Dementia is arguably the most pressing public health challenge of our age. Since dementia does not have a cure, identifying risk factors that can be controlled has become paramount to reduce the personal, societal and economic burden of dementia. The relationship between exposure to air pollution and effects on cognitive function, cognitive decline and dementia has stimulated increasing scientific interest in the past few years. This review of the literature critically examines the available epidemiological evidence of associations between exposure to ambient air pollutants, cognitive performance, acceleration of cognitive decline, risk of developing dementia, neuroimaging and neurological biomarker studies, following Bradford Hill guidelines for causality. The evidence reviewed has been consistent in reporting associations between chronic exposure to air pollution and reduced global cognition, as well as impairment in specific cognitive domains including visuo-spatial abilities. Cognitive decline and dementia incidence have also been consistently associated with exposure to air pollution. The neuro-imaging studies reviewed report associations between exposure to air pollution and white matter volume reduction. Other reported effects include reduction in gray matter, larger ventricular volume, and smaller corpus callosum. Findings relating to ischemic (white matter hyperintensities/silent cerebral infarcts) and hemorrhagic (cerebral microbleeds) markers of cerebral small vessel disease have been heterogeneous, as have observations on hippocampal volume and air pollution. The few studies available on neuro-inflammation tend to report associations with exposure to air pollution. Several effect modifiers have been suggested in the literature, but more replication studies are required. Traditional confounding factors have been controlled or adjusted for in most of the reviewed studies. Additional confounding factors have also been considered, but the inclusion of these has varied among the different studies. Despite all the efforts to adjust for confounding factors, residual confounding cannot be completely ruled out, especially since the factors affecting cognition and dementia are not yet fully understood. The available evidence meets many of the Bradford Hill guidelines for causality. The reported associations between a range of air pollutants and effects on cognitive function in older people, including the acceleration of cognitive decline and the induction of dementia, are likely to be causal in nature. However, the diversity of study designs, air pollutants and endpoints examined precludes the attribution of these adverse effects to a single class of pollutant and makes meta-analysis inappropriate.

Knowledge of the human health impacts associated with airborne nanoparticle exposure has led to considerable research activity aimed at better characterising these particles and understanding which particle properties are most important in the context of effects on health. Knowledge of the sources, chemical composition, physical structure and ambient concentrations of nanoparticles has improved significantly as a result. Given the known toxicity of many metals and the contribution of nanoparticles to their oxidative potential, the metallic content of the nanoparticulate burden is likely to be an important factor to consider when attempting to assess the impact of nanoparticle exposure on health. This review therefore seeks to draw together the existing knowledge of metallic nanoparticles in the atmosphere and discuss future research priorities in the field. The article opens by outlining the reasons behind the current research interest in the field, and moves on to discuss sources of nanoparticles to the atmosphere. The next section reviews ambient concentrations, covering spatial and temporal variation, mass and number size distributions, air sampling and measurement techniques. Further sections discuss the chemical and physical composition of particles. The review concludes by summing up the current state of research in the area and considering where future research should be focused