-
International Journal of Hygiene and Environmental Health 218
(2015) 111
Contents lists available at ScienceDirect
International Journal of Hygiene andEnvironmental Health
jo u r n al homepage: www.elsev ier .com/ locate / i jheh
Review
Effect o oispsycho
Lilian Tzi SchMohamm yra,a IUF-Leibniz Rb Department o yc
Medical Faculd Swiss Tropicae University of
a r t i c l e i n f o
Article history:Received 2 June 2014Received in revised form 20
August 2014Accepted 26 August 2014
Keywords:Cognitive funcDepressionDementiaAir
pollutionNoiseParticulate ma
a b s t r a c t
It has been hypothesized that air pollution and ambient noise
might impact neurocognitive function. Earlystudies mostly
investigated the associations of air pollution and ambient noise
exposure with cognitivedevelopment in children. More recently,
several studies investigating associations with neurocognitive
Introductio
While thtion and di2010; Rckthe effect oeven thougprominent
challenges air pollutionet al. (2002of brain tissrespectively
CorresponE-mail add
http://dx.doi.o1438-4639/ tion
tter
function, mood disorders, and neurodegenerative disease in adult
populations were published, yieldinginconsistent results. The
purpose of this review is to summarize the current evidence on air
pollution andnoise effects on mental health in adults. We included
studies in adult populations (18 years old) pub-lished in English
language in peer-reviewed journals. Fifteen articles related to
long-term effects of airpollution and eight articles on long-term
effects of ambient noise were extracted. Both exposures
wereseparately shown to be associated with one or several measures
of global cognitive function, verbal andnonverbal learning and
memory, activities of daily living, depressive symptoms, elevated
anxiety, andnuisance. No study considered both exposures
simultaneously and few studies investigated progressionof
neurocognitive decline or psychological factors. The existing
evidence generally supports associationsof environmental factors
with mental health, but does not sufce for an overall conclusion
about theindependent effect of air pollution and noise. There is a
need for studies investigating simultaneously airpollution and
noise exposures in association mental health, for longitudinal
studies to corroborate nd-ings from cross-sectional analyses, and
for parallel toxicological and epidemiological studies to
elucidatemechanisms and pathways of action.
2014 Elsevier GmbH. All rights reserved.
n
e associations of air pollution on cardiovascular func-sease
have been shown in many studies (Brook et al.,ler et al., 2011),
comparatively little is known aboutf long-term air pollution on
neurocognitive function,h sustained neurocognitive function at
older age is aelement of healthy ageing and will be one of the
mainin our ageing societies. The rst link between ambient
and neurotoxicity was made by Caldern-Garciduenas). This work
was based on a histological comparisonue from dogs, living in high-
and low-pollution areas,. Dogs from highly polluted areas had more
damages to
ding author. Tel.: +49 1522 9412016.ress:
[email protected] (L. Tzivian).
the bloodbrain barrier, degeneration of cortical neurons,
apoptoticglial white cells, non-neuritic plaques and neurobrillary
tanglescompared to dogs from low-polluted areas. Since then,
several epi-demiological and toxicological studies have
investigated chroniceffects of air pollution and ambient noise on
neurocognitive func-tion in children and adults.
Most of the epidemiological studies investigated whether
theeffect of air pollution was related to the development of
cogni-tion during childhood and possible changes of it in
adolescence(Edwards et al., 2010; Freire et al., 2010; Perera et
al., 2008;Siddique et al., 2011). Investigations on the effect of
air pollutionon neurocognitive function in adults are still rare.
In a recentreview, Guxens and Sunyer (2012) summarized studies on
neuro-psychological effects of air pollution, including 12 children
studies,and four studies of adult populations of which one
concentratedon short-term air pollution effects. In the most
current review(Block et al., 2012), six studies were related to
neurocognitive
rg/10.1016/j.ijheh.2014.08.0022014 Elsevier GmbH. All rights
reserved.f long-term outdoor air pollution and nlogical functions
in adults
viana,, Angela Winklerb, Martha Dlugajb, Tamaraad Vossoughia,
Kateryna Fuksa, Gudrun Weinma
esearch Institute for Environmental Medicine, Dsseldorf,
Germanyf Neurology, University Hospital of Essen, University of
Duisburg-Essen, Essen, Germanty, Heinrich Heine University of
Dsseldorf, Dsseldorf, Germanyl and Public Health Institute, Basel,
SwitzerlandBasel, Basel, Switzerlande on cognitive and
ikowskia,d,e, Barbara Hoffmanna,c
-
2 L. Tzivian et al. / International Journal of Hygiene and
Environmental Health 218 (2015) 111
and psychological functions of adults. These reviews
hypothesizeda potential role of air pollution on white matter
lesions andcerebrovascular pathology in adults that can lead to
cognitivechanges in adults. A role of PM in cognitive decits and
behaviorimpairmen2012; Guxe
The assoless investinoise and n(Elmenhorseffect on irSalame
andof the studibe related tand lead toVermeer an
Knowledneurocognihow particuhypothesizevates pro-incausing an
iInammatolation and Hirano et aties in the a
The secovous systemPathologicastages of Al(UFP) wererons after
e2008). Whiexposure adescribing paffecting ne
Recentlyrocognitiveand Calderoparticipantsations withnoise
levelmay have cgistic effectdate whicheffects on nreview the and
ambienneurocognidisease in a
Methods of
We perfambient airnitive functadults usinScholar. Losure
duringdays or hoFor this seadisease, anfunction,
coimpairmendisease, pe
noise exposure, particulate matter, particul*, ultrane
particles,ne PM, trafc, alone and in combination. The exact
searchhistory is available on request. An additional search was
per-formed based on the references of the retrieved articles
meeting
lusio relares s (lish
this .
s
liters werf air pient
and Persthe 2Franius ere w
andeffect noi
esign
e stues, oes inontroius epeat
studerforere estudyrform. In tcted n (Ra
on r et aeighon nrformcon
2). ctiveda an
asth
re as
g-terting f theckerre, tlongtternt in children and elderly was
also proposed (Block et al.,ns and Sunyer, 2012).ciation of noise
with neurocognitive function is evengated. Most studies on
association between ambienteurocognitive functions measured
short-term effectst et al., 2010; Schapkin et al., 2006) or
investigated therelevant speech in adults (Clark and Srqvist,
2012;
Baddeley, 1982; Smith and Broadbent, 1992). In mostes,
occupational and environmental noise was found too annoyance that
can disturb normal human activities
somatic and psychosomatic health effects (Passchier-d Passchier,
2000).ge about biological pathways linking air pollution totive
impairment is still scarce. Two possible pathways oflate matter PM
can affect neurocognitive function wered (Genc et al., 2012).
Respiratory intake of PM acti-ammatory cytokines in human
macrophages, therebynammatory response and subsequent oxidative
stress.ry compounds can spill over into the systemic
circu-penetrate the bloodbrain barrier (Genc et al., 2012;l.,
2003). This leads to different histological abnormali-nimal brain
(Nemmar et al., 2001).nd pathway is related to direct entry of PM
into the ner-
through the olfactory bulb following nasal inhalation.l changes
in the olfactory bulb were observed in earlyzheimers disease (AD)
(Doty, 2008). Ultrane particles
observed in human olfactory bulb periglomerular neu-xposure to
air pollution (Caldern-Garciduenas et al.,le these pathways
pertaining to long-term air pollutionre a major research subject,
there is a lack of studiesossible pathways of long-term ambient
noise exposureurocognitive functions., further epidemiological
studies on long-term neu-
effects of air pollution and noise were published
(Blockn-Garciduenas, 2009). These studies investigated adult, used
multiple cognitive tests and explored associ-
various air pollutants and a wide range of ambients. As air
pollution and ambient noise in many casesommon sources, such as
trafc, they may have syner-s on neurocognitive function. There are
no reviews to
integrate the studies on both air pollution and
noiseeurocognitive function. The purpose of this article is
toup-to-date articles investigating effects of air pollutiont noise
on different aspects of mental health, namelytive function, mood
disorders and neurodegenerativedult populations.
the search
ormed a literature search of articles relating long-term
pollution and ambient noise with mental health (cog-ions,
neurocognitive diseases and mood disorders) ing the two major
search engines PubMed and Googleng-term exposure was dened as the
average expo-
at least one year. Short-term exposures during theurs before
outcome assessment were not included.rch, the following keywords
were used: Alzheimersxiety, central nervous system, cognition,
cognitivegnitive decline, depression, dementia, mild cognitive
t, mood disorders, neurocognitive effect, Parkinsonsripheral
nervous system, vertigo, air pollution, noise,
the incstudiesexposuulationin Engfrom effects
Result
Thearticletions oof ambordersstudy (Six of 2013;
Wellentherefo(2012)nitive aircraf
Study d
NinanalysanalyscasecWellenwith reIn thewere p187 wIn the was
pevalue)conduwomeformed(Powe
Of noise ies pea case(Tableprospe(Yoshi2007),gated.
