10), nitrogen dioxide (NO2), and nitrogen oxides (NOX). A Cox proportional hazards model was used to investigate the associations between air pollution exposure and incident dementia among individuals with CVD. Air pollution was associated with dementia among individuals with CVD, and the hazard ratios of dementia associated with each interquartile range (IQR) μg/m3 increase in air pollution were 1.07 (95% CI: 1.02, 1.12) for PM2.5, 1.10 (95% CI: 1.04, 1.15) for PM10, 1.08 (95% CI: 1.03, 1.14) for NO2 and 1.05 (95% CI: 1.00, 1.09) for NOx. Associations between air pollution and all-cause dementia were found to be significant among individuals with hypertension. Adverse effects of air pollution were also observed for Alzheimer's dementia (AD) and vascular dementia (VaD), with a higher effect for AD. Observed associations remained similar in subgroups of APOE ε4 carriers and noncarriers, although there was a higher risk difference across different air pollution concentration among these individuals carrying APOE ε4. Air pollution emerges as a critical risk factor for dementia among individuals with CVD, regardless of genetic susceptibility indicated by the APOE genotype. Notably, individuals with hypertension might be susceptible to the adverse effects of air pollution, leading to a higher incidence of dementia. Understanding these impacts on dementia among individuals with CVD may promote better targeted prevention and clinical management strategies.

Occupational and domestic exposure associations with cerebral small vessel disease and vascular dementia: A systematic review and meta-analysis

INTRODUCTION

The prevalence of cerebral smallvessel disease (SVD) and vascular dementia according to workplace or domestic exposure to hazardous substances is unclear.

METHODS

We included studies assessing occupational and domestic hazards/at-risk occupations and SVD features. We pooled prevalence estimates using random-effects models where possible, or presented a narrative synthesis.

RESULTS

We included 85 studies (n = 47,743, mean age = 44·5 years). 52/85 reported poolable estimates. SVD prevalence in populations exposed to carbon monoxide was 81%(95% CI = 60-93%; n = 1373; results unchanged in meta-regression), carbon disulfide73% (95% CI = 54-87%; n = 131), 1,2-dichloroethane 88% (95% CI = 4-100%, n = 40), toluene 82% (95% CI = 3-100%, n = 64), high altitude 49% (95% CI = 38-60%; n = 164),and diving 24% (95% CI = 5-67%, n = 172). We narratively reviewed vascular dementia studies and contact sport, lead, military, pesticide, and solvent exposures as estimates were too few/varied to pool.

DISCUSSION

SVD and vascular dementia may be associated with occupational/domestic exposure to hazardous substances. CRD42021297800.

Elossaily G, Vellapandian C, Prajapati B. Investigating the Potential Impact of Air Pollution on Alzheimer's Disease and the Utility of Multidimensional Imaging for Early Detection

Pollution is ubiquitous, and much of it is anthropogenic in nature, which is a severe risk factor not only for respiratory infections or asthma sufferers but also for Alzheimer's disease, which has received a lot of attention recently. This Review aims to investigate the primary environmental risk factors and their profound impact on Alzheimer's disease. It underscores the pivotal role of multidimensional imaging in early disease identification and prevention. Conducting a comprehensive review, we delved into a plethora of literature sources available through esteemed databases, including Science Direct, Google Scholar, Scopus, Cochrane, and PubMed. Our search strategy incorporated keywords such as "Alzheimer Disease", "Alzheimer's", "Dementia", "Oxidative Stress", and "Phytotherapy" in conjunction with "Criteria Pollutants", "Imaging", "Pathology", and "Particulate Matter". Alzheimer's disease is not only a result of complex biological factors but is exacerbated by the infiltration of airborne particles and gases that surreptitiously breach the nasal defenses to traverse the brain, akin to a Trojan horse. Various imaging modalities and noninvasive techniques have been harnessed to identify disease progression in its incipient stages. However, each imaging approach possesses inherent limitations, prompting exploration of a unified technique under a single umbrella. Multidimensional imaging stands as the linchpin for detecting and forestalling the relentless march of Alzheimer's disease. Given the intricate etiology of the condition, identifying a prospective candidate for Alzheimer's disease may take decades, rendering the development of a multimodal imaging technique an imperative. This research underscores the pressing need to recognize the chronic ramifications of invisible particulate matter and to advance our understanding of the insidious environmental factors that contribute to Alzheimer's disease.

The association between ambient air pollution and migraine: a systematic review

Some studies have shown the effect of air pollution on migraine. However, it needs to be confirmed in larger-scale studies, as scientific evidence is scarce regarding the association between air pollution and migraine. Therefore, this systematic review aims to determine whether there are associations between outdoor air pollution and migraine. A literature search was performed in Scopus, Medline (via PubMed), EMBASE, and Web of Science. A manual search for resources and related references was also conducted to complete the search. All observational studies investigating the association between ambient air pollution and migraine, with inclusion criteria, were entered into the review. Fourteen out of 1417 identified articles met the inclusion criteria and entered the study. Among the gaseous air pollutants, there was a correlation between exposure to nitrogen dioxide (NO2) (78.3% of detrimental relationships) and carbon monoxide (CO) (68.0% of detrimental relationships) and migraine, but no apparent correlation has been found for sulfur dioxide (SO2) (21.2% of detrimental relationships) and ozone (O3) (55.2% of detrimental relationships). In the case of particulate air pollutants, particulate matter with a diameter of 10 μm or less (PM10) (76.0% of detrimental relationships) and particulate matter with a diameter of 2.5 μm or less (PM2.5) (61.3% of detrimental relationships) had relationships with migraine. In conclusion, exposure to NO2, CO, PM10, and PM2.5 is associated with migraine headaches, while no conclusive evidence was found to confirm the correlation between O3 and SO2 with migraine. Further studies with precise methodology are recommended in different cities around the world for all pollutants with an emphasis on O3 and SO2.

