Impact of air pollution on cognitive impairment in older people: A cohort study in rural and suburban China

�� He et al. This is an accepted manuscript of a book chapter published by IOS Press. The definitive, peer reviewed and edited version of this Article is published in Calder��n-Garcidue��as, L. (Ed.) Alzheimer���s Disease and Air Pollution, available online at: https://ebooks.iospress.nl/doi/10.3233/AIAD210021 The accepted version of the publication may differ from the final published version. For re-use please see the publisher's terms and conditions.Background: The impact of air pollution on cognitive impairment in older people has not been fully understood. It is unclear which air pollutants are the culprit. Objective: We assessed the associations of six air pollutants and air quality index (AQI) with cognitive impairment. Methods: We examined 7,311 participants aged ���60 years from the ZJMPHS cohort in China. They were interviewed for baseline socio-demographic and disease risk factors in 2014, and re-interviewed in 2015 and 2016, respectively. The presence of cognitive impairment was determined by the Chinese version of the Mini-Mental State Examination. Daily area-level data monitored for air pollution during 2013-2015 was then examined for associations with cognitive impairment in logistic regression models. Results: Over the two years follow-up, 1,652 participants developed cognitive impairment, of which 917 were severe cases. Continuous air pollution data showed the risk of cognitive impairment increased with exposure to PM 2.5 (fully adjusted odds ratio [aOR] 1.04, 95%CI 1.01-1.08), PM 10 (1.03, 1.001-1.06), and SO 2 (1.04, 1.01-1.08), but not with NO 2, CO, O 3, and AQI. Categorized data analysis for low, middle, and high level exposure demonstrated that the aOR increased with PM 2.5 and AQI, somehow with PM 10 and CO, but not significantly with SO 2 and NO 2, and decreased with O 3. The patterns for these associations with severe cognitive impairment were stronger. Conclusion: Lowering PM 2.5, PM 10, SO 2, and CO level could reduce the risk of cognitive impairment in older Chinese. Strategies to target most important air pollutants should be an integral component of cognitive interventions.Published versio