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April 28, 2020; 94 (17) Article

Long-term exposure to air pollution and trajectories of cognitive decline among older adults

Erin R. Kulick, Gregory A. Wellenius, Amelia K. Boehme, Nina R. Joyce, Nicole Schupf, View ORCID ProfileJoel D. Kaufman, Richard Mayeux, Ralph L. Sacco, View ORCID ProfileJennifer J. Manly, Mitchell S.V. Elkind
First published April 8, 2020, DOI: https://doi.org/10.1212/WNL.0000000000009314
Erin R. Kulick
From the Department of Epidemiology (E.R.K., G.A.W., N.R.J.), Brown University School of Public Health, Providence, RI; Departments of Neurology (E.R.K., A.K.B., N.S., M.S.V.E.) and Psychiatry (R.M.) and Gertrude H. Sergievsky Center (N.S., R.M., J.J.M., M.S.V.E.), Vagelos College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health (E.R.K., A.K.B., N.S., R.M., J.J.M., M.S.V.E.), and Taub Institute for Research on Alzheimer Disease and the Aging Brain (N.S., R.M., J.J.M.), Columbia University, New York, NY; Departments of Environmental and Occupational Health Sciences, Medicine, and Epidemiology (J.D.K.), University of Washington, Seattle; and Departments of Neurology, Public Health Sciences, and Human Genetics (R.L.S.), Evelyn McKnight Brain Institute, Miller School of Medicine, University of Miami, FL.
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Gregory A. Wellenius
From the Department of Epidemiology (E.R.K., G.A.W., N.R.J.), Brown University School of Public Health, Providence, RI; Departments of Neurology (E.R.K., A.K.B., N.S., M.S.V.E.) and Psychiatry (R.M.) and Gertrude H. Sergievsky Center (N.S., R.M., J.J.M., M.S.V.E.), Vagelos College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health (E.R.K., A.K.B., N.S., R.M., J.J.M., M.S.V.E.), and Taub Institute for Research on Alzheimer Disease and the Aging Brain (N.S., R.M., J.J.M.), Columbia University, New York, NY; Departments of Environmental and Occupational Health Sciences, Medicine, and Epidemiology (J.D.K.), University of Washington, Seattle; and Departments of Neurology, Public Health Sciences, and Human Genetics (R.L.S.), Evelyn McKnight Brain Institute, Miller School of Medicine, University of Miami, FL.
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Amelia K. Boehme
From the Department of Epidemiology (E.R.K., G.A.W., N.R.J.), Brown University School of Public Health, Providence, RI; Departments of Neurology (E.R.K., A.K.B., N.S., M.S.V.E.) and Psychiatry (R.M.) and Gertrude H. Sergievsky Center (N.S., R.M., J.J.M., M.S.V.E.), Vagelos College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health (E.R.K., A.K.B., N.S., R.M., J.J.M., M.S.V.E.), and Taub Institute for Research on Alzheimer Disease and the Aging Brain (N.S., R.M., J.J.M.), Columbia University, New York, NY; Departments of Environmental and Occupational Health Sciences, Medicine, and Epidemiology (J.D.K.), University of Washington, Seattle; and Departments of Neurology, Public Health Sciences, and Human Genetics (R.L.S.), Evelyn McKnight Brain Institute, Miller School of Medicine, University of Miami, FL.
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Nina R. Joyce
From the Department of Epidemiology (E.R.K., G.A.W., N.R.J.), Brown University School of Public Health, Providence, RI; Departments of Neurology (E.R.K., A.K.B., N.S., M.S.V.E.) and Psychiatry (R.M.) and Gertrude H. Sergievsky Center (N.S., R.M., J.J.M., M.S.V.E.), Vagelos College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health (E.R.K., A.K.B., N.S., R.M., J.J.M., M.S.V.E.), and Taub Institute for Research on Alzheimer Disease and the Aging Brain (N.S., R.M., J.J.M.), Columbia University, New York, NY; Departments of Environmental and Occupational Health Sciences, Medicine, and Epidemiology (J.D.K.), University of Washington, Seattle; and Departments of Neurology, Public Health Sciences, and Human Genetics (R.L.S.), Evelyn McKnight Brain Institute, Miller School of Medicine, University of Miami, FL.
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Nicole Schupf
From the Department of Epidemiology (E.R.K., G.A.W., N.R.J.), Brown University School of Public Health, Providence, RI; Departments of Neurology (E.R.K., A.K.B., N.S., M.S.V.E.) and Psychiatry (R.M.) and Gertrude H. Sergievsky Center (N.S., R.M., J.J.M., M.S.V.E.), Vagelos College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health (E.R.K., A.K.B., N.S., R.M., J.J.M., M.S.V.E.), and Taub Institute for Research on Alzheimer Disease and the Aging Brain (N.S., R.M., J.J.M.), Columbia University, New York, NY; Departments of Environmental and Occupational Health Sciences, Medicine, and Epidemiology (J.D.K.), University of Washington, Seattle; and Departments of Neurology, Public Health Sciences, and Human Genetics (R.L.S.), Evelyn McKnight Brain Institute, Miller School of Medicine, University of Miami, FL.
