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J Alzheimers Dis. 2018;61(1):67-78. doi: 10.3233/JAD-170658.

Association of Low-Level Ozone with Cognitive Decline in Older Adults.

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Center for Integration of Science and Industry, Bentley University, Waltham, MA, USA.
School of Health Sciences, Regis College, Weston, MA, USA.
Center for Data Science, University of Massachusetts Amherst, Amherst, MA, USA.
Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.
Department of Biological Sciences, University of Massachusetts Lowell, Lowell, MA, USA.


Increasing evidence points to an association of airborne pollutant exposure with respiratory, cardiovascular, and neurological pathology. We examined whether or not ground-level ozone or fine particulate matter ≤ 2.5 μm in diameter (PM2.5) was associated with accelerated cognitive decline. Using repeated measures mixed regression modeling, we analyzed cognitive performance of a geographically diverse sampling of individuals from the National Alzheimer's Coordinating Center between 2004-2008. Ambient air concentrations of ozone and PM2.5 were established using a space-time Hierarchical Bayesian Model that statistically merged air monitor data and modeled air quality estimates. We then compared the ambient regional concentrations of ozone and PM2.5 with the rate of cognitive decline in residents within those regions. Increased levels of ozone correlated with an increased rate of cognitive decline, following adjustment for key individual and community-level risk factors. Furthermore, individuals harboring one or more APOE4 alleles exhibited a faster rate of cognitive decline. The deleterious association of ozone was confined to individuals with normal cognition who eventually became cognitively impaired as opposed to those who entered the study with baseline impairment. In contrast to ozone, we did not observe any correlation between ambient PM2.5 and cognitive decline at regulatory limits set by the Environmental Protection Agency. Our findings suggest that prolonged exposure to ground-level ozone may accelerate cognitive decline during the initial stages of dementia development.


APOE4; Air pollution; Alzheimer’s disease; ozone; particulate matter

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