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Air pollution, stroke and dementia

Mohammad wasay MD FRCP FAAN

Recent studies have shown air pollution and PM to be associated with neuroinflammation and reactive oxygen species (ROS). High concentration of O₃ in the environment is associated with a 211% increase risk of AD onset. A recent study showed that people living in a polluted environment having high concentrations of O₃ had a 34% faster rate of cognitive decline annually on the Mini Mental Status Examination (MMSE) as compared to those exposed to lower concentrations of O₃ . PM exposure is also reported to cause 138% increase in risk of AD onset. Oudin et al. reported that residents exposed to high traffic-related pollution had greater than 40% increase in incidence of AD or vascular dementia. The Global Burden of Disease Study 2013 found 29.2% of the global stroke burden to be attributable to air pollution. Furthermore, a meta-analysis of 94 studies found stroke hospital admissions to be associated with high concentrations of carbon monoxide, sulfur dioxide and nitrogen dioxide. The “European Study of Cohorts for Air Pollution Effects” project reported that even a small increase of about 5 ml/m³ in PM_2.5 concentration in the air was associated with 19% increase risk of stroke. There is need for additional robust observational and experimental studies highlighting harmful air pollutants and their association with common neurological disorders. Safety measures and effective strategies to curb air pollution need to be implemented alongside increase in public awareness.

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When this topic was proposed to the WFN in early December 2019, Covid-19 had already started in Wuhan, China. Few anticipated the possibility of an impending international spread. ENSG's concern grew with the spread of the pandemic, which was officially declared by WHO on March 11, 2020. Given the involvement of the CNS in SARS, MERS and in early Chinese reports on SARS-CoV-2 , we called for development of national and regional registries to report neurological disorders in Covid-19 (Lancet Neurol. 2020; 19: 484–485), and later reviewed the subject in depth (J. Neurol. Sci. 2020; 414: 116884).
Since then, the global spread of Covid-19 has revealed most of the challenges and risk factors that humanity will face in the future, with the brain and neuromuscular system on the front line. We will review the risk factors which have underlain the pandemic but present their own threat. This includes environmental issues (zoonoses, biodiversity, climate change, air pollution), populations and lifestyles (transport, urbanization, migration) and individual and group biological and socioeconomic vulnerabilities (age, poverty and inequalities, cultural behaviour). Understanding and responding to these risks with urgency should help anticipate, mitigate and even avoid foreseeable disasters. We will conclude raising the question of a risk hierarchy and propose measures to increase awareness, preparedness and anticipation for future challenges.