From INM (Institute for Neurosciences of Montpellier) (N.L., L.-A.G., C.B.), INSERM, Univ Montpellier; Santé Publique France (C.P.), Lyon; Exposome and Heredity Team (F.A., A.E.), CESP, INSERM, Paris-Saclay University, UVSQ, Gustave Roussy; Population-Based Epidemiological Cohorts Research Unit (A.D., A.O., M.G., M.Z.), INSERM, UMS 011; VIMA Aging and Chronic Diseases (A.D., M.Z.), INSERM, UVSQ, Villejuif; Institut de Recherche en Santé, Environnement et Travail, Poisoning Control Center-Clinical Data Center Angers (A.D.), INSERM, EHESP, UMR S1085, CHU Angers, Univ Angers, Univ Rennes; Université de Paris (M.G., M.Z.); and Memory Research and Resources Center, Department of Neurology (C.B.), Montpellier University Hospital Gui de Chauliac, France.
Neurology. 2022 Feb 8;98(6):e633-e640. doi: 10.1212/WNL.0000000000013146. Epub 2021 Dec 22.
To our knowledge, no study has investigated the effect of exposure to formaldehyde on cognition in the general population. Our objective was to examine the association between occupational exposure to formaldehyde and cognitive impairment in middle-aged and young-old adults (≥45 years).
In the French CONSTANCES cohort, cognitive function was assessed with a standardized battery of 7 cognitive tests to evaluate global cognitive function, episodic verbal memory, language abilities, and executive functions (e.g., Digit Symbol Substitution Test [DSST]). A global cognitive score was created using principal component analysis. Cognitive impairment was assessed in reference to norms of neuropsychological battery according to age, sex, and education. Lifetime exposure to formaldehyde was assessed using a French Job Exposure Matrix created in the framework of the Matgéné project. After performing multiple imputation, separate modified Poisson regression models were used to evaluate the association between cognitive impairment (<25th percentile) and formaldehyde exposure (exposed/never exposed), exposure duration, cumulative exposure index (CEI), and combination of CEI and time of last exposure.
Among 75,322 participants (median age 57.5 years, 53% women), 8% were exposed to formaldehyde during their professional life. These participants were at higher risk of global cognitive impairment (for global cognitive score: adjusted relative risk [aRR] 1.17; 95% confidence interval [CI] 1.11-1.23), after adjusting for confounders (age, sex, education, income, solvent exposure, Effort-Reward Imbalance, night shift, repetitive work, and noisy work). They were at higher risk of cognitive impairment for all cognitive domains explored. Longer exposure duration and high CEI were associated with cognitive impairment, with a dose-effect relationship for exposure duration. Recent exposure was associated with impairment in all cognitive domains. Time did not fully attenuate formaldehyde-associated cognitive deficits especially in highly exposed individuals (for DSST: high past exposure aRR 1.23; 95% CI 1.11-1.36; high recent exposure: aRR 1.24; 95% CI 1.13-1.35).
Our findings highlight the long-term detrimental effect of formaldehyde exposure on cognitive health in a relatively young population.
据我们所知，目前尚无研究调查人群中接触甲醛对认知功能的影响。我们的目的是探讨中年和老年（≥45 岁）人群中职业性接触甲醛与认知障碍之间的关系。
在法国 CONSTANCES 队列中，使用标准化的 7 项认知测试成套测验来评估总体认知功能、情景性言语记忆、语言能力和执行功能（例如，数字符号替换测验）来评估认知功能。使用主成分分析创建总体认知评分。根据年龄、性别和教育程度，参照神经心理成套测验的常模评估认知障碍。使用在 Matgéné 项目框架内创建的法国职业暴露矩阵评估终生甲醛暴露情况。在进行多重插补后，使用修正泊松回归模型分别评估认知障碍（<25 百分位数）与甲醛暴露（暴露/从未暴露）、暴露持续时间、累积暴露指数（CEI）以及 CEI 与末次暴露时间的组合之间的关系。
在 75322 名参与者中（中位年龄 57.5 岁，53%为女性），8%的参与者在职业生涯中接触过甲醛。这些参与者发生总体认知障碍的风险更高（对于总体认知评分：调整后相对风险 [aRR]1.17；95%置信区间 [CI]1.11-1.23），在调整了混杂因素（年龄、性别、教育程度、收入、溶剂暴露、努力-回报失衡、夜班、重复工作和噪声工作）后。对于所探讨的所有认知领域，他们发生认知障碍的风险更高。较长的暴露持续时间和高 CEI 与认知障碍相关，且与暴露持续时间呈剂量-效应关系。近期暴露与所有认知领域的认知障碍相关。时间并不能完全减轻甲醛引起的认知缺陷，尤其是在高暴露个体中（对于数字符号替换测验：高既往暴露 aRR1.23；95%CI1.11-1.36；高近期暴露：aRR1.24；95%CI1.13-1.35）。
我们的研究结果强调了在相对年轻的人群中，甲醛暴露对认知健康的长期不良影响。