Relative contributions of ambient air and internal sources to multiple air pollutants in public transportation modes

Commuters are often exposed to relatively high air pollutant concentrations in public transport microenvironments (TMEs) because of their proximity to emission sources. Previous studies have mainly focused on assessing the concentrations of air pollutants in TMEs, but few studies have distinguished between the contributions of ambient air and internal sources to the exposure of commuters to air pollutants. The main objective of this study was to quantify the contributions of ambient air and internal sources to the measured particulate matter and gaseous pollutant concentrations in selected TMEs in Hong Kong, a high-rise, high-density city in Asia. A sampling campaign was conducted to measure air pollutant concentrations in TMEs in Hong Kong in July and November 2018 using portable air quality monitors. We measured the concentrations of each pollutant in different TMEs and quantified the infiltration of particulate matter into these TMEs. The double-decker bus had the lowest particulate matter concentrations (mean PM1, PM2.5, and PM10 concentrations of 5.1, 9.5, and 13 μg/m3, respectively), but higher concentrations of CO (0.9 ppm), NO (422 ppb), and NO2 (100 ppb). For all the TMEs, about half of the PM2.5 were PM1 particles. The Mass Transit Railway (MTR) subway system had a PM2.5/PM10 ratio of about 0.90, whereas the PM2.5/PM10 ratio was about 0.60-0.70 for the other TMEs. The MTR had infiltration factor estimates <0.4 for particulate matter, lower than those of the double-decker bus and minibus. The MTR had the highest contribution from internal sources (mean PM1, PM2.5, and PM10 concentrations of 4.6, 13.4, and 15.8 μg/m3, respectively). This study will help citizens to plan commuting routes to reduce their exposure to air pollution and help policy-makers to prioritize effective exposure reduction strategies.

To promote healthy aging, focus on the environment

To build health equity for an aging world marked by dramatic disparities in healthy lifespan between countries, regions and population groups, research at the intersections of biology, toxicology and the social and behavioral sciences points the way: to promote healthy aging, focus on the environment. In this Perspective, we suggest that ideas and tools from the emerging field of geroscience offer opportunities to advance the environmental science of aging. Specifically, the capacity to measure the pace and progress of biological processes of aging within individuals from relatively young ages makes it possible to study how changing environments can change aging trajectories from early in life, in time to prevent or delay aging-related disease and disability and build aging health equity.

Relationships of Residential Distance to Major Traffic Roads with Dementia Incidence and Brain Structure Measures: Mediation Role of Air Pollution

Background: Uncertainty exists regarding the operating pathways between near-roadway exposure and dementia incidence. We intend to examine relationships between proximity to major roadways with dementia incidence and brain MRI structure measures, and potential mediation roles of air and noise pollution. Methods: The cohort study was based on the UK Biobank. Baseline survey was conducted from 2006 to 2010, with linkage to electronic health records conducted for follow-up. Residential distance to major roadways was ascertained residential address postcode. A land use regression model was applied for estimating traffic-related air pollution at residence. Dementia incidence was ascertained using national administrative databases. Brain MRI measures were derived as image-derived phenotypes, including total brain, white matter, gray matter, and peripheral cortical gray matter. Results: We included 460,901 participants [mean (SD) age: 57.1 (8.1) years; men: 45.7%]. Compared with individuals living >1,000 m from major traffic roads, living ≤1,000 m was associated with a 13% to 14% higher dementia risk, accounting for 10% of dementia cases. Observed association between residential distance and dementia was substantially mediated by traffic-related air pollution, mainly nitrogen dioxide (proportion mediated: 63.6%; 95% CI, 27.0 to 89.2%) and PM2.5 (60.9%, 26.8 to 87.0%). The shorter residential distance was associated with smaller volumes of brain structures, which was also mediated by traffic-related air pollutants. No significant mediation role was observed of noise pollution. Conclusions: The shorter residential distance to major roads was associated with elevated dementia incidence and smaller brain structure volumes, which was mainly mediated by traffic-related air pollution.

Post-stroke dysphagia and ambient air pollution are associated with dementia

Introduction

This cohort study aimed to explore the potential association between ambient air pollution and dementia incidence in adults who have experienced a stroke. Additionally, the study aimed to determine dysphagia as a predictive factor for the subsequent development of dementia in patients with stroke.

Materials and methods

This retrospective nested case-control study used data from the Kaohsiung Medical University Hospital Database in Taiwan. Data collected include average ambient air pollution concentrations within 3 months and 1 year after the index dysphagia date. The primary outcome includes incident dementia in patients with or without dysphagia. Logistic regression analysis was performed to examine the association between significant air pollution exposure and the risk of dementia while controlling for baseline demographic characteristics (age and sex), and comorbidities.

