Exposure to air pollution as a potential contributor to cognitive function, cognitive decline, brain imaging, and dementia: a systematic review of epidemiologic research

Power, Melinda C.; Adar, Sara D.; Yanosky, Jeff D.; Weuve, Jennifer

doi:10.1016/j.neuro.2016.06.004

Cited by 422Air Quality and Health ImpactsDementia and Cognitive Impairment ResearchHealth, Environment, Cognitive Aging

Exposure to air pollution as a potential contributor to cognitive function, cognitive decline, brain imaging, and dementia: a systematic review of epidemiologic research

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Power, Melinda C., Adar, Sara D., Yanosky, Jeff D., Weuve, Jennifer·2016·NeuroToxicology

DOI 10.1016/j.neuro.2016.06.004PMC PMC5048530

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Abstract

Background Dementia is a devastating condition typically preceded by a long prodromal phase characterized by accumulation of neuropathology and accelerated cognitive decline. A growing number of epidemiologic studies have explored the relation between air pollution exposure and dementia-related outcomes.Methods We undertook a systematic review, including quality assessment, to interpret the collective findings and describe methodological challenges that may limit study validity. Articles, which were identified according to a registered protocol, had to quantify the association of an air pollution exposure with cognitive function, cognitive decline, a dementia-related neuroimaging feature, or dementia.Results We identified 18 eligible published articles. The quality of most studies was adequate to exemplary. Almost all reported an adverse association between at least one pollutant and one dementia-related outcome. However, relatively few studies considered outcomes that provide the strongest evidence for a causal effect, such as within-person cognitive or pathologic changes. Reassuringly, differential selection would likely bias toward a protective association in most studies, making it unlikely to account for observed adverse associations. Likewise, using a formal sensitivity analysis, we found that unmeasured confounding is also unlikely to explain reported adverse associations.Discussion We also identified several common challenges. First, most studies of incident dementia identified cases from health system records. As dementia in the community is underdiagnosed, this could generate either non-differential or differential misclassification bias. Second, almost all studies used recent air pollution exposures as surrogate measures of long-term exposure. Although this approach may be reasonable if the measured and etiologic exposure windows are separated by a few years, its validity is unknown over longer intervals. Third, comparing the magnitude of associations may not clearly pinpoint which, if any, pollutants are the probable causal agents, because the degree of exposure misclassification differs across pollutants. The epidemiologic evidence, alongside evidence from other lines of research, provides support for a relation of air pollution exposure to dementia. Future studies with improved design, analysis and reporting would fill key evidentiary gaps and provide a solid foundation for recommendations and possible interventions.

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Animal models suggest that airborne particulate pollutants accelerate neurodegenerative processes through cerebrovascular and cardiovascular disease, Aβ deposition, and amyloid precursor protein processing.
“Animal models suggest airborne particulate pollutants accelerate neurodegenerative processes through cerebrovascular and cardiovascular disease, Aβ deposition, and amyloid precursor protein processing.”
From Dementia prevention, intervention, and care: 2020 report of the Lancet Commission (2020) · cites this paper as [125]
The Discussion (page unavailable) says animal and experimental studies link particulate and gaseous pollutants to pathways involved in dementia, and describes cardiovascular and cerebrovascular disease as a possible indirect route. It also says evidence for that indirect route remains elusive. The copy does not specifically support amyloid precursor protein processing as a pollutant-related mechanism, so the full list of mechanisms is not established by this source. (LLM, conf=0.82)
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Research works printed but not linked: 4

[52]Weng SW Lin YT Hwang BF Air pollution and alzheimer’s disease: A population-based prospective cohort study in Taiwan Epidemiology (Cambridge, Mass.) 2012 23 5 S143
[55]Jung CR Lin YT Hwang BF Ozone, particulate matter, and newly diagnosed Alzheimer’s disease: A population-based cohort study in Taiwan Journal of Alzheimer’s Disease 2015 epub ahead of print 25310992
[59]Hebert LE Weuve J Scherr PA Evans DA Alzheimer disease in the United States (2010–2050) estimated using the 2010 census Neurology 2013 80 19 1778 1783 23390181 PMC3719424
[65]Taylor DH Østbye T Langa KM Weir D Plassman BL The Accuracy of Medicare Claims as an Epidemiological Tool: The Case of Dementia Revisited Journal of Alzheimer’s disease: JAD 2009 17 4 807 815 19542620 PMC3697480

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“125,126 Although the higher levels of dementia from air pollutants are still subject to the potential for residual confounding, the effects on animal models are evidence of physiological effects over and above those driven by life-course deprivation.”
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Authors: Power, M. C., Adar, S. D., Yanosky, J. D., & Weuve, J.
Affiliations: Johns Hopkins University (US)
University of Michigan (US)
Pennsylvania State University (US)
Boston University (US)
Corresponding author: Weuve, Jennifer
ORCID: Power, Melinda C.
Adar, Sara D.
Yanosky, Jeff D.
Weuve, Jennifer
Venue: NeuroToxicology
Publisher: Elsevier BV
Published: 2016-09
Volume: 56
Pages: 235-253
ISSN: 0161-813X (ISSN-L)
DOI: 10.1016/j.neuro.2016.06.004
PMC: PMC5048530
OpenAlex: W2423252051
Cited by: 422
References: 129
Citations by year: 2026: 25 · 2025: 46 · 2024: 38 · 2023: 35 · 2022: 59 · 2021: 55 · 2020: 62 · 2019: 45 · 2018: 33 · 2017: 20 · 2016: 3
FWCI: 3.69
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: NeuroToxicology (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute on Aging (T32AG027668)
National Institute of Environmental Health Sciences (R01ES020836, R21ES024700, R01ES019168, R21ES020404, R21ES016829)
Topics: Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Air Quality and Health Impacts
Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Health, Environment, Cognitive Aging
Keywords: air pollution exposure, dementia, cognitive decline, cognitive function, neuroimaging, neuropathology, misclassification bias, unmeasured confounding, exposure misclassification, long-term exposure, differential misclassification
MeSH terms: Air Pollution, Brain, Cognition Disorders, Dementia, Humans, Epidemiologic Studies

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Exposure to air pollution as a potential contributor to cognitive function, cognitive decline, brain imaging, and dementia: a systematic review of epidemiologic research

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