A critical review of the epidemiological evidence of effects of air pollution on dementia, cognitive function and cognitive decline in adult population

Delgado-Saborit, Juana María; Guercio, Valentina; Gowers, Alison M.; Shaddick, Gavin; Fox, Nick C.; Love, Seth

doi:10.1016/j.scitotenv.2020.143734

Cited by 160 publications

(82 citation statements)

References 171 publications

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“…49 Nevertheless, this is likely to be a potentially emergent public health factor to be examined in future studies. 50 Finally, we emphasise that our findings should be extrapolated beyond the narrow setting of Hai district with caution. Hai is known to have high rates of cardiovascular risk factors such as stroke and hypertension as discussed.…”

Section: Strengths and Limitationsmentioning

confidence: 85%

See 1 more Smart Citation

Prevalence estimates of dementia in older adults in rural Kilimanjaro 2009–2010 and 2018–2019: is there evidence of changing prevalence?

Yoseph

Paddick

Gray

et al. 2021

Int J Geriat Psychiatry

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Introduction Although limited, existing epidemiological data on dementia in sub‐Saharan Africa indicate that prevalence may be increasing; contrasting with recent decreases observed in high‐income countries. We have previously reported the age‐adjusted prevalence of dementia in rural Tanzania in 2009–2010 as 6.4% (95% confidence interval [CI] 4.9–7.9) in individuals aged ≥70 years. We aimed to repeat a community‐based dementia prevalence study in the same setting to assess whether prevalence has changed. Methods This was a two‐phase door‐to‐door community‐based cross‐sectional survey in Kilimanjaro, Tanzania. In Phase I, trained primary health workers screened all consenting individuals aged ≥60 years from 12 villages using previously validated, locally developed, tools (IDEA cognitive screen and IDEA‐Instrumental Activities of Daily Living questionnaire). Screening was conducted using a mobile digital application (app) on a hand‐held tablet. In Phase II, a stratified sample of those identified in Phase I were clinically assessed using the DSM‐5 criteria and diagnoses subsequently confirmed by consensus panel. Results Of 3011 people who consented, 424 screened positive for probable dementia and 227 for possible dementia. During clinical assessment in Phase II, 105 individuals met DSM‐5 dementia criteria. The age‐adjusted prevalence of dementia was 4.6% (95% CI 2.9–6.4) in those aged ≥60 years and 8.9% (95% CI 6.1–11.8) in those aged ≥70 years. Prevalence rates increased significantly with age. Conclusions The prevalence of dementia in this rural Tanzanian population appears to have increased since 2010, although not significantly. Dementia is likely to become a significant health burden in this population as demographic transition continues.

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Section: Strengths and Limitationsmentioning

confidence: 85%

“…Available data are scarce but suggest Tanzania has lower levels of air pollution than other areas of SSA 49 . Nevertheless, this is likely to be a potentially emergent public health factor to be examined in future studies 50 …”

Section: Discussionmentioning

confidence: 98%

Prevalence estimates of dementia in older adults in rural Kilimanjaro 2009–2010 and 2018–2019: is there evidence of changing prevalence?

Yoseph

Paddick

Gray

et al. 2021

Int J Geriat Psychiatry

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“…During the past decade, multiple investigations explored the effects of long-term exposure to air pollution on cognitive function in the older population after animal models had shown effects of air pollution on the central nervous system via inflammation and oxidative stress (Block & Calderon-Garciduenas, 2009). Delgado-Saborit et al reviewed 69 relevant epidemiological studies from 2006 to 2019 and found consistent associations of long-term exposure to air pollution with reduced global cognition, cognitive decline, and dementia (Delgado-Saborit et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

Environmental injustice - Neighborhood characteristics as confounders and effect modifiers for the association between air pollution exposure and cognitive function