Results

The univariable regression models revealed a higher likelihood of dementia diagnosis in patients with dysphagia (odds ratio = 1.493, 95% confidence interval = 1.000-2.228). The raw odds ratios indicated a potential link between air pollution exposure and elevated dementia risks in the overall study population and patients with stroke without dysphagia, except for O3. Particulate matter (PM)2.5 and nitrogen oxides (NOx) exhibited significant effects on the risk of dementia in the stepwise logistic regression models.

Conclusion

The presence of dysphagia following a stroke may pose a risk of developing dementia. Additionally, PM2.5 and NOx exposure appears to elevate the risk of dementia in patients with stroke.

The association of long-term exposure to criteria air pollutants, fine particulate matter components, and airborne trace metals with late-life brain amyloid burden in the Atherosclerosis Risk in Communities (ARIC) study

BACKGROUND

Studies suggest associations between long-term ambient air pollution exposure and outcomes related to Alzheimer's disease (AD). Whether a link exists between pollutants and brain amyloid accumulation, a biomarker of AD, is unclear. We assessed whether long-term air pollutant exposures are associated with late-life brain amyloid deposition in Atherosclerosis Risk in Communities (ARIC) study participants.

METHODS

We used a chemical transport model with data fusion to estimate ambient concentrations of PM2.5 and its components, NO2, NOx, O3 (24-hour and 8-hour), CO, and airborne trace metals. We linked concentrations to geocoded participant addresses and calculated 10-year mean exposures (2002 to 2011). Brain amyloid deposition was measured using florbetapir amyloid positron emission tomography (PET) scans in 346 participants without dementia in 2012-2014, and we defined amyloid positivity as a global cortical standardized uptake value ratio ≥ the sample median of 1.2. We used logistic regression models to quantify the association between amyloid positivity and each air pollutant, adjusting for putative confounders. In sensitivity analyses, we considered whether use of alternate air pollution estimation approaches impacted findings for PM2.5, NO2, NOx, and 24-hour O3.

RESULTS

At PET imaging, eligible participants (N = 318) had a mean age of 78 years, 56% were female, 43% were Black, and 27% had mild cognitive impairment. We did not find evidence of associations between long-term exposure to any pollutant and brain amyloid positivity in adjusted models. Findings were materially unchanged in sensitivity analyses using alternate air pollution estimation approaches for PM2.5, NO2, NOx, and 24-hour O3.

CONCLUSIONS

Air pollution may impact cognition and dementia independent of amyloid accumulation, though whether air pollution influences AD pathogenesis later in the disease course or at higher exposure levels deserves further consideration.

NEUROMETABOLOMIC IMPACTS OF MODELED WILDFIRE SMOKE AND PROTECTIVE BENEFITS OF ANTI-AGING THERAPEUTICS IN AGED FEMALE C57BL/6J MICE

Wildland fires have become progressively more extensive over the past 30 years in the US, and now routinely generate smoke that deteriorates air quality for most of the country. We explored the neurometabolomic impact that smoke derived from biomass has on older (18 months) female C57BL/6J mice, both acutely and after 10 weeks of recovery from exposures. Mice (N=6/group) were exposed to wood smoke (WS) 4 hours/day, every other day, for 2 weeks (7 exposures total) to an average concentration of 0.448mg/m 3 per exposure. One group was euthanized 24 hours after the last exposure. Other groups were then placed on 1 of 4 treatment regimens for 10 weeks after wood smoke exposures: vehicle; resveratrol in chow plus nicotinamide mononucleotide in water (RNMN); senolytics via gavage (dasatanib+quercetin; DQ); or both RNMN with DQ (RNDQ). Among the findings, the aging from 18 months to 21 months was associated with the greatest metabolic shift, including changes in nicotinamide metabolism, with WS exposure effects that were relatively modest. WS caused a reduction in NAD+ within the prefrontal cortex immediately after exposure and a long-term reduction in serotonin that persisted for 10 weeks. The serotonin reductions were corroborated by forced swim tests, which revealed an increased immobility (reduction in motivation) immediately post-exposure and persisted for 10 weeks. RNMN had the most beneficial effects after WS exposure, while RNDQ caused markers of brain aging to be upregulated within WS-exposed mice. Findings highlight the persistent neurometabolomic and behavioral effects of woodsmoke exposure in an aged mouse model.

Significance Statement

Neurological impacts of wildfire smoke are largely underexplored but include neuroinflammation and metabolic changes. The present study highlights modulation of major metabolites in the prefrontal cortex and behavioral consequences in aged (18 month) female mice that persists 10 weeks after wood smoke exposure ended. Supplements derived from the anti-aging field were able to mitigate much of the woodsmoke effect, especially a combination of resveratrol and nicotinamide mononucleotide.

Association of Long-term Exposure to Air Pollution and Dementia Risk: The Role of Homocysteine, Methionine, and Cardiovascular Burden

BACKGROUND AND OBJECTIVES

Growing evidence links air pollution with dementia risk, but the biological mechanisms are largely unknown. We investigated the role played by homocysteine (tHcy) and methionine in this association and explored whether this could be explained by cardiovascular diseases (CVDs).