Exposu
Lonestimatime oup (Dotherefoin the use pan criteria. Inclusion
criteria for the articles were: (1)ted to the effect of air
pollution and ambient noiseon mental health; (2) studies related to
adult pop-18 years old); (3) epidemiologic studies
publishedlanguage in peer-reviewed journals. We excludedreview
ecologic studies and studies on short-term
ature search was nished in November 2013. In total, 22e
retrieved, of which 14 investigated long-term associa-ollution, and
seven investigated long-term associationsnoise exposure on
neurocognitive functions, mood dis-neurodegenerative disease in
adults. Additionally, oneson et al., 2007) considered both, air
pollution and noise.2 reviewed studies (Bocquier et al., 2013;
Gatto et al.,ssen et al., 2013; Loop et al., 2013; Power et al.,
2013;t al., 2012) were published within the last 2 years andere not
included in the reviews of Guxens and Sunyer
Block et al. (2012); four of them analyzed neurocog-ts of air
pollution, and twothe effects of trafc andse.
and exposures******
dies related to air pollution conducted cross-sectionalf those
six studies were carried out as cross-sectional
ongoing cohort studies; two studies conductedl analysis (Table
1). In three studies (Lim et al., 2012;t al., 2012; Weuve et al.,
2012), follow-up examinationsed assessments of cognitive function
were performed.y of Lim et al. (2012), three follow-up
examinationsmed, each 3 years apart, but from 560 participants
onlyxamined all the three times during the study period.
by Wellenius et al. (2012), the follow-up examinationed
approximately 16.8 months after baseline (median
he study by Weuve et al. (2012), a reexamination wasafter 4.3
years. Two studies were performed only innft et al., 2009; Weuve et
al., 2012) and two were per-the same study population which
included only menl., 2011, 2013).t studies investigating the
association of long-termeurocognitive function or mood disorders,
four stud-ed cross-sectional analyses, two studies conductedtrol
analysis; and two studies were cohort studiesOne of them (Bocquier
et al., 2013) had a retro-
design. One study was performed only in womend Osada, 1997). In
one casecontrol study (Persson et al.,matic versus non-asthmatic
participants were investi-
sessment
m air pollution exposure is mostly approximated byaverage
exposure at the address of residence at the
outcome assessment or during the years of follow-y et al.,
1993). The exposure contrasts investigated are,he spatial patterns
of air pollution concentration which
run tend to be relatively stable due to similar land-s and
long-term meteorology (Cesaroni et al., 2012;
-
L. Tzivian et al. / International Journal of Hygiene and
Environmental Health 218 (2015) 111 3
Table 1Main characteristics of epidemiological studies exploring
the association of long-term air pollution on cognitive and
psychological functions in adults, by alphabetical orderof
authors.
Authors, year ofpublication, country
Type of analysis Study population N(age)
Exposure Principal outcomes/tests Investigated cognitive
andpsychological functions
Caldern-Garciduenaset al., 2004, Mexico
Cross-sectional N = 19 (51.2 4.9) PM, O3 Alzheimer like
pathology; COX2and mRNA levels
Histological examinations
Caldern-Garciduenaset al., 2009, Mexico
Cross-sectional N = 87 (21.0 2.6) PM2.510, PM2.5 University of
Pennsylvania smellidentication test (UPSIT)
Olfactory function
Chen and Schwartz,2009, USA
Cross-sectional N = 1764(37.4 10.9)
PM10, O3 Simple reaction time test (SRTT),Symbol-digit
substitution test(SDST), Serial-digit learning test(SDLT)
Attention and informationprocessing speed, verbalmemory
Finkelstein and Jerrett,2007, Canada
Casecontrol N = 52,986 (notavailable)
NO2, Ambient Mn l-DOPA prescription; physiciansdiagnosis of
Parkinson disease (PD)
Gatto et al., 2013, USA Cross-sectional N = 1496(60.5 8.1)
O3, NO2, PM2.5 Boston Naming Test, Symbol digitmodalities test,
Trail Making Test(TMT) A/B, Letter-numbersequencing, Animal
naming,California verbal learning test,Paragraph recall, Faces,
Blockdesign, Judgment of lineorientation
Attention, informationprocessing speed,confrontation
naming,executive functions, verbalmemory, nonverbalmemory,
visuoconstruction
Lim et al., 2012,Republic of Korea
Longitudinalfollow-up 3 years
N = 357 (71.0 5.0) PM10, CO, SO2, NO2,O3
Korean version of the Geriatricdepression scale-short
form(SGDK-K)
Depressive symptoms
Loop et al., 2013, USA Cross-sectional N = 20,150(64.0 9.2)
PM2.5 Incidence of cognitivedeclineSix-Item Screener
Persson et al., 2007,Sweden
Casecontrol N = 22,693(43.0 13.0)
NOx, Woodburning; industrialsmells
Psychic trait anxiety score Anxiety
Power et al., 2011,USA
Cross-sectional N = 680 (71.0 7.0) BC Mini-Mental State
Examination(MMSE), Pattern comparison task,Digit span backward
test,Long-term verbal immediate recall(IR) and delayed recall
(DR),Constructional praxis
Attention, workingmemory, long-term
verbalmemory(immediate/delayed recall,consolidation
andrecognition),visuoconstruction, globalcognition
Power et al., 2013, USA Cross-sectional N = 629 (70.0 7.1) BC
MMSE, Pattern comparison task,Digit span backward test,Long-term
verbal IR and DR,Constructional praxis
Attention, workingmemory, long-term
verbalmemory,visuoconstruction, globalcognition
Ranft et al., 2009,Germany
Cross-sectional N = 399 (74.1 2.6) PM10 Neuropsychological
CERAD-Plusbattery: MMSE, TMT, Stroopcolor-word test, long-term
verbalIR and DR, Constructional praxis,DR of gures
Attention, informationprocessing speed,confrontation
naming,executive functions, verbalmemory,
nonverbalmemory,visuoconstruction, globalcognition,
depression,olfactory function
Sun and Gu, 2008,China
Cross-sectional N = 7358(83.6 11.4)
API** MMSE; Activity of daily living(ADL); Self-reported
health
Global cognition,satisfaction with health,ability to perform
everydayactivities
Wellenius et al., 2012,USA
Cohort follow-up(median), 16.8years
N = 765 (78.1 5.4) Proximity tonearest road, BC
MMSE; Hopkins verbal learningtest-revised (HVLT-R);
TMT;Clock-in-the-box test (CIB);Category and letter uency tests
Global cognition,long-term verbal memory,attention and
informationprocessing speed,executive functions,cognitive
exibility,divided attention
Weuve et al., 2012, USA Cohort follow-up4.3 years
N = 10,409(74.0 2.2)
PM10; PM2.5,Coarse PM
Telephone interview for cognitivestatus (TICS); 10-Words DR;
EastBoston memory test (EBMT);Category uency; Digit spanbackward
test, modied MMSE
Global cognition, long termverbal memory, executivefunctions
Zeng et al., 2010, China Cohort follow-up 7years
N = 15,873 (86.3) API** ADL; MMSE; cumulative decitsindex (DI);
telephone interview forcognitive status, Self-reportedhealth
Global cognition, ability toperform everydayactivities,
satisfaction withhealth
*Additionally other environmental factors were measured.**Air
pollution index that includes SO2, NO2, PM10, CO, O3.
-
4 L. Tzivian et al. / International Journal of Hygiene and
Environmental Health 218 (2015) 111
Table 2Main characteristics of epidemiological studies exploring
the association of ambient noise on cognitive and psychological
functions in adults.
Authors, year of publication,country
Type of analysis Study population N Exposures Principal
outcomes/tests Investigated functions
Bocquier et 6h#
Brand et al., oise
Brink, 2011, fc;; aircr
Chiovenda e vel fo
Franssen et LAEQ, 2, 22-23
Hardoy et al noise
Persson et a soundrs; traentila
Yoshida and
*Restricted to # LAEQequiva## LDENday, e
Wang et al.tory of parinto accounstudies (Caviduals fromin
low-pollZeng et al.,low, mediuair pollutioDatabase.
Eleven sdifferent tecmeasured cand Schwar2009), threitoring
statPersson et use regressof residentiet al., 2012;studies useroad
or prosure to trafWellenius e
Particulalate matter most frequethem was pet al., 2007from
industthe studiespollution indioxide (SOand O3 was
biens (Past cof th
(Fraoise. al., 2013, France Retro-prospectivelongitudinal
follow-up1 year
N = 190,617(41.5 12.5)
LAEQ, 22-
2009, Switzerland Qualitative-quantitativecasecontrol
N = 63 (56.4 16.0) Trafc n
Switzerland Longitudinal follow-up5 years
N > 8000 (45.2) Road trarailwaynoise
t al., 2007, Italy Cross-sectional N = 81 (42.2 7.7) Noise le8
h/day
al., 2013, Netherlands Cross-sectional N = 11,812 (>18.0)
LDEN##;h#; LAEQ
., 2005, Italy Cross-sectional N = 355 (1875) Aircraft
l., 2007, Sweden Casecontrol N = 22,693(43.0 13.0)
LDEN##, neighbonoise; v
Osada, 1997, Japan Cross-sectional N = 366 (20.0-60.0)
LDEN##
psychological outcomes.lent sounds levels calculated over the
corresponding time period.vening, night equivalent sound level over
24 h.
, 2013). In most studies, the individual residential
his-ticipants before the outcome assessment is not takent. Four
studies exploited contrasts between cities: twoldern-Garciduenas et
al., 2004, 2009) compared indi-
highly polluted cities with those from communitiesution areas.
