Zhao Yong-Li, Qu Yi, Ou Ya-Nan, Zhang Ya-Ru, Tan Lan, Yu Jin-Tai
Department of Neurology, Qingdao Municipal Hospital, Qingdao University, China.
Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontier Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China.
Ageing Res Rev. 2021 Dec;72:101504. doi: 10.1016/j.arr.2021.101504. Epub 2021 Oct 29.
Dementia is a challenging neurodegenerative disease. This systematic review aimed to summarize natural, physical, and social environmental factors that are associated with age-related cognitive impairment and dementia.
We systematically searched PubMed, EMBASE, Web of Science, and PsychINFO till January 11, 2021 for observational studies. The hazard ratio (HR), relative risk (RR), and odds ratio (OR) with 95% confidence interval (CI) were aggregated using random-effects methods. The quality of evidence for each association was evaluated.
Of the 48,399 publications identified, there were 185 suitable for review across 44 environmental factors. Meta-analyses were performed for 22 factors. With high-to-moderate quality of evidence, risks were suggested in exposure to PM (HR=1.24, 95%CI: 1.17-1.31), NO (HR=1.07, 95%CI: 1.02-1.12), aluminum (OR=1.35, 95%CI: 1.14-1.59), solvents (OR=1.14, 95%CI: 1.07-1.22), road proximity (OR=1.08, 95%CI: 1.04-1.12) and other air pollutions, yet more frequent social contact (HR=0.82, 95%CI: 0.76-0.90) and more greenness (OR=0.97, 95%CI: 0.95-0.995) were protective. With low-to-very low quality, electromagnetic fields, pesticides, SO, neighborhood socioeconomic status, and rural living were suggested risks, but more community cultural engagement might be protective. No significant associations were observed in exposure to PM, NO, noise, silicon, community group, and temperature. For the remaining 22 factors, only a descriptive analysis was undertaken as too few studies or lack of information.
This review highlights that air pollutions, especially PM and NO play important role in the risk for age-related cognitive impairment and dementia.
痴呆症是一种具有挑战性的神经退行性疾病。本系统评价旨在总结与年龄相关的认知障碍和痴呆症相关的自然、物理和社会环境因素。
我们系统检索了截至2021年1月11日的PubMed、EMBASE、科学网和PsychINFO数据库中的观察性研究。采用随机效应方法汇总风险比（HR）、相对风险（RR）和比值比（OR）及其95%置信区间（CI）。对每种关联的证据质量进行评估。
在检索到的48399篇文献中，有185篇适合对44个环境因素进行综述。对其中22个因素进行了荟萃分析。证据质量为高到中等时，暴露于细颗粒物（HR=1.24，95%CI：1.17-1.31）、一氧化氮（HR=1.07，95%CI：1.02-1.12）、铝（OR=1.35，95%CI：1.14-1.59）、溶剂（OR=1.14，95%CI：1.07-1.22）、靠近道路（OR=1.08，95%CI：1.04-1.12）及其他空气污染被提示存在风险，但更频繁的社交接触（HR=0.82，95%CI：0.76-0.90）和更多的绿化（OR=0.97，95%CI：0.95-0.995）具有保护作用。证据质量为低到非常低时，电磁场、农药、二氧化硫、邻里社会经济地位和农村生活被提示存在风险，但更多的社区文化参与可能具有保护作用。在暴露于细颗粒物、一氧化氮、噪声、硅、社区团体和温度方面未观察到显著关联。对于其余22个因素，由于研究过少或缺乏信息，仅进行了描述性分析。
本综述强调空气污染，尤其是细颗粒物和一氧化氮在年龄相关认知障碍和痴呆症风险中起重要作用。