METHODS

Data were extracted from the ongoing Swedish National study on Aging and Care in Kungsholmen (SNAC-K), a longitudinal population-based study. At baseline, 2,512 dementia-free participants were examined up to 2013 (mean follow-up: 5.18 ± 2.96 years). Two air pollutants (particulate matter ≤2.5 μm [PM2.5] and nitrogen oxides [NOx]) were assessed yearly from 1990 until 2013 using dispersion models at residential addresses. The hazard ratio of dementia over air pollution levels was estimated using Cox models adjusted for age, sex, education, smoking, socioeconomic status, physical activity, retirement age, creatinine, year of assessment, and the use of supplements. The total effect of air pollutants on dementia was decomposed into 4 pathways involving tHcy/methionine: (1) direct effect; (2) indirect effect (mediation); (3) effect due to interaction; and (4) effect due to both mediation and interaction. To test whether the association was independent from CVDs (ischemic heart disease, atrial fibrillation, heart failure, and stroke), we repeated the analyses excluding those individuals who developed CVDs.

RESULTS

The mean age of the study participants was 73.4 years (SD: 10.4), and 62.1% were female individuals. During an average period of 5 years (mean: 5.18; SD: 2.96 years), 376 cases with incident dementia were identified. There was a 70% increased hazard of dementia per unit increase of PM2.5 during the 5 years before baseline (hazard ratio [HR]: 1.71; 95% CI 1.33-2.09). Overall, 50% (51.6%; 95% CI 9.0-94.1) of the total effect of PM2.5 on dementia was due to mediation of tHcy (6.6%; 95% CI 1.6-11.6) and/or interaction (47.8%; 95% CI 4.9-91.7) with tHcy and 48.4% (p = 0.03) to the direct effect of PM2.5 on dementia. High levels of methionine reduced the dementia hazard linked to PM2.5 by 31% (HR: 0.69; 95% CI 0.56-0.85) with 24.8% attributable to the interaction with methionine and 25.9% (p = 0.001) to the direct effect of PM2.5. No mediation effect was found through methionine. Attenuated results were obtained for NOx. Findings for tHcy were attenuated after excluding those who developed CVDs, while remained similar for methionine.

DISCUSSION

High levels of homocysteine enhanced the dementia risk attributed to air pollution, while high methionine concentrations reduced this risk. The impact of homocysteine on cardiovascular conditions partly explains this association. Alternative pathways other than cardiovascular mechanisms may be at play between methionine and dementia.

Global rural health disparities in Alzheimer's disease and related dementias: State of the science

INTRODUCTION

Individuals living in rural communities are at heightened risk for Alzheimer's disease and related dementias (ADRD), which parallels other persistent place-based health disparities. Identifying multiple potentially modifiable risk factors specific to rural areas that contribute to ADRD is an essential first step in understanding the complex interplay between various barriers and facilitators.

METHODS

An interdisciplinary, international group of ADRD researchers convened to address the overarching question of: "What can be done to begin minimizing the rural health disparities that contribute uniquely to ADRD?" In this state of the science appraisal, we explore what is known about the biological, behavioral, sociocultural, and environmental influences on ADRD disparities in rural settings.

RESULTS

A range of individual, interpersonal, and community factors were identified, including strengths of rural residents in facilitating healthy aging lifestyle interventions.

DISCUSSION

A location dynamics model and ADRD-focused future directions are offered for guiding rural practitioners, researchers, and policymakers in mitigating rural disparities.

HIGHLIGHTS

Rural residents face heightened Alzheimer's disease and related dementia (ADRD) risks and burdens due to health disparities. Defining the unique rural barriers and facilitators to cognitive health yields insight. The strengths and resilience of rural residents can mitigate ADRD-related challenges. A novel "location dynamics" model guides assessment of rural-specific ADRD issues.

Associations of air pollution with all-cause dementia, Alzheimer's disease, and vascular dementia: a prospective cohort study based on 437,932 participants from the UK biobank

OBJECTIVE

To prospectively assess whether air pollution, including PM2.5, PM10, and NOx, is associated with the risk of all-cause dementia, Alzheimer's disease (AD), and vascular dementia, and to investigate the potential relationship between air pollution and genetic susceptibility in the development of AD.

METHODS AND RESULTS

Our study included 437,932 participants from the UK Biobank with a median follow-up period of over 10 years. Using a Cox proportional hazards model, we found that participants exposed to PM2.5 levels of ≥10 μg/m3 had a higher risk of developing all-cause dementia (HR = 1.1; 95% CI: 1.05-1.28; p < 0.05) compared to the group exposed to PM2.5 levels of <10 μg/m3. However, there was no significant association between PM10 levels of ≥15 μg/m3 and the risk of all-cause dementia, AD, or vascular dementia when compared to the group exposed to PM10 levels of <15 μg/m3. On the other hand, participants exposed to NOx levels of ≥50 μg/m3 had a significantly higher risk of all-cause dementia (HR = 1.14; 95% CI: 1.02-1.26; p < 0.05) and AD (HR = 1.26; 95% CI: 1.08-1.48; p < 0.05) compared to the group exposed to NOx levels of <50 μg/m3. Furthermore, we examined the combined effect of air pollution (PM2.5, PM10, and NOx) and Alzheimer's disease genetic risk score (AD-GRS) on the development of AD using a Cox proportional hazards model. Among participants with a high AD-GRS, those exposed to NOx levels of ≥50 μg/m3 had a significantly higher risk of AD compared to those in the group exposed to NOx levels of <50 μg/m3 (HR = 1.36; 95% CI: 1.03-1.18; p < 0.05). Regardless of air pollutant levels (PM2.5, PM10, or NOx), participants with a high AD-GRS had a significantly increased risk of developing AD. Similar results were obtained when assessing multiple variables using inverse probability of treatment weighting (IPTW).