The two other studies (Sun and Gu, 2008;
Amsourcethe moSeven studiescraft n 2010) compared participants
living in the cities withm and high gross domestic products, using
citywiden indices obtained from the Chinese Natural Resources
tudies exploited within-city exposure contrasts usinghniques,
alone or in combination. Four studies assignedoncentrations from
the nearest monitoring site (Chentz, 2009; Lim et al., 2012; Loop
et al., 2013; Ranft et al.,e studies interpolated residential
exposure from mon-ions using GIS-based techniques (Gatto et al.,
2013;al., 2007; Weuve et al., 2012), ve studies used land-ion
models to estimate small-scale spatial contrastsal exposure
(Finkelstein and Jerrett, 2007; Wellenius
Power et al., 2011, 2013; Ranft et al., 2009) and threed trafc
indicators such as proximity to the nearestximity to high trafc as
markers of long-term expo-c-related air pollution (Finkelstein and
Jerrett, 2007;t al., 2012, Ranft et al., 2009).te matter less than
2.5 m in diameter (PM2.5), particu-less than 10 m in diameter
(PM10) and ozone (O3) werently investigated in the reviewed
studieseach one ofresented in four different studies. One study
(Persson) investigated exhaust fumes, wood burning and smellrial
production without specifying the PM fractions. In
of Sun and Gu (2008) and Zeng et al. (2010), an airdex (API)
assessing combined concentrations of sulfur2), nitrogen dioxide
(NO2), PM10, carbon monoxide (CO)
used.
from neighTrafc noismental noiet al., 2007,et al., 2009databases
(surrogate mexposure mequivalent during the ies, noise l(Bocquier
estudy (Chioofcers wercraft noise e2013; Hardaddressed tegories of
5mathemati
Outcome as
In mostogical testsdomains, sufunctions, wterm noisemostly
useMean number ofanxiolytic-hypnotic purchases
Migraine; headache; depressivedisorders; anxiety disorders*
Emotional status
aftSelf-reported health* Satisfaction with
health
r Digit span forward WAIS-R;attentive matrices; Digit
spanbackward; arithmetic reasoning;Raven PM38; Stroop
color-wordtest; State-trait anxietyinventory; prole of
moodstates*
Attention andinformationprocessing, executivefunctions,
workingmemory, inhibition,verbal memory,emotional status
3-7
h#
Self-reported healthquestionnaire (VOEG)*
Satisfaction withhealth
Generalized anxiety disorder(GAD); anxiety disorder nototherwise
specied (NOS); majordepressive disorder; depressivedisorder NOS;
eating disorder
Emotional status
fromfction
Psychic Trait Anxiety score * Emotional status
General nuisance, interferencewith daily
activities,psychological symptoms*
Satisfaction withhealth
t chronic noise is the sound generated by
environmentalsschier-Vermeer and Passchier, 2000). Road trafc
wasommonly investigated environmental source of noise.e eight
studies investigated road trafc noise and twonssen et al., 2013;
Hardoy et al., 2005) investigated air-In one study (Franssen et
al., 2013), the additional noise
borhood and from ventilation systems was assessed.e assessment
was performed using dedicated environ-se prediction models
(Bocquier et al., 2013; Persson
Yoshida and Osada, 1997), direct measurements (Brand), mandatory
noise mapping available through ofcialBrink, 2011; Chiovenda et
al., 2007), or by the use ofarkers such as occupation. Most
commonly, the noiseetrics dayeveningnight noise level, dened as
the
sound level over 24 hLDEN (Leq(24 h)), or the noise levelnight
period (226 h)LNIGHT were used. In three stud-evels were stratied
for analysis to groups of 5 dB(A)t al., 2013; Brink, 2011; Yoshida
and Osada, 1997). In onevenda et al., 2007), high road trafc noise
exposed policee compared to low noise exposed ofce employees.
Air-xposure for two cross-sectional studies (Franssen et al.,oy et
al., 2005) was assessed by proximity of residentialo the nearest
airport, and additionally stratied into cat-
dB(A), derived from the National Aerospace Laboratorycal noise
model (Franssen et al., 2013).
sessment
of the studies related to air pollution, neuropsychol-
investigating the impairment of different cognitivech as working
memory, verbal memory or executiveere used. Studies investigating
the association of long-
exposure with the central nervous system functionsd different
assessment methods than studies on air
-
L. Tzivian et al. / International Journal of Hygiene and
Environmental Health 218 (2015) 111 5
pollution. Only two cognitive tests (Digit span test and
Stroopcolor-word test) were used both in air pollution and noise
stud-ies, making direct comparisons between air pollution and
noiseeffects difcult. Few studies investigated mood disorders,
clinicaldiagnosis o
Most stusensitivity tMini-Menta2011, 20132012; Weu30-item
selassessed wItem ScreenIn this test,orientation
Among tion and infrequently. 2013; Ranftof targets hcorrectly
peof attentionpattern comstitution tetest (Chen athe
symbolattention anused to cheeffects is thtest assesse
Anotherbal memorywords) thatpant (GattoWellenius etrial, the
nuof verbal mlist, the parwords (delarecognitionshown to thously
learnefor verbal iand needs tusing a storined using study of
Cheassessed wiof eight num
Some stufor nonverb2009) and frecall test ccommon rof the
facessented, andrecognized ticipants.
The exaoutcome innitive exibTrail Makinet al., 2012)in order
witnumber of exibility a
assessed using a semantic category test in which a high numberof
items generated for the same category (for instance,
animals)indicated a 2012; Weu
phoe nure ofd w
et aand tcase,rgansesset, thelor nk insred. ithm
cognral st2013
or eral ss nsis optionn-Gmatimonino anal sfactocatio
ility -item
cogew snal ance
press009
logicic Deinclutivity
usinvssony-relontrxiet
Hard Mea2013State
ivity heck010, or o
at letrast, addplaied.
(Brn onf disease, medication intake or pathological ndings.dies
used comprehensive, but unspecic tests with lowo assess global
cognitive function. In seven studies, thel State Examination (MMSE)
was used (Power et al.,; Ranft et al., 2009; Sun and Gu, 2008;
Wellenius et al.,ve et al., 2012; Zeng et al., 2010), which
consists of af-administered questionnaire, and which can also beith
a telephone interview. One study applied the Six-er to assess
global cognitive function (Loop et al., 2013).
three items have to be recalled, and additionally the to year,
month and day of the week was checked.more specic test of
neurocognitive domains, atten-formation processing speed was
investigated mostSeveral studies used the Trail Making Test A
(Gatto et al.,
et al., 2009; Wellenius et al., 2012), in which a numberave to
be connected in the correct order. The number ofrformed connections
during certain time was a marker
and psychomotor speed. Other studies applied a test onparison
(Power et al., 2011, 2013), a symbol-digit sub-
st (Chen and Schwartz, 2009), a simple reaction timend Schwartz,
2009) and a complex attention test like
digit modalities test (Gatto et al., 2013) to check thed memory
of participants. An additional test that wasck participants
attentive capacity in studies of noisee attentive matrices test
(Chiovenda et al., 2007); thisd information processing as well.
frequently tested domain of cognitive function is ver-. It was
in most cases assessed using word lists (1016
were presented once or several times to the partici- et al.,
2013; Power et al., 2011, 2013; Ranft et al., 2009;t al., 2012;
Weuve et al., 2012). After every learningmber of immediately
recalled words serves as measureemory. After a delay and/or an
additional interferenceticipants were asked to recall the
previously learnedyed recall). Furthermore, most researchers
included a
trial at the end of the test in which a list of words wase
participants, and asked which ones were on the previ-d list. One
study (Gatto et al., 2013) examined memory
nformation that exceeds the immediate memory spanhe contribution
of meaning to retention and recall byy recall test. In this study
comprehension was exam-recall questions and multiple-choice
questions. In then and Schwartz (2009), short-term verbal memory
wasth a serial-digit learning test by reproducing a
sequencebers.dies additionally examined the memory performanceal
material like previously drafted gures (Ranft et al.,aces (Gatto et
al., 2013). Faces immediate and delayedonsisted of 16 colored
pictures of faces together withst and family name were presented.
Later recognition
was checked using 12 faces from 16 that were pre- additional 12
distracted faces. The amount of correctlyfaces was a marker of
visual episodic memory of par-
mination of executive function was another main many studies,
assessed with various specic tests. Cog-ility and divided attention
were measured using theg Test B (Gatto et al., 2013; Ranft et al.,
2009; Wellenius. In this test, a number of targets need to be
connectedh numerous letter targets on alternating sequence.
Thecorrectly performed connections measured cognitivend divided
attention of participants. Verbal uency was
using atest, thmeasuassesseWeuve2013) latter ning, owas asthis
tesin a coblue inmeasuwas ar
Thein seve2011, design
Sevto assediagnoprescriCalderinamples. A42-amadditiothe
olIdentipossibized 40in mild
A fadditiodisturbsis. Deet al., 2demioGeriatrwhich and
ac(2007)(Gustaanxiet
In cined an2007; 1997).et al., Mood only.
Actwere cet al., 2factorshavingin constudiescal
comexaminstudiesliving ibetter performance (Gatto et al., 2013;
Wellenius et al.,ve et al., 2012). Similarly, verbal uency was
checkednematic category test (Wellenius et al., 2012). In thismber
of words beginning with a given letter served as
phonematic uency. Moreover, working memory wasith the digit span
backwards (Power et al., 2011, 2013;l., 2012), a letternumber
sequencing task (Gatto et al.,he Clock-in-the-Box test (Wellenius
et al., 2012). In the
not only examining working memory, but also plan-ization and
visuoconstruction were tested. Inhibitiond with the Stroop
color-word test (Ranft et al., 2009). In
name of a color (e.g., blue, green or red) is printedot denoted
by the name (e.g., the word red printed intead of red ink), and a
reaction time to name a color isAn additional outcome used in
studies of noise effectsetic reasoning (Chiovenda et al.,
2007).itive domain of visual construction was also assessedudies
(Gatto et al., 2013; Ranft et al., 2009; Power et al.,) using the
Judgment of Line Orientation task, blockgure drawing
(constructional praxis).studies used clinical diagnoses or
pathological ndingservous system effects of air pollution. A
physiciansf Parkinsons disease (PD) and related medication
was investigated in Finkelstein and Jerrett (2007).arciduenas et
al. (2004) investigated postmortem brainon and Alzheimer like
pathology in autopsy brain sam-g others, cyclooxygenase-2 (COX2)
expression and thecid form of -amyloid (A42) were examined. In
antudy performed by Caldern-Garciduenas et al. (2009),ry functions
using University of Pennsylvania Smelln Test (UPSIT) test were
investigated as a marker of
of AD. This test includes self-administrated standard-s, of
which 10 items strongly predict conversion to AD
nitive impairment (MCI) patients.tudies also investigated mood
disorders, either asoutcomes or to statistically control for
psychologicals in the air pollution-neurocognitive function
analy-ion was assessed in two studies (Lim et al., 2012; Ranft). It
was identied by application of the Center of Epi-al Studies
Depression Scale (Ranft et al., 2009) or of thepression Scale-Short
Form (SGDS-K) (Lim et al., 2012),des questions about general life
attitude, satisfaction. Anxiety was investigated in the study of
Persson et al.g the Swedish Universities Scales of Personality
score
et al., 2000) that summarizes positive answers to sevenated
statements.ast to air pollution studies, most noise studies exam-y
and depression (Bocquier et al., 2013; Chiovenda et al.,oy et al.,
2005; Persson et al., 2007; Yoshida and Osada,n number of
anxiolytic-hypnotic purchases (Bocquier), the State-Trait Anxiety
Inventory and the Prole of
(Chiovenda et al., 2007) were assessed in noise studies
of daily living and instrumental activities of daily livinged in
two air pollution studies (Sun and Gu, 2008; Zeng). These
self-reported activities included personal-careutdoor
possibilities. For these instruments, participantsast one activity
limitation were dened as disabled,
to persons without any disabilities. In these Chineseitionally
self-reported health, as a number of physi-nts (e.g. back pain) and
symptoms (e.g. tiredness), wasSelf-reported health was also
investigated in two noiseink, 2011; Franssen et al., 2013), and
activity of dailye study (Yoshida and Osada, 1997).