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Joel D. Kaufman
From the Department of Epidemiology (E.R.K., G.A.W., N.R.J.), Brown University School of Public Health, Providence, RI; Departments of Neurology (E.R.K., A.K.B., N.S., M.S.V.E.) and Psychiatry (R.M.) and Gertrude H. Sergievsky Center (N.S., R.M., J.J.M., M.S.V.E.), Vagelos College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health (E.R.K., A.K.B., N.S., R.M., J.J.M., M.S.V.E.), and Taub Institute for Research on Alzheimer Disease and the Aging Brain (N.S., R.M., J.J.M.), Columbia University, New York, NY; Departments of Environmental and Occupational Health Sciences, Medicine, and Epidemiology (J.D.K.), University of Washington, Seattle; and Departments of Neurology, Public Health Sciences, and Human Genetics (R.L.S.), Evelyn McKnight Brain Institute, Miller School of Medicine, University of Miami, FL.
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Richard Mayeux
From the Department of Epidemiology (E.R.K., G.A.W., N.R.J.), Brown University School of Public Health, Providence, RI; Departments of Neurology (E.R.K., A.K.B., N.S., M.S.V.E.) and Psychiatry (R.M.) and Gertrude H. Sergievsky Center (N.S., R.M., J.J.M., M.S.V.E.), Vagelos College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health (E.R.K., A.K.B., N.S., R.M., J.J.M., M.S.V.E.), and Taub Institute for Research on Alzheimer Disease and the Aging Brain (N.S., R.M., J.J.M.), Columbia University, New York, NY; Departments of Environmental and Occupational Health Sciences, Medicine, and Epidemiology (J.D.K.), University of Washington, Seattle; and Departments of Neurology, Public Health Sciences, and Human Genetics (R.L.S.), Evelyn McKnight Brain Institute, Miller School of Medicine, University of Miami, FL.
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Ralph L. Sacco
From the Department of Epidemiology (E.R.K., G.A.W., N.R.J.), Brown University School of Public Health, Providence, RI; Departments of Neurology (E.R.K., A.K.B., N.S., M.S.V.E.) and Psychiatry (R.M.) and Gertrude H. Sergievsky Center (N.S., R.M., J.J.M., M.S.V.E.), Vagelos College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health (E.R.K., A.K.B., N.S., R.M., J.J.M., M.S.V.E.), and Taub Institute for Research on Alzheimer Disease and the Aging Brain (N.S., R.M., J.J.M.), Columbia University, New York, NY; Departments of Environmental and Occupational Health Sciences, Medicine, and Epidemiology (J.D.K.), University of Washington, Seattle; and Departments of Neurology, Public Health Sciences, and Human Genetics (R.L.S.), Evelyn McKnight Brain Institute, Miller School of Medicine, University of Miami, FL.
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Jennifer J. Manly
From the Department of Epidemiology (E.R.K., G.A.W., N.R.J.), Brown University School of Public Health, Providence, RI; Departments of Neurology (E.R.K., A.K.B., N.S., M.S.V.E.) and Psychiatry (R.M.) and Gertrude H. Sergievsky Center (N.S., R.M., J.J.M., M.S.V.E.), Vagelos College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health (E.R.K., A.K.B., N.S., R.M., J.J.M., M.S.V.E.), and Taub Institute for Research on Alzheimer Disease and the Aging Brain (N.S., R.M., J.J.M.), Columbia University, New York, NY; Departments of Environmental and Occupational Health Sciences, Medicine, and Epidemiology (J.D.K.), University of Washington, Seattle; and Departments of Neurology, Public Health Sciences, and Human Genetics (R.L.S.), Evelyn McKnight Brain Institute, Miller School of Medicine, University of Miami, FL.
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Mitchell S.V. Elkind
From the Department of Epidemiology (E.R.K., G.A.W., N.R.J.), Brown University School of Public Health, Providence, RI; Departments of Neurology (E.R.K., A.K.B., N.S., M.S.V.E.) and Psychiatry (R.M.) and Gertrude H. Sergievsky Center (N.S., R.M., J.J.M., M.S.V.E.), Vagelos College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health (E.R.K., A.K.B., N.S., R.M., J.J.M., M.S.V.E.), and Taub Institute for Research on Alzheimer Disease and the Aging Brain (N.S., R.M., J.J.M.), Columbia University, New York, NY; Departments of Environmental and Occupational Health Sciences, Medicine, and Epidemiology (J.D.K.), University of Washington, Seattle; and Departments of Neurology, Public Health Sciences, and Human Genetics (R.L.S.), Evelyn McKnight Brain Institute, Miller School of Medicine, University of Miami, FL.
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Long-term exposure to air pollution and trajectories of cognitive decline among older adults
Erin R. Kulick, Gregory A. Wellenius, Amelia K. Boehme, Nina R. Joyce, Nicole Schupf, Joel D. Kaufman, Richard Mayeux, Ralph L. Sacco, Jennifer J. Manly, Mitchell S.V. Elkind
Neurology Apr 2020, 94 (17) e1782-e1792; DOI: 10.1212/WNL.0000000000009314