CONCLUSION

Our findings indicate that individuals living in areas with PM2.5 levels of ≥10 μg/m3 or NOx levels of ≥50 μg/m3 are at a higher risk of developing all-cause dementia. Moreover, individuals with a high AD-GRS demonstrated an increased risk of developing AD, particularly in the presence of NOx ≥ 50 μg/m3.

Neighbourhood residential density, urbanicity and incident dementia and Alzheimer's disease: A 12-year prospective cohort study from the UK Biobank

INTRODUCTION

An increasing proportion of global population is exposed to urban densification in an aging society. However, little is known of the role of residential density and urbanicity on the risk of developing dementia including Alzheimer's disease. We examined long-term associations between residential density and urbanicity and risks of incident dementia and Alzheimer's disease.

METHODS

This prospective cohort study included participants from the UK Biobank who lived at the same residential address, had no self-reported neurological conditions and without dementia at baseline. Residential density was measured as the number of dwelling units within 1-km street neighbourhood of participant's home address. A composite index of urbanicity was developed from neighbourhood-level z-standardized densities of housing, retail, public transport and street centrality. Hazard ratios were derived from Cox proportional hazard models adjusted for known risk factors.

RESULTS

The analytic sample included 239,629 participants aged 38-72 years. During a median follow-up of 12.3 years (interquartile range 11.5-13.0 years), 2,176 participants developed dementia and 1,004 Alzheimer's disease. After adjustments for potential risk factors, each 1,000 units/Km2 increment in residential density was associated with higher risks of dementia (hazard ratio [HR]=1.10, 95% confidence interval [CI]: 1.06-1.15) and Alzheimer's disease (HR=1.10, 95% CI: 1.04-1.16). Consistently, categorical models showed that living in neighbourhoods of higher residential density and urbanicity were associated with higher risks of dementia (HR = 1.30, 95% CI: 1.12-1.51 for the highest density quintile compared to the lowest and HR = 1.21, 95% CI: 1.05-1.39 for the highest urbanicity quintile relative to the lowest). The associations were more pronounced in female, age >65 years, and among participants of the low income and those being frail and having shorter leucocyte telomere length (LTL).

CONCLUSIONS

Higher residential density and urbanicity was found to be positively associated with elevated risks of dementia and Alzheimer's disease. Optimizing neighbourhood residential density maybe one of the upstream considerations for mitigating against neurodegenerative diseases.

Air pollution is associated with faster cognitive decline in Alzheimer's disease

OBJECTIVE

Although chronic exposure to air pollution is associated with an increased risk of dementia in normal elderlies, the effect of chronic exposure to air pollution on the rates of cognitive decline in Alzheimer's disease (AD) has not been elucidated.

METHODS

In this longitudinal study, a total of 269 patients with mild cognitive impairment or early dementia due to AD with the evidence of brain β-amyloid deposition were followed-up for a mean period of 4 years. Five-year normalized hourly cumulative exposure value of each air pollutant, such as carbon monoxide (CO), nitrogen dioxide (NO2 ), sulfur dioxide (SO2 ), and particulate matter (PM2.5 and PM10 ), was computed based on nationwide air pollution database. The effects of chronic exposure to air pollution on longitudinal cognitive decline rate were evaluated using linear mixed models.

RESULTS

Higher chronic exposure to SO2 was associated with a faster decline in memory score, whereas chronic exposure to CO, NO2 , and PM10 were not associated with the rate of cognitive decline. Higher chronic exposure to PM2.5 was associated with a faster decline in visuospatial score in apolipoprotein E ε4 carriers. These effects remained significant even after adjusting for potential confounders.

INTERPRETATION

Our findings suggest that chronic exposure to SO2 and PM2.5 is associated with faster clinical progression in AD.

Exposure to quasi-ultrafine particulate matter accelerates memory impairment and Alzheimer's disease-like neuropathology in the AppNL-G-F knock-in mouse model