-
6 L. Tzivian et al. / International Journal of Hygiene and
Environmental Health 218 (2015) 111
Reported associations
The reviewed studies reported their results in a very
heteroge-neous way (Table 3). Even if the same instruments were
used, theresults wercomparisonanalysis of
Association In 10 stu
formance wperformancperformancLongitudinaa positive cindex
(API)supported bpopulation (Zeng et al.,outcome asassociated 18
determin
Similar rmatter withGeographic20,150 aduof PM2.5 onand mixed
(were suppoStudy Cogntion of highdecline wa4.3 years. Ghighest
ver
Inconsiseffect of pawas associaanalysis of tversus LateUS
Americalevels weretion processand socio-eNational HeUSA residen
Associatshowed incof Gatto et cognitive fucic cognitiincreasing
utive functiassociated wwas associaanother croterm exposattention
aeven after health covation assessmsuch incons
Associatnitive functto the nearestudies shoPower et a
(NAS) cohort participants, an adverse association between BC
con-centration and global cognitive function assessed by MMSE
testwas found. This adverse effect of BC on cognitive function
wasfound predominantly in overweight and obese individuals (p
of
tioner, n, sm
n the012)
scortests, butts wTrafnitiverforuen
(SALIen oius e
assosACaldmerslutiond aan astratitionsociatsion
studring t assncenSun a
in c) ands). Thted uppo
API ity o010)s of Aith
with in tea (Lunddditsociaerlipiound
(CV
tion y onenctior (Chfor aroop c
ociattudie013;e generally not presented in a way that allows
direct between studies. This prohibits a systematic
meta-results.
with air pollutiondies, the effect of ambient air pollution on
cognitive per-as investigated. In the earliest studies, global
cognitivee tests were used. In the rst study on global cognitivee
conducted in 7358 Chinese adults from the Chinesel Health Longevity
Survey (CLHLS) (Sun and Gu, 2008),ross-sectional association of the
citywide air pollution
with reduced MMSE was found. These results werey a consecutive
longitudinal analysis in a larger sub-
of 15,873 participants from the same CLHLS population 2010),
using similar methods both for exposure and forsessment. A one unit
increase in API in this study waswith a 0.9% increase in odds for
MMSE score less thaned as cognitive impairment.esults were obtained
for the association of particulate
cognitive functions in the cross-sectional Reasons for and
Racial Differences in Stroke (REGARDS) study oflts in USA (Loop et
al., 2013), where a signicant effect
incidence of cognitive decline was observed for urbanurbanrural)
areas, but not for rural areas. These resultsrted by the
longitudinal analysis of the Nurses Healthitive Cohort (Weuve et
al., 2012), in which an associa-er levels of PM2.5-10 and of PM2.5,
with global cognitives found in 10,409 women over a follow-up
period oflobal cognitive decline was signicantly bigger in thesus
lowest quintile of exposure.tent results were found in studies
investigating therticulate matter on specic cognitive domains.
PM2.5ted with lower verbal learning in the cross-sectionalhe Women
Isoavone Soy Health Trial (WISH) and Early
Intervention trial With Estradiol (ELITE) study of 1499n adults
(Gatto et al., 2013). In contrast, increased PM10
not associated with reduced attention and informa-ing speed and
verbal memory after adjustment for raceconomic status (SES) in the
cross-sectional study of thealth and Nutrition Examination Survey
study of 1764ts (Chen and Schwartz, 2009).ions of gaseous
pollutants with cognitive function alsoonsistent results. Although
in the cross-sectional studyal. (2013), O3 and NO2 were not
associated with globalnction, they were associated with the
functions of spe-ve domains. In this study at high O3 levels (49
ppb),ozone concentration was associated with lower exec-on, while
at the intermediate level (3449 ppb) it wasith higher logical
memory. Exposure to ambient NO2
ted with lower logical memory (Gatto et al., 2013).
Inss-sectional study (Chen and Schwartz, 2009), long-ure to high
levels of O3 was associated with a lowernd information processing
speed and verbal memory,adjustment for age, sex, gender, SES,
life-style andriates. Differences in tests applied for cognitive
func-ent in these two studies can be a possible reason for
istent results.ions of other trafc-related exposures with global
cog-ion were investigated in four studies, using proximityst road
and concentration of BC as exposures. All thesewed similar results.
In two cross-sectional studies ofl. (2011, 2013) performed on
Normative Aging Study
interacHowevtensionseen. Iet al., 2MMSEnitive MMSEticipanyears.
in cogwas pethe InAging in womWellen
Thediseaseies of Alzheiair polsion afound concencentra
Assdepresin fourcompanicanNOx costudy,
cultieseatingclotheassociawere sing thein activet al.,
2ciationcities wthose tigatedof Korwere foPM10 aThe asof hypwere
fdisease
AssociaOnl
tive fuworkefound the Strlevel.
Assthree set al., 2 = 0.1) and in ever smokers (p for
interaction = 0.07).o evidence for effect modication by diabetes,
hyper-oking or body-mass index (BMI) on the MMSE score was
MOBILIZE Boston Study of 765 participants (Wellenius, an
increase in BC level was also associated with loweres and worse
performance of additional specic cog-. Proximity to major road was
associated with a lower
affected only a part of the other cognitive tests in par-ith at
least college education and those younger than 77c exposure was
associated with reduced performance
tests as well in the study of Ranft et al. (2009) thatmed on 399
Germany women, a part of the Study ofce of air pollution on Lung
function, Inammation andA) cohort. In this study, the association
was not presentlder than 74 years, which corresponds to the study
oft al. (2012).ciation of air pollution with two neurodegenerativeD
and PDwas investigated in three studies. Two stud-ern-Garciduenas
et al. (2004, 2009) indicated more-related changes in individuals
with higher exposure ton (reduced olfactory functions, increased
COX2 expres-ccumulation of A42). Finkelstein and Jerrett
(2007)sociation with prevalence of PD only for an increasedon of
ambient manganese (Mn), but not for NO2 con-.ions of air pollution
with mood disordersanxiety and, and with activities of daily
livingwere investigatedies. In the casecontrol study of Persson et
al. (2007)22,693 asthmatic and non-asthmatic participants, a
sig-ociation of exhaust fumes from trafc approximated bytrations
with anxiety was found. In a cross-sectionalnd Gu (2008) found that
API was associated with dif-
oping with personal care activities (bathing, dressing,
instrumental activities (cooking, shopping, washingis study also
showed poor self-reported health to bewith an increase in air
pollution index. These resultsrted by the longitudinal study of
Zeng et al. (2010), link-with poor self-reported health and
increased difcultiesf daily living at 4.3 years over a follow-up
period (Zeng. However, in the study of Sun and Gu (2008), the
asso-PI with activity of daily living were found only for the
high gross domestic product (GDP), and not found for low GDP. An
association with depression was inves-he longitudinal study in 357
inhabitants of Republicim et al., 2012). Increased levels of PM10,
O3 and NO2
to increase the emotional symptoms of depression, andionally
increased the somatic and affective symptoms.tion with O3 was
stronger in participants with a historydemia than among those
without, and little differences
between participants with and without cardiovascularD) or
myocardial infarction (Lim et al., 2012).
with noise study investigated the association of noise with
cogni-ns in 81 police ofcers from high trafc areas and ofceiovenda
et al., 2007). A signicant effect of noise wasithmetic reasoning,
difculties in logical reasoning andolor-word test adjusting for
gender, age and education
ions of noise with health status were investigated ins,
reporting inconsistent results (Brink, 2011; Franssen
Yoshida and Osada, 1997). In the earliest cross-sectional
-
L. Tzivian et al. / International Journal of Hygiene and
Environmental Health 218 (2015) 111 7
Table 3Results of studies on long-term air pollution and noise
effect on cognitive and psychological functions in adults, by
outcome.
