Long-Term Air Pollution and Traffic Noise Exposures and Mild Cognitive Impairment in Older Adults: A Cross-Sectional Analysis of the Heinz Nixdorf Recall Study

Background: Mild cognitive impairment (MCI) describes the intermediate state between normal cognitive aging and dementia. Adverse effects of air pollution (AP) on cognitive functions have been proposed, but investigations of simultaneous exposure to noise are scarce. Objectives: We analyzed the cross-sectional associations of long-term exposure to AP and traffic noise with overall MCI and amnestic (aMCI) and nonamnestic (naMCI) MCI. Methods: At the second examination of the population-based Heinz Nixdorf Recall study, cognitive assessment was completed in 4,086 participants who were 50–80 years old. Of these, 592 participants were diagnosed as having MCI (aMCI, n = 309; naMCI, n = 283) according to previously published criteria using five neuropsychological subtests. We assessed long-term residential concentrations for size-fractioned particulate matter (PM) and nitrogen oxides with land use regression, and for traffic noise [weighted 24-hr (LDEN) and night-time (LNIGHT) means]. Logistic regression models adjusted for individual risk factors were calculated to estimate the association of environmental exposures with MCI in single- and two-exposure models. Results: Most air pollutants and traffic noise were associated with overall MCI and aMCI. For example, an interquartile range increase in PM2.5 and a 10 A-weighted decibel [dB(A)] increase in LDEN were associated with overall MCI as follows [odds ratio (95% confidence interval)]: 1.16 (1.05, 1.27) and 1.40 (1.03, 1.91), respectively, and with aMCI as follows: 1.22 (1.08, 1.38) and 1.53 (1.05, 2.24), respectively. In two-exposure models, AP and noise associations were attenuated [e.g., for aMCI, PM2.5 1.13 (0.98, 1.30) and LDEN 1.46 (1.11, 1.92)]. Conclusions: Long-term exposures to air pollution and traffic noise were positively associated with MCI, mainly with the amnestic subtype. Citation: Tzivian L, Dlugaj M, Winkler A, Weinmayr G, Hennig F, Fuks KB, Vossoughi M, Schikowski T, Weimar C, Erbel R, Jöckel KH, Moebus S, Hoffmann B, on behalf of the Heinz Nixdorf Recall study Investigative Group. 2016. Long-term air pollution and traffic noise exposures and mild cognitive impairment in older adults: a cross-sectional analysis of the Heinz Nixdorf Recall Study. Environ Health Perspect 124:1361–1368; http://dx.doi.org/10.1289/ehp.1509824

[1]  Joel Schwartz,et al.  Exposure to particulate air pollution and cognitive decline in older women. , 2011, Archives of internal medicine.

[2]  Franca Tecchio,et al.  Environmental noise-exposed workers: event-related potentials, neuropsychological and mood assessment. , 2007, International journal of psychophysiology : official journal of the International Organization of Psychophysiology.

[3]  A. Wimo,et al.  The global prevalence of dementia: A systematic review and metaanalysis , 2013, Alzheimer's & Dementia.

[4]  P. Goldman-Rakic,et al.  Noise stress impairs prefrontal cortical cognitive function in monkeys: evidence for a hyperdopaminergic mechanism. , 1998, Archives of general psychiatry.

[5]  M. G. Estes,et al.  Fine Particulate Matter and Incident Cognitive Impairment in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Cohort , 2013, PloS one.

[6]  L. Calderón-Garcidueñas,et al.  Air pollution: mechanisms of neuroinflammation and CNS disease , 2009, Trends in Neurosciences.

[7]  Rosalind J Wright,et al.  The outdoor air pollution and brain health workshop. , 2012, Neurotoxicology.

[8]  Bert Brunekreef,et al.  Estimated long-term outdoor air pollution concentrations in a cohort study , 2007 .

[9]  Bert Brunekreef,et al.  Development of NO2 and NOx land use regression models for estimating air pollution exposure in 36 study areas in Europe - The ESCAPE project , 2013 .

[10]  Staffan Hygge,et al.  The effects of road traffic noise and meaningful irrelevant speech on different memory systems. , 2003, Scandinavian journal of psychology.

[11]  F. Lurmann,et al.  Components of air pollution and cognitive function in middle-aged and older adults in Los Angeles. , 2014, Neurotoxicology.

[12]  Raimund Erbel,et al.  Population-Based Distribution and Psychometric Properties of a Short Cognitive Performance Measure in the Population-Based Heinz Nixdorf Recall Study , 2011, Neuroepidemiology.

[13]  S. Janssen,et al.  Auditory and non-auditory effects of noise on health , 2014, The Lancet.

[14]  Wolfgang Babisch,et al.  Road traffic noise and cardiovascular risk. , 2008, Noise & health.

[15]  B. Hoffmann,et al.  Effect of long-term outdoor air pollution and noise on cognitive and psychological functions in adults. , 2015, International journal of hygiene and environmental health.

[16]  Samantha Windflower.  Assessment and management of environmental noise , 2014 .

[17]  Klaus Mann,et al.  Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis: the Heinz Nixdorf Recall study. , 2010, Journal of the American College of Cardiology.