Exposure to traffic-related air pollution consisting of particulate matter (PM) is associated with cognitive decline leading to Alzheimer's disease (AD). In this study, we sought to examine the neurotoxic effects of exposure to ultrafine PM and how it exacerbates neuronal loss and AD-like neuropathology in wildtype (WT) mice and a knock-in mouse model of AD (AppNL-G-F/+-KI) when the exposure occurs at a prepathologic stage or at a later age with the presence of neuropathology. AppNL-G-F/+-KI and WT mice were exposed to concentrated ultrafine PM from local ambient air in Irvine, California, for 12 weeks, starting at 3 or 9 months of age. Particulate matter-exposed animals received concentrated ultrafine PM up to 8 times above the ambient levels, whereas control animals were exposed to purified air. Particulate matter exposure resulted in a marked impairment of memory tasks in prepathologic AppNL-G-F/+-KI mice without measurable changes in amyloid-β pathology, synaptic degeneration, and neuroinflammation. At aged, both WT and AppNL-G-F/+-KI mice exposed to PM showed a significant memory impairment along with neuronal loss. In AppNL-G-F/+-KI mice, we also detected an increased amyloid-β buildup and potentially harmful glial activation including ferritin-positive microglia and C3-positive astrocytes. Such glial activation could promote the cascade of degenerative consequences in the brain. Our results suggest that exposure to PM impairs cognitive function at both ages while exacerbation of AD-related pathology and neuronal loss may depend on the stage of pathology, aging, and/or state of glial activation. Further studies will be required to unveil the neurotoxic role of glial activation activated by PM exposure.

Assessing the causal effect of long-term exposure to air pollution on cognitive decline in middle-aged and older adults - Empirical evidence from a nationwide longitudinal cohort

Air pollution remains a risk factor for the global burden of disease. Middle-aged and older people are more susceptible to air pollution because of their declining physical function and are more likely to develop diseases from long-term air pollution exposure. Studies of the effects of air pollution on cognitive function in middle-aged and older adults have been inconsistent. More representative and definitive evidence is needed. This study analysed data from the Chinese Family Panel Study, an ongoing nationwide prospective cohort study, collected in waves 2014, 2016 and 2018. Rigorously tested instrument was selected for analysis and participants' PM_2.5 and instrument exposures were assessed using high-precision satellite data. The causal relationship between long-term exposure to air pollution and poor cognitive function in middle-aged and older adults was investigated using the Correlated Random Effects Control Function (CRE-CF) method within a quasi-experimental framework. This study included a total of 7042 participants aged 45 years or older. A comparison of CRE-CF with other models (OLS model, ordered probit model, and ordered probit-CRE model) demonstrated the necessity of using CRE-CF given the endogeneity of air pollution. The credibility and validity of the instrumental variable were verified. In the CRE-CF model, long-term exposure to PM_2.5 was found to accelerate cognitive decline in middle-aged and older adults (coefficients of -0.159, -0.336 and -0.244 for the total cognitive, verbal and mathematical scores, respectively). Taken together, these results suggest that chronic exposure to ambient air pollution is associated with cognitive decline in middle-aged and older adults, which highlights the need for appropriate protective policies.

Association of air pollution with dementia: a systematic review with meta-analysis including new cohort data from China

It remains unclear whether a total exposure to air pollution (AP) is associated with an increased risk of dementia. Little is known on the association in low- and middle-income countries. Two cohort studies in China (in Anhui cohort 1402 older adults aged ≥ 60 followed up for 10 years; in Zhejiang cohort 6115 older adults followed up for 5 years) were conducted to examine particulate matter - PM_2.5 associated with all dementia and air quality index (AQI) with Alzheimer's disease, respectively. A systematic literature review and meta-analysis was performed following worldwide literature searched until May 20, 2020 to identify 15 population-based cohort studies examining the association of AP with dementia (or any specific type of dementia) through PubMed, MEDLINE, PsycINFO, SocINDEX, CINHAL, and CNKI. The cohort studies in China showed a significantly increased relative risk (RR) of dementia in relation to AP exposure; in Anhui cohort the adjusted RR was 2.14 (95% CI 1.00-4.56) in people with PM_2.5 exposure at ≥ 64.5 μg/m³ versus <63.5 μg/m³ and in Zhejiang cohort the adjusted RR was 2.28 (1.07-4.87) in AQI>90 versus ≤ 80. The systematic review revealed that all 15 studies were undertaken in high income countries/regions, with inconsistent findings. While they had reasonably good overall quality of studies, seven studies did not adjust smoking in analysis and 13 did not account for depression. Pooling all eligible data demonstrated that dementia risk increased with the total AP exposure (1.13, 1.08-1.19). Data analysis of air pollutants showed that the RR significantly increased with PM_2.5 (1.06, 1.03-1.10 in 2nd tertile exposure; 1.13, 1.07-1.19 in 3rd tertile versus 1st tertile), PM₁₀ (1.05, 0.86-1.29; 1.62, 0.60-4.36), carbon monoxide (1.69, 0.72-3.93; 1.52, 1.35-1.71), nitrogen dioxide (1.06, 1.03-1.09; 1.18, 1.10-1.28) and nitrogen oxides (1.09, 1.04-1.15; 1.26, 1.13-1.41), but not ozone. Controlling air pollution and targeting on specific pollutants would reduce dementia globally.

Ambient air pollution and clinical dementia: systematic review and meta-analysis

OBJECTIVE

To investigate the role of air pollutants in risk of dementia, considering differences by study factors that could influence findings.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

EMBASE, PubMed, Web of Science, Psycinfo, and OVID Medline from database inception through July 2022.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Studies that included adults (≥18 years), a longitudinal follow-up, considered US Environmental Protection Agency criteria air pollutants and proxies of traffic pollution, averaged exposure over a year or more, and reported associations between ambient pollutants and clinical dementia. Two authors independently extracted data using a predefined data extraction form and assessed risk of bias using the Risk of Bias In Non-randomised Studies of Exposures (ROBINS-E) tool. A meta-analysis with Knapp-Hartung standard errors was done when at least three studies for a given pollutant used comparable approaches.