Authors, year of publication Covariates Obtained results*
Effect of air pollutionNeurocognitive assessmentCognitive
functionsSun and Gu, 2008 P, L, E 1 unit air pollution index (API):
For high gross domestic product (GDP): MMSE score = 2.67,
p < 0.001. For medium GDP: MMSE score = 1.84, p <
0.001Chen and Schwartz, 2009 P, L, H Increased PM10: SDLT =0.48,
95% CI 0.270.68; SDST = 0.10, 95% CI 0.050.15. After adjustment
for race and SESnon-signicant effect. Increased O3: SDST = 0.11,
95% CI 0.010.22; SDLT = 0.52, 95% CI 0.031.01
Ranft et al., 2009 P, L, H, E Trafc exposure: CERAD-plus battery
b = 3.8, p < 0.1; Stroop test b = 5.1, p < 0.01; Snifng testb
= 1.3, p < 0.05 (age 74). No independent effect of PM10
Zeng et al., 2010 P, L 1 unit API: cognitive impairment OR =
1.009, p < 0.05Power et al., 2011 P, L, H BC (doubling
concentration, g/m3): MMSE OR = 1.3, 95% CI 1.11.6Wellenius et al.,
2012 100 m from major road: MMSE < 26 for at least college
education OR = 1.54, 95% CI 1.102.17; for
77 years OR = 1.34, 95% CI 1.011.76. Not associated with HVLT-R
recognition, TMT Part A ad CIB.Interquartile increase in BC (0.11
g/m3): MMSE < 26, OR = 1.15, p = 0.06; worse performance ofHVLT
= R immediate recall, p = 0.046
Weuve et al., 2012 P, L PM2.510: worse global cognitive score (p
for trend 0.01); worse for highest vs. lowest level(p = 0.003).
Highest vs. lowest quintile of PM2.5: changes in global cognitive
score for women(p = 0.03). Global cognitive score (SD/2 years) per
10 g/m3 increment: PM2.510 0.020 (95% CI0.32 to 0.008); PM2.5:
0.018 (95% CI 0.035 to 0.002)
Gatto et al., 2013 P, L None association with global cognition.
Per 10 g/m3 PM2.5: lower verbal learning ( = 0.32,p = 0.05). NO2
> 20 ppb: lower logical memory ( = 0.62, p = 0.095). O3 > 49
ppb: lower executivefunction ( = 0.66, p = 0.059). O3 range 3449
ppb: higher logical memorywomen ( = 0.46, 95%CI 0.090.83), adults
60 y. o. ( = 0.51, 95% CI 0.110.91)
Loop et al., 2013 P, L, H, E Per 10 g/m3 PM2.5: for urban
areaincident cognitive impairment OR = 1.40 (95% CI 1.061.85);for
mixed areasincident cognitive impairment (OR = 0.32, 95% CI
0.110.98). No associations forrural area and total population
Power et al., 2013 P, L, H BC (doubling concentration, g/m3):
for lacked an HFE C282Y low MMSE (OR = 1.37, 95% CI1.081.73); for
at least one HFE H63D variant (OR = 1.74, 95% CI 1.06, 2.87). HFE
C282 modies theassociation between BC and global cognitive
function
Neurodegenerative diseasesAlzheimers diseaseCaldern-Garciduenas
et al., 2004 Frontal cortex tissue: Elevation of COX2 mRNA in
high-exposure group (p = 0.009); elevation of
COX2 immunoreactivity (p = 0.01). Hippocampus tissue: Elevation
in COX2 mRNA in high-exposuregroup (p = 0.045); no differences in
COX2 immunoreactivity between high and low-exposuregroups (p =
0.37)
Caldern-Garciduenas et al., 2009 Mean UPSIT scores lower for
high-exposure group (p = 0.03). No differences in UPSIT scores
indifferent APOE statuses (p = 0.52)
Parkinson disease (PD)Finkelstein and Jerrett, 2007 P 10 g/m3
increases in Mn: PD or Dopa prescription for men OR = 1.041, 95% CI
0.9971.09; for
female: OR = 1.035, 95% CI 0.971.10. With type of clinic as
confounder OR = 1.044 (95% CI1.001.09)
Activity of daily living and mood disordersAnxietyPersson et
al., 2007 P, H Exhaust form trafc: anxiety OR = 1.66, p =
0.001Activity of daily livingSun and Gu, 2008 P, K, E 1 unit API:
For high GDP: difculties in ADL ( = 1.41, p < 0.01);
instrumental ADL ( = 0.98,
p < 0.001), self-related health (OR = 2.20, p < 0.001).
For medium GDP instrumental ADL = 0.6,p < 0.001, self-related
health, (OR = 1.87, p < 0.001), no associations with ADL
Zeng et al., 2010 P, L 1 unit API: increased ADL disability
(25%, p < 0.001); increased health decits (8%, p <
0.05)DepressionLim et al., 2012 P, L, H Interquartile increase of
PM10: Increase in composite score of emotional symptoms: 38.2%, p
< 0.01,
NO2 118.2%, p < 0.05. Increase in somatic symptoms score
38.9%, p < 0.05. Increase in affectivesymptoms score 11.5%, p
< 0.01. O3: Increase in composite score of emotional symptoms
132.5%,p < 0.05
Effect of noiseNeurocognitive assessmentCognitive
functionsChiovenda et al., 2007 P Differences between police ofcers
from high trafc areas and ofce workers: Raven PM38
(t = 3.24, p = 0.002); arithmetic reasoning (t = 2.30, p =
0.024), Stroop color-word test (t = 2.02,p = 0.047)
Activity of daily living and mood disordersActivity of daily
livingYoshida and Osada, 1997 P Noise 70 dB(A): appetite loss (OR =
5.2***)AnxietyHardoy et al., 2005 General anxiety disorder OR = 2.0
(95% CI 1.04.2); Anxiety disorder NOS OR = 2.9 (95% CI
1.04.1)Persson et al., 2007 P Associated with anxiety: trafc noise
55 dB(A), OR = 1.32, p = 0.009; sound from neighbors
OR = 1.47, p = 0.001; trafc vibration OR = 1.37, p = 0.042;
sound (other) OR = 1.72, p = 0.003. Soundfrom ventilation not
associated with anxiety
General nuisanceYoshida and Osada, 1997 P Noise 70 dB(A): OR =
5.2***Brand et al., 2009 Difference between groups with different
noxious environment (X2 = 34.0, p < 0.001)**DepressionYoshida
and Osada, 1997 P Noise 70 dB(A): OR = 2.9***
Hardoy et al., 2005 P Major depressive disorder and depressive
disorder NOSnot related to aircraft noise
-
8 L. Tzivian et al. / International Journal of Hygiene and
Environmental Health 218 (2015) 111
Table 3 (Continued)
Authors, year of publication Covariates Obtained results*
Bocquier et al., 2013 P, H Censors blockneighborhood
environment: low deprivation, intermediate deprivation,
highdeprivation. Regardless deprivation: RR = 1.33 (95% CI
1.021.24) for LAEQ, 22-6 h# 55 dB(A). For
ow deate anations
Health statuYoshida and e OR =Brink, 2011 d modFranssen et ted
to
61, (95I 1.26% CI 1
Ppersonal fa hnicitchildren, coun ng, exBMI. Hhealth ,
diabehypertension, olluti*Results relate**Results are r***Condence#
LAEQequiva## LDENday, e
study perfowomen, an status, adjuhouse was only effect
inhibiting adinal studyyears of follels was fouroad noise Lstatus
and sFrassen et astatus and within a radwas observand LDEN health.
Highand tirednedegree of uOsada (199
Three stsion (Yoshid2005). Yoshciated withbeing a criti190,617
Fredepressive of low sociointermediasignicant. disordersotherwise
sin the crossthe effect ovicinity of Ecities or rur
While Hsion, anxietnoise (Hardand no accinhibits a cbetween
aigated in a cno signica
er rod soted ted
tionsdies on n. Onlf boiffertion
noistion
ssion
his rend snt asoods th, andunctre oisenLAEQ, 22-6 h# 55 dB(A) in
l70 dB(A), with the noise level of 70 dB(A)cal threshold. Bocquier
et al. (2013) found in a cohort ofnch that the effect of trafc
noise on purchase of anti-
howevtion anassociaassocia
AssociaStu
noise scarceation owith dassocialution,interac
Dis cu
In t2013 adifferetion, mexpand(2012)nitive fexposufar to ddrugs
was only positive in participants living in areaseconomic
deprivation, while for participants living in
te and high deprivation areas such an effect was non-In contrast
to these studies, two forms of depressivemajor depressive disorder
and depressive disorder notpeciedwere not found to be related to
aircraft noise-sectional study of Hardoy et al. (2005). In this
study,f aircraft noise was investigated in people living in thelmas
airport in contrast to a sample of people living inal or mining
villages of Italy.ardoy did not nd associations of noise with
depres-y disorders were found to be associated with aircraftoy et
al., 2005). No multiple models were constructedurate noise levels
were specied in this study, whichomparison with other mentioned
studies. Associationrcraft noise and anxiety disorders were also
investi-asecontrol study of Persson et al. (2007) that foundnt
effect of aircraft noise on the trait anxiety (p = 0.101),
and outcomexpand the
All preseand noise wleast for onations diffein the cognet al.,
2013)in air pollutcomes wasassociationdepressionair pollutiolittle,
mostexposures s
Differenmental heaTill now, tprivation level RR = 1.16 (95% CI
1.011.32) (reference LAEQ, 22-6 h#
d high deprivation and for other noise levels (4550
andnon-signicant effect
3.0***. No associations with listlessnessel
noise exposure during the night. Noise 60 dB(A): poor% CI
1.012.56). LDEN##: headache (OR = 1.16, 95% CI 1.011.34),1.70),
listlessness (OR = 1.17, 95% CI 1.011.36), not fully rested
in.031.41). Remaining seven complainsnon-signicant
y, childhood SES, education level, marital status, number of
survivingercise, leisure activities, dark sh consumption, computer
experience,tes, incident stroke, presence of depressive symptoms,
dyslipidemia,on, temperature, season.
ad trafc noise, sounds from neighbors, trafc vibra-und from
other sources were shown to be signicantlywith anxiety. Sound from
ventilation systems was notwith anxiety.
with air pollution and noiseinvestigating the concurrent effects
of air pollution andeurocognitive outcomes in the same population
arey one of the reviewed studies investigated the associ-th air
pollution and trafc noise (Persson et al., 2007)ent aspects of
mental health in the same study. Thes were calculated for each one
of the exposures (air pol-e) separately. However, possible
synergistic relations ors between these two exposures were not
investigated.
view, we analyzed 22 studies published until Novemberummarized
the effect of environmental exposures onpects of mental health,
namely neurocognitive func-
disorders and neurodegenerative disease. This reviewe works of
Guxens and Sunyer (2012) and Block et al.
supports a possible role of air pollutants on neurocog-ion in
the adult population and a role of long-term noisen mood disorders.