Christensen

Lah

et al. 2021

Preprint

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Background: Air pollution has been associated with cognitive decline among the elderly. Previous studies have not evaluated the simultaneous effect of neighborhood-level socioeconomic status (N-SES), which can be an essential source of bias. Objectives: We explored N-SES as a confounder and effect modifier in a cross-sectional study of air pollution and cognitive function among the elderly. Methods: We included 12,058 participants age 50+ years from the Emory Healthy Aging Study in Metro Atlanta using the Cognitive Function Instrument (CFI) score as our outcome, with higher scores representing worse cognition. We estimated 9-year average ambient carbon monoxide (CO), nitrogen oxides (NOx), and fine particulate matter (PM2.5) concentrations at residential addresses using a fusion of dispersion and chemical transport models. We collected census-tract level N-SES indicators and created two composite measures using principal component analysis and k-means clustering. Associations between pollutants and CFI and effect modification by N-SES were estimated via linear regression models adjusted for age, education, race and N-SES. Results: N-SES confounded the association between air pollution and CFI, independent of individual characteristics. We found significant interactions between all air pollutants and N-SES for CFI (p-values<0.001) suggesting that effects of air pollution differ depending on N-SES. Participants living in areas with low N-SES were most vulnerable to air pollution. In the lowest N-SES urban areas, interquartile range (IQR) increases in CO, NOx, and PM2.5 were associated with 5.4% (95%-confidence interval, -0.2,11.4), 4.9% (-0.4,10.4), and 9.8% (2.2,18.0) increases in CFI, respectively. In lowest N-SES suburban areas, IQR increases in CO, NOx, and PM2.5 were associated with higher increases in CFI, namely 13.4% (1.3,26.9), 13.4% (0.3,28.2), and 17.6% (2.8,34.5), respectively. Discussion: N-SES is an important confounder and effect modifier in our study. This finding could have implications for studying health effects of air pollution in the context of environmental injustice.

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“…A recent study has estimated that, between 1991 and 2018, 37% of global heat-related deaths could be attributed to manmade climate change (Vicedo-Cabrera et al 2021). Exposure to air pollution has been associated with cardiovascular and respiratory diseases (Arden Pope et al 2011;Atkinson et al 2013), birth defects (Padula et al 2013), poor mental health (Braithwaite et al 2019;Horsdal et al 2019), and cognitive function (Delgado-Saborit et al 2020). Globally, an estimated 7 million deaths from cardiorespiratory diseases are attributable to indoor and outdoor air pollution annually (WHO 2018a).…”

Section: Introductionmentioning

confidence: 99%

The significance of urban systems on sustainability and public health

Taylor

Howden‐Chapman

2021

Buildings and Cities

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Urban areas are highly complex systems, with interconnections between their political, economic, social, natural and built environments components, and each with its own unique priorities and contexts. They are also facing key global and local sustainability challenges such as a changing climate, air pollution and waste, all of which also present risks for population health. Improving urban sustainability can provide co-benefits for population health; however, the effectiveness-or unintended consequences-of policies or actions can depend on the behaviours and relationships in the wider urban system. The papers published in this special issue explore issues related to urban sustainability and health, including urban design and environmental justice, scale, and informal settlements. The papers also describe issues at the interface of different system components, demonstrating the systemic challenges that can act to enhance or prevent sustainable change. The complexity of urban environments presents challenges for research and policy, both of which can be reductive, and conducted independent from other disciplines or government departments. However, by moving from this siloed approach towards a broader systemic understanding, there are opportunities to develop and implement evidence-based solutions that have the potential to lead to significant improvements in sustainability and health.

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A critical review of the epidemiological evidence of effects of air pollution on dementia, cognitive function and cognitive decline in adult population

Cited by 160 publications

References 171 publications

Prevalence estimates of dementia in older adults in rural Kilimanjaro 2009–2010 and 2018–2019: is there evidence of changing prevalence?

Prevalence estimates of dementia in older adults in rural Kilimanjaro 2009–2010 and 2018–2019: is there evidence of changing prevalence?

Environmental injustice - Neighborhood characteristics as confounders and effect modifiers for the association between air pollution exposure and cognitive function

The significance of urban systems on sustainability and public health

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