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Short-term air pollution, cognitive performance and nonsteroidal anti-inflammatory drug use in the Veterans Affairs Normative Aging Study

A Publisher Correction to this article was published on 19 May 2021

This article has been updated


Air pollution, especially fine particulate matter (PM2.5), may impair cognitive performance1,2,3, but its short-term impact is poorly understood. We investigated the short-term association of PM2.5 with the cognitive performances of 954 white males measured as global cognitive function and Mini-Mental State Examination (MMSE) scores and further explored whether taking nonsteroidal anti-inflammatory drugs (NSAIDs) could modify their relationships. Higher short-term exposure to PM2.5 demonstrated nonlinear negative associations with cognitive function. Compared with the lowest quartile of the 28-d average PM2.5 concentration, the 2nd, 3rd and 4th quartiles were associated with 0.378, 0.376 and 0.499 unit decreases in global cognitive function score, 0.484, 0.315 and 0.414 unit decreases in MMSE score and 69, 45 and 63% greater odds of low MMSE scores (≤25), respectively. Such adverse effects were attenuated in users of NSAIDs compared to nonusers. This study elucidates the short-term impacts of air pollution on cognition and warrants further investigations on the modifying effects of NSAIDs.

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Fig. 1: Associations of PM2.5 levels with GCF score, MMSE score and odds of low MMSE scores in the exposure window of 28 d.
Fig. 2: Best-fitting models for the relationships of 28-d average PM2.5 levels with GCF score, MMSE score and odds of low MMSE score.
Fig. 3: Best-fitting models for the relationships of 28-d average PM2.5 levels with GCF score, MMSE score and odds of low MMSE score by NSAID use.

Data availability

The data that support the findings of this study are available upon reasonable request from A.A.B. The data are not publicly available due to restrictions of ethical approval requirements for this study.

Code availability

The SAS v.9.4 TS1M5 code used for the statistical analysis are available upon request from X.G.

Change history


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This work was supported by the National Institute of Environmental Health Sciences (grant nos. P30ES009089, R01ES021733, R01ES025225, R01ES015172 and R01ES027747). The Veterans Affairs Normative Aging Study is supported by the Cooperative Studies Program/Epidemiology Research and Information Center of the U.S. Department of Veterans Affairs and is a component of the Massachusetts Veterans Epidemiology Research and Information Center. A.S. was supported by a Senior Research Career Scientist award from the Clinical Science R&D Service of the U.S. Department of Veterans Affairs.

Author information

Authors and Affiliations



X.G. and A.A.B. developed the research question. X.G. carried out the main data analyses, interpreted the data and drafted the manuscript. J.S. and A.A.B. conducted the NAS study and contributed to all aspects of this work. P.V. and A.S. provided the data of the NAS study. B.C., X.L. and L.H. contributed to the statistical modeling. All authors reviewed the manuscript drafts, critically revised the manuscript and approved the final manuscript.

Corresponding author

Correspondence to Xu Gao.

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The authors declare no competing interests.

Additional information

Peer review information Nature Aging thanks Howard Fink, Francis Pope, Joanne Ryan and Deborah Slechta for their contribution to the peer review of this work.

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Extended data

Extended Data Fig. 1 Best-fitting models for the relationships of PM2.5 levels with GCF score, MMSE score, and odds of low MMSE score in the exposure window of 21 days.

Analyses were performed based on the data of 2551 medical visits from 954 participants. Solid line: point estimates; dash line: confidence intervals; dot: knots; green line: reference line.

Extended Data Fig. 2 Best-fitting models for the relationships of PM2.5 levels with GCF score, MMSE score, and odds of low MMSE score in the exposure window of 21 days, by NSAID use.

Analyses were performed based on the data of 2551 medical visits from 954 participants. Solid line: point estimates; dash line: confidence intervals; dot: knots; green line: reference line.

Supplementary information

Supplementary Information

Supplementary Tables 1–10, Figs. 1–4 and STROBE statement.

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Gao, X., Coull, B., Lin, X. et al. Short-term air pollution, cognitive performance and nonsteroidal anti-inflammatory drug use in the Veterans Affairs Normative Aging Study. Nat Aging 1, 430–437 (2021).

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