However, no evidence is available sotangle the effects of these two
closely related exposures
es. In this review, we add newly published studies and
investigated outcomes.nted studies, assessing the association of
air pollutionith neurocognitive functions, found an association
at
e of the investigated pollutants. However, these associ-red in
effect size (Gatto et al., 2013; Loop et al., 2013) anditive domain
that showed positive associations (Gatto
and are therefore not easily comparable. Additionally,ion
studies, an association with AD- and PD-related out-
observed for highly exposed participants. A positive of air
pollution and noise was also found for anxiety,
and impaired activities of daily living. Associations ofn and
noise with mental health outcomes overlappedly due to a lack of
common outcomes to both types oftudied.t associations of air
pollution and noise with aspects oflth can also be a result of
different biological pathways.he biological pathways of an effect
of long-term air
-
L. Tzivian et al. / International Journal of Hygiene and
Environmental Health 218 (2015) 111 9
pollution or noise exposure on the brain are not
completelyclaried. Two different biological pathways were proposed
forlong-term effects of air pollution. First, the direct
respiratory intakeof air pollutants can provoke a local inammatory
effect that leadsto productithe systemand damagshown in tolevels of
dieexpression brain micromay affect Ranft et al.that were increase
in the hippoca
Possibletion have nHowever, etion and nopollution dewell as
noistion memoris known asing and mem2005). Thuswhich
showneurotransmndings bylarly, associfunctions wmale mice eto
sub-chrolike symptothe biologicical functioshown thatin human (the
release thalamus ththat is respo
Some coand they hi
Concurrent
Only onand noise ainformationpollution anhigh correlaent noise
arin time andnoise, and able. It is theexposure in
Diversity of
Studies rlution use dthe effect oflution used studies, invtive
functiodifferent te
necessary to conduct studies on air pollution and noise using
thesame clinical and subclinical outcomes to be able to
adequatelycompare and tease apart the effect of either
exposure.
ual s
en innoiseimpopairm009;lutiobgroutivelyge mg therly p
dina
y fewciat
th of lutiofunct
al ceuv
cogf Chwas alent tf Wes pe
to tpart
assoitive
nal c
st stuersondern wortates .ilarlyt bodnd S2009eridenuat
theynicalise c
gend
of tn. Sexeen s-Levnmen
pot2013on of pro-inammatory cytokines which can pass intoic
circulation and can disrupt the bloodbrain barriere brain cells
(Genc et al., 2012). This pathway wasxicological studies. For
instance, rats exposed to highsel exhaust showed elevated levels of
interleukin IL-1and elevated levels of tumor-necrosis factor TNF
inglia (Levesque et al., 2011). Secondly, air pollution
olfactory functions (Caldern-Garciduenas et al., 2004;, 2009),
similar to that found in animal models. Dogshighly exposed to air
pollution showed a signicantDNA damage in olfactory bulbs, the
frontal cortex andmpus (Caldern-Garciduenas et al., 2002).
associations between noise and neurocognitive func-ot been
investigated in epidemiological studies so far.xperimental studies
showed similar effects of air pollu-ise on animals. For example, 10
months exposure to aircreased spatial learning in mice (Fonken et
al., 2011), ase exposure for 15 days produces working and recogni-y
decits in rats (Haider et al., 2012). The hippocampus
the key region critically involved in both, spatial learn-ory
formation (Broadbent et al., 2004; Kahlmann et al.,
, the toxicological ndings from experiments in rodents, that
noise exposure causes changes in hippocampalitter signaling in rats
(Cui et al., 2012), support the
Fonken et al. (2011) and Haider et al. (2012). Simi-ations of
both air pollution and noise with psychologicalere also
demonstrated in animal studies. For example,xposed to long-term
PM2.5 exposure and rats exposednic noise exposure were found to
display depressive-ms (Fonken et al., 2011; Naqvi et al., 2012).
However,al pathways of possible effects of noise on psycholog-n are
not well established yet. Briey, animal studies
noise provokes mild acute stress similar to that occurArnsten
and Goldman-Rakic, 1998). This stress evokesof high levels of
noradrenaline and dopamine in hypo-at in turn impairs the
regulation of prefrontal cortexnsible for cognitive abilities
(Arnsten, 2009).
mmon problems were identied in the reviewed studiesnder a full
comparison of results of these studies.
environmental exposures
e of the reviewed studies analyzed both air pollutionssociation
(Persson et al., 2007). However, even though
on both exposures was available, no analysis with aird noise
simultaneously was conducted, possibly due totion of these two
exposures. Air pollution and ambi-e both related to trafc and often
occur simultaneously
space. The effect of air pollution may be modied by synergism
between the two exposures seems possi-refore necessary to include
both air pollution and noiseto account when investigating the
effect of either.
outcomes
elated to cognitive and psychological effect of air pol-ifferent
panels of tests than studies, which investigated
noise. Most of the studies exploring the effect of air pol-a
large battery of objective cognitive tests, while in
noiseestigators mostly used self-reported outcomes. Cogni-n was
less investigated in noise studies, and completelysts were
performed for its assessment. It is therefore
Individ
Whtrafc is also ing imet al., 2air polthe surespecolder
adilutinof elde
Longitu
Onlits assostrengair polnitive to norm2009; Wrelatedstudy oozone
equivastudy ochangesimilaryears aing theof cogn
Additio
Motook pconfouisfactioan impcovariastudies
SimcurrenChen aet al., triglycan atteyses asone cliand no
Role of
Fivewomehave bMeyerenvirotigatedet al. (usceptibility
vestigating the effect of trafc proximity (indicator for as well
as for trafc-related air pollution) or noise, itrtant to take into
account a rising prevalence of hear-ent with age. In two out of 22
reviewed studies (Ranft
Wellenius et al., 2012), an association of trafc-relatedn with
decreased cognitive function was found only inp of younger
participants (74 years and 77 years,), but not in the older group.
A decline in hearing inay lead to a lower sensitivity to trafc
noise, thereby
effect of noise in study populations with a large
fractionarticipants.
l data on cognitive decline
studies on progression of cognitive impairment andion with air
pollution and ambient noise also limit thethe existing evidence. In
adults, long-term exposure ton and ambient noise may have a
negative effect on cog-ion that will result in cognitive impairment
additionalognitive aging. Only two studies (Chen and Schwartz,e et
al., 2012) performed a comparison of air pollution-
nitive decline with normal aging-related decline. In theen and
Schwartz (2009), an increase in 10 ppb of annualssociated with the
decline in cognitive functions that iso 3.5 till 5.3 years
normal-aging decline. Similarly, in theuve et al. (2012),
differences in rates of global cognitiver 10 g/m3 of PM2.510 and
PM2.5 exposures were foundhe difference in rates between women who
were 12
in age. There is an urgent need for studies investigat-ciation
of environmental exposures with progression
decline in older age.
ovariates
dies investigating air pollution or noise associationsnal
characteristics and life-style factors as potentials into account.
However, depressive symptoms, sat-ith health and activities of
daily living might playnt role in cognitive performance. The effect
of theseis poorly investigated both in air pollution and noise
, the role of comorbidities is poorly investigated in they of
evidence. Five of reviewed studies (Brink, 2011;
chwartz, 2009; Loop et al., 2013; Lim et al., 2012; Ranft)
included factors related to CVD (BMI, hypertension,
level) as intermediates in sensitivity analyses, showingion of
effect in some studies. These are important anal-
suggest that general or cardiovascular health may be pathway
through which a possible effect of air pollutionan be mediated.
er in studies of neurocognitive functions
he 22 reviewed studies were performed only in men or differences
in different domains of cognitive function
described in several studies (Darley and Smith, 1995;y, 1989;
Torres et al., 2006). However, few studies oftal exposures and
cognitive function specically inves-
ential effect modication by sex. For example, Gatto) showed that
logical memory was more affected by
-
10 L. Tzivian et al. / International Journal of Hygiene and
Environmental Health 218 (2015) 111
long-term air pollution exposure in women than in men. In
mousemodels, sex differences in behavioral patterns and neuron
differ-entiation due to exposure to nano-sized particulate matter
werefound (Davis et al., 2013). The role of sex in modifying effect
esti-mates is largbiological mand stratic
A lack of inf
Althougair pollutioaddress is nyears of livfor participthe whole
pestimates fo
Conclusion
Investigtal health rexposures rshown to benitive funcin several
sof reviewedambient airtive functiolong-term eies investigin
associatiroborate ntoxicologicaand pathwa
Acknowled
Lilian Tzdoctoral feJerusalem, IFoundation
References
Arnsten, A.F.T.structure a
Arnsten, A.F.Tcognitive fArch. Gen.