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Abstract

Objective To evaluate the association between long-term exposure to ambient air pollution and cognitive decline in older adults residing in an urban area.

Methods Data for this study were obtained from 2 prospective cohorts of residents in the northern Manhattan area of New York City: the Washington Heights–Inwood Community Aging Project (WHICAP) and the Northern Manhattan Study (NOMAS). Participants of both cohorts received in-depth neuropsychological testing at enrollment and during follow-up. In each cohort, we used inverse probability weighted linear mixed models to evaluate the cross-sectional and longitudinal associations between markers of average residential ambient air pollution (nitrogen dioxide [NO2], fine particulate matter [PM2.5], and respirable particulate matter [PM10]) levels in the year prior to enrollment and measures of global and domain-specific cognition, adjusting for sociodemographic factors, temporal trends, and censoring.

Results Among 5,330 participants in WHICAP, an increase in NO2 was associated with a 0.22 SD lower global cognitive score at enrollment (95% confidence interval [CI], −0.30, −0.14) and 0.06 SD (95% CI, −0.08, −0.04) more rapid decline in cognitive scores between visits. Results were similar for PM2.5 and PM10 and across functional cognitive domains. We found no evidence of an association between pollution and cognitive function in NOMAS.

Conclusion WHICAP participants living in areas with higher levels of ambient air pollutants have lower cognitive scores at enrollment and more rapid rates of cognitive decline over time. In NOMAS, a smaller cohort with fewer repeat measurements, we found no statistically significant associations. These results add to the evidence regarding the adverse effect of air pollution on cognitive aging and brain health.

Glossary

CI=
confidence interval;
EPA=
Environmental Protection Agency;
IPCW=
inverse probability of censoring weights;
IQR=
interquartile range;
MESA Air=
Multi-Ethnic Study of Atherosclerosis and Air Pollution Study;
NOMAS=
Northern Manhattan Study;
PM2.5=
fine particulate matter less than 2.5 µm in diameter;
PM10=
respirable particulate matter;
SES=
socioeconomic status;
WHICAP=
Washington Heights–Inwood Community Aging Project

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Editorial, page 727

  • Patient page e1872

  • Received October 7, 2018.
  • Accepted in final form November 22, 2019.
  • © 2020 American Academy of Neurology
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