Exposure to Air Pollution in Relation to Risk of Dementia and Related Outcomes: An Updated Systematic Review of the Epidemiological Literature
Open accessAbstract
BACKGROUND: Dementia is a devastating neurologic condition that is common in older adults.We previously reviewed the epidemiological evidence examining the hypothesis that long-term exposure to air pollution affects dementia risk.Since then, the evidence base has expanded rapidly.OBJECTIVES: With this update, we collectively review new and previously identified epidemiological studies on air pollution and late-life cognitive health, highlighting new developments and critically discussing the merits of the evidence.METHODS: Using a registered protocol (PROSPERO 2020 CRD42020152943), we updated our literature review to capture studies published through 31 December 2020, extracted data, and conducted a bias assessment.RESULTS: We identified 66 papers (49 new) for inclusion in this review.Cognitive level remained the most commonly considered outcome, and particulate matter (PM) remained the most commonly considered air pollutant.Since our prior review, exposure estimation methods in this research have improved, and more papers have looked at cognitive change, neuroimaging, and incident cognitive impairment/dementia, though methodological concerns remain common.Many studies continue to rely on administrative records to ascertain dementia, have high potential for selection bias, and adjust for putative mediating factors in primary models.A subset of 35 studies met strict quality criteria.Although high-quality studies of fine particulate matter with aerodynamic diameter ≤2:5 lm (PM 2:5 ) and cognitive decline generally supported an adverse association, other findings related to PM 2:5 and findings related to particulate matter with aerodynamic diameter ≤10 lm (PM 10 , NO 2 , and NO x ) were inconclusive, and too few papers reported findings with ozone to comment on the likely direction of association.Notably, only a few findings on dementia were included for consideration on the basis of quality criteria.DISCUSSION: Strong conclusions remain elusive, although the weight of the evidence suggests an adverse association between PM 2:5 and cognitive decline.However, we note a continued need to confront methodological challenges in this line of research.
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Studies specific to dementia and related outcomes have reported that higher long-term exposure to PM2.5 is associated with worse cognitive decline, reduced brain volumes and increased rates of incident dementia.
“Studies specific to dementia and related outcomes have reported that higher long‐term exposure to PM2.5 is associated with worse cognitive decline, 179 , 220 reduced brain volumes 179 and increased rates of incident (newly onset) dementia. 220 , 221 , 222”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [179]
In Results > Summary of Study Findings (page not available), the review reports adverse associations between PM2.5 and cognitive decline and a tendency toward smaller brain volumes with higher exposure. It also says the brain-volume estimates were often imprecise and associations with incident cognitive impairment or dementia were less consistent, so the unqualified claim of increased incident dementia rates overstates the evidence. (LLM, conf=0.86)
Experimental — accuracy not yet measuredHigher long-term exposure to fine particulate matter air pollution is associated with worse cognitive decline.
“Higher levels of long-term exposure to fine particulate matter air pollution are associated with worse cognitive decline.166,200”
From 2023 Alzheimer's disease facts and figures (2023) · cites this paper as [166]
The strongest effect found in that review was with respect to PM2.5 and cognitive decline.
“The strongest effect found was with respect to PM2.5 and cognitive decline.”
From Changes in tropospheric air quality related to the protection of stratospheric ozone in a changing climate (2023) · cites this paper as [113]
There is growing evidence that exposure to air pollutants may be detrimental to the central nervous system and contribute to deficits in cognitive development, neurodegenerative diseases and dementia.
“There is also growing evidence that exposure to air pollutants maybe detrimental to the central nervous system and contribute to deficits in cognitive development, neurodegenerative diseases and dementia [112, 113].”
From Changes in tropospheric air quality related to the protection of stratospheric ozone in a changing climate (2023) · cites this paper as [113]
A recent review found only suggestive evidence that air pollution may influence late-life cognitive health because there is still substantial heterogeneity of findings across studies.
“A recent review [113] found that, despite a substantial increase in publications, there is only suggestive evidence that air pollution may influence late-life cognitive health as there is still substantial heterogeneity of findings across the studies.”
From Changes in tropospheric air quality related to the protection of stratospheric ozone in a changing climate (2023) · cites this paper as [113]
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- Authors
- Weuve, J., Bennett, E. E., Ranker, L., Gianattasio, K. Z., Pedde, M., Adar, S. D., Yanosky, J. D., & Power, M. C.
- Affiliations
- Boston University (US)
- George Washington University (US)
- University of Michigan (US)
- Pennsylvania State University (US)
- Corresponding author
- Power, Melinda C.
- ORCID
- Venue
- Environmental Health Perspectives
- Publisher
- American Chemical Society (ACS)
- Published
- 2021-09
- Volume
- 129
- Issue
- 9
- Pages
- 96001-96001
- ISSN
- 0091-6765 (ISSN-L)
- 1552-9924
- PMC
- PMC8462495
- OpenAlex
- W3199357056
- Cited by
- 209
- References
- 152
- Citations by year
- 2026: 26 · 2025: 56 · 2024: 49 · 2023: 36 · 2022: 36 · 2021: 6
- FWCI
- 3.02
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- public-domain
- Locations
- Environmental Health Perspectives (publishedVersion, public-domain)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Alzheimer's Association
- Health Effects Institute
- National Institute on Aging (R01AG067497, R01AG065359, R01AG051125, R01AG030153)
- National Institute of Environmental Health Sciences (R01ES028694, R01ES029509)
- 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 › Indoor Air Quality and Microbial Exposure
- Keywords
- air pollution, dementia, cognitive decline, particulate matter, PM2.5, PM10, nitrogen dioxide, ozone, exposure assessment, selection bias, neuroimaging, cognitive impairment
- MeSH terms
- Aged, Air Pollutants, Air Pollution, Dementia, Environmental Exposure, Humans, Particulate Matter
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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