RESULTS

2080 records identified 51 studies for inclusion. Most studies were at high risk of bias, although in many cases bias was towards the null. 14 studies could be meta-analysed for particulate matter <2.5 µm in diameter (PM2.5). The overall hazard ratio per 2 μg/m3 PM2.5 was 1.04 (95% confidence interval 0.99 to 1.09). The hazard ratio among seven studies that used active case ascertainment was 1.42 (1.00 to 2.02) and among seven studies that used passive case ascertainment was 1.03 (0.98 to 1.07). The overall hazard ratio per 10 μg/m3 nitrogen dioxide was 1.02 ((0.98 to 1.06); nine studies) and per 10 μg/m3 nitrogen oxide was 1.05 ((0.98 to 1.13); five studies). Ozone had no clear association with dementia (hazard ratio per 5 μg/m3 was 1.00 (0.98 to 1.05); four studies).

CONCLUSION

PM2.5 might be a risk factor for dementia, as well as nitrogen dioxide and nitrogen oxide, although with more limited data. The meta-analysed hazard ratios are subject to limitations that require interpretation with caution. Outcome ascertainment approaches differ across studies and each exposure assessment approach likely is only a proxy for causally relevant exposure in relation to clinical dementia outcomes. Studies that evaluate critical periods of exposure and pollutants other than PM2.5, and studies that actively assess all participants for outcomes are needed. Nonetheless, our results can provide current best estimates for use in burden of disease and regulatory setting efforts.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42021277083.

Air pollution and traffic noise interact to affect cognitive health in older Mexican Americans

BACKGROUND

Both air pollution and noise exposures have separately been shown to affect cognitive impairment. Here, we examine how air pollution and noise exposures interact to influence the development of incident dementia or cognitive impairment without dementia (CIND).

METHODS

We used 1,612 Mexican American participants from the Sacramento Area Latino Study on Aging conducted from 1998 to 2007. Air pollution (nitrogen dioxides, particulate matter, ozone) and noise exposure levels were modeled with a land-use regression and via the SoundPLAN software package implemented with the Traffic Noise Model applied to the greater Sacramento area, respectively. Using Cox proportional hazard models, we estimated the hazard of incident dementia or CIND from air pollution exposure at the residence up to 5-years prior to diagnosis for the members of each risk set at event time. Further, we investigated whether noise exposure modified the association between air pollution exposure and dementia or CIND.

RESULTS

In total, 104 incident dementia and 159 incident dementia/CIND cases were identified during the 10 years of follow-up. For each ∼2 µg/m3 increase in time-varying 1- and 5-year average PM2.5 exposure, the hazard of dementia increased 33% (HR = 1.33, 95%CI: 1.00, 1.76). The hazard ratios for NO2-related dementia/CIND and PM2.5-related dementia were stronger in high-noise (≥65 dB) exposed than low-noise (<65 dB) exposed participants.

CONCLUSION

Our study indicates that PM2.5 and NO2 air pollution adversely affect cognition in elderly Mexican Americans. Our findings also suggest that air pollutants may interact with traffic-related noise exposure to affect cognitive function in vulnerable populations.

The bidirectional lung brain-axis of amyloid-β pathology: ozone dysregulates the peri-plaque microenvironment

The mechanisms underlying how urban air pollution affects Alzheimer's disease (AD) are largely unknown. Ozone (O3) is a reactive gas component of air pollution linked to increased AD risk, but is confined to the respiratory tract after inhalation, implicating the peripheral immune response to air pollution in AD neuropathology. Here, we demonstrate that O3 exposure impaired the ability of microglia, the brain's parenchymal immune cells, to associate with and form a protective barrier around Aβ plaques, leading to augmented dystrophic neurites and increased Aβ plaque load. Spatial proteomic profiling analysis of peri-plaque proteins revealed a microenvironment-specific signature of dysregulated disease-associated microglia protein expression and increased pathogenic molecule levels with O3 exposure. Unexpectedly, 5xFAD mice exhibited an augmented pulmonary cell and humoral immune response to O3, supporting that ongoing neuropathology may regulate the peripheral O3 response. Circulating HMGB1 was one factor upregulated in only 5xFAD mice, and peripheral HMGB1 was separately shown to regulate brain Trem2 mRNA expression. These findings demonstrate a bidirectional lung-brain axis regulating the central and peripheral AD immune response and highlight this interaction as a potential novel therapeutic target in AD.

