Invited Perspective: Air Pollution and Dementia: Challenges and Opportunities.

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Authors: Beate Ritz and Yu Yu
Date: Aug. 2021
From: Environmental Health Perspectives(Vol. 129, Issue 8)
Publisher: National Institute of Environmental Health Sciences
Document Type: Report
Length: 1,465 words
Lexile Measure: 1570L

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Alzheimer's disease and related dementias (ADRD) are a major public health challenge in societies with aging populations. ADRD's contributions to increased morbidity in the elderly, a heavy burden on informal caregivers such as family members, high health care costs, loss of health-related quality of life, and a paucity of treatment options make preventive actions urgent (Paul et al. 2019; Wong 2020; Yu et al. 2020). Air pollution exposure is ubiquitous globally. Strong evidence links air pollutants to cardiovascular events and diabetes, both known to affect cognition in elders. However, data in support of the contributions of air pollution to aging-related cognitive decline are only just emerging (Paul et al. 2019). As exposures are chronic and affect large populations, even modest risks result in large numbers of cases (Kuenzli 2002).

In their new study, Shaffer et al. (2021) relied on the Adult Changes in Thought (ACT) cohort study based in Seattle to examine associations between exposures to fine particulate matter with an aerodynamic diameter of [less than or equal to] 2.5 [micro]m ([PM.sub.2.5]) and incident all-cause dementia. Although not the first to report on this subject, this study makes an important contribution to the field, not only due to its size and careful exposure and outcomes assessment, but especially because it suggests that the cognitive health of even a low-risk, low-exposure population may be affected.

For a longitudinal cognitive outcomes study, the ACT study is quite large (5,546 total enrollees as of 2018), and loss to follow-up was minor (14% had no informative follow-up after enrollment), likely because participants were enrolled in a large health maintenance organization. The possibility remains that some ADRD cases were missed because participants with cognitive problems did not return for testing (Kukull et al. 2002). This older population (on average 75 years of age at enrollment) had a very low baseline prevalence of comorbidities related to dementia (such as diabetes and cardiovascular disease), and the cohort thus likely avoided any substantial loss of subjects due to competing risks. A large number (1,267) of subjects were diagnosed with a form of dementia during its average 9.7 years of follow-up. The researchers administered sensitive outcome measures, including the Cognitive Abilities Screen Instrument (CASI) exam...

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