Outdoor air pollution exposure and inter-relation of global cognitive performance and emotional distress in older women

Andrew J Petkus; Xinhui Wang; Daniel P Beavers; Helena C Chui; Mark A Espeland; Margaret Gatz; Tara Gruenewald; Joel D Kaufman; JoAnn E Manson; Susan M Resnick; James D Stewart; Gregory A Wellenius; Eric A Whitsel; Keith Widaman; Diana Younan; Jiu-Chiuan Chen

doi:10.1016/j.envpol.2020.116282

Outdoor air pollution exposure and inter-relation of global cognitive performance and emotional distress in older women

Environ Pollut. 2021 Feb 15:271:116282. doi: 10.1016/j.envpol.2020.116282. Epub 2020 Dec 14.

Authors

Andrew J Petkus¹, Xinhui Wang², Daniel P Beavers³, Helena C Chui⁴, Mark A Espeland⁵, Margaret Gatz⁶, Tara Gruenewald⁷, Joel D Kaufman⁸, JoAnn E Manson⁹, Susan M Resnick¹⁰, James D Stewart¹¹, Gregory A Wellenius¹², Eric A Whitsel¹³, Keith Widaman¹⁴, Diana Younan¹⁵, Jiu-Chiuan Chen¹⁶

Affiliations

¹ University of Southern California, Los Angeles, CA, USA. Electronic address: petkus@usc.edu.
² University of Southern California, Los Angeles, CA, USA. Electronic address: xinhuiwa@usc.edu.
³ Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: dbeavers@wakehealth.edu.
⁴ University of Southern California, Los Angeles, CA, USA. Electronic address: Helena.Chui@med.usc.edu.
⁵ Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: mespelan@wakehealth.edu.
⁶ University of Southern California, Los Angeles, CA, USA. Electronic address: gatz@usc.edu.
⁷ Chapman University, Orange, CA, USA. Electronic address: gruenewa@chapman.edu.
⁸ University of Washington, Seattle, WA, USA. Electronic address: joelk@uw.edu.
⁹ Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: jmanson@rics.bwh.harvard.edu.
¹⁰ Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, USA. Electronic address: resnicks@grc.nia.nih.gov.
¹¹ University of North Carolina, Chapel Hill, NC, USA. Electronic address: j.stewart@unc.edu.
¹² Boston University, Boston, MA, USA. Electronic address: wellenius@bu.edu.
¹³ University of North Carolina, Chapel Hill, NC, USA. Electronic address: eric_whitsel@med.unc.edu.
¹⁴ University of California, Riverside, Riverside, CA, USA. Electronic address: keith.widaman@ucr.edu.
¹⁵ University of Southern California, Los Angeles, CA, USA. Electronic address: dyounan@usc.edu.
¹⁶ University of Southern California, Los Angeles, CA, USA. Electronic address: jcchen@usc.edu.

Abstract

The interrelationships among long-term ambient air pollution exposure, emotional distress and cognitive decline in older adulthood remain unclear. Long-term exposure may impact cognitive performance and subsequently impact emotional health. Conversely, exposure may initially be associated with emotional distress followed by declines in cognitive performance. Here we tested the inter-relationship between global cognitive ability, emotional distress, and exposure to PM_2.5 (particulate matter with aerodynamic diameter <2.5 μm) and NO₂ (nitrogen dioxide) in 6118 older women (aged 70.6 ± 3.8 years) from the Women's Health Initiative Memory Study. Annual exposure to PM_2.5 (interquartile range [IQR] = 3.37 μg/m³) and NO₂ (IQR = 9.00 ppb) was estimated at the participant's residence using regionalized national universal kriging models and averaged over the 3-year period before the baseline assessment. Using structural equation mediation models, a latent factor capturing emotional distress was constructed using item-level data from the 6-item Center for Epidemiological Studies Depression Scale and the Short Form Health Survey Emotional Well-Being scale at baseline and one-year follow-up. Trajectories of global cognitive performance, assessed by the Modified-Mini Mental State Examination (3MS) annually up to 12 years, were estimated. All effects reported were adjusted for important confounders. Increases in PM_2.5 (β = -0.144 per IQR; 95% CI = -0.261; -0.028) and NO₂ (β = -0.157 per IQR; 95% CI = -0.291; -0.022) were associated with lower initial 3MS performance. Lower 3MS performance was associated with increased emotional distress (β = -0.008; 95% CI = -0.015; -0.002) over the subsequent year. Significant indirect effect of both exposures on increases in emotional distress mediated by exposure effects on worse global cognitive performance were present. No statistically significant indirect associations were found between exposures and 3MS trajectories putatively mediated by baseline emotional distress. Our study findings support cognitive aging processes as a mediator of the association between PM_2.5 and NO₂ exposure and emotional distress in later-life.

Keywords: Aging; Air pollution; Cognition; Emotional distress.

MeSH terms

Adult
Aged
Air Pollutants* / analysis
Air Pollution* / adverse effects
Air Pollution* / analysis
Cognition
Environmental Exposure / adverse effects
Environmental Exposure / analysis
Female
Humans
Nitrogen Dioxide / analysis
Particulate Matter / analysis
Psychological Distress

Substances

Air Pollutants
Particulate Matter
Nitrogen Dioxide

Abstract

MeSH terms

Substances

Grants and funding