Increased Risk of Dementia in Patients Exposed to Nitrogen Dioxide and Carbon Monoxide: A Population-Based Retrospective Cohort Study

Chang, Kuang-Hsi; Chang, Mei-Yin; Muo, Chih‐Hsin; Wu, Trong-Neng; Chen, Chiu-Ying; Kao, Chia‐Hung

doi:10.1371/journal.pone.0103078

Cited by 136 publications

(124 citation statements)

References 41 publications

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“…29 Of the 29 citations we identified for full text review, 26,27,29–55 18 published articles met our eligibility criteria. 26,27,29,30,33,34,36,38–41,45–47,49,50,53,54 We describe the features of these studies in Section 3.1 and discuss individual and aggregate study quality in Section 3.2.…”

Section: Resultsmentioning

confidence: 99%

“…27,30,34,38,45–47,49,50,54 or presence and/or severity of neuroimaging markers obtained from a single brain magnetic resonance imaging (MRI) assessment (N=2). 36,53 Two studies evaluated the association between air pollution and change in cognitive test scores over time, 26,49 four evaluated the association between air pollution and incident cognitive impairment or dementia, 29,33,39,41 and one used a time-series-like approach to link year-to-year fluctuations in air pollution with year-to-year variation in hospital admissions for dementia or Alzheimer’s disease dementia. 40 Even within broad study design groupings, there was significant heterogeneity in both the approach to cognitive assessment and choice of instrument.…”

Section: Resultsmentioning

confidence: 99%

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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

et al. 2016

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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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

et al. 2016

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“…For example, the increased dementia risk in the Santiago Metropolitan Region may be related to air pollution, many aspects of which - nitrogen oxides, carbon monoxide, particulate matter (PM 10 and PM 2.5 ), and ozone - have been related to dementia risk [33,34,35]. There is further supporting evidence from another large metropolitan area: a recent study found a biomarker which has been proposed for Alzheimer's disease [36] (reduced cerebrospinal fluid levels of Aβ 1-42 ) in children from Mexico City who had been exposed to high levels of air pollution in utero and throughout their life compared to controls [37].…”

Section: Discussionmentioning

confidence: 99%

Geographical Variation in Dementia Mortality in Italy, New Zealand, and Chile: The Impact of Latitude, Vitamin D, and Air Pollution

Russ¹,

Murianni

Icaza

et al. 2016

Dement Geriatr Cogn Disord

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Background: Dementia risk is reported as being higher in the north compared to the south, which may be related to vitamin D deficiency. If this were the case, an opposite gradient of risk would be observed in the southern hemisphere, but this has not been investigated previously. Methods: We calculated standardised mortality ratios (SMRs) for deaths in 2012 where dementia (Alzheimer's disease, vascular or unspecified dementia) was recorded as the underlying cause for 20 regions in Italy, 20 District Health Board areas in New Zealand and 29 Health Service areas in Chile. Results: Dementia SMRs were higher in northern than central or southern Italy. The inverse pattern was seen in women in New Zealand, with rates higher on South Island than North Island. However, dementia risk was raised in eight regions in the north and centre of Chile in both men and women. Conclusions: Geographical variation plays a key role in dementia risk, but patterns vary in men and women. In the northern hemisphere, dementia mortality is higher in the north, but the pattern in the southern hemisphere is more complex.

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“…While there is insufficient data to date on the link between air pollution and dementia risk, there is some evidence high levels of air pollution is associated with greater cognitive impairment in older adults (106-108) and air pollution has been associated with AD neuropathology (108). …”

Section: The Role Of Biomarkers: Indicators Of Mechanismsmentioning

confidence: 99%

Bridging the Translation Gap: From Dementia Risk Assessment to Advice on Risk Reduction

Anstey¹,

Eramudugolla²,

Hosking³

et al. 2015

J Prev Alz Dis

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Dementia risk reduction is a global health and fiscal priority given the current lack of effective treatments and the projected increased number of dementia cases due to population ageing. There are often gaps among academic research, clinical practice, and public policy. We present information on the evidence for dementia risk reduction and evaluate the progress required to formulate this evidence into clinical practice guidelines. This narrative review provides capsule summaries of current evidence for 25 risk and protective factors associated with AD and dementia according to domains including biomarkers, demographic, lifestyle, medical, and environment. We identify the factors for which evidence is strong and thereby especially useful for risk assessment with the goal of personalising recommendations for risk reduction. We also note gaps in knowledge, and discuss how the field may progress towards clinical practice guidelines for dementia risk reduction.

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Increased Risk of Dementia in Patients Exposed to Nitrogen Dioxide and Carbon Monoxide: A Population-Based Retrospective Cohort Study

Cited by 136 publications

References 41 publications

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

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

Geographical Variation in Dementia Mortality in Italy, New Zealand, and Chile: The Impact of Latitude, Vitamin D, and Air Pollution

Bridging the Translation Gap: From Dementia Risk Assessment to Advice on Risk Reduction

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