Ambient air pollution and the risk of neurological diseases in residential areas near multi-purposed industrial complexes of korea: A population-based cohort study

Emerging evidence suggest that long-term exposure to air pollution may induce adverse effects on the central nervous system. However, no study explored the associations in large industrial complex (IC) areas which are one of the major contributors to air pollution. Therefore, we aimed to investigate the pollution status and the association between residential proximity and incidence of neurological diseases near two major ICs characterized as multi-purposed ICs in Korea. A retrospective cohort of residents near the ICs was constructed using Korea's health insurance data and monitored from 2008 to 2019. Emission amounts of the ICs and the air pollution status in the nearby (exposed) and remote (control) area were evaluated using data from national regulatory networks, and hazard ratios (HRs) and 95% confidence intervals (CIs) for neurological diseases of the exposed group compared to the control group were calculated using Cox proportional regression models. Overall, the complexes emitted large amounts of VOCs, CO, NOx, and PM10, and annual levels of ambient PM (2.5, 10), gaseous substances (NO₂, SO₂), VOCs and PAHs were higher in the exposed area compared to the control and/or the national average. The risk of inflammatory disease of the CNS (G00-09) and extrapyramidal and movement disorders (G20-26) were higher in the exposed area with a HR (95% CI) of 1.36 (1.10-1.68) and 1.33 (1.27-1.39) respectively. Among the subclasses, other extrapyramidal and movement disorders (G25) and epilepsy (G40) were associated with higher risks in the exposed area (HR (95%CI): 1.11 (1.04-1.18), 1.08 (1.00-1.16)) after adjusting for potential confounders. These results suggest that people living near ICs are more likely to be exposed to higher air pollution levels and have higher risks of developing several neurological disorders. However, further epidemiological studies in these industrial areas supplemented with other indicators of environmental exposure and control of other diverse factors are warranted.

PM2.5 and Dementia in a Low Exposure Setting: The Influence of Odor Identification Ability and APOE

BACKGROUND

Growing evidence show that long term exposure to air pollution increases the risk of dementia.

OBJECTIVE

The aim of this study was to investigate associations between PM2.5 exposure and dementia in a low exposure area, and to investigate the role of olfaction and the APOE ɛ4 allele in these associations.

METHODS

Data were drawn from the Betula project, a longitudinal study on aging, memory, and dementia in Sweden. Odor identification ability was assessed using the Scandinavian Odor Identification Test (SOIT). Annual mean PM2.5 concentrations were obtained from a dispersion-model and matched at the participants' residential address. Proportional hazard regression was used to calculate hazard ratios.

RESULTS

Of 1,846 participants, 348 developed dementia during the 21-year follow-up period. The average annual mean PM2.5 exposure at baseline was 6.77μg/m3, which is 1.77μg/m3 above the WHO definition of clean air. In a fully adjusted model (adjusted for age, sex, APOE, SOIT, cardiovascular diseases and risk factors, and education) each 1μg/m3 difference in annual mean PM2.5-concentration was associated with a hazard ratio of 1.23 for dementia (95% CI: 1.01-1.50). Analyses stratified by APOE status (ɛ4 carriers versus non-carriers), and odor identification ability (high versus low), showed associations only for ɛ4 carriers, and for low performance on odor identification ability.

CONCLUSION

PM2.5 was associated with an increased risk of dementia in this low pollution setting. The associations between PM2.5 and dementia seemed stronger in APOE carriers and those with below average odor identification ability.

Air pollution and dementia in older adults in the Ginkgo Evaluation of Memory Study

INTRODUCTION

Growing evidence implicates air pollution as a risk factor for dementia, but prior work is limited by challenges in diagnostic accuracy and assessing exposures in the decades prior to disease development. We evaluated the impact of long-term fine particulate matter (PM2.5 ) exposures on incident dementia (all-cause, Alzheimer's disease [AD], and vascular dementia [VaD]) in older adults.

METHODS

A panel of neurologists adjudicated dementia cases based on extensive neuropsychological testing and magnetic resonance imaging. We applied validated fine-scale air pollutant models to reconstructed residential histories to assess exposures.

RESULTS

An interquartile range increase in 20-year PM2.5 was associated with a 20% higher risk of dementia (95% confidence interval [CI]: 5%, 37%) and an increased risk of mixed VaD/AD but not AD alone.

DISCUSSION

Our findings suggest that air pollutant exposures over decades contribute to dementia and that effects of current exposures may be experienced years into the future.

Association of solid fuel use with a risk score capturing dementia risk among middle-aged and older adults: A prospective cohort study

OBJECTIVES

Whether household air pollution is associated with dementia risk remains unknown. This study examined the associations between solid fuel use for cooking and heating (the main source of household air pollution) and dementia risk.

METHODS

This analysis included data on 11,352 participants (aged 45+ years) from the 2011 wave of China Health and Retirement Longitudinal Study, with follow-up to 2018. Dementia risk was assessed by a risk score using the Rotterdam Study Basic Dementia Risk Model (BDRM), which was subsequently standardized for analysis. Household fuel types of cooking and heating were categorized as solid (e.g., coal and crop residue) and clean (e.g., central heating and solar). Multivariable analyses were performed using generalized estimating equations. Moreover, we examined the joint associations of solid fuel use for cooking and heating with the BDRM score.

RESULTS

After adjusting for potential confounders, we found an independent and significant association of solid (vs. clean) fuel use for cooking and heating with a higher BDRM score (e.g., β = 0.17 for solid fuel for cooking; 95% confidence interval [CI]: 0.15-0.19). Participants who used solid (vs. clean) fuel for both cooking and heating had the highest BDRM score (β = 0.32; 95% CI: 0.29-0.36). Subgroup analysis suggested stronger associations in participants living in rural areas.

CONCLUSIONS

Solid fuel use for cooking and heating was independently associated with increased dementia risk in Chinese middle-aged and older adults, particularly among those living in rural areas. Our findings call for more efforts to facilitate universal access to clean energy for dementia prevention.