Ambient air pollution and long-term trajectories of episodic memory decline among older women in the whims-echo cohort

Abstract

BACKGROUND: Episodic memory decline varies by age and underlying neuropathology. Whether ambient air pollution contributes to the heterogeneity of episodic memory decline in older populations remains unclear. OBJECTIVES: We estimated associations between air pollution exposures and episodic memory decline according to pollutant, exposure time window, age, and latent class subgroups defined by episodic memory trajectories. METHODS: Participants were from the Women’s Health Initiative Memory Study–Epidemiology of Cognitive Health Outcomes. Older women (n = 2,056; 74–92 years of age) completed annual (2008–2018) episodic memory assessments using the telephone-based California Verbal Learning Test (CVLT). We estimated 3-y average fine particulate matter [PM with an aerodynamic diameter of ≤2:5 lm (PM2:5)] and nitrogen dioxide (NO2 ) exposures at baseline and 10 y earlier (recent and remote exposures, respectively), using regionalized national universal kriging. Separate latent class mixed models were used to esti-mate associations between interquartile range increases in exposures and CVLT trajectories in women ≤80 and >80 years of age, adjusting for covariates. RESULTS: Two latent classes were identified for women ≤80 years of age (n = 828), “slow-decliners” {slope = − 0:12=y [95% confidence interval (CI): −0:23, −0:01] and “fast-decliners” [slope = − 1:79=y (95% CI: −2:08, −1:50)]}. In the slow-decliner class, but not the fast-decliner class, PM2:5 exposures were associated with a greater decline in CVLT scores over time, with a stronger association for recent vs. remote exposures [−0:16=y (95% CI: −2:08, −0:03) per 2:88 lg=m3 and −0:11=y (95% CI: −0:22, 0.01) per 3:27 lg=m3, respectively]. Among women ≥80 years of age (n = 1,128), the largest latent class comprised “steady-decliners” [slope = − 1:35=y (95% CI: −1:53, −1:17)], whereas the second class, “cognitively resilient”, had no decline in CVLT on average. PM2:5 was not associated with episodic memory decline in either class. A 6:25-ppb increase in recent NO2 was associated with nonsignificant acceleration of episodic memory decline in the ≤80-y-old fast-decliner class [−0:21=y (95% CI: −0:45, 0.04)], and in the >80-y-old cognitively resilient class [−0:10=y (95% CI: −0:24, 0.03)] and steady-decliner class [−0:11=y (95% CI: −0:27, 0.05)]. Associations with recent NO2 exposure in women >80 years of age were stronger and statistically significant when 267 women with incident probable dementia were excluded [e.g., −0:12=y (95% CI: −0:22, −0:02) for the cognitively resilient class]. In contrast with changes in CVLT over time, there were no associations between exposures and CVLT scores during follow-up in any subgroup. DISCUSSION: In a community-dwelling U.S. population of older women, associations between late-life exposure to ambient air pollution and episodic memory decline varied by age-related cognitive trajectories, exposure time windows, and pollutants.