[18]  R Core Team,et al.  R: A language and environment for statistical computing. , 2014 .

[19]  A. Marks,et al.  Executive brain functions after exposure to nocturnal traffic noise: effects of task difficulty and sleep quality , 2006, European Journal of Applied Physiology.

[20]  Günter Oberdörster,et al.  Ultrafine particles in the urban air: to the respiratory tract--and beyond? , 2002, Environmental health perspectives.

[21]  D. Grönemeyer,et al.  Assessment of clinically silent atherosclerotic disease and established and novel risk factors for predicting myocardial infarction and cardiac death in healthy middle-aged subjects: rationale and design of the Heinz Nixdorf RECALL Study. Risk Factors, Evaluation of Coronary Calcium and Lifestyle. , 2002, American heart journal.

[22]  A. Costello,et al.  Non-amnestic mild cognitive impairment is a prominent aspect in Parkinson’s disease patients being considered for deep brain stimulation , 2011 .

[23]  J. Bogousslavsky,et al.  Connecting Cardiovascular Disease and Dementia: Further Evidence , 2013, Journal of the American Heart Association.

[24]  M. Memmesheimer,et al.  Long-term simulations of particulate matter in Europe on different scales using sequential nesting of a regional model , 2004 .

[25]  R Erbel,et al.  Residential Exposure to Traffic Is Associated With Coronary Atherosclerosis , 2007, Circulation.

[26]  Jean Krutmann,et al.  Long-term exposure to traffic-related particulate matter impairs cognitive function in the elderly. , 2009, Environmental research.

[27]  C. Henríquez-Roldán,et al.  Long-term Air Pollution Exposure Is Associated with Neuroinflammation, an Altered Innate Immune Response, Disruption of the Blood-Brain Barrier, Ultrafine Particulate Deposition, and Accumulation of Amyloid β-42 and α-Synuclein in Children and Young Adults , 2008, Toxicologic pathology.

[28]  Stephen Stansfeld,et al.  The Effect of Transportation Noise on Health and Cognitive Development:A Review of Recent Evidence - eScholarship , 2007 .

[29]  V K Irmer,et al.  Die EG-Richtlinie zur Bewertung und Bekaempfung von Umgebungslaerm / The European Directive relating to the assessment and management of environmental noise , 2002 .

[30]  J. Sunyer,et al.  A review of epidemiological studies on neuropsychological effects of air pollution. , 2012, Swiss medical weekly.

[31]  R. Petersen.  Mild cognitive impairment as a diagnostic entity , 2004, Journal of internal medicine.

[32]  E. Tangalos,et al.  Mild Cognitive Impairment Clinical Characterization and Outcome , 1999 .

[33]  J. Schwartz,et al.  Long-term PM2.5 Exposure and Neurological Hospital Admissions in the Northeastern United States , 2014, Environmental health perspectives.

[34]  S. Beevers,et al.  Traffic-related Air Pollution in Relation to Cognitive Function in Older Adults , 2014, Epidemiology.

[35]  E. Glisky.  Changes in Cognitive Function in Human Aging , 2007 .

[36]  Melinda E. Lull,et al.  Diesel Exhaust Activates and Primes Microglia: Air Pollution, Neuroinflammation, and Regulation of Dopaminergic Neurotoxicity , 2011, Environmental health perspectives.

[37]  J. Schwartz,et al.  Neurobehavioral effects of ambient air pollution on cognitive performance in US adults. , 2009, Neurotoxicology.

[38]  Steven J. Melly,et al.  Long-term PM2.5 Exposure and Neurological Hospital Admissions in the Northeastern United States , 2016, Environmental health perspectives.

[39]  Bert Brunekreef,et al.  Development of Land Use Regression models for PM(2.5), PM(2.5) absorbance, PM(10) and PM(coarse) in 20 European study areas; results of the ESCAPE project. , 2012, Environmental science & technology.

[40]  M. M. Haines,et al.  A Review of Environmental Noise and Mental Health. , 2000, Noise & health.

[41]  J. Schwartz,et al.  Traffic-Related Air Pollution and Cognitive Function in a Cohort of Older Men , 2010, Environmental health perspectives.

[42]  Ulrich Ettinger,et al.  Understanding noise stress-induced cognitive impairment in healthy adults and its implications for schizophrenia. , 2014, Noise & health.

[43]  C. Ferri.  Global prevalence of dementia , 2009, Alzheimer's & Dementia.

[44]  David Craig,et al.  Risk factors for dementia. , 2001 .

[45]  A. Peters,et al.  Particulate Matter Air Pollution and Cardiovascular Disease: An Update to the Scientific Statement From the American Heart Association , 2010, Circulation.

[46]  R. Maronpot,et al.  Brain Inflammation and Alzheimer's-Like Pathology in Individuals Exposed to Severe Air Pollution , 2004, Toxicologic pathology.

[47]  S. Moebus,et al.  Prevalence of mild cognitive impairment and its subtypes in the Heinz Nixdorf Recall study cohort , 2010, Alzheimer's & Dementia.