Block, M.L., Caammatio
Block, M.L., ED.A., CostH.A., KaufNadadur, Wright,
Rhttp://dx.d
Bocquier, A., CGaudart, Jrisk factorJ. Public H
Brand, S., HelSchwarzenwith envirdiagnostic
Brink, M., 201tionship wSwitzerlan
Broadbent, N.Jand the hi
Brook, R.D., Rajagopalan, S., Pope III, C.A., Brook, J.R.,
Bhatnagar, A., Diez-Roux,A.V., Holguin, F., Hong, Y., Leupker,
R.V., Mittleman, M.A., Peters, A., Siscov-ick, D., Smith, S.C.,
Whitsel, L., Kaufman, J.D., et al., 2010. Particulate matterair
pollution and cardiovascular disease. An update to the scientic
state-ment from the American heart association. Circulation, DOI:
10.1161/CIR.
3e31-Garc
aya, Newca
-Garcez, R.s, M., mmatolluti-Garcerritt., Gon. Lon
ltered particildren-Garc
zalez-ks, Don, R.,
Dotypatho://dx.d., Schitive da, P.apozze-expssmen, Srqvbehav
u, Me desphory
.K., S: an eertisin.A., BBerhaatal el diffe://dx.di, G.,
stiere
modrt st://dx.d, D.W.morta., 200le? An, S.C.,, E., Le polyin a
p133rst, Easnere follo
Arch. Oein, M
and mo Can
L.K., Xollutiocam987., E.A.Me arouicatio., Ramandezn wit232.M.,
Mack
in m://dx.d
Zadeohe nerely unclear but may provide some insights into
possibleechanisms. Investigations of mixed gender populationsation
of results by sex are therefore necessary.
ormation on the length of residential exposure
h the reviewed studies assessed long-term exposure ton and
noise, length of residence at the same residentialot mentioned in
most of these studies. Information oning at the same address, and
stratication of analysisants that did or did not change the living
address duringeriod of exposure can help to provide the more
accurater the relevant exposureoutcome associations.
s
ations on the association of air pollution and noise men-eceived
increased attention during recent years. Botheviewed in this
article (air pollution and noise) were
associated with one or several indicators of neurocog-tion, mood
disorders and neurodegenerative diseasetudies. Despite some
limitations and inconsistencies
studies, they generally support the hypothesis that pollution
and noise are associated with neurocogni-ns, mood disorders and
neurodegenerative disease inxposed persons. Nevertheless, there is
a need for stud-ating simultaneously air pollution and noise
exposureson with mental health, for longitudinal studies to
cor-dings from cross-sectional analyses, and for parallell and
epidemiological studies to elucidate mechanismsys of action.
gements
ivian gratefully acknowledges the support by a post-llowship
from the Environmental and Health Fund,srael. This work was
supported by the German Research
(DFG; HO 3314/2-1).
, 2009 June. Stress signalling pathways that impair prefrontal
cortexnd function. Nat. Rev. Neurosci. 10 (6), 410422.
., Goldman-Rakic, P.S., 1998. Noise stress impairs prefrontal
corticalunction in monkeys: evidence for a hyperdopaminergic
mechanism.
Psychiatry 55, 362369.lderon-Garciduenas, L., 2009. Air
pollution: mechanisms of neuroin-n and CNS disease. Trends
Neurosci. 32 (9), 506516.lder, A., Auten, R.L., Bilbo, S.D., Chen,
H., Chen, J.-C., Cory-Slechta,a, D., Diaz-Sanchez, D., Dorman,
D.C., Gold, D., Gray, K., Jeng,man, J.D., Kleinman, M.T., Kirshner,
A., Lawler, C., Miller, D.S.,S., Ritz, B., Semmens, E.O., Tonelli,
L.H., Veronesi, B., Wright, R.O.,., 2012. The outdoor air pollution
and brain health
workshop,oi.org/10.1016/j.neuro.2012.08.014.ortaredona, S., Boutin,
C., David, A., Bigot, A., Sciortino, V., Nauleau, S.,., Giorgi, R.,
Verger, P., 2013. Is exposure to night-time trafc noise a
for purchase of anxiolytichypnotic medication? A cohort study.
Eur.ealth, http://dx.doi.org/10.1093/eurpub/ckt117.ler, P., Bicher,
A.J., Braun-Fahrleander, C., Huss, A., Niederer, M.,bach, S.,
Waeber, R., Wegmann, L., Kuechenhoff, J., 2009.
Patientsonment-related disorders: comprehensive results of
interdisciplinarys. Int. J. Hyg. Environ. Health 212, 157171.1.
Parameters of well-being and subjective health and their rela-ith
residential trafc noise exposurea representative evaluation ind.
Environ. Int. 37, 723733.., Squire, L.R., Clark, R.E., 2004.
Spatial memory, recognition memory,ppocampus. PNAS 101 (40),
1451514520.
0b01Caldern
OsnA., R373.
CaldernChavForeinaair p
CaldernB., HD.M2008an anein ch
CaldernGonBrooJardR.R.,and http
Chen, J.Scogn
ChiovenG., Cnoisasse
Clark, C.and
Cui, B., Wnitivpho
Darley, WgiesAdv
Davis, DJ.C., Prenronahttp
CesaronForasioncohohttp
Dockeryand
Doty, R.Lviab
EdwardsFlakbornage 1326
ElmenhoM., Bin thInt.
Finkelsteasein tw
Fonken,Air phipp973
Franssennoismed
Freire, CFernlutio64, 2
Gatto, NJ.C., tionhttp
Genc, S.,on t81dbece1.iduenas, L., Azzarelli, B., Acuna, H.,
Garcia, R., gambling, T.M.,., Monroy, S., Tizapanzi, M.D.R.,
Carson, J.L., Villarreal-Calderon,stle, B., 2002. Air pollution and
brain damage. Toxicol. Pathol. 30,
iduenas, L., Reed, W., Maronpot, R.R., Henriques-Roldan, C.,
Delgado-, Caldern-Garciduenas, A., Dragustinovis, I., Francco-Lira,
M., Aragon-Solt, A.C., Altenburg, M., Torres-Jardon, R., Swenberg,
J.A., 2004. Brainion and Alzheimers-like pathology in individuals
exposed to severeon. Toxicol. Pathol. 32, 650.iduenas, L., Solt,
A.C., Henrquez-Roldn, C., Torres-Jardn, R., Nuse,, L.,
Villarreal-Caldern, R., Osnaya, N., Stone, I., Garca, R.,
Brooks,zlez-Maciel, A., Reynoso-Robles, R., Delgado-Chvez, R.,
Reed, W.,g-term air pollution exposure is associated with
neuroinammation,
innate immune response, disruption of the blood-brain barrier,
ultra-ulate deposition, and accumulation of amyloid -42 and
-synuclein
and young adults. Toxicol. Pathol. 36 (2), 289310.iduenas, L.,
Franco-Lira, M., Henrquez-Roldan, C., Osnaya, N.,Maciel, A.,
Reynoso-Robles, R., Villarreal-Caldern, R., Herritt, L.,., Keefe,
S., Palacios-Moreno, J., Villarreal-Calderon, R., Torres-
Medina-Cortina, H., Delgado-Chavez, R., Aiello-Mora, M.,
Maronpot,, R.L., 2009. Urban air pollution: Inuences on olfactory
functionlogy in exposed children and young adults. Exp. Toxicol.
Pathol.,oi.org/10.1016/j.etp.2009.02.117.wartz, J., 2009.
Neurobehavioral effects of ambient air pollution onperformance in
US adults. Neurotoxicology 30, 231239., Pasqualetti, P., Zappasodi,
F., Ercolani, M., Milazzo, D., Tomei,ella, A., Tomei, F., Rossini,
P.M., Tecchio, F., 2007. Environmental
osed workers: event-related potentials neuropsychological and
moodt. Int. J. Psychophysiol. 65, 228237.ist, P., 2012. A 3 year
update on the inuence of noise on performanceior. Noise Health 14,
292296.., She, X., Liu, H., 2012. Impulse noise exposure in rats
causes cog-cits and changes in hippocampal neurotransmitter
signaling and taulation. Brain Res. 1427, 3543.mith, R.E., 1995.
Gender differences in information processing strate-mpirical test
of the selectivity model in advertising response. J.g XXIV (1),
4156.ortolato, M., Godar, S.C., Sander, T.K., Iwata, N., Pakbin,
P., Shih,ne, K., McConnell, R., Sioutas, C., Finch, C.E., Morgan,
T.E., 2013.xposure to urban air nanoparticles in mice causes
altered neu-rentiation and depression-like responses. PLoS One 8
(5), e64128,oi.org/10.1371/journal.pone.0064128.Porta, D.,
Badaloni, C., Stafoggia, M., Eeftens, M., Meliefste, K.,, F., 2012.
Nitrogen dioxide levels estimated from land use regres-els several
years apart and association with mortality in a largeudy. Environ.
Health: A Global Access Science Source 11
(48),oi.org/10.1186/1476-069X-11-48., Pope III, C.A., Xu, X., et
al., 1993. An association between air pollutionlity in six U.S.
cities. N. Engl. J. Med. 329, 17531759.8. The olfactory vector
hypothesis of neurodegenerative disease: is itn. Neurol. 63,
715.
Jedrychowski, W., Butscher, M., Camann, D., Kieltyka, A., Mroz,
E.,i, Z., Wang, S., Rauh, V., Perera, F., 2010. Prenatal exposure
to air-cyclic aromatic hydrocarbons and childrens intelligence at 5
years of
rospective cohort study in Poland. Environ. Health Perspect. 118
(9),1..M., Elmenhorst, D., Wenzel, J., Quehl, J., Mueller, U.,
Maass, H., Vejvoda,, M., 2010. Effects of nocturnal aircraft noise
on cognitive performancewing morning: doseresponse relationships in
laboratory and eld.ccup. Environ. Health 83, 743751.
