DOI: 10.1002/alz.079499 ISSN: 1552-5260

Associations between air pollution exposure and empirically derived subtypes of mild cognitive impairment in older women

Andrew J. Petkus, Xinhui Wang, Daniel P. Beavers, Mark A. Espeland, Joshua Millstein, Susan M. Resnick, Joel D. Kaufman, Margaret Gatz, Stephen R. Rapp, Jiu‐Chiuan Chen
  • Psychiatry and Mental health
  • Cellular and Molecular Neuroscience
  • Geriatrics and Gerontology
  • Neurology (clinical)
  • Developmental Neuroscience
  • Health Policy
  • Epidemiology



Exposure to air pollution in older adulthood is a novel risk factor for mild cognitive impairment (MCI). MCI is a heterogenous construct with different subtypes likely reflecting different disease etiologies. Understanding if long‐term exposure to air pollution is differentially associated with MCI subtypes may provide insight into the neurotoxic effects of air pollution exposure on the aging brain.


Participants included women from the Women’s Health Initiative Memory Study. Data from 651 women without dementia who screened positive for cognitive impairment on the modified mini‐mental state examination (3MS) and a randomly selected comparison sample of 2,560 women who were cognitively intact based on the 3MS were utilized. Participants were administered the 3MS annually (1996‐2008). Those who screened positive for cognitive impairment on the 3MS completed the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) cognitive battery and the Trailmaking Test parts A and B. Average annual levels of particulate matter of aerodynamic diameter<2.5 (PM2.5) and nitrogen dioxide (NO2) were estimated at the participant’s residence using regionalized national universal kriging models and averaged over the 3‐year period before the cognitive assessment. Latent class structural equation models (SEM) were constructed to identify MCI subtypes. We then examined associations between air pollution exposure and latent class membership using multinomial regression while adjusting for demographic, lifestyle, and clinical confounders.


Four significant MCI subtypes were identified (Figure 1): multidomain MCI (n = 147; 23%), amnestic MCI (n = 141; 22%), dysnomic/dysexecutive MCI (n = 200; 31%), and subtle MCI (n = 163; 25%). Women living in locations with higher levels of PM2.5 (per interquartile range [IQR] = 3.93 µg/m3; OR = 1.28; p = .04) or NO2 (per IQR = 9.25 ppb; OR = 1.36; p = .02) were more likely to be classified as having subtle MCI compared to normal comparisons. One IQR increase in NO2 was also associated with increased likelihood of being classified with dysnomic/dysexecutive MCI (OR = 1.38; p = .003) compared to normal comparisons.


Our study illustrates that long‐term exposure to PM2.5 and NO2 may be associated with specific subtypes of MCI. Our findings provide further evidence that air pollution may exert neurotoxic effects on brain areas underlying executive function and language ability in older women.

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