On Jul. 24, 2025, an analysis of studies incorporating data from almost 30 million people has highlighted the role that air pollution – including that coming from car exhaust emissions – plays in increased risk of dementia. In a paper published in The Lancet Planetary Health, a team led by researchers at the Medical Research Council (MRC) Epidemiology Unit, University of Cambridge, carried out a systematic review and meta-analysis of existing scientific literature to examine this link further. This approach allowed them to bring together studies that on their own may not provide sufficient evidence, and which sometimes disagree with each other, to provide more robust overarching conclusions.

Dementias such as Alzheimer’s disease are estimated to affect more than 57.4 million people worldwide, a number that is expected to almost triple to 152.8 million cases by 2050. The impacts on the individuals, families and caregivers and society at large are immense.

Air pollution has recently been identified as a risk factor for dementia, with several studies pointing the finger at a number of pollutants. However, the strength of evidence and ability to determine a causal effect has been varied.

In total, the researchers included 51 studies, including data from more than 29 million participants who had been exposed to air pollutants for at least one year, mostly from high-income countries. Of these, 34 papers were included in the meta-analysis: 15 originated in North America, 10 in Europe, seven in Asia, and two in Australia.

The researchers found a positive and statistically-significant association between three types of air pollutant and dementia. These were:

• Particulate matter with a diameter of 2.5 microns or less (PM_2.5), a pollutant made up of tiny particles small enough that they can be inhaled deep into the lungs. These particles come from several sources, including vehicle emissions, power plants, industrial processes, wood burning stoves and fireplaces, and construction dust. They also form in the atmosphere because of complex chemical reactions involving other pollutants such as sulphur dioxide and nitrogen oxides. The particles can stay in the air for a long time and travel a long way from where they were produced.
• Nitrogen dioxide (NO₂), one of the key pollutants that arise from burning fossil fuels. It is found in vehicle exhaust, especially diesel exhaust, and industrial emissions, as well as those from gas stoves and heaters. Exposure to high concentrations of nitrogen dioxide can irritate the respiratory system, worsening and inducing conditions like asthma and reducing lung function.
• Soot from sources such as vehicle exhaust emissions and burning wood. It can trap heat and affect the climate. When inhaled, it can penetrate deep into the lungs, aggravating respiratory diseases and increasing the risk of heart problems.

Several mechanisms have been proposed to explain how air pollution may cause dementia, primarily involving inflammation in the brain and oxidative stress (a chemical process in the body that can cause damage to cells, proteins, and DNA). Both oxidative stress and inflammation play a well-established role in the onset and progression of dementia. Air pollution is thought to trigger these processes through direct entry to the brain or via the same mechanisms underlying lung and cardiovascular diseases. Air pollution can also enter circulation from the lungs and travel to solid organs, initiating local and wide-spread inflammation.

The researchers point out that the majority of people included in the published studies were white and living in high-income countries, even though marginalised groups tend to have a higher exposure to air pollution. Given that studies have suggested that reducing air pollution exposure appears to be more beneficial at reducing the risk of early death for marginalised groups, they call for future work to urgently ensure better and more adequate representation across ethnicities and low- and middle-income countries and communities.