Background The aging rate in Taiwan is the second highest in the world. As the population ages quickly, the prevalence of dementia increases rapidly. There are some studies that have explored the association between air pollution and cognitive decline, but the association between air pollution and dementia has not been directly evaluated. Methods This was a case-control study comprising 249 Alzheimer's disease (AD) patients, 125 vascular dementia (VaD) patients, and 497 controls from three teaching hospitals in northern Taiwan from 2007 to 2010. Data of particulate matter <10 μm in diameter (PM 10 ) and ozone were obtained from the Taiwan Environmental Protection Administration for 12 and 14 years, respectively. Blood samples were collected to determine the apolipoprotein E ( APOE ) ɛ4 haplotype. Bayesian maximum entropy was used to estimate the individual exposure level of air pollutants, which was then tertiled for analysis. Conditional logistic regression models were used to estimate adjusted odds ratios (AORs) and 95% confidence intervals between the association of PM 10 and ozone exposure with AD and VaD risk. Results The highest tertile of PM 10 (≥49.23 μg/m 3 ) or ozone (≥21.56 ppb) exposure was associated with increased AD risk (highest vs. lowest tertile of PM 10 : AOR = 4.17; highest vs. lowest tertile of ozone: AOR = 2.00). Similar finding was observed for VaD. The association with AD and VaD risk remained for the highest tertile PM 10 exposure after stratification by APOE ɛ4 status and gender. Conclusions Long-term exposure to the highest tertile of PM 10 or ozone was significantly associated with an increased risk of AD and VaD.

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