.M., Jerrett, M., 2007. A study of relationships between
Parkinsons dis-arkers of trafc-derived and environmental manganese
air pollutionadian cities. Environ. Res. 104 (3), 420432.u, X.,
Weil, Z.M., Chen, G., Sun, Q., Rajagopalan, S., Nelson, R.J.,
2011.on impairs cognition, provokes depressive-like behaviors and
alterspal cytokine expression and morphology. Mol. Psychiatry 16
(10),
., van Wiechen, C.M.A.G., Nagelkerke, N.J.D., Lebret, E., 2013.
Aircraftnd a large international airport and its impact on general
health andn use. Occup. Environ. Med. 61, 405413.os, R., Puertas,
R., Lopez-Espinosa, M., Julvez, J., Aguilera, I., Cruz, F.,, M.-F.,
Sunyer, J., Olea, N., 2010. Association of trafc-related air pol-h
cognitive development in children. J. Epidemiol. Commun.
Health28.Henderson, V.W., Hodis, H.N., St John, J.A., Lurmann, F.,
Chen,, W.J., 2013. Components of air pollution and cognitive
func-iddle-aged and older adults in Los Angeles.
Neurotoxicology,oi.org/10.1016/j.neuro.2013.09.004.glulari, Z.,
Fuss, S.H., Genc, K., 2012. The adverse effects of air
pollutionvous system. J. Toxicol.,
http://dx.doi.org/10.1155/2012/782462.
-
L. Tzivian et al. / International Journal of Hygiene and
Environmental Health 218 (2015) 111 11
Gustavsson, J.P., Bergman, H., Edman, G., Ekselius, L., von
Knorring, L., Linder, J.,2000. Swedish universities Scales of
Personality (SSP): construction, internalconsistency and normative
data. Acta Psychiatr. Scand. 102, 217225.
Guxens, M., Sunyer, J., 2012. A review of epidemiological
studies on neuropsychol-ogical effects of air pollution. Swiss Med.
Weekly 141, w13322.
Haider, S., Naqvi, F., Batool, Z., Tabassum, S., Perveen, T.,
Saleem, S., Haleem, D.J., 2012.Decreased hippocampal 5-HT and DA
levels following sub-chronic exposure tonoise stress: impairment in
both spatial and recognition memory in male rats.Sci. Pharm. 80,
10011011.
Hardoy, M.C., Carta, M.G., Marci, A.R., Carbone, F., Cadeddu,
M., Kovess, V., DellOsso,L., Carpiniello, B., 2005. Exposure to
aircraft noise and risk of psychiatric disor-ders: the Elmas
survey. Soc. Psychiatry Psychiatr. Epidemiol. 40, 2426.
Hirano, S., Furuyama, A., Koike, E., Kobayashi, T., 2003.
Oxidative-stress potency oforganic extracts of diesel exhaust and
urban ne particles in rat heart microves-sel endothelial cells.
Toxicology 187 (23), 161170.
Kahlmann, S., Piel, M., Wolf, O.T., 2005. Impaired memory
retrieval after psycholog-ical stress in healthy young men. J.
Neurosci. 25, 29772982.
Levesque, S., Taetzsch, T., Lull, M.E., Kodavanti, U., Stadler,
K., Wagner, A., Johnson,J.A., Duke, L., Kodavanti, P., Surace,
M.J., Block, M.L., 2011. Diesel exhaust acti-vates and primes
microglia: air pollution, neuroinammation, and regulation
ofdopaminergic neurotoxicity. Environ. Health Perspect. 119,
11491155.
Lim, Y-H., Ho Kim, J.H., Bae, S., Park, H.Y., Hong, Y-C., 2012.
Air pollution and symp-toms of depression in elderly adults.
Environ. Health Perspect. 120, 10231028.
Loop, M.S., Kent, S.T., Al-Hamdan, M.Z., Crosson, W.L., Estes,
S.M., Estes, M.G., Quat-trochi, D.A., Hemmings, S.N., Wadley, V.G.,
McClure, L.A., 2013. Fine particulatematter and incident cognitive
impairment in the REasons for geographic andracial differences in
stroke (REGARDS) cohort. PLoS One 8 (9), e75001.
Meyers-Levy, J., 1989. Gender differences in information
processing: a selectiv-ity interpretation. In Cafferata, P.,
Tybout, A.M. (eds.), Cognitive and AffectiveResponses to
Advertising. Lexington Books, Canada.
Naqvi, F., Haider, S., Batool, Z., Perveen, T., Haleem, D.J.,
2012. Sub-chronic exposureto noise affects locomotor activity and
produces anxiogenic and depressive likebehavior in rats. Pharmacol.
Rep. 64 (1), 6469.
Nemmar, A., Vanbilloen, H., Hoylaerts, M.F., Hoet, P.H.,
Verbruggen, A., Nemery,B., 2001. Passage of intratracheally
instilled ultrane particles from the lunginto the systemic
circulation in hamster. Am. J. Respir. Crit. Care Med. 164
(9),16651668.
Passchier-Vermeer, W., Passchier, W.F., 2000. Noise exposure and
public health.Environ. Health Perspect. 108 (1), 123131.
Perera, F., Li, T., Zhou, Z., Yuan, T., Chen, Y., Qu, L., Rauh,
V.A., Zhang, Y., Tang, D., 2008.Benets of reducing prenatal
exposure to coal-burning pollutants to childrensneurodevelopment in
China. Environ. Health Perspect. 116 (10), 13961400.
Persson, R., Bjrk, J., Ard, J., Albin, M., Jakobsson, K., 2007.
Trait anxiety and modeledexposure as determinants of self-reported
annoyance to sound, air pollution andother environmental factors in
the home. Int. Arch. Occup. Environ. Health 81(2), 1791
Power, M.C., Weisskopf, M.G., Alexeeff, S.E., Coull, B.A., Spiro
III, A., Schwartz, J.,2011. Trafc-related air pollution and
cognitive function in a cohort of oldermen. Environ. Health
Perspect. 119, 682687.
Power, M.C., Weisskopf, M.G., Alexeeff, S.E., Wright, R.O.,
Coull, B.A., Spiro III., A.,Schwartz, J., 2013. Modication by
hemochromatosis gene polymorphisms ofthe association between
trafc-related air pollution and cognition in older men:a cohort
study. Environ. Health 12, 16.
Ranft, U., Schikowski, T., Sugiri, D., Krutmann, J., Kramer, U.,
2009. Long-termexposure to trafc-related particulate matter impairs
cognitive function in theelderly. Environ. Res. 109, 10041011.
Rckler, R., Schneider, A., Breitner, S., Cyrys, J., Peters, A.,
2011. Health effect of par-ticulate air pollution: a review of
epidemiological evidence. Inhal. Toxicol. 23(10), 555592.
Salame, P., Baddeley, A.D., 1982. Disruption of short-term
memory by unattendedspeech: implications for the structure of
working memory. J. Verb Learn. VerbBehav. 21, 150164.
Schapkin, S.A., Falkenstein, M., Marks, A., Griefahn, B., 2006.
Executive brain func-tions after exposure to nocturnal trafc noise:
effects of task difculty and sleepquality. Eur. J. Appl. Physiol.
96, 693702.
Smith, A.P., Broadbent, D.E., 1992. Non-auditory effects of
noise at work: a reviewof the literature. HSE Contract Research
Report No. 30. HMSO, London.
Siddique, S., Banerjee, M., Ray, M.R., Lahiri, T., 2011.
Attention-decit hyperactivitydisorder in children chronically
exposed to high level of vehicular pollution. Eur.J. Pediatrics 170
(7), 923929.
Sun, R., Gu, D., 2008. Air pollution economic development of
communities, andhealth status among the elderly in urban China. Am.
J. Epidemiol. 168,13111318.
Torres, A., Gmez-Gil, E., Vidal, A., Puig, O., Boget, T.,
Salamero, M., 2006. Genderdifferences in cognitive functions and
inuence of sex hormones. Actas Esp.Psiqiatr. 34 (6), 408415.
Wang, R., Henderson, S.B., Sbihi, H., Allen, R.W., Brauer, M.,
2013. Temporal stabilityof land use regression models for
trafc-related air pollution. Atmos. Environ.64 (0), 312319.
Weuve, J., Puett, R.C., Schwartz, J., Yanosky, J.D., Laden, F.,
Grodstein, F., 2012. Expo-sure to particulate air pollution and
cognitive decline in older women. Arch.Intern. Med. 172 (3),
219227.
Wellenius, G.A., Boyle, L.D., Coull, B.A., Milberg, W.P.,
Grypais, A., Schwartz, J., Mit-telman, M.A., Lipsitz, L.A., 2012.
Residential proximity to nearest roadway andcognitive function in
community-dwelling seniors: results from the MOBILIZEBoston Study.
J. Am. Geriatr. Soc. 60 (11), 20752080.
Yoshida, T., Osada, Y., 1997. Effects of road trafc noise on
inhabitants of Tokyo. J.Sound Vibr. 205, 517522.
Zeng, Y., Gu, D., Purser, J., Hoenig, H., Christakis, N., 2010.
Associations of environ-mental factors with elderly health and
mortality in China. Am. J. Public Health100, 298305.91.
Effect of long-term outdoor air pollution and noise on cognitive
and psychological functions in adultsIntroductionMethods of the
searchResultsStudy design and exposures******Exposure
assessmentOutcome assessmentReported associationsAssociation with
air pollutionAssociation with noiseAssociations with air pollution
and noise
DiscussionConcurrent environmental exposuresDiversity of
outcomesIndividual susceptibilityLongitudinal data on cognitive
declineAdditional covariatesRole of gender in studies of
neurocognitive functionsA lack of information on the length of
residential exposure
ConclusionsAcknowledgementsReferences