Background: Extensive evidence links air pollution exposure to cognitive decline; however, it remains unclear whether cognitive reserve and brain reserve modify this association. We examined the moderating roles of cognitive reserve contributors and brain reserve in the association between air pollution and cognitive function in dementia-free adults.
Methods: Cross-sectional data were obtained from 650 participants who underwent 3T brain magnetic resonance imaging and completed the Montreal Cognitive Assessment (MoCA). Cognitive reserve contributors were assessed based on education, occupation, and social engagement. Brain reserve was quantified using the ventricle-to-brain ratio derived from brain scans. Five-year average concentrations of particulate matter with diameters ≤10 and ≤2.5 μm and nitrogen dioxide were estimated based on residential addresses. Partial least squares structural equation modeling was applied to construct latent variables representing the air pollution mixture and composite cognitive reserve (contributors). Analyses examined whether cognitive reserve contributors and brain reserve modified associations of air pollution with MoCA scores and suspected mild cognitive impairment.
Results: In individuals with an average level of cognitive reserve, a 1-standard deviation increase in air pollution mixture was associated with a 0.24-point decrease in MoCA scores (95% confidence interval [CI]: -0.31 to -0.16). This association was attenuated in individuals with higher cognitive reserve (β = -0.12; 95% CI: -0.25 to 0.02) and intensified in those with lower cognitive reserve (β = -0.36; 95% CI: -0.37 to -0.35). The moderating effect of brain reserve was not significant.
Conclusions: Higher cognitive reserve may mitigate the effects of air pollution on cognitive function.
Keywords: MoCA score; air pollution; brain health; cognitive impairment; cognitive reserve.